Newsletter
AMERICAN ASSOCIATION OF PHY SICISTS IN MEDICIN E VOLUME 32 NO. 5
SEPTEMBER/OCTOBER 2007
AAPM President’s Column
Mary K. Martel UT MD Anderson Cancer Center
Minneapolis and the Annual Meeting
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inneapolis has been on our minds lately because of the recent bridge collapse in the Twin Cities. The AAPM expresses its solidarity with its members in Minnesota following this tragedy, and Russ Ritenour, chairman of the Board and a Minnesota resident, has personally contacted AAPM members in Minnesota. The 49th annual meeting in Minneapolis was a great success (and not just because it was my presidential year!), due in large part to the efforts of a number of people, among them: Scientific Program Co-Directors Charlie Ma and Chris Shaw, Education Program co-Directors Indrin Chetty and Perry Sprawls, Professional Program co-directors Mike Herman and Bruce Gerbi, Education Program Subcommittee
Chair Mark Rzeszotarski, Scientific Program Subcommittee Chairs Gary Ezzell and Andrew Maidment, Therapy Track organizer Tom Bortfeld, the Meeting Coordination Committee Chair Melissa Martin, the Local Arrangements Committee, including the chair, Richard Geise, and the entire AAPM HQ staff. I was the scientific program director several years ago, and I know first-hand that many people work tirelessly nearly all year round to ensure the meeting is of high quality, and runs smoothly. Besides the happenings taking place in the convention center, we have fond memories of: the Twins beating the Angels at the Metrodome, the fireworks over the mighty Mississippi marking the end of the Aquatennial, the outdoor cafes along Nicollet Mall, lawn bowling at Britt’s, the afterconcert party with Nickelback, meeting friends on Nicollet Island at the Night-out event, and the highlight of the meeting, members of Board and Excom doin’ a little logrolling …and subsequent swimming [video available]. Town Hall meeting The AAPM new member symposium (combined with “Meet the Experts”) was well attended this year, perhaps because our new members were able to have access to some legends (and legends-inthe making) in our field. New to the annual meeting this year was the Town Hall meeting. This
meeting event was proposed by the Board, via a motion by Chris Serago at last summer’s Board meeting, in order to give members face-toface access to the Board in a public meeting. Though the Town Hall meeting was in the same time slot as the New Member symposium of the previous day, the attendance was not quite as good. Thirty-some Board members did attend and perched on stools at the front of the room. And for a time, the Board members may have outnumbered the audience members 2 to 1. Questions from the audience were slow to come for the first half of the meeting, but picked up in number and relative importance until it was time for the Annual Business Meeting. For next year, we may need to change the format a bit to facilitate participation, such as having the Town Hall meeting at the beginning of the annual TABLE OF CONTENTS President Elect’s Column Executive Director’s Column Editor’s Column Education Council Report Science Council Report Professional Council Report CAMPEP News Leg. & Reg. Affairs Coolidge Award Speech ACR Accreditation FAQS Partners in Physics update Health Policy/Economics Persons in the News
p. 3 p. 4 p. 7 p. 8 p. 11 p. 12 p. 13 p. 15 p. 16 p. 20 p. 22 p. 24 p. 32
AAPM Newsletter
September/October 2007
business meeting time slot, and/or adding refreshments, or perhaps soliciting questions via “YouTube” (though minus any snowmen!). In the end, though, the Town Hall Meeting was a success, and I encourage you all to come meet the members that represent you on the Board, at next year’s annual meeting. 2012 and the ABR Update I had a number of people approach me during the annual meeting to inquire about the change in requirements to sit for the American Board of Radiology exam in Radiologic Physics as of the year 2012. The chief worry was what happens to those that are already in the “pipeline” of taking the Boards prior to the year 2012. AAPM leadership met with the ABR physics trustees during the annual meeting, and were assured that those in the process of board certification will be able to continue without having to meet the new requirements. By the time of the publication of this newsletter issue, medical physics leadership of several societies, including AAPM and CAMPEP, will have attended an ABR summit meeting in mid-August to discuss the policy change and its ramifications. AAPM will report on the results of this summit as soon as possible. Imaging as a Biomarker: the Biomarker Consortium At the President’s Symposium this year, Dr. Barbara Mittleman was the final speaker in the program. In case you missed her lecture, she talked about a fairly recent phenomenon at the NIH called Pubic-Private Partnerships, an outgrowth of the NIH Roadmap, and administered from the Office of Science Policy of the Director of the National Institutes of Health. As described on the website [http://ppp.od.nih.gov/]: “The mission of the NIH Program on Public-Private Partnerships is to facilitate collaborations to improve public health through biomedical research. As NIH’s central resource
on public-private partnerships, the program provides guidance and advice to NIH and potential partners on the formation of partnerships that leverage NIH and non-NIH resources.” Of interest to the AAPM membership, Dr. Mittleman spoke about the Biomarker Consortium, launched late last year as a public-private partnership including the NIH, FDA, CMS, pharmaceutical, biotechnology, diagnostics, and medical device industries, non-profit organizations and associations, and advocacy groups. The consortium will search for and validate new biomarkers – in order to accelerate the delivery of successful new technologies, medicines, and therapies for prevention, early detection, diagnosis, and treatment of disease. This partnership mechanism is an excellent resource for medical physicists with projects in imaging used: as a biomarker per se, as a means of probing structure or function for biomarker discovery, as a means of qualifying biomarkers, or as one of a panel of biomarkers. Barbara told me
that she did not know what a medical physicist did until she attended our meeting, but now she does, and she looks forward to project proposals from our members! For more information about the Biomarkers Consortium and to find project concept proposal instructions, visit http://www.fnih.org/Biomarkers Consortium/Biomarkers_home.shtml. National Patient Safety Foundation grants A new grant is available through the AAPM and funded by the National Patient Safety Foundation. Proposals on the topic of hazard reduction and patient safety in radiation medicine were solicited earlier this year, and three applications were funded. More details regarding this grant is given elsewhere in this newsletter. As always, I would be pleased to hear about any issues from the membership, via my contact information in the directory.
The 30th Winter Institute of Medical Physics (WIMP) Holiday Inn in Frisco, CO February 9 - 13, 2008 Program, registration and hotel information is contained in our website at www.utmem.edu/WIMP. If you’ve never participated you just might enjoy the relaxed and informal, yet very informative nature of this special meeting. All who attend present a 15 minute talk (often highlighting their own clinical experiences) and there is considerable opportunity for personal contact with senior medical physicists and vendor representatives, as middays are free for mountain sports. Two reknowned invited speakers will present special topics. Over 300 medical physicists from all over the US as well as several from foreign countries have participated. Contact either Ray Tanner, Director (rltanner@utmem.edu) or Marc Kessler, Program Coordinator (mkessler@umich. edu) for more details.
AAPM Newsletter
September/October 2007
AAPM President-Elect’s Column on the right side, not the left. The chain would likely catch on the car door hardware, the only plus I could think of was less conflict with my right sided belt mounted pager (replaced by conflict with my left mounted OSL dosimeter, I suppose.
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Gerald A. White Colorado Springs, CO
esterday I was talking to one of our hospital administrators; nice guy, bright, well-spoken, good insight and most importantly a fine appreciation for the value of quality medial physics in the process or care. He, like all of the management folks in our multi hospital chain, is participating in a training program focused in part on “change”. As we were preparing to part we both looked at the time (nearly 7 pm, too many hours that day, a subject for another column) and conversation turned to the fact that he now wore his watch on the right rather than the left arm. An exercise in change subsequent to an earlier meeting in the upper ranks with the trainers, they asked everyone to switch their watch to the opposite arm at the meeting. As I rode my bicycle home later that evening, I thought a bit about how I might have coped with that exercise had I been a participant. The first thought was that, as a 38-year pocket watch user, there would be some challenges. Dextral from an early age, reaching into the left pocket constantly would certainly put me in a bad mood. All my pants would need to be modified, the couture houses of LL Bean and Lands End all provide a watch pocket
Further reflection on the bike ride home my suspicious semiotician side kicked in —this had all the signs of a truly wrongheaded change event. It was imposed from above. It offered no improvement in the process, and in fact made learning the time of day more complicated. There was no time to anticipate and prepare for the change. The change regents failed to make the appropriate infrastructure changes (here I’m thinking about sewing watch pockets into the left side of all my pants, and although the change came from within our organization, I did not participate in the process). Those of you who have heard my talk to the chapters know that much of its about change. Change imposed from above, change that may not make any sense, change that comes with little warning. Much of it is like the change in the chronometry process described above. The trick to success, I suspect, in this world of change is two fold. The first is to avoid these types of change by identifying opportunity and making the appropriate changes well in advance so that they are useful, well thought out, and beneficial to us, our profession and those we serve. Some examples of this process within AAPM are the Science effort to place the AAPM in a position to engage in grant funding, and the ability to work in research consortia with other entities (SNM, RSNA, Universities come to mind
currently) to produce important scientific work; the Education effort to refine the curricula and materials for training physicians and physicists and the continuing education of both groups; and the professional effort to create tools and infrastructure to support the practice needs of the clinical physics community. As change overtakes us from outside, (the “didn’t see the train coming” events) it is essential that we get on the train rather than be hit by it. We need to find ourselves in the engine rather than on the cowcatcher. Examples of this process are the current interactions with NRC and CMS to mitigate damage associated with recent and proposed ruled changes; and the newly and belatedly begun effort to work with the ABR, CAMPEP, training program directors and residency directors to create a firm foundation for the 2012 requirement for accredited training to sit for the Boards in the Radiological Physics specialties. One common aspect of all these processes is the need for and the participation of bright, well-spoken volunteers with good insight and an appreciation for quality medical physics. Now is the time to step up, find yourself in the engine rather than on the cowcatcher and find a place within the AAPM to learn how to participate in the process. Coming soon is an opportunity listing from AAPM. Look it over, as well as the committee tree and find a ladder that will take you into the change process. This is how we honor the past, celebrate the present and prepare for the future.
AAPM Newsletter
September/October 2007
AAPM Executive Director’s Column
Angela R. Keyser College Park, MD Annual Meeting Recap sit down to begin this column on my first day back at HQ following the 2007 Annual Meeting in Minneapolis. The Annual Meeting is always both an exciting and exhausting time for the HQ team! It is the one time during the year when many of us get to meet with you, our customers, face-to-face. I am proud of the AAPM HQ Team and the wonderful job they did supporting the many AAPM volunteers who planned the Minneapolis meeting. We hold a “debriefing” meeting on Thursday afternoon before we depart to share what worked, what didn’t, our lessons learned and areas for improvement. I’m always excited by the energy in the room and the true desire of your staff to improve upon the recent experience. Vegetarians – please know that we have heard your cry and noted the need for more vegetarian meals during the meeting!
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I’m pleased to report that the meeting continues to grow. There were 2,297 scientific attendees, up slightly from the 2,216 scientific registrants for the 2006 meeting in Orlando. There were 134 companies exhibiting, up substantially from the 118 in Orlando. There were also 319 attendees who participated in the Self Assessment Modules sessions (SAMs).
