AAPM Newsletter March/April 2007 Vol. 32 No. 2

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 32 NO. 2

MARCH/APRIL 2007

AAPM President’s Column

Mary K. Martel UT MD Anderson Cancer Center

QA Symposium

I

am reporting in to you from the Quality Assurance of Radiation Therapy and the Challenges of Advance Technologies Symposium taking place in Dallas (sponsored

by AAPM, ASTRO and NCI). The planning committee hoped for at least 150 attendees, and was pleased that over 300 people registered for the meeting. It is a jam packed program with a stellar cast of speakers, and I am impressed with the engagement of the audience during the discussion sessions. Clearly advanced technologies rapidly implemented in the clinic these days has overwhelmed the QA schedule of many physicists, and this three day symposium is allowing us to take a step back to reevaluate the QA process. Take a look at the scientific program schedule via the website http://www.oncologymeetings.org/ quality_assurance.htm, which now includes links to PDF files of the

talks, a great resource for those who could not attend. In addition, short papers were authored by each of the speakers and will be published in a special edition of the International Journal of Radiation Oncology, Biology and Physics. Summary (and perhaps consensus) papers will be included also, and hope to capture the essence of the discussions during the conference. I am writing this during day 2 of a 3-day conference and so don’t yet know of specific recommendations that will come from this symposium, but the leadership of the AAPM will undoubtedly come away with many suggestions and proposals to consider.

Look to the next newsletter for a more detailed report.

AIP On a different topic, the relationship of the American Institute of Physics (AIP) with the AAPM has recently come forward in my consciousness for several reasons. For one, new AAPM individual appointments to the AIP have been made in the past year. This prompted me to find out more about our link to the AIP. I asked Chris Marshall, lately an AIP Governing Board Representative, to send me some salient points that I could include here (thanks, Chris): 1) We are the AAPM with “physics” coming first on our name by intent, and the AIP is our main connection to the physics community at large; 2) The AIP and its member societies have much collective experience

and insight into the world of scholarly publishing. The AAPM publishes its own journal and we gain greatly from working with AIP and meeting those in other societies in this respect; 3) The AIP and its member societies have concerns about science education, funding of research, government policies, public education, etc.

With an alternative context than that of the medical world. This context helps inform the AAPM membership. The AIP also has an infrastructure that provides research, programs and other support on such issues; 4) The AIP provides us with numerous services which can benefit a relatively small society such as the AAPM and we can maximize this and other benefits if we actively engage with the AIP through member participation in its many committees

(see Martel p. 2) TABLE OF CONTENTS Chairman of the Board Column President-Elect’s Column Executive Director’s Column Education Council Report Professional Council Report Science Council Report CAMPEP News Health Policy/Economics Leg. & Reg. Affairs Editor’s Column Ethics’ Committee News MOC update Workgroup on Clinical Trials Chapter News Mammography FAQS Letter to the Editor Memorial

p. 2 p. 3 p. 4 p. 5 p. 7 p. 9 p. 11 p. 12 p. 13 p. 15 p. 17 p. 20 p. 21 p. 23 p. 25 p. 26 p. 27

AAPM Newsletter

March/April 2007

(Martel from p. 1) and in the governance of the AIP. This last point is the second reason I have been thinking about the AIP. We have lately made recommendations for appointments to various AIP committees, as terms of service expire. Currently, AAPM members serve on committees such as Physics Resources Policy, Advisory on Career network, Media and Government Relations, Publishing Policy (and others). My purpose here is to raise awareness that such opportunities exist for AIP service, and encourage those members with background and experience relevant to particular AIP committees to indicate interest to our AIP appointees, Bruce Curran and Bill Hendee.

ABR Congratulations to Geoff Ibbott on his election to the Board of Trustees

of the American Board of Radiology. He will serve a (first) 4 year term, commencing in June 2007. Geoff is one of three trustees on the ABR representing Radiologic Physics (along with Don Frey and Richard Morin, replacing Bhudatt Paliwal). Thanks to Bhudatt Paliwal for his terms of service on the ABR. Election Finally, I would like to mention that the election of AAPM officers and Board members-atlarge will soon be upon us. Unfortunately only a third of the eligible members have voted in past election, meaning that a low percentage of members decide the composition of the Board.

This could be unfortunate given that your interests may not be

represented on the Board, and ultimately, the Board sets the priorities and direction of our society.

In my mind, the member-at-large position is meant to bring to the Board table broader issues of concern at hand in the AAPM. These can be of a scientific, education or professional nature, depending on the viewpoint of the Board member. Hence, the nominating committee is striving to put forth a slate of candidates that is a balance of therapy and diagnostic physicists, and among academic, communitybased practice and private practice physicists. It will be up to you to have a look at the nomination information provided by the candidate, (maybe even read the statements of interest!), and vote!

Chairman of the Board’s Column

E. Russell Ritenour Minneapolis, MN

A

s I dutifully meet my Feb 15 deadline for this column it is very cold here in Minnesota. When you wake up to negative double digits (Fahrenheit) you don’t really feel like starting projects, particularly if you have to go somewhere outside of a warm house to do them. Recently, I

learned from the Discovery Channel program “Mythbusters” that you can start a fire by taking a piece of ice, rubbing it into a roundish shape, and using it as a magnifying glass to focus sunlight on kindling. If you are freezing to death on a very sunny day, this might be your only hope.

The ice has to be fairly clear for it to work, but Minnesota lake waters are reasonable pure. Remember this survival skill if you come to visit me during the winter.

Anyway, when you don’t feel like going anywhere, it’s great to communicate electronically. The members of the Board of Directors have been doing a lot of that lately. We’ve made a lot of use of the BBS to discuss issues and work on documents. President Mary Martel has also polled the Board via e-mail, taking straw votes

2

and having whatever discussion the Board thinks is necessary. This was on a topic that, in the past, the Executive Committee (Excom: Pres., Pres-elect, Treasurer, Secretary, Executive Director, and Chair. of Board) would have handled and then just reported to the Board at the next face-to-face meeting. Furthermore, this took place in the two months after RSNA, during which the leadership of the AAPM used to have a fairly quiet time period that we could devote to those pesky day-jobs of ours. But, again, the nice thing about BBS (note to printer: please do not drop one of the B’s or the meaning will be altered greatly – I think) and e-mails are that you can deal with them whenever you can make the time. Finally, and perhaps most importantly, we have started a monthly

(See Ritenour p. 16)

AAPM Newsletter

March/April 2007

AAPM President-Elect’s Column

Gerald A. White Colorado Springs, CO lectrons are tiny little things. Standing still they weigh in at only a little over 9x 1031 kg, somewhat more if they get moving faster. Many of us spend large parts of our day dealing with the more exotic electrons that have been accelerated in someway but today I’m intending to focus on the more sedentary (but not quite motionless) members of the electron clan. I’m thinking about the ones that push themselves and their siblings through wires to allow us to connect with one another at larger distances with sufficient speed and detail so as to approximate the photon and acoustic wave dominated face-toface meetings so singularly essential in the past. After its virtually unnoticed beginning years ago (when the roll out of Bitnet addresses through AIP was to have facilitated communication among AAPM leadership), the role of electronically based communication has replaced most of the communication and collaboration done at meetings in which the participants share the same temporal and physical coordinates. Within the AAPM, Councils, Committees, Task Groups, and Work Groups have substantially (if not entirely) replaced PnP F2F (ask a 13 y.o. for a translation if necessary) work with electronically mediated forums. Unfortunately, the process by

E

which we form these groups remains based on processes that worked well in the earlier rubric, but fails in the current juncture. mbers who may wish to participate on a committee, task group or workgroup may find it difficult to sit in as an observer. For many, if not most, meetings the group members are sitting in their offices or homes (perhaps even in their jammies) making a casual drop-in on the part of an interested AAPM member virtually impossible. The appointment process, however, anticipates that AAPM members who wish to serve have some familiarity with the group they would like to join and the chair of the group has some knowledge of the potential contribution of the postulant.

To facilitate the volunteer/appointment process in this increasingly wired work world, some changes in the process of the volunteer call and committee match will be rolled out this year.

I’ll describe the changes in the next paragraph. The process will apply to all the committee-like structures (committees, work groups, task groups). For ease of description I’ll exercise my new thesaurus (described in my previous newsletter article) and use the broader term “Divan” to describe all of these groups. This will also penalize those readers who habitually skim newsletter articles rather than read them carefully as you are now doing; only those who have read the preceding sentence (or have an already well developed vocabulary) will be able to make any sense of what follows.

Rather then sending a request to members asking that they volunteer for positions, we will ask AAPM members to review the committee tree, the charge and/or expected work product of the various Divans and, upon finding one of interest, spend some time looking at past minutes, reports, etc. This request

3

to members will go out formally in the Spring of 2007, but of course, members can get started now. Members can then contact the chair of the Divan, supply an expression of interest, CV or other supporting information that will allow the chair to evaluate the applicant. On mutual agreement, the chair may grant a “guest” position in the Divan. This will allow the electronic equivalent of sitting in on a meeting, offering the opportunity for both parties to better understand the likelihood of a productive collaboration. Sometime in the early fall of 2007, another call will go out to the chairs of the various Divans asking for recommendations for appointments to be made by the President Elect, or for names of appointees for positions where the appointments are made by other than the President Elect. Once the appointments are formalized, we also anticipate a “Member Designate” status that will allow incoming Divan members to more carefully follow developments until the official beginning of the appointment in January of 2008.

