Newsletter
AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE VOLUME 31 NO. 6
NOVEMBER/DECEMBER 2006
AAPM President’s Column Into the 21st Century E. Russel Ritenour Minneapolis, MN This is my last column as president. It appears in this November/December issue but was written with a deadline of October 15. The AAPM Board Meeting at RSNA has not taken place and there are two and a half months left in the year. So, I can’t really do an endof-the-year summary. Maybe I’ll do some of that in my first column next year as chairman of the board. Instead I’d like
to write about some of the issues that the AAPM will have to confront as we move a little farther into the 21st century. First, however, I want to take some space here to thank three people who have devoted and continue to devote a tremendous amount of time and energy to the AAPM. I’m referring to the three council chairs. As most of you know, they are (in reverse alphabetical order—my last name comes late in the alphabet, so I have some bias here) Jerry White (Professional Council), Herb Mower (Education
Chairman of the Board Report Putting into the Sunset - My Last Column
(See Ritenour - p. 2)
TABLE OF CONTENTS
Howard I. Amols New York, NY “Glory is fleeting, but obscurity is forever.” –Napoleon Bonaparte This is my last newsletter column as a member of the AAPM Executive Committee. On November 29 at approximately 5:55PM Central Standard Time at the end of the AAPM Board
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Council), and John Boone (Science Council). They have made my job easier throughout the year. The executive committee, composed of the president, the chairman of the board, the treasurer, the secretary, the executive director and the president-elect, acts on behalf of the board of directors between
of Directors meeting, I will ceremonially turn over the reigns of chairman of the board to outgoing President Russ Ritenour. (See Amols - p. 4)
President-elect Report Executive Dir’s Column Education Council Report CAMPEP News Leg & Regulatory Affairs Health Policy/Economics Chapter News Summer Undergrad Prgrm Travel Grant Report Letter to the Editor Letter from the Editor
p 7 p 8 p 9 p 10 p 11 p 14 p 15 p 17 p 17 p 22 p 23
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Ritenour (from p. 1) board meetings. So, obviously, we deal with many, many issues. I didn’t used to think that I did “Instant Messaging,� but on many days the six of us send e-mails back and forth so fast that it may as well be that. We also conduct conference calls throughout the year. My point here is that as we discuss things like new appointments, communications with other societies, requests to start new programs, and so on, there is almost always a point where we decide that we need input from one or often two or three of the council chairs. They, in turn, often have to communicate with one or more committee chairs before getting back to
the executive committee. We rely on the council chairs to be a link between the board and the hundreds of volunteers who serve on committees, task groups, working groups, etc. We also ask them to do a lot of work beyond coordinating all of their committees. For example, all task group reports are now reviewed by all three councils. This step was taken approximately two years ago mostly because some states have made direct reference to TG reports in their Radiation Control regulations. Therefore, we are concerned with how adoption of TG reports might affect the professional situation of medical physicists and how they may influence educational needs. So, in our concern, we
turned to the council chairs. I didn’t realize how much the council chairs do for the AAPM throughout the year until I became a member of the Executive Committee. EXCOM officers deserve a lot of thanks for what they accomplish for us and I suggest that the next time you see one of them, you might want to thank him/her. Now, in the space remaining, I plan to ramble on a little about how the AAPM functions and how it might be changing. One example goes back to the opening paragraph of this column. There is about a month and a half delay between the deadline for submission of materials to the newsletter and the time that the members can view it. Maybe its time for the newsletter to be
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constructed more like a Web page than like a traditional newsletter. Maybe that would shorten the delay time considerably. This would not be a step to be taken lightly, as it would affect advertising and it might not be in keeping with the preferences of the membership. Fortunately we have someone who will be looking into this and other issues affecting the newsletter. Mahadevappa Mahesh has been recommended to and approved by the board of directors as the new editor of the AAPM Newsletter. When he takes over as editor in 2007, the production of the newsletter comes in-house to be conducted by AAPM staff. The actual assembly of the newsletter will be done electronically in more of a Web-based format. This won’t necessarily affect the appearance of the newsletter to the membership, but it creates opportunities. I know that Mahesh will be looking into a number of possible new directions for the newsletter and that he will seek a lot of input regarding any changes. Here’s more rambling. I know that a lot of space in the newsletter has been devoted to a discussion of ways to change the composition or the function of the board so that it becomes more efficient. You may be getting tired of hearing about it. Let me assure you that we haven’t suspended activities of the association and spent all our time philosophizing about how to “recreate” the AAPM. Almost all of the “IM’ing” that I referred to earlier is about doing real things. Although I
haven’t listed many specific activities in this column, I assure you that a lot has been done. I think that many of us realize that we could just reframe the discussion of board reorganization under the heading: How do we proceed into the 21st century as we recognize that the AAPM and the professional world of medical physicists have changed tremendously in nearly fifty years of existence? We have a lot of staff who do things that volunteers used to do and also do things volunteers never really could do. We still have a lot of volunteers—over 600 people are active on committees. But we all have to be more efficient in how we spend our time and how we budget our travel time and travel dollars. We already do make use of things that the founders of the AAPM never envisioned; we e-mail, we do conference calls, we make use of Web-based reports and documents. We need to continue to look at how we function now and how we can do it better—not just through technology, but through reexamining things such as the timing of board meetings, how much the board might use the internet, and possibly how some things might be done by virtual meetings. At the moment, several committees of the AAPM have put a lot of time and energy into thinking about these issues and researching ways that we could do things more efficiently. The board has received either preliminary or final reports from these groups
and is beginning to discuss what recommendations to follow. The board has decided to meet in the spring and do some long-range planning. We may also modify when the board meets at RSNA. We’re taking small steps toward using online Web-conferencing tools. So, I look forward to working with the board as chair in 2007. I hope to continue the work that has been done on rethinking how we should function in this century, and I look forward to using new techniques to help the board make some strategic decisions for the future. ■ AIP/APS CONGRESSIONAL SCIENCE FELLOWSHIPS Experience a unique year in Washington, DC! Make a personal contribution to U.S. policy while learning how the legislative process operates. The AIP Fellowship is open to qualified members of the AAPM and other AIP Member Societies; the APS Fellowship is open to APS members. These programs benefit the government, the science community, and the individual Fellows. Qualifications include U.S. citizenship; appropriate society membership; PhD or equivalent in physics-related field; and interest or experience in S&T policy. All ages and career levels are welcome to apply. APPLICATION DEADLINE: January 15, 2007 (postmarked). For details on the AIP and APS Fellowships, please visit http://www.aip.org/gov/ cf.html
