AAPM Newsletter January/February 2008 Vol. 33 No. 1

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICISTS IN ME DI CI NE VOLUME 33 NO. 1

JANUARY/FEBRUARY 2008

AAPM President’s Column

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Gerald A. White Colorado Springs, CO

recently had the occasion to travel to Las Vegas for a meeting of the Alliance for Quality Imaging to work on strategy for the CARE Bill. Before the junket alarm goes off, be advised that I flew in after work, arriving at about midnight, and left the next evening just as the meeting ended.

The only thing that “stayed in Vegas” was my MacDuff tartan wool tie that I unfortunately left in the room.

(Certainly the next occupant was thrilled to add that to his Las Vegas wardrobe). Let me say that I am not a gambler in the Las Vegas sense. By way of reference I describe an event at my computer literacy training at the hospital. When the enterprise servers went up, everyone, no exceptions, was required to take a class to introduce them to the computer world prior to getting a login and password. The Mordac of our deployment was not impressed with the fact that we in Oncology had pulled cables and installed our own network years before there was an IT department in the hospital. The instruction was, as

one might expect, silly, error ridden and frustrating to an important character such as me who had so many other things waiting to be done. I was humbled, however, at the Mouse function exercise. We were asked – yes forced – to play the Microsoft Solitaire on our screens in full view of other classmates. I did not know how to play Solitaire and so failed my Mouse test miserably.

(I did get my login, but still do not know how to play the game.)

As I walked through the casino on my way to the CARE meeting, I passed the craps tables. They are, to the non-initiate, quite complex, and far more puzzling than Solitaire.

There are 40 plus regions, some with multiple texts and perhaps subregions with their own meanings.

I suspect, however, that they all have a function and to those with the appropriate knowledge and motivation they can each be used to gain success or failure depending on chance, strategy and which side of the enterprise you sit on.

As I sat in the CARE Bill meeting amidst talk of education and training I thought about the many pathways we have in Medical Physics for entry into the profession. They are quite complex, with multiple disciplines and sub disciplines, different degrees and different education and training offerings associated with degrees from various Departments and Universities. Fortunately, success or failure in the broad endeavor is not dictated so much by chance but rather by vision, planning, and

execution. We are now at a point where vision, planning and execution of training programs for clinical Medical Physicists will change the way we prepare ourselves for the profession. The ABR has adopted a close variant of the AAPM consensus position on requirements for entry into the profession. Beginning in 2012, examinees will need to be enrolled in or have completed a CAMPEP accredited degree program or residency, and beginning in 2014 a CAMPEP approved residency will be required. This will require a large scale up of both degree programs and residencies, and more fundamentally, a review of our conceptions of the necessary components of both.

We are firmly planted in the related and non-exclusive worlds of Science TABLE OF CONTENTS Chair of the Board Column Executive Director’s Column Editor’s Column Science Council Report Education Council Report New Board Members ACR Accreditation FAQS Professional Council Report 50th Anniversary News Treasurer’s Report Website Editor’s Report Health Policy/Economics Chapter News Ethic’s Committee Update Joint Licensure Subcommittee Rad Onc Safety Info System Persons in the News

p. 3 p. 4 p. 7 p. 8 p. 9 p. 10 p. 11 p. 12 p. 14 p. 15 p. 19 p. 20 p. 23 p. 27 p. 28 p. 30 p. 31

AAPM Newsletter and Clinical Practice. We have two journals, Medical Physics and the Journal of Applied Clinical Medical Physics. We have members who devote their careers to science, to the clinic and to a mixture of the two. We are both Scientists and Clinicians. Our preparation process must reflect these similarities and differences, enhancing the probability of success, no matter what side of the table you sit on. With so many years of success in the formal preparation of scientists, we now in addition face the task of formally preparing clinicians and also those who would like to plan a career in both science and clinical practice. Some thoughts on what the future might hold follow.

We, as a profession, must insist on clinical experience as a component of the qualifying accredited degree regardless of the position of the ABR or other outside organizations.

We cannot wait until the 2014 ABR residency requirement for this to occur. Medical Physicists find themselves alone within the hospital as the only clinical staff who can obtain the qualifying degree without significant clinical experience. As I look around in our facility I see Physicians, Nurses, Radiation Therapists, Dieticians, Genetic Counselors, Psychologists, Physical Therapists. Radiologic Technologists, Chaplains, all of whom have had didactic, laboratory and clinical components to their training. Many physicians now come to the hospital with both residency and fellowship training. They may have more knowledge of the clinically applied Medical Physics aspects of their practice than the medical physicists with whom they work. That balance of knowledge and skill is inconsistent with the long-term survival of the profession. There are a number of interesting (can I say exciting?) proposals for change in this regard.

January/February 2008 opportunities. A recent M.S. graduate has joined our group; in his 2-year program he was active in the clinic for 17 months. He came to us having done hundreds of External Beam and Brachytherapy plans, skills and knowledge regarding weekly chart checks, the ability to work with and around patients and to function collegially and productively within the physics practice. There are several M.S. programs that offer this level of clinical training, others may well follow. Recognition for this sort of training could be given by offering residency credit for structured clinical activities that met existing CAMPEP residency requirements. Thus an M.S. Graduate could leave a program with both the degree and a substantial portion of residency completed.

Graduate programs that continue to have difficulty finding resources for clinical experience for their students may find that the proposals for distributed residency described in the work of AAPM TG 133 may assist them in finding structured clinical training in institutions that affiliate with the training programs for this purpose.

Discussions are beginning in earnest on a professional degree, a Doctor of Medical Physics, and there is at least one such degree

Certainly M.S. programs will begin to offer more intense clinical training

program already underway. Likely a 4-5 year program, the DMP would include didactic, laboratory and clinical (residency) components, perhaps a research component. Such a training pathway is analogous to the training pathway found in Psychology. Those who intend to work primarily in research may choose to pursue a Ph.D., those who wish to work primarily in clinical care may choose to pursue a Psy.D. There is substantial overlap in the preparation and also in the career paths of the degree recipients.

Certainly we will hear much more in the months to come about clinical training in M.S. and Ph.D. programs, traditional and distributed residency programs and professional doctorates. We will need to maintain an open mind to embrace the need for vision, an open sprit of volunteerism to embrace the need for planning and an open pocketbook to embrace the need for execution. Fear not, we will fulfill the missive from the past: “One learns by doing a thing; for though you think you know it, you have no certainty until you try.� (Sophocles).

Let us move forward, honor the past, celebrate the present and prepare for the future.

AAPM Newsletter

January/February 2008

Chairwoman of the Board’s Column

Mary K. Martel UT MD Anderson Cancer Center 2008 Budget he 2008 budget for the society includes two big ticket items to start to fund two major initiatives, both put forth and endorsed by the AAPM Board in 2007. One is the funding of efforts for licensure (or equivalent to licensure) in all the states in the US. This task has been taken on by the Joint Medical Physics Licensure Subcommittee chaired by Jeff Limmer (under the Clinical Practice committee of the Professional Council). You may read more about the charge of the subcommittee on http://aapm. org/org/structure/?committee_ code=JMPLSC. The other is called the “2012 Initiative,” which will deal with developing a strategic plan for how to meet the number of residency graduates needed by the year 2012 in order to have enough qualified physicists to fill jobs that open each year. The Executive Committee of the Board will shepherd this effort, starting with a summit meeting early in 2008.

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Years 2012/2014 Though we are still calling this the 2012 Initiative, there has been a change in the ABR Radiologic Physics Exam requirements than what was previously reported by me in this newsletter. The communication

from Dr. Steve Thomas, AED of the ABR, of Oct 13, 2007 (and posted on theabr.org) reads: “Beginning in 2012, in order to take the American Board of Radiology Part 1 examination in Radiologic Physics, candidates must be enrolled in or have graduated from a CAMPEP accredited education program (e.g., MS, PhD, or residency). Beginning in 2014, in order to take the American Board of Radiology Part 1 examination in Radiologic Physics, candidates must be enrolled in or have completed a CAMPEP accredited residency program. ABR procedures require application submission by September 30th of the year before the examination.”

While the date for a requirement of residency only has slipped to the year 2014, it is important to keep in mind the urgency of developing residency programs within the next 5 years.

The RSNA and the AAPM The AAPM president is invited by the RSNA board each year to address the RSNA at their annual meeting’s opening session in Chicago’s Arie Crown Theater. I have attended a number of RSNA meetings though the years, but did not realize the depth of the connection that the AAPM has with the RSNA until I was AAPM president this year. This connection is at many levels and involves many people in both societies, but during the address I mentioned only several of the recent and notable efforts. One effort spearheaded by Dr. Dan Sullivan of the RSNA and Dr. John Boone of the AAPM is that the two societies have agreed to work together cooperatively to raise awareness of the need for quantitative imaging methods in healthcare, to build an infrastructure to support

quantitative imaging, and to increase the incorporation of quantitative methods in radiology practices. This cooperation will include several joint efforts including meetings, working groups, and initiatives designed to facilitate methods and protocols which provide a foundation for quantitative imaging applied to a variety of diseases. This has been a major initiative of the RSNA and chairman Gary Becker, who addressed the AAPM at the president’s symposium during our annual meeting this summer on this topic.