Bylaws Vote in October Voting members will receive balloting information in October regarding a vote to change the AAPM Bylaws. The proposed change is to Article VI Finance, Section 1. on Dues. Currently, dues changes must be voted on by those present at the Annual Business Meeting. The amendment proposed would allow all eligible members to approve or reject any future dues changes through an online vote. The proposed procedure follows that used for By-Laws amendments. The deadline to cast your vote is October 31. Financial Update The 2006 audit report has been reviewed by the Audit Ad Hoc Committee and submitted to the Board of Directors. Here are a few highlights from the 2006 financial summary: • Excess of revenues over expenses of $1,380,490, including an unrealized gain on investments of $669,049. • An improvement of $1,851,898 over the original 2006. • AAPM reserves at the end of 2006 were $8,457,009. Conservative projections for the 2007 year indicate a surplus of $249,856 at year’s end, versus a budgeted deficit of ($541,193). The major portion of the difference in estimate versus budget is due to the success of the 2007 Annual Meeting and Summer School, increase in members and investment earnings. Attention Junior and Student Members The qualifications for Junior membership were changed back in 2006 to require that the individual be a Resident, Post-doctoral Student or
Fellow on a full- or part-time basis in a medical physics training program. All Junior Members were sent an email in mid-August with instructions on the new process. Junior Members must request that a Full AAPM Member go online and attest that the individual meets the current requirements for Junior membership. In order to remain a Student member after the first year of membership, first students are asked to identify whether they are Graduate or Undergraduate, then: • Graduate Students must request that a Full AAPM Member go online and attest that the individual is a Graduate Student on a full- or part-time basis in a medical physics program. • Undergraduate Students must ask their program director to send attestation to membership@aapm. org stating they are an Undergraduate Student in an academic program in science, engineering or a related field program. The deadline for the online attestation to be provided is October 1. If you have any questions, please contact Jennifer Hudson at jennifer@aapm. org or 301-209-3365. U.S. Physics Team Bring Home Gold and Silver The United States Physics Team, co-sponsored by the American Association of Physics Teachers (AAPT) and the American Institute of Physics (AIP), earned two gold and three silver medals at the 2007 International Physics Olympiad held is Isfahan, Iran from July 1322. AAPM joins with other societies to provide financial support for the team. The 24 members of the U.S. Physics Team were selected through two competitive examinations. Team
AAPM Newsletter members attended a nine-day training camp during which time the team members refined their problemsolving and laboratory skills. The five students who make up the national Traveling Team are chosen at the close of camp. The U.S. was represented by: • Gold Medalist Jason LaRue, Miami, FL (teacher: David Jones) • Gold Medalist Haofei Wei, Oklahoma City, OK (teacher: Shayne Johnston)
• Silver Medalist Kenan Diab, Gates Mills, OH (teacher: Bob Shurtz) • Silver Medalist Rui Hu, Wilmington, DE (teacher: David Stover) • Silver Medalist Jenny Kwan, San Marcos, CA (teacher: Jose Fernandez) AAPM Reception during RSNA meeting Reminder! The AAPM Tuesday evening reception during the RSNA
September/October 2007 meeting is back on! Plan to join your colleagues on Tuesday, November 27, 2007 at the Chicago Hilton. 2008 AAPM Dues Renewals Dues renewal notices for the 2008 year will be sent out during October. I encourage you to pay your dues via the AAPM website to reduce administrative costs. New this year! HQ will be processing dues for several of the chapters. Make sure to check the invoice to see if your chapter is participating.
2007 John R. Cameron Young Investigator Competition Results 1st Place Reed Selwyn University of Wisconsin The Development and Validation of An Image-Based Dosimetry System for 90Y Microspheres Used to Treat Hepatic Tumors http://www.aapm.org/meetings/07AM/PRAbs.asp?mid=29&aid=6744
2nd Place Antje-Christin Knopf Massachusetts General Hospital Quantitative Assessment of the Accuracy of Proton Beam Range Verification with PET/CT http://www.aapm.org/meetings/07AM/PRAbs.asp?mid=29&aid=7414
3rd Place Jonas Fontenot University of Texas M. D. Anderson Cancer Center Stray Radiation Exposure During Proton Radiotherapy of the Prostate: The Influence of the Patient On Scatter and Production http://www.aapm.org/meetings/07AM/PRAbs.asp?mid=29&aid=6983
AAPM Newsletter
September/October 2007
The Education and Training of Medical Physicists Committee of the
Education Council PRESENTS: Medical Physics: What Do I Need to Know And How Should I Teach It? South Shore Harbour Resort & Conference Center Houston, Texas August 1-3, 2008 Co-Directors: William R. Hendee, PhD; Herbert W. Mower, ScD; and Ervin B. Podgorsak, PhD Save the dates now for this interactive and informative workshop on how to teach medical physics to:
Graduate Students in Medical Physics Residents in Medical Physics Diagnostic Radiology Residents and
Radiation Oncology Residents This two and one-half day workshop will immediately follow the 2008 AAPM Annual Meeting, starting at 9 AM on Friday, August 1, 2008 and concluding on Sunday August 3, 2008. It will focus on the challenges in, and opportunities for, effective teaching of medical physics to various constituencies. The workshop will be appropriate for all medical physicists, from those just starting their careers in medical physics to senior medical physicists, including those with major teaching responsibilities for radiology and radiation oncology residents and practicing physicians, residents and practicing physicians in other specialties, medical physicists, radiographers and radiation therapists. Information will be available at www.aapm.org in September.
AAPM Newsletter
September/October 2007
Editor’s Column
Mahadevappa Mahesh Johns Hopkins University
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very year it amazes me how fast the summer passes by. Over the past few years, it has become more obvious to me that a large chunk of the summer is spent preparing and attending the AAPM annual meeting. Even though preparation for the
meeting is hectic, I enjoy the time spent at the annual meeting as it provides me with the opportunity to visit with friends and colleagues – and to share stories of fun and laughter. This year was no exception, Minneapolis was a great town for the meeting and the conveniences in downtown were remarkable. In fact, my kids did not want to return home as they were having so much fun. The recent news about the bridge collapse in Minneaspolis is tragic. In fact, the evening that it happened, my friends called to check whether I had returned from Minneapolis as it was only few days earlier I had traveled across that bridge many times. From this issue I am starting a new section called “Persons in the News”. The purpose of this
section is to highlight unique and exceptional achievements of AAPM members. The new section will provide an opportunity to introduce AAPM members who have achieved exemplary achievements, for example, endowed professorship chairs, recognition by other professional societies through fellowships or gold medals and so forth. The news about our colleagues who have been honored enhances the standing of the entire community and hopefully all readers will enjoy reading this new section. This issue is getting into your hands a bit later than originally scheduled as I made a decision to wait for our regular contributors to submit their articles after the annual meeting.
Photograph taken at the AAPM annual meeting – the current newsletter editor (Mahesh) with his daughter seen here with the past AAPM Newsletter editors - Robert Dixon (extreme left) and Alan DeGuzman (center).
AAPM Newsletter
September/October 2007
Education Council Report
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Herb Mower Education Council Chair
s I write this the Annual Meeting has just winded down and we are now at the Summer School in Collegeville. The various committees, sub-committees, working groups and task groups have been working hard during the past year and many exciting things were presented by them here at the annual meeting. First, my thanks to all of you who are serving our Association by donating your time and talents on these groups! Several of you have done some really remarkable things during the past year. Unfortunately I did not manage to visit each group during the meeting but those I did have the opportunity to sit on were all very dynamic. The new process relative to volunteering to serve on various Task Groups, Working Groups, Sub-Committees and Committees of the various Councils is addressed elsewhere in this Newsletter. Our hope is that this will make the process easier for our members to get involved, not more complex. I hope that you had the opportunity to sit in on some of the groups of interest to you at our annual meeting and introduced yourself to the Chair. If you did not make the meeting, do check the listing on our website and contact the Chair indicating your interest and
willingness to assist. It is usually easier and far more interesting to start on a task group, working group or sub-committee than jumping in at the committee level. The latter is usually more involved with the process of receiving reports and providing guidance to the entities reporting to them. Council membership is almost always limited to the chair and vice-chair of the council and the chairs of the committees reporting to the council. Again, this is more of a review and enabling panel rather than a working unit of the Association. Highlights of the Council as Reported at the Annual Meeting The Medical Physics Education of Physicians Committee reported on the rewrite of the diagnostic radiology physics curriculum. This task was completed between the Physics Summit in January 2006 and the follow-up RSNA summit this past February. Since February it has been reviewed and endorsed by the Association of University Radiologists, the Association of Program Directors in Radiology and the Academic Council on Radiology. The revised curriculum is available through the AAPM website. You can access this publication from the AAPM Homepage by following the path: Reports → Online Only Reports → Un-Numbered Reports → Radiology Residents Physics → Curriculum. Phil Heintz, chair of the curriculum subcommittee welcomes all comments and suggestions on the curriculum as posted. As a result of this effort the AAPM has received inquiries from
the RSNA, ACR, and the Roentgen Ray Society for assisting in producing appropriate web-based modules to be used as an aid in the teaching of physics relevant to radiology residency programs. The Committee has established a task group to facilitate this endeavor with William Hendee as chair. The task group’s first business will be to establish a mechanism for administering the funds and setting up guidelines for the modules. At that point the task group will then publish a ‘call for assistance’ soliciting individuals, academic institutions and practices that wish to assist in creating these programs. If you are involved with the teaching of physics to diagnostic radiology residents, consider if you wish to be considered as we endeavor to produce these teaching aids. Our Public Education Committee under the guidance of Mary Fox conducted a very successful Education Council Symposium at the Annual Meeting on interacting with the media. We had over 200 people in attendance at this event. They also reported on the successful “Educators’ Day” at ASTRO 2006 and that they would be repeating the event at ASTRO 2007. The Physics Training of Allied Health Professionals Committee has setup a sub-committee please contact Don Peck. Assistance is needed in helping to identify resources for all related sub-specialties that relate to our profession. The International Education Committee now has a formal liaison relationship with the IAEA. They are working on a course on advanced imaging in radiation therapy. This course is designed to assist leaders of developing countries. For more information on the possibilities of service with this group, contact Don
AAPM Newsletter Frey. They are also preparing for two courses in India this year sponsored by the International Center for Theoretical Physics. The History Committee is gearing up for our upcoming 50th anniversary. Amongst other projects, through the initiative of Perry Sprawls, they are trying to accumulate biographies on all of our members. If you have the opportunity, log on to the AAPM web-site and complete yours. The History Committee will also present the Education council at the 2008 AAPM meeting in Houston. The Committee, working with headquarters had two more large panels on display at our meeting this year. They hope to add another two or three for next year’s meeting. The Education and Training of Medical Physicists Committee held two meetings in Minneapolis. The first three-hour meeting was to work on the program and logistics for the training workshop related to teaching medical physics that will be held in Houston August 1 – 3, 2008, immediately following our 2008 Annual Meeting. The objective of the workshop is to address the issues related to teaching that have emerged as a result of the AAPM’s Physics Summit and the follow-up summit of the RSNA. It will address all aspects related to teaching including: understanding the needs of the audience, new modalities of teaching, tag-team approaches to teaching, integration of traditional programs with electronic techniques, and much more. The Committee noted that 14 summer undergraduate fellowships had been awarded this year. This program continues to be a very successful outreach program.