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Amols (from p.1) As chairman I’ve focused this year on a few main goals: 1. Expand the AAPM Web site as our ‘window’ to the world and as the major link between AAPM members and AAPM committees, and as a tool for conducting AAPM business. 2. Accelerate AAPM’s efforts to confront the education and training challenges facing our profession in this age of rapid technological advancement coupled with tighter budgets. 3. Revamp the way the AAPM Board of Directors functions from its current mode of being primarily a perfunctory rubber stamp of EXCOM and council actions to what the bylaws say it should be, namely ‘responsible for the affairs of the Corporation,’ and the body from which AAPM goals, priorities, and policies emanate. EXCOM and councils (i.e., Science, Education, and Professional councils) are extensions of the board and carry out board directives, but the priorities should be set by the board and accountability rests with the board. We’ve made progress in all of these areas but not nearly enough. We were successful in creating the new position of AAPM Web site editor, with Chris Marshal already having started his duties in that capacity. The Ad Hoc Committee on ‘Alternate Pathways to Medical Physics Residency’ spawned TG-133 ‘Alternative Clinical Medical Physics Training Pathways’ (chaired by Mike Herman) and should be issuing its
report next year. This year we’ve also created a new ‘International Education Activities Committee’ (chaired by Don Frey) to better coordinate and monitor these affairs in conjunction with the International Affairs Committee, and also created the position of AAPM Liaison to the IAEA (subject to board approval). With regard to revamping the board of directors, we have instituted a one-day orientation session at AAPM Headquarters for all new board members, and now provide them with more advance information about the board’s responsibilities, activities, and the resources that are available to them to help them do their job. The first of these orientation sessions was held late last year, and the second one was held last month (for members joining the board on January 1, 2007). As reported last time, beginning in 2007 the board will have three face-toface meetings per year instead of only two, with the third meeting being devoted to long-range planning and strategy. Also more of the board’s business is being conducted online. But we still have a long way go in changing the way the board operates. As Vince Lombardi once said, ‘ “We didn’t lose the game; we just ran out of time.” My parting thoughts are not on progress, but rather on the challenges that lie ahead. There have been enormous changes in medical physics since the AAPM was founded nearly 50 years ago. Technology has accelerated beyond all expectations and the already large knowledge base
required by a medical physicist is growing at an exponential rate. Yet, when the AAPM was founded, the overwhelming majority of its few dozen members were Ph.D.-based university physicists. Today more than half of our nearly 6000 members have master’s degrees rather than Ph.D.s, and most are so busy coping with increasing clinical responsibilities that staying abreast of new technology is becoming almost impossible. Very few of us have the time, energy, or money to properly train the next generation of medical physicists, and I rank this as the greatest challenge facing our profession. A related problem with similar root causes is that the development of new technologies has shifted from the medical physicist-scientist to industry-based engineers. We are arguably no longer the leaders in the development of new technology. Instead the medical physicist now relies more and more on industry for these developments and, even worse, we rely on industry for training us in how to use them. I wish I had a dollar for every time a manufacturer’s installation engineer led a medical physicist by the nose through the acceptance testing of a new linear accelerator or PET scanner. The medical physicist is starting to look more and more like a technician, and less and less like a scientist. If I can be permitted to editorialize, many medical physics training programs wittingly or unwittingly foster this change in focus from thinking like a scientist to (not) thinking like a technician.
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The AAPM also faces longterm questions of financial solvency. Right now we are reasonably flush. But roughly two-thirds of our income comes from the journal and the annual meeting, both of which are possibly in long-term peril because of the ‘www.’ Sooner or later, and probably sooner, all scientific journals, including ours, will exist only in electronic form, and this changes the whole nature of advertising. In particular, we may not be able to count on the current levels of advertising revenue in the future. Similarly, as Web-based meeting technology becomes more sophisticated, more available and less expensive, there likely will be less need for a ‘live’ annual meeting, at least in its current format. And finally, the AAPM faces the problem of member commitment. Fewer and fewer members have the time or wherewithal to volunteer for AAPM activities. Indeed, many things for which members used to volunteer no longer even lend themselves to volunteerism. The annual meeting, for example, used to be run almost entirely by member volunteers. But now, with approximately 3000 attendees and a budget of close to $2 million, it’s the kind of enterprise that requires professional management. This comment is not in anyway meant to minimize the work done by the Meeting Coordination Committee, but simply reflects the reality that we now also require professional help for this and most other AAPM activities that used to be done almost entirely by volunteers.
Another example of the demise of volunteerism is the annual budget. Would you really want an amateur volunteer preparing the AAPM’s $6 million annual budget? Again, no reflection on the hard work done by the AAPM treasurer, but we also need professional help. Hence, AAPM Headquarters staff has grown to 20 people with concomitant increases in annual expenses. But no matter how large our staff, only AAPM members can or should set AAPM goals, and the reality is that most activities of most AAPM committees can only be done by people with medical physics expertise. So we face a difficult balancing act. I do not want to end my final column with a message of gloom and doom. The bottom line is that the AAPM and medical physics are both pretty healthy right now. But neither is the kind of endeavor that will continue to move forward for very long on inertia alone. It’s not a frictionless road. The AAPM and medical physics both require a continuous source of energy if they are to continue rolling down the road. That energy can only be supplied by our members. So, that’s all folks!
the past three and a half years. I want to thank all of my colleagues on EXCOM both past and present, particularly my immediate predecessors Marty Weinhous and Don Frey, for their advice and mentoring, and to every AAPM member who’s volunteered his/her time during my tenure. For those of you who have not yet become involved in AAPM affairs, this will be my last appeal urging you to e-mail Mary Martel or Gerry White and volunteer for something. There is an old saying by the great philosopher Anonymous,1 “The difference between involvement and commitment is like a ham and eggs breakfast; the chicken was involved but the pig was committed.” If you’re not able or willing to be committed to AAPM activities, please consider at least becoming involved. Also, special thanks to Angela Keyser and the entire staff at AAPM Headquarters, and to my colleagues at Memorial Sloan Kettering for picking up the slack for me during all of the times over the past three years that I wasn’t pulling a full load at my ‘day job.’2 And finally, to my wife, Nancy, for about a million different reasons. ■
Envision me with the Looney Tunes characters bidding farewell, “That’s All Folks!”