On the education front, the AAPM and RSNA have led education summit meetings over the past 2 years which have focused on challenges for residents and practicing radiologists to master the technology of radiology through enhanced understanding of the science, especially physics, underlying the discipline. A recent article in Radiology by Dr. William Hendee summarizes several important efforts, including web based educational modules which have strong support from the RSNA. A workshop on teaching physics will follow the next AAPM annual meeting to help medical physicists become better teachers of physicians, students and technologists. The AAPM leadership thanks the many people involved in this education initiative and taskforce, and in particular to RSNA board member Dr. George Bisset.

The RSNA honored a medical physicist this year among their Gold Medal awardees, Dr. William Hendee. As we all know, Dr. Hendee’s important contributions have influenced the fields of diagnostic radiology and radiation oncology as well as medical physics. He is a superb scientist and educator, and the AAPM is grateful for his leadership, which continues to this day.

AAPM Newsletter

January/February 2008

Finally, I mentioned that profound changes are on the horizon for the field of medical physics. The next decade will perhaps be turbulent times for us all as we grapple with implementation of the CARE

bill soon, we hope, to be passed

by Congress, the change in the eligibility criteria to sit for the ABR boards, and licensure efforts. The RSNA leadership has indicted their strong support of our efforts and we expect to partner with several

organizations including RSNA to accomplish the CARE bill goal of consistency, accuracy, responsibility and excellence in medical imaging and radiation therapy.

AAPM Executive Director’s Column email notification and you will have access to download the revised file and save it locally.

Angela R. Keyser College Park, MD Happy Birthday AAPM! 008 is a very special year for AAPM and the medical physics profession. Congratulations to all the many volunteers who have toiled over the years to build an association.

I hope that you will enjoy the special activities scheduled in 2008 to commemorate this special occasion.

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AAPM encourages you to go online Remember, starting in 2007, hardcopy membership directories are no longer published and mailed to each AAPM member. While we encourage all members to use the online directory for the most up-to-date information, we do understand that there are times when you do not have access to the internet during the course of your day. A PDF of the directory information is posted to the web on a quarterly basis. Please go to your member profile to indicate that you would like to be notified when the PDF is posted. HQ will send you an

2008 Dues Payments 2008 renewal notices were sent in October and November, with payments due by March 1, 2008. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on “Pay Your 2008 Dues Online.”

The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301-209-3396.

Meeting News The 2008 Summer School will be held June 25 – 27 at the Edwin Hornberger Conference Center in Houston, Texas. The program on “The Physics and Applications of PET/CT Imaging,” is organized by Program Directors Dianna Cody and Osama Mawlawi. Additionally,

there will be an optional hands-on session covering scanner testing, accreditation and shielding calculation on Saturday, June 28 at MD Anderson Cancer Center. Registration for the hands-on course is separate, and is limited to 96 participants. Registration will open on February 13. Summer School Scholarships are available, with an application deadline of February 20. Make note to register

by May 16 to take advantage of the discounted registration fees.

The 50th AAPM Annual Meeting will be held July 27 – 31, 2008 at the George R. Brown Convention Center, 1001 Avenida de las Americas in Houston, Texas. Committee meetings will be held at the headquarters hotel, the Hilton Americas Houston, while sessions and exhibits will be held at the convention center.

The deadline for Annual Meeting abstract submission is March 2. Heading the program development efforts are Scientific Program Co-Directors Thomas Bortfeld and Chris Shaw, along with Education Program CoDirectors Indrin Chetty and Ron Price, and Professional Program Directors Chris Serago and Mike Herman. Meeting information is continually updated online, with the full program scheduled to be posted by May 14. Please go to www.aapm.org and click on “Meetings” for the latest information. The online registration process is scheduled to open on March 19, with discounted registration until June 11.

AAPM Newsletter Golden Anniversary Service Project - Houston Food Bank You and your family members are invited to volunteer at the Houston Food Bank on Saturday, July 26, just prior to the Annual Meeting. The Houston Food Bank is a certified member of America’s Second Harvest. 80,000 people are fed each week with the help of volunteers.

You will help by sorting and packing food into boxes for needy families, or by weighing boxes or inspecting cans.

More details are available online.

Second Annual AAPM Blood Drive in Houston Please consider donating blood during the Second Annual AAPM Blood Drive on Tuesday, July 29. Collected units of blood will be used for patients at M.D. Anderson.

Summer Undergraduate Fellowship Program Please consider participation as a mentor in AAPM’s Summer Undergraduate Fellowship Program.

The program is designed to provide opportunities for undergraduate university students to gain experience in

medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Both student and mentor applications are due by February 1, 2008. For details, go to: http://www.aapm.org/ education/SUFP/ Funding Opportunities Make sure to check out the funding opportunities online at aapm.org: • The Research Seed Funding Initiative provides start-up funds for research-oriented medical physicists. Two $25,000, one-year awards will be made in 2008. For details, go to: http://www.aapm.org/announcements/ResearchSeed.asp • Applications are being accepted for the Fellowship for Graduate Study in Medical Physics until April 15, 2008. Go to: http://www. aapm.org/announcements/Fellinfo_app.pdf

January/February 2008 Online Education Online Education (RDCE) Credits are now flowing to the CAMPEP database at the end of each day.

Check out the AAPM Online Education offerings at: http://www. aapm.org/education/ce/info.asp Staff News I am pleased to report that Jackie Ogburn joined the AAPM team in November as the new Customer Service Representative, the position vacated when Laurie Hayden was promoted late in 2007. Jackie answers the main phone line, handles general inquiries, sets up conference calls and assists with the Medical Physics journal.

Tammy Conquest also joined the team in November as Applications Developer, filling the position vacated

by Catherine Murashchyk. Tammy has extensive web development/ programming experience, the last 2 years with a local mortgage company as a Database/PHP programmer/ web developer. Tammy also spent a number of years in the Air Force and MD Air National Guard.

AAPM 2008 Workshop “Becoming a Better Teacher of Medical Physics” We know that physicists can be better teachers, and this workshop is designed to help South Shore Harbour Resort & Conference Center League City, Texas July 31 - August 3, 2008 http://www.aapm.org/meetings/08Workshop Registration and Housing open: March 14, 2008

AAPM Newsletter

January/February 2008

Houston, Texas is home to the world’s largest concentration of medical professionals. The world-renowned Texas Medical Center is home to more than 42 institutions, including the University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine.

The Main Event area of downtown Houston spans Main Street between Capitol and Congress. This pedestrian-friendly location showcases some of the city’s best restaurants, nightlife and entertainment. Just a few blocks away is the Houston Theater District, ranked second in the nation for the number of theater seats in a concentrated downtown area.

The scientific program will include the highest quality abstracts in oral, moderated poster, and poster sessions on basic research & clinical application topics in medical imaging & therapeutic medical physics. Continuing education will be offered through daily courses to keep the membership up to date on the current & new technologies & techniques. An expanded education program, combined with an enhanced professional program, will offer significant opportunity to gain practical knowledge on emerging technical and professional issues. A major focus of the scientific program is the increasing integration of advanced imaging concepts in the routine practice of various therapies, especially radiotherapy.

Imaging Track

Therapy Track

• Advances in digital radiography, MRI, CT • Vascular/interventional imaging, nuclear imaging • New developments in breast imaging • Ultrasound elasticity imaging, • Image display, processing and analysis

• Optimization of treatment plans • Feedback mechanisms in RT • Outcome-guided biological planning • Informatics in radiation oncology • Technology translation in radiation oncology

Continuing Education Imaging Track

Continuing Education Therapy Track

There will be approximately 30 Continuing Education courses in Diagnostic Imaging Physics and Technology.

They will cover all imaging modalities, radiation safety and risk management issues, issues related to accreditation and recent developments in medical imaging physics education.

The Therapy Physics CE series will feature approx. 30 lectures. The program will feature courses on the use of functional imaging in planning & assessment of response, a course on cellular and molecular biology for the medical physicist, and additional lectures in the areas of IMRT, IGRT, adaptive RT, proton therapy, clinical measurements, radiation safety & other important aspects of clinical therapy physics.

