AAPM Newsletter May/June 2006 Vol. 31 No. 3

Newsletter

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 31 NO. 3

MAY/JUNE 2006

AAPM President’s Column E. Russell Ritenour Minneapolis, MN I attended the Intersociety Forum on Sharing Resources in early April. Hosted by the Health Physics Society, it was a continuation of a similar meeting held two years ago. The purpose was to discuss collaborative educational efforts among societies that share similar goals in areas such as radiation protection, public education, graduate training, and post graduate training for radiation safety officers. It is also

hoped that there can be some collaboration in the area of specification of qualification of individuals for certification in medical and industrial applications.

This has particular ramifications for many of us with regard to qualifications for radiation safety officers. I will address this issue, in particular, later in this column.

The effort was headed by Ken Kase, who was wearing the hats of a past president and the current intersociety liaison of the Health Physics Society. However, a quick check of the AAPM

Membership Directory shows Ken’s substantial record of service to our society, as well. Below is a list of societies that participated in the forum. The full names are given at the end of this (See Ritenour - p. 2)

2006 AAPM Awards & Honors Congratulations to the recipients of the following awards, achievements and honors in 2006: William D. Coolidge Award is presented to Ervin B. Podgorsak, PhD

AAPM-IPEM Medical Physics Travel Grant is presented to Mark Oldham, PhD

Achievement in Medical Physics Award is presented to Azam Niroomand-Rad, PhD

AAPM Medical Physics Travel Grant (none this year) (See Awards - p. 3)

TABLE OF CONTENTS Chairman’s Report President-elect Report Executive Dir’s. Column Education Council CAMPEP News Science Council Development Committee Clinical Trials MedPhys Sessions Held CIRMS Leg. & Reg. Affairs Health Policy/Economics Chapter News New Member List Letters to the Editor

p 5 p 7 p 9 p 11 p 12 p 13 p 14 p 15 p 17 p 19 p 20 p 23 p 25 p 25 p 29

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Ritenour (from p. 1) column. Take this as a quiz. See how many you can name: AAPM HPS ACR AIHS SNM CRCPD NRRPT OAS ANS First, in the area of K-12 education, the AAPM owns the copyright for educational materials developed in 1995 specifically for middle school and high school science modules on the use of radiation in medicine by Radiology Centennial, Inc. This group, formed to produce historical and educational material to celebrate the centennial of the discovery of X rays, was well funded by industry and a number of professional societies. The educational materials were developed by medical physicist volunteers working in collaboration with educational professionals, awardwinning science teachers, and professional film makers. The project was headed by Paul Carson and resulted in a videotape, workbook, and teacher’s manual that was sold by a publisher that specialized in K-12 educational materials and was therefore seen and taken seriously by school districts. The videotape includes vignettes in which, for example, a young woman with an injury moves through medical diagnostic studies (plane films and CT) to arrive at a diagnosis. There

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are class projects simulating collimation in radiation therapy and in nuclear medicine, using visible light to stand in for ionizing radiation. Now, the publisher has released the copyright and the material belongs to the AAPM. We have a committee, the Secondary Education and Teaching Subcommittee (SETS) of the Education and Training of Medical Physicists, which has been formed to oversee the conversion of the videotape to electronic format and to consider the prospect of updating the material. The current plan is to make it into a number of stand-alone mpeg files that will be of manageable size to download. We plan to put this material on the public part of the AAPM Web site to encourage its use. There was enthusiasm from most of the societies who attended the forum for participating as liaisons to SETS. Some other ways in which we forum participants plan to collaborate on the education of both the public and ourselves, are by sharing information on educational programs at annual meetings, along with information that you do not have to register for the meeting to take the courses. We also discussed including some general industrial hygiene material in suggested curricula for medical physicists and some general radiation safety for industrial hygienists. The purpose is not to allow trainees to cross disciplines, but to promote effective communication between specialties so that practitioners understand each other’s roles and responsibilities.

The AAPM introduced some of the forum participants to an ini2

tiative called the Science, Technology, Engineering, & Mathematics (STEM) Education Coalition. The STEM Coalition is composed of over 40 groups representing all sectors of the technological workforce—from educators and education researchers to scientists, engineers, and technicians. These include groups such as the American Association of Physics Teachers, the American Chemical Society, etc. STEM’s purpose is to promote funding for education and research through letters sent directly to the heads of funding agencies. STEM speaks with a loud voice because it speaks for a large number of societies, and voters. The AAPM has been a participant in STEM’s efforts for several years and the other members of the forum expressed support for their initiatives.

So, there has been and will continue to be a lot of collaboration in educational areas among the forum participants. However, in the areas of graduate and post graduate training for radiation safety officers, there are some problems. Recently the American Academy of Health Physics, in collaboration with the Medical Physics Section of the Health Physics Society, produced a document titled “Qualifications for Healthcare Facility Radiation Safety Officer” (Standards of Qualification and Practice, SQP002). This document clearly states that to be qualified to be a radiation safety officer, one must be a certified health physicist.

I’m not aware of any nationwide compilation of data, but some regional data was collected by the

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2006 AAPM Awards & Honors - continued Fellows

Honorary Membership is awarded to Robert Hattery, MD Francis Mahoney, PhD

The following are named Fellows in 2006 for their distinguished contributions to the AAPM:

Farrington Daniels Paper Award (dosimetry) is given for "Benchmarking analytical calculations of proton doses in heterogeneous matter" by G. Ciangaru, J. C. Polf, M. Bues and A. Smith. Med. Phys. 32, 3511 (2005)

Sylvia Sorkin Greenfield Paper Award (non-dosimetry) is given for "Performance of a Static-Anode/Flat-Panel X-ray Fluoroscopy System in a Diagnostic Strength Magnetic Field: A Truly Hybrid X-ray/MR Imaging System"

by R. Fahrig, Z. Wen, A. Ganguly, G. DeCrescenzo, J. A. Rowlands, G. M. Stevens, R. F. Saunders and N. J. Pelc. Med. Phys. 32, 1775 (2005)

Michael Davis, MS Gary Ezzell, PhD Michael Flynn, PhD David Followill, PhD Gig Mageras, PhD Andrew Maidment, PhD Janelle Molloy, PhD Michael Mills, PhD Mary Moore, MS, MEd Herbert Mower, ScD Robert Pizzutiello, Jr., MS Mark Rzeszotarski, PhD Beth Schueler, PhD Jeff Shepard, MS Gerald White, MS Fang-Fang Yin, PhD

The 2007 Call for Nominations and Applications is available on the AAPM Web site at http://www.aapm.org/org/committees/awards_honors/index.html Please note that the deadline to receive nominations and applications is October 15, 2006

ACR representative to the forum (who happens to have been Jerry White, chair of the AAPM Professional Council– we wear many hats). His data showed that over 70% of RSOs are ABR/ABMP diplomats but only a few percent are CHPs. If this is true nationally, then there will be a problem. The HPS representative at the forum stated

that they are going to revisit this issue. The AAPM has offered to work on a joint document with HPS, and the HPS representative gave the opinion that the offer would be accepted.

Unfortunately, while we may be able to work together with the HPS to present a united front as far as recommendations are concerned, there is still, at the present 3

time, a big problem. According to NRC proposed rules, most of us in the AAPM would not qualify to be RSOs. The following is a quote from Lynne Fairobent, AAPM’s legislative and regulatory affairs manager (who can keep the facts straight on complicated legislative affairs (See Ritenour - p. 4)

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Ritenour (from p. 3) much better than I can): “On March 30, 2005 the Nuclear Regulatory Commission (NRC) published in the Federal Register the last section of the revision to 10 CFR Part 35, Medical Uses of Byproduct Materials.

This section of the regulation delineates the requirements for training and experience for authorized medical physicists (AMPs), authorized users (AUs), authorized nuclear pharmacists (ANPs), and radiation safety officers (RSOs). The rule will be effective April 29, 2005 for non-Agreement States with implementation being October 25, 2005 after 10 CFR Subpart J expires. Agreement States have three years to adopt. The boards that have been recognized can be found at: http://www.nrc.gov/ materials/miau/miau-reg-initiatives/spec-board-cert.html. At the time of this article no medical physics board has been recognized. AAPM continues to work with the American Board of Radiology and the American Board of Medical Physics as they

Vote

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

So, unless the NRC changes course, if a medical physicist is not currently accepted as an RSO, it will be difficult for most medical physicists or radiologists to become RSOs unless we satisfy alternative pathways. One of the ABR physics trustees, SteveThomas, has been in com-

munication with the NRC and is currently preparing answers to detailed questions that the NRC has posed regarding how the ABR ascertains accredited status of institutions, how it verifies preceptorship, etc. The issues get complicated, but do not seem insurmountable. The AAPM will continue to work with the ABMP, the ABSNM, and the ABR (for both physician and medical physicist certification) towards acceptance by the NRC of credentialing from these bodies to allow one to serve as an RSO.

Answer Key to Abbreviation Quiz: AAPM - American Association of Physicists in Medicine HPS - Health Physics Society ACR - American College of Radiology AIHS - American Industrial Hygienists Society SNM - Society of Nuclear Medicine CRCPD - Conference of Radiation Control Program Directors NRRPT - National Registry of Radiation Protection Technologists OAS - Organization of Agreement States ANS - American Nuclear Society If you achieved a score of: 4 or less: Good, but you should get out and read more 5-6: Nice going. Are you an RSO? 7 or more: You’re a radiation organization policy wonk!

AAPM ELECTION

Vote

The 2006 AAPM election will open for online voting on June 21, 2006. Paper ballots will be mailed to members who have no e-mail address or a bad e-mail address and members that have opted out of online voting.

The deadline to submit your vote electronically or by paper ballot will be July 12, 2006.

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Chairman of the Board Report Introduction to the Mahatma Gandhi Memorial Medical Trust Howard I. Amols New York, NY

medical physics resources are throughout the world.