If you don’t believe me about how great a philosopher Anonymous was, try Googling ‘quotes by Anonymous.’ You’ll get about 16 million links! 2 Except for the one smart alec in my group who said, ‘Gee, I didn’t notice any difference.’ 1
It’s been an honor and a privilege to serve on EXCOM for 5
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President-elect Report Dolly Levi I’m Not Mary K. Martel Chicago, IL I am currently knee-deep in a flood of names of AAPM members who have newly volunteered for committees. (This is a good thing!) There were approximately 160 new volunteers indicating their interest in service to the AAPM via a Web site interface open earlier this year. (‘New’ means a person volunteering for a committee on which he/she does not currently serve.) Each of those 160 people could choose up to three committees for membership (and many did). The council and committee trees, and their respective new volunteers from this year, look like this (more or less): •Administrative Committee (121 new volunteers overall) 14 committees, 20 subcommittees; •Education Council (158 new volunteers) seven committees, 16 subcommittees, three working groups; •Professional Council (39 new volunteers) five committees, five subcommittees; •Science Council (101 new volunteers) two committees, 17 subcommittees, 21 working groups. The distribution of volunteer choices among the three councils and the Administrative committees was interesting,
instructive and…lopsided, and posed a rather large challenge for both me (as I try to make appointments) and some committee chairs. For example, the Education and Training of Medical Physicists Committee had 52 “new” volunteers, and the Medical Physics Education of Physicians Committee had 30 new volunteers. It is just not possible for the chairs to take more than a couple of new committee members onto a committee already consisting of approximately 20 members. Other committees such as the Rules Committee and the Development Committee each had only one and three new volunteers, respectively! Some committees have a large number of volunteers (Therapy Physics Committee with 75, International Affairs with 50), but at least have a number of subcommittees and working groups that could utilize a portion of these volunteers. The chairperson can “see” the list of volunteers for their particular committee via their committee Web site, and select from the list to place people on their roster. Unfortunately the subcommittee (SC) and working
group (WG) chairs cannot see this same list, since it was not possible for the new volunteer to indicate interest in other than the primary committee. I have had to e-mail each of the SC and WG chairs with the list of names, and they have had to plow through it. A couple of changes are needed for next year to improve the chance of a new volunteer actually receiving placement on a committee of his/her primary choice. First, the AAPM member must contact the chairperson of the committee, subcommittee or working group either via e-mail or in person at a committee meeting (or both). This is a crucial step since it is the chair that chooses members for their rosters, and not the presidentelect. Committees, SCs, and WGs meet at the annual AAPM, ASTRO and RSNA meetings, with committee schedules posted on the AAPM Web site prior to each of the meetings. Second, changes will be made to the Web site interface such that the new volunteer will be able to choose SCs and WGs in addition to the primary committees. Interest can then more effectively be filtered to the proper chairperson, who can assess the fitness of the volunteer for that particular committee (or SC, WG). These changes will go into effect when the call for new volunteers goes out at the first of next year (2007). (See Martel - p. 8)
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Martel (from p. 7) While I have enjoyed playing matchmaker for the new volunteers and the committees, I can only go so far to find places for
all who are interested (that’s 160 people but 419 “choices”!). The process just needs some improving, and perhaps next year will be better for volunteers and president-elect alike. And, as
always, should you have any other suggestions regarding the volunteering issue, please feel free to e-mail me with your suggestions at mkmartelaapm@ yahoo.com. ■
Executive Director’s Column are required to complete a Potential Sources of Conflict of Interest form, listing relevant connections and interests that may constitute potential sources of conflict of interest within the meaning of this policy in light of the responsibilities falling to the Association.” Angela Keyser College Park, MD
Your Online Member Profile You can now manage your journal delivery options in the “Journal Preferences” area of the Member Profile. If you are eligible for print but prefer to read the journal online only, you may turn off paper and turn it back on again at any time. It was suggested that it would be a great thing for younger members if more members included a picture in their member profile. Please, upload your picture if you have not already done so. Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy. This policy states that “Individuals selected for service to the Association
Fellowships and Residencies Your October monthly mailing included a flyer announcing the availability of a fellowship for the training of a doctoral candidate and a full-time clinical residency in imaging medical physics. •The RSNA/AAPM Fellowship for Graduate Study in Medical Physics is awarded for two years of graduate study in medical physics to begin on July 1, 2007. The graduate study must be undertaken in a medical physics doctoral degree program accredited by CAMPEP. This fellowship is funded through the AAPM Education and Research Fund. The deadline for applications to be received at HQ is December 30, 2006. •The Clinical Residency in Imaging Medical Physics is a two-year grant to be made to institutions in partial support of
a full-time clinical residency in imaging medical physics at the Ph.D. level. The residency programs must be accredited by CAMPEP, or have applied for CAMPEP accreditation by the end of the second year of funding. This residency is funded through the AAPM Education and Research Fund. The deadline for applications to be received at HQ is February 1, 2007. Application information is available on the Web.
Staff News Clarise Gilmore resigned her position as the AAPM’s database administrator in September to relocate to Florida. During her one and a half years with AAPM, Clarise was instrumental in automating and documenting many AAPM IS processes. Yan-Hong Xing is scheduled to join the AAPM HQ team as the database administrator at the end of October. Yan-Hong has a degree in electrical engineering from Beijing Union University. She will bring to the team over 10 years of professional experience in the electronic and computer fields. Part of the success of the AAPM HQ operations is our
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ability to attract and retain an excellent team of high-performing association management professionals. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2006. I want to publicly thank them and acknowledge their efforts. Lisa Rose Sullivan 13 years of service Penny Slattery 10 years of service Michael Woodward 10 years of service Farhana Khan 8 years of service Shantelle Corado 4 years of service Catherine Murashchyk 4 years of service Peggy Compton 2 years of service Noel Crisman-Fillhart 1 year of service Seana Miller 1 year of service In November, I celebrated my 13th anniversary as a member of the AAPM HQ team. I thank you all for your continued support and for the confidence that you place in me as your executive director. The AAPM Headquarters office will be closed on Monday, December 25 and Monday January 1. Staff will take vacation days during the holiday season, but sufficient help will be available to service your needs. As we end the 2006 year, I want to take this opportunity, speaking for all the staff, to wish you and your loved ones a happy and healthy holiday season. ■
Education Council Report Herbert W. Mower Council Chair The council chairs, EXCOM and the Budget Committee just completed reviewing the budget requests for the AAPM for fiscal year 2007. What an exciting year ahead! As a result of the many requests for programs and activities to benefit our members, we looked closely at each request and suggested areas where the budget could be tightened without having a major effect on our programs. Although the Education Council has cut back on several program allotments, I feel that we will still provide for the expanding needs of our membership. We are excited about a new subcommittee of the Education and Training of Medical Physicists Committee. This subcommittee, to be known as the “Student Physicist Association,” will have the responsibility of overseeing activities within the association relative to the needs of current and prospective medical physics students. This group has met in the past few years at our annual meeting, but this move will give some structure to the group and provide a place for it in future years. Many thanks to Stephen Kry for his work in helping to get this group formally organized. The work started at this year’s Physics Summit is continuing into 2007 and the future. In
January the ‘Radiation Physics Syllabi’ will address updates and changes relative to the medical physics in diagnostic/ imaging programs. This information will then go forward to the RSNA “Physics Education Conference” to be held in February of 2007. The needs are being identified and there is a great deal of interest in exploring avenues to enhance these programs in the various imaging departments and programs. We expect to follow up on this with a Summer School program in the next two to three years. In previous columns I have encouraged each and every one of you to consider if you were interested in participating on a committee, subcommittee, task group or working group. Many have responded indicating interest in a couple of our groups. In talking with the various chairmen/women, we realize that, to be effective, there is probably a limit to the number of participants. Thus, we will try to recommend to the president-elect to appoint interested individuals to their (See Mower - p. 10)
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Mower (from p. 9) choices. However, in some instances we will recommend related committees so as to bet-
ter balance the workload for all. This being said, all committee, subcommittee, task group and working group meetings of the Education Council at the
CAMPEP News
AAPM meeting, ASTRO (for those meeting there) and RSNA are open to all. Do feel free to come by and participate. ■
We make continuing education simple
AAPM Online Continuing Education
Brenda Clark CAMPEP President brclark@ottawahospital.on.ca Currently, there are four graduate program applications under review, two for reaccreditation and two new applications. The new applications have site visits scheduled within the next couple of months. The Residency Program Review Committee has four programs under review and six pending. On the continuing education front, CAMPEP has been working with the American Board of Radiology to try to simplify the mechanics of Maintenance of Certification. One item under discussion presently is the definition of Category 2 activities. Under category 1 type credits, CAMPEP will now accredit programs by vendors or pertaining to a single product as long as the programs are scientific and professional rather than commercial. The program director must submit the application. We continue to try to simplify your lives!
