AAPM Newsletter May/June 2007 Vol. 32 No. 3 by AAPM Docs

Newsletter

AMERICAN ASSOCIATION OF PHY SICISTS IN MEDICI N E VOLUME 32 NO. 3

MAY/JUNE 2007

AAPM President’s Column details here, but comprehensive information on the bill has appeared in the AAPM newsletter before, most recently in the past two newsletter columns of Lynne Fairobent, the AAPM’s Legislative and Regulatory Affairs Manager.

Mary K. Martel UT MD Anderson Cancer Center

he CARE bill, licensure, ABR requirements to sit for the board exam, and pathways into medical physics (specifically clinical training): all are interlocking issues that will and must come together over the next few years, due in large part to on-going efforts on several fronts in the AAPM over the past decade. This year in particular is a crucial one; let me explain in a little more detail in this column. CARE Bill You may have heard of the CARE bill, probably because it has been around for at least eight years. It has a very good chance of being passed by both houses of Congress this year. This optimism stems from the successful passing of a form of the bill by the Senate in December ’06, and the introduction of the bill into the House of Representatives in January ’07. The history is more than a bit complicated and I leave out many

To briefly recap, CARE stands for “Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy” Bill (www.thomas.loc.gov). To quote from Lynne Fairobent’s presentation at the Spring Board meeting: “The CARE bill will require that providers utilize individuals, who meet Federal education and credentialing standards, to perform the technical components of medical imaging and radiation therapy in order to participate in federal health programs such as Medicare, Medicaid and other programs administered by the Department of Health and Human Services (HHS). 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.” The passage of this bill will require the Secretary of HHS to work with expert advisors to develop standards. The “experts” are the Alliance for Quality Medical Imaging and Radiation Therapy, a coalition of 18 health care professional organizations (instrumental in the CARE bill development). Our AAPM representatives have been Jerry White,

David Keys and Jeff Masten, and with the Alliance, have been working to develop revised standards or regulations that will be submitted to HHS after the CARE bill has been enacted. Current regulations were published in 1985, and we all know these need updating! And so, the standards coming from HHS will need to be adopted by the states in order for providers in those states to participate in federal health programs. It is vital that the AAPM influence the new standards, in particular with recommendations to include requirement of board certification and, probably, licensure. Licensure Efforts A joint medical physics licensure subcommittee of the Professional Information and Clinical Relations committee (PICR) of the AAPM and the Board of Chancellors of the ACMP

(see Martel p. 17) TABLE OF CONTENTS ‘07 Award & Honor Recipients Chairman of the Board Column Executive Director’s Column Editor’s Column Professional Council Report Science Council Report CAMPEP News Education Council Report Health Policy/Economics Leg. & Reg. Affairs Incident Report Chapter Programs Chapter News MOC update ACR Accreditation FAQS Letter to the Editor

p. 2 p. 3 p. 4 p. 5 p. 6 p. 7 p. 8 p. 11 p. 12 p. 13 p. 14 p. 18 p. 19 p. 21 p. 25 p. 26

AAPM Newsletter

May/June 2007

Congratulations to the recipients of the following awards, achievements and honors in 2007! William D. Coolidge Award is presented to: Arthur L. Boyer, PhD

Achievement in Medical Physics Award is presented to: Lawrence N. Rothenberg, PhD and Marilyn Stovall, PhD

AAPM Medical Physics Travel Grant is presented to:

AAPM-IPEM Medical Physics Travel Grant is presented to:

Sonja Dieterich, PhD

George A. Sandison, PhD

Honorary Membership is awarded to: Donn Brascho, MD

Farrington Daniels Paper Award (dosimetry) is given for:

Sylvia Sorkin Greenfield Paper Award (non-dosimetry) is given for: “SemiSPECT: A small-animal single-photon emission computed omography (SPECT) imager based on eight cadmium zinc telluride (CZT) detector arrays” by H. Kim, L. Furenlid, M. Crawford, D. Wilson, H. B. Barber, T. Peterson, W. J. Hunter, Z. Liu, J. Woolfenden, and H. Barrett. Med. Phys. 33, Num. 12, 4590 (2006)

“AnEGSnrc investigation of the PTP correction factor for ion chambers in kilovoltage x ray²” by D. J. La Russa and D. W. O. Rogers. Med. Phys. 33, Num. 2, 465 (2006)

(see Awards - p. 27)

AAPM Newsletter

May/June 2007

Chairman of the Board’sColumn Column AAPM President-Elect’s

E. Russell Ritenour Minneapolis, MN

he Board of Directors of the AAPM held a Long Range Planning Meeting on Saturday March 31 at the Crowne Plaza O’Hare Airport Hotel. No one present could recall the Board having held such a meeting before. Sometime in the 1980’s there was a Board Retreat with a facilitator. But, this was the first long range planning meeting, probably since the first few AAPM Board meetings nearly fifty years ago. I assume that there was some long range planning at that time. I doubt that they would have predicted the size, the budget, and full-time staff support that we have today. I know I’m not going to try to predict fifty years into the future. That’s awfully easy to do, but hard to do correctly. After all, I’m still waiting for the atomic powered flying cars that I was promised for the 21st century back in the fifties. The first item that we dealt with wasn’t exactly “long range,” but it fits into some long range goals we have discussed at previous meetings. We are trying to make the Board more active than reactive. Rather than have the Board meet on Wednesday and deal with items that were brought forward from committee and council meetings that took place a few

days before, we are requiring that action items be presented to the Board at least two weeks before a meeting. We are also providing monthly mailings to the Board to keep them up to date on issues that arise between meetings. A lot of committees are taking advantage of conferencing and document sharing capabilities through WebEx that AAPM provides. So they often have action items coming up at different times of the year. These items now go into the monthly Board Bulletins and the Board gets the time to consider and discuss, via the BBS, what action might need to be taken. At the RSNA, many of the Board members would prefer not to stay through the week to wait for the Board meeting. So, at our March 31 meeting, the Board voted to move the RSNA Board meeting to the Saturday before RSNA. Committees will still meet on Saturday and Sunday, but to work on their projects, not to take items to the Board that same week. Next, we discussed the implications of the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE) bill that is currently before congress. All indications are that it is not seen by anyone in congress as controversial and that it will therefore pass in 2007. CARE will require that providers of medical imaging and radiation therapy meet certain professional standards. The bill includes medical physicists but specifically excludes physicians, nurses, and nurse practitioners. The CARE bill does not mandate licensure. However, licensure or at least registration of medical physicists is a way that the states could meet the standards of the bill. If states do not meet

the standards of the bill then they would be ineligible for Medicare funding. Therefore, we see forty-six states having a high probability of enacting such legislation over the next 2 – 5 years. We certainly want to have a say in how the legislation is written. Jeff Limmer chairs the Joint Medical Physics Licensure Subcommittee which operates under the Professional Information and Clinical Relations Committee. It is a joint committee with the ABMP. The Board has directed Jeff ’s committee to look into ways that the AAPM can work with members in each state, providing them with information that they can take to their legislators and also coaching members on effective methods for communicating with their legislators. Jeff ’s committee will coordinate its efforts with the Government and Regulatory Affairs Committee (chaired by Ralph Lieto) and will report to the Board at our Minneapolis meeting. We’ll be looking to the chapters to help identify people who would go to meet with legislators, speak at hearings, etc. Legislators will want to hear from their constituents, not from someone who flies in from another state. So it is imperative that we find individuals in each state who are willing to spend time with their legislators and their staff. This will be interesting. We then turned our attention toward pathways into medical physics. The American Board of Medical Specialties is putting some pressure on the American Board of Radiology to require applicants to all of its exams to have completed an accredited residency program. So, the ABR in 2000 set 2012 as a deadline by which all medical physicists, in order to be eligible to take the Board

(see Ritenour p. 26)

AAPM Newsletter

May/June 2007

AAPM Executive Director’s Column • • •

Angela R. Keyser College Park, MD AAPM Reception during RSNA Meeting ark your calendars! The AAPM Tuesday evening reception during the RSNA meeting is back on! Plan to join your colleagues on Tuesday, November 27, 2007 at the Chicago Hilton.

AAPM Online Directory AAPM’s Membership Directory is now available via PDF. There are two versions of the Directory PDF, one optimized for printing and another which replicates all the information in the original printed directory. Both of these, along with printing instructions, may be found at the url below: http://www.aapm.org/memb/directory/pdfdirectory.asp We estimate the cost of printing for the optimized version to be approximately $37.00 and the full directory to be approximately $60.00 ($50.00 when using 100% recycled paper).

