AAPM Newsletter July/August 2007 Vol. 32 No. 4 by AAPM Docs

Newsletter

AMERICAN ASSOCIATION OF PHY SICISTS IN MEDICIN E VOLUME 32 NO. 4

JULY/AUGUST 2007

AAPM President’s Column

Mary K. Martel UT MD Anderson Cancer Center

ractically all the information you need regarding the annual meeting is available online at aapm. org/meetings/07AM/, but I would like to highlight a couple of the meeting activities in this column. President’s Symposium “Biomarker” can mean different things to different scientists, dependent on the medical or biological science specialty they are in. For those of us in the cancer therapy field, imaging as a biomarker has been emerging as an important area of research. In particular, measurement of treatment response with imaging could aim towards use of imaging as a predictive factor pre-treatment (or during treatment), eventually aiding in the choice of a targeted therapy for patients. The previous sentence contains a lot of complex information, and indicates loads of research and development work for decades to come! Validation

of imaging as a biomarker(s) is the first step towards use of imaging in a reliable way in drug development and oncology trials, providing a robust clinical trial infrastructure. The President’s Symposium this year will explore several facets of this subject with “Imaging as a Biomarker for Therapy Response: Challenges, Opportunities and Initiatives”. The following questions (and more) will be addressed: How can imaging become ‘more’ quantitative? What role will the medical physicist play in future developments and use of imaging as a biomarker? What funding opportunities for research and development exist, particularly at the national level? Our invited speakers are LH Schwartz, MD, Vice Chair for Technology Development and Director of MRI at Memorial Sloan-Kettering, Barbara Mittleman, MD, director of the NIH’s Public-Private Partnership Program, Biomarker Consortium, Michael Vannier, MD, Professor of Radiology at the University of Chicago, and Gary Becker, MD, Professor of Radiology at the University of Arizona and Chairman of the Board of RSNA. Thanks to Dr. Larry Clarke of the NIH for his guidance in the development of this symposium. There are also two associated symposiums later during the meeting week: Molecular Imaging: Biomarkers on Tuesday afternoon and Imaging for Therapy Assessment on Wednesday afternoon and of course a number of related talks and sessions throughout the meeting.

Meet the AAPM Leadership There will be several venues during the annual meeting that provide opportunities to directly interact with the AAPM leadership. On Tuesday afternoon, there will be a New Member Symposium combined with “Meet the Experts.” A Town Hall meeting, followed by the Annual Business Meeting is scheduled for Wednesday afternoon. And for those of you still in Minneapolis on Thursday, the AAPM Board meets that day. The leadership wants to hear from you: what should the AAPM be working on? How can the organization better serve you? Each of these events gives the membership a chance to ask those burning questions of members of the Board and Council Chairs; don’t pass it up!

TABLE OF CONTENTS Chairman of the Board Column p. 2 President Elect’s Column p. 3 Executive Director’s Column p. 5 Editor’s Column p. 7 Education Council Report p. 8 Professional Council Report p. 10 CAMPEP News p. 13 Health Policy/Economics p. 14 Leg. & Reg. Affairs p. 17 Chapter News p. 18 Copyright Issues p. 20 ACR Accreditation FAQS p. 25

AAPM Newsletter

July/August 2007

Radiotherapy Service Engineer Association (RSEA) Meeting The 6th Annual Meeting of the RSEA will be held in conjunction with the AAPM annual meeting. For more information on this meeting, go to

www.linaceng.org. Many engineers may not know about the RSEA, and AAPM member physicists are encouraged to alert their linear accelerator engineers to consider joining this organization and attend

their annual meeting. The RSEA is the only organization for engineers to interact and exchange information with their colleagues and I hope that it continues to flourish. See you in Minneapolis!

Chairman of the Board’s Column have to have attended a CAMPEPapproved graduate program or residency. That still leaves the loophole of CAMPEP programs that don’t necessarily have clinical training.

E. Russell Ritenour Minneapolis, MN Springtime in Minnesota

s I write this column, it is early May in Minnesota. The grass is finally green, the birds are singing and its actually above 70o F. In springtime my thoughts usually turn to ABR issues and the way that the Board of Directors functions. Well, at least they did this year. Many of us are concerned that medical physicists are not getting the full range of clinical training that would allow them to function independently as sole medical physicists. Most of the graduates of medical physics programs get their clinical experience in on-the-jobtraining (OJT). Some get training that is both comprehensive and detailed. But you can ask any oral board examiner in physics and they will tell you that many get neither. In 2001 the American Board of Radiology stated officially that, starting in 2012, in order to be eligible to sit for the Boards in Physics a candidate will

There is a way that all entry level medical physicists can obtain clinical training – to formalize, accredit, and monitor OJT. While existing CAMPEP-approved residency programs can’t handle clinical training for all the new medical physicists, they can farm out the new physicists to private practice medical physics groups. Or, conversely, when private practice MP groups have a new hire, there can be an arrangement with a regional academic center to supervise the new physicist in a residency that takes place primarily at the private practice location. After all, most radiology and radiation oncology residents do at least part of their medical residencies at hospitals away from the main academic center. The main requirements for the medical physicists would be similar to the requirements for medical residents. The residents have to do some number of tasks under the supervision of a qualified practitioner – the checklist. It would be the responsibility of the regional academic center to monitor the quality of training at each “clinical site” through the same procedures that clinical sites are monitored for medical residents. These include periodic visits, meetings, etc.

At the Board of Directors long-range planning meeting in March, the Board passed the following resolution: It is the policy of the AAPM that graduation from an accredited clinical residency program should be a requirement for qualifying for board certification, with an implementation date to be negotiated with the certification boards. The BOD further directed the Medical Physics Residency Training and Promotion Subcommittee (chaired by Mike Herman) to survey existing residency and other clinical training programs to determine if it is possible to meet the goal of having clinical training in place by 2012. Task Group 133 is developing recommendations that would increase the number of opportunities for individuals to obtain accredited clinical residency training. AAPM Report 90 already provides a good list of the content that is needed in residency training. Funding for such programs can be sought from various groups who share our concern about the training of medical physicists – notably the Radiological Society of North America, an organization that in meetings with our leadership has already expressed interest in funding programs to increase clinical training of medical physicists. Another issue that was discussed at the March long-range planning meeting was that issue that has been with us for a number of years, now. The issue is this: Is the Board of Directors too large? This leads, of course, to the

AAPM Newsletter companion question: If it is too large, what do we do about it? The discussion among Board members at the March meeting was wide ranging. It included reviving the possibility of making a Council of Chapters that would have representation on the Board, but that would reduce the number of chapter representatives that actually sit on the Board. But the Board decided not to proceed along those lines. There is some concern that the number of chapters could grow, and as things are now structured, the size of the Board could grow. While there is disagreement as to whether the Board is oversize right now, I think there is agreement that it shouldn’t get much larger. As things stand now, every chapter of the AAPM gets a Board Representative. Article 5 of our By Laws states that only 15 members are necessary to maintain a chapter (although 50 members must petition the Regional Organization Committee to start the chapter). It doesn’t say anything in the article about them being in the same geographical area. Some have pointed out that chapters

could be formed around interests. However, to be fair, Article five is titled “Regional Organizations” and Section 1 of that article is titled “Regional Chapters”. So most would interpret the spirit of the article as designating regional chapters. But, back to the original question: Is the Board too big? There is some disagreement among the membership as there is disagreement among Board members. Since the Board meeting, the Board has carried on a lively discussion via the BBS. As of this writing, the tenor of the discussion is that, instead of jumping into a solution to the problem at this time, we have realized that if there is a problem, the “problem” is a moving target. The way that the Board functions has changed significantly since the latest discussion of Board reorganization started some years ago. In 2006 an Ad Hoc Committee of the Board on Board Meetings delivered its report. Chaired by Ken Vanek, the Ad Hoc made a number of recommendations that the Board has since adopted to streamline and render more efficient

July/August 2007 the operations of the board. These included the timing of the meetings, disassociation of Board activities from committee meetings that took place just days before, and electronic communication that allows the Board to be “somewhat” in session all year long. There is also an orientation session for new Board members at AAPM HQ, so they can really hit the ground running in terms of service on the Board. So, the question: Is the Board too big? really becomes: Does it work well? I think the consensus at the March Board meeting is that it seems to be working. Maybe its time to let it work for awhile and see if specific problems can be defined. If so, then the question would become: Would a smaller Board solve these problems? We’ll continue to consider the issue of Board reorganization. But, for now, the Board seems more enthusiastic about just trying to function well. That sounds fine to me. As fine as a spring day in Minnesota – which is very nice indeed.

