Newsletter
A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 32 NO. 1
JANUARY/FEBRUARY 2007
AAPM President’s Column
Mary K. Martel UT MD Anderson Cancer Center
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hough I was president-intraining this past year, I had the opportunity to participate in several activities on behalf of the AAPM. Herein I report on a few of the most notable activities as President-elect. In August 2006, I attended a conference on the topic of practice quality improvement (PQI), arranged by the American Board of Radiology (ABR) (http://www.theabr.org/ PQISummit06.htm). Representatives from 34 sponsoring (or interested) societies participated in the conference. PQI is otherwise known as Part 4 of the maintenance of certification (MOC) process for the ABR. For those who don’t know, all holders (diplomates) of ABR certificates in radiological physics issued in 2002 and later must participate in the MOC program or otherwise lose certification when the time limit is up (10 years). Background information
on MOC exists on the ABR web site (http://www.theabr.org/RP_home. htm), and the FAQs there and on the AAPM web site (http://aapm. org/org/committees/committee/ article.asp?id=1483) provide succinct answers to burning MOC questions. When requirements for Parts 1-3 were announced by the ABR, concern was raised by AAPM members on the practicality of the accomplishing the criteria put forth. In response, the AAPM Board asked that a task group (TG-127) be created under the Education Council to act as a resource to the ABR and AAPM members concerning MOC. Under the leadership of Per Halvorsen and Michael Yester, the task group has interacted with the ABR trustees, and efforts have resulted in the acceptance of Category 2 activities for half of the Continuing Education credit requirement. Michael Yester has indicated that a newsletter column will appear in the March/ April newsletter issue regarding self assessment modules (SAMs), which are needed for Part 2, and that SAMs will be offered at the annual meeting and available in the virtual library. A progress report on TG127 activities will be forthcoming in a future newsletter. In the meantime, minutes of the group’s meetings, FAQ’s about MOC, and online discussion of MOC on the AAPM BBS (bulletin board) can all be found on the AAPM committee web site. Thanks TG-127 members for taking on this daunting task (and helping me with this column)!
But back to the Summit. ABR diplomates are probably wondering (at least the ones that work with me are) what the ABR is requiring for Part 4 PQI completion. Parts 1-3 are somewhat defined, but Part 4 is not, and one of the recommendations from the summit was to refer development of practice guidelines back to the AAPM, ACR and ACMP societies. This is another daunting task and will be a long term project for the AAPM. Per Halvorsen (TG127) has recently developed a plan for the individual program for PQI, and the next step will be ABR trustee approval. The Trustees do ask that diplomates be trained in the process of Quality Improvement with
TABLE OF CONTENTS President-Elect’s Column Executive Director’s Column New Board Members Editor’s Column Education Council Report Professional Council Report Science Council Report Health Policy/Economics Treasurer’s Report 2007 Budget Leg. & Reg. Affairs CAMPEP News CIRMS Update TG 133 Update Chapter News John S. Laughlin Award Mammography FAQS Memorial Ed. & Research Fund
p. 2 p. 4 p. 6 p. 7 p. 9 p. 11 p. 13 p. 14 p. 16 p. 18 p. 20 p. 23 p. 24 p. 26 p. 27 p. 28 p. 32 p. 34 p. 35
AAPM Newsletter respect to an individual’s practice of radiological physics. Training courses are on the program of next summer’s annual meeting. So plans are moving forward for Part 4, and stayed tuned for more information, at least via this newsletter. After TG127 has finished their work, it is likely that several subcommittees will be created that will monitor SAMs and Part 4 component development and implementation. I also had the privilege to give a lecture on QA efforts from the AAPM at the International Conference on Quality Assurance and New Techniques in Radiation Medicine in September at the IAEA (International Atomic Energy Agency) headquarters in Europe (www-pub.iaea.org). It was a well organized and comprehensive QA meeting for radiation therapy, diagnostic and nuclear medicine, with a number of international speakers and attendees. From talks and discussions at this meeting, and elsewhere, it seems evident that with the availability of more and more technology for the clinic, physicists can be overwhelmed with QA tasks that are time consuming, and perhaps ineffective. This may be particularly crucial for physicists working in developing countries. The IAEA has had recent activities in the treatment planning, IMRT and the entire radiotherapy process QA resulting in documents that are directed at their member states to (for example) help make the transition form simple to more complex techniques. There is also movement afoot in radiation therapy in the US to shift the philosophy from prescriptive to more risk-informed QA programs. TG-100 (Method for Evaluating QA Needs in Radiation Therapy) has begun to tackle this problem, and a conference cosponsored by the AAPM, ASTRO, NCI and ACR has been organized for February 2007. Called “Quality
January/February 2007 Assurance of Radiation Therapy and the Challenges of Advanced Technologies” (see ASTRO, AAPM and NCI Symposium announcement on page 25 of this Newsletter issue), this 3 day conference will start to build towards a new paradigm for radiotherapy quality management.
volunteers can be matched up with a committee of their choice. And they finish the year failing miserably! In hindsight, at least for this past year, the volunteering process was flawed and in need of some fixing; please watch for a future newsletter column from Jerry White, President-elect, for updates on this subject.
Finally, it is the job of the presidentelect to make appointments to committees for member volunteers. The president-elect starts the year hopeful that all
I would be pleased to hear at anytime from any of our members with comments and issues of concern. Feel free to e-mail me at the e-mail address listed in the online directory.
AAPM President-Elect’s Column
Gerald A. White Colorado Springs, CO
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hat sort of preparations is appropriate for an incoming President Elect? As I moved toward the 1 January inaugural date, still in the postulant stage, a few preparative activities were directed by others. I needed to find a worthy location to store and preserve the robe of office that my practice colleagues presented to me. A full length crimson cape with an ermine collar (I was not distracted the “flammability of nylon” label on the fur), a warm matching hat (again with ermine trim) in deference to heat loss issues in my most cephlad regions, and a silver jewel encrusted
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scepter. Actually, the scepter had a bit of a low density polyethylene feel to it, calling into question the quality of the jewels, but it seemed best not to look too closely into the details. (Pictures may follow in an upcoming newsletter). My wife quietly suggested (using the weight of 40+ years of friendship) that a reorganization of my office at home was mandatory. A leaf blower was suggested as the first step. Carloads of paper went off to recycling (didn’t really need those last 10 years of AAPM Board binders), much accumulated swag went to Goodwill. When I was at RSNA she and a group of kindred spirits turned a bleak hovel into a serene workspace where I sit this morning writing this newsletter piece. But the acquisition that has generated the most hope is a new thesaurus. Not just one of those bulky Barnes and Noble quotidian thesauri, but rather a slim volume from Powell’s in Portland with a jacket blurb “words to gladden the hearts of linguistic poseurs”. Looking at old words convolved with new possibilities is just the metaphor for looking at our current state of affairs in Medical Physics and seeing new possibilities
AAPM Newsletter and opportunities. Some of these will come to us from others, some, hopefully most, will be generated from within our profession. When they come from others they often carry the label of “problem”, “crisis”, or the eye grabbing “train wreck”. The labels are unfortunately less compelling for opportunities that we create for ourselves but it is in those possibilities that we will find the most gain, I believe. Among the opportunities that seem to me to be particularly engaging are the proposal by John Boone and others in Science Council to move forward with creating a facility within AAPM for accepting research and other grant funding. As he describes elsewhere in this newsletter, there are significant benefits from such a capability within AAPM, perhaps the most significant yet ephemeral is the maturation of the AAPM to join many of our sister societies on the national stage in this area. Jeff Limmer and subcommittee have begun revitalization the quest for licensure of clinical Medical Physicists, timely in that the CARE bill has a strong chance of enactment in the upcoming congressional season. Jim Hevezi and the Professional Economics Committee have initiated personal contacts with CMS regarding reimbursement issues, a first for the AAPM and a milestone on the long road to maintaining and expanding the recognition of the essential role of the Medical Physicist in medical procedures. Mike Herman’s Task Group on alternate training pathways for Medical Physicists is laying the groundwork for a revamped array of preparation pathways for the profession that will work in the real world. What about the problems, crises, and train wrecks on the horizon?
• Federal spending is impacted by huge war costs, tax cuts and diversion of research funds from health related areas to defense and homeland security. Grant money that funds much of the academic sector of Medical Physics is increasing harder to obtain, with paylines at an all time low. • The increasing complexity of the work that we do necessitates a high legal of skill and intellectual functioning, but there will be financial pressures, exacerbated by the increasingly entrepreneurial nature of medicine, to transfer those tasks to inappropriately qualified individuals. • Both the physician and payer communities have taken note of the fact that procedure based specialties are more highly paid than specialties that are heavily cognitive. Tasks for Cardiologists, Radiologists and Radiation oncologists, for example, are more highly compensated than tasks for Pediatricians, Internists and Psychiatrists. In the years ahead, we can expect a shift in the AMA Relative Value Update Committee (the folks who value relative physician work effort) to have a weight change from the former to the latter group. Our work effort is primarily with the procedure based specialties. • Imaging procedures are migrating from Radiology Departments to a more diverse group of physician specialties. This is combined with a huge increase in the frequency and cost of complex diagnostic imaging and invasive imaging procedures, placing stress on the Sustainable Growth Rate process for cost containment and raising the profile of these procedures in the eyes of those entities charged with meeting cost constraint goals.
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January/February 2007 • In radiation oncology, increasing accuracy and precision in dose delivery via both external beam and brachytherapy will make the fractionation schemes historically derived from larger field, low precision dose delivery obsolescent. I believe we can look forward to an increasing proportion of our patients treated with hypofractionated schemes, to their benefit, but complicating our reimbursement structure which is based on treatment events, not treatment process of care. • Lastly, note that Medical Physics is rare (perhaps alone) in the medical professions in that we admit colleagues to the clinical practice profession without mandatory clinical training. The ABR anticipates that in the future, admission to the Board examination process will be limited to physicist applicants with appropriate structured clinical training. Existing residency programs cannot possibly meet this demand with either the current or foreseeable employment market and residency capacity. The careful reader will note that the foundations that will provide a basis for addressing the bulleted problems above are described in the preceding opportunities paragraph. Our challenge will be to continue to develop opportunities that will allow us to be in a position to deal with the unforeseen problems lurking in our future. That is best done by focusing on building an energetic and aggressive Science capability, an Education program of depth and quality and a Professional service armamentarium to rival that of our other medical colleagues. Honoring the past, celebrating the present, and preparing for the future, we are looking forward to the next 50 Years of AAPM.
AAPM Newsletter
January/February 2007
AAPM Executive Director’s Column
Angela R. Keyser College Park, MD AAPM encourages you to go online
H
ard copy membership directories will no longer be published and mailed to each AAPM member. While we encourage all members to use the online directory for the most up-to-date information, we do understand there are times when you do not have access to the internet during your day. Starting in 2007, AAPM will make available a PDF of the directory information on a quarterly basis. Please go to your member profile to indicate that you would like to be notified when the PDF is posted. HQ will send you an e-mail notification and you will have access to download the revised file and save it locally. Moving in this direction will save the organization an estimated $38,000 annually. In addition, AAPM will not be sending monthly membership mailings beginning in 2007. Analysis of the information circulated via the monthly mailing showed the AAPM business items were available online and the mailing was used more for reminders. You will still receive a hard copy AAPM newsletter six times a year and the IOMP newsletter two times a year. This change will save AAPM roughly $87,000 annually.