The “Guest” status will expire in January of the new year, but of course, the process could begin anew (even for the same committee) if mutually agreeable to the AAPM member and Divan chair. The President Elect will continue to consider applicants for and appoint members to Committee and Council Chair positions as in the past.

The Divan appointment process has been overtaken by electron mediated changes in our workflow, it is unlikely to serve us well in coming years. We anticipate that the alteration will simplify the currently Byzantine committee appointment process and result in a better placement of motivated volunteers in the right place in the AAPM. I hope this change will be one small step forward as we honor the past, celebrate the present and prepare for the future.

AAPM Newsletter

March/April 2007

AAPM Executive Director’s Column address information. Soon, it will be expanded to include items from any committees you serve, and much more.

Your Member Profile is available from http://www.aapm.org/ memb/profile/ This area has a lot of the preferences we use to service your membership.

Angela R. Keyser College Park, MD AAPM encourages you to go online The AAPM website has a lot of features that many people may not realize. For example, you can search the AAPM Online Member Directory in a variety of ways. The directory has both Simple and Advanced Search forms on the same page.

If you want to search quickly, just enter the name or some portion of the name in the Simple Search box and press “Go” for a list of matches.

AAPM uses SOUNDEX technology to find matches even when names are not an exact match.

If you wish to find members based on some other criteria than last name, use the Advanced Search where you may search on many different fields, including institution, address, city, state, chapter and even phone number.

Newly added to the profile and directory listings is a formal and informal salutation field, so you will know when you contact, for example, J. Anthony Seibert to call him Tony, not Jay or Anthony.

We are working on personalization of the Member homepage, giving you information at the top that is relevant to you. Right now, that includes payment, voting and incorrect

Click on E-Preferences to see a list of the notification emails we send on a regular basis and opt-in/out of any you like. Click Journal Preferences to see if you are eligible to receive Medical Physics Journal in print. If so, you may opt to go paperless and sign up for the Online Journal. There is also a way to subscribe to be notified when new articles are added to the Journal website.

The AAPM BBS now has a friendly User Guide that walks you through the system, step-by-step to get you started interacting with other members.

If you think you might have missed an email from the headquarters, or want to make sure that an email was sent from us, you can visit http:// www.aapm.org/memb/email/ to see all of the mass-email we have sent to you.

We strive to constantly improve the tools you use and welcome any feedback you might have.

Annual Meeting News 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.

4

Dates to remember: • Authors will be notified of paper disposition by April 17.

• The full Annual Meeting program will be available on line by May 11.

• Register by June 1 to receive discounted registration fees.

• June 25 is the last date to make housing reservations at the convention rate.

• Pre-registration for the meeting closes on June 25.

New in 2007!

Self Assessment Modules (SAMs) Completion of two Self Assessment Modules (SAMs) per year is a requirement for the Maintenance of Certification (MOC) process as defined by the ABR. AAPM program organizers have identified sessions in Diagnostic, Medical Nuclear and Therapy Physics to be offered with audience response technology at the annual meeting in 2007. These sessions will allow those who require MOC to fulfill their SAMs requirements. Credits for these sessions are available only to attendees who pre-register for the modules. No SAMs registration will be offered on-site in Minneapolis.

Please note that the SAMs sessions are open to everyone, but only those pre-registered for the audience response technology will be eligible to receive an interactive response unit.

Questions will be asked during the SAMs sessions, and participants must answer electronically in order to receive certification. There is no pass/ fail. The idea is to assess knowledge gained during the session.

AAPM Working Toward a ‘Greener’ Meeting AAPM staff members realize the amount of waste created by a single

(See Keyser p. 16)

AAPM Newsletter

March/April 2007

Education Council Report of the National Society of Black Physicists at their meeting in Boston. Those taking part include: Steven Avery, Paul Gueye, Cynthia Keppel and myself. I will have the opportunity to discuss the AAPM with emphasis on its services and support for students and younger members.

Herb Mower Council Chair ell, the year 2007 is getting off to a great start! Under the leadership of Phil Heintz with gentle prodding from Bill Hendee, a sub-group of the physics syllabus subcommittee for diagnostic radiology programs had a ‘high-powered’ meeting in St. Louis in January. Over a two-day period the attendees reworked the syllabus and have it in a near complete state. We will now take this to the RSNA Physics Education Conference in Dallas in March for review with this group. The syllabus and the two groups should have a major impact on the physics required of radiology residents, the best methods of teaching this material, the response by the Boards to evaluate an understanding of the material, and opportunities to include the material in MOC programs. My thanks to Kim Applegate (Radiologist), Dan Bedmate, Joanna Fair (Radiology Resident), Lynne Fairobent (AAPM Staff), Phil Heinz, Bill Hendee, Don Peck, Tijuana Rung, Ehsan Samei, Tony Seibert and Jerry Thomas for a job well-done.

W

Under the leadership of Paul Gueye and the subcommittee on Minority Recruitment (Education and Training of Medical Physicists Committee), several AAPM members will be addressing the Medical Physics Section

By now you should have received information on our upcoming Summer School that immediately follows our Annual Meeting. It will be at St. John’s University in Collegeville, Minnesota. Melissa Martin is coordinating the academic program and it promises to be an exciting experience. The topic is: Shielding Methods for medical Facilities: Diagnostic Imaging, PET and Radiation Therapy.” For any who have ever attended a program coordinated by Melissa, you know that she always does an outstanding job. I look forward to seeing you at the Summer School.

While we are talking about the Summer School, if you are new to the field of medical physics or know of anyone fitting this designation, look into our ‘registration scholarship’ program. Each year up to ten registration waiver scholarships are available for those meeting the criteria. In addition there are usually two travel grants to assist a couple of those with scholarships attending the Summer School.

We also have our “Fellowships for Undergraduate Summer Study in Medical Physics” program. This program provides opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. Several scholarships

5

are available in general through the Summer Fellowship subcommittee with a limited number earmarked for distribution through the minority Recruitment subcommittee. Contact headquarters or check our website for further details on this program and deadlines.

This year our Education Council Symposium will be Sunday morning, 11:00 – 12:30 at the Annual Meeting.

Mary Fox and the Public Education Committee are putting together a great presentation that will include information on what is available on the web but possibly hard to find that would be of interest to our members.

This will include things as assistance for talks and information for patients. In addition there might be a presentation on how to deal with the press. Do join us for this session.

American Board of Radiology Physics Trustees G. Donald Frey, PhD Charleston, South Carolina Richard L. Morin, PhD Jacksonville, FL Bhudatt R. Paliwal, PhD Madison, WI -----------------------------Geoffrey Ibbott, PhD Houston, TX (will replace Dr. Paliwal in June 2007)

AAPM Newsletter

March/April 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

6

DOSIMETRY

BRACHYTHERAPY

AAPM Newsletter

March/April 2007

Professional Council Report ate staffing to our administrators?

On the national level, is there anything we can do to assure that the technical work units associated with the CPT code procedures are sufficiently robust to support our efforts?

Michael Mills Professional Council Vice-Chair

I

n this column, I want to focus on the activities of the Economics Committee and Government Relations Committee. Let’s consider Economics first: Professional concerns for medical physicists include such basic concepts as income, security, credentials, professional status and quality of life.

The final point, quality of life, must not be overlooked, as a relatively high salary may be deceptive, considering the working hours of many medical physicists. If an Associate or Bachelors level physics assistant works hourly and is limited to 40 hours a week making, say $100 K per year, while a Masters or Doctorate level certified physicist works 60 hours a week at $150 K, who has the better deal?

Clearly medical physicists must defend not only the professional nature of our work, but also the manpower and effort required to support the latest technologies. Within radiation oncology, we are all familiar with how advancing technologies such as IGRT, image guided stereotactic and respiratory gating consume more physicist time than ever before. How will we defend the need for appropri-

Beginning in 1995, the AAPM Professional Council has supported a periodic study of manpower for radiation oncologist physicists: The Abt Study of Medical Physicist Work Values for Radiation Oncology Physics Services. The latest version of this study, from 2003, can be found on the AAPM web site: Publications, Reports, and Unnumbered Reports. There you will find information respecting the time and effort to perform most of the physics services common in 2002-3, the time frame of the survey. The work and intensity associated with a variety of routine and special procedures are measured and reported, along with a survey of staffing levels by practice type. Although the Abt study is specific for radiation oncology physics services, it also serves as a template for how such a study might be done for diagnostic and nuclear medicine physicists. I understand the ACR is working on a similar manpower evaluation for diagnostic physics services.