4 members have clicked on the “FedEx Kinko’s” link to print a PDF directory 707 members downloaded the full directory since it was posted on 3/20/07. 349 members downloaded the al pha/geo (for print) directory since it was posted on 3/20/07

Meeting News The program for the 49th AAPM Annual Meeting is now available on line. The meeting will be held July 22 – 26 at the Minneapolis Convention Center in Minneapolis, Minnesota. Dates to remember: • Register by June 1 to receive discounted registration fees. • June 25 is the last date to make housing reservations at the con vention rate. • Pre-registration for the meeting closes on June 25. 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.” Make sure you register by JUNE 6 to receive discounted registration.

Staff News Hadijah Robertson, AAPM’s Meeting Assistant, has announced her engagement to Musa Kagolo. They will be married in Atlanta, GA over the Memorial Day weekend. Jennifer Davis, AAPM’s Membership Services Coordinator, and her fiancé, Brad Hudson, will be married on June 9. It is with great pride and pleasure that I announce that Karen MacFarland has recently received the designation of “Certified Meeting Planner” (CMP). The CMP designation recognizes those who have achieved the meeting industry’s highest standard of professionalism. The requirements for certification are based on professional experience and an academic examination. Karen sat for her “CMP” exam in January, 2007. Karen now joins an elite group of professionals! I’m sure you will join me in offering Karen our most sincere congratulations! Laurie Hayden joined the AAPM team on April 2, 2007 as the new Customer Service Representative. Laurie comes to AAPM with over 20 years of administrative experience with a Rockville, MD law firm. Laurie fills the position vacated by Seana Miller at the end of January.

Because of SPAM concerns, members have the opportunity to opt out of including their email address in the directory PDF. As of April 3, 2007: • 86 members have elected not to have contact information listed in the AAPM Directory • 276 members have elected not to include their email address in the PDF directory

AAPM Executive Director Angela Keyser presents Karen MacFarland, Meetings Manager, with flowers to congratulate Karen on receiving her “Certified Meeting Planner” designation.

AAPM Newsletter

May/June 2007

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

ow that the newsletter survey has been open to readers for nearly two months, I want to thank all of you who responded to the survey. I was pleased to see the response rate is nearly 20%, which is fairly high when compared to the approximate 30% response rate to the AAPM annual elections. Speaking of the AAPM elections, by the time you read this column, you will most likely have received the notification about the AAPM elections. I would like to remind the readers about their civic duties to participate in the election process. Our complaints or suggestions will be effective only if we actively participate in the election process.

be able to adopt/implement all of your suggestions, however, I shall keep in mind and will attempt to incorporate as many as possible into future issues. Two comments that reoccurred frequently were:

were many suggestions regarding the newsletter presence on the web. Based on the website traffic to the newsletter, I will attempt to accommodate most of the suggestions within reasonable cost and effort.

1) Shorter articles - I am working on setting page/word limits on certain regular columns.

In this issue, I would like to draw your attention to two new programs AAPM is planning to fund or host. One of them is the program to reimburse local chapters for expenses incurred in bringing external speakers, putting materials in the virtual library with the sole purpose of providing CAMPEP credits to the AAPM members (for details read Dan Pavord’s article) and the second is the development of ‘Focused Research Meetings (FOREMs)’ to potentially attract researchers to AAPM (for details read John Boone’s article).

2) Timeliness - There were many comments about the newsletter reaching the membership in the middle of the period. As I mentioned in my previous column, we are in the process of changing the print schedule and targeting the July/Aug issue to arrive at your desk during the first week of July. The newsletter is posted on the AAPM website as soon as the print version is ready. Nearly 82% of those who read the online version of the newsletter preferred PDF format. Thanks to the website editor and web staff, now we can navigate to the articles from the table of contents directly instead of paging through the entire newsletter. There

2007 AAPM Summer School

APM

We are still compiling all of the suggestions and comments from the newsletter survey. Some of the highlights include: * Nearly 82% of survey participants read 75% of the newsletter articles. * Nearly 89% of survey respondents read and preferred the print version of the newsletter. As the saying goes, ‘You build it, they will come’, we asked for your response and we got many useful suggestions and comments. We may not

Finally, I would like to congratulate and wish the best for our sister organization, the American College of Medical Physics (ACMP) on its 25th birthday celebration this year (24th Annual meeting of ACMP, May 2629, 2007, Baltimore, MD).

AT THE

ABBEY

Shielding Methods for Medical Facilities St. John’s University • Collegeville, MN July 27-29, 2007

AAPM Newsletter

May/June 2007

Professional Council Report lations to implement the intent of the Act. This is where the specifics for training and experience will be published. The AAPM and other members of the Alliance have been working on draft documents for HHS for many years in preparation. Eventually, each of the states will have to abide by this legislative text.

Michael Herman Professional Council Chair Council Retreat he Professional Council has its retreat scheduled for the end of May this year. We invite each of you to submit items for discussion that pertain to our profession or specifically to any of the member committees of the PC.

A Seat at the Table There exists an array of federal agencies that influence our practice, our education and our science. The AAPM is making ongoing efforts to nominate medical physicists for various advisory groups to these federal agencies. The advisory boards provide direct guidance to the agencies that create health care policy, regulation and influence scientific research and funding (e.g., CMS, NIBIB, NCI, NRC, etc). We attempt to coordinate nominations with other associations (ACR, ACMP, ASTRO, ABS, etc.) to increase our visibility. CARE Lynne describes the current status of the CARE bills, now in both houses of Congress in her column. After the act passes Congress (which has a very good chance this year), the Department of Health and Human Services will be directed to develop the regu-

As the AAPM Board reviewed this very important issue at the spring meeting, explicit messages were developed for the Joint Medical Physics Licensure Sub Committee (JMPSC) and for ALL AAPM members. Each of the United States is unique and AAPM members in each state will have to mobilize to guide proper state adoption of the HHS text. Each of us should consider how we might contribute. The JMPSC will help provide the guidance and resources for action within each state. Specifically, the JMPSC will describe the current viable mechanisms for licensing and regulation that would satisfy the legislation, develop guidance on political interaction, provide educational material for state regulators/legislators, and educate AAPM membership. It is worth restating that AAPM member constituents in each state must do the presentation to the state legislators and regulators. Individuals must be identified to take the lead in each state. If you are one of those people, please identify yourself to Jeff Limmer now. Crucial Role of Medical Physicists For a number of reasons, PICR was asked to develop an AAPM position statement on the crucial role of medical physicists in providing quality medical care. This document is being drafted and is essentially based on the AAPM definition of

a qualified medical physicist and the AAPM-ACMP Scope of Practice of Medical Physics (PP 17A). Accreditation Guidance Recently AAPM was asked by the Intersociety Accreditation Commission (IAC) to provide guidance on accreditation of imaging equipment. Medical physicists actively participate in practice accreditation with ACR and ACRO. The IAC represents a new and perhaps growing need for guidance on the components of accreditation that fall under the domain of medical physics. To this end, PICR has been asked to develop a strategy to provide guidance to any accrediting body relative to essential medical physics procedures and performance. Professional Survey The annual survey collects a lot of meaningful data for our membership. The survey validation working group is working toward developing methods that will make the AAPM survey a more valuable and trusted account of compensation. Ethics Guidelines New ethics guidelines for the practice of medical physics are currently before the BOD and will be published as PP 8C. The Ethics Committee continues to develop a new comprehensive Code of Ethics as well (TG109). Professional Economics Wendy reviews revised clinical trials policy for Medicare to potentially expand payment for services delivered to patients on clinical trials in her column. Abt Survey The third Abt survey goes out, with expanded and clarified questions. (see Herman - p. 9)

AAPM Newsletter

May/June 2007

Science Council Report

John M. Boone Science Council Chair

any members of the Association have attended numerous AAPM annual meetings over the years. They have been getting bigger – more attendees, larger venues, more parallel tracks, more days. Do you spend your time getting the requisite CME’s, check out a scientific track of interest, or sit by the pool and talk to an old friend? – It gets harder to choose as the number of options increases. These are the realities of a successful meeting of a society which specializes in a number of scientific disciplines which have increasing relevance in medicine. But is a bigger meeting actually better? Given the fact that the fiscal proceeds from the annual meeting are a major source of revenue to the AAPM, the answer is simple – bigger is more profitable, and that is better. A more prosperous AAPM benefits all members. Nevertheless, the AAPM annual meeting has grown so large that it is impossible to take it all in. The flip side, of course, is that the meeting has the breadth and depth now to have something for almost everyone. Science Council has implemented a new meeting format which focuses on smaller, more specific, and more in-depth scientific topics. These focused research meetings (FOREMs)

are not hosted by the AAPM per se, they are organized at the local level (individual AAPM members or groups of members), and the entire cost of the actual meeting is borne by its attendees – travel, hotel, food, and registration. The AAPM involvement in these meetings is in helping to organize them, capitalizing on the significant experience of the AAPM staff in negotiating with hotels, and in setting up webbased registration and abstract submission systems. While FOREMs are likely to be most attractive to academic members of the society, who can host a small meeting of 20 to 30 attendees on a specific scientific topic using a University-based venue, after a pilot test in the first year, the FOREM structure will be available to all members of the society who chose to utilize it. The details of the FOREM meetings – the what, when, where, why, and who, are up to the host. The AAPM staff will play only a minor supporting role. Initially, we will provide the infrastructure to support only a few FOREMs per year, on a first come, first served basis.