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 Access the Online Continuing Education site at www.aapm.org/educ/rdce.asp
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Working Group on the Prevention of Errors in Radiation Oncology Peter Dunscombe WGEP Chairman The Working Group on Error Prevention (WGEP) first met at the AAPM Meeting in Seattle in 2005. The WGEP was formed by the Quality Assurance and Outcome Improvement Subcommittee of the Radiation Therapy Committee. Late in 2005 your correspondent was invited to join the working group, and took over the chairmanship two months ago from Eric Klein. At our meeting this year three main topics were discussed. First was the relationship between this working group and other AAPM committees, subcommittees, and task groups; specifically, interaction with TG 100 was thought to be essential. Error prevention is one component of quality management so it is necessary that there be consistency between these two groups. A connection with TG 100 has now been established, so hopefully these two groups can move forward in concert. Among the radiation therapy team, it is the physicists who have the sole responsibility for the clinical infrastructure, such as treatment planning and delivery systems and dosimetry protocols. Although many of the more publicized errors affecting cancer patients have been (correctly) assigned to a failure of physics support, in the area of error prevention in radia-
tion therapy we are more likely to be successful if we work together with our colleagues. To this end, the Working Group is exploring the opportunities for information exchange and collaboration with other professional societies. We do already have a representative from ASTRO on the WGEP. The final issue we discussed was that of sharing our experiences of errors in radiation therapy. If we can learn from the experience of others, we can do a better job of protect-
ing our own patients. In this regard, the pioneering work of the European group who developed the ROSIS system is noteworthy (www.clin.radfys. lu.se). The working group is currently exploring approaches to facilitate “Incident Learning” within the North American continent. If you have any views on what you have just read, please feel free to contact the author or any member of the working group. ■
Legislative & Regulatory Affairs Lynne Fairobent College Park, MD
AAPM Files Petition for Rulemaking with the U.S. Nuclear Regulatory Commission On September 10th, the AAPM filed a Petition for Rulemaking to amend 10 CFR § 35.57, Training for experienced Radiation Safety Officer, teletherapy or medical physicist, authorized medical physicist, authorized user, nuclear pharmacist, and authorized nuclear pharmacist. The purpose of this petition is to revise the “grandfather” provision of Part 35 to recognize individual diplomates of certifying boards that were previously named in
Part 35 prior to October 25, 2005. The AAPM believes that medical physicists have demonstrated their competence to practice through certification by the American Board of Radiology or the American Board of Medical Physics. With the change in the NRC process for recognition of certifying boards, the AAPM is concerned that only individuals (See Fairobent - p. 12)
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Fairobent (from p. 11) certified after the effective date assigned by the NRC staff, once it recognizes a board’s certification process, can use certification to meet the training and experience requirements of the rule. This requires individuals certified prior to the effective date to have to go through the alternate pathway. The medical physics community believes there is no evidence to support a rulemaking assertion that training and education requirements for listing as an Authorized Medical Physicist or Radiation Safety Officer acceptable before October 25, 2005 are no longer acceptable as of October 25, 2005. The NRC has 90 days to determine if the petition meets the requirements to be published in the Federal Register for public comment. The petition can be found at: http://www.aapm.org/govern ment_affairs/documents/ AMPPetitionfinal9-11-06.pdf.
Senate Committee Passes S. 2322 RadCARE Act – September 20, 2006 A Senate committee has passed the Consumer Assurance of Radiologic Excellence (RadCARE) bill, opening the door for the bill to proceed to the full Senate for a vote. The Senate Health, Education, Labor and Pensions Committee approved S. 2322, the RadCARE bill, on September 20th with minor amendments. The minor amendments are:
•Inclusion of language clarifying that nothing in this bill would adversely impact the Mammography Quality Standards Act (MQSA). •Inclusion of language allowing a state’s governor to appeal a decision by the secretary that a state’s imaging law was inadequate to meet federal minimum standards. •Inclusion of language authorizing a governor to request that alternative standards (rural and underserved areas) not apply in his/her state. •Inclusion of a sunset clause that requires the Congress to review and reapprove the RadCARE law no later than 2016. This is similar to the provision in the MQSA legislation that requires periodic Congressional review and approval. The RadCARE bill, when passed, will set minimum educational and credentialing standards for medical physicists, medical imaging technologists, and radiation therapists. The standards must be met in order to receive reimbursement for medical imaging examinations or radiation therapy treatments performed on patients covered by Medicare, Medicaid or any program under the jurisdiction of the U.S. Department of Health and Human Services. The RadCARE bill was introduced in February by Sen. Mike Enzi, R-Wyo., who is chairman of the Health, Education, Labor and Pensions Committee. The committee made minor amendments to the bill at its September 20th meeting, including the ad-
dition of a sunset provision that would require the legislation to be reauthorized in 2016. The AAPM is optimistic that the full Senate will vote on passage of this legislation before the end of this congressional session perhaps as part of a larger bill. A companion bill pending in the House of Representatives, H.R.1426, is known as the CARE bill. The AAPM hopes that the House will address this before the end of the Congressional session. The AAPM and other members of the Alliance for Quality Medical Imaging and Radiation Therapy are leading supporters of the RadCARE bill. The alliance is a coalition of 20 health care organizations whose members represent more than 300,000 medical imaging and radiation therapy professionals. The American Cancer Society, several medical imaging and radiation therapy manufacturers and a variety of patient advocacy associations also support the bill. To view the summary and full text of either bill and related amendments, go to http:// thomas.loc.gov/ and search by bill number for “S.2322” or “H.R.1426”.