The methodology to generate the manpower information in the Abt Report is by design very similar to that used to measure physician work. Briefly, a Preliminary Panel of medical physicists designs and refines the survey instrument to the profile of contemporary medical physics practice. The survey is sent to 100 medical physicists; the data collected includes time and intensity estimates, service mix data and

7

staffing patterns based on type of practice. An Expert Panel of senior physicists then reviews the survey for face validity and validates the results. The Centers for Medicare and Medicaid Services has recognized this methodology as valid for manpower estimates and has in the past considered the values reported in the Abt study in determining classification for certain CPT codes. And while the Abt survey is probably not a contributing factor to the impressive rise in medical physicist salaries beginning in 1995, it surely contributed to justifying support for staffing and maintaining some semblance of quality of life for radiation oncology physicists.

The Abt survey, however, is out of date. Image guided procedures, respiratory gating, and image guided stereotactic procedures were not a part of the 2003 study. The AAPM has decided once again to sponsor an Abt study for 2007. There is therefore a chance you will receive a survey instrument as part of the 2007 study. If so, you will find the survey is rather lengthy, you will need to find some information you may not have immediately at hand, and will take over an hour to complete. You may be tempted to ignore it. However, please consider it is to all of our advantage to have this information available when it is time to negotiate for staff positions and resources. So thanks in advance; your colleagues really do need your completed survey instrument in order to make the Abt 2007 study as strong and valid as possible.

Please take a look at Wendy Smith Fuss’s column respecting some new Work Groups that will focus on ra(see Mills - p. 17)

AAPM Newsletter March/April 2007 !!0- .EWSLETTER !D PDF 0-

8

AAPM Newsletter

March/April 2007

Science Council Report mitment tactically; in Academia, this means getting the right faculty and motivating them in the right way. In time, and with hard work and some luck, excellence happens.

John M. Boone Science Council Chair

S

cience Council met in January at Stanford University, and our host Norbert Pelc arranged for an excellent start to the meeting with a tour of numerous imaging and radiation therapy labs at one of the West Coast’s premier academic medical centers. Although I had visited Stanford before, this visit was far more comprehensive in scope. We visited one impressive lab after another, from MRI to x-ray CT physics, radiation therapy to molecular imaging, image processing to small animal imaging. My impression took a few days to sink in, but it was unmistakable after comprehension caught up in the aftermath of our meeting: Breadth, depth, and excellence. Indeed, excellence in medical physics research was evident at a scale that is perhaps matched by only a handful of universities in North America. Excellence -- there is a concept.

What does it take for an institution to be so ..... excellent? Clearly, achieving true excellence requires a commitment from the top decision makers (Chancellors and Presidents) to provide the resources and environment necessary to achieve excellence, and then the next level of administration (Deans and Chairs) needs to have the skill and vision to act on that com-

I see the AAPM as two thirds the way along this road to excellence, and headed in the right direction. I have had the great pleasure to work over the years with leaders in EXCOM who are bright, dedicated, and have vision. Together we as an organization have become greater than the sum of our parts. For example, (1) The Medical Physics journal is a source of excellence that all members of the AAPM should be proud of, and the succession of Editors, journal management and Editorial Board members have all continued to build on the considerable success of their predecessors. (2) The AAPM annual meeting has also gradually improved to be the excellent meeting that is has become. While it is impossible for the meeting to be everything for everyone, the quality of the science and educational and professional forums have steadily improved over the years, generally achieving excellence. The growth of the meeting is impressive, and only through the dedication of the AAPM staff and the commitment of those medical physicists who volunteer their time and energy does this meeting hit its laudable goals. It all looks so easy rolling out of a taxi and heading to the registration booth, but the preparations start five or more years in advance. (3) The staff of the AAPM, now 20 or so strong, is the mortar that keeps the individual stones of the organization together in a cohesive manner. Under the savvy leadership of Angela Keyser, the efficiency, quality, and respon-

9

siveness of our headquarters staff continues to grow, and we as an organization are doing things that in the past we would not have imagined.

(4) The elected leadership of the AAPM (the 5 members of EXCOM) amazes me with their dedication, intelligence, and vision. Being human, every person on EXCOM has their strengths and weaknesses, but I am impressed that the combined skill set of this management group has been so complimentary over the years.

The road to excellence also requires jettisoning things that are not excellent. The AAPM has moved beyond the partisan bickering which surrounded the contentious board issue of the 90’s, and this dark cloud has finally moved over the horizon.

There was a more recent effort to reduce the size of the Board of Directors, and though that did not happen it is clear that some changes are necessary to make the AAPM board leadership more efficient. Steps have been taken towards this goal by having the board meet electronically and also to separate the timing of the board meeting from the AAPM annual meeting.

As with our counterparts in the Education and Professional Councils, the members of Science Council are working to build on the steppingstones which those who went before us have set in place. Science Council underwent significant reorganization recently, which has lead to some streamlining and improvement in interaction. We are moving towards the use of more teleconferencing,

not only at the Council level, but also at the Committee, Subcommittee, Working Group and Task Group levels. The vast majority of (see Boone - p. 11)

AAPM Newsletter

March/April 2007

FEATURING

GAFCHROMIC EBT ®

A simple, quick and reliable IMRT QA system for the processor-less environment!

BY FAR THE MOST ECONOMICAL IMRT QA SYSTEM

Film for radiotherapy dosimetry

•• •• ••

Competitively priced Self-develops – no processor or dark room needed!

Energy independent Can be handled in room light (avoid prolonged exposure)

Stable and uniform Wide dose range (1cGy to 800cGy)

Works with professional graded 16 bits/channel transparent color scanners (As listed in our manual)

Also available GAFCHROMIC® dosimetry films for other RT and radiology/ diagnostic applications. For more info visit: www.gafchromic.com

FILMQA

TM

te IMRT A comple the ! le b a il a plus Now av : FILMQA ® m te s y S QA + TM

D MIC Q ge O R H C a GAF t Pack r a t s k Quic r box Includes e ” sheets p , 25 8” x 10 -site training lm fi T EB f n o • 4 boxens V700 scanner • 1 day odetails!

• Epso r more Call fo

Simplifies film analysis and lowers the cost!

•• • • •• ••

ISP Quality management of applied radiation.

Fast! Complete analysis/report in less than 5 minutes!

Rapid registration of films / plans Sophisticated quantitative analysis tools Customizable reports can be viewed over the web if necessary without compromising patients' privacy!

Supports all IMRT QA phantoms Optimized for EDR2 and the new ® GAFCHROMIC EBT film and supports radiographic and flatbed scanners Flexible payment plans Supports all major TPS

973.628.3531 or 973.628.3688 Technical assistance: 973.628.3138 or 866.218.0594

INTERNATIONAL SPECIALTY PRODUCTS

10

www.ispcorp.com

AAPM Newsletter

March/April 2007

News from CAMPEP ganization in the bigger picture of the profession and build a consensus of where we are going. I want the Board and committee chairs to all be clear about CAMPEP’s role in the continuing evolution of our profession. The retreat is planned for April 2nd in Houston and I will report on our discussions in the following newsletter.

John Hazle President, CAMPEP

O

ne of my first actions as the incoming President of CAMPEP is to write this article. I’d like to begin by welcoming Peter Dunscombe, Marlene McKetty and Palmer Steward back as Board members, and Geoff Clarke, Richard Maughan, Ervin Podgorsak and Tim Solberg as new Board members. We also have Bruce Gerbi and Bruce Thomadsen returning as Chairs of the Residency Education Program Review Committee and Continuing Education Review Committee, respectively. I also welcome Ed Jackson as the new Chair of the Graduate Education Program Review Committee. All of these folks are giving graciously of their time to make CAMPEP work for everyone. Please join me in extending a big thanks to all of them!

Since we have quite a bit of “new blood” on the Board and a new committee chair, I’ve made our first order of business to hold a retreat to review the mission, vision and operation of CAMPEP. We meet annually at the AAPM and RSNA meetings. However, these meetings are usually taken up with lots of procedural matters and program approval discussions.

My goal for the retreat is to specifically look at where we are as an or-

One issue Brenda Clark touched on in her last Newsletter article was the revision of our Policies and Procedures. Not so much changed, most of the work was clarifying the intent of the original philosophies. We now have the revised documents on our website and I welcome any comments from the community.

One of my other priorities for the next year is to make sure that CAMPEP is meeting the needs and expectations of our sponsoring organizations: AAPM, ACMP, ACR and CCMP. Further, we need to be sure that good communication exists between the American Board of Radiology and the American Board of Medical Physics with CAMPEP. Much of these communications are being facilitated by the AAPMRSNA initiative to review educational activities throughout the medical imaging and radiation therapy communities.

Graduate programs update Two medical physics graduate programs, East Carolina University and Louisiana State University, were granted initial CAMPEP accreditation in 2006. Two other programs, University of Calgary - Tom Baker Cancer Centre and the University of Oklahoma Health Science Center, were accredited in 2005. With the addition of these four new programs and the reaccreditation of several

11

other programs, there are currently 15 CAMPEP accredited graduate education programs in North America; four of these programs are in Canada.