AAPM President-Elect’s Column

Gerald A. White Colorado Springs, CO

hildren of Medical Physicists face certain challenges life. Perhaps unspoken in many families, my children have not found a motivation to be reticent about recounting and perhaps embellishing what they found to be physics-specific memories. I would have thought they would focus on the early morning departures or the many not quite home for dinner evenings or at least the “Dad is late for the Birthday Party and he has the cake in his car” occurrence. No, really, conversation from my (now adult) offspring seems to move to recollection of overheard casual banter among my colleagues at

social or semi-social gatherings, some outright boring technical talk but mostly retelling of what struck us as funny or macabre situations encountered in our practice or just outright Physics jokes. I particularly recall a Rocky Mountain Medical Physics excursion at South Colony Lakes at the foot of Crestone Peak and Humboldt Mountain in the Sangre de Cristo mountain range of Colorado. Steve Jones had demonstrated how remarkably far down a backcountry 4 wheel drive road a Subaru could actually travel and Dave Thompson gave physical proof to the clinical physics axiom that good equipment is essential

AAPM Newsletter by transporting the tents, packs and bags of the entire contingent across streams and rocks in his Scout (indeed , anything else was just a car). Gathered around a campfire after the more fit and adventuresome had returned from an assault on Crestone Needle, the stories began. Not limited to just ghost stories, the voices in the night turned to the macabre regions of Physics. Really scary stories of strange x-ray machines we had encountered in full daylight took on a truly ominous aura when recounted before the coughing embers of the waning fire. My contribution to this portion of the historical canon - hope you are not reading this alone on a dark night - is a diagnostic x-ray unit (more properly a diagnostic x-ray pastiche) in the office of a GP physician I surveyed about 15 years ago. It was used primarily for chest films. It ran at a nominal maximum of 80 kVp, an optimistic specification as the measured potential was 60ish kVp. The chest images were taken at about 2-4 seconds per exposure using a mechanical timer that resembled a wind up kitchen timer on a wire. The collimation was unencumbered by contemporary technology; a single megaphone type cone was affixed to the tube, limiting the beam to roughly 60 inches diameter at the skin. Filtration was easy to check, it consisted of only the glass structure of the x-ray tube, the filament and stationary anode were clearly visible by looking up through the cone collimator. The film processing was matched to the acquisition system, any hint of detail that had managed to be transmitted to the cassette face was filtered by the developing process. Each film came from the processor with its own collection of physical debris dried onto the emulsion. Now comes the really scary part. The bulk of my visit, and a great deal of follow up phone time,

July/August 2007 was dedicated to explaining to the physician and his staff not just how and why the images were so poor and the machine received the Colorado “Unsafe for Human Use” sticker, but also why I had the audacity to make such judgments. Who in fact is a “Medical Physicist”, what sort of training do creatures such as you have and how dare you offer opinions about my medical x-ray process of care? I made little progress with the education of the Physician in this regard, but fortunately the Colorado Department of Health and Economic realities made the questions moot; imaging referral was far less troublesome and expensive for his practice. Now in our practice travel into the non-radiology imaging world has changed dramatically. We no longer see the ghost story class of machines described above. Rather, 64 slice CT’s, PET systems, digital cardiac x-ray imaging systems, SPECT cameras, Dental CT’s and angiographic quality C-arms proliferate. The technical quality is potentially superb, the dose potentially high, the radiation protection issues potentially significant and the opportunity for quality Medical Physics support is potentially high. What has not changed in many settings is

the mutual recognition of the Physicist and Physician imager (Cardiologist, Vascular Surgeon, Urologist, Medical Oncologist). Often times we do not know them and they do not know us.

We do not have the benefit of our academic Medical Physics colleagues presenting medical physics in the residency training programs of many of these physicians, and we do not have the same presence in their literature, professional meetings and departments as we have for our Radiologist colleagues. As imaging technology continues to

roll out to these physician specialties we must begin to build bridges between our societies and theirs. AAPM, through the initiative of several of our members, has created bridges to Professional Societies of many of these imaging specialties, and, of course also to specialties involved in therapeutic applications of radiation such as Neurology and Urology. Some of these bridges are older and stronger than others, some need careful tending, and some need a new foundation. But all will eventually look like the famous Pittsburgh “Bridge to Nowhere” (for years built about ¾ of the way across the Allegheny River) unless we can complete the process at the local level. In the Hospital and Clinic we need to get to know the Cardiologists, the Vascular Surgeons, the Oral Surgeons, the Medical Oncologists who will be making decisions about imaging systems in their departments and clinics. In the Academy, we need to find ways to integrate Medical Physics into the residency curricula for these specialties. It’s not easy, not comfortable, to leave the Radiology and Radiation Oncology setting familiar to us and where we are familiar to others in an effort to reach the growing spectrum of imaging applications in medicine. But we need to take the leap. Stepping into the unfamiliar may be as unsettling as a scary physics tale around the campfire, but will be necessary for the profession both nationally and locally. It will be necessary to do so as we honor the past, celebrate the present and prepare for the future.

AAPM Newsletter

July/August 2007

AAPM Executive Director’s Column lunch in the exhibit hall on Tuesday afternoon, and visit with the AAPM exhibitors. All scientific registrants will receive a $10 voucher toward lunch in the exhibit hall on Tuesday, July 24 between 11:30am-1:00pm. Use the voucher at any exhibit concession or snack stand in Hall B or C.

Angela R. Keyser College Park, MD Meeting News

se the online Meeting Planner to generate your personal meeting schedule by compiling sessions, talks and committee meetings you plan to attend into a single chronological document. You must be logged in to the abstract system to use the Meeting Planner. Then, compile your schedule, download the .vcs file to import to your PDA, or print it out as a reference. If the time of your meeting, session or talk changes, the planner automatically updates your personal schedule. Selected speakers have been asked to provide handouts for their presentations. The speakers will either provide the handout for posting on the website pre-meeting or at show site, to be posted following the meeting. Please check the Handout site for the progress on submissions. The AAPM Message Center will have a new feature this year. Messages received for you at the Message Center can be automatically forwarded to your cell phone. Meeting attendees will find a $10 meal voucher in their meeting registration bag, good towards lunch on Tuesday during the meeting. Make plans to eat

2006 Salary Survey The 2006 Salary Survey is available online only. You can download a PDF from the web or have the document emailed to you. If you have any problems, please contact HQ. Attention Junior Members The AAPM Membership voted in the fall of 2006 to change the requirements for Junior Members. AAPM Bylaws now state the requirements for Junior Membership as: “The individual shall be a Resident, Post-doctoral Student or Fellow on a full- or part-time basis in a medical physics training program and shall provide an annual attestation from a Member of the Association that they are currently eligible for Junior Membership on that basis.”

HQ will be contacting all Junior Member in August with instructions on how to provide the required attestation to remain a Junior Member or change their membership status to Full. More details to follow. New Online Features Committee members will now see a list of their committees in the new “My AAPM” section of the menu. Those members wishing to create a shortcut to a committee page they do not serve on may now do so from the Committee Tree. Click on “bookmark this committee” to add a shortcut to the “My AAPM” menu. The AAPM Member Directory now lets you search by Gender and we are working on allowing a search by zip code to members within a certain distance of you (US only). Staff Recognition Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high-performing professionals. The following AAPM team members celebrated an AAPM anniversary in the first half of 2007. I want to publicly thank them and acknowledge their efforts. See you in Minneapolis!

AAPM HQ Anniversaries

Jean Rice Nancy Vazquez Jennifer Hudson Zailu Gao Hadijah Robertson Cecilia Hunter Karen MacFarland Lynne Fairobent Lisa Giove

13 years of service 11 years of service 6 years of service 6 years of service 6 years of service 4 years of service 4 years of service 3 years of service 2 years of service

AAPM Newsletter

July/August 2007

Enhancements to the Medical Physics Journal Announced The American Association of Physicists in Medicine (AAPM) announces publication in its journal Medical Physics of a new and ongoing series of articles under the heading Vision 20/20. The first article in the series, Quality in Radiation Oncology appeared in the May 2007 issue. Medical Physics is AAPM’s flagship publication and an official journal of the Canadian Organization of Medical Physics, the Canadian College of Physicists in Medicine, and the International Organization for Medical Physics. The journal’s growing influence in the medical physics community is reflected in the publication’s Impact Factor, which has risen nearly 40% in just the last two years. Vision 20/20 articles will examine the state-of-the-art of a scientific activity important to medical physics, predict where that activity will be in another 5-10 years, and identify the path that must be taken to arrive at that goal. All articles are peer-reviewed and will not exceed 12 pages. “A Vision 20/20 article is the mirror image of a review article, because it focuses on the future rather than on the past,” said William R. Hendee, Editor of Medical Physics. “With the help of our distinguished editorial board, topics and authors have been identified for more than 30 articles that are scheduled to appear over the next couple of years.” Later this year, the journal will introduce another new feature, Medical Physics Letters. These articles are brief presentations of seminal advances in medical physics research – or occasionally clinical problems – that demand rapid dissemination. In most cases, a Medical Physics Letters article will be followed by a full-length article in Medical Physics at a later time. Medical Physics will also publish reviews from Doody’s Review Service, an extensive bibliographic database of reviews on 90,000 book and software titles in medical physics and related fields. This will provide Medical Physics readers with a broader, more comprehensive range of book reviews, as Doody Publishing receives titles from publishers that traditionally do not send review copies to Medical Physics. Another new benefit readers are enjoying is outbound reference linking from PDF versions of Medical Physics articles to cited articles or abstracts in many other journals. Medical Physics is hosted on Scitation, the online platform of the American Institute of Physics, and through AIP’s association with the Crossref linking service, readers can access the articles or abstracts directly rather than having to use a separate search engine. Other slated changes for Medical Physics will coincide with AAPM’s 50th anniversary in 2008. To celebrate this landmark event, the journal will publish at least two review articles each month throughout the year, except for June. Most of the articles will examine particular advances in medical physics, and the role of medical physicists and the AAPM in bringing the advances to fruition.