The letter from Drs. Raju and Ayyangar concludes with a request for help and for used equipment. In the spirit of open disclosure, I need to inform the reader that I have some personal interest in this venture as very early in my career Raju was an

important mentor and friend, teaching me not just physics and radiobiology, but perhaps, more importantly, a little philosophy and ethics. With that disclaimer, I let their letter speak for itself: The Mahatma Gandhi Memorial Medical Trust, located in a (See Amols - p. 6)

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Amols (from p. 5) rural area very proximal to the town of Bhimavaram, West Godavari District, Andhra Pradesh, India, opened an International Cancer Center in December 2004. Prior to that there was no cancer center in the District of West Godavari despite a population of 4 million. Dr. M.R. Raju had the privilege of working in the field of particle therapy for 33 years in the United States. He decided to take this undertaking as a model to fill the needs of a common man suffering with cancer with a hope that some of the socially conscious scientists working in the forefront of radiation treatment of cancer will join in this effort. The mission of this cancer center is to provide cancer care for the common man living in rural areas, especially radiation treatment using appropriate technology. Most of the cancer centers in India are located in large cities while more than 75% of the population continues to live in rural areas. Partly because of this distant location of the existing cancer centers and lack of cancer awareness in the rural areas, more than 75% of cancer patients present themselves for treatment when the disease is in advanced and incurable stages. One of the objectives of this center is to reduce this unacceptably high percentage by good cancer awareness programs and to provide the required treatment facilities in proximity to people in their familiar surroundings.

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The basic structure is about 55,000 square feet of space, which includes a radiation facility with rooms for low and high energy external beams, low and high dose rate brachytherapy, CT scan, X-ray, ultrasound and mammography all in a five-acre natural parklike land. A cobalt-60 unit, a

Komanduri Ayyangar who spent about four weeks training our staff about treating patients, including a CT based three-dimensional treatment plan. He also initiated some technology development programs to build a multi-leaf collimator, etc. He guided our medical physicist, who is a re-

India President A.P.J. Abdul Kalam cuts the ribbon during the formal inauguration of the Mahatma Gandhi Memorial Medical Trust with Dr. M.R. Raju by his side (left).

spiral CT, X-ray, mammography and ultrasound units are installed and are operating. Patient treatments were started in December 2004 and a total of 185 patients have completed radiation treatment.

The patients and their families are happy to receive treatment in their familiar surroundings and close to where they live.

This cancer center was formally inaugurated by Prof.

A.P.J. Abdul Kalam, president of India, on January 9, 2006, and his talk on that occasion can be seen in his Web site: www.presidentofindia.nic.in under ‘lectures’ on the above date.

We wish to express our appreciation to the AAPM for its support in deputing Dr. 6

cent graduate. Medical physics training is being done in various institutions in India and is not totally adequate without additional training. Also during his stay, the in-house ASHA-3D treatment planning system was commissioned. Cobalt-60 BJR25 depth-dose and TMR data were entered. An independent timer calculation computer program was implemented. This program has saved appreciable time during first day setups. Machine calibration procedure using TRS277 protocol was checked. The Siemens Mammomat-3000 mammography unit was commissioned. Technique charts and procedure manuals were developed. The brachytherapy sources were checked

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for output. Hand calculation methods for cervix were developed.

However, we are still in need of services that can be provided by medical physicists and radiation oncologists able to devote significant time to our center. Also, we are in need of simple equipment such as phantoms, and quality control kits for diagnostic X-ray, CT and mammography systems, radiation dose meters, radiation monitors, personal dosimeters, etc., in good working condition since it is not easy to find good quality products in India. Also, hard copies of simple text books and practical reports are extremely useful for our library. The following is a list of equipment of which we are in need:

Theratron-80 auxiliary equipment (block trays, wedges), non-allergic patient tape (patients are getting allergic to paper tape; we need different tapes), quality control kits (for diagnostic X-rays, CT and mammography), phantoms (for CT and mammography), barometer or reliable aneroid pressure gauge, radiation wall monitor, portable digital GM counter, ionization-type radiation monitor, direct reading pocket dosimeters (for nurses during brachytherapy), transparency sheets (to trace field outlines from patient setups), radiographic therapy verification film (for verifying light field and radiation field congruence), hand-held digital densitometer (to measure film density), ion chamber (0.125cc

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for point measurements), electrometer (the current electrometer is dedicated towards calibration. It does not give reading in Coulombs), PC desktop and/or laptop computers.

Please send available equipment to: Ayyangar M. Komanduri 13227 Willis Circle Omaha, NE 68164 Tel: 402-964-9621. Please call or write before mailing: akomanduri@gmail.com

Perhaps apropos of the above letter, the answer to last month’s ‘just for frustration’ brain teaser about Hardy/Ramanujan sums of cubes is 1729.

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President-elect Report Off-label Use of Medical Devices and the Medical Physicist Mary K. Martel Chicago, IL I will be devoting my bimonthly columns this year to briefly discussing issues that have caught my attention for one reason or another, but may not be covered elsewhere in the newsletter. One such important topic is what the medical physicist should do when confronted with the off-label use of medical devices. In radiation therapy, for example, an

off-label use may be the irradiation of a second area during the application of an intravascular brachytherapy source. In this case, the off-label use is happening ‘on the fly’ in the cardiac cath lab, and the physicist has to move quickly to speak up. Another ex7

ample may be the use of balloon brachytherapy as the sole source of irradiation for breast cancer. In this case the physicist often knows prior to procedure and can ask questions in advance of the off-label use. I have been personally involved in both rather difficult situations, and the implications of the off-label use were not crystal clear to me. What constitutes off-label use can be a moving target, and new commercial devices turn up for clinical implementation. And so, a physicist’s guide to off-label use would be timely and welcome.

(See Martel - p. 9)

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Martel (from p. 7) We are in luck. A new task group has been formed under the Radiation Safety Subcommittee of the Therapy Physics Committee (Science Council), called TG121: Off-Label Use. This task group is chaired by Henry (Tom) Heaton and Bruce Thomadsen, and they were kind to share some information about the task group with me. I excerpt from comments by Tom Heaton and the Web page on the AAPM Web site for TG-121 (http://aapm.org/org/ structure/default.asp? committee_code=TG121).

The objectives of TG-121 are: 1) to clarify the issues with offlabel use, including: definition, with background on FDA approval of medical devices; legal and regulatory ramifications treating patient off-label; responsibilities and liabilities the medical physicist assumes when treating patients off-label; and 2) to clarify the responsibilities of radiation oncology staff as part of the clinical team treating an individual patient in an off-label manner, what actions should be taken before the treatment, and provide guidance to facilitate those actions.

There has been concern that medical physicists may not even realize that there is such a thing as off-label use of an FDA-approved medical device. All FDAapproved medical devices have labeling identifying their intended use. If the device is used to treat patients in a manner outside the information specified in the labeling, it is an ‘off-label’ use of an FDA-approved device. Techni-

cally, a medical device can be used off-label to treat an individual patient if the clinical team decides that this is the best method to treat the patient. The clinical team deciding to use the medical device off-label should be alerted to any safety and effectiveness issues that the medical physicist determines in the proposed use of the device to treat the patient. In an ideal world, protocols would be conducted to thoroughly test the efficacy of a medical device, including disease control and survival, and not just toxicity. At the very least, how-

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ever, one would hope that patients are made aware of the risks and benefits of treatment of the offlabel use when treated off protocol. I am guessing that they are often not (and may even be unconscious on the cardiac cath table during the off-label use!).

Task group 121 is the first step towards helping medical physicists understand the important off-label use issues. The report is currently under development and the group is aiming towards a working draft by the summer meeting. We look forward to its publication.

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Executive Director’s Column Angela Keyser College Park, MD

2006 Summer School University of Windsor Ontario, Canada June 18–22, 2006 The topic for the 2006 Summer School is “Integrating New Technologies into the Clinic: Monte Carlo and Image Guided Radiation Therapy.” Program Directors Bruce Curran, James Balter and Indrin Chetty have put together an impressive faculty. By the time this issue of the newsletter reaches the membership, the June 1 deadline for pre-registration for the summer school will be quickly approaching. After June 1, only on-site registration will be available. For those traveling from the United States into Canada, remember to check out the U.S. Customs and border 9

crossing guidelines posted online.

For the latest summer school information, go to www.aapm.org and click on ‘Meetings.’

48th Annual Meeting Orange County Convention Center, Orlando, Florida July 30–August 3, 2006 Indications are that this will be a very successful meeting. Scientific Program Co-directors Jeff Siewerdesen and Gikas Mageras, Education Program Co-directors (See Keyser - p. 10)

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Keyser (from p. 9) Perry Sprawls and Eric Klein, Therapy Track Organizer Chang-Ming Charlie Ma and Professional Track Co-directors Mike Herman and Jerry White have put together an outstanding program. Detailed program information is available on the Web site.

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center. New members are sometimes overwhelmed by the size and complexity of the organization and may be discouraged from taking full advantage of its benefits or from participating in some activities. The AAPM recognizes this, and wishes to make the association more accessible to new members. At the New Member Symposium, you will

The Orange County Convention Center, which houses 2.1 million square feet of exhibit space (Photo courtesy of the Orlando/Orange County Convention & Visitor’s Bureau, Inc.®)

Remember to register for the 48th AAPM Annual Meeting before June 7 to receive discounted registration fees. Housing reservations must be made by June 30.

Pre-registration closes on July 6.

Plan to attend the Technical Exhibits and show your support to our vendors. They are a vital part of the annual meeting’s success and are great supporters of the AAPM and the medical physics profession. Exhibits are open: Sunday 1–5:30PM, Monday and Tuesday from 9:30AM– 5:30PM and Wednesday from 9:30AM–1PM. New members of the association are encouraged to attend the New Member Symposium scheduled for Wednesday, August 2 from 4PM–5:30PM in Room 330A of the convention

Now members will be able to create a personal schedule for the annual meeting that includes committee meetings and sessions, and import that schedule to your vCard compatible calendar or PDA. •In past years the AAPM meeting included four and a half days of sessions, from Sunday morning through midday on Thursday. A full day of sessions will be scheduled for Thursday in Orlando. Make plans to stay a little longer!