2007 Dues Payments 2007 Renewal notices were sent in October, with payments due by March 1, 2007. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on “Pay Your 2007 Dues Online.” The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301209-3396.
2007 Annual Meeting The 49th AAPM Annual Meeting will be held July 22 – 26 at the Minneapolis Convention Center in Minneapolis, Minnesota. Committee meetings will be held at the headquarters hotel, the Hilton Minneapolis, while sessions and exhibits will be held at the convention center. The deadline for Annual Meeting abstract submission is March 7. Heading the program development efforts are Scientific Program Directors Chang-Ming Charlie Ma and Chris Shaw, along with Therapy Track Organizer Thomas Bortfeld, Education Program Directors Perry Sprawls and Indrin Chetty, and Professional Program Directors Bruce Gerbi and Mike Herman. Meeting information is continually updated online, with the full program scheduled to be posted by May 11. Please go to www.aapm.org and click on “Meetings” for the latest information. The online registration process is scheduled to open on March 7, with discounted registration until June 1.
(see Keyser - p. 30)
Mississippi River and the Minneapolis Skyline
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AAPM Newsletter
January/February 2007
Minneapolis is more than the Mall of America. Visitors appreciate the natural beauty of the area’s parks & riverfront region. The Warehouse District is the center of Minneapolis nightlife where upscale bars & hip dance clubs line the streets. The Hennepin Theatre District is home to three historic theaters & plenty of nightspots. Near the convention hotels & convention center, check out Nicollet Avenue's "Eat Street" to sample an extraordinary variety of ethnic restaurants & quaint bistros. The scientific program will include the highest quality abstracts in oral, moderated poster, & poster sessions on basic research & clinical application topics in medical imaging & therapeutic medical physics. Continuing education will be offered through daily courses to keep the membership up to date on the current & new technologies & techniques. An expanded education program, combined with an enhanced professional program, will offer significant opportunity to gain practical knowledge on emerging technical & professional issues. A major focus of the scientific program is the increasing integration of advanced imaging concepts in the routine practice of various therapies, especially radiotherapy. 2007 Dates to Remember
NOW AVAILABLE 2007 AAPM Annual Meeting website - view the site for the most up to date meeting & abstract submission information. January 8 MARCH 7 (3 PM ET) March 7
Web site activated to receive electronic abstract submissions. Deadline for receipt of 300 word abstracts & supporting data. Meeting Registration available on-line.
July 22-26
AAPM Annual Meeting – Minneapolis Convention Center – Minneapolis, MN
July 27-29
AAPM Summer School: Shielding Methods for Medical Facilities – St. John’s Univ, Collegeville, MN
The 2007 program includes a number of symposia, forums, & workshops on various high profile & emerging topics: Imaging Track
• • • • •
Advances in CT, MRI, US Image quality, diagnostic accuracy Molecular imaging Digital x-ray imaging Radiation dose measurement, control
Therapy Track
•Advances in particle acceleration techniques • Advancement in proton therapy & IMPT • Planning strategies for advanced RT • Robustness of IMRT treatments • Biological modeling & novel dose schemes
Continuing Education Imaging Track
There will be approximately 30 Continuing Education courses in Diagnostic Imaging Physics & Technology. They will cover all of the imaging modalities, radiation safety & risk management issues, & recent developments in medical imaging physics education.
Continuing Education Therapy Track
The Therapy Physics CE series will feature approx. 30 courses. The program will feature courses on the use of functional imaging (PET, SPECT & MRI) in planning & assessment of response, a course on the use of proton therapy & additional CE lectures on IMRT, IGRT, adaptive RT, clinical measurements, radiation safety & other important aspects of clinical therapy physics.
Professional Track
• PQI-Practice Quality Improvement • Errors-why they occur, how to minimize them • Introducing new technology into clinical practice • Technical performance standards • New members symposium & “Meet the Experts” • MOC update
Joint Imaging-Therapy Track
• • • • •
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Imaging for RT assessment Spatial-temporal imaging for RT Imaging-guided alternative therapies Tomographic imaging for RT Functional imaging for RT
AAPM Newsletter
January/February 2007
Newly Appointed 2007 AAPM Board Members
Gerald White President-Elect
Daniel Low Member-at-Large
Bruce Gerbi Member-at-Large
Chapter Representatives D Jay Freedman Member-at-Large
Raj Mitra Member-at-Large
Douglas Pfeiffer Rocky Mountain Valley
Jerry Soen Midwest
Mary Moore Delaware Valley
Michael Taylor Mid-Atlantic Christopher Cagnon Southern California
Charles Wissuchek Penn Ohio
John Gibbons Southwest
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Martin Fraser New England
AAPM Newsletter
January/February 2007
Editor’s Column
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respond. For example, in this issue I had asked John Boone (Chair of Science Council) to respond to the question of “why AAPM should get involved in applying for research grants?” and he has graciously responded to the query. Similarly, from time to time updates regarding preparation for the AAPM 50th anniversary meeting (July 2008 in Houston, TX) will be included. Also, I have requested the AAPM History committee to provide articles on the practice of medical physics and to look at the history of medical physics for the past half of a century.
In addition to the regular feature columns, I welcome you to submit questions related to activities of the AAPM-Board of Directors, Councils or Committees. I will ask corresponding Board of Directors, Council and Committee Chairs to
Already, the newsletter is well read by the membership. In fact, when pondering about the editorship position, it was gratifying for me to read that more than 80% of the AAPM members read part or the entire newsletter on a regular basis (President-elect report, AAPM Newsletter, July/August 2006). In pursuit of enlarging our perspective, I plan to conduct a survey about the newsletter, its reading habits and will be seeking suggestions for improvements. Please don’t forget to complete the survey and provide me with your comments and/or suggestions on how to further improve your newsletter. Finally with much gratitude I would like to say “thanks” to my good friends Allan deGuzman and his wife Susan deGuzman for the wonderful job they have done in the past six years on the newsletter. I would also like to thank them for patiently going through the transition process with me, as well as sharing their expertise on navigating through the land mines that I will inevitably step on (If I haven’t already done so) as I acclimate myself to this new role. I
Mahadevappa Mahesh Johns Hopkins University t is with great pleasure to announce that I have taken on the responsibility as the next Editor of AAPM Newsletter. As I take on this new responsibility, the focus of my intention will be directed towards making the newsletter into a vehicle for maximum dissemination of information to the general AAPM readership. One of the main changes about the newsletter is that from this point forward the AAPM headquarters staff will manage it. Nancy Vazquez, located at AAPM Headquarters, will assist me and will be the contact person for newsletter issues. I would like to extend a warm invitation to all AAPM members to contribute articles related to our profession either through letters to the editor or through committee activities. Also, I would like to extend a personal invitation to leaders of the AAPM local chapters to submit information regarding present or future activity updates.
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expect a head-on-collision with some issues but I am optimistic that they can be resolved with help from all of you and from the members of the Newsletter Editorial Board. I would like to welcome, William Hendee, Penny Butler, Allan deGuzman and Christopher Marshall (ex officio) who have agreed to serve on the Newsletter Editorial Board. I want to thank Robert Rice, Chair of the Professional Services Committee, for providing me this opportunity to serve as Editor of the newsletter. I would also like to express my gratitude to Russell Ritenour (2006 AAPM President), Howard Amols (2006 Chairman of the AAPM Board of Directors) and the AAPM Board of Directors for this appointment and the confidence they have in me by bestowing this responsibility. I look forward to working with the entire membership on this newsletter.
AAPM Newsletter
January/February 2007
Calling all Members‌.. The Association will celebrate its 50th Anniversary in 2008. In connection with that celebration, an Ad Hoc Committee has been designated to develop a program that will span the Anniversary year. This program will include our publications, our annual meeting and our web site. Over the course of the next few Newsletters, we hope to share some aspects of the various events with you and we solicit your ideas and input. As you may imagine, the History Committee is represented on the Ad Hoc Committee and will be finding our Charter Members to make sure they are part of the Anniversary events. If you would like to help the Committee in contacting and working with the charter members, please contact Robert Gould (robert.gould@radiology.ucsf.edu). Our 2008 meeting will be in Houston, TX (July 27 - 31, 2008) and the local committee chaired by John Hazle is already gearing up for the anniversary meeting. Please save the dates now so you can be part of the 50th Anniversary meeting. Now, we need photographs, mementos, letters, etc., in order to prepare exhibits and presentations. It is intended that these exhibits and items would be part of exhibits that could travel to chapter and regional meetings as well as meetings where the AAPM booth is on display. We would especially like to receive photos and correspondence pre-1982, the date when AIP assumed headquarters responsibility. Please collect any pictures or mementos that you can contribute and send these to Lisa Giove (Lisa@aapm.org) at AAPM headquarters. Please indicate if you would like them returned. This is a golden opportunity to clear out old pictures and to help us remember special moments. Jean St. Germain Chair, Ad Hoc Committe
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AAPM Newsletter
January/February 2007
Education Council Report
Herb Mower Council Chair
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he RSNA meeting once again ended with a white covering in Chicago. Like many others, I ducked out just as the storm was coming in. I hope all of you also made it home at a reasonable time and without serious travel problems. Although the Education Council had no “Action Items” for the Board at their meeting at RSNA, we did have several items of note:
• The deadline for receipt of applications for the Summer Fellowships has been moved up to February 1st with the notification of awards to be sent out by March 1st. • The council approved a new subcommittee under the Education and Training of Medical Physicists Committee. This is the “Students and Trainees” subcommittee to be chaired by Stephen Kry. This group has met during the past few AAPM Annual Meetings with an attendance of about 125 in Orlando this past summer. The formation of an official subcommittee will assure the continuation of this group that will provide a forum for graduate students and residents. Here they can meet and network in a setting designed to address their concerns and challenges.
• We have several offerings at the RSNA meeting each year. To provide greater cohesion in the program and to find a good home for the “Equipment Selection Tutorial,” it is now housed under the auspices of the Medical Physics Education of Physicians Committee. This will allow for greater coordination in the programs offered in this tutorial and the “Physics Tutorial for Residents.” • There will be a trial run at the 2007 Annual Meeting on a method for accumulating Self-Assessment Modules (SAMs) during certain sessions. • Following the 2008 Annual Meeting there will be a 2.5 day workshop in the Houston area titled: “Workshop on Teaching Physics.” This will address many of the issues
and challenges as noted at our Physics Summit meeting last January, the ASTRO / AAPM curriculum followup, the upcoming RSNA Physics Education Conference and other activities related to this important topic. • The Virtual Library will again be recording approximately 70 hours this year including items from the Annual Meeting, the Summer School and the physics symposium at the Conference for Radiation Control Program Director’s meeting. • The Educator’s Day held at the recent ASTRO meeting was very successful with 26 participants in attendance. We expect to continue offering this program in conjunction with upcoming ASTRO meetings as well as with our AAPM meetings.