formal symposium, which had an attendance of about 125, they also took a day for a rafting trip. About 25 hearty souls participated in this event. As best we can tell, all who departed for this event did return. The committee noted two things which are of concern to our younger members and future members. Although a final resolution was not reached, they are working with the ABR on the 2012 deadline requiring completion of a CAMPEP accredited residency program from that date forward in order to sit for the ABR Boards. The other program they are investigating is the formation of “Doctorate of Medical Physics” academic programs, looking into suggestions as to what should be in such programs, both academically and practically. The Summer School this year, at St. John’s Seminary in Collegeville, has an enrollment of 273. Local arrangements for the school are under the leadership of Mary Fox. Melissa Martin and Pat McGinley, as program directors, have arranged a great school. The 2008 school will be at the end of June in Houston. The topic will be
September/October 2007 CT and there will be associated ‘hands on’ evening sessions (restricted to 96 participants). The Continuing Professional Development Committee noted that some of our chapters are not taking advantage of making available to their members continuing education credits for their local chapter meetings. Yes, there is a fee and some paperwork associated with this but there are great benefits for our membership, especially for those time-limited certifications. The committee will work with CAMPEP and the AAPM Board relative to this program. The Education Council will work with the Meeting Program Committee to see if we can make available at the 2008 Annual Meeting a repeat of the course on HazMat training. A few years ago the Department of Transportation decided that all who sign for the shipment of radioactive materials must have participated in a training program within the past three years. Our previous two presentations of this program at our annual meeting were quite successful and we expect that the time is right to repeat this for those needing this certification.
AETNA Physics Consult Settlement AETNA has agreed to settle a class action lawsuit regarding the denial of claims for physics consultations under CPT 77336. If you or your facility had a CPT 77336 claim denied as incidental to other services for consultations between October 1, 2003 and April 1, 2005, you may be eligible for 100% reimbursement as part of the settlement. To file under the settlement or for further information contact: Hanzman, Criden and Love, PA Suite 515 7301 SW 57th Court South Miami, Florida 33143 (305) 357-9010
The newly established Students and Trainees sub-committee sponsored two events at the Annual Meeting this year. In addition to the more
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Science Council Report our mission to promote science, education, and professional issues is delayed, postponed to an uncertain future which itself is a minefield of over-commitment for most of us.
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September/October 2007
John M. Boone Science Council Chair
olunteerism. George H.W. Bush called this notion “one thousand points of light”. An apt analogy to our society, given our expertise with photons. The AAPM is a volunteer organization, and without scientific volunteers, what we do as a society would come to an end or be substantially diminished. While our staff in College Park is absolutely fantastic and are the glue that holds us together as a society, AAPM members provide the scientific vision for our annual meetings, provide the talks and posters at our annual meetings, become the unpaid elected leadership, and are the appointed chairs of councils, committees, subcommittees, task groups and working groups. Every one of our missions in science, education, and professional activities takes AAPM members - medical physicists, to execute. Without volunteers, the AAPM is just a social club. But alas, the world of medical physics has changed from 20 years ago. Whether you are solely clinical, solely academic, or somewhere in between, there is less time. There is more stress. There is more to do. Consequently, task groups meet infrequently, and are poorly attended. Solid initiatives that were born in a moment of clarity and enthusiasm lose momentum due to lack of attention, and ultimately
Many volunteer organizations provide incentives for volunteer activity. But what can the AAPM do to encourage members of TG’s or WG’s (including the chairs of these groups) to become more engaged, and prosecute the task in a more timely manner (for instance, by having active participation in monthly conference calls)? We do the real basics, including providing food at the AAPM and RSNA meetings, paying for conference calls, and sending members an annual listing of their activities so they can update their CV’s. What else could we do? Money. Money is often an incentive for things, but by its nature converts volunteers into consultants. The AAPM budget is not large enough to actually pay for TG or WG activity, and that would be a bad precedent anyway. We could reduce the registration fee for the annual meeting for active TG members and chairs – but since many of us who do volunteer don’t pay those dues personally, that is not much of an incentive, either. So, in the end, financial incentives for more aggressive, enthusiastic and productive AAPM participation appear to be crass and ultimately unproductive. Failing financial incentives, I propose “status” as the incentive for participation in AAPM activities. It works for blood drives - I walked by a guy last week with a T-shirt that had “Ten Gallon Donor” on it. He was proud to participate in the noble act of blood donation, and was honored for his efforts by receiving a T-shirt that only a few people could rightly don. More to the point, currently, becoming a Fellow of the AAPM
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follows a process. There are two general categories of fellows as I understand it, one for scientific, educational, or professional accomplishments, the other is for service to the AAPM. I suspect that most fellow candidates have merit in both categories. So, for the AAPM service category, what if we developed a point system that awards points for participation at all levels of our organization – TGs, WGs, subcommittee, committee, council, board of editors (Medical Physics), Excom, board of directors, etc. The points are awarded not for mere membership, but for genuine participation (for instance, actually showing up to the TG meetings and T-cons, and helping in the writing process if appropriate). Details are not important here, but the notion is that you need to earn your stripes to be considered as a candidate for Fellow. So, just as you Fellows were thinking of relaxing, we could require a maintenance level of AAPM volunteerism to remain a Fellow. The Society of Breast Imaging, for example, requires a point system for becoming a fellow, and indeed if you do not attend the Fellow’s meeting once every three years, you are de-listed. Of course, under such a system an Emeritus Fellow status would be appropriate for our retired or less-active colleagues. So, let’s reward volunteerism and honor those who contribute their time unselfishly to the AAPM. Wearing that deep blue “Fellow” ribbon at the meetings, and having the plaque in your office or den, is earned by explicit and quantifiable acts of volunteerism, much like that ten gallon T-shirt. So many points to be considered for Fellow, so many points per 3 year period to maintain your status as a Fellow (and perhaps an off-color ribbon for the status of “former Fellow”). It’s just a thought.....
AAPM Newsletter
September/October 2007
Professional Council Report
ad hoc working group to evaluate and recommend a modified ACMP structure, in particular to eliminate duplication with AAPM PC effort. This will focus on what ACMP does well and allow AAPM PC to move forward with the rest.
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Michael Herman Professional Council Chair
very significant appointment to the Advisory Panel on Ambulatory Payment Classification (APC) Groups for AAPM member Michael Mills has been confirmed. His term begins on 8/1/2007 and ends on 9/30/2010. This is a huge statement of respect for the AAPM and allows us direct input into the payment schemes developed by CMS. This effort was successful due to multiple societies coming together to support the nomination of Michael Mills. Congratulations Mike. In May, the Professional Council held its annual retreat to discuss many issues. Some highlights are listed below: AAPM Mission The BOD requested that PICR develop a more succinct and direct mission statement. A draft was discussed and will have been reviewed at the summer meeting. Structure Extensive discussions on the structure of the AAPM PC and its relationship with the ACMP were held. We discussed removing duplication of effort and getting the most out of the two organizations in the future? We reviewed possible models and we note that ACMP has created an
The internal structure of PC relative to task group (TG), working group (WG), subcommittee (SC) etc. was also reviewed. Various new WG and SC were established to distribute the load (all available on the AAPM committee tree). The Committee on Professional Information and Clinical Relations (PICR) was given a name change to the Clinical Practice Committee (CPC) to better reflect its charges. The Ethics Committee and TG109 have made extensive progress on the new ethics code, particularly related to the process for filing, evaluating and taking action on an ethics complaint. We discussed the concept of a “yellow book” to be used by councils, committees, etc., to solicit volunteer members for important work in the AAPM. This would replace the current volunteer systems and allow individuals to actively be aware of what needs exist within the organization to best utilize their talents. We hope to have this on-line in 2007. Legislation and Regulation There is a strong expectation that CARE bill will pass this year and draft versions of the necessary Health and Human Services text for implementation were reviewed and are being firmed up. This will be the guidance that all states must follow after the legislation passes. Related to this, we discussed the need to energize grass roots work to guide
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implementation at the State level and the Joint Medical Physics Licensure responsibilities in this regard. YOU may be the grassroots in your state! The recent AAPM BOD passage of PP 19-A, which states “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” adds commitment to standards for qualifications to practice. TG133 is defining the mechanisms to meet this important goal. PICR (now CPC) has developed a document on the Critical Role of Medical Physicists in the practice of medicine, essentially based on the Medical Physics Scope of Practice. This would be for general educational use. We reviewed the many facets of GRAC involvement at the federal and state level and note the very large scope of its responsibilities. Work Value and Economics Abt III, work values for radiation oncology physics, is under evaluation and should be reported later this year. A similar study for imaging physics workload was proposed and a group is being organized to develop this survey. Budgetary considerations for 2008 were made. Intersociety Coordination We reviewed the importance of coordinating with other related professional organizations to assure consistency of regulations/standards affecting medical physics and to promote a unified front on important issues. Professional Education We identified some professional education needs including
AAPM Newsletter Ethics Education for Medical Physicists, effective professional communication, leadership and teaching. This may be a focus for the professional track in 2008. We also discussed the annual meeting professional program and we welcome input from the membership for future meetings.
Standards/Guidance We reviewed the necessity for AAPM to provide consistent guidance for practice accreditation (IAC, ACR, ACRO, CRCPD etc.). A CPC working group to this effect is being formed. We also reviewed the need to monitor & coordinate response/guidance for medical
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ell, the Minneapolis AAPM meeting was a success by any measure. However, our sympathies go out to those struck by tragedy in the bridge collapse shortly after the meeting. CAMPEP activity with respect to the ABR 2012 initiative requiring CAMPEP accredited training (graduate school or residency) for qualification to sit for the Board examination and the new concept of a professional doctoral degree in medical physics are heating up The ABR summit to discuss the 2012 initiative will take place this month in Dallas. Stakeholders from all interested organizations have been invited to participate in this discussion. CAMPEP will be represented by Peter Dunscombe as Vice President, Ed Jackson as the Graduate Education Program Review Committee (GEPRC) chair, Bruce
physics advisory organizations that set standards and recommendations, (e.g., NCRP, ICRP, ICRU, ANSI; IEC). This is assigned to GRAC and AAPM Staff, but it is a daunting task.
News from CAMPEP Gerbi as the Residency Education Program Review Committee (REPRC) chair and me. We anticipate not only the professional society leaders to attend, but several graduate and residency program directors to give their perspectives as well.
John Hazle President, CAMPEP
September/October 2007
CAMPEP is also working closely with Michael Herman and the AAPM TG-133 to develop guidelines for alternative pathways in clinical training of medical physicists, a topic that will likely be discussed at the Dallas summit. The goal is to develop working models of how clinical residency program capacity can be expanded to meet manpower needs while maintaining quality and accountability. We are also actively participating in developing criteria for a professional doctoral degree in medical physics. One current model for this degree includes about the equivalent of an M.S. degree in coursework followed by a two-year residency, resulting in a five year long program with immediate qualification to sit for the Board exam, much like the path our dentist and veterinarian colleagues take. We know of one university that recently received final approval to implement such a program with others in the queue. Geoff Clarke is chairing a CAMPEP task group to make recommendations on how accreditation of these programs will be performed.