Three new programs have requested applications and noted their intent to apply for accreditation in the coming year. This is a welcome trend, and the GEPRC is putting into place plans for enhanced support of both the initial applications as well as ongoing reaccreditation reviews.

Residency programs update CAMPEP recently site visited one new radiation therapy residency program and is currently work to help four other programs prepare self-studies.

We are also preparing to carry out our five-year reaccreditation site visit for the M. D. Anderson Cancer Center Imaging Physics residency program.

There are now thirteen therapy and two imaging residency programs with accreditation.

(Boone from p. 9) initiatives from any of the Councils involve voluntary work by AAPM members, and the past paradigm of two meetings per year (AAPM and RSNA) to get the work accomplished is outdated and inefficient. We are therefore emphasizing moves to make interaction on Science Council and its subsidiaries on the AAPM org-chart more efficient, in the hopes of getting more done in less time. If you have ideas which you think will help move the scientific mission of the AAPM forward, I encourage you to call or E-mail me or any member of Science Council. Together, through the collective efforts of the AAPM membership and leadership, it is my hope that someday in the not too distant future we will all look around and realize that indeed, excellence happened.

AAPM Newsletter

March/April 2007

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant

Call for Volunteers for New Economics Work Groups

T

he Professional Economics Committee has recently established four new work groups that will focus on radiation oncology and medical physics coverage and reimbursement issues. AAPM is seeking volunteers for each of the work groups (volunteers do not have to be members of the Professional Economics Committee). We anticipate that work groups will convene conference calls on a quarterly basis and the time commitment for volunteers will be 1-2 hours per month. Please contact Wendy Smith Fuss (Wendy@ HealthPolicySolutions.net) or Lynne

Fairobent (Lynne@aapm.org) to sign-up for one the Work Groups described below.

The Coding Work Group will respond to AAPM member coding inquiries. This Work Group will interact with AAPM staff to provide answers to coding and billing questions. In addition, this Work Group will be responsible for reviewing the bi-annual revisions of the ASTRO/ ACR Guide to Radiation Oncology Coding.

The Hospital Outpatient Work Group will focus on issues that relate to the hospital setting, including the Medicare Hospital Outpatient Prospective Payment System regulations and program transmittals. This Work Group will work with AAPM staff to draft correspondence and

comments on issues that relate to the hospital outpatient setting.

The Freestanding Center Work Group will focus on issues that relate to the freestanding radiation oncology centers, including the Medicare Physician Fee Schedule regulations and program transmittals. This Work Group will work with AAPM staff to draft correspondence and comments on issues that relate to the freestanding setting.

The Emerging Technology Work Group will address issues related to new technology. The Work Group interacts with professional medical societies on CPT applications and RUC surveys that apply to medical physics procedures or services.

%XTREMELY )NTELLIGENT 1! $EVICE Unfors Xi - Beyond today’s technology for diagnostic x-ray test meters. • Active Compensation for all beams • One meter - all modalities • Minimal setup time • MQSA compliant

48 Anderson Avenue, Suite 1, New Milford, CT 06776 Phone: (866) 4UNFORS, Fax: (860) 350-2664 www.unfors.com info@unfors.com

12

AAPM Newsletter

March/April 2007

Legislative and Regulatory Affairs Column

Lynne Fairobent College Park, MD NRC Chairman Dale L. Klein visits Johns Hopkins University Medical Center, February 5, 2007

C

hairman Dale L. Klein was accompanied by his Assistant, Douglas Broaddus. Dr. Mahadevappa Mahesh - Assistant Professor of Radiology and Chief Physicist - Johns Hopkins University School of Medicine and Dr. Nicholas Detorie, Clinical Manager Medical Physics hosted them for a tour and discussion of the use of radioactive materials in medicine.

Also present were Roland Fletcher, Head of the State of Maryland Radiation Health Program and Raymond Manley, Chief of the Radioactive Materials/Licensing & Compliance Division for the State of Maryland. Participating from Johns Hopkins were: Jonathan Lewin, MD -Chairman Department of Radiology, Richard Wahl, MD Professor of Radiology - DirectorNuclear Medicine/PET; – Department of Radiology; Dean Wong, MD, PhD - Professor of Radiology Benjamin Tsui, Ph.D - Professor of Radiology; and Stanley Wadsworth, Radiation Safety Officer. Angela Keyser, AAPM’s Executive Director and I also were present.

Chairman Klien was sworn in July 2006. Before becoming NRC chair, Dr. Klein served as the Assistant to the Secretary of Defense for Nuclear and Chemical and Biological Defense Programs. He served as the principal staff assistant and advisor for all policy and planning matters related to nuclear weapons, and nuclear, chemical and biological defense. In addition, he served as the Vice-Chancellor for Special Engineering Programs at the University of Texas System and as a professor in the Department of Mechanical Engineering (Nuclear Program) at the University of Texas at Austin. A native of Missouri, Dr. Klein holds a bachelor’s and master’s degree in mechanical engineering and a doctorate in nuclear engineering, all from the University of MissouriColumbia.

CARE Bill Introduced in House of Representatives (H.R. 583) with a Name Change The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (CARE bill) was introduced into the U.S. House of Representatives on Friday, Jan. 19. This bill, H.R. 583, introduced by Rep. Mike Doyle, DPa., was previously known as the Consumer Assurance of Radiologic Excellence bill. The lead Republican cosponsor on the bill is Rep. Chip Pickering, from Mississippi, who has been a long time supporter of the legislation and helped advance the bill in the 109th Congress to its furthest point to date. Other cosponsors of the bill are Reps.

Marsha Blackburn, R-Tenn.; Lois Capps, D-Calif.; John J. Duncan, Jr., R-Tenn.; Mike Rogers, R-Mich.; and Heather Wilson, R-N.M.

13

The RadCARE bill was unanimously passed by the Senate in December 2006. Last-minute efforts to get the bill through Congress, however, were not successful. The CARE bill would require people performing the technical components of medical imaging and radiation therapy to meet federal education and credentialing standards in order to participate in federal health programs such as Medicare, Medicaid and other programs administered by the Department of Health and Human Services. Medical imaging examinations and procedures, as well as radiation therapy treatments for patients covered under these programs, would need to be performed by personnel meeting the federal standards in order to be eligible for reimbursement.

NRC Updates 1. Energy Policy Act of 2005.

NRC’s rulemaking efforts to implement Section 651(e) of the Energy Policy Act of 2005 (EPAct) on “Treatment of Accelerator-Produced and Other Radioactive Material as Byproduct Material.” NRC notified Congress on January 24, 2007 that although significant progress has been made on the promulgation of the final regulations for accelerator-produced and other naturally occurring radioactive material, NRC will not meet the February 7, 2007 date, but expect to publish the final rule in the spring of 2007. AAPM has requested that the draft staff paper (SECY) with the proposed final rule be made publicly available while the Commission deliberates the staff ’s recommendations. (see Fairobent p. 18)

AAPM Newsletter

March/April 2007

WWW.AAPM.ORG/MEETINGS/07AM

Therapy, Imaging & Joint Programs Therapy Program Scientific Symposia • • • • •

Hypofractionated RT Robustness of IMRT treatments Advances in proton therapy Novel acceleration techniques Advanced biological modeling for RT • Challenges in differential dose delivery with IMRT

Proffered Abstract Submissions

• IMRT optimization, treatments & QA • Monte Carlo method & validation • Dosimetry instrumentation methods & QA • Brachytherapy isotopes, pharmaceuticals, methods & applications • Stereotactic radiosurgery and radiotherapy • radiobiology modeling and treatment planning • Networks and informatics

Imaging Program Scientific Symposia

• Beyond mammography • Status and developments in breast ultrasound imaging • Advances in CT: beyond the slice war • Tomographic guidance of RT procedures • molecular imaging: techniques and applications

Proffered Abstract Submissions

• CT, MRI, PET, ultrasound, mammography • Radiography/fluoroscopy • Vascular & cardiac imaging • optical imaging, CAD • multi-modality imaging • Display & visualization • Image registration & fusion • Image segmentation, dosimetry

Joint Imaging/Therapy Program Scientific Symposia

• Challenges in in-room target localization • Temporal and spatial imaging for RT • Tomographic guidance for RT procedures • Image-guided alternative therapies • Imaging for therapy assessment • Functional imaging for RT guidance

Proffered Abstract Submissions

• Target definition • Image-guided procedures • Imaging for therapy assessment

14

AAPM Newsletter

March/April 2007

Editor’s Column issue as Editor of the AAPM Newsletter and also received an e-mail directing you to a survey regarding the Newsletter. Please take some time to complete the survey and let me know your thoughts on the Newsletter.

Mahadevappa Mahesh Johns Hopkins University By the time you are reading this column, I hope that spring is in the air in your geographic location (or Fall to those living south of the equator).

You have already received my first

My plan is to get the Newsletter published one month earlier than the current print schedule. The July/August Newsletter is targeted for publication on the 1st of July and should arrive in your mailbox by the end of the first week of July. My intent is to have the July/August issue in your hands before the AAPM Annual Meeting (July 22-26, 2007).