DOE Source Recovery Program The U.S. Department of Energy (DOE) Los Alamos National Laboratory (LANL) sponsors a program to recover excess and unwanted radioactive sealed sources presenting disposal difficulties. The DOE conducts
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this program with reduced or no costs to the licensees. Traditionally, the program dealt largely with americium-241 and plutonium sources. Owing to heightened concerns about terrorist threats to steal radioactive material for use in a dirty bomb, the DOE is moving aggressively to include other isotopes of concern. In addition, the NRC is considering including Category 3 sources to the source tracking database initiative within the next three years. The AAPM has been working with the Conference of Radiation Control Program Directors (CRCPD) and DOE/LANL to initiate a program to “round up” sources in a geographic area that would not by themselves qualify under the DOE Source Recovery Program. The CRCPD hopes to have this program under way in 2007. However, in order to qualify for a campaign to manage large numbers of small obsolete sources, examples of which are cesium-137 brachytherapy sources, and various radium-226, americium-241, and other sources, medical licensees must register these sources with LANL. To learn more and to register online, please visit http://osrp.lanl. gov/what_is_osr.shtml.
NRC Publishes new Regulatory Issues Summaries and Guidance Document The following documents have been posted on the NRC Web site:
•New fact sheet on risks associated with medical events: http://www.nrc.gov/readingrm/doc-collections/fact-sheets/ risks-assoc-medical-events. html. •RIS-06-018: Requesting Exemption from the Public Dose Limits for Certain Caregivers of Hospital Patients – http://www.nrc.gov/readingrm/doc-collections/gen-comm/ reg-issues/2006/ri200618.pdf
•RIS-06-019: Availability of Guidance on Radioactive Seed Localization - http://www.nrc. gov/materials/miau/med-usetoolkit/seed-localization.html •Iodine-125 and Palladium103 Low Dose Rate Brachytherapy Seeds Used for Localization of Non-Palpable Lesions - http://www.nrc.gov/ materials/miau/med-use-toolkit/seed-localization.html. ■
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NOVEMBER/DECEMBER 2006
Health Policy/Economic Issues Wendy Smith Fuss, MPH Health Policy Consultant
AAPM Submits Comments to Medicare Regarding 2007 Proposed Rules The AAPM Professional Economics Committee has had a very busy regulatory season reviewing multiple Medicare proposed rules and their impact on medical physics procedures, meeting with Centers for Medicare and Medicaid (CMS) officials, and submitting comment letters, including recommendations to CMS that benefit the practice of medical physics. In the September/October 2006 issue of the AAPM Newsletter, we provided highlights of key issues contained in the two proposed rules. In this issue, we summarize the key comments and recommendations made by the AAPM in our formal written comments to CMS.
Medicare Physician Fee Schedule On September 18th, the AAPM submitted comments to CMS regarding the 2007 Medicare Physician Fee Schedule proposed rule. This Physician Fee Schedule applies to global and technical component payments to freestanding radiation oncol-
ogy centers, as well as physician reimbursement. The AAPM made the following comments and recommendations: •The AAPM recommends that CMS review and refine the direct practice expense inputs for Medical Physics CPT codes 77336 and 77370 early in the transition period so that accurate salary and time data for medical physicists can be assigned to these codes for 2008. •CMS should replace the Sustainable Growth Rate in 2007 with an annual update system like those of other provider groups so that payment rates will better reflect actual increases in physician practice costs and take into account Medicare Part B savings associated with new technologies. •CMS should finalize their proposal to assign a global period of “XXX” to Remote Afterloading High Intensity Brachytherapy procedure codes 77781, 77782, 77783 and 77784. •The AAPM applauds CMS for its decision not to implement in 2007 the 50% reduction for multiple diagnostic imaging procedures performed on contiguous body parts.
Hospital Outpatient Prospective Payment System On September 20th, the AAPM submitted comments to CMS
regarding the 2007 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. This payment system applies to technical component or facility payments to hospital outpatient departments. The AAPM made the following comments and recommendations: •The AAPM is concerned that CMS is proposing to assign G0339 Robotic linear accelerator radiosurgery, first fraction to the same APC as G0173 LINAC SRS complete course of therapy in one session when the hospital claims data is clear that the median cost of G0339 has been significantly higher for the past two years (75% in 2004 and 31% in 2005). •The AAPM recommends that CPT 19296 be maintained in New Technology APC 1524 with a payment of $3,250.00 for 2007. Further, based on the low volume of claims data, the AAPM recommends that CPT 19297 be maintained in New Technology APC 1523 with a payment of $2,750.00 for 2007. Alternatively, the AAPM recommends that CMS reassign CPT 19296 and 19297 to APC 648 Breast Reconstruction with Prosthesis. •The AAPM recommends that CPT 77421 be maintained in New Technology APC 1502 in 2007 with a payment of $75.00. •The AAPM supports the development of new innova-
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tive cancer treatments and does not support the CMS proposed definition of a brachytherapy source. •The AAPM recommends that CMS continue reimbursing hospitals based on use of the HDR Iridium-192 source (C1717) but that CMS establish a maximum charge for the reusable source (i.e. $700 per fraction). •The AAPM encourages CMS to finalize their proposal of continued deferral of the multiple diagnostic imaging reduction under HOPPS for 2007. To access the complete AAPM comment letters, go to the AAPM Web site at http://www.aapm.org/govern m e n t _ a ff a i r s / C M S / 2 0 0 7 HealthPolicyUpdate.asp. ■
WIMP Ray Tanner Meeting Coordinator rltanner@utmem.edu The Winter Institute of Medical Physics will feature Dr. Eric J. Hall - “IMRT, Protons and the Risk of Second Cancers” and Mr. Matt Luhr - “Beer at its Best” (on Super Bowl Sunday) during its 29th annual meeting February 3 - 7, 2007 in Frisco, Colorado. See the Web page at www. utmem.edu/WIMP for all details. If you’ve never been, you’ve really missed a lot!