AAPM Newsletter

July/August 2007

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

elcome to the 4th issue of the newsletter. I am happy to report that the comments received in the recently completed newsletter survey were quite positive. I am still looking forward to seeing articles on historical aspects of our young profession (2008 is 50th year anniversary) and would invite all of you to submit articles of interest either as stand-alone or as letters to editor. Recently, I had the opportunity to visit Capitol Hill as part of the team from the American College of Radiology. We had appointments to meet with our State Senators and Congressmen. Even though we did not get to meet face-to-face with the Senators or the Congressmen, we met with senior staff members, who are in fact the conduits to our ideas and suggestions. On more than one occasion, I was asked about medical physics and what we do in the hospitals. I also had the opportunity to talk about radiation doses and the need for increased funding for research. It was a very interesting day visiting the power halls of the government. I believe that each small step taken towards bringing awareness to the elected offices about our profession will carry a long way when they introduce new bills and regulations.

I want to draw your attention to a news blurb (see pg. 15) about the Journal of the American College of Radiology (JACR). Some of you may be familiar with this fairly new journal (4th year in print) from the American College of Radiology (ACR) as it was recently accepted for listing under MEDLINE. The journal carries a column entitled “Technology Talk and the Medical Physics Column” dedicated to medical physics. With circulation of nearly 28,000 read widely by the practicing radiologists and radiation oncologists, I feel strongly that this column offers us an opportunity to present various topics and opinions. We need to take advantage of the opportunity available and therefore welcome AAPM members to contact the column editors if you

are interested in submitting articles in the areas of Technology Talk and Medical Physics Consult. Finally, I would like to draw your attention to two items. One is the invitation to the President’s Symposium about Imaging as a Biomarker at the upcoming AAPM annual meeting (for details read Mary Martel’s column) and the second is the importance of developing good rapport between medical physicists and physicians (not only Radiologists and Radiation Oncologists, but Cardiologists, Urologists, Vascular Surgeons, Neurologists and an entire cadre of physicians) who are purchasing their own imaging equipment (for details read Jerry White’s column). I wish all of you a very happy summer.

What’s happening at AAPM 2007? VISIT OUR VENDORS.... Plan your time with the Vendors by viewing the 2007 Buyers Guide and Exihibit Hall Floorplan for a complete listing of exhibiting organizations, booth locations, contact and product information. www.aapm.org/07AM and click on Exhibits 2nd ANNUAL AAPM BLOOD DRIVE Do you have an extra hour to save a life? Please consider donating blood during the Second Annual AAPM Blood Drive on Tuesday, July 24. Memorial Blood Centers in Minneapolis will park a van right in front of the convention center from 9:00 am - 4:00 pm. Our goal is to beat last year’s 28 units collected! Look for the “gems” of appreciation on the badges of 2006 generous blood donors, and get your own gem for donating this year. ENJOY LUNCH ON AAPM Each Scientic Attendee at the Annual Meeting will receive a $10 lunch voucher with their registration materials. This voucher is good for $10 towards your food and/or beverage purchase at any Minneapolis Convention Center Exhibit Hall B-C. VALID only on Tuesday, July 24 Hours: 11:00am - 1:00pm only WORKING TOWARD A GREENER MEETING The Exhibit Hall opens on Sunday at 1:00pm, and once again box lunches will be provided to scientic registrants. This year we’re providing environmentally-friendly packaging for box lunches, made from 100% recycled fully biodegradable material. This is just one step toward reducing waste at the meeting. Did you know the Minneapolis Convention Center’s designated caterer recycles food scraps by donating them to local pig farmers?

AAPM Newsletter

July/August 2007

Education Council Report program recommendations for graduate degrees in medical physics. With the recent significant changes in the practice of medical physics, the TG is doing a major revision of the report. TG #3: Radiation Effects & Protection lecture for Medical Students. Contact: Michael Dennis.

Herb Mower Education Council Chair

he big news at this time of year, of course, is the Annual Meeting. This year the Association is changing its process for soliciting volunteers for the various committees, subcommittees, task groups, etc. In the past the President-elect has sent out an open invitation to the members asking for preferences when one wished to volunteer. This has resulted in some matches that were not the best fit. This year we are trying to work the system in the opposite direction, having people look at the various committees, subcommittees, task groups, etc, perhaps sitting in on their meetings, getting on their email and conference call lists and going forward from there. Thus I am noting some of the various working groups within the Education Council as well as a name to contact for further information. If one of these interests you, check the “meeting” schedule for the Annual Meeting and see if they are meeting at a time when you can join in. If so, plan on visiting them and seeing what they are doing. Here goes a partial list: TG #1: Revision of Report No. 44: Academic Program for an MS Degree in Medical Physics. Contact: Bhudatt Paliwal. This group is working on a revision of AAPMP Report No. 79 with academic

TG # 124: Guide for Establishing a Fluoroscopy Credentialing Program for Physicians. Contact: Mary Moore. Their charge is to provide guidance for obtaining approval and support to establish a program relative to fluoroscopy credentialing. They are reviewing existing programs. TG # 127: MOC Task Group. Contact: Michael Yester and Per Halvorsen. This group is working with the ABR regarding the “nonCategory 1” credit definition. They also have a SAM subgroup working with them. TG # 133: Alternative Clinical Medical Physics Training Pathways. Contact: Michael Herman. This group is developing a draft document focused on affiliated residency programs that will have full CAMPEP recognition.

school to assist in understanding and meeting deadlines, needs of the faculty, and other educational support activities. AAPM / RSNA Tutorial on Physics in Radiology Subcommittee. Contact: Mahadevappa Mahesh. International Scientific Exchange Programs Subcommittee. Contacts: Doracy Fontenla and Mahadevappa Mahesh. Media Relations Subcommittee. Contact: Jeff Limmer Medical Physics Residency Training and Promotion Subcommittee. Contact: Michael Herman. Minority Recruitment Subcommittee. Contact: Paul Gueye. This is one of our newer subcommittees. It is interested in making minorities more aware of the career opportunities available in medical physics. On-Line Continuing Education Subcommittee. Contact: Jacqueline Gallet. This group is on the edge of the expanding role of electronic media and communications as they relate to maintaining our level of education and expertise. Physics Curriculum for Radiation Oncology Medical Residents. Contact: Robert Price.

Work Group on Coordination of Medical Physics Residency Programs. Contact: John Bayouth.

Review of Radiation Physics Syllabi for Imaging Residents. Contact: Phil Heintz

Work Group on Summer School Local Arrangements. Contact: Paul Feller. This group works with the local arrangements chair and committee with all of the onsite arrangements for the summer school.

RSNA Education Coordination Subcommittee. Contact: Jerry Allison. This group is involved with RSNA related activities such as the Daily Bulletin, educational exhibits, technical exhibits, and the tutorial on physics in radiology, refresher courses and electronic communications.