ACMP CELEBRATES 25TH BIRTHDAY IN BALTIMORE, MD The American College of Medical Physics (ACMP) is celebrating its 25th birthday in 2007. This momentous occasion will be the backdrop for the ACMP 2007 Annual Meeting, May 26-29, 2007, at the Renaissance Harborplace Hotel, Inner Harbor, Baltimore, MD. The ACMP Annual Meeting is a wonderful way to earn Medical Physics Continuing Education Credits (MPCEC’s) in addition to networking with colleagues and vendors alike. The 2007 meeting will also showcase a new session designed for medical physics graduate students, residents, post docs and recent graduates who are preparing to sit for their ABR exams in physics. Speakers will include young physicists who recently passed their Boards as well as two ABR Physics Trustees. By sharing their experiences – good and bad – and their recommendations on what to study, the young physicists will provide valuable information to those preparing to sit for their Boards. The ACMP 2007 Annual Meeting will also feature a “Young Investigators Symposium” in addition to featuring physicians and physicists from the prestigious medical centers in the Baltimore area, as well as representatives from the nearby governmental agencies: NCI, NRC, FDA, and NCRP. As in the past, there will be a series of symposia on mammography to provide the MPCEC’s needed for maintenance of MQSA certification. Other joint and concurrent sessions will address the ongoing educational needs of clinical medical physicists practicing in radiation oncology, diagnostic radiology and nuclear medicine. No birthday celebration would be complete without a birthday party! The ACMP 25th Birthday Party will be held in conjunction with the annual awards banquet. Watch for program and registration information at www.acmp.org. We hope to see you in Baltimore, May 26-29, 2007, to help ACMP celebrate its 25th birthday!
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AAPM Newsletter
January/February 2007
•
New in Version 3.0! Simultaneous Multiple Point Calculations Electron Calculations Advanced Diode Support
MU VERIFICATION IMRT VERIFICATION PATIENT SPECIFIC IMRT QA
3-Source Model Illustration
IMSure QA is the only software that utilizes the patented Stanford University 3-Source Model algorithm to accurately calculate dose by including the two main sources of scattered radiation, the flattening filter and the main collimators. Single source algorithms, like the modified Clarkson algorithm, do not take into account this scattered radiation that can contribute up to 12% of dose at isocenter.1 In less than a minute, IMSure QA delivers an accurate secondary check of your patient treatment plan. 1. T. C. Zhu, B. E. Bjarngard, Y. Xiao, and C. J. Yang, ‘‘Modeling the output ratio in air for megavoltage photon beams,’’ Med. Phys. 28, 1352–1358 ~2001.
1280-22, 09/06
QA SOFTWARE
EXRADIN ION CHAMBERS
PHANTOMS
BEAM QA
PH 800.261.4446 PH 608.831.0025 www.standardimaging.com
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DOSIMETRY
BRACHYTHERAPY
AAPM Newsletter
January/February 2007
Professional Council Report physics interest. Working groups and task groups are chartered to produce answers to specific pertinent questions. The guidance for all of this comes from the membership. We, the members, choose the direction and the priorities of the association through voting and by volunteering to be heard. Much has been done, yet much remains to be accomplished. Michael G. Herman Professional Council Chair
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elcome to the New Year and thanks to the leaders of previous years and all the volunteers for making AAPM what it is. In particular thanks to Jerry White and recent Executive Committees for continuing to invigorate the Professional Council. The AAPM is a society focused on the application of physics in medicine. With this there are many scientific, educational and professional opportunities, demands, and expectations. The common theme is that all of these are focused on the bottom line of improving the medical care of patients. Whether it involves basic imaging science and the development of breakthrough diagnostic technology, or teaching basic nuclear physics to physicians, or supporting and influencing legislation or regulation that impact the rules by which we practice, it is all about the quality of care for the patient. The AAPM is structured into three councils to provide support for and facilitate development of the practice/ profession of medical physics. Each council is composed of committees and subcommittees, which represent constituent components of medical
Specifically in the Professional Council, issues related to clinical practice, ethics, economics, legislation and regulation and professional services are addressed through our committee structure. To help put it in perspective, a brief overview/sampling of the council is presented. The Government and Regulatory Affairs Committee (GRAC) is chaired by Ralph Lieto and is comprised of members from various AAPM committees and councils. GRAC monitors legislative and regulatory activity and develops policy and position statements for the AAPM. The GRAC also develops communication channels with regulators to provide accurate and timely information. The Conference of Radiation Control Program Directors (CRCPD) is one such organization that represents the radiation control officers from every state. GRAC has a CRCPD subcommittee to interface with the program directors and explicitly provide guidance to CRCPD on issues like suggested state regulations for QA. GRAC actively remains informed of key vacancies on regulatory advisory committees and provides direction to AAPM for nominations. The Senate version of CARE passed, but the House bill did
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not during this Congressional session. When it does pass next year, much work remains to guide the interpretive text specific to qualified medical physicist recognition. Lynne Fairobent is the AAPM staff to the Professional Council and plays a key role on GRAC in maintaining communication, developing position and policy statements and liaising with other professional and political organizations. Please also look for Lynne’s separate column with specific updates and news on government and regulatory activities important to us. The committee on Professional Information and Clinical Relations (PICR), chaired by Per Halvorsen is responsible for clinical practice related activities, including practice peer review, practice guidance and reviewing task group reports from science council for practice implications. There are two new groups in PICR. The first is the joint subcommittee on medical physics licensure (JSMPL), chaired by Jeff Limmer. This subcommittee is responsible for medical physics licensure related discussions and activities and is a joint subcommittee with the ACMP. With recent progress on the CARE bill, the JSMPL will be working with GRAC to address the eventual Health and Human Services rule text used to interpret the CARE bill for implementation. The second new group in PICR is a Working Group on Vendor relations and Product Suitability intended to allow an organized flow of information between medical physicists and vendors related to clinical technology. The Professional Economics Committee (PEC) is chaired by (see Herman - p. 29)
AAPM Newsletter January/February 2007 !!0- .EWSLETTER !D PDF 0-
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AAPM Newsletter
January/February 2007
Science Council Report
John M. Boone Science Council Chair
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he issue of whether or not the AAPM should become an organization which is able to receive grants from federal or state agencies (or from private foundations or corporations) was recently discussed at the Board of Directors meeting in Chicago (November 2006). I was asked by the newsletter editor and board member, Mahesh, to discuss this issue for this column. While there are some compelling reasons for the AAPM to go forward with the government approvals necessary to enable the submission and receipt of federal grants, there are legitimate concerns by some members of the association with regards to the risks and other downsides of such action. In this article, I will briefly outline the position of Science Council on this matter. First, however, it should be made clear that positioning the AAPM to be able to submit grants or contracts does not then lead directly to the society receiving grants (with one exception, discussed later). A member of the association would need to actually write a grant and submit it through the AAPM, and that grant would have to receive a meritorious rating in the review process to be funded
– not an easy task. Grants are not only for conducting research, they can be for collecting data, providing certain services, or holding scientific or educational conferences.
appropriate committee (e.g. Council chairs and vice chairs) be formed which would rapidly review potential grant topics to assure that they meet this criterion.
The AAPM employs no medical physicists. Therefore, for the AAPM to submit and then receive external grant funding, an AAPM member (a medical physicist) would have to write the grant as its principal investigator (PI). Why would any AAPM member be interested in writing a grant and submitting it through the AAPM, as opposed to their own institution? Firstly, this would require a fair degree of altruism on the part of the principal investigator. Senior members of our society do, however, routinely perform altruistic activities on behalf of the AAPM - no member of the executive committee, the board of directors, or of the Councils receives a salary - not one dollar is earned by any of these individuals, who spend hundreds and in some cases thousands of hours per year on AAPM activities. Thus, the altruism necessary for writing a grant through the AAPM may indeed exist. Secondly, it is my belief that no AAPM-based grant activities should compete directly with the research activities of individual AAPM members. This suggests that grant funding pursued by the AAPM (through the initiative of an AAPM member or members) should be matched to the unique circumstances the AAPM offers – the scientific breadth, the geographic distribution, the vast amount of equipment at our disposal, and the huge array of procedures that are supervised, performed, and developed by its members. I would suggest that an
So why should the AAPM engage in grant funded activities?