Professional Track

Joint Imaging-Therapy Track

• Small animal IGRT: Systems and studies • IMRT targeting: from anatomy to physiology • Targeting using surrogates • MRI in RT: from simulation to online guidance • Tomographic imaging in radiation therapy • Image registration, process and analysis in radiation therapy

• A Code of Ethics for the AAPM • Effective Professional Communication/Comportment • CARE Bill/Legislation & Licensure update • New member symposium & “Meet the Experts” • Civil Law, Ethics & Medical Physics • Quality Symposium/Errors • ABR-MOC update

2008 Dates to Remember: • JANUARY 7 • MARCH 2 • MARCH 19 • BY APRIL 22 • BY MAY 14 • JUNE 11 • JUNE 25 • JULY 27-31 • AUGUST 1-3

Web site activated to receive electronic abstract submissions Deadline for receipt of 300 word abstracts and supporting data Meeting Registration and Housing available on-line Authors notified of presentation disposition Annual Meeting Scientific Program available on-line Deadline to receive Discounted Registration Fees Housing Reservation deadline AAPM Annual Meeting – George R. Brown Convention Center – Houston, TX AAPM Physics Education Workshop, South Shore Harbour Conference Center, TX

AAPM Newsletter

January/February 2008

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

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et me start this leap year by wishing all of you a very happy and prosperous new year. This year is special for all of us as we will be celebrating the 50th birthday of our association. It is rather a young organization with rich potential to play a key role in patient care in future.

As we begin the new-year, I am implementing two key changes to the newsletter. First, as I mentioned in my last column, we are switching from first class mail to standard mail in order to lower mailing expenses.

Secondly, after discussions with members of the newsletter editorial board and other advisors, I have decided to shift from the glossy print paper to a more economical ‘70 lb off-set’ paper. This will further reduce the overall cost of newsletter production. This first issue may be arriving to you a few days later than expected because I had extended the date to receive certain regular columns to after the Radiological Society of North America (RSNA) meeting and also the combination of switching to new paper type and standard mail contributed to the delay. I do not expect this to occur with other issues this year.

Talking about the RSNA meeting, as usual it continues to be one of the

largest medical meetings. According to latest figures, nearly 62,000 registered members of the RSNA attended this meeting. One of the highlights of the meeting was the awards ceremony. Each year RSNA honors the luminaries in our field with an “RSNA Gold Medal”, the highest award of the association.

This year it was quite special for me as I knew all three members who received the medal. One who we all know very well was Dr. William R. Hendee. In his acceptance speech he started out saying that “this medal is for all the medical physicists,” a rich tribute to our profession. Year 2007 is also special because another AAPM member Dr. Willi Kalender, was recently awarded the European Science Foundation’s Latsis Prize, the highest scientific award in the field of medical imaging. Congratulations to both Drs. Bill Hendee and Willi Kalender.

I know we at AAPM have been constantly exploring ways to better explain our career and attract new minds among the younger generations that may enter into our field.

This month in the American Association of Physics Teachers’ newsletter entitled ‘Interactions’, they focused on ‘Physicists at Work.’ I was asked to write about a medical physics career. This short ‘primer on how to develop a career in medical physics’ followed an invited article from Dr. Hendee, discussing his career.

As a result of these articles, some of you may have heard from your local high schools requesting that you come and speak about medical physics. For those who are asked and wish to speak at local schools about medical physics, you may obtain slides and other resource materials to assist you by contacting AAPM Headquarters.

Finally, I wish you find the changes to the newsletter welcoming and if you have any comments, please feel free to write to me.

AAPM Virtual Library Now online…

Selected presentations given at the: 2007 AAPM Annual Meeting Minneapolis, MN July 22 – 26 2007 AAPM Summer School “Shielding Methods for Medical Facilities: Diagnostic Imaging, PET, and Radiation Therapy” St. John’s University, Collegeville, MN July 27 - 29 Dose Management in CR, DR and other imaging modalities; Adult and Pediatric Considerations and Topical Training Session Presented at the CRCPD Annual Meeting Spokane, WA - 2007 Physicists of Note Interviews Minneapolis, MN - 2007 Xoft, Inc. - AAPM Corporate Affiliate as presented during the 2007 AAPM Annual Meeting

Presentations posted in the Virtual Library include…

• streaming audio of the speakers • transcription of the audio presentations • slides of the presentations Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs. www.aapm.org/meetings/virtual_library/

AAPM Newsletter

January/February 2008

Science Council Report cated breast MRI systems, SPECT/ CT and PET/CT, digital mammography, cardiac CT systems, and all the rest.

John M. Boone Science Council Chair

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s it possible for a medical physicist to excel in all three job categories of clinical service, education, and research? While this may have been possible in the 1980’s and 1990’s, I maintain that today, it is the rare individual who can be the true master of all these activities. It is also becoming increasingly less common that employment opportunities realistically permit such diversification. It goes without saying that our clinical responsibilities have become more complicated, and this is especially true in radiation therapy. The simple technologies of the 1980’s were transformed by the multi-leaf collimator, image guidance systems, and other advancements. Radiation oncology physicists now must deal expertly with IMRT, gamma and accelerator-based radiosurgery procedures, rotational therapy systems, EPIDS, systems with cone beam imaging allowing IGRT, and all the rest. In addition, more sophisticated brachytherapy systems are prevalent, including electronic brachytherapy sources. The workload in diagnostic medical physics is also increasing because there are substantially fewer diagnostic medical physicists in the workforce (compared to therapy) and the number of imaging systems in hospitals is increasing, with dedi-

Research in medical physics has also become more complicated, and the old days of non-funded or minimally funded research programs are no longer competitive. External funding from the federal government or other sources is not only necessary for employing staff, maintaining students and post-docs, and performing research, it is the required “ticket” to sit at the table of “real” research scientists at a Universitywide gathering. Confounding this reality, with the funding levels at the NIH at record lows, maintaining a grant funded research program takes more time writing grants (only 10% or so are funded) and requires a greater degree of collaboration.

While research collaboration is stimulating and rewarding, it is also more time consuming. Research regulations are increasing, and human subjects’ research projects at my institution require approval by the radiation use committee, the cancer center scientific review committee, and the institutional review board – typically a six month process. Just being a faculty member requires hours of university-mandated training in human subjects, sexual harassment, ethics, magnetic field safety, JCAHO training, etc.

Each requirement is minor, but all tolled these required courses take vital time away from the laboratory.

While there are few medical physicists who are involved in education exclusively, the time required for being an educator in many arenas is increasing as well. Teaching a CME course requires that learning objectives be articulated and documented, lecturing at a conference

in many cases requires assurances of off-label use and extensive conflict of interest statements. Many times the electronic presentation is required weeks or months ahead of the actual presentation, fundamentally hampering the chronic last minute habits of most busy medical physicists. In many cases, separate handouts need to be prepared, over and above the presentation itself.

In the academic environment and in many private practice medical physics settings, there are other time commitments as well. Sitting on an NIH study section can take weeks of preparation, and reviewing for scientific journals can become a substantial time commitment as well. Much of these activities require air travel, and we all know what that has become like.

It is hard to imagine that one person can be involved in all of these activities at the expert level, on top of having a family and some resemblance of a life. Indeed, there is timely discussion ongoing in the medical physics community in regards to the development of a professional degree in medical physics – doctor of medical physics or DMP. Such a degree is an acknowledgement of the need for a well trained clinical medical physicist who does not participate in leading research activities. While I believe that there are both pros and cons to establishing such a career path, it is hard to avoid the simple realities (outlined above in part) that have got us to this point. I do hope that we proceed down this road cautiously so that we don’t undermine the respect that the field of Medical Physics has currently achieved.

AAPM Newsletter

January/February 2008

Education Council Report With two new chairs for two of our seven committees, the Council will assemble sometime during the first quarter of 2008 to reevaluate its goals as we prepare for the many challenges ahead of us. In addition to the more routine workings of the Council, we will be addressing the needs and goals of some of our newer initiatives. These include, but certainly are not limited to: Herb Mower Education Council Chair

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he article for the first edition of the Newsletter in the New Year is always an interesting one. Why, you ask? No, it is not the amount of turkey awaiting us as we progress into the holiday season. Rather it is the RSNA meeting in Chicago, more than enough to scare any rational being, even some irrational ones as medical physicists. This year it is even a more interesting time as we try the rearranged format for committee and council meetings relative to the Finance Committee and Board’s meetings. One thing remains true, however; we will make decisions about our goals and direction for the upcoming year at this meeting.

At the AAPM Board meeting in Chicago, the President-Elect will present his recommendations for appointments to the Board for ratification.

Although I don’t know who the replacements will be, I do want to thank Ervin Podgorsak and Donald Peck for their service to the Education and Training of Medical Physicists Committee and the Medical Physics Education of Allied Health Professionals Committee respectively. Both are stepping down at the end of this year and we will have some new faces on the Council for 2008.