Work Group on Summer School Program Arrangements. Contact: Paul Feller. This group works with the faculty directors of the summer

Secondary Education and Training Subcommittee. Contact: Russell Ritenour. This group is concerned

AAPM Newsletter with our outreach to high school and pre-college students and faculty. Students and Trainees Subcommittee. Contact: Stephen Kry. This is also one of our newer subcommittees. They are endeavoring to assess and meet the needs of our graduate students and trainees. Don’t be left high and dry by this group for, rumor has it, they will be on the river while the rest of us are hiding inside during this Annual Meeting. Bring your water wings and frog feet and join with them, if room permits. Summer School Subcommittee. Contact: Paul Feller. This group is responsible for the venue and topics for the summer schools. Summer Undergraduate Fellowship Program. Contact: George Sandison. This group oversees the summer fellowship program which funds several students per year with a modest stipend as they work with medical physicists in clinical settings or university research labs. Training and Practice of medical Dosimetry Subcommittee. Contact: Larry Sweeney. Virtual Library Subcommittee. Contact: Melissa Martin. This group is working on activities as recording of portions of our Annual Meeting, summer schools, CRCPD meetings, Educators’ Day presentations. They are also evaluating what historical data needs to be converted to modern technology. Web Site Subcommittee. Dan Bourland

Minority Recruitment, Residency Training and Promotion, Students and Trainees and Summer Undergraduate Fellowships. As a part of the committee meeting at this year’s Annual Meeting they will be working on plans for the training workshop that will follow the Annual Meeting next year in Houston, Texas. History Committee. Contact: Robert Gould. Perfect group to visit if history is your nitch as we approach our 50th anniversary. They will have a major role in our Education Council Symposium in 2008. International Educational Activities Committee. Contact: Don Frey. This is the third of the newer groups within the Education Council. It is concerned with the educational aspects of our various outreach programs on the international scene. Medical Physics Education of Allied Health Professionals Committee. Contact: Donald Peck. This is the parent committee with oversight of various task groups and subcommittees as ARRT Exams, AAMD, etc. If the professional is not a medical physicist or physician, then our educational outreach to that group is through this committee.

Contact:

Continuing Professional Development Committee. Contact: Michael Yester. This is the parent committee with oversight of various task groups and subcommittees as: RSNA Education Coordination, Summer School and On-Line Continuing Education. Education and Training of Medical Physicists Committee. Contact: Ervin Podgorsak. This is the parent committee with oversight of various task groups and subcommittees as:

July/August 2007 Medical Physics Education of Physicians Committee. Contact: Richard Massoth. This is the parent committee with oversight of various task groups and subcommittees related to our educational outreach to physicians. They also have several liaisons to these groups housed under their oversight. Presently various subcommittees of this committee are very involved with curriculum revision and innovative ways of teaching physics in our rapidly changing technological field. Public Education Committee. Contact: Mary Fox. This is the parent committee with oversight of various task groups and subcommittees related to our outreach and education of the general public relative to medical physics and those who serve in this profession. They are responsible for our Education Council Symposium this year. They are involved with activities as: the web site and media relations. OK – take a deep breath, let it out slowly, and say: “Ah!” Sure I forgot somebody but this gives you a brief overview of things in the Education Council. Do drop by and see for yourself what the various groups are doing.

AAPM Newsletter

July/August 2007

Professional Council Report

Michael Mills Professional Council Vice-Chair

here are significant happenings in the Economics and Government and Regulatory Affairs Committees. These will be the focus of the newsletter column this issue. With respect to the Economics Committee: One of the primary functions of the Economics Committee is to interact with the Center for Medicare and Medicaid Services (CMS), the American College of Radiology (ACR) and the American Society for Therapeutic Radiology and Oncology (ASTRO) respecting CPT Codes that involve medical physics services. Several members have been actively interfacing with the ASTRO/ACR Joint Economics Committee and contributing to an updated coding guide. The ASTRO/ACR Guide to Coding – 2007 has been published and is available on the ASTRO and ACR web sites. If you visit the ASTRO site, select “Publications”, then “Shop.” On the ACR site, select “ACR Store” and “Economics.” If you are a member of the ACR or ASTRO, you may purchase the Guide for $150.00. If you are not a member, the Guide costs $650.00. At this point, ACR and ASTRO do not make this publication available to the AAPM at the member price. BUT, there is yet another source: The American Medical Association sells

this guide for $150.00 to anyone (at least at this point)! Go to the AMA website http://www.amaassn.org/, select “Bookstore”, “CPT/Coding”, “CPT Specialty Coding References”, and the guide is available for $150.00 to anyone ($140.00 for AMA members). This is a vital reference document for physicists to understand and design procedures to capture charges and recover revenue for physics services. There are always governmental pressures to reduce the cost of providing medical services, but this year the priority to contain costs has an especially high priority. All medical physicists need to become familiar with the process of how services are conceived, valued, and approved for reimbursement. To that end, the AAPM Board of Directors has supported the development of the “Economics Road Show.” A full presentation uses over 100 slides and can take up to 90 minutes to cover all the concepts and ideas. This presentation is available to any AAPM Chapter; the Board of Directors has allocated funds to support travel and expenses for Committee members to make this presentation. If you are responsible for program development for an AAPM Chapter meeting, please keep this opportunity in mind. The third Abt Associates “Survey of Practice Parameters Associated with Radiation Oncology Physics Services” is underway. As I mentioned in my last column, the Abt survey has been used to document physicist clinical procedure effort, defend staffing levels for physicists, and to defend an increased level of reimbursement for the Special Medical Physics Consultation CPT

Code (77370). The AAPM leadership considers this survey to be an activity of essential importance to the medical physics community. Survey packets were mailed out April 30 for delivery during the first week in May. Survey instruments were due for return to Abt Associates by Tuesday, May 29. Analysis will take place during June and early July. If you are reading this newsletter column and still have an unreturned survey instrument, there may still be time to include it in the analysis. Please complete it today, and return it overnight. Survey results are planned to be released at the AAPM Annual Meeting in July. Please take a look at Wendy Smith Fuss’s column dealing with CMS Program Transmittal 1209. It is essential that medical physicists performing IMRT procedures to know how this procedural work is measured and accounted within the CPT system. Questions can be directed to Wendy Smith or to Jim Hevezi, Chairman of the Economics Committee. Respecting the Government and Regulatory Affairs Committee, I want to follow up on several of the bullet items I mentioned in my previous column:

•

CARE Bill: The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (CARE bill) has now been introduced into both the House and the Senate. In the House, bill H.R. 583 is sponsored by Rep. Mike Doyle, D-PA, while the Republican co-sponsor is Rep. Chip Pickering, from Mississippi. There are a total of 89 co-sponsors for the House bill. The Senate Care bill is S.1042. The Senate CARE bill was introduced in the U.S. Senate by Sen. Michael Enzi, R-WY., and Sen. Ted Kennedy, D-MA., on March 30. The Senate bill currently has 18 co-sponsors. It

AAPM Newsletter is likely that this information will be out of date by the time this newsletter reached you. There is every possibility that the bill will pass sometime during this session of Congress, so please check the AAPM website for news, details and updates.

•

The U.S. Nuclear Regulatory Commission has not yet responded to the petition filed by the AAPM 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. The NRC may take up to a year to respond to this petition. Detailed information can be found on the AAPM website under Government Affairs.

• 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. Lynne Fairobent’s column explores this issue in detail. The complete draft of the Proposed Rule can be found on the AAPM website under Government Affairs.

• There

is discussion of a new Task Group that would be formed under the Government Relations Committee to draft an AAPM document on Radiation Safety Officer Qualifications for Healthcare facilities. The document would consider medical physicists, physicians (authorized users), health physicists, and technologists to

July/August 2007 serve as a radiation safety officer in the spectrum of healthcare facilities. The Task Group would use a 2003 AAHP document as a springboard for formulating the AAPM document. The AAHP document on this subject was published originally in 2003. It is currently outdated and incomplete with respect to the revised Part 35 regulations. There is also a need to consider addressing situations where one individual serves as the RSO for multiple facilities. Details on these and other Government and Regulatory Affairs Committee issues may be found in Lynne Fairobent’s column and on the AAPM website under Government Affairs.

AAPM Newsletter

July/August 2007

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AAPM Newsletter

July/August 2007

News from CAMPEP

John Hazle President, CAMPEP

ctivity at CAMPEP has been relatively light since my last correspondence. However, there are several applications for accreditation of new graduate and residency programs that will be addressed between now and RSNA, making it a busy fall for the GEPRC and REPRC. This is encouraging in light of the current ABR timetable to require CAMPEP accredited training to sit for their exam after 2012.

the programs I am aware of are designating this as a Doctor of Medical Physics or D.M.P. degree. This degree would be similar to the professional pathways of dentists and veterinarians where a curriculum of classwork is followed by a defined period of clinical training. To address the accreditation aspects of this new degree I have asked Geoff Clarke to chair a task group to develop accreditation guidelines. This TG will establish the didactic and experience requirements necessary for accreditation. It is our goal for the CAMPEP requirements to be aligned with the ABR and other Board requirements such that at the completion of the D.M.P. program the candidate would immediately sit for the board exam and begin independent practice almost immediately.