Summer Undergraduate Fellowship Program

meet the AAPM president, the executive director and a number of senior officers. The symposium will focus on those services the organization provides that are especially helpful for new members, and on how new members can become active in the organization.

A reminder of the new features of the 2006 meeting: •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! Do not miss this opportunity to participate.

•A new feature of the annual meeting planner will be the addition of the committee schedule.

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This year 63 undergraduate students competed for 12 summer fellowships. The number of applications received is down slightly from the 65 received in 2005. The selected junior- and senior-ranking undergraduates will each receive a $4,000 stipend from the AAPM. Student fellows are selected based on a combination of the quality of their personal statement, their GPA and their potential future in medical physics. Each student fellow chooses his or her mentor who is a Full AAPM member, and based on location and the student’s interest in the mentor’s proposed project.

Membership Recruitment Efforts There were 226 attendees of the 2005 RSNA meeting who identified themselves as medical

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physicists, but not as members of the AAPM. The RSNA provided the contact information for these

attendees and AAPM staff sent them information on the benefits of AAPM membership. As of the

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end of March, 10 applications were received from these contacts.

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Education Council Report Herb Mower Council Chair In a few weeks many of us will probably be heading to sunny Florida for a week of relaxation and entertainment. Well, for some it might be so, but for many it is a week of excitement, learning and sharing as we gather together for the 48th Annual Meeting of the AAPM. Almost all of the committees, subcommittees and related groups of the Education Council will be meeting in the two-day period of Saturday July 29 and Sunday July 30. I invite you to sit in on as many of our sessions as you like and get a feeling for how the committees and the council function. A lot goes on behind the scenes in order for the association to provide the programs and educational activities we do for our members.

The annual Education Council Symposium will be held at 8AM on July 30. This year Ben Stein of the American Physical Society will be doing an introduction on the DBIS Program. DBIS stands for “Discoveries & Breakthroughs in Science” and the AAPM joined as a partner in this program. Ben will explain what the program is, the type of programs that have been aired to date, and how members of the AAPM can submit suggestions for future programs. Bob Gould

and the History Committee will share the symposium, using their time to help launch our upcoming anniversary.

Our summer school is June18– 22 at the University of Windsor, Ontario, Canada. Directors Bruce Curran, James Balter and Indrin Chetty have put together a great educational experience on “Integrating New Technologies into the Clinic: Monte Carlo and Image Guided Radiation Therapy.” As in past years, we hope to provide partial scholarships for up to 10 ‘new’ (to the field) medical physicists for the school. If you have not taken advantage of this scholarship program, put a note in your calendar and consider applying next year. There are years when scholarships outnumber applications.

Our Educator’s Day, under the leadership of Amy Readshaw, is expanding this year to reach out to high school and college physics faculty both during the 11

AAPM meeting and the ASTRO meeting. In the past we have only done this at our meeting. This program invites secondary and college physics educators to the meeting for a day, gives them an overview of the medical physics field and career possibilities, and provides them with a day-pass to the meeting. Over the years we have had some very positive responses from those who have attended this event.

The new International Education Committee is under the leadership of Don Frey. This is their first year and we are looking forward to new ways that we can interact on the international level in the area of medical physics education. If this appeals to you, check out their meeting or speak to Don. Paul Guèye and the newly formed Minority Recruitment Subcommittee have been very busy in their first year. They are actively encouraging minorities to apply for the summer undergraduate fellowships offered by the association. Their goal is to increase the participation of minorities in the area of medical physics, and to increase their involvement within the society.

As you can see, the various groups within the council are very active. We will report on other activities in future newsletters.

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CAMPEP News Brenda Clark President Bruce Gerbi, chair of our REPRC, reports that three new residency training programs are currently under review.

One has already been visited by the review committee with positive results and, subject to approval of the board, should be listed soon. Richard Maughan, chair of our GEPRC, has received a few inquiries from new graduate programs seeking accreditation

and is expecting three applications for re-accreditation.

I am pleased to report that the long-heralded Web-based continuing education application

system and database has finally been inaugurated: check our Web site for details. This has been a major piece of work by many individuals, notably the AAPM staff led by Lisa Rose Sullivan and the CAMPEP Continuing Education Program Review Committee, led by Bruce Thomadsen. Thanks to all involved in this major effort. We hope that this new database will reduce our workload and solve all our problems–maybe we are living in fantasy land!

We make continuing education simple AAPM Online Continuing Education Obtain medical physics continuing education credits by enrolling in the AAPM Online Continuing Education program. Sources of information listed in the Online Continuing Education program for which continuing education credits can be obtained include: • AAPM Virtual Library presentations • Medical Physics journal articles • AAPM reports and proceedings • NCRP reports • Other governmental reports Earn credits in the areas of: • CT • Diagnostic • Digital Radiography • Mammography • MRI • Nuclear Medicine • PACS, DICOM, and Monitors • Quality Assurance Programs • Radiation Oncology • Radiation Dosimeters • Radiation Protection • Ultrasound Join the hundreds of other AAPM members who are using the AAPM Online Continuing Education Program for their continuing education, research, and information needs Access the Online Continuing Education site at www.aapm.org/educ/rdce.asp 12

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Science Council Report John Boone Council Chair Science Council hosted its annual scientific retreat at AAPM Headquarters April 20–22, 2006. With the reorganization of the council well behind us, the machinery for ongoing projects (primarily task groups and working groups) churns steadily under the guidance of the Imaging Physics Committee (IPC), chaired by Paul Carson, and of the Therapy Physics Committee (TPC), chaired by Ellen Yorke.

This frees up our discussions in Science Council to focus on re-energizing the AAPM scientific mission.

Radiation oncology has undergone enormous advances in the last decade, and these technologies continue to improve treatment options for cancer (and other) patients. The potential of molecular imaging for targeted radiotherapy is huge, with the promise to treat areas of high metabolic tumor activity or high affinity for tumor markers. The radiation biology of high-dose rate radiotherapy may be quite different from the more traditional fractionated therapy, and a better understanding is necessary to optimize radiosurgery and other high-dose applications. There is an enormous effort nationwide on the development of proton beam sources, and the clinical implications and tumor biology of this are still not fully understood. Underlying all these themes in radiation oncology is the increased use of

imaging, in particular, computed tomography, and these trends are anticipated to increase.

New applications and technologies in medical imaging are also on the minds of those of us on Science Council. Hybrid technologies such as PET/CT and SPECT/CT are becoming more commonly available and require more broad clinical expertise on the part of medical physicists than has been required in the past, but these are also areas of research opportunity. The technology of computed tomography continues to advance with 64-slice cardiac CT systems now clinically available. The radiation dose ramifications of these systems are not well understood. While the technology of CT continues to change, the utilization of CT also continues to increase. This comes at a time when BEIR VII states that the linear-nothreshold model of dose response should be the accepted standard— implying that no amount of ionizing radiation exposure is without risk. The field of medical imaging and the physician groups involved in the field are also in transition. While medical physicists are generally bystanders in physician credentialing (“turf”) issues, the prospect of nonradiologists performing routine Xray imaging procedures can produce a more stressful work environment, and challenge traditional allegiances, but also create new venues for research for image scientists in underexplored areas.

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The genome project of the last decade has driven the new frontier of molecular medicine, and molecular imaging stands as a necessary tool for the evaluation of many molecular, stem cell, and genetic-based therapies. This trend has also created research opportunities amongst medical physicists in areas such as small animal and veterinary imaging.

Nuclear medicine physicists have experienced a virtual rebirth in their field with the acceptance of positron emission tomography as a clinically reimbursed procedure. Although the future of molecular imaging is bright, the scientific questions and research applications of MI are expanding rapidly.

Advancements in radiation therapy, diagnostic imaging and nuclear medicine technology demand that all medical physicists expand our breadth of knowledge, as well as develop new methods for optimizing and evaluating the use of these tools.

Much of what I have touched on here relates to important activities that are ongoing in the Education and Professional councils.

The opportunity for harnessing the resources of the AAPM for improving scientific investigation and facilitating more collaborative research or data collection activities is vast. We on Science Council seek to capitalize on these opportunities and engage interested medical physicists in these activities. Stay tuned…. ■

AAPM NEWSLETTER

MAY/JUNE 2006

Development Committee News Shantelle Corado Special Projects Manager College Park, MD The American Society for Therapeutic Radiology and Oncology (ASTRO) Education and Development Fund, along with the AAPM, has approved funds for four residencies to facilitate the development of radiation oncology physics residencies across the United States.

The initiation and development of radiation physics residency programs in the United States would lead to more graduates and more qualified professionals entering the workforce. However, the colleges and universities that could potentially house medical radiation physics residency programs are under severe financial stress due to cuts in state and federal funding. Because clinical radiation oncology physics residency programs are expensive to create and operate, these schools are not likely to open a program unless they receive financial support.

Purpose: To promote the development of radiation physics residency programs in the United States leading to more graduates and more qualified professionals entering the workforce.

Award Amount: Up to $36,000 in total funding will be awarded

by ASTRO and matched by the AAPM each year. Individual program grants will not exceed $12,000 each.

Eligibility Requirements: Applications will be accepted from radiation oncology physics residency programs which meet the criteria set forth by AAPM Report #36, “Essentials and Guidelines for Radiation Oncology Physics Residency Training Programs.”

Method of Application/ Format: All requested information must be provided in a clear and succinct manner. The application must be typed in 12-point font, doubled spaced, printed on 8 ½ by 11 paper with pages consecutively numbered, and stapled. An original, 14 copies and an electronic copy of the application package must be submitted. All submitted applications and materials will become the property of ASTRO and the AAPM and will not be returned.

The grant application must contain the following information, in the following order: 1. Application form 2. Program narrative (not to exceed four typed pages) 3. Planning timeline 4. Pre-accreditation budget 5. Institution’s budget Grant Applications Review and Award Process: Applications will be reviewed by the ASTRO medical physics working taskforce and the AAPM Awards Selection Subcommittee. Applications will be evaluated and grants will be awarded 14

based upon the following criteria: 1. Training design a. Rotation sequence b. Mentored clinical experience 2. Forecast for program development a. Budgets b.Significant Milestone Timeline 3. Good faith commitment for program implementation Please send 14 printed copies and an electronic version of the completed application no later than May 31, 2006 to the address below. The electronic version must be submitted as a single MS-Word file to omarik@astro.org.