13
(1) Our society is in a unique position in the medical physics world to pursue scientific, data collection, homeland security, and other externally sponsored activities. We are an organization with over 6000 members, with comprehensive and collective in-depth expertise in physics as it is applied to medicine and biology. We are geographically distributed, and therefore are able to represent national and even international perspectives on the science and practice of medical physics. We could utilize our geographic distribution to assess national practice standards, and help define reference values for radiation dose, diagnostic protocols, or treatment norms. The collective members of the AAPM have at their disposal virtually every type of radiation treatment device, imaging system, and analytic tool that exists in modern medicine. This would allow comprehensive analysis on specific types of equipment, or scientific or clinical comparisons between different types of equipment. Our widely distributed membership have calibrated radiation meters, the expertise to use them, and the skill to interpret the ramification of the radiation levels that they report. With DHS funding, the AAPM could maintain a callback list of physicists throughout the country who would be willing to respond to a radiation emergency (e.g. dirty bomb) in their communities. (see Boone - p. 30)
AAPM Newsletter
January/February 2007
Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant Congress Passes Medicare Reform
O
n December 9, 2006, the Senate passed a sweeping Medicare relief package that blocks a 5% physician reimbursement cut slated to hit physicians in 2007 and extends a host of additional Medicare provisions scheduled to sunset. The physician payment fix and other Medicare measures came bundled with a larger package that extended popular tax cuts to families, businesses and students, expanded normalized foreign trade to Vietnam, and opened more than 8 million acres of Gulf of Mexico waters to off-shore drilling. Despite an outcry from a small number of budget hawks, the bill passed the Senate 79 to 9. The measure passed the House of Representatives on December 8th by a vote of 367 to 45. The physician payment fix was central to the health package, providing doctors with a 0% reimbursement update in 2007, but stacking on top an additional 1.5 percent for physicians who report specific quality measures between July 1 and December 31, 2007. Coinciding with passage of the bill, CMS unveiled the quality measures that would apply to the reporting process, none of which pertain to radiation oncology. The 1.5% update “is a good first step” toward installing a broader system of quality reporting, Sen. Charles Grassley (R-IA) said. The legislation was met with cautious applause from physician groups, which had pushed for a positive
update without the reporting stipulation but also were pleased to have avoided the 5% cut, dictated by the sustainable growth rate (SGR), which would have gone into effect on January 1st. In addition, two brachytherapy provisions were included in the bill. The first requires the Centers for Medicare and Medicaid Services (CMS) to extend for one year the current payment methodology of hospital charges adjusted to costs for all brachytherapy sources. This provision applies to brachytherapy performed in the hospital outpatient setting and means that brachytherapy sources will not be paid a fixed cost in 2007 as was proposed by CMS. Further, CMS will be required to establish new HCPCS codes for stranded brachytherapy sources by July 1, 2007. CMS Releases 2007 Medicare Physician Fee Schedule Final Rule The Centers for Medicare and Medicaid Services (CMS) released the Physician Fee Schedule final rule on November 1, 2006. The Physician Fee Schedule provides payment to physicians and to freestanding radiation oncology centers. Two major policies finalized by CMS would have yielded significant reductions in medical physics payments for 2007, however, the 5.0% reduction in the annual update factor (also known as the conversion factor) was averted by legislation passed by Congress in early December (see related story). CMS did finalize, however, their
14
proposal to change the methodology used to calculate practice expense relative value units (PERVUs). CMS will implement on January 1st a “bottom-up” methodology that favors equipment intensive procedures. The new methodology does not benefit the majority of medical physics codes, including CPT codes 77336 and 77370 (see table on page 16). However, the proposed changes to the practice expense RVUs for all radiation oncology codes have an overall positive impact of 2% in 2007 and 6.0% in 2010 at the end of the four-year transition period. As previously reported, AAPM met with CMS officials on August 14th to discuss the role of the medical physicist and the impact of the reduction to the medical physics codes under the new practice expense methodology. Based on AAPM’s meeting, CMS accepted the AAPM 2005 salary data (deflated to 2002) and updated the wage rate per minute for medical physicists from $1.21 to $1.523; and medical dosimetrists / medical physicists from $0.92 to $1.075. In addition, based on AAPM’s written comment letter CMS altered the proportion of hospital-based radiation oncologists from 75% to 63% and freestanding radiation oncologists from 25% to 37%, which yields a significant increase in the practice expense per hour for radiation oncology from $161.08 to $209.19. CMS also agreed with AAPM’s recommendation to apply the budget neutrality adjustor to the physician work RVUs, which results (see Fuss - p. 21)
AAPM Newsletter
January/February 2007
2007 AAPM Summer School Shielding Methods for Medical Facilities: Diagnostic Imaging, PET and Radiation Therapy July 27-29 ● St. John’s University ● Collegeville, MN
http://www.aapm.org/meetings/07SS/ Immediately follows the 2007 AAPM Annual Meeting in Minneapolis
Session topics include: Basis of Design and R/F Shielding ● CT Shielding Design ● Shielding Design for PET ● AAPM Task Group 108 Report on PET and PET/CT Shielding Requirements ● Neutron Calculations for Linac Shielding ● Primary and Secondary Wall Calculations; Composite Materials ● Maze Calculations; Door Designs ● Direct Shielded Sliding Door Calculations Registrants will receive hard copies of the following NCRP reports as part of the registration fee:
Report No. 151 - Structural Shielding Design and Evaluation for Megavoltage X- and Gamma-Ray Radiotherapy Facilities (2005) Report No. 147 - Structural Shielding Design for Medical X-Ray Imaging Facilities Dates to Remember March 14 March 5 June 1 June 25
July 22-26 July 27-29
Summer School Meeting Registration and Housing available on-line. Registration is limited. First come; first served. Deadline to submit Summer School scholarship application Summer School Meeting Registration Deadline to receive Discounted Registration Fees No refunds given for registration or housing cancellations received after this time. Last day to make Summer School housing reservations. On-line registration closes. On-site registration only after this date. AAPM 49th Annual Meeting, Minneapolis Convention Center AAPM Summer School, St. John’s University, 1 hour north of Minneapolis in Collegeville, MN 15
AAPM Newsletter
January/February 2007
Treasurer’s Report
2006 Estimates
Programs; Lynne Fairobent, Manager, Government Relations; and Cecilia Hunter, Director, Finance and Administration, and her staff from the headquarters office, made substantial contributions to this effort. I am grateful to all of them for their hard work in putting this budget together. This year we had significant participation from the Council chairs, whose willingness to revise their requests to reduce an initial substantial deficit, made the subcommittee’s job much easier.
e are pleased to report that 2006 is expected to be another successful financial year for our Society. Due in large measure to the significant gains on our investment portfolio, we estimate that we will realize a surplus of just under $600,000 for the year. Our approved budget was for a deficit of $500,000. Therefore, the total variance from the approved budget will total $1.1 million.
Next a second draft was approved and moved forward to the full Finance Committee on November 25th. Various additions and/or changes were incorporated therein and a revised budget moved forward for approval by the Board of Directors. This budget is compared in Figure 1, with the 2006 budget and estimated actual (see Figure 1 on page 17).
Highlights of the variances appear in Table 1 on page 17.
The 2007 Budget, as approved, reflects a deficit of $524,693. Income is budgeted at $6,378,211 and expenses at $6,902,904.
Maryellen Giger Chicago, IL
W
2007 Budget First my thanks to the various councils, committees, task groups, and working groups for submitting their budget requests by the appropriate deadlines. After the submission of the various budget requests, the first draft of the 2007 budget contained a deficit of almost $1 million, which we felt was unacceptable. Therefore, each line item was scrutinized and reviewed extensively by members of the Budget Subcommittee last October. Along with myself, this subcommittee included: Mary Martel, Richard Massoth, Mary Moore, Russ Ritenour, and Peter Rosemark. Angela Keyser, Executive Director; Lisa Rose Sullivan, Director, Meetings and
Highlights of the proposed budget: Sources of Revenue • An increase in income from Membership is based on an increase in membership numbers, coupled with the 5th year of a pre-approved dues increase. Membership income is expected to provide $1.3 million, or approximately 20% of anticipated income. • Our annual meeting, scheduled for Minneapolis in 2007, is budgeted to generate $2.1 million, or 33% of the gross. • The publication of our scientific journal, Medical Physics, also pro-
16
vides a significant income stream. In 2007, Journal revenue is expected to total $1.85 million. • Other revenue sources include the Placement Service, interest on operating funds, and services provided to other organizations. Figure 2 is a chart of expected 2007 income. Major areas of expense include: • Requests for project funding from the councils and committees for 2007 are shown in Figure 3 on p.19 and include the following: o o o
Education Council -- $476,245; Professional Council -- $399,100; Science Council -- $296,997;
• Our Society supports a number of administrative and ad hoc committees, as well as liaisons to other scientific societies. Direct expenses for these activities are budgeted at $272,075 in 2007. • There are two important changes in the member services budget lines, including discontinuing the production of a paper copy of the Membership Directory. The Directory information will be provided electronically to all members. The Monthly Mailing is also being discontinued in 2007. It was determined that all of the Society information contained therein is available on the AAPM web site. These two changes made a significant impact on our bottom line, saving approximately $125,000 in direct expenses annually. • Organizational and governance expenditures are expected to increase with the appointment of a standing Audit Committee and the addition of a Spring Board of Directors’ meeting. The budget for these activities is just over $200,000 in 2007.
AAPM Newsletter • Administrative expenses include the services provided by AIP, our legal and audit firms, insurance, and the fees we pay for credit card transactions. For 2007, our budget estimate is $247,940, slightly less than 2006. • Overhead expenses include rent, staff expenses, and other costs of maintaining a headquarters office. Staff members keep detailed records of their time and actual time allocations are projected forward in order to estimate total program expenses for the coming year. In 2007 the total estimated overhead spread among the program areas is $2,277,457. Figure 4 on p.19 summarizes expenses by program area. The complete budget appears in Table 2. Questions or comments concerning the budget can be addressed to the Treasurer, Maryellen Giger at m-giger@uchicago.edu.
January/February 2007
Major Variances from 2006 Budget • Dues income higher than budget • Governance expenses lower than budget • Committee expenses lower than budget • Annual Meeting • Medical Physics • “Unrealized” Investment Gains • Other TOTAL