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Several programs were reviewed by the GEPRC and REPRC at the AAPM meeting and recommended for site visits. These visits are planned to take place prior to RSNA so that program accreditation will occur before January 1. Bruce Thomadsen is working with Michael Woodward to rework the continuing education application interface. The goal is to make this a more user friendly system. We see continuing growth in demand for CMPE credits and we must meet the needs of the community in an efficient manner. Finally, I’d like to again thank the AAPM leadership and headquarters staff for their ongoing support. Availability of the HQ resources as CAMPEP matures and grows is a major factor in our success.
2008 Call for Nominations and Applications now available on the AAPM Website at: h t t p : / / w w w. a ap m . o r g / org/callfornominations. asp#nominations or see the AAPM Homepage under “What’s New.” Please note that the deadline to receive nominations and applications: October 15, 2007
AAPM Newsletter
September/October 2007
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AAPM Newsletter
September/October 2007
Legislative and Regulatory Affairs Column
Source Collection and Threat Reduction Program (SCATR) REGISTER YOUR UNWANTED SOURCES!
L
Lynne Fairobent College Park, MD
ast issue I stated that the Conference of Radiation Control Program Directors (CRCPD) and DOE/LANL have signed a contract to initiate a program to “round up” sources in a geographic area that would not by themselves qualify under the DOE Source Recovery Program. CRCPD is 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. For more details, see announcement on page 14.
Mark Your Calendar for BIROW V The 5th Bioengineering & Imaging Research Opportunities Workshop (BIROW) will take place at the Bethesda North Convention Center, January 17-19, 2008. The purpose of the workshop is to identify and explore new opportunities for basic science research and engineering development in biomedical imaging, as well as related diagnosis and therapy. The workshop will provide information and ideas for new investigators, support accelerated development of biomedical imaging as a scientific discipline, and facilitate coordinated imaging research. Experts will speak on selected topics, and discussion will continue I focused breakout groups, poster sessions, and with invited government representatives. The theme for BIROW V is “Imaging and Characterizing Structure and Function in Native and Engineered Tissue” A small number of specific topics will be explored in order to stimulate creative thinking. The 2008 Workshop includes the following topics: • Integrating Heterogeneous Single Cell Measurements into Tissue and Organism Models • Functional, Molecular and Structural Imaging of Engineered Tissue in vitro and in vivo • Development and Integration of Imaging and Other Technologies for Minimally Invasive and Non-invasive Analysis of Human Tissue Viability • Imaging for Targeted Cell, Gene and Drug Delivery The 2008 Workshop is sponsored by the AAPM, the Academy of Radiology Research (ARR), the American Institute for Medical and Biological Engineering (AIMBE), the International Society for Analytical Cytology (ISAC), and the RSNA. Funding is being provided by the NIBIB. A number of other organizations that are particularly strong in medical imaging – its science, engineering and applications -- are participating. Details can be found at www.birow.org 15
the
AAPM Newsletter
September/October 2007
Introduction of William D. Coolidge Award Recipient
The following is an introducation of Arthur Boyer, Ph.D. by colleague Kenneth Hogstrom, Ph.D.
I
t was my honor to introduce Art Boyer as this year’s Coolidge Award recipient at the Awards and Honors Ceremony during the AAPM Annual Meeting in Minneapolis, MN. I consider Art to be an excellent clinical medical physicist, who is knowledgeable, innovative, and tireless, and through his dedication to our field and profession, he has contributed significantly to medical physics in the areas of research, education, and service. Art’s stellar career has included stints at The Massachusetts General Hospital and the Harvard Medical School in Boston, MA (1971-1979); the Cancer Therapy and Research Center and The University of Texas Health Science Center in San Antonio, TX (1979-1986); The University of Texas M D Anderson Cancer Center and The University of Texas Graduate School of Biomedical Sciences in Houston (1986-1995); the Stanford School of Medicine in Stanford, CA (1995-2005); and the Scott & White Clinic and Texas A&M University Health Science Center in Temple, TX (2005present). Art’s scientific contributions to medical physics include his publishing approximately 110 journal articles, 20 proceedings and book chapters, and 150 meeting abstracts. He has given over 70 invited lectures and seminars, and he
has been the principal investigator on 10 peer-reviewed grants. His major research contributions have been in photon radiotherapy. His early works led to a popular method for missing tissue compensation, based on Moiré camera imaging. Subsequently, he focused on using the fast Fourier transform for xray beam dose calculations, primarily for x-ray therapy, but also for neutron beams and internal emitters. This work was paramount in the evolution of convolution dose algorithms in popular use in today’s 3D treatment planning systems. Next, Art’s interest shifted to use of the MLC for conventional, conformal, and intensity modulated x-ray therapy, where his major contributions were early demonstration of the feasibility of MLC-modulated beams for IMRT and later quality assurance of IMRT. Also, Art was a pioneer in using digital portal imaging for automated patient alignment, and his efforts were the catalyst for the development of a radiotherapy-specific PACS at M D Anderson in the early 1990s. Art has significantly impacted the career development of medical physicists. He has supervised 12 postdoctoral fellows and has served on 19 graduate student supervisory committees, directly supervising 8. His trainees include Lei Dong, Tomas Bortfeld, Yunping Zhu, and others who have had successful research and clinical careers. He coordinated or taught in 5 courses in the M D Anderson medical physics graduate program, and he has continuously taught radiotherapy residents his entire career. Presently, he is director of both a medical dosimetry and a radiation oncology physics residency program in Temple. There are two noteworthy educational projects, which Art led. First is the short course on anatomy for medical physicists, which Art developed in 1983
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and was taught through 1995. This course led to the M D Anderson graduate course “Anatomy and Oncology for Medical Physicists” and a similar course at the University of Heidelberg. Second, Art responded to the need for assistance in expanding medical dosimetry programs though leading the development of a web-based, computer-aided medical dosimetry curriculum at Stanford (20022007). Art has made significant service contributions to the AAPM and our field. He has served as President of the New England and Southwest AAPM Chapters, member of the AAPM Board of Directors, associate editor of Medical Physics for 13 years, member of the AAPM Newsletter Board of Editors, and member or chair of 11 AAPM committees and task groups. Art has also made two important service contributions in education, having served as director and lecturer for the AAPM Dosimetry Review Course in Radiation Therapy for 14 years and having served 2 times as codirector of AAPM Summer Schools. Arthur L. Boyer was born in El Paso, TX on September 10, 1945, son of Andrewton Blanchard Boyer and Lois Pinson Boyer. He graduated from Richardson High School in Richardson, TX. Art received his B.A. in Physics from the University of Dallas in 1966 and his MA and PhD in Atomic Physics from Rice University in Houston in 1970. He was the fourth Rice alumni to receive the Coolidge Award. From 1970-1971, Art completed his training in medical physics under Bob Shalek at The University of Texas M D Anderson Hospital Research and Tumor Institute in Houston. Art’s family attending the Awards and Honors Ceremony included his wife Suzanne Wing Boyer, children-Chris, Bryce, and Sherry, and brother Robert.
AAPM Newsletter
September/October 2007
Coolidge Award Acceptance CopyrightSpeech Issuesby Dr. Arthur Boyer
AAPM Annual Meeting
Minneapolis, Minnesota July 23, 2007
M
adame President, officers of the AAPM, members of the Honors and Awards Committee, distinguished guests, colleagues and friends: This is a poignant moment for me, not because I am being honored tonight by an august body composed of individuals I do not know personally, but rather, because I am being honored tonight by an august body composed of individuals that have been my closest friends for many years, as typified by Ken Hogstrom. My sincere thanks to the Awards and Honors Committee, chaired by Marty Weinhouse, for selecting me to receive the Coolidge award this year. But one must wonder how a simple country physicist has come to receive this award. It is very clear to me. It is because I have been fortunate to have been surrounded throughout my life and career by family and friends, and indeed by a whole community of outstanding and exceptional people, who have nurtured, mentored, promoted, forgiven, and supported me on my life quest. This talk is recognition of their contribution. A wag has said that the most important choice one can make in life is your parents; if so, I made the
best of best choices. My father, The Rev. A. Blanchard Boyer, and mother, Lois Pinson Boyer, were unflagging in their sacrifice and love to provide for me, intellectually, emotionally, and spiritually. They have my special gratitude for music, art, and the divine in my life. The credit for this award tonight goes to them more than to anyone else. I also owe much to my grandparents; in particular, my grandfather, John Arthur Pinson, who had a profound effect on me personally as well as financially, having saved the funds that allowed me to attend college. I am deeply grateful for my immediate family’s support and encouragement; my son Chris and his wife, Roxanne, their daughters Kaylie and Bethany, my son Bryce and his wife Christi, and their daughter, Olivia, my daughter, Sherry and my brother Robert. My wife Suzanne has been my closest soul-mate, seeker, best friend, lover, and constant encourager. But for these, I would not be standing here tonight.
For the more recent members of the AAPM, I would like to digress and mention William Coolidge. William David Coolidge was an American physicist who worked at the General Electric Research Laboratory. In 1913 he invented an improved externally-heated tungsten filament cathode for use in X-ray tubes that allowed for consistent control of Xray production. The Coolidge tube was a major development in the then new medical specialty of radiology, and its basic design is still in use. The first AAPM Coolidge Award was presented to Coolidge in July 1972. Next I recognize the University of Dallas in Irving, Texas for providing an outstanding undergraduate liberal arts education. In particular, I wish to recognize Dr. Donald Cowan, a physicist and President of the University, who mentored me. He directed me to the field of medical physics and encouraged me to apply for a scholarship offered by the M.D. Anderson Cancer and Tumor Institute to attend Rice University in
Left to right: Dr. Mary Martel, AAPM President presenting the William D. Coolidge Award to Dr. Arthur Boyer at the 49th AAPM Awards Ceremony. Dr. Ken Hogstrom (right side) introduced Dr. Boyer.
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AAPM Newsletter
September/October 2007
Houston, Texas. I am indebted to Dr. Robert Shalek, who, as Chair of the Physics Department at M.D. Anderson, awarded me that scholarship; and to Dr. James Jordan who served as my thesis advisor at Rice, and to Dr. Peter Almond who served as my scholarship advisor at M.D. Anderson. M.D. Anderson is recognized again for providing me a Post-Doctoral Fellowship that provided me an opportunity to learn the nuts and bolts of medical physics and for the staff and fellow students who provided the essential environment for that learning. It would be hard to give enough credit to Dr. Herman Suit who took a chance on taking a green Post-doc and his blushing bride to Boston to help him start a revitalized radiation oncology department at the Massachusetts General Hospital. Credit for the work I did there goes largely to Ed Epp who recruited an outstanding Physics Division and to my colleagues in that Division, Michael Goitein, Clif Ling, Lynn Verhey, Peter Biggs, Karen Doppke, and Miriam Gitterman.