American Society for Therapeutic Radiology and Oncology Attn: Omari W. Keeles, MPH Research and Health Policy Analyst 12500 Fair Lakes Circle Suite 375 Fairfax, VA 22033 Phone: 703/839-7398 Fax: 703/502-7852 omarik@astro.org For more information and to download the application packet go to: http://www.astro.org/research/funding_opportunities/ astro_awards/. If you have questions, contact Omari Keeles 703839-7398 or Shantelle Corado 301-209-3350.

■

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

Clinical Trials Update This is another in a series of articles provided by the AAPM Working Group on Clinical Trials. The Radiological Physics Center (RPC) has a number of anthropomorphic phantoms fitted with Gaf-Chromic film and TLD that are used to credential institutions for various advanced technology clinical trials. The phantoms are mailed to the institution which then scans, plans, and irradiates the phantom and then returns it to the RPC. The RPC has reported on the significant failure rate for the head and neck phantom in particular.1,2,3 This article is intended to provide tips for a successful credentialing process.

–Art Olch, chair

Tips for a Successful RPC Phantom Irradiation Andrea Nelson Molineu RPC Physicist Many advanced technology protocols require the successful irradiation of an RPC phantom for credentialing. Failing a phantom irradiation can delay the credentialing of an institution, possibly for several months, and can also take a significant amount of a physicist’s time. Sometimes a physicist at an institution requests an RPC phantom without being fully aware of the time involved in the entire process. In other cases the physicist skips some important steps in the imaging-planning-irradiation procedures that can result in poor results. Knowing what to expect, as well as some common problems to avoid, can keep you from having to repeat a phantom irradiation. The following provides the physicist with some simple steps to avoid a repeat or an unnecessary rush for credentialing.

1. Before accepting shipment of the phantom, be sure that you

are ready to put in the time and effort required to image, plan, and irradiate the phantom. The RPC asks that the process be completed within two weeks of receiving the phantom. Anticipate that this will take just as much time as a real patient takes. Often the phantom requires more of a physicist’s time than does a patient because the physicist must be present at every step of the process.

2. Know that the phantom irradiation and analysis takes time. You cannot irradiate the phantom one week and expect to be credentialed for a protocol requiring the phantom the next week. Once the RPC has all data required, it typically takes a month from the time of irradiation until phantom results are available.

3. Review the credentialing requirements of the protocol you are interested in. Many protocols require a questionnaire to be filled out and digital data to be submitted. Ensure that your institution has the ability to submit data digitally if it is required. Many of the RPC phantoms cannot be analyzed without the digital phantom treatment planning data. Be prepared to submit this data if needed.

15

4. The phantom should be dealt with exactly as if it was a patient.

It should be imaged and marked with fiducials as you would a patient. This makes positioning of the phantom on the treatment table much easier, but more importantly, accurate.

5. If possible, follow your standard departmental procedures in handling the phantom. Imaging should be performed by a therapist or simulation technologist, planning should be done by a dosimetrist, and the treatment should be delivered by a therapist. The RPC understands that this is not always practical, but believes the phantom experiment should be an evaluation of the department’s normal procedures, not simply the physicist’s ability.

6. Before you irradiate the phantom, perform the same plan-specific QA that you would for a patient. This is important because it can pinpoint problems in the plan. Perhaps your system cannot adequately deliver the planned dose distribution. In this case you should work with your treatment plan before irradiating the phantom. Also, be sure that you understand the results of your (See Molineu - p. 16)

AAPM NEWSLETTER

MAY/JUNE 2006

the instructions. If the instructions ask for 10 fractions, please irradiate with 10 fractions, otherwise the RPC will not be able to analyze your results and you will have to repeat the process.

Molineu (from p. 15) QA. If your dose results are outside of your criteria, try to determine the reason. Rectify the problem before irradiating the phantom. If you do not you will likely go through the entire phantom process again.

These guidelines should help you avoid misunderstandings and errors in the phantom irradiation credentialing process.

For more information or help with the credentialing process, please contact the RPC or visit the RPC Web site.

7. Double and triple check your phantom setup before you hit BEAM ON! Ensure that the correct marks on the phantom are used and that all shifts from these marks are incorporated. An incorrect setup can result in a repeat of the entire phantom process.

1 Cadman P, Bassalow R, Sidhu NPS, Ibbott G, Nelson A, Dosimetric considerations for validation of a sequential IMRT process with a commercial treatment planning system, Phys Med Biol 2002; 47: 3001-3010.

2 Molineu A, Followill DS, Balter PA, Hanson WF, Gillin MT, Huq M S,

8. Deliver the total dose in the number of fractions requested in

FILM

CR

Eisbruch A, Ibbott GS, Design and implementation of an anthropomorphic quality assurance phantom for intensitymodulated radiation therapy for the Radiation Therapy Oncology Group, International Journal of Radiation Oncology*Biology*Physics 01 October 2005 (Vol. 63, Issue 2, Pages 577-583) 3 Molineu A, Alvarez P, Hernandez N, Followill DS, Ibbott GS, Analysis of Errors Made During 138 IMRT Irradiations of an Anthropomorphic Phantom, International Journal of Radiation Oncology*Biology*Physics 01 October 2005 (Vol. 63, Issue (Supplement 1), Page S58) ■

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AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

Medical Physics Sessions Held Report on Medical Physics Sessions Held during the 2006 American Physical Society Meeting Paul Guèye, AAPM Minority Recruitment Subcommittee Chair, National Society of Black Physicists - Medical Physics Section Co-chair An historic medical physics event recently took place during the annual American Physical Society March meeting in Baltimore, Maryland. For the first time and jointly sponsored by the National Society of Black Physicists (NSBP), the AAPM and the Division for Biological Physics, three medical physics sessions were held between March 16 and 17.

The corresponding sessions consisted of Physics and Imaging in Medicine, Medical Physics Panel Discussion and Radiation Therapy and Medical Imaging Techniques.

The first session consisted of overview talks to introduce medical physics to the audience.

It started with Dr. Howard Amols, past president of the AAPM, who gave an outstanding review on the historical and current status of various technologies used in radiation oncology departments. He also addressed the career pathways to enter this field. Dr. Christopher Soares from the National Institute of Standards and Technology (NIST) provided key information on international standards that one is faced with when

dealing with radiation treatments. His presentation focused primarily on radioactive sources used in eye applicators. In regard to funding opportunities, Dr. Richard Baird from the National Institute for Biomedical Imaging and Bioengineering of the National Institute of Health (NIBIB/NIH) provided the audience with the various pathways to apply for grants from his institute. The session concluded with a presentation from Dr. Guèye from Hampton University who highlighted the medical physics graduate program at Hampton with an emphasis on the Brachytherapy research being conducted at this institution.

The second session consisted of a one-hour panel discussion. The seven panel members were: Drs. Amols, Soares, Baird, Shadia SelTeleati (SCSU), Drew Weisenberger (Jefferson Lab), Harald Paganetti (MGH) and Guèye. The session started with a brief overview talk from Dr. Weisenberger on the medical imaging research being conducted in the Detector and Imaging Group of Jefferson Lab. Dr. Sel-Teleati provided her expertise in developing an undergraduate medical physics program at her institution. Dr. Paganetti was invited to join in because of his extensive contribution in an emerging field of research in radiation oncology, i.e. proton therapy. The

interaction with the public audience was much sustained with questions ranging from career transitions to funding opportunities, including suggestions to establish medical physics programs, education and outreach.

The last session was on 15 technical presentations regarding research work in medical physics.

The institutions represented were Hampton University, Massachusetts General Hospital, the University of Maryland, the University of Missouri-Columbia, Walter Reed Army Medical Center and the Army Research Office.

The success of this event relied also on the dedicated contributions from two outstanding persons who welcomed and informed the public at the table located at the entrance to the session rooms. These persons were Jennifer Davis (membership services coordinator, AAPM) and Nathan Guèye (high school student from the Lycée Rochambeau, Bethesda, MD). While the former provided information on medical physics, in general, and the AAPM organization, in particular, the latter developed an Excel-based program for real time analysis of the attendance and interest of the APS members to this event, part of which was based on a questionnaire that was handed out prior to each session.

(See Guèye - p. 18)

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AAPM NEWSLETTER

Guèye (from p. 17) A total of 20 questionnaires were returned and used for this data analysis. The form consisted of 12 questions. Since multiple answers were sometimes given for one question by the same author, this analysis is more of qualitative than quantitative information.

•All three sessions were rated good from 54% (session 1), 75% (session 2) and 67% (session 3) of the responses.

•53% of the 19 who responded gained good information from the session.

•The overall event was rated good by 65% of the 20 persons who responded.

•Out of 21 answers received, 81% were interested in receiving more information about medical physics.

•Out of 36 responses, 11 (31%) would like to obtain information on the job market related to the medical physics field, 8 (22%) on graduate education, 6 (17%) on post-graduate education and 11 (31%) on research.

•41.2% felt that the session did have an impact on the future direction of their career aspirations, compared with 17.6% who did not and 41.2% who said it didn’t matter.

•79% are interested in a future medical physics research or career track.

•67% are considering graduate or postgraduate studies in medical physics.

•53% are interested in a summer fellowship in medical physics.

MAY/JUNE 2006

Conclusion of the analysis is that medical physics is a field that is not very well understood by the (general) physics community. As such, more advertising can be done to encourage physicists from other areas to participate in its development. This historical event is the first step towards establishing a bridge between the APS and the AAPM. The overwhelming response from the members of these organizations indicates a strong interest in developing pathways and collabo-

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rations in education and research, as well as new opportunities for exciting new career tracks. Future plans are underway for more medical physics sessions at APS, as well as more focused physics sessions at AAPM. ■

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

CIRMS Plans Annual Meeting for October Larry A. DeWerd AAPM Liaison to CIRMS, & Geoffrey S. Ibbott The Council on Ionizing Radiation Measurements and Standards will hold its 15th annual meeting at the National Institute of Standards and Technology (NIST) in Gaithersburg, Maryland, October 23–25, 2006. The theme of the meeting this year is Implications of Uncertainty in Radiation Measurements and Applications. An agenda for the meeting was developed at a CIRMS Executive Committee Meeting held at NIST on March 14.