With respect to the 2012 initiative, the ABR has called a summit in August to review this expectation and reaffirm that the medical physics community is ready for its implementation. After discussion with the CAMPEP Board and our program review committee chairs, we believe CAMPEP can address a reasonable surge in applications from programs in anticipation of this requirement. I will present CAMPEP’s position and preparedness for this expectation at the August meeting. One issue that appears to be gaining momentum is the development of a professional doctoral degree in medical physics. This idea was first floated at the RSNA/AAPM Education Summit in Atlanta last year (at least Eric Klein’s discussion was the first I had heard). So far,

CAMPEP has also been continuing discussion with a non-North American institution that would like to be considered for CAMPEP accreditation. This institution is in Western Europe and has support from their local government. Our Vice President, Peter Dunscombe, is continuing to discuss this matter with the requesting institution. Finally, I’d like to thank Michael Woodward and Shantelle Corado for quickly getting the communication for the CAMPEP database synced with the ABR CME gateway. Once again, very good support from AAPM HQ to assist us with something that will help the membership of AAPM. See you in Minneapolis!

AAPM Newsletter

May/June 2007

Health Policy/Economic Issues

Medicare Clarifies IMRT Billing Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant

he Centers for Medicare and Medicaid Services (CMS) recently published Medicare Program Transmittal 1209 (Change Request 5544) that provides information regarding the clarification of IMRT billing in the hospital outpatient setting. Specifically, CMS clarifies the transmittal by stating that “services identified by CPT codes 77280 through 77295, 77305 through 77321, 77331, 77336, and 77370 are included in the APC payment for IMRT planning when these services are performed as part of developing an IMRT plan that is reported using CPT code 77301. Under those circumstances, these codes should not be billed in addition to CPT code 77301 for IMRT planning.” The AAPM has received many inquiries regarding billing medical physics codes during a course of IMRT. The AAPM Professional Economics Committee has worked with both local and national Medicare carriers to come to an understanding regarding IMRT billing. CPT 77336 for the continuing weekly medical physics consultation and CPT 77370 special medical physics consultation may be billed if it is not part of developing an IMRT plan, but rather is invoked due to the continuing medical physics work associated with ongoing treatment activity for the patient. The codes for continuing medical radiation physics consultation and special medical radiation physics consultation are

distinct and entirely independent services provided during a course of radiation therapy. Both CPT 77336 and 77370 are technical-only codes. CPT 77336 Continuing Medical Physics Consultation The continuing medical radiation physics consultation is used to describe the ongoing medical physics assessment provided by a qualified medical physicist to each patient receiving radiation therapy. 77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy CPT 77336 involves weekly chart reviews, review and analysis of medical physics aspects of changes to the treatment regime, consultation on patient setup and treatment modifications, verification of dose calculation data, reviewing accuracy of the current data record, including review of patient-specific therapist treatment and technical notes, and patient radiation safety. The medical physicist reviews all aspects of the treatment delivery, including correlating the treatment prescription with the technical and medical physics aspects of treatment, and with the actual execution of the treatment. Documentation of these services should include a signed and dated indication by the medical physicist in

the patient’s chart that the continuing medical physics consultation has been done. CPT 77336 is reported once for five fractions of external beam radiation therapy, regardless of the actual time period in which services are provided. The services need not be furnished on consecutive days. Multiple fractions representing two or more treatment sessions furnished on the same day may be counted separately as long as there is a distinct break in therapy session. CPT 77336 is not included in CPT 77301 and may be billed separately if continuing medical physics consultation work is performed for reasons other than the work associated with the IMRT plan. CPT 77336 is appropriately charged for continuing medical physics consultation during the delivery phase of IMRT. Continuing medical physics is appropriate for the “weekly” continuing medical physics process and reports the work and oversight of the medical physicist in the care of the IMRT patient. It is not appropriately reported for work associated with the creation of the IMRT plan. A Medicare claim may be denied if CPT 77336 is billed on the same day as CPT 77301 for IMRT planning due to a national Correct Coding Initiative edit (CCI). CPT 77370 Special Medical Physics Consultation The special medical radiation physics consultation is used when the complexity of the treatment plan is of such magnitude that a thorough written analysis is necessary to address a specific problem, or when the service to be performed requires the expertise of a qualified medical physicist. The

AAPM Newsletter radiation oncologist makes a direct request to the qualified medical physicist for a special consultative report or for specific physics services for an individual patient. 77370 Special medical radiation physics consultation The qualified medical physicist will spend a considerable amount of time and effort on behalf of a specific patient and will render a customized written report to the radiation oncologist in reference to the problem or service being addresses. The medical physicist’s written report is part of the patient’s medical record.

A special physics consult is generally required no more than once per course of radiation therapy. A claim for a special medical physics consultation is appropriate only where the need for and use of the consultation are carefully documented and occur for work performed for the patient other than that necessary as a part of IMRT planning and associated plan verification measurements and analysis (e.g. a special physics assessment requested when already into a course of therapy). Note that if CPT 77370 is billed on the same day as CPT 77301 for

July/August 2007 IMRT planning, a CCI edit may be triggered. The clarification of IMRT billing is the culmination of AAPM communications to Medicare working with related professional societies, including ASTRO. You may review Medicare Program Transmittal 1209 on the CMS website at: www.cms. hhs.gov/Transmittals/2007Trans/ list.asp Excerpts of this article come from The ASTRO/ACR Guide to Radiation Oncology Coding 2007, which is available for purchase at: www.astro.org/Shop/createorder. asp

Journal of the American College of Radiology The American College of Radiology is pleased to announce that the Journal of the American College of Radiology (JACR) has been selected for inclusion in MEDLINE, the premier bibliographic database of the US National Library of Medicine (NLM). “The entire Editorial Board and I are extremely pleased that JACR is being added to the MEDLINE journal collection so soon after its launch in 2004,” says JACR Editor Bruce J. Hillman, MD, of the University of Virginia, Charlottesville. “Inclusion in this prominent database signals recognition of the Journal’s scientific merit and contribution to the field. But more importantly, MEDLINE indexing will help researchers and other interested parties throughout the world locate articles published in JACR.” As the official journal of the American College of Radiology (ACR), the peer-reviewed JACR (www.jacr.org <http://www.jacr.org/>) is circulated to the College’s 28,000 active members each month, as well as other subscribers and libraries. JACR publishes information on clinical practice, practice management, education, health-policy and health services research related to radiology and radiation oncology. The Journal strives to provide the tools needed to solve everyday problems, while also offering powerful food for thought on the larger issues evolving within and around the field today. Two popular columns on medical physics are co-edited by the AAPM members Mahadevappa Mahesh, PhD, and Nicholas Detorie, PhD: the Medical Physics Consult, which recently provided an update on the new physics education curriculum for radiologists, and Technology Talk, which recently addressed how new federal regulations for fluoroscope dose monitors will help clinicians keep track of patient dose. We invite AAPM members who are interested in submitting articles to the medical physics columns to contact either one of the above physics column editors. The ACR and its publishing partner, Elsevier, are gratified that researchers worldwide can easily find the valuable information offered in JACR now through MEDLINE. Information on receiving a journal subscription as a benefit of membership in the ACR can be found at www.acr.org <http://www.acr.org/>. Information on nonmember and library subscriptions can be found at www.us.elsevierhealth.com <http://www.us.elsevierhealth.com/>.

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AAPM Newsletter

July/August 2007

Legislative and Regulatory Affairs Column in nuclear medicine, some of the non-Agreement States did not regulate the accelerator-produced material. As a result of NRC’s new regulations, the acceleratorproduced radioactive material (as defined in the new definition) will be regulated throughout the country and U.S. Territories.