• Developing programs and activities to involve those in medical physics graduate programs and residencies.

• Understanding the effects of ‘2012’ on our profession.

• Answering to the question: “How do we teach medical physics to the students and residents of today?”

• Evaluating how we meet the needs of our minority members.

• Providing appropriate programs in our summer schools and workshops to address the needs of our members.

• Evaluating the physics education needs of non radiology / radiation oncology physicians who work with radiation producing machines and/ or radioisotopes.

• Preparing ourselves and our state

regulators for implementation of the CARE bill when it is passed.

As we move forward, we have many opportunities to involve you in the process. Do check out the new “yellow” pages on our website for committee, sub-committee and task groups who are looking for assistance.

This is a new tool developed specifically to keep you informed of these opportunities. As we make greater utilization of the tools provided in the current electronic media age, a great deal of the work done by these groups is done though conference calls reducing the ‘away from work’ time devoted to the Association in the past. Most of these groups have a ‘guest’ position allowing you to receive and take part in their meetings without formally committing your time. Think of asking to join one of them in this capacity.

This is a significant year in our history as we celebrate 50 years but it is also an opportunity to realize that the past is but a stepping stone to the future. For this reason we need to be sure that we don’t loose sight of the challenges that are facing us but that we use our history as a launching platform to face the challenges of the future.

Please mark your calendar!

American College of Medical Physics Annual Meeting Seattle, Washington • May 3 - 6, 2008 For details see: www.acmp.org

AAPM Newsletter

January/February 2008

Newly Appointed 2008 AAPM Board Members

Maryellen Giger, Ph.D. President-Elect

Jean Moran, Ph.D. Board Member-at-Large

Eric Hendee, M.S. North Central Chapter

Mary E. Moore, M.S. Treasurer

Martin Weinhous, Ph.D. Board Member-at-Large

Joerg Lehmann, Ph.D. San Francisco Bay Chapter

Mark Davidson, M.S. Board Member-at-Large

Howard Elson, Ph.D. Ohio River Valley Chapter

Richard Riley, Ph.D. New York (RAMPS) Chapter

Chang-Ming-Charlie Ma, Ph.D. Board Member-at-Large

Joseph Hanley, Ph.D. New Jersey Chapter

Mark Seddon, M.S. Florida Chapter

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AAPM Newsletter

ACR Accreditation no smaller than 7.6 x 8.0 cm and no greater than 12.6 x 13.4 cm. (See figure below.)

­ACR Mammography Accreditation: Frequently Asked Questions for Medical Physicists Does your facility need help on applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation,” then “Mammography.”

Most of the mammography accreditation application and QC forms are available for downloading. You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. I am a medical physicist who, by contract, is able to work at only one facility with a single mammography unit. Is it still possible to meet the FDA requirement for Medical Physicist Continuing Experience of surveying at least 2 mammography facilities and a total of 6 units during 24 months?

A. Yes. The FDA allows medical physicists to count surveys of the same facility and the same mammography unit more than once per year provided that the facility surveys are at least 10 months apart and the unit surveys are at least 60 days apart. See FDA’s Policy Guidance Help System for specific guidance on this topic: FDA’s Policy Guidance Help System.

For example, you may meet the FDA requirement for continuing experience by surveying your unit 3 times a year (once every 4 months). You will then have 6 surveys in 2 years and meet the requirements. Keep in mind that each year at least one of the surveys must be a full facility survey (i.e., it must include an evaluation of the technology QC).

January/February 2008

2. Printing the phantom images on the same size film as would normally be used to print clinical mammograms (usually 18 x 24 cm).

Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs Q. When printing FFDM phantom images for accreditation, what size should they be? May I magnify or minify the phantom image?

A. Print the digital images without magnification or minification and as close to “true size” as possible. The ACR recommends: 1. Printing the phantom images so that it is within 25% of the actual phantom size. Since the accreditation phantom’s outside dimensions are 10.1 x 10.7 cm, the dimensions of the submitted image should be

3. Not rotating the phantom during exposure or rotate the image when printing. ACR reviewers position digital films for scoring similar to screen-film images.

Q. What background density should be used when printing digital phantom images?

A. Printed images from a digital mammography unit must be of sufficient quality for diagnostic interpretation when sent to another facility for review. This means that clinical mammograms should be of sufficient density and contrast when viewed by other physicians on appropriately bright mammography viewboxes. Hence, the ACR recommends that the background density of the hardcopy phantom images be between 1.60 – 1.90.

Recommended Size of Hard-Copy Phantom Image

11

AAPM Newsletter

January/February 2008

Professional Council Report building, we passed through metal detectors and registered our laptop computers. Since CMS has financial information on practically every person and business in the US, the need for security is, in retrospect, not surprising.

Michael Mills Professional Council Vice-Chair

I

hope this New Year finds you refreshed after the Holiday Season and energized to plow through the challenges of winter weather. In this column, I want to focus on the activities of the Economics Committee, the Government and Regulatory Affairs Committee, and to follow up on several items mentioned in previous columns.

There is a lot of activity in the economic arena, and for the details, I need to refer you to Wendy Smith Fuss’ column. Rather than summarize this information, I want to share with you my experiences of my first meeting of the Advisory Panel on Ambulatory Payment Classification (APC) Groups. I was contacted by a very kind and helpful individual at the Centers for Medicare and Medcaid Serivces (CMS) that manages the activities of the Panel. The first surprise is that I would not be reimbursed by check; instead the Government wanted my bank account access numbers so that reimbursements would be by direct deposit! No real problem, but that was a surprise.

The security around the CMS Headquarters building near Baltimore was rigorous. The automobile was inspected using mirrors and we opened the trunk for inspection. Inside the

I was impressed with the quality of my fellow APC Panel members.

The selection process seems rigorous, and clearly, each component of the health care industry wanted it’s most effective and knowledgeable representatives present. The learning curve is steep and the financial mechanism is quite complex. So often, financial managers at hospitals have become accustomed to seeing CMS as “the enemy”! I was expecting an atmosphere of a little tension, maybe even some confrontation; but that was not what I saw. The CMS staffers were, for the most part, younger than I expected, and quite knowledgeable and bright. Many had healthcare experience with advanced degrees in law or public administration. The most important concern at CMS seems to be the need to maintain access to care for all Medicare beneficiaries.

The public portion of the meeting saw presentations by many Scientific and Professional Societies as well as Corporations and other Industry Representatives. The presentations were quite variable, both in topic and quality, and sometimes far removed from my personal experience. However, I was surprised to see that almost one-half of the presentations involved either radiology or radiation oncology. Overall, I felt I had an impact on the meeting, and I hope my additional experience will benefit me at future meetings.

The third Abt Associates “Survey of Practice Parameters Associated with Radiation Oncology Physics

12

Services” is now completed and the draft report is being reviewed by an expert panel of medical physicists.

The Abt survey has been used to document physicist clinical procedure effort, defend staffing levels for physicists, and to defend an increased level of reimbursement for the Special Medical Physics Consultation CPT Code (77370). The AAPM leadership considers this survey to be an activity of essential importance to the medical physics community. Survey results are planned to be released soon and discussed at the AAPM Annual Meeting in July, 2008.

Respecting the Government and Regulatory Affairs Committee, I want to follow up on several of the bullet items I mentioned in my previous column: • CARE Bill: The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill (CARE bill) has many additional co-sponsors. The House, bill H.R. 583 is sponsored by Rep. Mike Doyle, D-PA, while the Republican co-sponsor is Rep. Chip Pickering, from Mississippi. There are a total of 122 co-sponsors for the House bill.

The Senate Care bill is S.1042. The Senate CARE bill was introduced in the U.S. Senate by Sen. Michael Enzi, R-WY., and Sen. Ted Kennedy, DMA., on March 30. The Senate bill currently has 22 co-sponsors. I hope you took the opportunity to write or email your Representative and Senators in November during the AAPM letter writing campaign. If not, please take a moment to do so. In my experience, an opportunity to affect the position of medical physicists on the health care arena comes along once in a generation, and this is our opportunity. Please check the AAPM website for news, details and updates.

AAPM Newsletter • The Joint Medical Physics Licensure Subcommittee is carrying a huge load and has been very active. Quality patient care is the core justification and one component of this is to ensure that clinical practitioners are properly qualified. To ensure that qualified individuals perform the job of clinical Medical Physics as outlined in the AAPM/ACMP Scope of Practice is a primary premise. This is important with or without the passage of the CARE Bill, because the quality of care matters. However, the existence of the CARE Bill gives us the impetus to do this work. If we do not help the legislators define who is qualified to do our jobs, someone else will.