VOTE

If demand for this grows, we will then have to evaluate whether to expand the infrastructure or ration access, or both. The FOREM concept has been discussed amongst the Council leadership and both the Education and Professional councils are potentially interested in participating in this new meeting mechanism. To some extent, the Summer Schools which are hosted by the AAPM through the Education Council are similar in concept, however the FOREM meetings are meant to involve only minimal involvement of the AAPM staff resources, placing most of the organizing effort and all of the fiscal responsibility on the meeting host. The FOREM research meetings are not meant to replace or compete with the AAPM annual meeting. Indeed, there is hope that by bringing in researchers to the FOREM meetings, that this will be a basis for recruiting new AAPM members who may have a more research focus in fields relevant to the AAPM. I will keep you posted on the progress of these meetings in future newsletters.

VOTE

AAPM Election The 2007 AAPM election will open for online voting on June 13, 2007. Paper ballots will be mailed to members who have no e-mail address or a bad e-mail address and members that have opted out of online voting. The deadline to submit your vote electronically or by paper ballot will be July 5, 2007.

AAPM Newsletter

May/June 2007

News from CAMPEP priate new sponsors and how best to approach them.

John Hazle President, CAMPEP

n April 2 the CAMPEP Board, our program review committee chairman and staff that support CAMPEP from the AAPM met in Houston to spend a full day discussing a variety of topics important for defining our future direction. At the end of the day, the consensus was that we had a very productive meeting. The following is a summary of our discussions. I opened the day by getting everyone up to speed on some general CAMPEP business and my priorities for the next year (these were outlined in the last Newsletter). One of our first orders of business was to develop the following mission statement:: The mission of CAMPEP is to promote consistent, high quality education and training of medical physicists from graduate school through professional practice by accrediting graduate, residency and continuing education programs that meet defined standards. We believe this reflects CAMPEPâ&#x20AC;&#x2122;s goal of achieving a level of consistently high training for accredited programs from graduate school through retirement. We discussed the relationship we have with our sponsoring organizations and how these can be improved. We also considered whether CAMPEP should approach other organizations about sponsorship. The decision was to continue to consider who would be appro-

The summaries of recent educational summits were discussed and the role of CAMPEP in several recommendations from those summits considered. We had several discussions about alternate pathways and how CAMPEP can help to facilitate the growth of training programs by accrediting alternate pathways. In general, we want to be flexible in facilitating creative training programs, but the end result must be a product that meets the standards set forth by the community. The most significant indicator that this cohort is meeting those expectations is a high pass rate on certification exams. Cecilia Hunter and Shantelle Corado from AAPM reviewed what headquarters does in administrative support for CAMPEP. This was an eye-opening discussion for many of the CAMPEP attendees. The level of administrative support that AAPM continues to provide us is exemplary and critical to our success over the next few years. The representatives from all the sponsoring organizations wanted to expressly thank the AAPM leadership, membership and HQ staff for this unprecedented commitment to our success. We unanimously decided to continue to leverage this relationship as CAMPEP grows by paying for additional support services from AAPM, rather than trying to develop our own office at this time. A final note on this discussion is that we are planning to install a CAMPEP phone line through AAPM HQ that will be answered by our primary support person, Shantelle, as a new direct way to contact CAMPEP for questions or information. Ed Jackson overviewed the activities of the Graduate Education Program Review Committee. Several programs are in various stages of the process of

accreditation. Further, we are in fullswing of reaccrediting many programs. This committee continues to be very active. Bruce Gerbi reported on Residency Education Program Review Committee activities. There are several programs in various stages of the accreditation process with several others expressing interest. Bruce Thomadsen reported on Continuing Education Review Committee activities including CME gateway access of CAMPEP continuing education credits. We also discussed a request from an Irish institution to accredit a non-North American institution. While there are still several issues to be clarified with respect to our proceeding with this request, we decided to continue to evaluate how this could be done. Hopefully by the next Newsletter we will have a decision and more details about our process for this. Finally, we received a request for assistance in developing a Doctor of Medical Physics professional degree program. While this concept is still in the formative stages, we did decide to establish a dialogue with the institution to assist them in pursing this new degree. General discussions at the education summits and at our retreat have resulted in a model similar to dental school. About three years of didactic training (covering basically the current requirements for an M.S. degree) would be followed by two to three years of clinical training (equivalent to residency) at the end of which time the candidate would immediately sit for their Board exam and move into independent practice. Iâ&#x20AC;&#x2122;ll keep you informed as this progresses. In conclusion, I think CAMPEP is off to a busy year and we look forward to supporting the medical physics community.

AAPM Newsletter

May/June 2007

(Herman from p. 6) This essential survey defines medical physics work effort for all current procedures in radiation therapy. This quantification of effort is required to help justify appropriate staffing and to document the clinical involvement of the medical physicist in high quality patient care. The Professional Economics Committee is beginning to outline the necessary steps to perform a similar survey of work effort for imaging medical physics. Documenting the medical physics effort in imaging procedures is becoming more necessary to help insure high quality patient care in the many imaging studies done annually. If you have an interest in contributing to the AAPM effort for an Abt study for imaging physics, please contact me or Mike Mills. Professional Program 2007 The Professional program is focused on quality and quality improvement. Beginning with the Professional Symposium where a global view of Practice Quality Improvement is reviewed, the program flows through the many component aspects of our practice that culminate with best practice patient care. Monday afternoon, the program continues with establishing clinical procedures, including the huge challenges and balances involved with introducing new technologies. This includes the use and development of technical standards to provide a framework for delivering the best care. Monday closes with the highest rated professional papers delivered in the proffered session. Tuesday begins with the first in a two part series on medical errors, why they occur and how to minimize them. Part 1 focuses on error pathways and their dosimetric impact, including a case study of the Glasgow incident. Tuesday continues with the road to (training and practice of) the medical physicist of the future. The session focuses on CARE, licensure efforts, CRCPD and ABR 2012. The new member sym-

posium closes the day introducing AAPM leadership and providing a practical review of proper methods for applying for a job. The symposium is immediately followed by the highly successful “meet the experts” session, grouped into therapy research, therapy clinical, imaging research and imaging clinical. Wednesday begins with practice performance improvement and how it relates to certification maintenance. It will include education on process control and specific examples for each subdiscipline. Wednesday continues with a symposium on support for staffing and assuring quality in radiation oncology. This includes staff justification, using the Abt survey and approaches to setting tolerances for QA. Thursday begins with part 2 of the errors symposium with a focus on linac error pathways and correspond-

ing quality assurance. Examples from Tomotherapy and CyberKnife will demonstrate the application to special devices. Thursday continues with a discussion on training and documentation with a specific focus on preceptorships. Who can be a preceptor and what is required. The final session is dedicated to performance specification for new equipment purchases. This session provides specific insight into preparing to purchase imaging and therapy equipment, so you will know how to get what you need. Thanks AAPM HQ Staff The Professional Council would like to thank everyone at AAPM headquarters for excellent ongoing support for much of our effort. In particular, Lynne Fairobent for working with us on so many important and sometimes challenging regulatory and legislative issues and Wendy Fuss-Smith for her timely and thorough work on econom-

(see Herman - p. 18)

Professional Symposium Practice Quality Improvement, Global Perspective Professional Program Highlights: •

Establishing clinical procedures, Introducing new technology and developing technical standards

•

Errors - why they occur, how to minimize them, error pathways, c applications of analysis tools

•

Updates on CARE Act, licensure and ABR2012

•

New Member Symposium plus how to apply for a job

•

Meet the Experts: therapy and imaging, research and practice

•

Practice performance improvement for medical physicists preceptorships

ng and assuring quality in radiation oncology cation for new equipment purchases

AAPM Newsletter

May/June 2007

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AAPM Newsletter

May/June 2007

Education Council Report in Boston. Several of their members were very interested in medical physics and the support and programs provided by the AAPM, especially for student and younger members.