To accommodate the new print schedule for the Newsletter, I will need to request that the regular

contributors submit their columns to me earlier than in the past: Old date for July/August issue: June 16 Now will be required to submit by: May 16 Hence this should act as an early reminder to the regular contributors and also for all those who wish to submit any articles or letters to the editors to submit well within the deadline (May 16th, 2007) for the July/Aug issue. I am also working closely with Chris Marshall, the AAPM Website Editor to have a greater presence of the Newsletter on the AAPM website.

During RSNA 2006 in Chicago, IL Chairman of the AAPM Board, Russ Ritenour, presented former AAPM Newsletter Editor Al DeGuzman with a certificate of appreciation for his service as Editor. Also pictured is Susan DeGuzman, former Mangering Editor of the Newsletter.

15

AAPM Newsletter

(Ritenour from p. 2) e-mailing to Board members with informational items such as copies of official letters the President has written and also background material that will be needed for future discussions.

So, we’re moving into an era when the Board is virtually in session year round. Board members are working for the Association more often than ever before. Gone are the days (I hope) when Board members would show up at two meetings a year, read a book of information from committees and councils and vote on items that they had just learned about. Also, we’ve started holding a “Board Orientation” at AAPM headquarters for new board members to explain in detail processes and practices that, previously, only the staff and Excom usually dealt with.

In addition to the electronic presence, the Board has voted to meet face-toface a third time, unrelated to any other scientific or professional meeting.

This third meeting will concentrate on long-range planning, something that the Board hasn’t had much time to do during the AAPM annual meeting and RSNA because of the number of Action Items from committees and councils that had to be dealt with. So, by the time you read this, we will have held that meeting in Chicago on March 30.

I look forward to reporting the results of that meeting in a future Newsletter.

March/April 2007 • Review Course materials will be inserted into binders of 35% postconsumer recycled cardboard.

• Box lunches available during the official opening of the exhibit hall on Sunday will be packed in Greenware containers, rather than cardboard or styrofoam. These containers are made from natural cornstarch, and are fully compostable.

• Look for recycling bins for bottles, newspapers and general trash in the convention center.

• At the meeting’s conclusion, consider dropping off your badge in the badge recycle bin near the AAPM Registration Desk.

2007 AAPM 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.

Be sure you register by JUNE 6 to receive discounted registration.

®

Radcal 9095 Proven Technology

Radiography • Fluoroscopy • Mammography • Dental • CT

(Keyser from p. 4) meeting. Most green ideas cost nothing extra, and some even save our association money. In an effort to be more environmentally responsible, we’re working toward a greener meeting by taking these steps: • The pocket program will be printed on 30% post-consumer recycled paper with soy-based ink.

• The Minneapolis Convention Center’s designated caterer will recycle food scraps by donating them to local pig farmers.

Multi-Purpose Analyzer Installation and Acceptance Routine QA Portable and Compact The Gold Standard in Ion Chamber and kV Sensor Technology

www.radcal.com • sales@radcal.com • 626.357.7921

16

AAPM Newsletter

March/April 2007

AAPM Ethics’ Committee Communication Chris Serago Ethics’ Committee Chair

M

embers of the AAPM’s Ethics Committee have grown concerned about the occasional very public use by AAPM members of unprofessional written and oral styles of self-expression, especially in discussions of professional matters that stir strongly-held opinions. The MedPhys mailing list, in particular, seems to be a magnet for lapses of civility, though it also occurs at venues such as local, national conferences or committee meetings.

Our committee has deliberated as to whether such unprofessional communications violate standards of conduct in the current AAPM ethics guidelines and will continue to do so.

(Mills from p. 7) diation oncology reimbursement.

You do not need to be a member of the Economics Committee in order to serve on these Work Groups. If you have an interest, please contact Wendy or Chairman James Hevezi.

Now let us look at some Government Affairs Issues that concern every medical physicist. These issues are detailed and complex, so I will only list them in bullet form here. Complete information can be found for most of these topics on the AAPM website: • CARE Bill: The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (CARE bill) was introduced into the U.S. House of Representatives on Friday, Jan. 19 as bill H.R. 583. The Democratic spon-

We have many wonderful forums for rapid and informal exchanges, for considered responses, and for face-to-face dialogue. We certainly don’t want to dampen free speech by suggesting a formal, constrained atmosphere. But honest, open, friendly, mutually respectful communication is what we would encourage. Discussions should focus on the topic, not the individual or their opinion.

We recognize that MedPhys is an open listserver with many nonAAPM participants, and do not in any way mean to put an “AAPM stamp” on the listserver. However, on an open forum such as the MedPhys listserver, we remind all that when we speak, our words are heard by a broad audience extending beyond those immediately pressor is Rep. Mike Doyle, D-PA, and the Republican co-sponsor is Rep. Chip Pickering, from Mississippi.

This marks the fifth time the bill has been introduced. ASRT Leadership is optimistic the Alliance is in a strong position to get the bill passed this year.

• The AAPM has filed a petition for Rulemaking with the U.S. Nuclear Regulatory Commission to amend 10 CFR 35.57, Training for experienced Radiation Safety Officer, teletherapy or medical physicist, authorized medical physicist, authorized user, nuclear pharmacist, and authorized nuclear pharmacist. The purpose of the petition is to revise the “grandfather” provision of Part 35 to recognize individual diplomates of certifying boards that were previously named in Part 35 prior to October 25, 2005. Detailed information can be found on the AAPM website under Government Affairs.

17

ent, and not only medical physicists are listening. Unprofessional speech reflects poorly on all of us. This letter is a plea for civilized discourse, whatever the venue. Please remember the old adage of our youth -- “if you can’t say something nice, don’t say anything at all”; at times silence is indeed golden.

Ethics’ Committee Members: Jun Duan D Jay Freedman, Past-Chair Per Halvorsen Nabil Adnani Richard Morse Morris Bank Zoubir Ouhib Jose BenComo Andrew Schneider Steven Birnbaum George Sherouse Matthew Vossler • In the Energy Policy Act of 2005, the Nuclear Regulatory Commission was granted rulemaking authority over Naturally occurring and Accelerator produced Radioactive Material (NARM). This significant expansion of NRC authority will impact physicists that deal with accelerator produced nuclides, such as those used in PET. The complete draft of the Proposed Rule can be found on the AAPM website under Government Affairs.

• The Government and Regulatory Affairs committee will be actively seeking input to define goals and objectives for the next 3 years. GRAC staff member Lynne Fairobent and Chairman Ralph Lieto are the contact individuals for these issues.

If you will consult Lynne Fairobent’s column in this issue you will see more information on these concerns.

AAPM Newsletter (Fairobent from p. 13) 2. AAPM Petition for Rulemaking.

The comment period on the AAPM Petition for Rulemaking closed on January 16, 2007. To date 166 comment letters were submitted. The majority support the actions requested in the Petition. NRC staff is currently reviewing the comments. Thank you to all who submitted comments letters.

3. Information Notices. The NRC released the following medical Information Notice (IN): IN 2007-03: Reportable Medical Events Involving Patients Receiving Dosages of Sodium Iodide Iodine-131 Less Than The Prescribed Dosage Because Of Capsules Remaining In Vials After Administration. (http://www.aapm. org/government_affairs/NRC/documents/IN2007-03_NAI_dosages. pdf) The intent of this IN is to alert licensees about events in which patients were administered dosages of

March/April 2007 sodium iodide, iodine-131 (I-131) that were less than the prescribed dosages, because of sodium iodide I-131 capsules that remained in vials, containing multiple capsules, after administration. These occurrences resulted in medical events because the patients did not receive the prescribed dosages. It is expected that recipients will review the information for applicability to their facilities and consider actions, as appropriate, to avoid similar problems.

However, suggestions contained in this IN are not new NRC requirements; therefore, no specific action or written response is required.

4. Regulatory Issues Summaries (RIS): The following RIS were issued in December 2006 by the NRC and can be found at: http://www.nrc.gov/reading-rm/ doc-collections/gen-comm/reg-issues/2006/. a. NRC Regulatory Issue Summary

2006-27 Availability of NRC 313A Series of Forms and Guidance for Their Completion, Issued December 13, 2007. This RIS addresses the revision of the single NRC Form 313A used to document training and experience for medical Radiation Safety Officer, medical physicists, nuclear pharmacist, and authorized user (physician).

There are six distinct new NRC Form 313As, with the following titles: i. NRC Form 313A(RSO), “Radiation Safety Officer Training And Experience And Preceptor Attestation [10 CFR 35.50]”; ii. NRC Form 313A(AMP), “Authorized Medical Physicist Training And Experience And Preceptor Attestation [10 CFR 35.51]”; iii. NRC Form 313A(ANP), “Authorized Nuclear Pharmacist Training And Experience And Preceptor Attestation [10 CFR 35.55]”; iv. NRC Form 313A(AUD), “Au-

NRC Commisioner Dr. Dale Klein’s visit to Johns Hopkins University.