• The first component is increased AAPM staffing to support the effort. These include a Full time State, Legislative and Regulatory Affairs specialist, working with Lynne Fairobent and coordinating the statelevel efforts; Administrative Support; and Data support. This request has been completed and the AAPM Board approved the positions. We hope to have positions staffed by February 2008.

• The second component of the initiative is to approve funds to support the state-level lobbyists - to allow effective communication or critical elements for defining qualified medical physicists as noted above. Up to ~$300,000 per year has been approved by the AAPM Board to support this effort.

• The third component is ongoing Subcommittee work toward developing legislative language, strategies for implementation and pursuit, and tools for Medical Physicists to use in the legislative process. In the future, medical physicists will need a better understanding of and education about the licensure process and other recognition mechanisms.

• A new Subcommittee on Practice Guidelines has been formed within the Clinical Practice Committee aimed at providing timely review of AAPM documents that have practice implications and at developing practice guidance when appropriate.

The subcommittee will also facilitate AAPM interaction with other organizations as pertains to practice or facility accreditation programs or professional certification programs.

• The new Committee Classified Ads notification system is in place.

Gold Standard

New New

January/February 2008 Thanks to the Professional Services Committee and AAPM Headquarters staff, in a very short time, a tool was developed to provide the highest level of access to all AAPM members to vacancies in the volunteer network of AAPM Councils and Committees. This was conceived at the spring 2007 Professional Council retreat and implemented in early fall. Those of us that have posted ads have been very pleased with the ability to attract applications among interested AAPM members.

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• Ion chambers for critical acceptance testing and dose diodes for QA consistency tests.

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13

AAPM Newsletter

January/February 2008

AAPM 50th Anniversary News articles. Each member will also receive a special 50th Anniversary surprise.

Jean St. Germain, Chair Ad-Hoc Committee on Golden Anniversary Planning

J

anuary 1 begins AAPM’s 50th Anniversary year and our yearlong celebration is about to kick into full gear. Some of you will notice a special section on our web site regarding the 50th Anniversary.

You will also notice that each issue of our journal, Medical Physics, will carry special articles on AAPM and its history as well as special review

Our 50th Anniversary meeting will be in Houston, TX and we hope to see many members there.

AAPM has invited those charter members who can travel to join us. I am happy to report that Gail and Reba Adams, our first president and his wife, are planning to attend. Hopefully, both our senior and junior members will enjoy interacting with our charter members. The meeting will also feature some discussions about our history. The meeting will also feature a 50th Anniversary celebration. The celebration will be held in the headquarters hotel. This means no buses, no traffic conges-

14

tion and good food. Some people have asked about the cost of this celebration. We normally budget around $190,000 for our Night Out. This celebration, hopefully a memorable event, will cost about $50,000 above the usual budgeted number. It will also be possible for chapters to participate in the anniversary through the availability of mailed information.

Our headquarters staff has organized a group of souvenir items that members will be able to purchase and in case you have not visited our web site recently, be sure to check out the T-shirt contest winning slogan! Congratulations to us all on our Anniversary!!

AAPM Newsletter

January/February 2008

Treasurer/President-Elect’s Report

Maryellen Giger University of Chicago

A

s this is my last Treasurer’s Report, I would like to give a tremendous thank you to Cecilia Hunter, AAPM Director, Finance and Administration, who has been my budget advisor, who patiently explained various financial concepts and activities to me, who cheerfully and professionally answered all my questions, and who constructed the budget from the various sources of revenue and expenses. Cecilia restructured the budgetary process to enable timely and formatted submissions of all Council and Committee budgets. I have learned an incredible amount of financial knowledge from her and have treasured our interactions. She is a major asset of the AAPM. I would also like to thank past and present members of FINCOM and the Budget Subcommittee who have worked with me to ensure a solid financial future for AAPM. I look forward to serving the membership in 2008 as President-Elect, and I wish the best to Mary Moore, our new Treasurer.

2007 Estimates

close the books. Our 2007 original budget projected a deficit of slightly over $500,000. In total the variance from the approved budget will exceed $1.2 million. There are some significant variations from our original budget. These include a higher than expected return from our Annual Meeting. Both exhibit and registration income were higher than budget and provided approximately $238,000 to the surplus. Our Journal, Medical Physics, experienced higher income from advertising, as well as an increase in subscription income, returning just under $79,000 more than budgeted. The most significant increase was due to earnings on our investments and interest earned on our operating funds during the year.

Revenue from investing activity, most importantly the growth in the value of our portfolio, returned over $500,000 to the Association in 2007. As in previous years, lower expenditures by the council and committee volunteers contributed to the surplus.

Highlights of the major variances appear in Table 1.

2008 Budget First, I would like to give many thanks to the various councils, committees, task groups, and working groups for submitting their budget requests by the appropriate deadlines. After the submission of the initial budget requests, the first draft of the 2008 budget contained a deficit of almost $2 million, which we felt was unacceptable. Therefore, each line item was scrutinized and reviewed extensively by members of the Budget Subcommittee last October. Along with me, this subcommittee included: Sherry Connors, Robert Dahl, Mary Martel, Peter Rosemark and Jerry White. Angela Keyser, Executive Director; Lisa Rose Sullivan, Director, Meetings and Programs; Lynne Fairobent, Manager, Government Relations; and Cecilia Hunter, Director, Finance and Administration, and her staff from the headquarters office, made substantial contributions to this effort. I am grateful to all of them for their hard work in putting this budget together.

Again this year we had substantial participation from the Council chairs, which made the Subcommittee’s job much easier.

Major Variances from 2007 Budget • • • • • • • • •

Dues income higher than budget Governance expenses lower than budget Costs for postage, printing & processing of Newsletter higher than budget Committee expenses lower than budget Annual Meeting & Summer School, higher income from both exhibits and registrations Medical Physics Investment earnings higher than budget Administration & Overhead, additional staff + higher credit card processing fees Other TOTAL

We are pleased to report that 2007 was another successful financial year for our Society. A surplus of just under $750,000 is projected when we

Table 1 15

+$59,734 +$39,519 -$37,026 +$337,067 +$238,484 +$78,892 +$596,371 -$91,757 +$62,559 _________ $1,283,843

AAPM Newsletter

This year, in addition to an operating deficit of $670,000, two special projects with a total cost of $645,000 were also approved. These projects include a Professional Council/Joint Medical Physics Licensure Subcommittee effort for state licensure for medical physicists in response to the anticipated passage of the CARE Bill in Congress.

The second project, entitled the “2012 Initiative” responds to the additional education and training requirements being imposed by the ABR in order to sit for the certification exam beginning in 2012 and 2014.

The licensure effort alone requires the addition of 2+ FTE staff in the headquarters office as well as an estimated $300,000 to address licensure in 10 individual states in 2008. The 2012 Initiative includes $100,000 in 2008 to increase support for emerging CAMPEP-accredited residency programs.

These two programs will likely require continued funding in the future and the Finance Committee is charged with identifying additional revenue streams to fund these programs over the longer term.

January/February 2008 • The publication of our scientific journal, Medical Physics, also provides a significant income stream. In 2008, Journal revenue is expected to total $1.95 million. This represents 28% of total revenue.

• Other revenue sources include the Placement Service, investment earnings, and management services provided to other organizations.

Major areas of expense include: • Requests for project funding from the councils and committees for 2008 include the following: • Education Council -- $849,000, which includes funding for the 2012 Initiative; • Professional Council -- $1.1 million, which includes the licensure effort; • Science Council -- $455,000; • Other Committee activities -$374,000 • Support for member inquiries and requests, as well as maintenance of our web presence, accounts for just under $230,000.

• Organizational and governance expenditures are expected to increase with the addition of a Spring Board of Directors’ meeting. The budget for these activities is just over $375,000 in 2008.

• Expenditures for our professional development activities, including the Annual Meeting, Summer School and participation in RSNA, are budgeted to total $1.7 million in 2008.

• Medical Physics expenses will total $1.2 million next year.

• Administrative expenses include operation of our headquarters office, with a staff increase from 20 to 25; services provided by AIP, our legal and audit firms; insurance; and the fees we pay for credit card transactions. For 2008, this budget estimate is $1.5 million.

• Other miscellaneous categories of expenses include those incurred in servicing our other organizations, including management services, dues, contributions, etc.

Income by Major Source -A d 2008 B d Approved Budget

The 2008 Budget, as approved, reflects a deficit of $1,316,194, reflecting revenue of $7.1 million and expenses of $8.4 million. Table 2 shows the complete budget by program area.

MP/Pubs 28%

Other Rev 5%

Highlights of the proposed budget follow and graphs of the sources of revenue and expense are shown in Figures 1 and 2.

Sources of Revenue • Membership income is expected to provide $1.42 million, or approximately 20% of anticipated income.

• Our annual meeting, scheduled for Houston in 2008, and celebrating our 50th anniversary is budgeted to generate $2.4 million, or 34% of the gross.