+$70,370 +$39,739 +$245,608 +$241,159 +$80,561 +$351,871 +$60,306 _________ $1,089,614
Table 1
Comparison of Budget to Estimated Actual $7,000,000 $6,800,000 $6,600,000 $6,400,000 $6,200,000 $6,000,000 $5,800,000 $5,600,000 $5,400,000 2006 Budg
Est. Actual Revenue
Income by Major Source -Proposed 2007 Budget 9%
Figure 1
21%
5%
29%
36%
Dues
Placement
Prof Dev
Figure 2
MP
Other
17
Expenses
2007 Budget
AAPM Newsletter
January/February 2007 2007 Approved Budget Revenue
Expenses Direct
Approved by the Board of Directors November 29, 2006
Overhead
Net Total
Membership Dues Dues (Net of Journal) Renewal Notices Applications and Reinstatements Subtotal
1,305,962 10,000 17,000 $1,332,962
375 1,000 3,500 $4,875
0 0 77,100 3,000
Subtotal
0 0 21,900 0 0 $21,900
$80,100
$0
58,450 79,000 62,682 2,000 $202,132
72,851
$72,851
73,226 1,000 3,500 $77,726
1,232,736 9,000 13,500 1,255,236
Membership Services Member Inquiries/Services Membership Directory Monthly Mailings Newsletter AAPM Brochures AAPM Web Site
88,719 9,188 7,093 6,944
88,719 9,188 7,093 84,044 3,000 163,284 $355,328
(88,719) (9,188) (7,093) (62,144) (3,000) (163,284) (333,428)
1,936 $182,153
94,110 223,557 62,682 3,936 $384,285
(94,110) (223,557) (62,682) (3,936) (384,285)
476,245 399,100 296,997 234,025 38,050 $1,444,417
63,911 131,644 19,746 79,174 12,563 $307,038
540,156 530,744 316,743 313,199 50,613 $1,751,455
(472,656) (187,544) (281,743) (313,199) (50,613) (1,305,755)
259,236 23,606
1,414,311 132,166 54,200 $1,600,677
695,652 11,721 (54,200) 653,173
1,055,655 3,453 1,000 $1,060,108
791,935 2,547 3,000 797,482
163,284 $275,228
Organizational Board of Directors Executive Committee Executive Committee - Contingency Elections & Society Votes Subtotal
35,660 144,557
Councils and Committees Education Council Professional Council Science Council Administrative Committees Liaisons with other Organizations
67,500 343,200 35,000
Subtotal
$445,700
Education & Professional Development Annual Meeting (Including Review Courses) Summer School RSNA
2,109,963 143,887 Subtotal
$2,253,850
1,155,075 108,560 54,200 $1,317,835
Subtotal
1,847,590 6,000 4,000 $1,857,590
981,803 1,100 1,000 $983,903
0
65,000 20,000 5,000 90,000 67,940 $247,940
$282,842
Publications Medical Physics Journal Books Reports
73,852 2,353 $76,205
Administrative Professional Services Headquarters Travel General Operations Credit Card Processing AIP Services
0
Subtotal
0 $0
955,565
$955,565
65,000 20,000 960,565 90,000 67,940 $1,203,505
(65,000) (20,000) (960,565) (90,000) (67,940) (1,203,505)
3,000 1,000 19,619 175 (1,400) 132,000 8,307 (56,928) 19,736 6,500 (16,600) (36,520) 500 79,389
(441,693)
Other Income & Expense Credit Card Royalties Computers in Physics, Royalties AAPM Mailing Lists Membership Certificates RSEA Investment Earnings & Fees COMP CAMPEP AAMD ICCR Contributions and Donations Dues and other payments Miscellaneous
3,000 1,000 25,000 300 1,600 150,000 9,500 29,309 129,000 7,000
Subtotal
500 $356,209
$151,245
$125,575
0 0 5,381 125 3,000 18,000 1,193 86,237 109,264 500 16,600 36,520 0 $276,820
TOTAL
$6,268,211
$4,432,447
$2,277,457
$6,709,904
Table 2
18
0 1,000 125 3,000 18,000 500 10,000 65,000 500 16,600 36,520
4,381
693 76,237 44,264
AAPM Newsletter
January/February 2007
2007 Approved Budget Revenue
Expenses Direct
Approved by the Board of Directors November 29, 2006
Net
Overhead
Total
AAPM Education & Research Fund AAPM/RSNA Fellowship - From Endowment AAPM Imaging Residency - From Endowment AAPM Matching Grant with ASTRO RSNA Varian Research Grant MP Fellowship Other Subtotal
38,000 $110,000
18,000 18,000 36,000 36,000 36,000 25,000 18,000 6,000 $193,000
Grand Total
$6,378,211
$4,625,447
72,000
0 0 0 0 0
$0
18,000 18,000 36,000 36,000 36,000 25,000 18,000 6,000 $193,000
(18,000) (18,000) (36,000) (36,000) 36,000 (25,000) (18,000) 32,000 (83,000)
$2,277,457
$6,902,904
(524,693)
Table 2 continued
2007 Council & Committee Expense Budgets
$500,000 $400,000 $300,000
Education Professional Science
$200,000 $100,000 $0
Figure 3
Expenses by Major Source -Proposed 2007 Budget 4%
6%
6% 24%
18%
16%
26%
Mbrshp
Prof Dev
MP
Admin
Gov
Other
Figure 4
19
Committees
AAPM Newsletter
January/February 2007
Legislative and Regulatory Affairs Column medical imaging technologists and radiation therapists. The standards must be met 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. Lynne Fairobent College Park, MD Senate Passes S. 2322 RadCARE Bill in Closing Hours of the 109th Congress/House Adjourns without taking Action
T
he U.S. House of Representatives adjourned in the predawn hours of Saturday, Dec. 9, without taking action on the Consumer Assurance of Radiologic Excellence bill. The bill had gained unanimous approval in the U.S. Senate on December 6 before being forwarded to the House for a vote. In the end, however, the congressional calendar wasn’t on the bill’s side. Despite the disappointment of not receiving a vote in the House, we should be proud of the progress the bill made this year. We need to remember that the bill moved through the Senate unanimously. Based on this, we are very well positioned when we reintroduce the bill next year. Lawmakers understand the need to set standards for medical imaging and radiation therapy personnel. The intent is to reintroduce the bill quickly after the 110th session of Congress convenes in January 2007. The bill is designed to set minimum educational and credentialing standards for medical physicists,
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. A copy of the bill as passed by the Senate can be found at: http:// www.aapm.org/org/committees/ committee/article.asp?id=1486 DOE Source Recovery Program Update In the last issue I discussed that 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 original purpose of the source recovery program was to recover excess and unwanted radioactive sealed sources presenting disposal difficulties. The DOE conducts this program with reduced or no costs
20
to the licensees. Traditionally, the program dealt largely with americium241 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. The contract with CRCPD and DOE has not been finalized although it is expected to be signed in early 2007. Many members have contacted me about the mechanics of the program. Because the contract has not been signed, full details have not been finalized. However, the key detail that is final is that AAPM members must register any sources that they would like to have considered for the program. It is anticipated that the program will manage large numbers of small obsolete sources, examples of which are cesium-137 brachytherapy sources, and various radium-226, americium-241, and other sources. To register sources with LANL online, please visit http://osrp.lanl.gov/what_is_osr. shtml. NRC Issues Regulatory Issue Summary (RIS) 2006-26 titled: NRC Regulatory Issue Summary 2006-26 Training and Experience and Grandfather Provisions For Authorized Medical Physicists Under 10 CFR Part 35 The Nuclear Regulatory Commission (NRC) issued RIS 2006-26 on December 7, 2006. The purpose of this RIS is clarify the provisions for recognizing and “grandfathering” authorized medical physicists (AMPs) under 10 CFR 35.2, 35.14, 35.51 and 35.57. The regulatory use of the term authorized medical physicist includes only medical physicists for the
AAPM Newsletter following medical uses: Strontium90 (Sr-90) eye applicators, remote afterloader units, teletherapy units, and gamma stereotactic radiosurgery (Gamma KnifeÂŽ) units. Therefore, this RIS applies only to licensees with these devices. No specific action nor written response is required. This RIS does not preclude the need for the AAPM Petition which asked the NRC to recognize all medical physicists certified prior to October 24, 2005. The RIS is simply providing clarification on the methods for being listed or being grandfathered as an AMP. The RIS can be found at: http://www.nrc.gov/readingrm/doc-collections/gen-comm/regissues/2006/ri200626.pdf .
(Fuss from p. 14) in an estimated 10% reduction to all physician work RVUs but does not impact technical component or practice expense RVUs. CMS did not increase the medical physicist work time for CPT codes 77336 and 77370, nor did they apply a reduction floor to any CPT codes negatively impacted by their changes to the practice expense methodology as was recommended by AAPM. However, CMS did implement a 4-year transition period and encourages effected specialties to identify errors and anomalies in the practice expense data and seek refinement through the RUC process prior to the full implementation of the practice expense changes in 2010. Based on AAPM recommendations, changes to the practice expense methodology in the final rule yielded a positive impact to radiation oncology payments overall and lessened the severity of payment reductions to medical physics codes CPT 77336 and 77370. AAPM may consider a formal review and revaluation of some medical physics codes in 2007. A complete summary of the final rule and impact tables is on the
CPT Code
77336 Continuing medical physics consult
January/February 2007 AAPM web site at: http://www. aapm.org/government_affairs/ CMS/2007HealthPolicyUpdate.asp 2007 Medicare Payments to Hospital Outpatient Departments On November 1st, the Centers for Medicare and Medicaid Services (CMS) published the 2007 Hospital Outpatient Prospective Payment System (HOPPS) final rule. The majority of hospital outpatient payments for radiation oncology procedures will increase in 2007, however, hyperthermia treatments (CPT 77600-77620), some stereotactic radiosurgery codes (HCPCS G0173, G0339 and G0340) and IGRT code 77421 have decreases greater than 10%. Of note, the proton beam therapy codes increase by more than 22% and CPT 77778 for prostate brachytherapy has a 55.4% increase in payment. Medical physics codes 77336 and 77370 have reductions of 6.2% slated for 2007 (see table on page 17). All payments and policies will be implemented on January 1, 2007. A complete summary of the final rule and impact tables is on the AAPM web site at: http://www. aapm.org/government_affairs/ CMS/2007HealthPolicyUpdate.asp
2006 PERVU 2007 PERVU 2010 PERVU 2006-2007 PERVU Percent Change
2006-2010 PERVU Percent Change
2.99
77370 Special 3.5 medical radiation physics consultation
2.52
1.14
-15.70%
-61.90%
3.38
3.05
-3.40%
-12.90%
21
AAPM Newsletter
January/February 2007
2007 Hospital Outpatient Payments APC
Description
CPT Codes
2006 Payment
2007 Payment
Payment Change 2006 to 2007
Proposed Percentage Change 2006 to 2007
65
Level I Stereotactic Radiosurgery
G0251
$1,150
$1,249.18
$99.18
8.60%
66
Level II Stereotactic Radiosurgery
G0340
$3,750
$2,644.95
($1,105.05)
-29.50%
67
Level III Stereotactic Radiosurgery
G0173, G0339
$5,250
$3,895.59
($1,354.41)
-25.80%
127
Level IV Stereotactic Radiosurgery
77371*
$7,304.87
$8,510.16
$1,205.29
16.50%
257
Level I Therapeutic Radiologic 77421 Procedures
$75.00
$67.45
($7.55)
-10.10%
260
Level I Plain Film
77417
$43.42
$43.60
$0.18
0.40%
299
Misc. Radiation Treatment
77470
$343.25
$361.67
$18.42
5.40%
300
Level I Radiation Therapy
77401-77409, 77789
$87.24
$91.13
$3.89
4.50%
301
Level II Radiation Therapy
77411-77416, 77422,77423,
$131.26
$137.04
$5.78
4.40%
77750 303
Treatment Device Construction
77332-77334
$168.07
$180.90
$12.83
7.60%
304
Level I Therapeutic Radiation Treatment Prep
77280, 77299
$103.09
$96.72
($6.37)
-6.20%
305
Level II Therapeutic Radiation Treatment Prep
77285, 77290, 77310, 77315, 77321, 77327, 77328
$234.09
$244.17
$10.08
4.30%
310
Level III Therapeutic Radiation Treatment Prep
77295, 77301
$826.12
$848.76
$22.64
2.70%
312
Radioelement Applications
77761, 77762, 77763, 77776, 77777, 77799
$331.32
$298.54
($32.78)
-9.90%
313
Brachytherapy
77781, 77782, 77783, 77784
$774.85
$789.70
$14.85
1.90%
314
Hyperthermic Therapies
77600-77620
$332.31
$205.68
($126.63)
-38.10%
412
IMRT Delivery
77418, 0073T
$318.82
$336.42
$17.60
5.50%
651
Complex Interstitial Radiation Source Application
77778
$666.21
$1,035.50
$369.29
55.40%
664
Level I Proton Beam Therapy
77520, 77522
$947.93
$1,161.29
$213.36
22.50%
667
Level II Proton Beam Therapy
77523, 77525
$1,134.08
$1,389.37
$255.29
22.50%
77300, 77305, 77326, 77331, 77336, 77370, 77399
*Please note that HCPCS code G0243 has been deleted effective January 1, 2007. Please use new CPT code 77371.
22
AAPM Newsletter
January/February 2007
News from CAMPEP Congratulations to: London Regional Cancer Program London, Ontario Program Director: Jacob Van Dyk, M.Sc.