In the picture left to right: Angela Keyser, AAPM; Dr. Nicholas Detorie, JHU; Doug Broaddus, NRC; Dr. Jonathon Lewin, JHU; Chairman Klein, NRC; Stanley Wadsworth, JHU; Dr. Dean Wong, JHU; Dr. Mahadevappa Mahesh, JHU; Dr. Richard Wahl, JHU; Roland Fletcher and Raymond Manley from State of MD Radiation Health Program.

Photo by Lynne Fairobent, AAPM.

18

AAPM Newsletter thorized User Training And Experience And Preceptor Attestation (For Uses Defined Under 35.100, 35.200, And 35.500) [10 CFR 35.190, 35.290, And 35.590]”; v. NRC Form 313A(AUT), “Authorized User Training And Experience And Preceptor Attestation (For Uses Defined Under 35.300) [10 CFR 35.390, 35.392, 35.394, And 35.396]”; And vi. NRC Form 313A(AUS), “Authorized User Training And Experience And Preceptor Attestation (For Uses Defined Under 35.400 And 35.600) [10 CFR 35.490, 35.491, And 35.690].”

NRC Form 313 must be submitted by all applicants seeking authorization for the use of byproduct material. The information required to complete the forms is aligned with the requirements in the 2005 revision of 10 CFR Part 35. Revised guidance is also included in the RIS to aid applicants in completing

the six forms in the NRC Form 313A series. b. RIS 2006-26: Training and Experience and Grandfather Provisions for Authorized Medical Physicists Under 10 CFR part 35, issued December 7, 2006. The regulatory use of the term authorized medical physicist includes only medical physicists for the following medical uses: Strontium-90 (Sr90) eye applicators, remote afterloader units, teletherapy units, and gamma stereotactic radiosurgery (Gamma Knife®) units. Therefore, this RIS applies only to licensees with these devices. No specific action or written response is required.

NCRP 43rd Annual Meeting: “Advances in Radiation Protection in Medicine” April 16 – 17, 2007 The National Council on Radiation Protection and Measurements (NCRP) 2007 Annual Meeting will feature presentations by physicians,

March/April 2007 medical physicists, and experts in radiation health effects who will discuss the rapid growth in use of relatively new medical radiation diagnostic and therapeutic procedures, and the current state of understanding of radiation doses received by patients and the associated health risks. Topical areas of focus at the meeting will include diagnostic radiology, nuclear medicine, interventional radiology, radiation oncology, and interdisciplinary issues such as the implications of radiation doseresponse models for the prediction of long-term patient responses to irradiation from diagnostic and therapeutic procedures.

The NCRP Forty-Third Annual Meeting will be held on April 16-17, 2007 in the Crystal Forum of the Crystal City Marriott in Arlington, Virginia. There is no registration fee for the meeting, but attendees should register in advance at http://NCRPonline.org.

RIT: the EPID QA Solution It’s True - RIT Does EPID QA • Varian aS500 / 1000 • Elekta iView GT™ • Siemens • IMRT QA • MLC Tests

Precision is the entire point of IMRT.

• Dose Calibration • Composite Analysis 719-590-1077 • sales@radimage.com • www.radimage.com © 2007 Radiological Imaging Technology, Inc. Protected by US Patents 6528803, 6675116, 6934358, 6934653, 6937751, 7013228, 7016464, 7024026, EU Patent 1252550, JP Patent 3817176 and other pending US and foreign patents.

ISO 13485 Certified • FDA 510(k) Clearance • CE Marked Rev. 1/07

19

AAPM Newsletter

March/April 2007

Maintenance of Certification Update Michael Yester UAB Medical Center

A

s those members that have obtained American Board of Radiology (ABR) certification since 2002 are aware, ABR certification became time limited as of that year.

This came about as an action of the American Board of Medical Specialties (ABMS), of which the ABR is a member board. As part of the recertification process, a Maintenance of Certification (MOC) requirement was instituted by the ABMS. So regarding the ABR physics Diplomates, ABR Physics Trustees are responsible for the MOC program for physicists, but the program must be approved by the ABMS. When the initial program was announced, there were significant concerns about some of the elements of the program for physicists and a Task Group (TG-127) was initiated in November of 2005 to work with the ABR Physics Trustees. The charge of the Task Group was: 1. Act as a resource and liaison with the ABR trustees to provide information on MOC to AAPM members, 2. provide information/suggestions on activities that meet MOC requirements, 3. insure that educational activities are available to members.

The Task Group is chaired by Michael Yester and Per Halvorsen.

Since the formation of the Task Group and the initial days of announcement of the program, some elements have been modified and work is progressing on defining other parts of the program. The intent of this article is to provide an update on the MOC program.

There are four basic parts of the MOC program as established by the ABMS. Part 1 relates to Professional Standing Part 2 relates to Lifelong Learning and Self-assessment Part 3 relates to Cognitive Expertise Part 4 relates to Performance in Practice Evaluation The major focus of work by the Task Group to this point has involved Part 2 and Part 4. Thus the remainder of this article will address those aspects.

Part 2: Regarding the Lifelong Learning section, initially there were some concerns over the number of hours of continuing education credits needed over the ten year period, namely 500 hours of category 1 credit which could include Self-Directed Educational Projects (SDEPs). The hours were based on the recommendation of the ACR for continuing education for physicists but the ACR also recognizes category 2 credits for half of the number. This was pointed out to the ABR Physics trustees by the Task Group and, as this seemed reasonable, the requirements were recently modified to: 250 hours of category 1 credits and, 250 hours of category 1, category 2 or SDEP credits over the ten year period. Examples of category 2 credits and SDEPs are provided at http://www.theabr.org/RP_MOC_ Req.htm.

This change was made in January 2007 so this may be breaking news to some.

Self Assessment Modules (SAMs) A second ingredient of Part 2 relates to Self-Assessment and consists of educational modules to provide in-

20

dividual assessment and direction for further educational activities. These modules will be approved for category 1 credit and count towards the 500 credits noted above, also. The modules consist of the usual educational lecture but associated with it are a minimum of five questions to be answered on the topic. To gain credit for a SAM, an individual must answer each question to the best of his/her knowledge. Feedback relating to the correct answer and an explanation of the choice is to be provided, as well as the performance of the group. The requirement is a total of 20 SAMs within the ten year period with at least 1 per year.

To this end, the AAPM will initiate the first SAM type sessions at the 2007 Annual Meeting. There will be separate sessions identified as such for Diagnostic, Nuclear Medicine, and Radiation Therapy, and an audience response technology will be used. Credits for these sessions are available only to attendees who pre-register for the modules. No SAM registration will be offered on-site in Minneapolis. Each individual wishing to participate in the session will “rent� a keypad (a nominal fee of $10 plus a deposit, which will be returned once the keypad is returned). This will be a first for the AAPM and should be interesting.

Please note that the SAM sessions are open to everyone, but only those preregistered for the audience response technology will be eligible to receive an interactive response unit. Questions will be asked during the SAM sessions, and participants must answer each question in order to receive certification. There is no pass/fail; the fundamental idea is to assess knowledge gained during the session.

(see Yester - p. 22)

AAPM Newsletter

March/April 2007

Workgroup on Clinical Trails update The following is another in a series of articles on issues related to quality assurance for clinical trials by the AAPM Work Group on Clinical Trials.

The author, Jean Moran, is chair of TG113, Physics Practice Standards for Clinical Trials.

Report on the January RTOG Meeting The January meeting of the Radiation Therapy Oncology Group (RTOG) held in Tampa included many discussions among physicists that involved balancing tradeoffs between data consistency for clinical trials using advanced technologies and encouraging participation among centers with different resources and equipment.

This article reports on the one-day Advanced Technology Consortium (ATC) meeting and the three-day RTOG meeting that followed. Both meetings focused on a broad range of topics of interest to physicists.

The ATC for Clinical Trials Quality Assurance (QA) is supported by a National Cancer Institute (NCI) U24 grant to Washington University (Dr. James Purdy, P.I.). It functions as a “virtual entity” made up of the following clinical trials QA Centers: (1) Image-Guided Therapy QA Center (ITC – Washington University in St. Louis and UC Davis); (2) Radiation Therapy Oncology Group (RTOG) Headquarters Dosimetry Group, (3) Radiological Physics Center (RPC, M.D. Anderson Cancer Center), (4) Quality Assurance Review Center (QARC), and (5) Resource Center for Emerging Technologies (RCET – University of Florida - Gainesville).

It capitalizes on the existing infrastructure and strengths of national QA programs. The overall mission of

the ATC is to facilitate and support NCI sponsored advanced technology clinical trials, particularly those requiring volumetric digital data submission. ATC coordination and service efforts include (a) elimination of duplication of efforts and facilitate sharing of QA resources among cooperative groups; (b) assisting Cooperative Group’s in protocol development, particularly credentialing requirements; and (c) managing and facilitating protocol digital data submissions, credentialing, QA review, and data analysis.

Developmental efforts include (a) electronic data exchange of digital planning data between protocol participating institutions and ATC QA Centers.; (b) web-based software tools to facilitate protocol digital data submissions and QA reviews; and (c) archival treatment planning & QA databases that can be linked with cooperative group’s clinical outcomes database.