Misc 1%

Dues 20%

Councils/Comm 10%

Prof Dev 36%

Total = $7,058,198

Figure 1 1

AAPM Newsletter

January/February 2008

2008 Approved Budget Revenue Approved by Board of Directors, Nov. 24, 2007 Membership Dues Dues (Net of Journal) (Incl Chapters) Renewal Notices Applications and Reinstatements

Membership Services Member Inquiries/Services Membership Directory Monthly Mailings Newsletter AAPM Brochures AAPM Web Site

Organizational Board of Directors Executive Committee Executive Committee - Contingency Elections & Society Votes

Councils and Committees Education Council Professional Council Science Council Administrative Committees Liaisons with other Organizations

Education & Professional Development Annual Meeting (Including Review Courses) Summer School* RSNA

Publications Medical Physics Journal Books Reports

Administrative Professional Services Headquarters Travel General Operations Credit Card Processing AIP Services

Other Income & Expense Credit Card Royalties Computers in Physics, Royalties AAPM Mailing Lists Membership Certificates RSEA Investment Earnings & Fees ACMP COMP CAMPEP AAMD ICCR Contributions and Donations Dues and other payments Miscellaneous

Subtotal

Direct

1,402,025 10,000 17,000 $1,429,025

425 3,500 1,000 $4,925

Expenses Overhead 51,350

Total

$51,350

51,775 3,500 1,000 $56,275

1350250.00 6500.00 16000.00 1372750.00

31,019 3,602

31,019 3,602

(31019.00) (3602.00)

194,815 $229,436

194,815 $229,436

(194815.00) (229436.00)

52,905 69,578

(132905.00) (164528.00) (70039.98) (9205.00) (376677.98)

Moved to Professional Council

Subtotal

Subtotal

236,650 388,200 85,200 600 Subtotal

$710,650

2,388,525 136,968

80,000 94,950 70,040 2,000 $246,990

7,205 $129,688

132,905 164,528 70,040 9,205 $376,678

765,074 876,895 382,529 248,365 49,105 $2,321,968

83,448 237,782 72,784 65,315 11,534 $470,863

848,522 1,114,677 455,313 313,680 60,639 $2,792,831

(611872.00) (726477.00) (370113.00) (313080.00) (60639.00) (2082181.00)

322,241 30,287 38,063 $390,591

1,505,266 130,214 103,363 $1,738,843

883259.00 6754.00 (103363.00) 786650.00

83,806 1,038

1,195,308 2,138 1,000 $1,198,446

754671.93 3862.00 3000.00 761533.93

80,000 14,200 1,203,752 130,000 71,017 $1,498,969

(80000.00) (14200.00) (1203252.00) (130000.00) (71017.00) (1498469.00)

2500.00 1000.00 17311.00 150.00 (1300.00) 231000.00 (45505.00)

Subtotal

$2,525,493

1,183,025 99,927 65,300 $1,348,252

Subtotal

1,949,980 6,000 4,000 $1,959,980

1,111,502 1,100 1,000 $1,113,602

500

Subtotal

$500

80,000 14,200 90,945 130,000 71,017 $386,162

$84,844

1,112,807

$1,112,807

2,500 1,000 25,000 300 1,700 250,000 65,000

100 150 3,000 19,000 5,000

105,505

7,689 150 3,000 19,000 110,505

32,350

4,200

139,250

143,450

(111100.00)

9,600 38,520

7,589

Subtotal

500 $378,350

$79,570

$252,344

$331,914

(9600.00) (38520.00) 500.00 46436.00

TOTAL

$7,003,998

$5,501,469

$2,721,923

$8,223,392

(1219394.05)

54,200

151,000

151,000

(96800.00)

$7,058,198

$5,652,469

$8,374,392

(1316194.05)

AAPM Education & Research Fund Grand Total

9,600 38,520

$2,721,923

Licensure 2012 Initiative

Table 2 12/5/2007, 2:03 PM

Net

17

Operating Deficit

521110.00 123450.00 644560.00 (671634.05)

AAPM Newsletter

Figure 3 is a bar graph which provides a historical perspective of the AAPM’s actual revenue and expenses compared to the original budget.

The Members should be aware that your Board of Directors gave serious consideration to approving a budget with such a substantial deficit. Looking historically at our net income, there have been very few years when all of the approved funding has been expended. The major variations over the years have come substantially from unpredictable gains and losses on our investments, from conservative estimates of annual meeting and Journal income, and from unspent funds budgeted for projects planned by our committees.

The Board feels strongly that the Licensure and “2012” projects merit funding and are absolutely essential in protecting the professional status of medical physicists in the future.

We have built a substantial reserve, expected to total $9.1 million at the end of 2007, and the Board has decided to use some of these funds, if necessary, to support these two major efforts.

Please email me any questions or comments concerning the budget (m-giger@uchicago.edu.).

January/February 2008

Expenses by Major Source -A d 2008 B d Approved Budget Other 6%

Gov 5%

Admin 18%

Mbrshp 3%

Prof Dev 21%

Pubs 14%

Committees

33%

Total = $8,374,392

Figure 2

Budget to Actual Net Income 2002 through Estimated 2007

$2 000 000 $2,000,000 $1,500,000 $1,000,000

Budget

$500,000

Have you looked at Medical Physics lately?

A brand new look to Medphys.org scheduled for release in early January 2008.

Actual

$0 ($500,000)

2002

2003

2004

2005

($1,000,000)

www.Medphys.org

Figure 3

1

2006

Est. 2007

AAPM Newsletter

January/February 2008

AAPM Website Editor Report

Christopher Marshall NYU Medical Center

A

s predicted in my last report, an Editorial Board for the website has been constituted on an ad-hoc basis as TG 164 of the Electronic Media Coordination Committee (EMCC) pending Board action on new Rules. So why do we need an Editorial Board for the Website? The answer may depend on how we envisage the evolution of the website but at minimum I need to be able to get second opinions on issues that I feel uncomfortable resolving alone, and many heads will be better than one as we wrestle with broader and longerterm issues. These are similar functions to those served by the Newsletter Editorial Board. In the limited time that the Website Editorial Board has existed I have consulted each member at least once, received rapid responses and found them helpful.

The members (and their specific areas of interest) are: Chris Marshall (Website Editor, Chair); John Boone (Science); Dan Bourland (Public); Nathan Childress (Links); Mark Davidson (Professional); Mahadevappa Mahesh (Newsletter Editor, ex-officio); Carter Schroy (Calendar); Perry Sprawls (Education).

Here are some general statistics on the use of the Website. In the two months ending on October 31, 2007, the site had over 100K visitors (members and others combined) from 138 countries of which nearly 35K came from unique IP addresses. The traffic is about 4 times greater on weekdays than at weekends. Many visitors presumably came to us by accident as part of a search and 30% left immediately, but on average our visitors viewed about 5 of our web pages, and spent 3 minutes on our site and of course many viewed more pages and spent much more time. Nearly 12K visitors came to us more than 3 times each day on average, weekends included. (You know who you are!) As we move forward we plan to gather more specific statistics and take greater advantage of the potential to analyze the use of the website in detail - which will help to inform our decisions about allocation of resources as we develop the site.

member Directory, Placement Services, Continuing Education, and Staff Contacts along the top of the screen? These avoid the need to click through main menus and sub-menus on the left side of the page to access these popular resources. Have you also noticed that if you click each left menu item once it will display sub menus for that topic, but if you click again it will also open a topical home page? Currently some of these topical home pages have limited content but we plan to enhance their usefulness as we move forward.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www.aapm. org/pubs/newsletter/WebsiteEditor/3301.asp

Here is just one item on the website you may have missed. In the “Public and General” section under “Medical Physics in the News” you can access videos that the AAPM helps sponsor in partnership with AIP and other organizations and supported by the NSF. These videos plus background web-based materials are distributed to local TV stations that insert them into their own newscasts and websites and they thereby reach a national audience. The AAPM is specifically mentioned in the background materials for the last two programs (September and October).

AAPM is pleased to announce the creation of a Research Seed Funding Initiative to provide start-up funds for researchoriented medical physicists

There are some features of the website that may be missed. Have you noticed the shortcuts to the

www.aapm.org/announcements/ResearchSeed.asp

19

2008 Research Seed Funding Initiative

Application Deadline: February 15, 2008 Funding commencement: July 1, 2008

AAPM Newsletter

January/February 2008

Health Policy/Economic Issues

Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant 2008 Policies & Final Payment Rates 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) final rule, which provides facility payments for procedures performed in hospital outpatient departments.

CMS

estimates that hospitals will receive an overall average increase of 3.8% in Medicare payment for outpatient services in 2008.