Brenda Clark, President, CAMPEP
T
here has been a great deal of activity in the last two months. Three new program accreditations have been granted and one reaccreditation. Many thanks to all the volunteers who participated in these program reviews. For graduate programs, three reviews have been completed and one is pending, with a site visit scheduled for early in 2007. Congratulations on accreditation to:
MS Graduate Program in Medical Physics East Carolina University Greenville, North Carolina Program Director: Edson L. B. Justiniano, PhD and MS Graduate Program in Medical Physics and Health Physics Louisiana State University Baton Rouge, Louisiana Program Director: Kenneth Hogstrom, PhD and on reaccreditation to: Graduate Program in Medical Physics University of Florida Gainesville, Florida Program Director: David Hintenlang, PhD For residency programs, three reviews are in progress and one is complete
Additionally, the CAMPEP Residency Education Program Review Committee has drafted changes to their guidelines to accommodate the accreditation of “affiliate-type” programs and forwarded them to the CAMPEP board for review. On the continuing education front, we are receiving positive feedback from users of the new on-line accreditation application system. So far, so good! This is my last bulletin as president of CAMPEP as my term on the board is complete at the end of December. CAMPEP’s new president will be John Hazle; I wish him success in his new role. There are also three other board members who have completed their terms: Richard Geise, vice president, Jim Smathers, secretary/treasurer and Peter Biggs. I would like to thank all of them for their diligence and hard work for CAMPEP over the last few years, especially Jim in his role as secretary/treasurer. CAMPEP was incorporated exactly 12 years ago and the terms of appointment to the board have been set at 3 years, renewable once, which explains why 4 of the 8 board members are being replaced at the same time. To provide greater continuity on the board in the future, the terms of office have been adjusted with the aim of replacing 2 members each year. New to the CAMPEP board in January will be Richard Maughan (representing AAPM), Tim
23
Solberg (ACMP), Geoff Clarke (ACR) and Ervin Podgorsak (CCPM). With Richard moving onto the board, he has nominated Ed Jackson to succeed him as Chair of the Graduate Education Program Review Committee. I would like to thank Richard for his sterling work as chair of the GEPRC for the last 4 years and welcome Ed to his new role. The last 6 years have seen a substantial growth in activity of CAMPEP. When I joined the board, there were only 7 accredited graduate programs and accreditation was perceived to be something to which only the few could aspire. Now, the total has more than doubled to 15 and the perception has changed to that of being a requirement rather than a luxury. Much of the motivation for this increase has come from the potential students who have tended to vote with their feet! There has been an even greater percentage rise in the number of accreditations of residency programs, from 4 to 15, with the motivation coming from several directions including the marketplace and the certification bodies. These numbers translate into a considerable workload for the volunteer committee chairs and program reviewers which has prompted some changes in the management of CAMPEP, including our appointment of an administrative assistant, Shantelle Corado, who works for CAMPEP on a part-time basis and is also on the AAPM staff. Another recent initiative has been the development of a full set of policies and procedures which will be available from the web site before the end of the year. The motivation for this work came from the requirement to communicate our accreditation processes to the wider community of medical physicists and thereby provide transparency, while at the (see Clark - p. 24)
AAPM Newsletter
January/February 2007
CIRMS Meeting Update Meeting of The Council on Ionizing Radiation Measurements and Standards (CIRMS) on Implications of Uncertainty in Radiation Measurements and Applications By Larry A. DeWerd, Ph.D., FAAPM AAPM liaison to CIRMS and Geoffrey S. Ibbott, Ph.D., FAAPM
T
he Council on Ionizing Radiation Measurements and Standards (CIRMS) is organized for educational and scientific purposes to analyze the current and future needs of ionizing radiation measurements and standards. CIRMS has a broad-based membership from industry, state, federal government and academia. The main objectives of CIRMS are the advancement and dissemination of the physical measurements and standards needed for applications of ionizing radiations. For more information, see: www.cirms.org. The 2006 CIRMS annual meeting, held in Gaithersburg, Maryland on October 23-25, had as its theme “Implications of Uncertainty in Radiation Measurements and Applications.” The plenary sessions included presentations on uncertainties in Monte Carlo applications and measurement technologies. The meeting ended with student presentations, two of which were related to medical concerns. These talks included MCNP simulations to guide phantom fabrication and the calibration of CT chambers. The Medical Applications Subcommittee met on Monday and Tuesday afternoons, during the breakout sessions, and heard 17 presentations on the general topic of “Uncertainty in Medical Measurements and Standards.” The presentations were grouped under the following headings: • Uncertainty in External Beam Radiation Therapy – Standards • Uncertainty in External Beam
Radiation Therapy – Transfer to the Clinic • Uncertainty in External Beam Radiation Therapy – Other Beams and Detectors • Uncertainty in External Beam Radiation Therapy – Particle Beams • Brachytherapy – Uncertainties from the Primary Standard Through the Clinic • Brachytherapy – Uncertainties in the Clinic and Other Therapies From the presentations and the discussions that ensued in the Medical Subcommittee, the following conclusions can be drawn: 1. External Beam • The dosimetry standards are of high quality and have low uncertainty • The standards are easily transferred to the clinics via the ADCLs • Uncertainties increase in the clinic as applied to patient treatments • The biology involved is not well understood • Specialized treatment modalities such as protons have even greater uncertainties in treatment delivery • The dosimetry standard for protons is not highly certain, but most proton facilities follow the same protocol to calibrate their beams 2. Brachytherapy • Brachytherapy clearly has greater uncertainties than external beam therapy
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• Methods for transferring brachytherapy standards from NIST through the ADCLs to the clinic are improving, and the uncertainties are decreasing. • The uncertainties increase when brachytherapy is performed in the clinic. • The uncertainties associated with specialized brachytherapy procedures such as 90Y-labelled microspheres are quite high, although recent work has reduced the uncertainty of calibration. • However, the uncertainty of treatment delivery is very high.
(Clark from p. 23) same time ensuring confidentiality to our customers. I would like to personally thank the many colleagues who have contributed many volunteer hours on this not very exciting but essential effort. Judging by some of the requests for accreditation that we have received during the last year, CAMPEP’s reputation has spread worldwide. One of the challenges to face the new board will be the possibility of extending accreditation services outside North America. In closing, I would like to express my appreciation to all the board members and committee chairs that I have worked with over the last 6 years and who have supported the work of CAMPEP – it’s been fun!
AAPM Newsletter
January/February 2007
ASTRO, AAPM and NCI Symposium: “Quality Assurance of Radiation Therapy and the Challenges of Advanced Technologies� The jointly sponsored QA Meeting will be held February 20-22, 2007, at the Omni Mandalay Hotel at Las Colinas in Dallas. This 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. The program, designed primarily for physicists, is also appropriate for physicians, dosimetrists, therapists and administrators with an interest in quality assurance and safety. Please call ASTRO Education Department at 1-800-962-7876 or 703-502-1550 with any questions. The full program and registration information are now available at www.oncologymeetings.org.
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AAPM Newsletter
January/February 2007
Task Group 133 update AAPM Task Group on Alternative Clinical Medical Physics Training Pathways – TG133 Michael G. Herman TG 133
A
braham Flexner in his deliberations on American Medicine wrote in 1910, “There is probably no other country in the world in which there is so great a distance and so fatal a difference between the best, the average and the worst”1. This was for medical doctors 100 years ago and might be true of medical physicists today. The expectations of the patient are that individuals participating in their care are properly trained to deliver safe and effective care. For many reasons, medical physicists enter clinical practice without complete or thorough clinical training. The AAPM supports thorough and formal training for medical physicists (board action of Nov 2005), which includes an advanced degree, didactic medical physics training as outlined in AAPM report 79 and extensive clinical training as outlined in AAPM report 90 and delivered in a CAMPEP accredited program. The process is completed by becoming board certified. Task Group 133 was formed to address the shortage of accredited structured clinical training pathways. Background for the formation of the TG is summarized on the TG133 webpage (available to all AAPM members) under minutes and the file labeled 2006_06_09 Background and Charge Submitted.
models by which extensive clinical medical physics training as outlined in AAPM report #36(now Report 90) and delivered in a CAMPEP accredited clinical training program can be achieved, increasing dramatically the number of available qualified clinical medical physicists and reducing the burden on the limited number of conventional medical physics residency programs. 2. To ensure that Satisfactory completion of required core didactic medical physics coursework as outlined in AAPM report 79 is also achieved, either in an accredited graduate program or within the structure of the accredited training program(s) proposed in charge #1. 3. Detail in each training model how the requirements established for accreditation will be achieved, including program funding and expected program time frames. Specifically, the task group will consider: a. Current CAMPEP accredited medical physics residency program structure b. A structured mentorship, affiliated with a core CAMPEP accredited residency program c. The professional doctoral and/ or masters degree in the practice of medical physics. d. How an enhanced M.S. or Ph.D. medical physics graduate program could provide some or all of the necessary clinical training and if not all, how that fits into the residency, and a, b or c above.
Charges: Recognizing that CAMPEP accredited residency is the standard and based on the above background data, the charges of the Task Group on Alternative Clinical Training Pathways for Medical Physicists are the following:
4. Provide recommendations for (CAMPEP) assessment of programs described in charge #3, based on the reference structure defined in charges #1 and #2
1. To consider and propose a model or
5. Communicate
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with
other
organizations and AAPM committees with interests related to clinical training and competence of practicing medical physicists: a. ABR through the ABR physics committee b. CAMPEP, through a liaison c. AAPM licensure and national training standardization (CARE) efforts regarding specifics of training requirements 6. Review the essential economics issues associated with proper clinical medical physics training. The task group has been meeting and has determined to focus current efforts on expanding opportunities through structured mentorships affiliated with CAMPEP accredited residency programs. The bottom line is that the training material in reports 79 and 90 must be covered and it must be documented. The goal is to have a reviewable draft report by AAPM 2007. TG133 welcomes your comments and input. Flexner A. Medical Education in the United States and Canada Carnegie Foundation for the Advancement of Teaching 1910. 1.
AAPM Newsletter
January/February 2007
Chapter News Ohio River Valley Chapter Biannual Meeting Douglas Frye Chapter President
T
he Ohio River Valley Chapter (ORVC) held the second of its biannual 2006 meetings Saturday, November 18th at the Methodist Hospital of Indiana Conference Center in Indianapolis. The morning program included a resident presentation and three presentations approved for CE by CAMPEP. Medical Physics Resident Mathew Meineke, from Memorial Hosp. in South Bend IN, spoke on the clinical implementation of the IMSure MU/ IMRT QA product. Our Guest Speaker Twyla Willoughby, who was visiting from MD Anderson-Orlando, discussed clinical implementation of BrainLab’s respiratory gating and Calypso’s RF localization. The morning session concluded with Niek Shreuder, from ProCure Centers, describing the rationale, design and future of the ProCure Proton Development and Training Center under construction in Bloomington IN. The morning session was followed by a lunch in the vendor exhibits, the Chapter business meeting and student presentations. During the business meeting it was decided that the CAMPEP registration and processing fees would be supplied by the Chapter as a service to the membership. Chapter Secretary/ Treasurer Niek Schreuder briefly described the financial status of the chapter. Chapter Representative Board Member Paul Feller described ongoing efforts to reanimate the AAPM Board re-organization. The Chapter voted to align honoraria policy in keeping with the profession’s de facto standard, ie. only presenters from outside the chapter will be awarded honoraria. The Chapter also voted to implement
different emphasis for Spring and Fall meetings in 2007. The Spring meeting will emphasize student participation, with more student presentations. The Fall meeting will emphasize CE and professional development. The next ORVC meeting, Spring 2007, is tentatively scheduled for March/April 2007 in Cincinnati. Mike Loyd and Paul Feller have graciously volunteered to make local arrangements. Following the business meeting, students from Indiana University, Midwest Proton Research Institute, Ohio State University, University of Kentucky, and Purdue University each gave brief descriptions of research projects they’ve been working on. The Chapter provided each of the student presenters with a $250 travel award. It is anticipated
that students selected to present at the Spring 2007 Chapter meeting will also each receive a travel award. The Chapter wishes to recognize our vendor partners whose generosity and presence enlivened and enhanced the meeting: BK Medical Systems, BrainLab, Calypso Medical Systems, Dot Decimal, Fluke Biomedical, IMPAC, Laco Inc., LXU Medical, Siemens, Tomotherapy, and Varian Medical Systems. Special vendor recognition and thanks go to Calypso Medical Systems, BrainLab, Varian Medical Systems, and Clarian Health Partners. The Program Director also wishes to recognize the contributions of the following Clarian Health employees for their assistance: Tim Weaver-AV technician, Laurie Stultz,facilities scheduling, and Doris Harris-food service.