Lynne Fairobent College Park, MD

NRC APPROVES FINAL RULE ON EXPANDED DEFINITION OF BYPRODUCT MATERIAL

n May 14, 2007 the Nuclear Regulatory Commission approved by a vote of 5-0 a final rule expanding the definition of radioactive materials subject to its regulatory authority, implementing provisions of the Energy Policy Act of 2005. Background. On August 8, 2005, the President signed into law the Energy Policy Act of 2005 (EPAct). Section 651(e) of the EPAct, titled “Treatment of Accelerator Produced and other Radioactive Material as Byproduct Material” expanded the definition of byproduct material as defined in the Atomic Energy Act of 1954, as amended (AEA). The additional byproduct material includes certain naturally-occurring and acceleratorproduced radioactive material (NARM), such as Fluorine-18 used in PET imaging, Cobalt-57 in flood sources, and Gallium-67, Indium111, Iodine-123, and Thallium-201 used in nuclear medicine diagnostic studies. While many of the 34 Agreement States regulate accelerator produced radioactive materials used

Waivers. Although the legislation made NRC’s authority over these new materials effective immediately, the NRC issued a waiver on August 31, 2005 (70 FR 51581) to: (1) allow States to continue with their regulatory programs for NARM; (2) allow persons engaged in activities involving NARM to continue with their operations in a safe manner; and (3) allow continued use of radiopharmaceuticals for medical purposes. The waiver is in effect through August 7, 2009, unless the NRC terminates it earlier. The NRC plans to terminate the waiver in phases, starting from the effective date of the rule and ending on August 7, 2009. During the initial phase of waiver terminations, which will occur in conjunction with the effective date of the final rule, the Commission intends to terminate the waiver for Federal Government agencies, Federally Recognized Indian Tribes, Delaware, District of Columbia, Puerto Rico, the U.S. Virgin Islands, Indiana, Wyoming, and Montana. A notice in the Federal Register will be published approximately six months before the effective date of the waiver termination to notify users of their waiver terminations and implementation dates of the rule. NRC staff will notify

impacted State regulators individually prior to the publication of the Federal Register notice. The NRC also plans to provide additional notification to known entities impacted by the initial phase of waiver terminations following publication of the final rule in the Federal Register. Upon waiver termination, all persons that possess the new byproduct materials in these States, U.S. Territories, or areas of exclusive Federal jurisdiction must be in compliance with NRC regulations, including, for example, meeting the reporting and recordkeeping requirements for the new byproduct material. Such persons will also either be required to: 1) apply for license amendments for the new byproduct material within 6 months from the date the waiver is terminated, if they hold an NRC specific byproduct materials license; or 2) submit a license application for the new byproduct material within 12 months from the date the waiver is terminated. In conjunction with the effective date of the final rule, the NRC also intends to terminate the waiver for any of the 34 Agreement States that provide a certification from their Governor to the Commission as described in the EPAct and the Commission’s Transition Plan mandated by the EPAct (see below). Users of the new byproduct materials in Agreement States should contact their respective Agreement State regulatory agency with any questions related to plans for continuing to regulate these materials. Transition Plan: The EPAct requires the NRC to prepare and publish a transition plan to facilitate an orderly (see Fairobent p. 26)

AAPM Newsletter

Ohio River Valley Chapter Spring Meeting Douglas Frye Ohio River Valley Chapter President

he Ohio River Valley Chapter of the AAPM held its Spring meeting Saturday, April 28th at the Vontz Center for Molecular Studies at the University of Cincinnati, Cincinnati, Ohio. The Chapter’s thanks go to site host/organizer Mike Lamda and program director Colleen DesRosiers for providing a spacious and well equipped venue, as well as stimulating and engaging content, respectively. The presenters at the meeting ranged from the young (Melaine Dybvig, Bloomington High School) to the young at heart (William Van de Riet, Bloomington Hospital). The Spring meeting emphasized student/resident and post-doc presentations in keeping with the Chapter’s intention to provide greater student access in the Spring and CE/professional development in the Fall. Students hailed from Bloomington High School, Midwest Proton Research Institute, University of Cincinnati, Indiana University, University of Kentucky, Ohio State University, Purdue University, and the University of Toledo. In all, there were 14 student/resident/post-doc presentations. Each student presenter received a travel award. In addition to student presentations, the chapter also heard from the Dr. Van de Riet on MLC QA with and EPI and Dr. Gloria Beyer (Sicel Technologies) on implantable MOSFETs. A business meeting was held immediately following the student presentations. Chapter President Douglas Frye introduced Colleen DesRosiers as the new Chapter President Elect. The Chapter also recognized Dr. Paul Feller’s contributions and service as the retiring Chapter Board Representative. Paul gave a brief report of Board business, including expanded board meetings to

July/August 2007

Chapter News three per year, the CARE bill status and board position on same, and the board reorganization that won’t die. The election of the Paul’s replacement was discussed. There were snags in the e-voting process due to spam filters. A supplementary process became necessary to capture votes from those unable to receive e-vote links. Doug then gave a quick summary of Chapter Finances for Chapter Treasurer/ Secretary Jonathan Farr, who was unable to attend. Volunteers for hosting the next Fall meeting were requested. Dr. Howard Elson, on behalf of Mike Lambda and the UC, volunteered to host the Spring meeting on an ongoing basis, noting the Vontz Center facilities and central location of the venue to regional academic programs. The UC, Drs. Lamda and Elson were thanked for their generosity. Action was deferred to

the Fall meeting. A request was also made for those willing to be candidates for the President Elect office which will be open in December, as Colleen moves into the Presidency. Finally, a discussion of potential means for expanding Chapter membership and involvement among community based practicing physicists in the geographic region was discussed. It was felt in general that the Fall CE/ professional program would attract more interest/involvement than anything else. The Chapter would like to recognize our vendor/sponsor partners, whose support and participation enlivened and enhanced the meeting: Varian Medical Systems, Tomotherapy USA, Siemens Medical Solutions, Lux HealthCare, Best Medical, PTW-New York, Landauer Inc, Nuceltron, Sun Nuclear Corp., Accuray Inc., and Isoray Medical.

Everybody deserves a little credit..... COMMISSION ON ACCREDITATION OF MEDICAL PHYSICS EDUCATION PROGRAMS, INC.(CAMPEP) We anticipate that for each hour of verified attendance (this includes scientific sessions, poster discussion sessions, symposia, professional and educational courses), 1 MPCEC hour of credit will be awarded. AAPM will request up to eight (8) credits for general poster viewing. MAINTENANCE OF CERTIFICATION (MOC) as defined by ABR Many AAPM members now require Maintenance of Certification (MOC) as defined by the American Board of Radiology. AAPM is offering Self-Assessment Modules (SAMs) which allow for interactive learning and self-assessment of knowledge gained during 8 designated sessions, to be submitted for ABR approval. Please note that the SAMs 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 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. MEDICAL DOSIMETRIST CERTIFICATION BOARD (MDCB) The Medical Dosimetrist Certification Board (MDCB) has approved 263 continuing education credit hours of the meeting program, which includes the Review Courses. Medical Dosimetrists seeking credit should ask for a paper MDCB form at the AAPM registration desk in Minneapolis.

AAPM Newsletter

Southeastern Chapter Meeting Robin Miller, SE-AAPM Chapter President

he Southeastern Chapter of AAPM held its annual chapter meeting and annual symposium on “Digital Imaging: Measuring the Present and Considering the Future An Educational Symposium for the Clinical Medical Physicist” on March 22-24, 2007 in Atlanta, GA. Over 60 colleagues and friends registered for the meeting along with vendors who provided solid support.

Chapter News T. Badea, Laurence W. Hedlung, Ming De Lin, Julie F. Boslego Mackel and G Allan Johnson. Duke University Medical Center. Contrast Med. Mol. Imaging 1: 153-164 (2006).”

Robert Saunders both from the Duke University. If you missed our meeting or symposium this year, make sure to keep room in your schedule for next year’s spring meeting. See you there.

This year’s scientific symposium was co-directed by Ehsan Samei and 0704-5563 AAPM_07ProbeGAd:AAPM Ad

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New for this year at the chapter meeting, the chapter offered a travel stipend for one student from each of the 5 medical physics graduate programs in our region to give a presentation on their research or area of interest. The students did an outstanding job. All of the presented abstracts along with the meeting program are listed on our webpage at http://www.seaapm.org/ mtgprog/MtgProg2007.htm. The chapter also gave several awards and honors to recognize some of our distinguished members. Our ‘Jimmy O. Fenn’ award given to members for outstanding career achievements, leadership and contribution’ went to Gary Barnes and Raymond Tanner. We also recognized the authors from our chapter, for the best paper in therapy and imaging physics. The best publication in therapy physics went to: “Use of multileaf collimator to increase the field width achievable with a dynamic wedge by Brezovich, Popple, and Jun Duan. JACMP, Vol 7, Number 3, Summer 2006” and the best publication in imaging physics went to “Tumor Imaging in small animals with a combined micro-CT/micro-DSA system using iodinated conventional and blood pool contrast agents. Cristian

July/August 2007

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AAPM Newsletter

Fair and Useful Copyright Marc H. Brodsky Executive Director Emeritus American Institute of Physics

s Executive Director Emeritus of the American Institute of Physics (AIP) I often deal with intellectual property issues, particularly those pertaining to copyright. Earlier in my career, as an author eager to report my research results to colleagues, copyright was just one more form to fill out en route to getting my paper published. If I thought about it at all, I probably just assumed that the publisher, usually a society to which I belonged (over the years, I have been a member of six of AIP’s ten member societies), needed me to transfer copyright in order to protect my work in some way. I actually probably thought it was for my benefit more than anyone else’s. While that turns out to be true, it also is an oversimplification of what, in the modern world of electronic dissemination, is a very complicated and controversial issue. Since coming to AIP in the fall of 1993, just as the first widely available Web browsers stimulated electronic distribution of articles, I have learned more about copyright than any scientist or engineer should care to discover. Nevertheless there are a few basic concepts all authors should understand because the future of their societies may depend on their decisions. An important issue confronting learned society publishers and authors today is: Who should own the copyright of published articles and what rights should be given, by license or otherwise, for the pre- and post-publication use of those articles? There are many aspects of this issue,