Chapter News Upstate New York Members Participate in American Association of Physics Teachers Conference Ken Hoffman Chapter Secretary/Treasurer kh9@buffalo.edu Three members of the Upstate New York Association of Physicists in Medicine presented an invited session at the national conference of the American Association of Physics Teachers in Syracuse, New York July 22-26. This joint AAPT-AAPM session was proposed and organized by Kevin W. Corrigan, PhD, the AAPM’s liaison to the AAPT. Daniel Kim, Ph.D., Department of Radiation Oncology, SUNY Upstate Medical University, presented Physics, Physicists, and Networks in Radiation Oncology. The presentation included descriptions of the physics and physicists involved in radiation oncology, and a summary of his research in radiation oncology informatics, including his 2006 AAPM Jack Fowler Junior Investigators’ Award presentation. Kenneth R. Hoffmann, Ph.D., Department of Neurosurgery, SUNY-Buffalo, presented Vascular Analysis, Where Geometry is King. His presentation was focused on the geometrical aspects of vas-
cular analysis and the research that is ongoing at the Toshiba Stroke Research Center at SUNY-Buffalo. Robert J. Pizzutiello, MS, Upstate Medical Physics, Inc., presented Clinical Diagnostic Medical Physics: The Bridge between Technology and People. The presentation included the facts and stats about the AAPM, opportunities for physicists in medical physics, and a glimpse of professional life for a consulting medical physicist. The presentations were attended by about 25 physics teachers and students and resulted in a number of questions primarily along the lines of how to become a medical physicist and how to direct students who might or should be interested in medical physics. Given the number and variety of the questions, the information about the AAPM was useful and apparently needed. This event provided a good opportunity for outreach as it was obvious that the audience was not aware of the opportunities and rewards of being a medical physicist. It seems that the conversations and information exchange that have already begun between the AAPM and AAPT continue to benefit the memberships of both associations, and we encourage the AAPM’s continued support of this mutually beneficial joint session. ■
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AAPM NEWSLETTER
NOVEMBER/DECEMBER 2006
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Summer Undergraduate Fellowship Program The AAPM Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain exposure to and experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. The program
is aimed at junior and senior undergraduate students, particularly those that will become qualified for future graduate studies in medical physics. We expect there to be 14 summer undergraduate fellowships in 2007, each carrying a $4,000 stipend. The fellowship will be for a period of 10 weeks during the summer academic period (May 1 to September 30),
which is mutually suitable to the mentor and fellow. Should you need additional information or an application, please contact Program Administrator Shantelle Corado at the AAPM Headquarters Office at (301) 209-3350, or visit www. aapm.org/education/sufp/ Default.asp.
Travel Grant Report Venturing to the United Kingdom in the Name of Medical Physics Stanley H. Benedict Charlottesville, VA How fortunate I was to receive the AAPM-IPEM travel award at this juncture in my career, and to be off on a knightly quest for the grail, or at least for a round table in some friendly pub where I would have the benefit of discussing the many facets and nuances of medical physics with my colleagues in the United Kingdom. It all began with a flight into London’s Heathrow Airport in the middle of the night. After collecting my bags and negotiating with the wonderful and curious train station sandwich shops, and traveling to Central London and Buckingham Palace Road, I realized that all of the British
coins and bills I had purchased in advance had been spent. Actually transportation throughout England via train, and the Tube within London, are quite efficient and enjoyable, and I was quickly able to get my bearings on the ‘wheres’ and ‘hows’ of travel. After a few days spent going to the magnificent British Museum and the Tower of London, I was off to begin my first of seven visits to some of the most distinguished and impressive medical centers across the UK. Clatterbridge Centre for Oncology, Wirral, UK: My first visit was to Clatterbridge Centre for Oncology, Wirral. To get there I was wisely advised by Alan Nahum to stop in Chester, which is a fabulous little village dating back a mere 2000 years. A wonderful walk around the village can be done in two hours, including its unique walkway above the shops dating back to when the Romans were marching around England.
Stan at the British Museum in London with his ‘friends’ from the Roman Empire.
The Medical Physics Section at CCO is directed by Dr. Philip Mayles, and the physicists include his wonderful wife, Helen, and several distinguished faculty. CCO is one of the largest cancer centers in the UK with nearly 7000 new patients registered each year, together with many thousands of initial and follow-up appointments. The visit at Clatterbridge was impressive; they have nine linacs and a cobalt unit, two orthovoltage, and a 46 MeV cyclotron originally designed (See Benedict - p. 18)
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Benedict (from p. 17) for neutron treatments which now treats about 100 patients per year for ocular disease with protons. The Douglas Cyclotron Unit is a separate clinical facility within the CCO Trust and is the only proton therapy facility of its kind in the United Kingdom. The investment in new equipment has been impressive across the UK, and at CCO they were utilizing the new Varian OBI system and CBCT for analysis of two different stereotactic masks systems, which should be quite helpful for those of us involved in relocatable head frames for SRT. Edinburgh – Western General Hospital: Next on my itinerary was Scotland, known to me as the land where there are miles and miles of stone walls that have been bordering properties since time began. Once in Edinburgh, the Castle appears as every American boy’s dream of what a castle should look like, and it dominates the city. A millennium of history sits on top of the famous Edinburgh rock. While there I had the great fortune to meet up with Tony Redpath, director of the Medical Physics Program at Western General Hospital and head of the Computing and Imaging sections. The WGH, which is located directly next to the University of Edinburgh, is undergoing massive reconstruction and remodeling that includes new vaults, machines, physics offices and labs. I certainly had a great time meeting with Tony’s distinguished colleagues and staff, and
discussing their developments for brachytherapy suites and stereotactic programs. It was in Edinburgh where I experienced the beginning of a recurrent theme across the UK—lots of construction and building of new facilities with new, highly sophisticated equipment. There is no question that the Radiation Therapy Department of Western General Hospital will indeed be a very impressive site upon completion. As a wind-up to my visit in Edinburgh, I was very fortunate to see the sites of the city from a convertible Lotus with the top down; the only way to drive according to Tony. We drove out to the Firth of Forth Bridge, which is one and a half miles of what must be the world’s largest and strongest all-steel bridge. The Firth of Forth (Black River in Scottish Gaelic) is the estuary, or firth, of Scotland’s River Forth. Another quick trip back into Edinburgh and Tony let me off on the Royal Mile for site visits and a chance to try some of the world-renowned beverages made famous by the Scots. Yorkshire Cancer Centre/ University of Leeds: Next on my list was a venture to the University of Leeds where David Thwaites, who had been a fixture in Edinburgh, now heads up the Medical Physics Program. I should add that I am very grateful to David for providing keen insight with my travel itinerary. Yorkshire is home to the ancient city of York with historical attractions such as the Viking and Roman
heritage, the Minster, and the Shambles. Outside of this quaint area is the University of Leeds, which is part of the fastest growing city in the UK, a fact that was quite apparent to me. They are currently building huge new facilities downtown within Leeds with an amazing investment of 12 linac vaults, but until they are completed, the radiation therapy is offered at Cookridge. Opened in 1869, Cookridge is currently up for sale in preparation for the move of cancer services to a wing on the St. James’ University Hospital site in 2008, including a £200M cancer centre. The hilltop site at Cookridge “where patients could be cheered up among the bracken and pure air” was chosen in part to address the public fears of radioactivity. Years ago government policy set out to place radiation facilities well away from major population centers, apparently prompted by fear of air raids, and the relative isolation of Cookridge met that criteria. Indeed times have changed, and now the Leeds Teaching Hospitals NHS Trust’s move is in recognition of changing priorities, whereby clinical advice is now that cancer treatment should occur within a major hospital site and high density urban areas where there is access to other high tech facilities. It was indeed a pleasure to meet with Dr. David Thwaites, Andrew Morgan and the distinguished staff during my visit at YCC, and to tour their impressive facilities and to view from afar the new facilities at St. James