As Ken described, the lure of Texas was too much for us. Bob Waggoner and Gary Fullerton at the University of Texas at San Antonio welcomed us back to a position at the Cancer Therapy and Research Center. There I had the incredible good fortune to recruit Ed Mok who was pivotal in the writing of my first NCI grant. The credit to MD Anderson grew larger when Ken Hogstrom and Lester Peters drew me back to Houston. The contributions of the staff there, including John Horton, George Starkshall, Vic Otte, Almon Shiu, and Tim Ochran are inestimable. My medical physics students there get credit for most of the productivity that occurred, including Yunping Zhu, Michael Moyers, Scott Jones, Greg Desobry, Yuan Giap, John Bayouth, Tim Waldron, Lei Dong, and, most prominently, Thomas Bortfeld. Dr. Richard Hoppe now takes a lion’s share of credit for the productivity at Stanford. His leadership and support were truly outstanding. Credit also goes
Left to right: Chris Boyer - son, Robert Boyer - brother, Bryce Boyer - son, Art Boyer, Sherry Boyer - daughter, Suzanne Boyer - wife. Dr. Arthur Boyer with his family following the Awards Ceremony in Minneapolis, Minnesota.
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to the radiation oncology faculty and residents that supported and participated in the development of IMRT as a clinical tool. At Stanford, success was the award for sober and determined concentration (well – sometimes). Credit for the work at Stanford goes to the physics faculty including the late Richard Cox, Charlie Ma, Lei Xing, Gary Luxton, Todd Pawlicki, Ken Forster, and Ted Graves. The physics staff including David Findley, Ed Mok, Penny Peng, the late Jenny Hai, Tony Lo, Sam Brain, and the Project Manager of the Dosimetry Training Tool grant, Scott Kaylor along with special credit to my Administrative Assistant, Libby Roberts made it all possible. Once again the strange attraction of Texas (and not-so-strange attraction of granddaughters) pulled us back and I found haven in the Radiology Department at Scott & White, astutely chaired by Dr. Gill Naul. The Physics Division there consists of a dozen skillful and wonderful people. Credit for this award is welldistributed over the thirty or so students and fellows who provided the time and youthful vigor needed to complete the research and write the papers that repose in my CV. It took 168 boon companions to write peer-reviewed papers and still more to do all the stuff Ken talked about earlier. Credit for those papers is due primarily to the coauthors. They shared the essence of their life-work with me and allowed me to stand beside them in the spotlight of recognition. But it took a whole national and international community of colleagues to provide the environment, the inspiration, the web and skein of ideas and notions that led to this award. It is to you, my life-long friends and associates that credit for this award truly belongs.
AAPM Newsletter
0704-5563 AAPM_07ProbeGAd:AAPM Ad
I will not deny that I am on a quest. I am deeply grateful to receive the Coolidge award. But such laurels in themselves do not define the quest. The NCI marked its fiftieth anniversary in an issue of the NCI Cancer Bulletin published December 12, 2006 (Volume 3, Number 48). A figure on page 7 of that issue illustrates where the quest has gone and where it must continue to go. Over the span of our careers, the slope of the per capita mortality of major cancer sites has changed from positive to negative. This is an astounding fact. We are succeeding. Yet, the quest is not over, and like Moses it will not be for me to enter the Promised Land. The denigration of cancer from a fearful scourge to an annoying chronic disorder is the goal to be achieved by the next generation of medical physicists. I know it can be done, because I have been the beneficiary of what this marvelous community of people can accomplish. My deepest thanks and the best of God’s blessings to all of you.
September/October 2007
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Medical Dosimetry Call for Reviewers Medical Dosimetry, the official journal of the American Association of Medical Dosimetrists, is expanding its team of experts to review submissions dealing primarily with radiation physics. Peer reviewers are asked to assess clinically relevant manuscripts for their importance, originality, clarity, validity, and other qualities. Reviewers make recommendations to the editors, who make final publication decisions. Medical physicists who work in dosimetry are encouraged to join the journal’s team of expert reviewers and to help the mission of the journal. An advanced degree is helpful but not necessary for all submissions. Medical Dosimetry is included in Medline, Thomson/ISI, and other major indexes. For more information about the journal and its editorial board and policies, the types of submissions under review, and the online review process, please contact the Editor-in-Chief: Lon Marsh, CMD (Department of Radiation Oncology, University of Michigan Hospitals, Ann Arbor) at lonner@ med.umich.edu. Visit www.meddos.org to learn more about the journal, ees.elsevier.com/meddos to learn about the review process, and www.medicaldosimetry.org to learn about the AAMD.
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AAPM Newsletter
September/October 2007
ACR Accreditation
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 ACR Stereotactic Breast Biopsy Accreditation Program: Frequently Asked Questions for Medical Physicists Q. How many stereotactic breast biopsy facilities are accredited by the ACR? A. As of July 1, 2007, the ACR had accredited 456 units at 443 stereotactic breast biopsy facilities. Q. What is the current pass rate for units applying for accreditation in stereotactic breast biopsy? A. In 2006, the first-attempt pass rate for new or renewing units was 86%. Close to 95% of the facilities passed on their second attempt at accreditation (after taking appropriate corrective action to improve quality). Q. In order to obtain continuing education credit for stereotactic breast biopsy, must the coursework be specifically designed for stereotactic breast biopsy? A. No. Many general or breast continuing education activities include topics relevant to stereotactic breast biopsy. The following are just a few examples: • Breast imaging conferences that include discussion of stereotactic breast biopsy cases. • Breast tumor board meetings that include cases undergoing stereotactic breast biopsy. • Quality control seminars that include topics on processor or laser
printer quality control or mammography phantom image evaluation. • Physics courses that cover generators or digital detectors. The individual is responsible for documenting their continuing education in stereotactic breast biopsy. This can be done by documenting how much time was spent on the stereotactic breast biopsy related subject and attaching a note to the syllabus or CME certificate. Q. I have received training in digital image receptors used for stereotactic breast biopsy. Can that training count toward the 8 hours of training specific to FFDM? A. Maybe. Training received in digital image receptors used for stereotactic biopsy can count toward the 8 hours of training specific to FFDM if the training is essentially the same as that being given for FFDM. For example, if the individual received training in the manipulation of stereotactic digital images, and the FFDM manipulation of images is essentially the same as with stereotactic, that training could count toward the 8 hours of training specific to FFDM. Q. We heard that the ACR is requiring personnel working in stereotactic breast biopsy to have 5 continuing education credits in stereotactic breast biopsy? Is this true? If so, is this requirement per year or per 3-year renewal?
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A. No, this requirement does not apply to stereotactic breast biopsy. Starting July 1, 2007, the ACR Accreditation Programs will implement new continuing education requirements for physicians and medical physicists practicing in non-breast imaging modalities (i.e., CT, MRI, ultrasound, nuclear medicine, and PET). The vast majority of physicians performing stereotactic breast biopsy are qualified under MQSA to interpret mammograms, and MQSA already imposes stringent requirements for continuing education (15 CME every 3 years) that allow personnel to include credits in stereotactic breast biopsy. Because of this, the new ACR requirements will not apply to the breast accreditation programs. (See the article on New Accreditation Requirements for details on the non-breast requirements.) The ACR Accreditation Programs do recommend that qualified physicians follow the ACR Practice Guideline for Continuing Medical Education (a minimum of 150 hours in Categories 1 and 2 every 3 years with at least 75 of these hours in Category 1). The CME should include credits in stereotactic breast biopsy appropriate to the physician’s practice needs. (For diagnostic radiology, the guideline recommends that at least 70% be specialty-specific.) For accreditation in the Stereotactic Breast Biopsy Program, the ACR requires physicians to have 3 hours of Category 1 CME in stereotactic breast biopsy every 3 years. (These
AAPM Newsletter also may be counted towards the MQSA CME requirements.) See the Stereotactic Breast Biopsy Accreditation Program Requirements for details on personnel requirements. Q. I am a medical physicist with a BS in a physical science. I meet all Qualifications
MQSA requirements and started performing mammography and stereotactic physics surveys before 1999. Would I be considered qualified to perform surveys on stereotactic units at accredited facilities even though I do not have a master’s degree?
September/October 2007 A. Yes, the ACR’s requirement for medical physicists performing surveys of stereotactic breast biopsy units are consistent with the MQSA requirements:
Initial
Medical Physicist* Qualified to perform mammography surveys under MQSA AND Performed 1 hands-on stereotactic breast biopsy survey under a qualified medical physicist or at least 3 independent surveys prior to 6/1/97
Continuing Experience
1 stereotactic breast biopsy unit physics survey per year
Continuing Education
3 CEUs in stereotactic breast biopsy every 3 years
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AAPM Newsletter
September/October 2007
T
Task Group 109
Chris Serago Chair, TG 109
ask Group 109 was formed to write a code of ethics for the AAPM. Currently, our association has a policy (PP 8C, about to become PP 8D) titled “Guidelines for Ethical Practice for Medical Physicists”. The intent of the new code is to incorporate all of the existing guidelines and then significantly expand the scope of ethical issues covered. For example,
a small group in a relatively short amount of time will be challenged to encompass the entirety of the field.
The code of ethics will be an important document for all members of the AAPM. Task Group 109 is working hard to craft a document that will be a useful source of guidance. The composition of the Task Group is diverse and they endeavor to consider every aspect of the ethical landscape. Nonetheless,
Therefore, I would like to invite the membership for their input. If you have a particular ethical issue that you think TG 109 needs to consider for the code, please send me a brief email. I will also be happy to share the preliminary draft of the code in its present form.
Partners in Physics Program
Charles Shang, M.S. AAPM PIP Chair An Update of PIP Program of AAPM t is certainly my privilege to take on the voluntary role as the curator of the Partner-in-Physics (PIP) program of AAPM since this year. During the discussion of AOAS meeting in 2005, the urgency of setting up guidelines for maintaining a healthy PIP program became evident. Initiated by AOAS, after over one year’s diligent effort by every member in the task group, TG130 report – “Guidelines for Working with AOAS Supported PARTNERS IN PHYSICS” was completed. In February of this year, IA committee approved this report, and indicated that it “may be used as
I
research ethics and education ethics will be described in some detail in the new code.