Herb Mower Education Council Chair n the previous Newsletter we noted the progress on the physics curriculum by Phil Heintz and his committee. This went to the RSNA Physics Education Conference in February where it was very well received. Being a ‘living document’ it will undoubtedly undergo changes in the future but we hope to keep abreast of things and be more proactive in this. As things progress on this front I expect that Phil and his committee will be looking for new and innovative methods of presenting educational materials in radiology residency programs. Let them know if you have any suggestions, techniques or special programs you would like them to consider. Many thanks to Geoff Clarke, Don Frey, John Hazle, Phil Heintz, Bill Hendee, Mark Madsen, Mahadevappa Mahesh, Rick Morin, Ed Nickoloff, Mark Rzeszotarski, Ehsan Samei, Tony Seibert, Keith Strauss and Steve Thomas for participating in the RSNA Conference. A special thanks to those officially representing AAPM at this meeting: Tony Seibert and Ehsan Samei. Lynne Fairobent from headquarters rounded out those from the AAPM.

Thanks to an invitation from Paul Gueye, I had the opportunity to address the Medical Physics Section of the National Society of Black Physicists / National Society of Hispanic Physicists at their recent meeting

I understand that the Summer School Scholarship Committee is presently reviewing the applications for registration assistance to this year’s school. The topic is: Shielding Methods for Medical Facilities: Diagnostic Imaging, PET and Radiation Therapy.” Melissa Martin and Patton McGinley have put together a great program and I look forward to seeing you there. A reminder that our Education Council Symposium at the Annual Meeting this year will be Sunday

morning, 11:00 AM – 12:30 PM at the Annual Meeting. Many thanks to Mary Fox and the Public Education Committee for putting together this year’s program. It 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. As you make your plans for attending the Annual Meeting this year, feel free to include time to drop in on the various task group, subcommittee and committee meetings of the Council. There will also be special sessions for our newer members and graduate students under the auspice of the Students and Trainees Subcommittee chaired by Stephen Kry.

Continuing Education Highlights Therapy Physics Continuing Education Highlighted Courses: 33 Therapy CE Courses, with 8 available for SAMs credit, will be offered at the meeting • • • • • • • • • • •

Daily Localization: kV and MV imaging Protons: Planning and Delivery Functional/Molecular Imaging: PET for planning and assessment Functional/Molecular Imaging: MRI for planning and assessment Use of PET/SPECT imaging in treatment planning optimization 4D Planning and Delivery Patient Motion: Adaptive RT Monte Carlo clinical impact Accurate Clinical measurements QA for IMRT and IGRT QA for clinical trials Diagnostic Imaging Continuing Education The program includes 32 courses covering the physics and technology of all of the imaging modalities, related topics such as radiation and MRI safety and risk management, and a special session on recent activities in Radiology Resident Education. Eight of the imaging courses are available for SAM credit.

AAPM Newsletter

May/June 2007

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

tions may enroll healthy patients in order to have a proper control group.

MEDICARE PROPOSES REVISED CLINICAL TRIAL POLICY

The original NCD limited the payment for items and services provided to Medicare beneficiaries in qualified trials to routine costs. In general, the policy defined “routine costs” as those items and services that would generally be available to Medicare beneficiaries outside the

he Centers for Medicare and Medicaid Services (CMS) recently announced proposed revisions to the Clinical Trial Policy national coverage decision (NCD). Under the Clinical Trial Policy, first developed in September 2000, Medicare pays for certain items and services for Medicare beneficiaries involved in clinical trials. The original Clinical Trial Policy was developed in response to a June 7, 2000 Executive Memorandum, issued by President Clinton, requiring Medicare to pay for routine care costs in clinical trials.

trial. In addition, the original NCD excluded items and services that are the subject of the investigation even if they are covered outside the trial. In developing the revised Clinical Trial Policy, CMS convened the Medicare Evidence Development and Coverage Advisory Committee (MedCAC) on December 13, 2006. The MedCAC proposed several recommendations, subsequently reviewed by a federal

PRECISION DECISION, NO COMPETITION.

In the original NCD, CMS determined the circumstances under which certain items and services would be reasonable and necessary when provided to Medicare beneficiaries in clinical trials. The current policy, unchanged since the original version in 2000, lists three requirements of a qualified clinical trial:

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1) The subject or purpose of the trial must be the evaluation of an item or service that falls within a Medicare benefit category (e.g., physicians’ service, durable medical equipment, diagnostic test) and is not statutorily excluded from coverage (e.g., cosmetic surgery, hearing aids).

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2) The trial must not be designed exclusively to test toxicity or disease pathophysiology. It must have therapeutic intent. 3) Trials of therapeutic interventions must enroll patients with diagnosed disease rather than healthy volunteers. Trials of diagnostic interven-

(see Fuss - p. 20)

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AAPM Newsletter

May/June 2007

Legislative and Regulatory Affairs Column This was the first of four scheduled meetings directed toward specific worker populations. The purpose of these meetings is to give OSHA the opportunity to clarify issues related to OSHA’s regulations and mandate in the regulation of protecting workers from ionizing radiation and to address questions that the stakeholder communities have in an informal setting. Lynne Fairobent College Park, MD CARE Bill Introduced in Senate (S. 1042) S. 1042 was introduced by Senators Enzi and Kennedy on Thursday, March 29. The bill’s title is the “Consistency, Accuracy, Responsibility & Excellence (CARE) in Medical Imaging and Radiation Therapy bill” and matches the version passed by the Senate in December 2006. We anticipate passage in this Congress and working towards quick action on the legislation. Report on the OSHA Meeting March 16, 2007 The Occupational Safety and Health Administration (OSHA) held the first of four stakeholder meetings on March 16, 2007, in Washington, DC. Attending for AAPM were Kevin Buckley, Mike Taylor and Lynne Fairobent. This meeting was a follow up to OSHA’s Request for Information (RFI) on the use of, and potential worker exposure to, ionizing radiation in the workplace (70 FR 22828 5/3/05). For the complete document see: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_ table=FEDERAL_REGISTER&p_ id=18341. AAPM filed extensive comments on the RFI.

OSHA’s mandate established under the Occupational Safety and Health (OSH) Act of 1970 was to minimize the risk of harm to workers and ensure their health in the workplace. In some cases OSHA responsibilities are shared with other Federal agencies, such as the Nuclear Regulatory Commission (NRC), the Department of Energy (DOE), and the Environmental Protection Agency (EPA). Even with the NRC’s increased responsibilities and regulatory activities under the Energy Policy Act; OSHA will still be responsible for worker exposures associated with x-ray equipment or non-radionuclide accelerator production operations. A number of key points are listed below. • Due to emergency technologies, such as intravascular x-ray units in medicine and new security devices, and the proliferation of such devices, OSHA officials believe that the development of new regulations should be considered since the NRC and DOE are only involved with a small aspect of ionizing radiation exposure to workers. Nevertheless, no updating of regulations will be made if current OSHA regulations prove to be adequate. • OSHA officials indicated that they did not intend to duplicate regulations for workers that may

exist under other agencies, such as the NRC. Consequently, OSHA will not move forward with regulation development until the NRC publishes its regulations requirements under the Energy Policy Act of 2005 for accelerator produced radioactive material, and Ra-226 and other discrete, naturally-occurring radioactive sources. • It was also stated that there appears to be no need to modify the current Memorandum of Understanding between NRC and OSHA. • In accordance with the OSH Act of 1970, regulations do not provide for “zero risk” to workers, but will control workplace safety to ensure increased health risks are less than 1/1000. It was also noted that OSHA does not have a concept akin to the NRC’s ALARA philosophy. Consequently, if certain work practices have associated secondary “residual” risks, such as cancer, these risks will have to be considered separately in the regulatory development process. • While cost-versus-benefits analysis is not used to the development of OSHA regulations, feasibility and effects of proposed regulations are considered in the development process. • While Federal facilities adhere to OSHA regulations, only 25 states have comparative OSHA regulations, and any changes to existing OSHA regulations will have to be considered by these states. • It should be recognized that while new standards and technological developments in patient care are changing medicine, OSHA regulatory limits may not change for workers. • Certain medical practices such as interventional radiography result in (see Fairobent p. 22)

AAPM Newsletter

May/June 2007

Incident Report The Radiation Therapy Incident at the Centre Hospitalier Jean Monet, Épinal, France

he ASN [Autorité de Sureté Nucleaire] was informed on July 6, 2006 that 23 patients treated by external beam [radiation] therapy for prostate cancer between May 2004 and August 2005 [at the Centre Hospitalier Jean Monet, Épinal, France] received an exposure at a dose exceeding (by 7% to 34%) the radiation dose initially prescribed 1. A final report 2 was published in February 2007, and details the investigation that was carried out in response to this incident, the most important incident involving radiation therapy that has ever occurred in France. In a communication from the Societé Française de Physique Médicale (SFPM), a technical explanation of the incident was posted on the SFPM website in October 2006. This present report includes a literal translation (NP) of the technical explanation 3 followed by our brief observations. Radiation Therapy Accident at Épinal

• The choice of the box dynamic wedge resulted in the opening of a new window where the choice of the angle for the dynamic wedge could be done, not by checking a box but by selecting the angle value (figure 2). For example, 30°, as shown on the adjacent schematic. Note that the two windows were very similar and that the software was not in French. 2) resources and equipment • 2 treatment machines • 1 physicist • dosimetry is often carried out by radiation therapists: 3 to 4 radiation therapists simultaneously in the “dosimetry-simulator” area, 2 radiation therapists at each treatment machine. • The treatment parameters defined in the treatment planning system (TPS) were entered manually in an in-house “Control and Verification (C&V)” software. In other words, there was no automatic transfer of the treatment parameters between the TPS and the accelerator.