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University Hospital, which will certainly be impressive. Manchester / Christie Hospital: Next on my schedule was a quick trip to Manchester. This city has some amazing sports enthusiasts, especially for football, where the Manchester United team usually has a winning season. The City of Manchester Stadium is the new home for the Manchester City Football Club and has 48,000 seats; the design of the seating in the stands is such that no spectator is more that 100 meters from the centre of the pitch. I understand that the stadium can be used for conferences and as a focal point for the local community and schools, but clearly football is numero uno. Manchester is also where the Christie Hospital NHS Trust
is located, which is one of the largest cancer treatment centers in Europe, and an international leader in cancer research and development. The Radiotherapy Physics Section is headed up by Dr. Ranald MacKay, and with Past Director Peter Williams, they have indeed assembled an impressive staff and facilities. The Radiotherapy Department has eight linear accelerators and there is a Radiotherapy Theatre housing a high dose rate microselectron. As a testament to the large number of patients for which care is provided, adjacent to one ward is a low dose rate Selectron remote afterloading suite capable of handling two patients simultaneously. Members of the radiotherapy physics group are active participants in
the international R&D consortium for IMRT, and the Christie Hospital was the first in the UK to clinically implement dynamic IMRT for customized compensation in bladder treatment, and several new collaborations for Image Guided Radiation Therapy are underway. Hull / Princess Royal Hospital and University of Hull: Not surprising by this point in my visits to major medical centers in the UK, there is also much construction underway at Hull, and this keeps Viv Whitton (head of Radiation Physics) quite occupied. I knew that no visit to the UK is complete without experiencing Andy Beavis and company at (See Benedict - p. 20)
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NOVEMBER/DECEMBER 2006
Benedict (from p. 19) Princess Royal Hospital in Hull. Hull and East Yorkshire Hospitals NHS Trust are currently in the middle of a huge £250M capital development program. Over 70 capital projects are currently underway, including a £65M Castle Hill Cancer Centre. The development will be one of the most significant capital investments in the local region in the past 100 years, costing more than the major city projects of the Deep and the KC Stadium. My first experience with radiation therapy physics at Hull was unreal, or should I say virtual. I began the day at the Hull Immersive Visualization Environment (HIVE) based at The University of Hull. HIVE is located alongside the Department of Computer Science, and Andy serves on their faculty. They have developed a virtual radiation therapy suite which was submitted to the Midipex NHS Innovation competition held on The National Railway Museum in York in March 2006. The first prize in the innovation category went to Andrew Beavis, Roger Phillips and James Ward of Hull & East Yorkshire Hospitals NHS Trust for their Immersive (Virtual Reality) tools for training radiographers. In this novel system students use a 3D simulator that mimics high energy radiotherapy equipment and its effect on patients. It was quite impressive that with this system, I could walk around the virtual room and operate the
Stan with his wife, Lori, at Picadilly Square in London.
linac equipment–couch, gantry motions, etc. Of course no trip to Hull is complete without a visit to a rugby game, and fortunately that was something Andy was quick to provide at the local and very impressive KC Stadium. It was quite a night; Hull made it to five straight wins, coming from 12-6 down to beat Bradford 28-12 at the fabulous stadium. I agree with Hull’s coach, when he said, “It was a proper game of rugby league, and indeed it was a night for the front-rowers to shine…” London/Royal Marsden/Fulham Road and Sutton: The final leg of my trip was a return to London and to the most distinguished of UK Cancer Centers— the Grandfather of them all—the Royal Marsden Hospital, which was the first hospital in the world dedicated to cancer treatment and to research into the causes of cancer. Today the hospital with its academic partner, The Institute of Cancer Research, form the largest comprehensive cancer centre in Europe with
over 40,000 patients from the UK and abroad seen each year. The Royal Marsden, was founded in 1851 by Dr. William Marsden, who was deeply affected by the death of his wife from cancer and resolved to classify tumours, research the causes, and find new treatments. Eventually the institute settled on Fulham Road, Chelsea in 1862, which continues to this day in conjunction with the Sutton campus. I had the distinct privilege of visiting both centers courtesy of Margaret Bidmead and Professor Steve Webb. Continuing with the spirit and commitment of Dr. Marsden, the Joint Department of Physics, which spans the Trust and the Institute of Cancer Research, provides creative scientific input to clinical development and translational research for cancer diagnosis and treatment. They have a wide array of research and postgraduate teaching programs, and major research areas include: intensity-modulated radiation therapy and the instigation of clinical trials, stereotactic radiotherapy, TBI, radiopharmaceutical development, biologically targeted radionuclide therapy with associated dosimetry and diagnostic imaging. Once again, there is a huge amount of construction that is ongoing at RMH. In fact, it was most intriguing to look out the office windows of Dr. Webb and the other faculty to monitor the ongoing progress as they bulldozed and poured concrete for their new vaults.
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Summary of Findings: I was very grateful to have an audience at all of my talks that included a wide spectrum of clinical professionals to discuss the growing field of stereotactic body radiation therapy. The ongoing protocols and radiobiological justification for delivering these large radioablative doses and hypofractionated courses for lung and liver cancer generated a great deal of ideas and discussion which I greatly appreciated. Throughout my travels I found that there is a great deal of impressive capital investment throughout the UK for new sophisticated linacs, which will not only improve treatment delivery capabilities (IMRT), but also provide new important modalities (IGRT). However, as we all know on both sides of the Atlantic, that paradigm will necessarily require a greater and greater investment in human resources as well. In that regard, we are all going to be grappling more and more with training, education, and research to improve technology and delivery. All of the new buildings and equipment currently being installed bring us toward the goal of improving patient outcomes, but these equipment and building investments must be coupled with the necessary human resources that will be required when they are up and running in order to be a success. Of course getting the linacs is good, but getting the qualified physicists will be the rub for years to come. Finally, as a side topic, while
I was in the UK there was a story that kept creeping up in the newspapers, which was probably highly sensationalized and usually led with a title of ‘over 200 hurt or killed by botched radiation therapy.’ Without going into detail about this situation, it certainly does call into mind how important it is that we have professional societies like the AAPM and IPEM that can help effectively communicate to the public how to better understand these “incidents” and to continue to provide the proper public relations for our field of therapeutic radiological physics. Thank you to my hosts and the AAPM and IPEM. This collaborative award that has been established between the medical physics societies of the USA and the UK has indeed been a fantastic opportunity and one that I will always be grateful for to my hosts, the AAPM and the IPEM. This award is also made possible by a donation from Charles Lescrenier, to whom I am also very grateful. A special thanks goes out to the Virginia Commonwealth University in the tradition of the Medical College of Virginia who generously supported my time away from the department. I would like to thank my wonderful wife who supported my time away, and then joined me happily for a week in London that we will always remember. Last, but certainly not least, I wish to thank the team of Grandma Becky Pavlat, Aunt Sue Pavlat, and Uncle Jerry Pavlat who provided absolutely
stellar love, care, and affection for our children (Erin and Noelle) while we were away. Thank you!! ■
ASTRO/AAPM Symposium ASTRO and AAPM will cosponsor the 2007 Quality Assurance of Radiation Therapy and the Challenges of Advanced Technologies Symposium. This meeting will be held February 20-22 at the Omni Mandalay Hotel at Las Colinas in Dallas. The comprehensive three-day program of invited talks will address the broad range of quality assurance concepts and procedures used in modern day radiation therapy, including both established and emerging image-based and adaptive radiation therapy modalities. The objectives of this program are to assess and critique the currently available QA guidance and methods of formulating QA protocols, as well as to explore risk-informed industrial engineering approaches to radiation therapy error mitigation. Please call the ASTRO Education Department at 1-800-962-7876 or 703502-1550 with any questions. Registration is now open at www.oncology meetings.org.