CMS reports 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. CMS attributes most of the growth to the insertion of devices and the provision of complex imaging services.

Summary of 2008 Radiation Oncology HOPPS Payments

Major Changes to the 2008 Packaging Approach CMS states that during the evolution of the HOPPS over the past seven years, significant attention has been concentrated on procedure-specific payment for services furnished to patients, rather than on creating incentives for the efficient delivery of services through encounter or episode-of-care-based payment.

In order to further efficiencies within the HOPPS payment structure, CMS finalized its proposal to package payment for items and services in seven categories of supportive ancillary services into the payment for primary diagnostic or therapeutic modality with which they are performed: • • • •

• • •

Guidance services Image processing services Intraoperative services Imaging supervision and interpretation services Diagnostic radiopharmaceuticals Contrast agents Observation services

Effective January 1, 2008, CMS will 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 primary procedure.

Two radiation oncology codes (CPT 77417 & 77421) and several radiology ancillary services (CPT 76000, 76001, 76950, 76965, 77011, 77014) will be packaged and no longer receive separate payment in the hospital outpatient setting.

CMS did not agree with the APC Advisory Panel’s recommendation to exclude radiation oncology image

Changes in APC assignment for 2008 are highlighted in bold

20

AAPM Newsletter guidance procedures from the 2008 packaging approach. CMS states that there were no unique clinical aspects to these radiation oncology guidance services that would differentiate them from other guidance services.

Image processing codes 76376 & 76377 for three-dimensional rendering will also be packaged in 2008.

Hospitals are strongly encouraged to continue to report charges for all image guidance and image processing services regardless of whether the service is paid separately or packaged, using the correct CPT codes. The goal is to continue to capture the costs of the packaged image guidance services utilized in procedures in the hospital claims data used to develop future APC payment rates.

New Composite APC for LDR Prostate Brachytherapy CMS finalized their proposal to create 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 will pay for two types of care, specifically low dose rate (LDR) prostate brachytherapy and cardiac electrophysiologic evaluation and ablation, through composite APCs that have a single payment rate assigned to each APC. In addition, CMS implemented two additional composite APCs for observation services in the 2008 final rule.

Effective January 1, 2008, CMS implements APC 8001 LDR Prostate Brachytherapy Composite that would provide one bundled payment for 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 also includes the payment for commonly associated

imaging guidance services, which are now packaged under the new 2008 packaging approach discussed above. Brachytherapy sources would be paid separately and in addition to the Composite APC 8001 rate of $3,432.71.

CMS states that composite APCs could move the HOPPS toward payment based on an encounter or episodeof-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.

Prospective Payment in 2008 for Brachytherapy Sources In 2007 brachytherapy sources were paid based on the hospital charges reduced to costs. As required by law, CMS continues separate payment for brachytherapy sources in 2008 on a “per unit source” basis to recognize the high variability of treatment costs. However, CMS is changing the payment methodology in 2008 by basing payment on the sourcespecific median costs, as reflected in the hospital claims data.

A complete summary of the hospital outpatient final rule and 2008 impact tables are on the AAPM website at: http://www.aapm.org/government_ affairs/CMS/default.asp CMS Publishes 2008 Medicare Physician Fee Schedule Final Rule CMS published the 2008 Medicare Physician Fee Schedule (MPFS) final 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. Medicare is expected to pay approximately $58.9 billion to

21

January/February 2008 900,000 physicians and other health care professionals for services paid under the fee schedule in 2008.

Sustainable Growth Conversion Factor

Rate

&

The conversion factor is updated on an annual basis according to a formula specified by statute. The final rule indicates that payment rates for all services under the MPFS would be reduced by 10.1% for 2008, a reduction required by the statutory formula that takes into account substantial growth in overall Medicare spending. The 2008 conversion factor is $34.0682.

CMS forecasts approximate 5.0% annual reductions each year under the SGR system for 2009 through 2016. Congressional action would be necessary to alter physician payment reductions in 2008 and beyond.

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.

The overall impact to radiation oncology payments in 2008 is 1%. 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 to right).

AAPM advised CMS that the current practice expense RVUs for medical

AAPM Newsletter physics code 77336 are undervalued.

This code has not been reviewed 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 plans to work with ASTRO to have CPT 77336 revalued by the AMA’s Relative Value Update Committee (RUC) in 2008.

Summary of 2008 Impacts to Radiation Oncology There are no new policies that directly impact radiation oncology payments or medical physics services in 2008.

However, the annual update factor is reduced by 10.1% across all physician and freestanding center payments. It is likely that Congress will act in late 2007

January/February 2008

to avert the physician cuts for 2008.

CMS continues the transition to a new methodology to calculate practice expense RVUs. The changes to the practice expense RVUs have a 1.0% impact for radiation oncology payments in 2008 and 2.0% in 2010, after completion of the four-year transition period.

The “Total Impact� of all policy changes yields a negative 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 below).

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

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AAPM Newsletter

January/February 2008

Chapter News RAMPS New York Chapter Eugene Lief Chapter President

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he Radiological and Medical Physics Society [RAMPS] will celebrate its 60th year in 2008! We will launch it by presenting our prestigious Failla Award jointly with the Greater NY Chapter of the HPS to John R. (Jack) Cunningham on January 23. (Further details will be posted on our website soon.) We will follow this event with our usual full program of monthly meetings and sponsorship of a one day symposium.

We also look forward to a joint birthday celebration with the AAPM in Texas as one of the AAPM’s several parents.

In September we hosted a presentation

by AAPM President-Elect Gerald A. White on “Professional Issues in Medical Physics in the United States”; in October Robert J. Barish discussed “Innovative Vault Design and Practical Shielding Tips for Radiotherapy Facilities” and in November Donna L. Neil spoke on the topic “You Don’t Have to be Einstein to Understand Radiation Oncology Billing! ” And in case you had not noticed …

RAMPS also continues to prepare the annual RAPHEX examination in collaboration with Medical Physics Publishing.

Ohio River Valley Chapter Biannual Meeting

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Douglas Frye Chapter President

he Ohio River Valley Chapter recently held its Fall 2007 meeting in the Petticrew Auditorium of the Clarian Health Partners Methodist Hospital of Indiana on Saturday, October 13th. The Fall meeting, titled “PET/CT: Shielding, Acceptance Testing, Clinical Applications in RT”, entertained speakers from

industry, medicine and medical physics who addressed issues related to PET/CT use in radiation therapy. In addition, several speakers also covered timely RT topics. Tours of the new PET/CT installation at the Methodist Hospital were provided during breaks and at lunch. The Chapter obtained CAMPEP approval for 5.5 hours of CE. Finally, the meeting closed with a Chapter business meeting which dealt with several ongoing and forward looking items.

The morning session enjoyed presentations from Piotr Maniawski of Philips Medial, Michael Miller from Indiana University, and Douglas Frye of Methodist Hosp. Dr. Maniawski discussed current trends in PET/CT as applied to radiation therapy. Dr. Miller described some tests for characterizing a clinical PET/CT following installation. In a brief change of topic, Dr. Frye covered the Methodist experience with a commercial product for US HDR prostate.

The afternoon sessions returned to PET/CT with Patrick Byrne of Medical Physics Consulting, Inc., Steven Westphal from the IU medical staff and Michael Casey from Siemens. Mr. Byrne’s talk provided insights into PET/CT facility design, shielding, and installation evaluation. Dr. Westpahl described clinical uses and pitfalls of PET/CT imaging, as well as commons artifacts. Dr. Casey discussed some advanced reconstruction algorithms under investigation for PET/CT. The afternoon sessions were rounded out

by Ali Meigooni of the University of Kentucky, who talked about a GRID therapy.

The membership spent time during the business meeting acknowledging the contributions of Paul Feller as the outgoing Chapter Board representative and welcomed Howard Elson as

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the newly elected Chapter Board representative. Chapter Treasurer Jonathon Farr gave a brief report concerning Chapter finances. The members present voted in favor of accepting the generous offer of the University of Cincinnati to host the Spring meeting on a recurring basis. Memorial Hospital of South Bend, the Midwest Proton Research Institute, and the University of Kentucky all volunteered to host the Fall meeting on a rotating basis. Ohio State University agreed to consider joining the rotation. Several members suggested submitting a request for speaker funding to the AAPM for the next Fall meeting in order to host a speaker to address CARE, MOC, SAMs, etc. Outgoing Chapter President Douglas Frye thanked the Chapter for the honor of serving the Chapter over the last two years.

The Chapter wishes to acknowledge support and participation of our vendor colleagues whose presence enlivened and enhanced the meeting. Principal Sponsorship-Philips Medical. Keynote Sponsorship-Siemens and Varian Medical Systems. Sponsors-Best Medical International, BrainLab, Fluke Biomedical, LACO Inc., PTW, Tomotherapy.