WORKSHOP ON TEACHING PHYSICS On August 1-3, 2008 (Friday – Sunday) immediately following the AAPM Annual Meeting in Houston, TX, the AAPM will conduct a 2 ½ day Workshop on “How We Learn and How We Should Teach Physics.” The Workshop will be important for all medical physicists with current or future responsibilities of teaching physicists, radiologists, radiation oncologists, radiographers, dosimetrists, radiation therapists and others. It will address the shortcomings in physics teaching and learning identified in the AAPM Educational Summit held in January, 2006 in Atlanta. More information and registration materials will be provided at a later time. This announcement simply allows you to mark your calendar and plan your attendance and budget for the 2008 meeting to include the Workshop.
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AAPM Newsletter
January/February 2007
John S. Laughlin Award
T
he Graduate Student Association of Rosalind Franklin University of Medicine and Science, Department of Medical Radiation Physics, would like to announce the inaugural presentation of the John S. Laughlin Award. This award is presented to one graduating PhD student who best demonstrates the innovative spirit, dedication and excellence in the field of Medical Radiation Physics that the late Dr. John S. Laughlin embodied. This year the award was presented to Dr. Eric E. Klein on June 2, 2006 in Chicago, IL during the graduation of the medical physics class.
Dr. Laughlin was a pioneer in the use of high-energy photons for therapeutic use and initiated the first use of highenergy electrons. Similarly, Dr. Klein is a pioneer in the field of modulated
electron radiation therapy (MERT) as demonstrated by his PhD dissertation and continuing work. As Dr. Laughlin was instrumental in teaching hundreds of residents, graduate students, and physicists at Memorial Sloan Kettering, Dr. Klein has been instrumental in teaching and directing the medical physics residency program at Washington University in St. Louis. Dr. Klein’s leadership and participation in shaping the policies of the field of Medical Physics through his Task Group participation is laudable and akin to the leadership roles Dr. Laughlin undertook in the AAPM.
future success on any endeavors he undertakes, as well as pay homage to the late Dr. John Laughlin, a father figure in the AAPM whose presence, guidance and wisdom is missed and whose memory lives on through those he touched.
Once again the Graduate Student Association would like to congratulate Dr. Klein on his achievements and wish him
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AAPM Newsletter (Herman from pg. 11) Jim Hevezi and is responsible for monitoring economic factors and helping AAPM take appropriate positions on important economic issues, in particular with value setting entities and with other professional organizations. To this end Wendy Smith Fuss has been serving as a consultant to the AAPM to provide information, interpretation, insight and recommendations on the many and sometimes very complex economic issues that confront us. In Wendy’s column posted separately, detailed summaries of important and current economic activities that effect our profession and related stakeholders locally and nationally are presented. Of note this month, quality is beginning to be tied to reimbursement (P4P) and Medicare and HOPPS fee schedules continue to change (and the importance of being able to quantify medical physics effort in any procedure increases as well as
the need to continue to influence fee structure). On a related note, the PEC is setting out on the next Abt survey of medical physics work values to be done in 2007. The Professional Services Committee has grown in size and stature over the years and Bob Rice, who lead this growth period, has now completed his term as chair. This committee is responsible for the newsletter, the professional survey, the insurance program and other services that we, the membership, think are important. George Sherouse has taken the reins of this committee and will be happy to hear your thoughts about ways that AAPM can improve member professional services. Current projects include a validation of the compensation component of the professional survey and further work on medical physicist workforce supply and demand.
January/February 2007 The Ethics Committee maintains our ethics policy and handles charges of ethics violations. The committee has been writing a new ethics code for medical physicists as TG109, under the guidance of outgoing committee chair D.J. Freedman. The new chair, Chris Serago will carry this update to completion. The new Vice Chair for the Professional Council is Mike Mills, who brings a wealth of experience in all aspects of our profession to the Council. Finally, going back to why we do what we do for the quality of patient care. The professional program this year will be co-directed by Bruce Gerbi and the overall theme and thread related to quality. We have heard much about errors, and error reduction, better quality and practice quality improvement, from regulators, certification bodies, insurance carriers and plenty in the newspaper. How (see Herman - p. 33)
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AAPM Newsletter
January/February 2007
(Keyser from p. 4)
(Boone from p. 13)
2007 Summer School The 2007 Summer School will be held July 27-29, immediately following the Annual Meeting, at St. John’s University, located one hour north of Minneapolis in Collegeville, Minnesota. The topic is “Shielding Methods for Medical Facilities: Diagnostic Imaging, PET and Radiation Therapy.” Program Directors are Melissa Martin and Pat McGinley. The Local Arrangements Committee is headed by Mary Fox and Sherry Connors.
There are numerous opportunities for the AAPM to participate in grant funded educational activities. Indeed, the National Institute of Biomedical and Imaging and Bioengineering (NIBIB) is already poised to transfer a conference contract (U13) to the AAPM in the upcoming year, for two intersocietal conferences (in 2007 and 2008).
Session topics include: Basis of Design and R/F Shielding, CT Shielding Design, Shielding Design for PET, AAPM Task Group 108 Report on PET and PET/CT Shielding Requirements, Neutron Calculations for Linac Shielding, Primary and Secondary Wall Calculations; Composite Materials, Maze Calculations; Door Designs, and Direct Shielded Sliding Door Calculations.
(2) Grants that are administered by the AAPM (and conducted by multiple AAPM members) may lead
to high profile scientific results with important conclusions pertinent to our field. Medical physicists could be the unsung heroes of a dirty bomb event, reducing panic and clogged emergency rooms while assuring police that while their Geiger counters are clicking away, the radiation risk is actually quite low (if that indeed were the case). These (hypothetical) examples would raise the scientific stature of the AAPM, which in turn would make all members proud.
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AAPM Newsletter 3) The establishment of a grants portfolio could provide the AAPM with additional infrastructure. For example, the American College of Radiology (which includes the ACR Imaging Network – ACRIN), received $39 million dollars in 2005, 55% percent of its total budget. Mind you, the lion’s share of those proceeds went towards the direct support of research. By setting up the apparatus for AAPM HQ to administer grants, we would be poised to also receive industry-sponsored grants on topics such as beam commissioning or QA of treatment machines. Indeed, all the AAPM’s sister societies in the American Institute of Physics have some form of grants administration structure in place. (4) Over the years, the Science Council and research committees have spent considerable effort in stimulating research activities on the part of medical physicists within the AAPM. If the AAPM were to receive grant funding for research, data collection, or educational endeavors, under most circumstances these funds would be reallocated as subcontracts to a number of individual AAPM members or medical physics departments throughout the country. This mechanism, therefore, would facilitate and stimulate the participation of many AAPM members in research or educational activities who would otherwise not have these opportunities. So, what are the risks of the AAPM (through its members) submitting and receiving grants from various state or federal agencies, or from private industry? There are others who could better represent this case, however I will present some of the issues that I have heard discussed in regards to the downsides of the AAPM becoming a grant receiving organization.
(1) Financial risk to the organization: Certainly, agreeing to participate in grant funded activities is a two-way street - the AAPM could take in grant money, but would be expected to perform the activities described in the grant. While this is a genuine concern, there are few scientists who would go to the enormous bother and time-consuming task of writing a competitive grant proposal, get the award, and then not pursue what was proposed. Furthermore, the types of grants that should be pursued by the AAPM would mostly be distributed to a number, and typically a large number, of investigators (AAPM members) around the country. This essentially diversifies the portfolio for performance of grant activities. Furthermore, checks and balances would be implemented to assure appropriate performance on any grant funded activity, and this would be the responsibility of the principal investigator ( an AAPM member) and an oversight committee. it should be noted that the AAPM routinely enters into contracts involving large amounts of money-hundreds of thousands of dollars. The annual AAPM meeting is an example of such a contractual process. If for some reason the AAPM annual meeting were to be canceled at the last minute (e.g. SARS in Toronto and Katrinia in New Orleans), the society could potentially lose hundreds of thousands of dollars in committed expenses and lost revenue. However, insurance was purchased to mitigate these risks. (2) There are also concerns about the potential of financial mismanagement of grant funds. The AAPM has a million-dollar budget which could, in theory, cause a liability due to misfeasance, natural disaster, etc. However, we create operating procedures and carry insurance to mitigate that risk. The same would be done for grant funded activities.
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January/February 2007
3) Other forms of risk: There are other forms of risk than financial impropriety. What if a research program that was funded through the AAPM led to the injury or death of a patient? To mitigate this risk, I have proposed that grants administered through the AAPM should not involve direct patient care or treatment –as a matter of policy. Retrospective analysis of clinically indicated patient treatments or imaging procedures would be allowable, however. Finally, what if the recommendations that resulted from AAPM based research activities were misinterpreted (or simply wrong) and led to the harm of a patient? There is no reason that I can think of why recommendations from funded activities would bring more liability to the AAPM than the many unfunded reports that the association already publishes. Summary Action taken by the Board of Directors on November 29, 2006 directed Science Council to explore the ramifications of the AAPM situating itself to become a grant receiving organization. Based upon those recommendations and other feedback, the Board of Directors will decide on this issue one way or another at the 2007 summer meeting. While it is my personal feeling and the consensus of Science Council the AAPM could expand its relevancy and scientific impact by acting upon selective grant funding opportunities, ultimately this is the decision of the Board of Directors. We understand and respect the authority and responsibility of the board in regards to this issue, and will happily abide by their decision on this topic.