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NOVEMBER/DECEMBER 2006
Letter to the Editor The Fattened Calf Richard Peksens, MS St. Petersburg, FL Richard.Peksens@baycare.org Forget the escalating cost of oil and higher education. What about the escalating cost of treating a whole brain? As an old school physicist, I remember the days when a whole brain was a single dosimetry calculation. With the advent of fluorocapable simulators, a whole brain became an irregular field plan with the subsequent escalation to an intermediate isodose plan. Enter the CT simulator
FILM
CR
and, suddenly, a whole brain becomes a complex isodose plan with added complex cerrobend blocking and dosimetry calculations. Administrators and physicians then began attending radiation oncology billing seminars that, along with a free lunch, were focused on maximizing reimbursement. Note, there is no mention of improving patient outcomes! The focus is to bill for everything allowed rather than what is justifiable and ethical. Finally, bean counters were told that if the dosimetry staff used a CT scanner to define a whole brain GTV and created a subsequent
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DVH, then they could also bill a special treatment procedure and a 3D simulation. They put forth the argument that other centers were billing these procedures, so why should you lose out on these free dollars? Also, as long as you are billing for a 3D simulation, why not have the physicist look at the plan and charge a special physics consult? Is there any likelihood that any federal agency might question these inflated charges? I believe the answer is “no” as long as the physician has bought into the convoluted billing logic and has deemed the work a medical
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necessity. Governmental agencies and health care companies are reluctant to dictate treatment options to a physician. If the paperwork is properly documented, the charges may be considered overkill, but nobody will deny their validity. Should the medical physicist be concerned with the escalating costs of providing a simple procedure? Currently, physicists do not have control over their procedural billing. The physicist performs the special physics consult as requested by the radiation oncologist. It should be obvious that a special physics consult is not warranted for a palliative whole
brain; nevertheless, administration requires its completion. If a physicist was in a position to validate the consult request, he would evaluate the plan as not needing a special consult. Unfortunately, in most cases, we are not in charge of our own billing and must choose to either fall on our sword or become a silent accomplice to this billing chicanery. This real example of inflated billing is only the tip of the iceberg. What about a prostate IMRT plan that uses three cone-downs or a simple electron boost charged as a 3D simulation? Does anyone charge for a simple or intermediate isodose plan? Most
facilities have no methodology for physician peer review and these excess charges are not criticized. I believe that the AAPM, in conjunction with ASTRO, should establish a judicial committee for reviewing inflated charges. A physicist, or physician, would present his case to this committee and the committee would respond to the institution. By curtailing superfluous charges, reimbursement for needed procedures would benefit in a budget-neutral environment. Perhaps we should modify the Hippocratic Oath for physicists by stating “First, do no funky charges.” ■
Letter from the Editor Hasta la Vista… baby! Allan F. deGuzman Winston-Salem, NC deguzman@wfubmc.edu It’s hard to believe that it’s been six years since I took over as editor of the AAPM Newsletter. I guess time flies when you’re having fun or are extremely busy. It’s been a little of both. The past six years have provided me with a wonderful opportunity to work with and get to know the various leaders of the AAPM, the headquarters staff and all of the members who sent me letters and e-mails. That has been a lot of fun. Most of the people associated with the AAPM are extremely nice
and work very hard for the organization. Having to read 32 pages worth of newsletter articles at 11 o’clock at night after a long day at the office can certainly keep one busy. Most of the work, however, was really done by the managing editor, Susan deGuzman, who happens to be my wife. She was the one who made all of the phone calls during the day to remind people that their articles were late or that the picture they sent was too fuzzy to use. She was the one who did the layout of each issue and who reminded me that I had to read (and reread) the articles before the dreaded deadline. She was the one who stayed up later than I did to make sure everything was perfect, and who read each issue frontwards and backwards
(really!) several times to make sure there were no errors. All of the compliments that have been given to me over the past six years related to the quality of the newsletter really should have been directed to her. I also would like to express my thanks to the Newsletter Advisory Board. I tried not to work them too hard over the years, but their advice and input was valuable when needed. I am expecting that the newsletter will continue on course under the new editor and managing editor. As of January 1, 2007 the new editor of the AAPM Newsletter will be Mahadevappa Mahesh from John’s Hopkins University, and (See deGuzman - p. 24)
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deGuzman (from p. 23) the new managing editor will be Nancy Vazquez, programs manager from AAPM HQ. Please join me in congratulating them, thanking them in advance and wishing them well.
Although my time as editor is over, I will continue to be involved in other AAPM activities. I am involved with the Membership Committee and have agreed to stay on as a member of the Newsletter Advisory Board. I look forward to continued in-
teraction with various members of the organization and to seeing many of you at meetings, etc. Thanks again to all of you who have shown your support and provided encouragement over the past six years. ■
AAPM NEWSLETTER
Editor Allan F. deGuzman
Managing Editor Susan deGuzman
“Maybe our handicaps will improve now.”
Advisory Board Arthur Boyer, Nicholas Detorie, Kenneth Ekstrand, Geoffrey Ibbott, C. Clifton Ling Please send submissions (with pictures when possible) to the new editor: Mahadevappa Mahesh - mmahesh@jhmi.edu or (410)955-5115 or to Nancy Vazquez, AAPM Headquarters - nvazquez@aapm.org or (301)209-3390
The AAPM Newsletter is printed bi-monthly. Next Issue: January/February 2007
Postmark Date: January 15
Submission Deadline: December 15, 2006 AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE
One Physics Ellipse College Park, Maryland 20740-3846 (301)209-3350 Phone (301)209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org
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