Travel grants to attend this meeting are available for students on a competitive basis. Information on CIRMS can be found on its Web site: www.cirms.org, which has links to the presentations from last year’s annual meeting and to the fourth issuance of the CIRMS triennial report on “Needs in Ionizing Radiation Measurements and Standards.” This report also contains information on the history and background of CIRMS, its mission and objectives, as well as detailing many specific areas requiring program work in radiation measurements.

CIRMS is an open forum that promotes dialog amongst its three main constituencies: industry, academia and government. To facilitate this dialog, CIRMS rotates its officers amongst these three areas. The 2006 CIRMS

president is Professor Mohamad Al-Sheikhly of the University of Maryland. Assisting Prof. AlSheikhly is First Vice President Shawna Eisele of the US Department of Energy’s Los Alamos National Laboratory, and Second Vice President Dr. Manny Subramanian of Best Medical International. The CIRMS Science and Technology Committee is composed of subcommittees which address issues in medical applications, radiation protection, including matters of interest in homeland security, and in industrial applications.

A tentative list of topics was assembled for the Medical Subcommittee breakout session for the October 23–25 meeting. The general theme of the medical breakout session aligns with the topic of the meeting and will be concerned with the effect of uncertainty on clinical results and the transition to the clinic. The determination of uncertainty is becoming more of an issue in medical physics literature, and it is important for the medical physicist to understand its uses and implications.

The CIRMS 2006 tentative medical breakout session will include the following topics: •Uncertainties of Monte Carlo calculations in radiation therapy •Uncertainties of external beam dose measurements (photons and electrons)

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•Uncertainty of proton dose measurements •Uncertainty of brachytherapy dosimetry •Uncertainty of neutron dosimetry •Uncertainty of PET/nuclear medicine dosimetry •Uncertainty of dose measurements in diagnostic radiology •Uncertainty of dose delivery in IMRT •Uncertainties at the ADCLs •Uncertainty of gel dosimetry measurements •Uncertainty of TLD dosimetry measurements Additional information on this year’s meeting will be posted on the CIRMS Web site as it becomes available, or can be obtained by contacting CIRMS Executive Secretary Katy Nardi at knardi@cirms.org or phone/ ■ fax: 770-622-0026.

AAPM NEWSLETTER

MAY/JUNE 2006

Legislative and Regulatory Affairs Column rials under U.S. Nuclear Regulatory Commission (NRC) jurisdiction. Specifically, the ACT expanded the definition of byproduct material by:

NRC Releases Early Draft of the Proposed Rule: Requirements for Expanded Definition of Byproduct Material (SECY-06-0069) Lynne Fairobent College Park, MD The NRC Commissioners approved an early release of the draft documents that address the NRC’s proposed rulemaking to implement NRC authority over NARM. The expansion of NRC authority was granted by Congress in the Energy Policy Act of 2005 (the ACT). The draft NRC paper and proposed rules are released in SECY-06-0069 (Proposed Rule: Requirements for Expanded Definition of Byproduct Material, RIN: 3150-AH84). The document can be found at: http://www. aapm.org/government_affairs/ SECY060069.asp.

The purpose of the early release is to maximize the opportunity for public review and comment. The proposed rules will be published in the Federal Register in the near future with a very short (45 days) official public review period. We ask members to read and provide input because these rules will significantly impact the use of accelerator-produced radioactive materials and radiation producing machines. While the actual published rules in the Federal

Register may differ from the draft, major changes from the draft are not expected. The AAPM is appreciative of the NRC Com–missioner’s positive response to the request of AAPM and other radiological societies for this early draft release to maximize input from affected radioactive materials licensees. A bulletin board for AAPM members has been established to allow for discussion on the draft proposed rule.

AAPM is currently reviewing the advanced proposed rule in detail. The following highlights some of the key changes being proposed by the NRC and were extracted from SECY-06-0069.

1. Adding any discrete source of radium-226 that is produced, extracted, or converted after extraction for a commercial, medical, or research activity; 2. Adding any material that has been made radioactive by use of a particle accelerator and is produced, extracted, or converted after extraction for a commercial, medical, or research activity; and 3. Adding any discrete source of naturally occurring radioactive material, other than source material, that (a) the commission, in consultation with other federal officials, determines would pose a threat similar to the threat posed by a discrete source of radium226 to the public health and safety or the common defense and security; and (b) is used in a commercial, medical, or research activity.

Background: The Energy Policy Act of 2005 (The ACT) was promulgated on August 8, 2005. Section 651(e) of the ACT expanded the definition of byproduct material, as defined in Section 11e. of the AEA, to include certain discrete sources of radium, certain accelerator-produced radioactive material, and certain discrete sources of naturally occurring radioactive material, thereby placing these mate-

There are currently 16 nonAgreement States plus U.S. territories, government agencies, and federally recognized Indian tribes that would be affected by this rulemaking. Although most non-Agreement States and U.S. territories have some type of program for NARM, the regulatory structures vary greatly from state to state. Four non-Agreement States (Idaho, Montana, South Dakota, and Wyoming) do not

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AAPM NEWSLETTER AAPM NEWSLETTER

have any programs. At least two non-Agreement States (New Jersey and Pennsylvania) use a licensing approach similar to NRC regulations as their regulatory structure for managing NARM. The remaining non-Agreement States use some type of registration process as their regulatory structure. In general, there is limited regulatory oversight where registration is used in non-Agreement States.

Accelerator-Produced Radioactive Material as a Byproduct Material: The ACT only gives the NRC authority over certain accelerator-produced radioactive material; it does not give the NRC authority to regulate the possession or use of particle accelerators. In evaluating the accelerator-produced radioactive material, the NRC proposes to regulate the radioactive material both intentionally and incidentally produced by accelerators that are operated to intentionally produce a radioactive material for use for a commercial, medical, or research activity, (e.g., radiopharmaceuticals or positron emission tomography (PET) drugs). The rationale for the NRC’s proposal is that the incidentally produced radioactive material is a direct result of producing the radioactive material for use for a commercial, medical, or research activity, and the NRC should consider all radioactive material to ensure public health and safety.

The NRC does not propose regulating the radioactive ma-

terial incidentally produced by accelerators that are operated to produce only particle beams and not radioactive materials. These accelerators are used primarily for industrial or medical purposes such as neutron radiography in industrial imaging and cancer treatment in radiation therapy. The reasons for not regulating the incidentally produced radioactive material are that: (1) no radioactive material is produced for use for a commercial, medical, or research activity, and (2) the incidentally produced radioactive material resides within the accelerator or facility. In addition, the Organization of Agreement States (OAS) indicated that linacs pose no real decommissioning issues because the induced radioactive material is usually short lived, and because machines are generally refurbished instead of decommissioned.

Regulatory Considerations for Accelerator-Produced Radioactive Material. The NRC believes that the existing NRC regulatory framework is also applicable to the commercial production and manufacture (Part 30); distribution (Part 32); and medical use (Part 35) of radionuclides, radioactive drugs, and sealed sources and devices containing the newly added byproduct material (i.e., NARM). Using the existing regulatory framework would minimize the impact on the availability of radiopharmaceuticals to physicians and patients. Because of the extremely short half-life of PET radionuclides for medical use, a 21

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

PET radionuclide production facility must be located near the medical use facility. This also increases the need for noncommercial distribution of PET radionuclides or PET drugs; however, the existing NRC regulations do not have a provision addressing this issue. In this proposed rule, the NRC has included a provision to allow noncommercial distribution of medical use radioactive material between medical use licensees to increase the availability of radiopharmaceuticals to physicians and patients. Among other things, the NRC also has included provisions to: (1) recognize existing PET production facilities; (2) grandfather certain individuals (such as an authorized user, authorized nuclear pharmacist, and authorized medical physicist) with regard to certain regulatory requirements; and (3) permit individuals to continue to prepare and use radioactive drugs while applying for a new license or a license amendment.

Definition of Discrete Source: “a source with physical boundaries, which is separate and distinct from the radiation present in nature, and in which the radionuclide concentration has been increased by human processes, with the intent that the concentrated radioactive material will be used for its radiological properties.” This definition of “discrete source” will apply to radium-226 and other naturally occurring radioactive material, other than source material, that will now be (See Fairobent - p. 22)

AAPM NEWSLETTER

Fairobent (from p. 21) defined as byproduct material.

The term “discrete source” does not apply to acceleratorproduced radioactive material.

The term applies to naturally occurring radioactive material that the Commission determines presents a threat to public health and safety or to the common defense and security similar to the threat posed by discrete sources of radium226.

Clarification of Low-Level Radioactive Waste and Decommissioning FinancialAssurance. The ACT mandates that the newly added byproduct material not be considered to be low-level radio-

MAY/JUNE 2006

active waste for the purposes of the compact under the Low-Level Radioactive Waste Policy Amendment Act (42 U.S.C. 2021b) (LLR WPAA). This provision allows disposal of NARM without being impacted by the compact process under the LLRWPAA, and does not affect authority to dispose of NARM and radium at an existing disposal facility in accordance with any federal or state solid or hazardous waste law. This provision does not affect NRC policy and only requires minor adjustments to NRC’s existing regulations.

The NRC needs to ensure that there is adequate funding to properly decontaminate and decommission facilities including the newly added byproduct material. Radionuclides with a short 22

half-life produced in accelerator facilities do not pose a concern with regard to decommissioning the facility. However, activated material residing within the accelerator facilities that is produced incidental to the production of accelerator-produced radioactive material would still pose a concern. These radionuclides with a longer half-life must be considered along with the accelerator-produced radioactive material to ensure adequate safety throughout the production operation and must be managed adequately at the time of decommissioning of the accelerator and the associated facility.