a reference to promote PIP support by other subcommittees of IAC”. During the process, I, with sincere appreciation, frequently received coaching and help from, Drs. Raymond Wu, Allan Wilkinson, Mahadevappa Mahesh, as well as other members in the group. Now, more than ever, I sensed the importance to address the awareness among AAPM members, and to promote its general participations. PIP program of AAPM is a program that provides a special AAPM affiliation with financial support and professional contacts to medical physicists in developing countries. The medical physics profession in such countries or regions often demonstrates its need for additional financial support, and the regular AAPM membership dues may significantly impact the individual’s financial status. The PIP Program has been providing financial assistance to pay for the dues for such candidates as Corresponding III (international affiliates). The program consists of individual relationships between a physics partner in a developing country and
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a sponsoring partner. The PIP dues are paid by the sponsoring partner – an individual AAPM member, local chapter, regional subcommittee, and other affiliated organization. The current financial obligation for such sponsorship is for 3 years, unless the status of the sponsored partner becomes inactive during this period. A candidate who applies for the Partners in Physics Program must meet all requirements for AAPM membership, which is “offered to those scientists or engineers who define themselves to be working in the field of medical physics including medical engineering and bioengineering and who are desirous of affiliating with the AAPM and meet the training and experience requirements in the By-Laws”. The applicant shall be a resident of a developing country at the time of application. The number of such International Affiliates under PIP is limited by the availability of sponsoring partners and the fund. The dues for regular PIP are currently half of the full membership annual dues and the electronic PIP (ePIP) dues are one
AAPM Newsletter fourth of the full membership annual dues. A regular PIP receives Medical Physics and certain other AAPM publications (hard copy or electronic) that are generally distributed to the membership. An ePIP will receive all AAPM materials electronically via the internet. In addition, all PIP will be able to access AAPM website pages reserved for AAPM members only. All PIP affiliates are eligible to attend/register for all AAPMsponsored meetings at the member’s registration fee. Detailed comparisons are tabulated in “AAPM Membership Dues and Benefits for 2007” which can be found at http://www.aapm. org/memb/DuesBenefits07.pdf. To effectively maintain the quality of the program, and correctly allocate the found of the sponsorship, AAPM regional subcommittees may modify its future renewal process for members under PIP. An annual evaluation may be proposed, as suggested in TG130. As the profession of medical physics is rapidly evolving around the world,
September/October 2007
physicists or engineers in fields of medical physics in developing countries often find it hard to practice due to the scarcity of resources and training. Thus, AAPM implemented the Partners in Physics (PIP) Program under the International Affairs Committee (IAC) about two decades ago. The objectives of the PIP program are to provide opportunities for collaboration between the medical physicists in the developing countries and the AAPM members or the AAPMaffiliated associations. The PIP program attempts to build a bridge to connect those medical physicists with AAPM. Thus it will ultimately improve the practice of medical physics and earn the recognition of AAPM in those sponsored regions. Under the earlier organizers, Perry Sprawls, and Azam NiroomandRad, the member partners in PIP had reached 50 by 2001. The program in the next 6 years took off, propelled by Mahadevappa Mahesh, as the curator of PIP.
Today, the number of PIP program has grown to over 90 and is still counting. The discussion on regional PIP program has been routinely included in agenda for many AAPM regional committees, and associated regional organizations. Over the years, PIP candidates have been sponsored under this program by individual AAPM members as well as affiliated associations of the AAPM. Today, more than ever the PIP program has attracted interests of medical physicists, engineers, and related scientists around the world. Please allow me to humbly invite you or your organization to participate in PIP as a respectful sponsor. If we can be of more assistance, please contact me or AAPM membership team. I thank you in advance for your support or being interested in this program.
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Number of Partners in PIP as in June, 2007
12
10
8
6
4
2
0 Uganda
Tunisia
Trinidad Tobago
Tanzania
Srilanka
S. Africa
Saudi Arabia
Russian
Poland
Phillipines
Nepal
Libya
Korea
Kenya
Indonesia
Ghana
Estonia
Costa Rica
Bangladesh
Turkey
Romania
Nigeria
Egypt
Bulgaria
Sudan
Pakistan
Malaysia
Brazil
Thailand
Iran
Argentina
India
China
23
AAPM Newsletter
September/October 2007
Health Policy/Economic Issues
Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant 2008 Policies & Payments for Hospital Outpatient Departments Released by CMS
T
he Centers for Medicare and Medicaid Services (CMS) published the 2008 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The majority of radiation oncology procedure codes will realize increases in hospital payments in 2008, however, the proton beam therapy codes (CPT 77520-77525) have a 27% reduction in payment slated for 2008. High dose rate brachytherapy (CPT 77781-77784) and some stereotactic radiosurgery codes (CPT 77371 and HCPCS G0251) will realize minor reductions. Hyperthermia (CPT 77600-77620) payments are slated to increase 86.7% and low dose rate brachytherapy (CPT 77761-77763, 77776, 77777) would increase 79% in 2008. CMS proposes an 8% increase in payments for medical physics codes 77336 & 77370 in 2008 (see table 1). CMS notes that Medicare expenditures for Part B services have grown rapidly over the past several years due in significant part to increases in spending for hospital outpatient services. Recent experience has shown that both the number and the complexity of procedures furnished to each Medicare beneficiary is growing rapidly. In addition to proposing payment changes for services in hospital outpatient departments, the 2008 proposed rule includes provisions that would encourage higher quality care through the reporting of quality measures and would improve efficiency through larger payment bundles that would give hospitals greater flexibility in managing their resources. The proposed reforms focus on value-based purchasing.
For 2008, CMS is proposing to package payment for items and services in seven categories of supportive ancillary services (known as “dependent” services) into the payment for primary diagnostic or therapeutic modality (known as “independent” services) with which they are performed: ▪ ▪ ▪ ▪ ▪ ▪ ▪
Guidance services Image processing services Intraoperative services Imaging supervision and interpretation services Diagnostic radiopharmaceuticals Contrast agents Observation services
CMS proposes to package payment for “guidance” codes, specifically those codes that are reported for supportive guidance services, such as ultrasound, fluoroscopic and stereotactic navigation services, which aid in the performance of an independent procedure. There are two radiation oncology codes (CPT 77417 & 77421) and several radiology ancillary services (CPT 76000, 76001, 76950, 76965, 77011, 77014) included in this proposal. No separate payment will be made for the guidance service that supports the independent service. AAPM is analyzing the CMS packaging proposals and has concerns that packaging image guidance codes will negatively impact the quality of patient cancer care. AAPM will provide comments to CMS prior to the September 14th deadline. In addition, CMS is also proposing the creation of encounter-based composite APCs for services that would provide a single payment for certain common combinations of component services that are reported on the same date of service. CMS is proposing to pay for
24
two types of care, specifically low dose rate (LDR) prostate brachytherapy and cardiac electrophysiologic evaluation and ablation, through composite APCs. CMS states that they are proposing these specific encounterbased composite APCs for 2008 because they believe that this approach could move the HOPPS toward payment based on an encounter or episode-of-care basis, enable the use of more valid and complete claims data, create hospital incentives for efficiency, and provide hospitals with significant flexibility to manage their resources that do not exist when CMS pays for services on a per service basis. Specifically, CMS proposes to create Composite APC 8001 (LDR Prostate Brachytherapy Composite) that would provide one bundled payment for LDR prostate brachytherapy when the hospital bills both CPT codes 55875 and 77778 as component services provided during the same hospital encounter (same date of service.) CMS reports that the payment bundle would also include payment for the commonly associated imaging guidance services, which would be newly packaged under the proposed 2008 packaging approach discussed above. Brachytherapy sources would be paid separately and in addition to the Composite APC 8001 rate of $3,166.52. Also of note, CMS proposes to continue separate payment for brachytherapy sources, basing payment on the source-specific median costs, as reflected in the hospital claims data (see table 2). Payment would be on a per unit source basis to recognize the high variability of treatment costs. Currently, brachytherapy sources are paid based on the hospitals charges reduced to costs. Lastly, CMS proposes to assign the
AAPM Newsletter
September/October 2007
Table 1 - Summary of 2008 Proposed Radiation Oncology HOPPS Payments APC
Description
CPT Codes
2007 Payment
2008 Proposed Payment
N N 65 66 67 127
N/A N/A Level I SRS Level II SRS Level III SRS Level IV SRS
77417 77421 G0251 G0340 G0173, G0339 77371
$43.60 $67.45 $1,249.18 $2,644.95 $3,895.59 $8,510.16
$0 $0 $1,095.47 $3,017.56 $3,918.43 $7,864.15
Proposed Payment Change 2007 to 2008 ($43.60) ($67.45) ($153.71) $372.61 $22.84 ($646.01)
299
Hyperthermia & Radiation Treatment
77470
$361.67
$383.91
$22.24
6.1%
299
Hyperthermia & Radiation Treatment
77600-77620
$205.68
$383.91
$178.23
86.7%
300
Level I Radiation Therapy
$91.13
$95.54
$4.41
4.8%
301
Level II Radiation Therapy
$137.04
$146.07
$9.03
6.6%
303
Treatment Device Construction
$180.90
$195.26
$14.36
7.9%
304
Level I Therapeutic Radiation Treatment Prep
$96.72
$104.51
$7.79
8.1%
305
Level II Therapeutic Radiation Treatment Prep
$244.17
$266.08
$21.91
9.0%
310
Level III Therapeutic Radiation Treatment Prep
$848.76
$896.78
$48.02
5.7%
312
Radioelement Applications
$298.54
$534.48
$235.94
79.0%
313
Brachytherapy
$789.70
$739.46
($50.24)
-6.4%
412
IMRT Treatment Delivery
77418, 0073T
$336.42
$364.80
$28.38
8.4%
77778
$1,035.50
$981.88
($53.62)
-5.2%
77520, 77522
$1,161.29
$845.50
($315.79)
-27.2%
77523, 77525
$1,389.37
$1.011.71
($377.66)
-27.2%
651 664 667
Complex Interstitial Radiation Source Application Level I Proton Beam Therapy Level II Proton Beam Therapy
new Category III CPT 0182T for High Dose Rate (HDR) Electronic Brachytherapy to New Technology APC 1519 with a 2008 proposed payment rate of $1,750.00 per fraction.
77401-77409, 77789 77411-77416, 77422,77423, 77750 77332-77334 77280, 77299 77300, 77305, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77310, 77315, 77321, 77327, 77328 77295, 77301 77761, 77762, 77763, 77776, 77777, 77799 77781, 77782, 77783, 77784
A complete summary of the proposed rule and impact tables CMS Publishes 2008 Medicare Physician Fee Schedule Proposed Rule CMS published the 2008 Medicare
25
Proposed Percentage Change 2007 to 2008 -100% -100% -12.3% 14.1% 0.6% -7.6%
is on the AAPM website at: http:// w w w. a a p m . o r g / g ove r n m e n t _ affairs/CMS/default.asp The final rule will be published by November 1st, with an effective date of January 1, 2008.