The ATC continues to make progress on several frontiers. Almost 5,000 digital submissions have been received by the ATC for patients on clinical trials. By using digital data, investigators can continue to improve the quality of the information that can be gained from clinical trials. For example, digital data permits investigators to explicitly evaluate the relationship between patient outcome and dose quantitatively.

Internationally, the ITC is continuing its support of digital submission for trials in Canada and now in Japan with the Japan Cooperative Oncology Group (JCOG). Other efforts include working on QA for the use of protons in clinical trials and streamlining of the accreditation/ credentialing process for IMRT and other advanced technologies.

21

A number of challenges face the RTOG, ATC and the medical physics community. For example, 1) How should the accuracy and quality of motion management be assessed for clinical trials? What information is needed? How should a center’s ability to localize moving tissues such as for lung and liver be assessed: on an individual patient basis, in a moving phantom, or in both situations? Each vendor supplies its own solutions, methods, and export capabilities in dealing with motion.

The RTOG and ATC must be able to assess and quality assure these methods in the context of clinical trials.

Methods must address a range of imaging tools (e.g. electronic portal imaging, cone beam CT) and different delivery systems (e.g. conventional linear accelerators, Tomotherapy, and Cyberknife).

2) What methods should be approved for review of images fused for pre-treatment localization?

Current methods of image fusion review for localization for RTOG protocols are cumbersome, requiring screen shot captures and a lengthy review by an expert physicist for the RTOG. These methods are only qualitative although physicians and physicists need to be able to quantitatively judge the appropriateness of the margins for stereotactic body localization. New methods are now being put into place at RTOG Headquarters to allow the registration of images to be rerun directly as credentialing process.

3) How should registration and data fusion be judged for multimodality target definition in clinical trials? For example, there are two protocols involving PET (RTOG

(see Workgroup - p. 22)

AAPM Newsletter

March/April 2007

(from Workgroup p. 21)

from clinical trials. The RTOG Lung Committee worked well into the night grappling with this issue so that developing protocols for stereotactic lung protocols can move forward as quickly as possible.

0522 and 0515). The current credentialing approach requires joint accreditation by the RTOG/ITC and ACRIN (American College of Radiology Imaging Network).

Collaboration with ACRIN avoids having to duplicate this groups established credentialing capabilities. However, there are discussions underway to investigate the possibility of either expanding RPC capabilities or forming a separate group to perform credentialing and general QA activities for the imaging component of cooperative group protocols.

Also, the ATC is investigating ways to streamline the credentialing process so that it does not impede participation and accrual of patients on clinical trials. Task Group No. 132: Use of Image Registration and Data Fusion Algorithms and Techniques in Radiotherapy Treatment Planning will also be addressing some of these issues.

4) Finally, what dosimetric criteria should be set for heterogeneous dose calculations?

Recent RTOG protocols have incorporated heterogeneity calculations into the design of clinical protocols. The RPC has developed a benchmark phantom for assessing the accuracy of heterogeneity calculations. A major concern from the recent dosimetric phantom evaluation by the RPC is the inaccuracy of pencil beam and scatter calculation methods for heterogeneity calculations.

Convolution/superposition models are more accurate if the treatment beams are correctly modeled. Decisions about the criteria for agreement and the acceptable dose calculation methods will have strong implications for the accuracy and quality of the data

Many of the RTOG Committees are disease site specific.

Within meetings of these site committees, efforts are also focusing on ensuring consistency of target volumes. These efforts are critical in ensuring consistency for patients treated on clinical trials to benefit from improvements in treatment delivery localization. Both the prostate and breast groups met to create consensus on how targets should be drawn. The breast group, led by Dr. Julia White, held a working meeting on creating an anatomical atlas that can be used by all centers participating in RTOG trials.

Several physicians contoured volumes prior to the meeting and then met to review their contours. In addition to discussing anatomical boundaries of the relevant structures, the group also discussed how the clinical target volumes and planning target volumes should be defined for trials involving breast treatments.

Approximately 50 physicists attended the Medical Physics Committee meeting that took place at the RTOG Meeting. It was clear that the number of physicists involved in the development of RTOG and other cooperative group protocols is not large. Increasing physicist involvement in this important and rewarding effort is critical in this time of rapid technological advancement. Medical physicists interested in clinical

22

trials should monitor the progress of the Work Group on Clinical Trials and the Task Group on Physics Practice Standards for Clinical Trials. In addition, there will be a continuing education course that addresses many of these issues and the impact on clinical trials at this year’s AAPM Annual Meeting.

(Yester from pg. 20) For those individuals unable to attend the meeting, the sessions will be captured as part of the AAPM Virtual Library and will incorporate time for the individual to answer the questions and feedback will be provided. So viewing the session on line will count as a SAM as part of the On-line Continuing Education portal of the AAPM. Part 4: Concerning Part 4, Per Halvorsen leads a subgroup of TG-127 that has been working on a proposal for meeting this requirement that takes into account the role of a physicist in the clinical environment. The proposal is currently being assessed by the ABR Physics Trustees. As details come forth they will be announced.

There is a section of the BBS part of the AAPM web-site that is dedicated to MOC. Per Halvorsen updates the site as needed and checks the site for questions and concerns that arise. That area and the ABR website given above are good repositories for up-to-date information.

AAPM Newsletter

March/April 2007

Chapter News Southern California Chapter Hosts All Day Meeting Marianne Plunkett Chapter President & Steven Goetsch Education Chair

T

he Southern California Chapter hosted its annual Midwinter Workshop at the Sheraton Universal Hotel in Los Angeles on Friday, January 19, 2007. The topic this year was “Physics at the Dawn of the 21st Century”. We were honored to have PresidentElect Jerry White give an address entitled “Healthcare Financing in the United States: A National Disgrace”. An all-star group of faculty included Karyn Goodman of Stanford University, Jatinder Palta from the University of Florida, Rock Mackie from the

University of Wisconsin, Olivier Morin from the University of California San Francisco Medical Center, and chapter members Tim Paul from Ironwood Cancer Center and Arthur Olch from Children’s Hospital of Los Angeles. Topics covered included robotic radiosurgery for pancreatic cancer, startup for a proton therapy center, adaptive radiation therapy, cone beam megavoltage CT, QA for radiation oncology trials and IGRT in the community. In addition, six of the Platinum vendors gave 10-minute presentations.

Approximately 100 people attended the all day meeting, which precedes the LARS/ASTRO meeting in the same hotel on the following two days. The meeting was well supported by nine Platinum sponsors and twelve

Gold sponsors, along with a registration fee. Continuing education credits were granted by CAMPEP, MDCB and ASRT. Medical physics and radiation therapist students attended for free. Photographs of the meeting are available now on the chapter web page: www.sccaapm.org Talks from each of the speakers are being collected in Powerpoint and Adobe Acrobat format and will be posted on the Educational Materials tab of the Southern California Chapter’s web page. The Midwinter Workshop is an annual event which has been held for close to 20 years and should be held during the same time frame next year.

The meeting is open to Physicists from all over the country.

Chapter President Marianne Plunkett is presenting an IPOD to Abiel Ghebrenmedhin from Loma Linda University Medical Center. He was the winner of a random drawing to encourage attendance.

23

AAPM Newsletter

March/April 2007

The National Patient Safety Foundation and the American Association of Physicists in Medicine Announce a Request for Proposals in the Area of Patient Safety in Radiation Medicine Funding is available for the support of up to three demonstration sites for the application of hazard reduction and patient safety techniques in radiation medicine. Proposed techniques must reflect hazard reduction and patient safety methods proven to be of value in industry and accepted as beneficial in hazard reduction. No proposal may exceed $10,000 total cost, and no indirect costs will be paid. The Principal Investigator’s salary and benefits may not exceed 50% of the total budget. a. The project must focus on a particular tool or set of hazard-reduction patient safety tools and metrics to evaluate the effectiveness of the tools, and must include the preparation of a training document describ ing the implementation of the tool or set of tools in a radiotherapy facility. b. Proposals will be reviewed by a Committee of the Working Group on Prevention of Hazards in Radiation Oncology. c. Up to three grant proposals felt to be the most promising and well conceived will be selected for funding. d. The projects will run for two years: six months for preparation, one year for execution, and six months for evaluation of effectiveness. Alternate schedules may be approved based on the particulars of the proposal.

Each investigator will submit an interim report on the project at the end of the first year and a final report within three months of the completion of the evaluation phase.

Proposals will meet the following requirements: no longer than three pages, single spaced, 12 point. Proposals must include the following sections: Title, Principal and Co-Investigators, Objective, Methods, Deliverables and Timelines, Budget and Budget Justification. Proposals must be accompanied by the NIH-style biosketch of the Principal Investigator and key personnel, and must be submitted electronically to Peter Dunscombe peterdun@cancerboard.ab.ca by June 1, 2007. Selected projects will be announced at the 2007 AAPM annual meeting.