The NRC believes that the financial assurance requirements,

AAPM NEWSLETTER AAPM NEWSLETTER

currently in 10 CFR 30.35, are adequate to ensure that individuals will be required to have adequate financial assurance in place for decommissioning the facility including any NARM. Consideration of Fees. The NRC believes that the majority of NRC licensees affected by this rulemaking could be accommodated within the existing fee categories due to similarity in the activities involved.

The NRC is, however, proposing three new fee categories and one revision to an existing category for specific licenses engaged in activities involving items and products containing radium-226 and for specific licenses involved in production of accelerator-produced radioactive material.

The NRC is proposing to add a new fee category for the production of accelerator-produced radioactive materials because of the complexity of the production process and the radiation health and safety concerns when compared to activities that only involve use of existing radionuclides. The proposed fees would be comparable to about $4,700 for the application fee and $10,200 for the annual fee. It is not clear whether these fees are per accelerator or per facility.

ACMUI Coordination. The NRC Advisory Committee on Medical Use of Isotopes (ACMUI) endorsed the regulatory approach of regulating NARM similarly to reactor-produced radioactive material. It

strongly supported the accelerator groupings and NRC’s intention to regulate only accelerators that are intentionally operated to produce a radioactive material. It is also important that NRC regulations and Agreement State programs be as compatible as possible. It indicated that some proposed compatibility levels are low, and that there will be a wide variation among Agreement States unless there is a high level of compatibility. The ACMUI indicated that it is critical that the regulatory burden does not limit access to patient care and availability of radioactive drugs, especially for PET.

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

OSHA Request for Information regarding their radiation regulations. On May 3, 2005 OSHA published a request for information (RIS) related to the increasing use of ionizing radiation in the workplace and the potential worker exposure to it.

The AAPM filed extensive comments on the RIS. OSHA has indicated to the AAPM their appreciation of the time and effort the AAPM put forth in responding to the entire suite of questions raised and that they will be requesting a meeting with the AAPM to discuss the responses and next steps in the rulemaking process. I would like to thank the members who provided the de■ tailed responses.

Health Policy/Economic Issues Professional Economics Committee Holds First Annual Economics Summit Wendy Smith Fuss Health Policy Consultant Members of the Professional Economics Committee (PEC) met on April 1 in Reston, Virginia to discuss payment policy and economic issues that impact radiation oncology and medical physics services. The meeting marked the first annual PEC Economics Summit and was led by Committee Chair James Hevezi, Ph.D. Albert Blumberg, M.D. spoke on behalf of the ASTRO Gov23

ernment Relations Committee regarding the “politics of health policy issues” and how to affect government regulations. Dr. Blumberg noted ASTRO’s four key legislative issues for 2006: •Sustainable Growth Rate (SGR) Fix •Pay For Performance •Imaging Provisions in the Deficit Reduction Act of 2005 (DRA) •National Cancer Institute Budget Dr. Blumberg also reported that ASTRO has established a task force to develop pay for performance measures. He stated that ASTRO created 12 radiation on(See Fuss - p. 24)

AAPM NEWSLETTER

Fuss (from p. 23) cology measures; three of which are of current interest to the Centers for Medicare and Medicaid Services (CMS).

Trisha Crishock, ASTRO director of health policy, provided an overview of the organizational structure of the Health Policy Council & committees. Ms. Crishock stated that some of ASTRO’s key policy issues are: •Stereotactic Body Radiation Therapy (SBRT) •Medicare’s Proposed Practice Expense Methodology for 2007 •Correct Coding Initiative (CCI) Edits •Updating the ASTRO/ACR Coding Guide for 2007 Pam Kassing, ACR senior director of economics and health policy, provided an overview of ACR staff responsibilities. Ms. Kassing stated that the ACR’s key legislative issue was the impact of the DRA of 2005. ACR is working with CMS to exclude therapeutic imaging from the DRA provisions. The ACR is also working to minimize or eliminate CMS’s multiple procedure imaging reduction adjustment in 2007.

Ms. Kassing stated that 2007 could be “the perfect storm” for radiology and radiation oncology issues. She listed several proposed policies that could negatively impact radiation oncology, including: •Imaging Provisions Included in the DRA •Multiple Imaging Procedure Discount

MAY/JUNE 2006

•Five-Year Review of Physician Work Relative Value Units (RVUs) •Changes to the Practice Expense Methodology •Reductions in the Sustainable Growth Rate Annual Update Factor under the Medicare Physician Fee Schedule PEC members discussed ways in which ACR and ASTRO can work together on medical physics issues. Ideas included: •Develop a physicist “Quick Responder” team for medical physics issues •Review CPT codes with medical physics input •Create a subcommittee of medical physicists to review CPT & RUC issues related to medical physics services •Better collaboration on coverage, coding and payment issues •Include a medical physicist on relevant ACR & ASTRO health policy committees A portion of the meeting was devoted to further educating PEC members on Medicare payment systems and coding processes. PEC members discussed issues related to CPT & HCPCS codes, the Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (HOPPS), and Ambulatory Surgical Centers Payment System.

Dr. Hevezi and AAPM staff provided an overview of the current “Top-Down” practice expense methodology under the Medicare Physician Fee Sched24

ule and CMS’s proposal to implement a new “Bottom-Up” methodology in 2007. The committee reviewed the proposed practice expense RVUs developed by CMS that are based on four different Bottom-Up methodologies. Committee members thought that the data might be incorrect for some of the medical physics codes and requested that the salary survey data for medical physicists be verified.

The PEC agreed to further study this important issue.

The committee engaged in a day-long policy discussion and examined the possible impacts on AAPM issues. Professional Economics Committee members agreed on several economic and health policy priorities for 2006-2007 that include: •Clarification and correction of Medicare Program Transmittals 804 & 896 as it relates to bundling procedures into the IMRT Planning code (CPT 77301), and associated Correct Coding Initiative Edits •Impact of the 2007 Physician Fee Schedule Proposed Rule on medical physicists •Impact of Medicare’s proposed practice expense methodology for 2007 •Impact of the imaging provisions in the DRA and recommended exclusion of therapeutic imaging services •Impact of the 2007 Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule on radiation oncology services •Impact of the Ambulatory Surgical Center Proposed Rule ■

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

Chapter News Southeast Chapter Thaddeus A. Wilson Chapter President The Southeast Chapter of the AAPM recently hosted its scientific meeting and symposium in Memphis, TN March 22-25, 2006. The symposium was entitled “Determination and Optimization of Dose and Image Quality in Radiology.” The scientific meeting had sessions in the latest diagnostic and therapy physics, including invited speakers on Tomotherapy and High Intensity Focused Ultrasound (HIFU). Both the meeting and symposium were lauded as successes by the attendees and faculty. The chapter would like to extend a special thanks to its vendor sponsors for their continued sup-

port in making these events possible. As a special note, this year’s meeting hosted the inaugural presentation of the Jimmy O. Fenn Award to its first recipient, Don Frey. Looking to next year, Ehsan Samei from Duke University has agreed to be the program director for the symposium. The topic for the 2007 symposium will be on Digital Image Science. The

chapter has also set forth a goal for next year’s annual meeting, which is to develop new ways to involve students. To obtain more information on chapter meetings and symposia, or just to stay abreast of the latest news from the Southeast, we welcome your visit to the chapter Web site at www.seaapm.org.

■

New Member List The following are AAPM ‘Change of Status’ and ‘New’ Members from October 2005 - March 2006

Change of Status

Corresponding

Associate

Bernhard Bauer Kleve, GERMANY Thomas A Heary Dublin, IRELAND

Angie Hu Durham, NC Anup S Jassal Kingsbridge Heights, NY Bradley Pollard Milpitas, CA Iain E Stark Ottawa, ON CANADA Varti M Vartanian Palo Alto, CA Albert Xthona Beaverton, OR

Tessa R. Bagala New Orleans, LA Erin R Barnett Surrey, BC CANADA Michael L. Beach Franklin, TN Caleb G Beck Austin, TX Sjirk N Boon Bothell, WA Esther Bouche Dechy, FRANCE Marylene Brodeur Huntington, WV Paul A Bruce Little Rock, AR

Full Melpo A Agathocleous Larnaca, CYPRUS Mustafa C Altunbas Houston, TX Maxwell Amurao Dallas, TX Melvin A Astrahan Los Angeles, CA

Thomas E Byrne Knoxville, TN Christina Ioannou Christou Ann Arbor, MI George Ciangaru Houston, TX Edward L Clouser Jr Cleveland, OH Nasser Danesh Canton, GA Nathan C Davis Indianapolis, IN Glenn R Deacon II Chula Vista, CA

(See Members - p. 26)

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AAPM NEWSLETTER AAPM NEWSLETTER

Members (from p. 25) Hua Deng Baltimore, MD Jeremy D Donaghue Erie, PA Kai Dou Lexington, KY Hong Du Ann Arbor, MI Weiliang Du Richmond, VA Suzan S El-Khatib Sun City, AZ John A Faircloth Opelika, AL Jiajin Fan Philadelphia, PA Ye Feng Waldorf, MD Kara K. Ferachi Baton Rouge, LA Jarod C Finlay Philadelphia, PA Gary D Fisher Dallas, TX Sandra C Fontenla New York, NY Dan J Fry Washington, DC Isabelle M Gagne Victoria, BC CANADA Stephen M Gajdos Cleveland, OH Razvan Gaza Houston, TX James K Geoghegan Jackson, TN Kent A Gifford Houston, TX Michael Gillard St. John’s, NL CANADA Cal Glisson Loma Linda, CA Jonathan K Ha Baltimore, MD Chunhui Han Duarte, CA Kristi Hendrickson Seattle, WA Neal S Holter State College, PA Yibing Hu Forty Fort, PA Zhong (John) Huang Tacoma, WA Jundong Huang Baltimore, MD Vicky W. Huang Surrey, BC CANADA Si Young Jang Houston, TX