The context 1) the software In the dose calculation software used in the radiation therapy department until 2005, the choice of wedges was displayed schematically as follows: • If one wanted to select a mechanical wedge, one would need to check, in a window, a box indicating the desired wedge angle (figure 1), and in this same window, it was also possible to check another box with a different acronym meaning: “dynamic wedge”. A bit like the adjacent schematic.

Because they confused the two windows defining the wedges, some people thought they were making calculations for dynamic wedges when in fact they were making calculations for mechanical wedges. The result was that the number of monitor units (MU) delivered to the patient was 20 to 30% higher than what it should have been, even though the isodose curves were correct. The parameters entered manually in the “C&V” software were: • Dynamic wedge • MU 20 to 30% too high This affected only one of the two treatment machines. The other treatment machine was using only mechanical wedges. The outcome Over the 107 patients suspected to have been affected by this error, only 23 patients were actually affected, at various degrees because: • Not all of the people doing dosimetric calculations committed the error • Not all of the beams of a treatment plan included a wedge • When used, the beams with a wedge were generally used only for part of the treatment. ----- End of Report ---A review of the final report 2 suggests that the following were important causes of the incident:

Figure 1

• In May 2004, the protocol for conformal radiotherapy for prostate cancer was modified by replacing mechanical wedges with dynamic wedges on one machine only. • The recording of the operations and a written protocol were not done.

Note: Here, dynamic wedge is called

the motion of a jaw in the collimator during irradiation, allowing the deformation of the dose distribution, similar to that achieved by a mechanical wedge.

The error

Figure 2

• Training of the operators on the use of the software was lacking.

AAPM Newsletter • The independent check on the number of MU, and in vivo dosimetry, were not continued for DW treatment because these checks, in the state they were at that time, were not operational for use with dynamic wedges. From the information available following the incident1,2,3, it was not possible to determine the beam geometry, the wedge angle and the beam weights used in these prostate treatments. However, from the wedge factors (mechanical and dynamic) given in the literature 4,5, it is possible to understand the magnitude and direction of the error that occurred during this incident as can be seen below (table). These ratios, given the limited information on treatment technique, are consistent with the overdoses reported in the 23 patients known to have been involved at this time. From the information publicly available for this incident, we conclude that the most significant basic causes are likely to be: 1. a lack of training / orientation with the implementation of a new technique 2. inadequate supervision 3. inadequate quality control

The basic causes of the Épinal incident, if correctly deduced by us, bear a striking similarity to some of those reported with regard to the 2006 incident 6 in Glasgow, UK, in which a 15 year old patient received a 58% overdose to part of the prescribed volume. March 26th 2007 Nicolas Ploquin*, Peter Dunscombe**, Thierry Sarrazin†, * University of Calgary, Department of Physics and Astronomy, Canada ** Tom Baker Cancer Centre, Department of Medical Physics, Canada † Centre Oscar Lambret, Physique Médicale et Radioprotection, Département Universitaire de Radiothérapie, Lille, France References International Atomic Energy Agency (IAEA). Radiological Protection of Patients. URL (March 2007): http://rpop.iaea.org/RPoP/ RPoP/Content/News/3_SevereRadiotherapyAccident23patients. htm

May/June 2007 Wack, G, Lalande F. Résumé du rapport ASN n° 2006 ENSTR 019 – IGAS n° RM 2007-015P sur l’accident de radiothérapie d’Epinal, URL (March 2007) : http://www.asn.fr/sections/rubriquesprincipales/publications/autrespublications/accident-radiotherapied-epinal

Société Française de Physique Médicale, URL (March 2007): http:// www.sfpm.asso.fr/ 4 Cheng CH, Tang W, Das IJ. Beam characteristics for upper and lower physical wedge systems of Varian accelerators, 2003, Phys. Med. Biol. 48:3667-83 3

Klein EE, Low DA, Meigooni AS, Purdy JA. Dosimetry and clinical implementation of dynamic wedge. Int. J. Radiat. Oncol. Biol. Phys., 1995, 31(3):583-92

Scottish Ministers for The Ionising Radiation (Medical Exposures) Regulations 2000. Unintended overexposure of patient Lisa Norris during radiotherapy treatment at the Beatson Oncology Centre, Glasgow in January 2006. URL (March 2007): http://www.scotland.gov.uk/Publications/2006/10/27084909

Table

Wedge Angle

30°

45°

Mechanical Wedge Factor* (MWF) Dynamic Wedge Factor* (DWF DWF/MWF

.633 .830 1.31

.515 .750 1.46

*The wedge factors are given at 10cm depth, for a 18MV photon beams, 10 x 10 cm2 field

AAPM Newsletter May/June 2007 !!0- .EWSLETTER !D PDF 0-

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AAPM Newsletter

(Martel from p. 1) has been formed to work towards a common position in support of licensure. This will include recommending minimum standards for the states, with suggested Acts and Rules for use in promoting the passage of a medical physics licensure law. Promotion of licensure has been an uphill battle in the past, with limited success in just a few states. It has required heroic efforts on the part of local medical physicists, and cash for lobbyists. One can note that the passage of the CARE bill will drive the need for requirement of licensure by the states, and AAPM members will now be able to work on implementation rather than “promotion.” The subcommittee, chaired by Jeff Limmer, has a full agenda and project list to move licensure endeavors forward. Indeed now the question is how the AAPM will interface with each state on this issue on a shortened timetable (due to the CARE bill). This was a topic of intense discussion at the Spring Board meeting, with a suggested plan to be relayed to the subcommittee. It will also be of paramount importance that extra money be allotted in the AAPM budget to help at the state level. We look forward to reports from the subcommittee over the next year.

from an accredited graduate program or clinical residency program. This is a sizeable departure from current requirements, and means that the network of accredited programs must be expanded to meet the job market demand. Now, it must be said that we do not have a good handle on the number of new graduates from accredited programs that are needed each year to fill newly created (or recently vacated due to retirement) job openings. Is it 100? 200? 400 openings per year? At the Spring Board meeting, the Workforce Subcommittee under Professional Services Committee was asked to report to the Board with a sense of the number of residency positions needed (not an easy task). The Board also passed a motion to support the policy that graduation from an accredited clinical residency program should be a requirement for board certification. Further, the Board passed a motion that it is the policy of the AAPM to support CAMPEP accredited residency programs, and seek methods of providing financial support for these programs. This

leads us to the next interrelated issue of pathways into medical physics. Pathways into Medical Physics This topic has been the subject of debate in newsletter columns and finally led to the formation of an adhoc committee and Task Group 133. Mike Herman, chair of the TG, has reported on the charge and the progress of this group previously and plans to have a completed report by this summer. There are currently 13 therapy and 2 diagnostic residency programs that are CAMPEP accredited, with more in the pipeline. The idea of TG133 is to propose alternate pathways into clinical medical physics with models of structured programs outside of but affiliated with accredited programs. This should greatly increase the number of opportunities for training for scientists of varying backgrounds. Ad-hoc training will essentially go away. Further to the development of clinical training models will be implementation on a wide scale, a challenge for the very near future.