AAPM Newsletter
September/October 2007
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AAPM Newsletter
September/October 2007
Table 2 - 2008 Proposed HOPPS Payments for Brachytherapy Sources HCPCS Code
Long Descriptor
Proposed 2008 Payment
A9527
Iodine I-125, sodium iodide solution, therapeutic, per millicurie
$28.62
C1716
$31.95
C2635
Brachytherapy source, non-stranded, Gold-198, per source Brachytherapy source, non-stranded, High Dose Rate Iridium-192, per source Brachytherapy source, non-stranded, Non-High Dose Rate Iridium-192, per source Brachytherapy source, non-stranded, Yttrium-90, per source Brachytherapy source, non-stranded, High Activity, Iodine-125, greater than 1.01 mCi (NIST), per source Brachytherapy source, non-stranded, High Activity, Palladium-103, greater than 2.2 mCi (NIST), per source
$47.06
C2636
Brachytherapy linear source, non-stranded, Palladium-103, per 1MM
$37.09
C2637
Brachytherapy source, non-stranded, Ytterbium-169, per source
$0.00
C2638
Brachytherapy source, stranded, Iodine-125, per source
$42.86
C2639
Brachytherapy source, non-stranded, Iodine-125, per source
$31.91
C2640
Brachytherapy source, stranded, Palladium-103, per source
$62.24
C2641
Brachytherapy source, non-stranded, Palladium-103, per source
$45.29
C2642
Brachytherapy source, stranded, Cesium-131, per source
$97.72
C2643
Brachytherapy source, non-stranded, Cesium-131, per source
$51.35
C2698
Brachytherapy source, stranded, not otherwise specified, per source
$42.86
C2699
Brachytherapy source, non-stranded, not otherwise specified, per source $29.93
C1717 C1719 C2616 C2634
Physician Fee Schedule (MPFS) proposed rule. MPFS specifies payment rates to physicians and other providers, including freestanding radiation oncology clinics, for more than 7,000 health care services and procedures, ranging from simple office visits to complex surgery. Medicare is expected to pay approximately $58.9 billion to 900,000 physicians and other health care professionals for services paid under the fee schedule in 2008. Sustainable Growth Rate & Conversion Factor The conversion factor is updated on an annual basis according to a formula
specified by statute. The proposed rule indicates that payment rates for all physicians’ services would be reduced across-the-board by 9.9% in 2008, a reduction required by the statutory formula that takes into account substantial growth in overall Medicare spending. CMS forecasts payment reductions under the Sustainable Growth Rate (SGR) system for 2008 and subsequent years. Congressional action will be necessary to alter physician payment reductions in 2008 and beyond. AAPM recommended that CMS replace the Sustainable Growth Rate
27
$173.40 $57.40 $11,943.79 $29.93
in 2008 with an annual update system like those of other provider groups so that payment rates will better reflect actual increases in physician practice costs. Practice Expense RVUs CMS will continue to implement the new “bottom-up” practice expense methodology. For 2008, the practice expense relative value units (PE RVUs) will be calculated on the basis of a blend of RVUs calculated using the new practice expense methodology weighted by 50% and 50% of the 2006 PE RVUs for each code.
AAPM Newsletter
September/October 2007
The overall impact to radiation oncology payments in 2008 is 0%. The majority of radiation oncology codes increase under the new practice expense methodology and these procedures will receive additional increases in PE RVUs in 2008. The medical physics consultation codes (CPT 77336 & 77370), however, will realize significant reductions under the new practice expense methodology. Initial reductions in the medical physics PE RVUs were implemented effective January 1, 2007 and these reductions will continue during 2008, the second year of the four-year transition period (see table 3). AAPM has advised CMS that the current practice expense RVUs for
medical physics codes 77336 and 77370 are undervalued. The AMA’s Practice Expense Committee has not reviewed these codes since 2002 and the standard of patient care has changed significantly since then. As technology continues to advance in radiation oncology, cancer treatments are becoming more complex and medical physicists spend more time on cases that involve IMRT, IGRT and SRS/SBRT. The role and responsibility of the medical physicist is of greater importance now than in 2002. AAPM advised CMS officials that a large decrease in RVUs, which leads to significant reductions in reimbursement, might result in the disastrous end effect of
poorer quality and safety of treatments for those cancer patients undergoing radiation therapy. Summary of 2008 Impacts to Radiation Oncology There are no new policies that directly impact radiation oncology payments or medical physics services proposed for 2008. However, the annual update factor is reduced by 9.9% across all physician and freestanding center payments. AAPM cautioned CMS that reductions in RVUs combined with the forecasted decreases in the annual update factor could have a major impact on the provision of radiation oncology procedures to Medicare beneficiaries in the freestanding radiation oncology center setting.
Table 3 - Medical Physics Practice Expense RVUs 2006 PE RVU
CPT Code 77336 Continuing medical physics consult
2.99
77370 Special medical radiation physics consultation
3.50
The “Total Impact” of all proposed policy changes yields a –10.0% impact on radiation oncology for 2008. Any legislative fix to increase the annual update factor (conversion factor) will further mitigate the reductions proposed for radiation oncology services in 2008 (see table 4).
2007 PE RVU
2008 Proposed PE RVU
2010 Proposed PE RVU
2007-2008 PE RVU Percent Change
2006-2010 PE RVU Percent Change
2.52
2.06
1.13
-18.3%
-62.2%
3.38
3.26
3.02
-3.6%
-13.7%
A complete summary of the proposed rule and impact tables is on the AAPM website at: http://www.aapm.org/ government_affairs/CMS/default. asp
payments being finalized and effective on January 1, 2008. AAPM will alert its members on key changes in policy and the final payment rates for 2008.
The final rule will be available by November 1st with all policies and
Table 4 - Total Impact of 2008 Medicare Physician Fee Schedule Proposed Rule Combined Impact with 2008 Reduced Update Factor
Impact of 2008 Imaging Provisions in the DRA Section 5102
Combined Impact of 2008 RVU and DRA Imaging Provisions
2008 Annual Update Factor (Conversion Factor)
0.0%
0.0%
0.0%
-10.0%
-10.0%
0.0%
0.0%
0.0%
-10.0%
-10.0%
Specialty
Medicare Allowed Charges (millions)
Impact of 2008 Work and PE RVU Changes
Radiation Oncology
$1,599
Radiology
$5,197
28
AAPM Newsletter
September/October 2007
Fellowships, Residencies & Research Awards
2007 Summer Undergraduate Fellowship Program
T
he purpose of this program is designed to provide opportunities for undergraduate university students to gain exposure to and experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. For more information about the SUFP go to: http://www.aapm. org/education/sufp/
2007 RSNA/AAPM 2 years PreDoctoral Fellowship
A
warded for two years of graduate study leading to a doctoral degree. A stipend of $13,000 per year is assigned to the recipient by the receiving institution. Tuition support will not exceed $5,000 per year per student. Amount of tuition support granted will be at the discretion of AAPM. All AAPM awards are paid to the recipient’s institution and distributed in accordance with the institution’s disbursement procedures. However, it is AAPM’s policy that none of the funds may be diverted to the institution’s “facilities”, “administrative”, or other overhead categories and the full amount of the award must be provided to the recipient. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc, (CAMPEP), listed below. Full addresses of CAMPEP-accredited programs are listed in the AAPM Directory and on the CAMPEP Web Page: http://www.campep.org
Institution: University of Florida Recipient: Bart Lynch
Student Fellow Keith Goodman Jonathan Rosenfield Maura Kirk Joey Cheung Ashley Temple Joseph Holmes Jean Anne Currivan Anna Diesslin Susanne Galyon James Bartz Nathan Busse Charles Peterson Jeremy Pigeon
Mentor Paul Gueye Rebecca Howell Peter Debus Jean Pouliot Joseph Beach John Sweet Andrew Maidment Marvin Friedman Rebecca Howell Cynthia Mccollough Jennifer Clark Hassan Alkhatib Andrew Jones
Institution Hampton University Emory University St. Luke’s Hospital UC San Francisco John D. Cronin Cancer Ctr Vail Valley Medical Center Univ Pennsylvania St. Luke’s Roosevelt Hospital Emory University Mayo Clinic John D. Cronin Cancer Ctr. Richland Memorial Hospital Geisinger Medical Center
2007 AAPM Clinical Residency in Imaging
2007 Research Seed Funding Initiative Award
ne $36,000 award granted to one institution for support of a clinical residency in medical physics (imaging). The grant of $18,000 per year is granted to an approved institution in partial support of a full-time clinical residency. It is the policy of the AAPM that none of the funds may be budgeted to Facilities and Administrative Costs.
Paul Keall, Stanford University
O
Per AAPM policy, any institution receiving award money from AAPM may not budget any of that money to Facilities and Administrative Costs (indirect or overhead expenses).
Residency program must be accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc, (CAMPEP), listed below, or have applied for CAMPEP accreditation by the end of the second year of funding. Full names and addresses of CAMPEP-accredited programs are listed in the AAPM Directory and on the CAMPEP Web Page: http://www.campep.org Institution: Henry Ford Health System Program Director: Dr. Donald Peck Student: Kenneth Nkongchu
29
H
ypoxia, pneumonitis, motion management, molecular imaging, Monte Carlo, proton range uncertainty, IMRT, IGRT, PET, brachytherapy …. These were some of the interesting topics of study proposed by the 23 applicants for the 2007 Research Seed Funding Initiative Award. A panel from varied backgrounds reviewed the applications (avoiding conflicts-of-interest) and evaluated the applications based on the proposal merit, the potential for further funding (e.g. NIH R21/R01 type awards) and the background of the investigator. The panel was looking for the almost unattainable combination of the importance of the problem, insight and rigor of proposed solutions and realistic goals. The reviewers were uniformly impressed by the exciting ideas, problem descriptions and research plans. The future of medical physics is in excellent shape. Many of these applications with further development would fare well in NIH reviews. Based on these proposals, the future of medical physics research is very
AAPM Newsletter
September/October 2007
encouraging. We encourage the applicants to further continue their work and seek funding from other sources. The differentiating features for the most highly ranked awards were those proposing to develop new science, methods and procedures. Still noteworthy, but less highly ranked, were those investigating features of systems or comparing various available methods. The most highly regarded proposal was Dr. Marco Carlone’s idea for Study of interference for real-time image guided adaptive radiotherapy. “The principal innovation behind this research is to develop technology required for true real-time imagine guided adaptive radiotherapy; one that would resolve both the motion and poor tumour definition issues, by coupling an MRI system with a linear accelerator.” The panel found this an intriguing idea, the problem was clearly defined, some preliminary studies had been performed and there was much support within the research group for this project. Also, Dr. Carlone had an impressive track record of research success. Congratulations Dr. Carlone and the group at the University of Alberta. We look forward to learning about the results of your investigations. Thank you to the reviewers, and also to Shantelle Corado at AAPM headquarters whose efforts greatly assisted the review process. We hope next year to increase the number of awards to increase the success rate from the current 4% level. For eligibility requirements, please visit the AAPM website. Institution: Cross Cancer Institute Recipient: Marco Carlone Project: “Study of RF-Interference for Real Time Image Guided Adaptive Radiotherapy”
The National Patient Safety Foundation and the AAPM Peter Dunscombe Tom Baker Cancer Centre Funding for Projects in Hazard Reduction and Patient Safety in Radiation Medicine.
A
generous grant of $30,000 from the National Patient Safety Foundation has enabled the NPSF and the AAPM to partner in promoting research and development activities in the area of hazard reduction and patient safety in radiation medicine. The task of developing the criteria for funding and evaluating applications was delegated to the AAPM’s Working Group on the Prevention of Errors in Radiation Oncology. A committee comprising Peter Dunscombe (chair), Eric Hendee, William Hendee, Eric Klein and Bruce Thomadsen was formed to carry out these tasks with a deadline for the conclusion of the selection process of the 2007 Annual Meeting of the AAPM. A call for proposals was emailed to all AAPM members on 14th March with a deadline for submissions of 1st June 2007. By the deadline, 7 applications had been received. The five person committee evaluated each application by assigning numerical scores in the following categories: Compliance with the RFP, Background Preparation, Originality, Potential Impact, Applicants’ Productivity and Likelihood of Success. One member of the committee was in a potential conflict of interest with respect to one application and did not participate in the evaluation of that particular proposal. At a telephone conference held on 13th July, the committee met to reach its decision. The numerical scores, previously and independently assigned, were used to facilitate the discussion and not to determine a ranking. The committee selected the following three projects (in alphabetical order of the PI) for funding:
30
• Mohammad Islam et al. Princess Margaret Hospital. “Improving patient safety during radiation therapy through human factors methods.” • Sasa Mutic et al. Washington University. “An error reporting and tracking database tool for process improvement in radiation oncology.” • Lee Myers et al. Johns Hopkins Hospital. “Assessment of suggested changes from failure modes and effects analysis of an external beam radiotherapy process map.” Each project was funded at the requested amount. All the applications were of a very high quality and the committee acknowledges the effort and commitment of all applicants to this important area of activity. Through this initiative, the interest of all applicants and many others within our community, we can further enhance the already very high standards of safety in radiation therapy.