JANUARY/FEBRUARY 2001 AAPM NEWSLETTER MAY/JUNE AAPM 2006 NEWSLETTER

Huaying Ji Washington, DC David W Jordan Smyrna, GA Joseph Kalen Richmond, VA Dennis J Kehoe Flushing, MI Gocha Khelashvili Chicago, IL Li-Chung Ku Dallas, TX Ravi Kulasekere Copley, OH Thomas R Larry Ruston, LA Giovanni Lasio Richmond, VA Etienne Lessard San Francisco, CA Guang Li Bethesda, MD Haisen Li Gainesville, FL Jun Li Philadelphia, PA Jubei Liu St. Louis, MO Ruiguo Liu Lecanto, FL William W Logan Portland, ME Gonca Long Arlington, VA Lanchun Lu Richmond, VA Lama K Muhieddine Mossolly Cleveland, OH Nadia Octave Paris, FRANCE Naim Ozturk Cooperstown, NY Katia Parodi Boston, MA Rajen M. Patel Winterville, NC Frank D. Pazik Summerville, SC Christina R. Plies Sioux Falls, SD Brent D. Purviance Wichita, KS Sharon X. Qi Milwaukee, WI Manisha K Ranade Gainesville, FL Nicolas Recalde Washington, DC Samuel J Rhoades IV Tulsa, OK Robin M Rodenbush Wellington, FL

Gabrielle M Rumley-Smith Greensboro, NC Habeeb H. Saleh Richmond, VA Howard W Salmon Gainesville, FL Abhirup Sarkar Newark, DE Jennifer M Shealy Corpus Christi, TX Igor V. Shishkov Windsor, ON CANADA Theodore J St. John Portsmouth, VA Christopher J Stepaniak Milwaukee, WI Jodi L Sulak Buford, GA Mei Sun Baltimore, MD Adam M Tazi Bridgeport, CT Jack H Towery III Ogden, UT Haifeng Tu Chicago, IL Xiaolin Tu Dallas, TX Christopher D Unger Milwaukee, WI Keith W Ver Steeg Spring Hill, TN Yizhen Wang Montreal, QC CANADA Zhou Wang Buffalo, NY Brad J Warkentin Edmonton, AB CANADA Christopher J. Watchman Tucson, AZ Lauren Weinstein Berkeley, CA Thomas J Whitaker Indianapolis, IN Matthew J White O’Fallon, MO Gene L Wollan Tigard, OR Frank Xia Washington, DC Hong F Xiang Boston, MA Da Guang Xu Philadelphia, PA Conrad F Yuen Winnipeg, MB CANADA Tiezhi Zhang Royal Oak, MI Lifei Zhang Houston, TX Mutian Zhang Elmhurst, NY

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JANUARY/FEBRUARY 2001 MAY/JUNE 2006 Jun Zhou Stony Brook, NY

Junior Francis Ai Placentia, CA Wayne Benjamin Allentown, PA Arup Bhattacharya Buffalo, NY Lesley A Buckley Ottawa, ON CANADA Corinne B Dallas Minneapolis, MN Blake M Dirksen Mason City, IA Elizabeth H Garver Seattle, WA Olivier Gayou Pittsburgh, PA Eun Young Han Minneapolis, MN William A Howard Indianapolis, IN Dylan C Hunt Toronto, ON CANADA Lihui Jin Philadelphia, PA Michael J Karaszewski San Antonio, TX Charles J Kirkby Edmonton, AB CANADA Tamara N Kouskoulas Grosse Pointe Woods, MI Anna T Kress Saint Louis, MO Maria Rybak Cleveland, OH Nicholas D Schupp Perryville, MO Emilie T Soisson Newport Beach, CA Kristin J Stewart Montreal, QC CANADA Brian Wang Camden, NJ Jikun Wei Park City, IL Mark P Winslow Upland, CA Ye Wu Tonawanda, NY Bin Yao Livonia, MI Pui Kuen Yuen Flushing, NY

Student Betsy Abraham Chicago, IL Luis Bravo Chicago, IL

AAPM NEWSLETTER AAPM NEWSLETTER

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

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Adam S Elliott Westmount, QC CANADA Yuntao Feng Cincinnati, OH Yuri Ishihara Boston, MA Jason C Mace Greenville, NC Jacqueline M Maurer Durham, NC Michael W Olex Winston-Salem, NC David J Perrin Baton Rouge, LA Marija Popovic Hamilton, ON CANADA June Song North Chicago, IL Eric Tischler Brooklyn, OH Michael J Walsh Philadelphia, PA

New Members

Full Adnan Z Alwatban Riyadh, SAUDI ARABIA Madhava Bhat Adelaide, AUSTRALIA Christine Boutry Montauban, FRANCE Stephen L Brown Detroit, MI Juan Carlos Celi Heidelberg, GERMANY Chandra Chatterjee Malvern, PA Doris M Dimitriadis Larnaka, CYPRUS Joseph P. Dugas Baton Rouge, LA Bing Fang Temple, TX Raynard K Fong Poway, CA Robert T Fritz El Paso, TX Linda D Gavagan Winnipeg, MB CANADA Rabih W. Hammoud Brownstown, MI

Associate Chadd E Smith Chicago, IL James R Stoner Nashville, TN

Corresponding Pawel F Kukolowicz Kielce, POLAND Joseph K Maria Das Lucknow, INDIA Raphaël Moeckli Lausanne, SWITZERLAND Laura Muchiutti Santa Fe, ARGENTINA Mark D Porter Cochester, UNITED KINGDOM KlaasJan Renema Nijmegen, NETHERLANDS Sankaranarayanan Venkataraman Glasgow, UNITED KINGDOM Yong Yin Jinan, CHINA

Conor J Heeney Dooradoyle, Limerick, IRELAND Chien-Min Kao Chicago, IL Miklos Z Kiss Madison, WI Thomas Lane Dallas, TX Heung-Rae Lee Maplewood, MN Dezhi Liu Detroit, MI Hongkui Ma Jamesburg, NJ Saikanth Mahendra Lynnwood, WA Sivasubramanian R Manoharan Redding, CA Luc L Mertz Strasbourg, FRANCE Randy B Nies Lincoln Park, NJ Petr Novak Little Rock, AR

(See Members - p. 28)

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AAPM NEWSLETTER

Members (from p. 27) Carmine A. Pierno Reading, PA Tarun Podder Rochester, NY Rui Qi Concord, MA Paul JM Rietveld Schiedam, NETHERLANDS Walter A Roberts Dexter, MI Andiappa P Sankar Edinburgh, UNITED KINGDOM Javier Santos Chandler, AZ Abdelhamid Saoudi Ottawa, ON CANADA George G Schiller New York, NY Bernhard T Schmidt Malvern, PA Ruth E Schmitz Seattle, WA Josh M Star-Lack Mountain View, CA Joshua R Stephenson Grand Island, NE Leonel A Torres Aroche Havana, CUBA Shuying Wan Sudbury, ON CANADA Jiaju Zhang Flushing, NY

Junior Adam M Alessio Seattle, WA Meng-Sang Chew Emmaus, PA Elizabeth M Crowley Somerville, MA Michael J Daly Toronto, ON CANADA Laura M Danielson Fargo, ND Brian C Heaton Mobile, AL Sean Hoyt West Chester, OH Scott R Jones Bethesda, MD Ioannis St Kandarakis Athens, GREECE Francis P Kelly Clarks Green, PA Jason M Leidel Dayton, OH Deborah L LeMay Indianapolis, IN Qijuan Li Omaha, NE

MAY/JUNE 2006 Jostin B Crass Clarksville, TN Matthew J Daniels Madison, WI Renee L Dickinson Houston, TX Jason J Durant Nashville, TN James M Eddy Lexington, KY Mary A Emmons Franklin, TN TjJamika English Lowell, MA Mark D English Nashville, TN Leia M Fanelli Nashville, TN Yuxin Feng Gainesville, FL Joel E. Fern Atlanta, GA Lourdes M GarciaFernandez Ottawa, ON CANADA Joshua A. Gesner Nashville, TN Shabbou Ghahremani San Antonio, TX George C Hanna Durham, NC Oliver D Hanson Winterville, NC Nicholas Hardcastle Thirroul, AUSTRALIA Bohyun A Hartmann Gainesville, FL Amanda R Havnen Winston-Salem, NC Vladimir L Henderson-Suite Greenville, NC Patrick M Hill Madison, WI Jared S Hoover Atlanta, GA Hrvoje Hrsak Zagreb- Dubrava, CROATIA Hsiu-Wen Hsieh New York, NY Yimei Huang Farmington Hills, MI Michael J Huberts Rochester Hills, MI Shima Ito Baton Rouge, LA Thompson W Joe Framingham, MA Daniel Johnson Oklahoma City, OK Jasjit Jolly Cincinnati, OH Joanne H Kang GERMANY

Derek M Manzow New Port Richey, FL Patrick H Martin Missoula, MT Dragan Mirkovic Houston, TX Andrew Palmiotti Park, PA Deborah L Schofield Burlington, MA Hemant I Shukla Iowa City, IA Ioannis (Yani) T Stathakos Albany, NY An Tai Wauwatosa, WI Tim AT van Zon Veenendaal, NETHERLANDS Kelin Wang New York, NY Miriam R Weinstock Brooklyn, NY Jamone B Williams Fort Wayne, IN Jian Wu Gainesville, FL Jun Yang Havertown, PA Myonggeun Yoon Goyang, Gyeonggi-do, KOREA, REPUBLIC OF Qinghui Zhang New York, NY

Student Justus D Adamson Detroit, MI Ismail AlDahlawi Montreal, QC CANADA Satoshi Ando Suzuka, JAPAN William A. Andre Mundelein, IL Seth N Ankrah Cleveland, OH Hemanthkumar Athiraman Detroit, MI Julie A Berglund Madison, WI Whitney E Bivens Houston, TX Frank G Calabro Parma, OH Xiaowan Chen Atlanta, GA Jung Uk (Michael) Choi Williston Park, NY Jennifer M Cole Lexington, KY Joseph B Colenda Greenville, NC