Laughlin Fund Established

ABR and the Year 2012 One of the requirements to obtain state licensure is board certification. The eligibility to sit for the ABR exam is in all probability about to change, as of year 2012. Representatives of the AAPM and other ABR sponsoring organizations will be meeting with the ABR trustees to discuss this at a summit meeting in August 2007. The issue is that medical physics is the only ABR specialty not requiring residency training and this is not acceptable to the American Board of Medical Specialties (for various reasons). Hence the ABR would like to change the eligibility requirements to a need for graduation

May/June 2007

C. Clifton Ling, Jean St. Germain, Lowell Anderson, Lawrence Rothenberg and Howard Amols

n 2005, several members of the Department of Medical Physics at Memorial Sloan-Kettering Cancer Center (MSKCC) issued an appeal for contributions to a fund to honor the memory of John S. Laughlin (1918-2004), a pioneer in medical physics who served as Department Chairman for thirty-eight years. The announced purpose of the fund was “to support educational and research activities of young medical physicists in North America who are either in training or in early phases of their careers.”

The Department is pleased to report that early in 2007 the initial goal of $120,000 has been met and further contributions are still both arriving and welcomed. It is expected that by the year 2009, investment income from the fund will be sufficient to fund initial grants or awards, as determined by an Executive Committee consisting of three members from the Department of Medical Physics, MSKCC, and four members from other institutions.

AAPM Newsletter

May/June 2007

Programs for AAPM Chapters evolve over time. Any suggestions would be appreciated. Requests will be processed on a first come, first serve basis.

Dan Pavord, Chair Regional Organization Committee

Two new programs for AAPM Chapters

he AAPM has funded two new programs designed to enhance the educational capabilities of the local chapters. We view this as particularly important given the need created by Maintenance of Certification requirements. The first program is intended to reimburse chapters for expenses used to bring in national speakers. To qualify, the speaker should be recognized as an expert in the topic to be discussed. Previous publications and membership in AAPM task groups will be used to support this requirement. The invitation of AAPM Officers will also be encouraged. We have $15,000 available this year. This will provide 15 $1000 grants. This should cover airfare, hotel, miscellaneous expenses, and a $300 honorarium for the speaker if they request one. Chapters would need to complete a request form posted on the AAPM web site and forward to myself. Each application will be reviewed by the entire Regional Organization committee for approval. The criteria will include the general interest of the topic and the need of the chapter. Preference will be given to applications that have applied for CAMPEP credit. This is a new program and we expect the criteria to

The other program involves reimbursing chapters for putting material in the virtual library. This would involve three processes; making a high quality audio recording of the presentation, obtaining a copy of the presentation in Powerpoint format, and video recording of the presentation. The audio will be linked to the Powerpoint presentation and used to produce a transcript. The video does not need to be extremely high quality as it will only be used to synch the audio with the Powerpoint. In addition a photo of the speaker and brief biographical info would be needed. If you need help with the technical aspects of the audio/video capture, please contact me. The production to format the presentations for the Virtual Library will be done by the company that takes care of the annual meeting, Blue Sky Productions. The cost for the production service is $850 per hour of presentation time. We have approximately $12,500 available for this program making a total of fourteen $850 grants available this year. Selection criteria will be similar to the travel reimbursement program. Chapters may submit for more than one presentation per event. We would like to reach as many chapters as possible, so no more than four per chapter will be considered. The program will be run in conjunction with the Virtual Library Committee, so the review panel will include members of both committees. Again the requests will be processed on a first come, first serve basis. We envision this program ultimately developing into providing material from which online CAMPEP credits could be earned. To help us

achieve that goal we would strongly encourage chapters to participate in this early stage of the program so that we can ultimately provide greater educational access for our members. At the current levels, the program will not be financially rewarding to chapters, but we are hoping that the small financial and larger time commitment will lead to the benefit of many. I think that sentiment sums up the volunteer spirit of the many committee, task group, and chapter members. I look forward to seeing that characteristic driving this program. Chapters could apply for both programs making a total $1850 in funding available to bring in a speaker and record their presentation. Please consider these programs when planning the next event for your chapter. I would also appreciate any comments regarding the selection criteria, funding amounts, or any other suggestions.

(Herman from p. 9) ics matters. This is the only mechanism by which we can remain informed and active on the myriad of ongoing and significant activities. Use Your Energy Productively Finally, I would urge every one of us to make the most positive impact with the energy that we have to offer to our profession. If you have time to write list serve dissertations, you have time to be active on committees and task groups and to provide succinct opinion/data to these entities. Contact committee, task group and council chairs of your choice with your specific ideas of what you wish to do to improve the profession of medical physics. Each step forward we make means better services, research and education in medical physics, which ultimately means better patient care.

AAPM Newsletter

May/June 2007

Chapter News Joint Meeting of Southwest Chapter and FMOFM

Geoffrey Clarke, SW-AAPM Chapter President

he Southwest Chapter of AAPM (SWAAPM) and the Federación Mexicana de Organizaciones de Física Médica (Mexican Federation of Medical Physics Organizations, or FMOFM) held a joint three-day meeting April 16-18, 2007. The FMOFM is a confederation of three regional medical physics groups, Asociación Mexicana de Física Medica (AMFM), Sociedad de Física Médica de Nuevo León (SOFIMED) and Sociedad de Mexicana de Física, Division de Física Médica . This marked the fourth SW Chapter meeting in Mexico, with the most recent being in Puerto Vallarta in 2000. The meeting was co-sponsored by the AAPM and was approved for up to 12 hours of CAMPEP continuing education credits.

The program was entitled “Physical Methods for Image Guided Interventions and Therapies” and included one session on Professional Medical Physics Issues in Mexico and the USA, three sessions on Image Guided Therapy Physics, a session on Interventional X-ray Imaging Physics, a session on Interventional MRI Physics, an Alternative Therapy/Imaging session, a session on General Medical Physics (where proffered papers were presented), and a Young Investigators’ Symposium. Invited speakers from outside the SW Chapter and the FMOFM included AAPM President-Elect Jerry White, Pei-Jan Paul Lin of Harvard, Di Yan of William Beaumont Hospital in Auburn Hills, MI, Luis Fong of the Mayo Clinic in Rochester, MN, Ed Hendrick of Northwestern University and Bill Phillips of the University of Texas Health Science Center in San Antonio.

The aqueduct of Queretaro is the iconic structure of the historic city. This time the meeting was held in the Commercial exhibitors and scienhistoric city of Queretaro, which is tific posters shared a large comabout 200 km northwest of Mexico mon area where refreshments were City and conveniently located in the served at the breaks. center of the country. Planning for All presentations were in English the meeting began in late 2005 after except for the final session with the SW Chapter received a formal invited papers in Medical Physics invitation from Dr. Mercedes Rodelivered in Spanish. In addition 47 driguez Villafuerte, the Representing posters on various topics in imagDelegate of FMOFM. The meeting physics, therapy physics, profesing venue was the Centro Educativo sional and historical issues in Mexiy Cultural del Estado de Querétaro can medical physics and biophysics Manuel Gómez Morín (Manuel Gowere presented, almost all of which mez Morin Center for Education and were in English. The full program Culture of the State of Queretaro) can be found at the meeting website which is very close to the historic cowhich is linked to the Chapter’s web lonial district of the city. The meetpage on the AAPM web server ing took place on a very Mexican (http://chapter.aapm.org/swaapm/). schedule, with sessions starting at 10 A total of 159 people attended the AM and continuing until 7:30 PM meeting including representatives with a lunch break at 2 PM.

of the 14 commercial exhibitors that helped support the meeting. Registered attendees hailed from 14 Mexican states (including the Federal District), 8 of the American states and one Canadian province. At the SW Chapter business meeting on Sunday morning, the Chapter resolved to continue its association with FMOFM and to plan to have Joint meetings of this type on a quadrennial basis. SW Chapter presi-

The meeting room, seating 120 people, was packed for almost every session. dent, Geoff Clarke, established a standing committee on Latin American Medical Physics, chaired by Donna Stevens, which will develop programs to encourage interactions between the SW Chapter and Latin American Medical Physics groups. The first charge of this committee will be to devise a plan to facilitate access to the AAPM in Houston in July, 2008 for Latin American medical physicists.

Commercial exhibitors and scientific posters shared a large common area where refreshments were served at the breaks.

AAPM Newsletter (Fuss from p. 12) panel led by the Agency for Healthcare Research and Quality (AHRQ). In addition to AHRQ, the federal panel included representatives from the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA), National Institutes of Health (NIH) and CMS. Based on the recommendations from the MedCAC and the federal panel, CMS is proposing to revise its Clinical Trial Policy. Below are some highlights of the proposed changes. • •

Renaming the policy as the Clinical Research Policy; Paying for investigational clinical services if they are covered by Medicare outside the

May/June 2007 trial or required under a cover age with evidence development (CED)through the NCD process; • Adding FDA post-approval stud ies and CED to studies that would qualify under this policy; • Requiring all studies to be registered on the NIH ClinicalTrials.gov website before enrollment begins; • Requiring studies to publish their results; and • Expanding the “deeming” agen cies to all Department of Health and Human Services Agencies, the Veterans Administration, or the Department of Defense. Deeming agencies are agencies that can “deem” whether a tri al has met the general stan dards outlined in the policy.