24

AAPM Newsletter

March/April 2007

ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Does your facility need help on applying for accreditation with the American College of Radiology (ACR)? Do you have a question about accreditation requirements? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation.” You can also call the Diagnostic Modality Accreditation Information Line at (800) 770-0145. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Priscilla F. Butler, M.S. Senior Director, ACR Breast Imaging Accreditation Programs Q. I had heard that UnitedHealthcare (UHc) will be requiring participating imaging facilities to be accredited in order to be reimbursed for services. What imaging modalities are involved?

A. The following imaging procedures are subject to accreditation: CT, CTA, MRI, MRA, nuclear medicine, nuclear cardiology, PET, and echocardiography. Visit the UHc web site at www.unitedhealthcareonline.com/ b2c/index.do and search on “accreditation” for more information about their accreditation initiative.

need support from their medical physicist as they apply for accreditation.

Q. Will the ACR be able to meet this increased demand for accreditation?

Q. Which of the above ACR accreditation programs require facilities to obtain the services of medical physicists?

A. Yes. The ACR is adding additional staff to its Reston, Va., headquarters to support the anticipated influx of accreditation. In addition, the ACR is seeking applications from both qualified radiologists and medical physicists to be trained as reviewers in the impacted programs. If you are an ACR member and interested in being a reviewer, please contact Lavonne Robbins at lrobbins@acr. org.

A. Facilities applying for MRI, CT, nuclear medicine and PET accreditation must have a qualified medical physicist or (MR scientist, for MRI) conduct an annual system performance evaluation. Please visit the ACR web site for medical physicist qualification and survey requirements for each program.

Q. When do these facilities need to be accredited and how soon should they apply for accreditation?

A. As UHc has mandated accreditation by March 1, 2008, early submission of complete accreditation applications and materials is strongly recommended. Facilities seeking to meet the new UHc requirements should submit accreditation applications by June 1, 2007.

Q. How will this impact medical physicists?

A. UnitedHealthcare is one of the nation’s largest third-party payers.

This new requirement calls for immediate action on the part of thousands of health care facilities across the country. Many of these facilities are not yet accredited and they will

2007 AAPM Summer School Shielding Methods for Medical Facilities: Diagnostic Imaging, PET and Radiation Therapy July 27-29, 2007 St. John’s University • Collegeville, MN

http://www.aapm.org/meetings/07SS/ campus housing is limited; first come, first served

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

25

AAPM Newsletter

March/April 2007

Letter to the Editor Peter R Almond Houston, TX palmond@mdanderson.org

I

always enjoy reading Howard Amols’ columns in the Newsletter and was struck by his concern that, “The medical physicist is starting to look more and more like a technician, and less and less like a scientist.” (Newsletter, November/December 2006). I have the privilege of teaching first and second year graduate students in a medical physics program and I ask each class how they define a medical physicist. Invariably I get answers like; “A medical physicist calibrates treatment machines.”

“A medical physicist carries out quality assurance on imaging equipment.” Some of the brighter students may give answers such as: “A medical physicist develops new treatment planning programs.” Or “A medical physicist devises new imaging techniques.” None of these answers, however, gives us a definition of a medical physicist. It is a common mistake to define who we are by saying what we do, whereas, in fact, it must be the other way round. What we do is determined by who we are. We are in fact physicists; medical is the descriptive adjective that indicates the area in which we apply our physics knowledge. For me the basic understanding of a medical physicist is this: When presented with a problem we must analyze and seek solutions to that problem using basic physics principles and our training as physicists in

the area of medicine. Our clinical colleagues will approach the same problem from their perspective and training in medicine. The solution comes from our collaborative work on solving the problem. This definition is true of all professions and in my mind determines what a professional is. Although some of the solutions we arrive at with our medical colleagues may ap-

pear to become routine, nothing in the medical arena should be taken as routine, since eventually everything comes down to the unique concerns for the individual patient. As medical physicists we must constantly think about the consequences of our decisions. What we do is determined by who we are.

D O YOU SEE WHAT WE SEE? THERE IS MUCH MORE TO THIS PHANTOM THAN MEETS THE EYE. The 467 Tissue Characterization Phantom provides a faster and easier method for tissue variation corrections in isodose treatment planning and it allows you to “see” more for reliable dose calculations. It offers a wide range of densities in the bone and tissue rods and data obtained using the phantom can easily be transferred to your treatment planning system to correct for tissue inhomogeneities.

But we don’t stop there — we also provided an innovative method for verifying CT scanner distance measurement. An optional titanium insert rod can expand the range and utility of the phantom even further.

As a result, you get more reliable dose calculations, more tissue characterization in the sample variety and more performance with our Solid Water® base. It’s more of what you’d expect from Gammex. For more information on the 467 Tissue Characterization Phantom, contact Gammex today at 1-800-GAMMEX 1 (426-6391).

GAMMEX RMI® P.O. BOX 620327 MIDDLETON, WI 53562-0327 USA 1-800-GAMMEX 1 (426-6391) 1-608-828-7000 FAX: 1-608-828-7500 EMAIL: SALES@GAMMEX.COM

26

GAMMEX–RMI LTD KARLSRUHE HOUSE 18 QUEENS BRIDGE ROAD NOTTINGHAM NG2 1NB ENGLAND (++44) (0) 115-985-0808 FAX: (++44) (0) 115-985-0344 EMAIL: UKSALES@GAMMEX.COM

GAMMEX-RMI GMBH MAINZER LANDSTRASSE 176 60327 FRANKFURT/M GERMANY (49)(0)69-97 35 8-110/122 FAX: (49)(0)69-97 35 81 01 EMAIL: DESALES@GAMMEX.COM

w w w. G A M M E X . c o m

AAPM Newsletter

March/April 2007

Memorial lege in 1968 and earned his PhD in High Energy Physics from the University of Chicago. Following four years of postdoctoral research in High Energy physics, Leon took a two-year postdoctoral fellowship in Radiation Therapy Physics at the University of Chicago, where he subsequently joined the Medical Physics faculty.

Leon C. Myrianthopoulos 1946- 2006

L

eon Myrianthopoulos, a medical physicist and educator at the University of Chicago, passed away on October 17, 2006 after a brief and heroic battle with pancreatic cancer.

Born in Cyprus on 15 August, 1946, Leon received an undergraduate degree in Physics from Dartmouth Col-

A dedicated Radiation Therapy Physicist, he was meticulous in his clinical work gaining the reputation that his calculations were always correct. A superb teacher who was passionate about his work and highly praised by medical physics graduate students and radiation therapy residents, he is the only Physics faculty to receive the Samuel Hellman Resident Teaching Award. Leon aspired to spend his years in retirement applying his skills to teach-

ing less fortunate inner-city youth in Chicago. In memory, his family has established a fund at the Inner-City Teaching Corps, https://app.etapestry.com/hosted/InnerCityTeachingCorp/OnlineGiving.html a charity that embodies his aspirations.

Leon is survived by his devoted wife, Maria, and loving daughter, Thalia.

In Cyprus, he leaves behind his 88year-old mother, Marika, and brother, Ntinos.

We, who were privileged to know and interact closely with Leon, will remember him as the ultimate gentleman, always calm and collegial, extremely conscientious and respected by his friends and colleagues.

Franca T. Kuchnir and Chester Reft University of Chicago, Chicago, Il.

How do I register for SAMs sessions/credits at the 2007 AAPM annual meeting?

1. Pre-register for the annual meeting by visiting www.aapm.org/meeting/07AM. You will not be able to register for SAMs on-site. If you have already registered for the annual meeting, but did not register for SAMs, you can still add SAMs to your registration by calling 1-508-743-0124.

2. During the registration process, you will be asked if you require Maintenance of Certification (MOC) as defined by ABR. Say YES. 3. You will be given the option to register for SAMs sessions ($10).

4. When you arrive at the Minneapolis Convention Center to pick up your badge and program materials, you will be given a ticket for your audience response unit. Exchange your ticket for the audience response unit at the SAMs counter.

NOTE: You will be asked for credit card verification. In the event you do not return your audience response unit, your creditcard will be charged $75.

5. Go to the SAMs sessions of your choice. There will be 8 sessions (total) offered in the categories of Diagnostic, Medical Nuclear and Therapy Physics. We’ll post the list of SAMs sessions in May, and send an email to all AAPM members.

6. During a SAMs session, the speaker will ask interactive questions. You will be able to respond using your SAMs audience response unit. The audience feedback will appear in real time on the screen.

7. At the end of the meeting, please return your audience response unit to the SAMs counter.

8. A list of all SAMs participants will be provided to the ABR. AAPM will send an email confirmation to all participants follow ing the meeting. The email will confirm your name has been forwarded to the ABR as a participant in MOC, but you are also responsible for self-reporting this activity.

Don’t require Maintenance of Certification, but still want to sit in on a SAMs session?? No problem. The sessions are open to everyone. An audience response unit is not required to attend.

27

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

PRINT SCHEDULE • • • •

The AAPM Newsletter is printed bi-monthly.

Next issue: May/June Submission Deadline: April 15, 2007 Postmark Date: May 25, 2007

American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846