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Rojano Kashani Ann Arbor, MI James J Kelley Las Vegas, NV Joshua B Kessler Greenville, NC Nadeem Khan Dhahran, SAUDI ARABIA Xiang Kong Norman, OK Michael J Lamey Edmomton, AB CANADA Michael V Lawrence Winston Salem, NC Susannah C Lazar Houston, TX James S Lee Chicago, IL Stephanie M Leon Gainesville, FL Wan Ting Liao Ann Arbor, MI Yixiang Liao Detroit, MI Yang Liu Oklahoma City, OK Anant K Mandapaka Atlanta, GA Fernando Marques Setubal, PORTUGAL Tracy L Marshall Muskego, WI Karen R Marutyan St. Louis, MO Zubin R Master Stony Brook, NY Jason Matney Baton Rouge, LA Raymond K Maynard Columbia, MO Alanna McDermott Houston, TX Ryan McMahon West Lafayette, IN Holly E Miller Lexington, KY Dimple Modgil Naperville, IL Jeffrey Moirano Madison, WI Pasquale J Montanaro Marietta, GA Andrew N Morrow Baton Rouge, LA Ganesh Narayanasamy Ann Arbor, MI Cathleen J O’Neill Co. Kerry, IRELAND Olurotimi S. Ojoniyi Ikeja, NIGERIA Xin Pan Wyomissing, PA David M Pascoe Lexington, KY

AAPM NEWSLETTER AAPM NEWSLETTER Adam B Paxton Madison, WI Jianguo Qian Williamsburg, VA Kavita Reddy Auburn, AL Eric P Reynard Cote-Saint-Luc, QC CANADA Sarah E. Rogers Nashville, TN Jonathan A. Rogers Nashville, TN Monica C Rossi Jonesville, VA Tsengchan Saechao San Diego, CA Jonathan H Saleeby Lowell, MA Scott Sample Auburn, GA David K Sasaki Edmonton, AB CANADA Joshua S Scheuermann Upper Holland, PA

Erick M Sweat Grovetown, GA Samson Tafon Penn Bethlehem, PA Laurent C Tantot Montreal, QC CANADA Randle E Taylor Ottawa, ON CANADA Christopher Tennant Newport News, VA Jonathan A Terrell Charlotte, NC Randall C Tobias Plainfield, IL Matt Vanderhoek Madison, WI Michael S. Varga Fredonia, PA Shannon P Voss College Station, TX Sarah E Walsh Monroe, NY Yun Wang Ann Arbor, MI

Leah K Schubert Madison, WI Derek Z Schulze Skokie, IL Scott L Shields Woodstock, GA Neetu A Shukla Clinton Township, MI Dmitry Shuster Cleveland, OH Shanna B Simmons Lexington, KY Thomas A Simon Gainesville, FL Benjamin J Sintay Winston Salem, NC Kelly J Sorensen Madison, WI Melissa A Sorrell Middletown, OH Benjamin K Sramek San Antonio, TX Donald R Sutton Pinetops, NC

JANUARY/FEBRUARY 2001 MAY/JUNE 2006 Christopher E Welch Baton Rouge, LA Ning Wen Detroit, MI David C Westerly Madison, WI Melissa L Wilson Pontiac, MI James F Winslow Gainesville, FL Alan H Wong Strongsville, OH Sridhar Yaddanapudi Columbia, MO Xiaoqin Yang Woodstock, GA Bo Zhao Detroit, MI Yingli Zhao Edmonton, AB CANADA Yiran Zheng Cleveland, OH ■

Letters to the Editor Complaining A Poor Substitute for Positive Action Ivan A. Brezovich, PhD Birmingham, AL ibrezovich@uabmc.edu In his ‘monthly diatribe’ (Chairman of the Board Report, AAPM Newsletter, March/April 2006) Dr. Amols justifiably complains that the “educational pathway into medical physics now resembles that of a technologist more than it does a physicist or a physician.” I can add that there are now medical physics training programs that use the internet for online course work. Howard is very critical of medical physicists who “want to have it both ways

– lots of respect but with minimal and virtually free training – . . .” and points out that traditional physicists, as well as radiologists and radiation oncologists, have to meet much more stringent standards to get into their respective fields. He implies that medical physicists, similar to traditional physicists or radiologists, should get a BS, a graduate degree in physics, and several years of specialty training. I agree with that, too. Unfortunately, Howard does not tell us how to reach such desirable goals.

Why would anybody want to become a medical physicist if he/she has the relatively rare talent and perseverance to make it through a demanding physics program, has the compassion to 29

care for very sick and often terminal patients, is not afraid of blood, urine, vomit, feces and the odor that goes with them, is ready to work long hours and weekends, is willing to take responsibility for the lives of hundreds of patients each year, accept the risks associated with radiation and radioactive sources, has the endurance to work occasional 90+ hour weeks taking care of a full patient load while implementing some of medicine’s most sophisticated new procedures, and has the resources to pay for his/her own education?

Unlike a medical student, a medical physicist can’t get “a couple of hundred grand in the hole,” even if he wants to. No (See Brezovich - p. 30)

AAPM NEWSLETTER

MAY/JUNE 2006

Letters to the Editor Brezovich (from p. 29) bank will take the risk of loaning money to someone training for an unpredictable job. Furthermore, why would anybody want to “orchestrate the entire treatment process” (words used in a letter to HCFA by an ASTRO chairman describing our work), yet accept pay that “pales in comparison to radiation oncologists” (words used by a former ASTRO president), and work under conditions resembling “hanging drywall for a living” (as a high-level ASTRO leader described practicing medicine without provider status), if he has other options?

Too many potential high-quality medical physicists are answering these questions with a resounding NO, instead choosing medical school or traditional physics. Others are leaving medical physics, wasting taxpayer’s money spent on their education.

One of our former staff radiation oncologists had a PhD in physics from Yale, but left the field because of poor job security. One of our previous oncology residents was ABR certified in medical physics, but switched careers because of poor recognition. (The article by Chuck Smith in the March/April AAPM Newsletter puts a human face on the pain of being sidelined.) One of our current radiation oncology residents has a PhD in medical physics from a highly reputed institution, yet did not stay in the field. Many of the applicants for our radiation

oncology residency program have physics and engineering backgrounds far superior to most medical physicists currently entering the discipline. None of these highly motivated individuals took the shortcut to the easy riches of medical physics at “the tender age of 23,” preferring the hardships (and rewards) typical for radiation oncology.

To endure the hardships required to achieve a level of competence comparable to physicians and traditional physicists, medical physicists need the prospect for comparable rewards. The recent RPC head phantom benchmarking tests for IMRT accreditation showed that we have strayed far from that level, thus grossly shortchanging our patients. Again, we should learn from radiation oncologists.

When their provider status was in doubt, quality and quantity of residents dropped drastically.

During one year of that bleak period, we had only one applicant for residency. And that resident was unable to do math beyond addition of double-digit integers and subtraction of single-digit numbers. Fortunately for the profession, including medical physics, the leading radiation oncologists did not complain about the poor state of their profession and the incompetent residents. They did not sit and do nothing to remedy the situation.

Instead they asked radiation oncologists and physicists to write letters to US Senators and 30

Congressmen, explaining why it would be harmful to cancer patients to single out radiation oncology as a specialty not entitled to provider status. The troops followed the leaders, and the resultant recovery brought on by their leadership is history.

Based on that positive experience, may I suggest that the AAPM leaders take the lead in developing a viable plan for the future of medical physics. Provider status is desired by nearly two-thirds of the membership. If this is not the solution, give us a better plan. Unless our leaders act on Howard’s superb analysis, it will become just another futile cry in the chorus of whiners (as Howard calls those who express their dissatisfaction with the current state of medical physics).

Our patients deserve better. ■

Provider Status Emeka S. Izundu, PhD Las Cruces, NM emeka.izundu@lpnt.net Again Dr. Brezovich (MEDPHYS Digest - 6 Mar 2006 to 7 Mar 2006, #2006-65) has presented vital points in support of provider status. The key issues are “improving job security, working conditions and recognition of medical physicists by obtaining the status of ‘professionals.’”

AAPM NEWSLETTER AAPM NEWSLETTER

Some of us may think that fat salaries are the most important issue, personally I do not think so. One may earn a fat salary but have a hell of a time at work. I am at my current job now (after trying three other centers), because I am well respected and treated on the same level as the physicians. The other three jobs placed me on the level of technicians! I am sure other medical physicists have gone through the same or similar experiences. At this point, I encourage anyone who has had such experiences or knows someone who has been through these types of humiliations to speak up.

How do you feel when, at your anniversary date, a manager or director (usually a nurse or a therapist), to whom you have explained a lot about radiation, who knows very little about your job, calls you in his/her office to do your evaluation and determine your pay increase? How do you feel about the following: You stayed at work on a Wednesday ‘til 10PM because you had to do some measurements. On Thursday you put in seven hours of work and feel sleepy and tired.

You leave your office at 3PM. You have not yet arrived at your house when the manager of your center calls and tells you to come back to work because it is not yet 5PM, though there is nothing for you to do?

The above two scenarios were real and I can cite more of such treatments that had happened to some medical physicists I know.

Money is important, but I would (See Izundu - p. 32)

JANUARY/FEBRUARY 2001 MAY/JUNE 2006

The AAPM Virtual Library Benefit from the most cutting edge information in the field!

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

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

www.aapm.org/meetings/VirtualLibrary/

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AAPM NEWSLETTER

MAY/JUNE 2006

The Dueling Dragons Coaster at the Islands of Adventure in Orange County, Florida; one of many attractions near the site of the 2006 AAPM Annual Meeting. (Photo courtesy of the Orlando/Orange County Convention & Visitor’s Bureau, Inc.®)

Izundu (from p. 31) not mind to lose a little money and gain the respect and job satisfaction I deserve as a professional.

The idea of how much money provider status will bring us should not be the key issue. ■

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

The AAPM Newsletter is printed bi-monthly.

Next Issue: July/August 2006

Postmark Date: July 15

Submission Deadline: June 13, 2006 AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

One Physics Ellipse College Park, Maryland 20740-3846 (301)209-3350 Phone (301)209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org

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