“This new decision signals our continued support to provide access to services for beneficiaries by facilitating participation in the full range of qualified, scientifically sound research projects,” said CMS Acting Administrator Leslie V. Norwalk, Esq. The proposed NCD has a 30-day comment period. CMS will review all the public comments and suggestions received and incorporate them into a final NCD. CMS will publish the final NCD no later than sixty days after the end of the comment period. The revised policy will be effective with the publication of the final Clinical Research Policy NCD. Details of the coverage policy are available at the CMS coverage website at: www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=186

Therapy Program includes...... • MRT: optimization, plan verication, delivery, QA

Imaging Program includes... • • • • • • • • • • • • • • • • •

Scientic Symposia: Advances in x-ray imaging, breast imaging Advances in MRI, Ultrasound Molecular imaging and biomarkers Image and observer performance Dose and quality control Image modeling and simulation Workshops: Writing and review for Medical Physics Funding and protecting biomedical research Digital mammography QA Image quality measurement Issues in cone beam CT PET CT- principles, applications and QA Proffered Papers: Image registration, fusion, segmentation and visualization Radiography, uoroscopy, vascular/cardiac imaging Computed tomography, cone beam CT, breast imaging Dosimetry, radiation protection, and quality control MRI, ultrasound, PET, PET CT, small animal imaging

• Measurements: new dosimeters, systems and pro cedures, calibration and QA,treatment techniques and clinical applications • Monte Carlo dose calculation • Brachytherapy • Stereotactic radiosurgery and radiotherapy • Radiobiology: fundamental and outcome modeling, treatment planning and evaluation • Treatment planning and delivery: clinical planning, dose calculation, new treatment techniques and systems

Joint Therapy/Imaging Program includes...... Scientic 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 denition • Image-guided procedures • Imaging for therapy assessment

AAPM Newsletter

May/June 2007

Maintenance of Certification Update SAM Sessions at the Annual Meeting Mark S. Rzeszotarski

he continuing education program for the annual meeting in July will include eight sessions designated as SAMs courses. SAMs are self-assessment modules which are designed to permit the physicist to assess their knowledge during a continuing education session. This is accomplished using an audience response system. Physicists who have pre-registered for SAMs credit will receive a calculator size interactive response unit which they will use during the SAMs presentations. No SAMs registration will be offered onsite in Minneapolis so pre-order your audience response system when you register for the annual meeting. During each SAMs session, approximately five questions are asked and the audience responses are automatically tallied and displayed. The advantage of this system is its anonymity as opposed to requiring individuals to raise their hands. As a result, audience participation is greatly improved. The speaker can then incorporate the audience response into their comments during the lecture. Your individual responses are not recorded since the purpose of these modules is to permit self-assessment of your own knowledge. Only your participation in a SAMs session is recorded. SAMs participants will also receive CAMPEP credit for the course, as is the case for all of the more than fifty hours of continuing education courses offered at this year’s annual meeting. 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 and receive SAMs credit for attending the course.

SAMs are a required component of the Maintenance of Certification program established by the American Board of Radiology. All physicists who were board certified since 2002 received time-limited board certificates and must participate in a minimum of 20 total SAMs modules during their 10-year cycle. Diplomats are expected to complete a minimum of one SAMs course each year. Individuals with lifetime board certificates may also want to begin the MOC process, since some hospitals are already requiring MOC

as part of their credentialing process and others are likely to add this requirement in the future. This year, there will be eight total SAMs modules offered at the annual meeting. There are four diagnostic, two medical nuclear and four therapy SAMs modules. Two of the SAMs modules are appropriate for both diagnostic and medical nuclear diplomats (PET/CT and shielding). The titles of the SAMs sessions and topics are provided below:

DIAGNOSTIC SAMs: The Physics and Technology of Breast Imaging • Digital Mammography The Physics and Technology of Computed Tomography • CT Dose and Protocol Optimization DIAGNOSTIC & MEDICAL NUCLEAR SAMs: The Physics and Technology of Radionuclide Imaging • PET and PET/CT Physics, Performance Evaluation and QA Radiation Safety and Risk Management • Shielding Design Workshop THERAPY SAMs: Kilovolt Imaging and IMRT Action Levels • Daily Localization - I: Kilovolt Imaging • Action Levels for IMRT QA MLC QA and IMRT GU Planning • QA for Linacs and MLC Used for IMRT • IMRT Site Specific - I: Prostate, GYN, Pelvis 4D Planning and Delivery and Linac Calibration Protocols • 4D Scanning: Imaging/Planning • AAPM TG-51 Brachytherapy and Heterogeneity Corrections for IMRT Planning • Brachytherapy: General Clinical Applications • Heterogeneity Corrections in the IMRT Era

AAPM Newsletter (Fairobent from p. 13) high doses to workers and provide significant benefits to patients. In developing regulations, OSHA can only indirectly consider the impact of its regulations on the patient care, and the economic impact regulatory changes would have on such practices. • It is believed that some worker populations in medicine, such as nurses, do not receive adequate safety training. Since OSHA can mandate safety training for some hazards, it may do so for ionizing radiation. • Several comments questioned future reporting requirements and the elimination of certain aspects of current regulations, such as quarterly exposure limits. OSHA official expect that such issues may or may not be considered in developing new regulations, and can be commented upon when posted for regulatory change in the Federal Register. DOE Source Recovery Program Update Previously 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 to the licensees. Traditionally, the program dealt largely with americium-241 and plutonium sources. Owing to heightened concerns about terrorist threats to steal radioactive material for use in a dirty bomb, the DOE is moving aggressively to include other isotopes of concern.

May/June 2007 The contract with CRCPD and DOE has been finalized. Many members have contacted me about the mechanics of the program. However, the first step to being included in this program 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 cesium137 brachytherapy sources, and various radium-226, americium-241, strontium90 eye applicators and other sources. To register sources with LANL online, please visit http://osrp.lanl.gov/what_ is_osr.shtml.

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AAPM Newsletter

May/June 2007

ACR Breast Ultrasound 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. How many breast ultrasound facilities are accredited by the ACR? A. As of January 1, 2007, 550 breast ultrasound facilities were accredited by the ACR. Q. What is the current pass rate for units applying for accreditation in breast ultrasound? A. In 2006, the first-attempt pass rate for new or renewing units was 78%. Close to 100% of the facilities passed on their second attempt at accreditation (after taking appropriate corrective action to improve quality). Q. Do we have to submit clinical images from all the units listed on the application? A. No. The ACR Breast Ultrasound Accreditation Program is facilitybased. Only one set of images per type (i.e., simple cyst, solid mass, core needle biopsy, fine needle aspiration cytology) is required regardless of the number of ultrasound units or the number of physicians at the facility. Q. May we submit clinical images on paper? A. Images should be submitted on standard transparency film; however, the ACR will accept images on photographic paper as long as they are of good quality.

A. No. FNAC involves the collection of tissue from a solid mass. Cyst aspirations are not FNAC. (Do not submit cyst aspiration images for FNAC.) Q. What quality control data do we need to submit for accreditation? A. As part of accreditation, you must submit a copy of your service engineer’s most recent preventa-

tive maintenance report or your medical physicist’s most recent equipment survey for each unit used for breast ultrasound. Although the ACR does recommend that routine quality control (QC) be performed by the technologist on all ultrasound units used for breast imaging, this is not required for accreditation at this time.

AAPM regrets to announce that the following members have passed away since our last Annual Meeting: Matija Bistrovic - Zagreb, Croatia Myung Choi - Great Falls, VA Carey Floyd - Durham, NC John Hale - Denver, CO Leon Myrianthopoulos - Alsip, IL If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honors Ceremony at our upcoming Annual Meeting. We respectfully request the notification via e-mail to: 2007.aapm@aapm.org Please include some supporting information so that we can take any appropriate steps.