July/August 2007

Copyright Issues some legal, but others which are matters of policy, fairness, usefulness, economics and the viability of peer review and scientific publishing itself. The copyright law aspects, while complicated and often costly, are relatively simple compared to the policy and economic ones. The basis of copyright law in the United States stems from Article I of the U.S. Constitution which empowers Congress “To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.” It is interesting to note the matched goals of this constitutional stricture to promote the progress of science and the AIP charter to advance and diffuse “the knowledge of the science of physics and its applications to human welfare, and to this end … to undertake, among other measures, the publication of scientific journals.” Internationally, the 1971 Berne Convention for the Protection of Literary and Artistic Works provides the basis for copyright law in most countries today. Congress and other legislatures throughout the world have created a system of property and moral rights for authors and their publishers. While granting exclusive rights to control reproduction and distribution of copyrighted works, there are exemptions for what is called “fair use” in the U.S. and “fair dealing” in the UK and parts of Europe. The most obvious fair use is the right to quote from or refer to published works. Also, copyright only protects original, tangible forms of expression and not ideas or data. Ideas or facts can be used by anyone, although in our fields it

is expected that suitable attribution is always given. The Berne Convention gives a three-step test to countries that might want to allow some exceptions to copyright protection, namely: (i) if it is a special case; (ii) if it does not conflict with a normal exploitation of works; and (iii) if it does not unreasonably prejudice the legitimate interests of owners of rights. So what exceptions are fair and reasonable and legal? For journals, some cases are easy. Most journals allow authors to distribute preprints or reprints of their articles to colleagues. Similarly if a scientist reads something of interest, it is generally acceptable to give or send a copy to a collaborator, student or colleague and say have a look at this. In lieu of a subscription, it is not fair use to regularly ask a subscriber to send copies of articles. It is not acceptable for organizations to make systematic copies for distribution to its employees, students or customers without permission of the rightsholder. There are many complicated issues in the middle ground. How often can one library subscribing to a journal copy articles for another that does not pay for a subscription? This is sometimes called “Inter-Library Loan” (ILL), analogous to loaning physical copies in the days before easy copying. Can a library charge for ILL? Can libraries sell copies (Documents Delivery or DocDel) to its patrons? Who is a library’s patron? Is it anyone in the world making a request via the Web? Who determines what rules apply? While the pre-Web era was somewhat more straightforward, even then there was controversy over just how much ILL was acceptable. Some voluntary guidelines were established in 1978

AAPM Newsletter by the National Commission on Technological Uses of Copyrighted Works (CONTU). While helpful, these Guidelines are not always well understood or followed. Realizing that the World Wide Web was enabling much easier use and reuse of copyrighted works, a new Conference of Fair Use (CONFU) was convened. After 2½ years of extended discussions and proposed Guidelines, it was unable to reach a consensus between users who “thought the Guidelines were over restrictive and copyright owners [who] thought they were giving away too much.” It ended in failure in 1997. I think today, many in either group would be happy with such reasonable Guidelines. Legal issues aside, what is the value of copyright for learned societies? Does it help sustain the valuable role of learned society journals in promoting the dissemination of information to the widest possible audiences of interest? In my mind there is no question that for AIP and its Member Societies, the transfer of copyright from author to publisher is a very positive ingredient for a scientific journal. It gives the society important freedoms of action available no other way. For example, it reduced the fear of legal complications when we scanned, digitized and posted online the articles from all our journals back to Volume One, Issue One. While perhaps the risk to us was small, some periodical publishers in other fields who only had licenses and not copyrights from authors were sued when they digitized older articles. In other cases, where some document delivery services were reselling articles from our journals, it was essential to have the copyright transfer forms in order to file legal cases to protect the journals. If instead of a transfer, journals only had a license, then protection against misuse would be much more difficult to pursue.

On the other hand, there are those who say that authors should retain copyright and only license certain non-exclusive rights to the publisher. Having viewed in detail some of the proposals , they contain terms that would undermine the subscription value of a journal by allowing posting on any site for any purpose, commercial or not, that might compete with the journal. AIP and many of its Member Societies already grant many author rights, including postings of their own articles on free-access, noncommercial e-print servers. But these arguments are only illustrative details. The big picture is that much of the current discussion on copyright is intertwined with debate about open access, dominated by advocates of the open access movement. In turn, much of the open access discussion is driven by four very important forces: • Libraries, whose budgets cannot keep up with growth of research and materials that they and their patrons want; • Ideologues, who feel that “information should be free;” • Funding agencies, which feel that if publications result from research they support, then they should be able to mandate free access to those publications without paying for the reviewing and editing costs incurred by publishers; • Technologies, which lower some of the barriers to entry for publishing and which make it easier to post copies of almost anything. It is incorrect to assume that electronic publishing is cheaper that print publishing. The submission, review and editorial costs are the same. For AIP, the print-specific costs – printing, binding, shipping and mailing – total less than 15% of the overall

July/August 2007 production costs. Even if there were no print, the extra production costs for electronic-specific production, such as tagging and linking, more than eats up that 15%. As a consequence of these forces, there are many who would like to see publishers of costly journals fail and attacking copyright has become one element of a strategy towards that end. While not as costly, on a per article or per page basis, as most commercial publishers, learned societies journals are been swept along in the wave of populism that threatens copyright and the right to choose business models most appropriate for any given society journal. As authors contemplate their reaction to requests to transfer or retain copyright, it pays to think about what problem we are trying to solve. Will author retention of copyright result in wider promotion, dissemination and acceptance of their results? The answer is not likely. This is because publishers not only add value by peer review and editing, but they also brand, market and distribute journals to audiences that recognize the value of reputable journals. Hopefully you feel that your society’s journals are the journals your colleagues are most likely to read. Yes, these journals are costly to subscribe to. They are also costly to produce, distribute and maintain. AIP and its Member Societies have embraced new technologies and have launched many new pricing models which have kept prices as low as we can while sustaining the financial viability of our operations. The result is that more authors submit to our journals and more researchers, educators and students have access to them and use them more effectively than at any previous point in history. Copyright ownership by the societies has helped create that wide dissemination that advances our fields.

AAPM Newsletter

July/August 2007

Final Report of the National Commission on Technological Uses of Copyrighted Works, July 31, 1978, Library of Congress, Washington, DC 1979, pages 54-55.

Georgia Harper, CONFU-The Conference of Fair Use, www. utsystem.edu/ogc/INTELLECTU-

ALPROPERTY/confu.htm, June 11, 1997. U.S. Supreme Court, NEW YORK TIMES CO. V. TASINI (2001); U.S. 11th Circuit Court of Appeals, GREENBERG v NAT’L GEOGRAPHIC (2001).

For example, http://web.mit. edu/ocwhq/pres/facpack/Amendment_to_Pub_Agreement.pdf

http://ftp.aip.org/aipdocs/forms/ copyrght.pdf

AMERICAN INSTITUTE OF PHYSICS POSITION ON OPEN ACCESS & PUBLIC ACCESS AIP's mission and policy is to achieve that widest dissemination of the research results and other information we publish. • Since the arrival of the Web, AIP believes it has achieved wider and more affordable dissemination than ever before in history, with more subscribers, more readers and more libraries and other institutions and people using our journals than ever before. Some use them free or at very low cost under various open access models. �• AIP believes it has been extremely successful in using and investing in technology and new online platforms towards that end. �• AIP has instituted and experimented with many business models, including free and open access. AIP believes that publishers should be free to experiment with various business models in the market place of ideas and economics. �• AIP is fearful of and against government mandates that provides rules in favor of one business model over another. �• AIP is against funding agencies mandating free access to articles after they have undergone costly peer review or editing by publishers. AIP is against the government posting or distributing free copies of articles that publishers have invested in producing. �• AIP believes that funding agencies have every right to report their results to the public, but that if they choose to use publisher-produced, peer-reviewed material to do that, then the publisher should receive appropriate compensation. �• AIP is also fearful about what government agencies might do with articles they receive under any deposit system. In particular, AIP is fearful of mission creep with government agencies using the deposited material beyond the goal of public access, for example in enhanced publications that compete with the private sector. American Institute of Physics October 2006

AAPM Newsletter

William R. Hendee Editor of Medical Physics

Assignment of Copyright

arc Brodsky of the American Institute of Physics (AIP), wrote a brief on Fair and Useful Copyright. The brief is intended for review by persons involved with journals such as Medical Physics that are published by the AIP. There are interesting points in the brief that I wish to share with AAPM members.