AAPM Newsletter
January/February 2007
ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Does your facility need help on applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s new accreditation web site portal at www.acr.org; click “Accreditation,” then “Mammography.” The “Program Overview” and “Frequently Asked Questions” were completely updated and reorganized to provide more useful information on accrediting digital mammography equipment. In addition, most of the mammography accreditation application and QC forms are now available for downloading. You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists. A. Yes, the FDA recently approved Q. How will an inspector inspect a Priscilla F. Butler, M.S. the ACR to accredit the Fuji FCRm CR unit? Senior Director, CR system beginning November 15, ACR Breast Imaging Accreditation A. Using laptop computers, FDA in- 2006. Programs spectors will download the records for a mammography unit(s) that uses CR Q. We plan to use our new Fuji comComputed Radiography in the same manner as for any other puted radiography (CR) system with FFDM unit. They will open and ex- an existing accredited mammography Q. From an MQSA standpoint, amine the applicable inspection pro- unit currently used with screen-film. are there any differences between a cedure screens. If a unit(s) is being What do we need to do to accredit computed radiography (CR) system used for both screen-film and CR on this new CR system? and a full-field digital mammography the same physical unit(s), the inspecA. Call the ACR at (800) 227-6440 system? tors will need to download separate for the appropriate accreditation mascreen-film records as well. A. No, although the systems have terials. If an inspector determines that CR is significant physical differences, FDA being used on a screen-film unit(s) for Q. I heard that if I use both screentreats them the same from an MQSA which there is no certificate extension film and CR on the same mammograregulatory standpoint. CR systems are approval, the inspector will: phy unit, my facility must accredit that considered part of the FFDM mamunit as 2 separate units. Is that true? mographic modality. This means that 1. add a new record for the CR unit(s) facilities wishing to use a CR system into the database (e.g., with the same A. Yes, because the image quality, must meet all applicable MQSA remodel, description, and serial number QC, and personnel requirements are quirements, including those specific as the screen-film unit(s) but with an different for screen-film and FFDM, to FFDM units. (For example, all perimage receptor type of CR); the facilities using both screen-film sonnel using a CR system must have 2. mark it as unaccredited (resulting and CR on the same mammography completed at least 8 hours of training in a Level 1 or 2 inspection observa- unit(s) must accredit (and test) each specific to digital mammography prior tion); unit as 2 separate units. to using the new CR system on pa3. answer the mammography equiptients. However, because CR systems Q. I know my facility needs to send ment evaluation question and all of are part of the FFDM mammographic the applicable questions in the QC the ACR the results of my Mammogmodality, personnel who have already records and Survey Report sections raphy Equipment Evaluation before obtained 8 hours of training in FFDM they can legally begin to use their new accordingly; and, do not have to obtain another 8 hours 4. instruct the facility that it should Fuji FCRm system. Where can I get in CR prior to use on patients.) stop using the unit(s) until it applies to copies of these summary forms to FDA for certificate extension on the complete? Q. What inspection costs are associA. The medical physicist’s Mammogunit(s) and has received a Letter of ated with CR certification? raphy Equipment Evaluation summaAcceptance. A. FDA will treat a screen-film unit ry forms for the Fuji FCRm (as well If a facility is performing both screen- as the other digital systems) are availthat is equipped with a CR system as film and CR mammography using the two separate units. Therefore, inspecable through the following link on the same physical unit(s), the inspector tors will inspect a single physical unit ACR web site: will treat the inspection as 2 separate that is used to perform screen-film units and the facility will be billed ac- http://www.acr.org/accreditation/ mammography and CR mammogramammography/mammo_qc_forms. cordingly. phy as two separate units, and the facilhtml Q. Does the ACR accredit the new ity will be billed for two units. FFDM Fuji computed radiography system? mammographic modality, personnel
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AAPM Newsletter
January/February 2007
(Herman from p.29) does it all fit together with a medical physicist doing his or her job? The program this year begins with the big picture in medical quality at the Sunday Professional symposium. Medicine has become very technical and very complex, allowing us to provide the highest quality of care to patients. At the same time we open the door for many new ways to make mistakes and we continue to try to manage new technology the way we managed our traditional tools. The process and practice has to be reviewed with the ultimate goal of reducing errors, improving quality and maintaining efficiency. A deliberate sequence of sessions will lead us through: •
Technical performance standards and the introduction of complex new technology
•
What happens when things go wrong, how it happens, error reduction, how to select the proper QA
•
Producing meaningful regulations and the impact of CARE The practice quality initiative (PQI) as it relates to medical physics practice and how it integrates with maintenance of certification
•
• • • •
Economic tools/factors that play a role in medical physics, from Abt to reimbursement Professional services necessary to support/facilitate increased efficacy, efficiency and quality Education and preceptorships for recognition as a qualified medical physicist Developing technical specifications for new equipment to meet the needs of improved quality
meet the expert and a discussion about employment applications. As always we will accept submitted abstracts for the professional track. This year the categories for submission are: Professional Practice of Medical Physics, Legislation and Regulation, Ethics and Legal, Economics, Clinical Education and Administration and Management. We look forward to your submissions.
It is only with a long term, concerted effort, with effective alliances that we make progress on significant issues that effect our profession. I look forward to an active and productive year for the AAPM Professional Council and welcome your thoughts, input and energy.
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AAPM Newsletter
January/February 2007
Memorial
Carey Floyd, Jr. 1954- 2006
A
Duke faculty member for over 20 years, Carey Everett Floyd, Jr., 52, died at home on August 28 after a lengthy battle with cancer. His love for life and for others sustained him during his illness, and he relished the time spent in conversation with family, friends, and his numerous students until his very last days. He continued the scientific work he so enjoyed right until the end of his life, even after experiencing diminished physical stamina in recent months. He was the epitome of courage, creativity, and dedication, and was greatly loved by many people. Carey was born on March 17, 1954 in Nashville, Tennessee. He received his undergraduate degree from Eckerd College in Florida and his PhD in physics at Duke University in 1981 in the area of experimental nuclear physics. He took a postdoctoral fellowship at the Triangle Universities Nuclear Laboratory in 1982, and a subsequent postdoctoral fellowship in the department of radiology at Duke University Medical Center in 1983. He became a full professor of radiology and biomedical engineering at Duke in 1997.
An eminent scientist, Dr. Floyd made numerous significant contributions to the science of medical imaging. His early work included important contributions in nuclear medicine, including a pioneering method of reconstructing SPECT images known as the inverse Monte Carlo technique. He then became well known for many significant research efforts in digital radiography, and he established one of the pre-eminent laboratories in the world in the field of computer-aided detection and diagnosis (CAD). One of his last research efforts was a novel combination of nuclear physics and medical imaging, wherein neutrons are used to stimulate gamma emission for the imaging of trace elements in the body. In recognition of his significant scientific contributions, Dr. Floyd was awarded a lifetime career achievement award from the department of radiology at Duke University on July 14, 2006. Dr. Floyd served the scientific community well in many capacities, including several decades on grant review study sections at the National Institutes of Health. He was director of the Digital Imaging Research Division within the department of radiology at Duke from 1992 until 2004. He also was co-director of the Duke Tumor Registry, and was involved in the establishment of the new medical physics graduate program at Duke. More important than his luminary scientific accomplishments was his superb mentorship of dozens of individual students over the past two decades. He mentored numerous PhD students in biomedical engineering, many of whom now have influential careers of their own.
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He truly cared for his students, and they greatly loved him. In recognition of Carey’s superb mentorship of students, a new graduate fellowship at Duke University was established in his honor. The Carey E. Floyd, Jr., Graduate Fellowship will be administered by the Medical Physics Graduate Program at Duke, and will provide future generations of outstanding students the distinction of being named Floyd Fellows. Carey was truly a renaissance man, excelling in numerous areas outside of science. He was a gifted musician, playing bass and guitar in ten bands over the years. He loved model rocketry and model trains, and was a skilled craftsman, as evidenced by the numerous house renovation projects he undertook. He enjoyed boating, and most of all, he treasured the company of family and friends with whom he loved to converse for hours on end about interesting topics. He was a humble, caring, loyal, and courageous person who will be greatly missed by those who knew and loved him. He is survived by his wife, Elizabeth Floyd; his father, Carey E. Floyd; and his stepmother, Ann Herbert Floyd of Nashville, Tennessee. In lieu of flowers, the family requests contributions be made in Carey’s memory to the Carey E. Floyd, Jr., Graduate Fellowship, in care of the Medical Physics Graduate Program, Duke University Medical Center, Suite 101, 2424 Erwin Road, Durham, NC 27705. Letters of condolence may be sent to the home.
AAPM Newsletter
January/February 2007
AAPM Education and Research Fund AAPM wishes to acknowledge and thank the following individuals for their contributions to the AAPM Education and Research Fund in 2006 Applebaum, David M. Arbique, Gary Michael Balog, John P. Barnes, J. Ed Benjamin, Areg Borasi, Giovanni Boyd, Robert A. Boyer, Arthur L. Bushe, Harry S. Chavaudra, Jean Jacques Corrigan, Kevin Craig, Tim Cytacki, Edmund P. Daniels, Cupido De La-Fuente-Calvo, Fermin Earl, Matthew A. Findley, David O. Ford, Eric C. Freedman, D. Jay Frey, G. Donald Frouhar, Vincent A. Gerbi, Bruce J. Gibbs, Gregory L. Glennon, Patrick T. Goetsch, Steven J. Goff, David Lee Greenspan, Bennett S. Guglani, Suveena Halverson, Per H. Hamidiam, Homayoun Hamilton, Russell J. Harper, Joanna Hazle, John Hearn, Christopher M. Hellman, Joseph P. Hendee, William
Henzler, Margaret Hoffman, Kenneth R. Isin, Gulkan James, Christopher D. James, Joshua A. Judy, Phillip F. Kasaee, Alireza Keyser, Angela Kirk, Bernadette L. Kitchen, Rebecca H. Klein, Susan B. Ladle, Roger O. LaFrance, M. Terry Landry, Danny Lee, Richard Leidholdt, Edwin M. Lemen, Lisa Catherine Lightfoot, David Liu, Hui Helen Lucas-Quesada, F. Anne Madsen, Mark T. Mageras, Gig Mah, Eugene Mahesh, Mahadevappa Marcus, Harold Martin, Rafael McMillan, Sharon K. Messenger, Jeffrey G. Metcalf, David Miller, Ira Mischke, Matthew Mitev, George Moore, Mary E. Myers, Lee Thomas Myrianthopoulos, Leon C Nelson, David M.
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Nelson, Joseph Alvin O’Rear, James H. Parks, Joon H. Parks, Norris J. Pawlicki, Todd Petrone, Thomas J. Pfund, John C. Philip, Jacob S. Pizzutiello, Robert Reft, Chester S. Robertson, Gene E. Rothenberg, Lawrence Scarbrough, Edward C. Shepard, S. Jeff Shope, Thomas B. Shumaker, Deborah J. St.Germain, Jean Stafford, R. Jason Stevens, Donna Swanberg, David J. Sweet, John B. Takahashi, Joseph M. Tanner, Raymond Tuley, Floyd H. Van De Riet, William G. VanderWall, William H. Virudachalam, Ramasamy G. Vulcan, Teodor G. Wallace, Steven A. Walters, Matthew David White, Gerald A. Willcut, Virgil M. Williams, Michael D. Willins, John D. Wollins, Myron Wright, Kenneth Yorke, Ellen D. Zagzebski, James A.
Editor
Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115
Editorial Board Priscilla Butler, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390
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The AAPM Newsletter is printed bi-monthly. Next issue: March/April Submission Deadline: February 15, 2007 Postmark Date: March 20, 2007
American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846