Q. Our facility uses needles to aspirate cysts. Is this fine needle aspiration cytology (FNAC)?

AAPM Newsletter

May/June 2007

NCRP and Knovel Partner to Provide Access to Information on Radiation Protection and Measurements On January 10, 2007, a partnering agreement was announced by Knovel Corporation (www.knovel.com), a leading provider of revolutionary internet-based research and information services, and the National Council on Radiation Protection and Measurements (NCRP), a premier resource for information, guidance, and recommendations on radiation protection and measurements. This partnership represents an important step in NCRPâ&#x20AC;&#x2122;s long-range goal of making the content of its publications available to scientists worldwide. NCRP joins McGraw Hill, Blackwell, John Wiley & Sons, Elsevier, Springer, World Scientific, and many other prominent technical publishers as a Knovel publishing partner. Knovel has access agreements to its extensive technical database with many major scientific institutions, including universities, national laboratories, and private corporations. Radiation protection and measurements are integral to developments in national defense and homeland security, space exploration, medicine and medical engineering, public safety, industrial hygiene, radiation dosimetry, and environmental radiation protection and radioactive waste management. NCRP has been active in the areas of radiation protection and measurements since its inception in 1929. A complete listing of NCRPâ&#x20AC;&#x2122;s currently available publications can be found on the website http://NCRPpublications.org. Through the exclusive content-sharing agreement between Knovel and NCRP, researchers will be able to use Knovelâ&#x20AC;&#x2122;s interactive database to search, analyze and manipulate data within NCRPâ&#x20AC;&#x2122;s highly regarded reports and commentaries. Knovelâ&#x20AC;&#x2122;s specialized suite of analytical tools provides researchers with powerful new methods of finding and applying critical information. Scientists, engineers, and medical researchers in the corporate, academic, and government sectors rely on Knovel for essential problem-solving data and innovative technology that allows for data extraction, mathematical calculations, tabular data analysis and equation solving. Contact Delores Meglio, VP of Content Management (dmeglio@knovel.com) or John Dooley, VP of Sales (jdooley@knovel.com) to obtain electronic access to NCRPâ&#x20AC;&#x2122;s publications.

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AAPM Newsletter

May/June 2007

Letter to the Editor Ivan A. Brezovich Birmingham, AL ibrezovich@uabmc.edu

edical physicists are medical specialists, not necessarily physicists.

Peter Almond hit the nail squarely on its head when he said in the March/April AAPM 2007 Newsletter, p. 26: “... nothing in the medical arena should be taken as routine, since eventually everything comes down to the unique concerns for the individual patient.” That’s exactly why medical physicists in radiotherapy are medical specialists. Every treatment plan is custom made, every treatment is special, and no two patients are identical. Peter’s contention that medical physicists are physicists was certainly valid when Roentgen, a physicist, imaged the hand of his wife with the newly-discovered x-ray. Or when Donald Kerst treated a brain

tumor of his graduate student with his recent invention, the betatron. Today’s medical physicists, however, come from many different backgrounds, from engineering, computer science, biology and other related fields. They no longer need to discover new physical phenomena or invent accelerators. They rely, like other medical specialists, on wellestablished principles and equipment. The value of therapeutic physicists lies in their expertise in utilizing these for the benefit of individual patients. Their common bond is the uncompromising dedication to patient care, irrespective of academic background or degree. Acknowledging the special features of radiation, physicians coined the term “radiologist” and later “radiation oncologist”. Radiation oncologists formed their own organizations, ASTRO and later ACRO, which were needed to address the unique needs of their subspe-

cialty. Radiation technologists became “therapists”, and are the driving force behind the CARE bill in Congress that promises to set national standards for healthcare professionals. Medical physicists are riding the coat tails of therapists by being included in the bill. I believe therapy physics has matured to the point that we can eliminate the misnomer “medical physicist” and agree on a term that more accurately portrays who we really are. We need to learn from radiation oncologists and form at least one therapy physicists’ organization that can deal with the unique features of our subspecialty. We need to achieve a level professional standing and independence where we all can, like other medical specialists, discharge our duties according to the best of our professional judgment and conscience, not that of an often excessively profit-oriented administration.

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AAPM Newsletter (Ritenour from p. 3) exams, must have completed an accredited residency program. We’re over half way to 2012 now and there are clearly not enough residencies. There are thirteen CAMPEP approved residencies in radiation therapy in the US and Canada and only two in imaging. While the 2012 deadline could be postponed, it can’t be put off forever. Task Group No. 133, Alternate Clinical Medical Physics Training Pathways chaired by Mike Herman, is looking into this and is drafting a report to the Board. It seems clear that it is time for existing residencies and graduate programs to work with medical physics groups in their region to provide some structured mentorship. We discussed having a checklist of things that a resident would have to complete under the supervision of a board-certified medical physicist. The resident may wind up working with several different groups to accomplish everything. The system of such “clinical rotations” would be supervised by the residency or graduate program, presumably at an academic center in that region. There is no current obstacle that would prevent CAMPEP accrediting such a dispersed residency as long as the overall requirements of TG Report #90 are met. We decided to have the Medical Physics Residency Training and Promotion Subcommittee ( also chaired by Mike Herman) inquire of the existing clinical residency programs how many slots (CAMPEPaccredited, pending, other) they have now, how many they could handle if funding were available, how many affiliate slots they might take on, and what impediments may exist to becoming CAMPEP-accredited? This is to be reported back to the Board at the summer meeting.

May/June 2007 We also discussed funding for such structured mentorships. The RSNA has expressed interest in funding more residencies if supplied with a plan that would meet workforce expectations. The AAPM is also on the verge of surpassing its goal for reserves. This could mean that the Association may be able to contribute funding. In light of these observations, the Board passed a motion as follows: “Moved that it is the policy of the AAPM to support CAMPEP-approved residency programs, and that AAPM will seek methods of providing financial support for the development and continuation of those programs, including providing direct financial support for those programs.” This guidance was provided to the Residency Training and Promotion Subcommittee and we look forward to seeing their report. We spent most of the rest of the meeting discussing the organization of the Board and whether it should be smaller. The reorganization plan that was defeated in 2005 did have majority support, but failed to achieve the two-thirds vote necessary for passage. There is ample evidence that more than two-thirds of the membership thinks that the Board is too large at 37 members. However, at our Long Range Planning Meeting there was some feeling that over just the past year or so, the Board has become more efficient and the Board members more engaged in the affairs of the Association. We’ve started having new Board Member Orientation sessions at AAPM headquarters in the fall of each year so that Board members “hit the ground running.” The Board has been discussing issues on the BBS and by e-mail throughout the year. Perhaps this issue should be put on the table for awhile.

There is some concern, however, about preventing the Board from growing. It is possible for new chapters to form, not bounded by geography. I’ve been thinking of starting a “Left Handed Medical Physicist” chapter, myself. If more chapters were to form, then the Board would increase in size which we agreed is probably not beneficial to the Association. So, we talked about the idea of forming a “council of chapters” that would meet current and future chapter’s needs and that would have direct communication with the Board. We discussed the possibility of not allowing new chapters to have Board reps but to allow them to have membership in the “council of chapters”. No action was taken at this meeting, but we did direct the Regional Organization Committee, an administrative committee that reports directly to the Board and is chaired by Dan Pavord, to examine the discussion that took place at the Long Range Planning meeting and bring forward a plan by RSNA to deal with the chapter issue and Board organization in general without a specific mandate to reduce the size of the Board at this time. Amazingly, we finished right on time at six p.m. Maybe the Board IS getting more efficient. I want to thank the Board members for being willing to depart from our usual meeting procedures and spend some time “blue skying” on some important issues that will certainly affect the future of the AAPM. I think it was time well spent. But I still want my atomic powered flying car.

AAPM Newsletter

May/June 2007

Congratulations to the recipients of the following awards, achievements and honors in 2007! (Awards from p. 2)

The following are named Fellows in 2007 for their distinguished contributions to the AAPM: Susan Brownie, MSc Chee-Wai Cheng, PhD Joanna Cygler, PhD Bruce Faddegon, PhD Steven Goetsch, PhD John Humm, PhD Mahadevappa Mahesh, PhD Cynthia McCollough, PhD Peter Munro, PhD Adel Mustafa, PhD William Roventine, MSc

Christopher Serago, PhD Jan Seuntjens, PhD George Sherouse, PhD Thomas Shope, PhD Ken Shortt, PhD Timothy Solberg, PhD Robin Stern, PhD Cheng-Shie Wuu, PhD Di Yan, DSc Marco Zaider, PhD Timothy Zhu, PhD

All of the award, achievement and honor recipients will be recognized during the 2007 AAPM Annual Meeting Awards and Honors Ceremony and Reception. Please join us in congratulating all of the recipients: DATE: TIME: PLACE:

Monday, July 23, 2007 6:00 PM Minneapolis Grand Ballroom Hilton Minneapolis

The 2008 Call for Nominations and Applications

is available on the AAPM Website at: http://www.aapm.org/org/callfornominations.asp#nominations or you can get to this via the AAPM Homepage under “What’s New.” Please note that the deadline to receive nominations and applications is October 15, 2007

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: July/August Submission Deadline: May 15, 2007 Postmark Date: June 26, 2007

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