AIPScience
Fellowships
FELLOWSHIP OPPORTUNITIES FOR AAPM MEMBERS: Experience a unique year in Washington, DC, working at the U.S. Department of State or in the halls of Congress! The American Institute of Physics State Department and Congressional Science Fellowships are open to qualified members of AAPM and other AIP Member Societies; several Member Societies also offer their own Congressional Fellowships. Qualifications generally include appropriate society membership; PhD or equivalent in physics-related field; and interest or experience in the scientific or technical aspects of domestic or foreign policy. Some require U.S. citizenship. Application deadlines vary between November and February. Fellowship terms begin the following September. For more information, please see http://www.aip.org/gov/fellowships.html.
AAPM Newsletter
September/October 2007
Tools of the Trade
The Lucy 3D QA Phantom performs image transfer QA, dosimetry QA, and machine QA within the exact coordinate system of commercially available stereotactic head frames.
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31
AAPM Newsletter
September/October 2007
Indra J. Das, Ph.D. Awarded Fellowship in the American College of Radiology
D
r. Das was awarded fellowship in the American College of Radiology (ACR) in May 2007 for his exemplary work in the field of Medical Physics and his contributions to ACR programs and activities. Dr. Das is a Professor of Radiation Oncology and the Chair of Clinical Physics for the Department of Radiation Oncology at the University of Pennsylvania and was the only medical physicist awarded ACR fellowship in 2007. He is a FELLOW of the AAPM and is a surveyor for ACR Radiation Oncology Accreditation Program and an examiner for the American Board of Radiology.
Persons in the News the University of Maryland Medical School and Hospital was recently awarded the Carl M.Mansfield, MD, EndowedProfessorshipinRadiation Oncology. He was recognized for his valuable contributions in Research, Education and Patient Care and his leadership qualities as a Senior Faculty Member at the University over the last ten years. Cedric Yu is a FELLOW of the AAPM and an active member of several committees.
Gold Standard
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Dr.Carl Mansfield is the immediate Past-Chairman of the Department of Radiation Oncology at the University of Maryland Medical School and is a nationally and internationally recognized Radiation Oncologist who has done pioneering work in promoting Lumpectomy and Interstitial Brachytherapy for the treatment of early Breast Cancer.
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32
AAPM Newsletter
September/October 2007
Image-Based Radiation Therapy Workshop Review
Ramathibodi Hospital Bangkok, Thailand June 30th – July 2nd, 2007
A
three-day Thailand Workshop with the theme, “Image-Based Radiation Therapy Workshop” was held in Ramathibodi Hospital, Bangkok, Thailand from June 30th to July 2nd, 2007. The invited faculty members from the United States for this workshop were Cheng B Saw, PhD (UPMC Cancer Centers, Pittsburgh, PA), Todd Pawlicki, PhD (University of California – San Diego, San Diego, CA), and Robert Zwicker, PhD (University of Kentucky, Lexington, KY). This workshop was organized by Cheng B Saw, PhD, Chirapha Tannanonta, MS, and Lucksana Pochanugool, MD. The National Health Security Office of the Ministry of Public Health and North American Chinese Medical Physicists Association (NACMPA) sponsored this workshop and it was endorsed by the Thai Medical Physicist Society. Vendor participation and financial contributions were from Computerized Medical Systems (CMS)
Inc, Prowess Inc, Nucletron Asia Pacific Ltd, Topslane International, Kamol Sukosol Electric Co. Ltd, Siemens Medical Solutions (Thailand) Limited, Supreme Products Co. Ltd, Philips Electronics Hong Kong Ltd, and Global Medical Solutions (Thailand) Co. Ltd. Asst. Prof. Chirapha Tannanonta, Chief of Medical Physics, Division of Radiation Oncology, Ramathibodi Hospital, and Assoc. Prof. Anchali Krisanachinda, President of Thai Medical Physicist Society gave the welcoming addresses at the workshop. Professor Lucksana Pochanugool, MD, Head of the Department of Radiology, Ramathibodi Hospital – Mahidol University performed the opening ceremony. The objective of this workshop was to provide the opportunity for the participants to interact in small groups with the application specialists of the treatment planning systems to understand three-dimensional (3D) radiation treatment planning. The faculty members explained the concepts of 3D radiation treatment
planning in the morning sessions. In the afternoon sessions, the application specialists of the treatment planning systems led the hands-on practice to understand the procedures of performing 3D radiation treatment planning. Four treatment planning system vendors: Computerized Medical System (CMS), Philips, Prowess, and Nucletron participated in these handson practice sessions. On the first day of the workshop, Dr. Saw gave an overview of 3D radiation treatment planning emphasizing the general processes of image registration, target and structure contouring, beam placement, dose computation and evaluation of treatment plans using 3D tools. Dr. Pawlicki presented on the commissioning of treatment planning systems, while Dr. Zwicker presented on the target and organsat-risk definitions consistent with ICRU Reports No. 50 and 62. On the second day, Dr. Pawlicki explained the issue of contouring as applied to IMRT for the Head and Neck. Dr. Zwicker examined the issue of image fusion tools to extract the best target definition for irradiation. Dr. Saw
Participants of the Image-Based Radiation Therapy Workshop held in Bangkok, Thailand
33
AAPM Newsletter
September/October 2007
presented on the concepts of dose volume histogram, the creation, the evaluation, and the applications in 3D radiation treatment planning. The third day emphasized the applications of 3D radiation treatment planning to conformal radiation therapy and intensity-modulated radiation therapy. Lastly Dr. Pawlicki reviewed the 3D dose algorithms in 3D treatment planning systems and also the emergence of image-guided radiation therapy (IGRT). The workshop was well attended with 140 participants, three times more than anticipated. In addition, 40 of the participants were radiation oncologists and 10 participants were from foreign countries of Malaysia, Singapore, and Philippines. A poll taken during the workshop indicated that about half of the participants have 3D radiation
treatment planning systems and less than 10% were performing IMRT. Of primary interests at the workshop was the acceptance testing and commissioning of the treatment planning systems in particular, the proper instruments to use and the type of cases needed to test the treatment planning systems. The participants expressed their delight for the opportunities to see different treatment planning systems at this workshop. The organizers appreciated the participation of the treatment planning system vendors as educators than presenters of commercial interests at this workshop. A number of copies of the textbook Foundation of Radiological Physics, authored by C.B.Saw, were distributed as door prize to the participants from Thailand. After the workshop, the
faculty and the hosts together toured Ayuthaya, the historic city outside Bangkok. The overall assessment of the workshop was very successful based on the comments from the participants, faculties, vendors, and organizers. The faculty members had a very exciting time and look forward to returning to Thailand in the near future. Submitted By: Cheng B Saw, PhD of UPMC Cancer Centers, Pittsburgh, PA and Chirapha Tannanonta, MS and Lucksana Pochanugool, MD of Ramathibodi Hospital, Bangkok, Thailand
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AAPM Newsletter
September/October 2007
Notes from the AAPM Exchange Scientist Program
T
Milton Woo Chair, Exchange Scientist Program Subcommittee
his is a continuation of the sponsorship of AAPM Exchange Scientist program awarded to Dr. Komanduri Ayyangar in 2004.(see report of the first trip in AAPM newsletter Vol 31. No.3 May/June 2006 page 5). In his second trip to India , Dr. Komanduri Ayyangar made several trips during Nov ’06- March ’07 to the Mahatma Gandhi Memorial Medical Trust Hospital, which is located in a rural area, very near the town of Bhimavaram, West Godavari District, Andhra Pradesh, India. He filed the following report. Dr. M.R. Raju, a well known scientist retired from Los Alamos National Laboratory has established the International Cancer Center, a model rural cancer treatment and research institute. There was no other cancer center in the District of West Godavari, which has a population of four million. Since my visit last year, the center has made significant progress. Most
importantly, the patients are very cheerful, happy and hopeful that the technology and expertise has come home directly to address their needs. The center is currently treating 2030 patients per day on their Cobalt60 facility. In addition, the center is equipped with Siemens CT scanner used for diagnosis and treatment planning. Dedicated treatment planning equipment is also available. The center is equipped with chemotherapy and lab facilities as well. Based on a grant that we have submitted last year, the Atomic Energy Regulatory Board (AERB) has awarded a grant to do a diagnostic radiology project at the center. Using some of the funds from this grant, the center has acquired additional physicist and a technologist. A lot of time was spent in acquiring bids and specifications and ordering the equipment required for the project. The equipment received from AAPM members, especially Dr. Natarajan of Winthrop Hospital, NY has been proved useful for this project.
The highlight of the trip is the ordering of HDR equipment. Dr. Raju has acquired sufficient funds to order a Cobalt-60 based HDR from BEBIG, Germany. The dedicated room which was designed for Iridium was surveyed and after several communications with the AERB, the layout was approved with additional shielding. The equipment is due to arrive in the next two months. The current staff includes the following individuals. Dr. M.R.Raju Director, Dr Ravindra, Dr. Satya Prasad and Dr. Manisha Radiation Oncologists, Mr. Pradush Narayanan, Mr. Fenedict Jesuraj physicists. In addition, there are many other technical and nursing staff. The MLC design that we have worked on last year has been constructed as a wood model and now is given to a fabrication facility in Hyderabad. This project will be continued and new indigenous accelerators are being envisaged that use the know-how from this technology. A seminar to mark the addition of HDR is also being planned. Dr. Raju’s goal is, in addition to quality care, to make the center gain international recognition as a model rural center. The center needs the support of AAPM in its future endeavors especially in sponsoring physicists every year. The center is in need of services that can be provided by medical physicists and radiation oncologists for significant length of time. This is a direct invitation and plea to the retired physicists of the AAPM to go visit this cancer center in India.
Top left: A view of the MGMMT hospital entrance Top right: Wooden model of the MLC design for Cobalt-60 Bottom left: In-service session on radiation safety to staff Bottom right: Teachers Dr. Raju, Dr. Ayyangar, Dr. Manisha and Dr. Ravindra
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Also, the center is in need of simple equipment such as phantoms, radiation dose meters, radiation monitors, personal dosimeters, patient immobilization devices, low melting point alloy shields etc. in good working condition since they are not easy to find good quality products in India.
Editor
Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115
Editorial Board
Priscilla Butler, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390
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The AAPM Newsletter is printed bi-monthly. Next issue: November/December Submission Deadline: September 14, 2007 Postmark Date: October 29, 2007
American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846