What is the advantage to the author(s) of assigning copyright to Medical Physics (AAPM)? First, grievous violations of copyright can be challenged, and potentially prosecuted, with the weight and resources of the AAPM rather than the individual author(s). Second, it allows the AAPM to place all issues of Medical Physics on line [from volume 1 (1974) forward] without legal complications. Third, it helps to protect the AAPM’s revenue from the journal by inhibiting unauthorized duplication and distribution of journal articles. Fourth, it provides revenue to the AIP to deploy new technologies that reduce

July/August 2007 the costs of journal publication. Medical Physics is a major revenue source for the AAPM, which helps to keep member dues down and allows publication of articles without page charges. Copyright assignment has been raised as a concern by individuals who favor “open access” to the scientific literature. The issues surrounding open access are complex and deserve consideration beyond that possible in this article. They are the subject of an editorial by the author that was published in the March 2007 issue of Medical Physics.

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Copyright protects the original forms of expression in a published work. It does not protect the ideas or facts in the work, because these can be used by anyone, preferably with proper attribution to the source. In the United States, copyright is addressed in the U.S. Constitution; international copyright protection is afforded through the Berne Convention for the Protection of Literary and Artistic Works (1971). When an article is accepted for publication in Medical Physics, the authors are required to assign copyright for the article to the journal and hence to the AAPM. Copyright protection is usually waived for certain situations such as an author distributing preprints or reprints to colleagues or students, or a teacher distributing copies of articles on a one-time basis to students in a class. Systematic distribution of copies of articles as a rule rather than an exception is not allowed under copyright protection unless permission is granted by the copyright-holder. Similar rules exist for libraries and the “inter-library loan” of documents.

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AAPM Newsletter

July/August 2007

ACR Accreditation

Does your facility need help on applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation,” then “Mammography.” Most of the mammography accreditation application and QC forms are available for downloading. You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists. Priscilla F. Butler, M.S. Senior Director, ACR Breast Imaging Accreditation Programs

Q. Every time one of the full-field digital mammography (FFDM) manufacturers updates its QC manual, the ACR changes its Medical Physicist’s Mammography QC Test Summary form. Why is this necessary? How can medical physicists keep informed of the most current summary form to use? The FDA requires accredA. iting bodies to evaluate the medical physicist’s Mammography Equipment Evaluation and Annual Survey results based on the most current version of the QC manual for the unit tested at the facility. Consequently, each time an FFDM QC manual is revised by the manufacturer, the ACR has to revise its Medical Physicist’s Mammography QC Test Summary form to ensure that the appropriate results are collected and evaluated. The most current ACR forms are available on the ACR website at www.acr.org. Note that the QC form names on the website now include the revision date so you may easily determine if you have the latest version. For example, in early 2007, both GE and Fuji revised their FFDM QC Manuals. The ACR modified the Medical Physicist’s Mammography QC Test Summary forms for those systems to be consistent with the changes in GE and Fuji’s required tests. See links below to these new documents. http://www.acr.org/accreditation/ mammography/documents/medical_physicists/med-phys-qc-summary_fuji-digital.xls

http://www.acr.org/accreditation/ mammography/documents/medical_physicists/med_phys_qc_summary_ge_digital.xls You are only required to submit the appropriate summary form that was applicable to the unit you tested and, obviously, that was current at the time of your survey. If you are testing a new installation, most likely you should be using the newest summary for the manufacturer of that system; please check the ACR website in those cases. If you are doing an annual survey on an older piece of equipment, the ACR will accept an older summary form. The ACR will announce updates to these forms on its website. We are also exploring other mechanisms to announce these updates to facilities and medical physicists. When patients or phyQ. sicians request mammogram hardcopies, may our film room staff print and release FFDM mammograms or must the hardcopy images be printed and released by mammography technologists? FDA does not specify who prints/ releases records. However, the FDA does require, for purposes of transferring films, that the facility be able to provide the medical institution, physician, health provider, patient or patient’s representative, with hardcopy films of final interpretation quality. See the FDA’s Policy Guidance Help System at www.fda. gov/CDRH/MAMMOGRAPHY/

robohelp/START.HTM. The facility should have a system in place to ensure that the printed and transferred hardcopy images are of final interpretation quality. The quality control technologist and lead interpreting physician should ensure the task is performed in accordance with these regulations. Does it matter if we use Q. lossless and lossy compression for FFDM? Yes. The FDA permits a A. facility to store and recreate images for final interpretation from original or lossless compressed files only. Lossy compressed images may not be used for final interpretation or storage. However, while lossy compression is not allowed for final interpretation, lossy compressed images from previously obtained mammograms may be used for comparison purposes, if the interpreting physician deems the images acceptable. FDA recommends that if lossy compressed images are used for comparison purposes, that only algorithms approved or cleared by FDA’s Office of Device Evaluation for such purposes be used. In addition, FDA recommends that phantom and clinical images produced by lossy compression pass all applicable quality control tests and are of such quality that if they were submitted, they would pass the facility’s accreditation body’s phantom and clinical image review process. Finally, lossy compressed images cannot be used for initial or continuing experience

(See Butler p. 27)

AAPM Newsletter

July/August 2007

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(Fairobent from p. 17) transition of regulatory authority with respect to the newly added byproduct material. The transition plan addresses both Agreement and non-Agreement States, and has been coordinated extensively with the States. The NRC anticipates that the final Transition Plan will be published in conjunction with the final regulations in the Federal Register, as required by section 651(e) of the EPAct. Additional Information and Supportive Activities: The NRC staff is also working on several activities that will be needed to support NRCâ&#x20AC;&#x2122;s new regulatory authority. Specifically, the NRC staff is working on finalizing revisions to guidance contained in NUREG-1556, Volumes 9 and 13, and developing a new NUREG (NUREG1556, Volume 21) which is focused on the production of radioactive material using an accelerator. The NRC staff is

also planning to make minor revisions to other guidance documents and procedures to reflect the regulation of the new byproduct material. Draft Text of Final Rule: The draft text of the final rule was posted on the NRC Web site at this address: http://www.nrc.gov/reading-rm/ doc-collections/commission/ secys/2007/secy2007-0062/20070062scy.pdf. The Commissionâ&#x20AC;&#x2122;s Staff Requirements Memorandum, which details the edits and revisions directed by the Commission to be incorporated in the rule, can be found at: http://www.nrc.gov/readingrm/doc-collections/commission/ srm/2007/. Source Collection and Threat Reduction Program (SCATR) REGISTER YOUR UNWANTED SOURCES!!!!!!!!! Lat issue I stated that the Conference of Radiation Control Program

Directors (CRCPD) and DOE/LANL have signed a contract to initiate a program to â&#x20AC;&#x153;round upâ&#x20AC;? sources in a geographic area that would not by themselves qualify under the DOE Source Recovery Program. CRCPD I working to identify the pilot area and will do so based on the number of sources registered in a geographical area. Therefore, AAPM members must register any sources that they would like to have considered for the program. It is anticipated that the program will manage large numbers of small obsolete sources, examples of which are cesium-137 brachytherapy sources, and various radium-226, americium-241, strontium-90 eye applicators, and other sources. To register sources with LANL online, please visit http://osrp.lanl.gov/what_ is_osr.shtml. If you have additional questions, please stop by Booth # 1211 at the AAPM annual meeting and speak to CRCPD representatives.

AAPM Newsletter

(Butler from p. 25) requirements. See the FDA’s Policy Guidance Help System at www.fda. gov/CDRH/MAMMOGRAPHY/ robohelp/START.HTM. My facility has a large Q. archive of film images. Can we legally digitize them and discard the old film images to help reduce our storage problem? A. No. The FDA regulations do not allow this because a digitized film image is not produced through radiography of the breast; under

MQSA it is not considered a mammogram and cannot be used for retention or final interpretation. See the FDA’s Policy Guidance Help System at www.fda.gov/CDRH/ MAMMOGRAPHY/robohelp/ START.HTM. My facility just purQ. chased a FFDM unit and wants to digitize all of our previous film images so they may be more efficiently used for comparison purposes. Is this allowed under MQSA?

July/August 2007 Yes. The FDA allows digiA. tized or copied images of previously obtained film mammograms to be used for comparison purposes, if the interpreting physician deems that acceptable. However, because such images are not considered mammograms under MQSA, they cannot be counted towards initial or continuing experience requirements for the interpreting physician. See the FDA’s Policy Guidance Help System at www.fda.gov/CDRH/MAMMOGRAPHY/robohelp/START.HTM.

All of the 2007 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: September/October Submission Deadline: July 16, 2007 Postmark Date: August 23, 2007

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