Fellowship for Graduate Study in Medical Physics

Two-Year Pre-Doctoral Study Commencing in July, 2008 AAPM is pleased to announce the availability of a Fellowship for the training of a doctoral candidate in the field of Medical Physics Application Deadline: April 15, 2008 www.aapm.org

AAPM Newsletter January/February 2008 !!0- .EWSLETTER !D PDF 0-

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AAPM Newsletter

Chapter News

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January/February 2008 11/20/07

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Southern California Chapter Names 2007 Baily Award Recipients PRECISION DECISION, NO COMPETITION.

Steven Goetsch, Education Chair Marianne Plunkett, Chapter President

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he Thirteenth Annual Norm Baily Student Awards were given at a Southern California Chapter meeting held at the UCLA faculty center on May 10, 2007.

A record number of 11 students entered this year’s competition. The winners of this year’s awards are: Michael Speiser’s (advisor, John De Marco) entry was “A CT-Based Multiphasic Maximum Intensity Projection (MMIP) Generator for the Treatment Planning of Lung Patients.” Al Douraghy (advisor Arion Hadjioannou) submitted “OPET: A Dual-modality Optical and PET Imaging Tomograph”; and Nam Vu (advisor, Arion Hadjioannou) submitted “Direct Detection of Beta Particles on a Microfluidic Chip Using Position Sensitive APDs.” Each student is working on a doctorate in the UCLA Biomedical Physics program.

The awards include certificate from Chapter President Marianne Plunkett (Hoag Hospital) and an award of $500.00. These awards are given in memory of the late Professor Norm Baily of the University of California San Diego.

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Chapter President Marianne Plunkett (left) with Nam Vu, Michael Speiser and Arion Hadjioannou

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AAPM Newsletter

January/February 2008

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AAPM Newsletter

January/February 2008

AAPM Ethics’ Committee Communication

Conflict of Interest with Vendors Richard Morse, Ethics Committee member and Chris Serago, Ethics Committee Chair

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he title of a recent ASTRO session is very telling: “Dining with doctors: The only Industry Where Being Nice to Your Customers Can Land You in Jail”.

Ethical Guidelines for Legal Compliance for Radiation Therapy Vendors and Healthcare Providers.” The issue of kickbacks or other inducements to purchase products that medical physicists work with were discussed in detail by National Electronic Manufacturers Association (NEMA) attorneys in a special session with vendor and provider representatives.

Medical physicists frequently participate in the selection of equipment and software for their employer or clients. As with other aspects of a medical physicist’s role in patient care, the best interests of patients must come first.

Vendors have their economical interests of course, but they must also consider meeting patient needs safely, not only by their own personal ethics, but by governmental laws and regulations, enforced mainly by the US Food and Drug Administration and the Office of Inspector General of the US Department of Health and Human Services (OIG).

Both the National Electronic Manufacturers Association (NEMA) and the Advanced Medical Technology Association (AdvaMed) are United States trade organizations. These organizations include most vendors of medical devices and software that interact with medical physicists. Both NEMA and AdvaMed have already adopted codes of ethics. These codes were originally developed in an effort by industry to police themselves in response to regulations from OIG that were written mainly for the pharmaceutical industry but also apply to the medical device industry in the United States.

Similar codes of conduct have recently

been adopted by Canada’s medical device companies (MEDEC) and their European counterparts (Eucomed).

A key component of these documents is to severely limit the nature of consultation arrangements, gifts, or grants to an individual or institution in situations that could be interpreted as inducements to purchase a particular product. NEMA in the United States and MEDEC in Canada prohibit any gift for any purpose that has a fair market value of greater than $100. This applies to any individual, company, or institution doing business, or influencing business, with the vendor. There is no distinction in the U.S. federal regulations, or in the NEMA and MEDEC ethics codes, between for-profit and non-profit health care providers.

Medical physicists, who are involved in decisions about lease or purchase of equipment, services and software, should also avoid relationships that would violate these guidelines. It is advisable to avoid the appearance of such conflicts of interest whenever possible.

This could include recusal from decisions about purchases from a vendor where you have a consultation agreement that includes any cash or in-kind compensation for your work or advice.

When performing acceptance tests on products from a company with which you have such relationship, the enlistment of a colleague not similarly encumbered would lessen the appearance of conflict. This could be particularly important in the case of a product that is new to the market with minimal history of acceptance tests in other places. If the participation of a colleague is not practical, there should at least be a back-up plan for joint review of acceptance in a case that becomes nonroutine because of problems with the product.

Research and educational grants are particularly suspicious in the eyes of OIG. Payment by vendors for athletic

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event tickets, golf fees, and other activities that are not part of the enterprise of patient care are viewed by OIG as guilty on their face. This means that the burden of proving innocence in such a transaction, even if legitimate business discussion did take place, is risky. When physicists, even when representing an AAPM chapter or other professional body, ask vendors for sponsorship of such events, they are putting the vendor in the awkward position of either saying “no” or violating company and trade association policies, let alone inviting scrutiny by the OIG. Research and educational grants, as well as consulting relationships, between a vendor and an individual or institution doing business with the vendor must have a documented legitimate scientific or medical purpose. The company must separate review and decisions about such grants and relationship from any influence by sales staff or others who are compensated in proportion to the sales of the company through commissions or other economic incentives.

Vendors providing grants will also need to have evidence in their files of due diligence that they have not allowed any of their cash or in-kind grants to be misused so that patient fees are paying for research work that is only of value to the vendor to improve their product and the patient derives no benefit from it.

If there is any patient identification that the vendor representatives would see as part of discussion about a research project, care should be taken that the company complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

On a final note, this issue and many others will be addressed in the new AAPM Code of Ethics which TG 109 is working on. If you wish to review a worksin-progress version of the code request one at serago.christopher@mayo.edu.

AAPM Newsletter

January/February 2008

Joint Licensure Subcommittee Update

Jeffery P. Limmer, Chair (JMPLSC) Joint Medical Physics Licensure SubCommittee (AAPM and ACMP)

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s this new year begins, if we take the time to stop, turn around, and review the year’s accomplishments, this is no different for the JMPLSC. Why is it important at this time to actively pursue Medical Physics State Licensure?

First let’s start with “beliefs” regarding clinical Medical Physics.

In our last meeting, David Keys summarized this well: • We believe that the level of complexity involved in medical imaging and radiation therapy is such that it is necessary that physicists with special training, education, and experience must be a part of the team providing these procedures.

• We believe it is the role of the physicist to oversee those processes involving the physics of these procedures. This includes, but is not limited to, the measurement of dose, the calibration of equipment, the evaluation of equipment the estimate of risk, the design of imaging and radiation therapy protocols and procedures, and the planning, implementation, and verification of radiation therapy.

• We believe that Medical Physics is the profession meeting those goals.

• For the benefit of patients and the general public, it is essential that the profession of Medical Physics be both defined and protected by law.

Second, there may be individuals who are either asked or seek to perform activities included in the joint ACMP

/ AAPM Scope of Practice who are not qualified. We have seen an example of this recently in the news. http://aapm.org/pubs/newsletter/ references/UnqualifiedMPFenton.pdf http://aapm.org/pubs/newsletter/ references/UnqualifiedMPBeale.pdf Thirdly, if we as a profession do not help define what a clinical Medical Physicist is and does then someone else will. Part of what defines our profession and what we do are the regulations and laws. We have choices. We can trust that the state and national legislatures will “do the right thing” - trusting that they will see what is obvious to us when defining a Medical Physicist, what they can do, what they must do, and the credentials needed to be qualified, or we can help steer this boat. We should do what we can to ensure that qualified individuals perform the job of clinical Medical Physics as outlined in the AAPM/ACMP Scope of Practice.

The ACMP Board of Chancellors and the AAPM Board of Directors have chosen to become more active in helping steer this boat. The result was the formation of the JMPLSC. This need is heightened with the pending passage of the CARE Act (The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE). At our last meeting Lynne Fairobent described the impact: The CARE Act would require people performing the technical components of medical imaging and radiation therapy to meet federal education and credentialing standards in order to participate in federal health programs such as Medicare, Medicaid and other programs administered by the Department of

28

Health and Human Services.

Medical imaging examinations and procedures, as well as radiation therapy treatments for patients covered under these programs, would need to be performed by personnel meeting the federal standards in order to be eligible for reimbursement.

The CARE Act would not mandate licensure but does not preclude licensure as a means to fulfill the requirements.

Looking back… here are some of the JMPLSC accomplishments: 1. We have a joint charge for the SC (AAPM / ACMP) 2. We have developed and submitted a 2-year budget as requested by the AAPM BOD; this is a significant, long term, multi-year investment (both in volunteer-hours and capital resources) (this vote will be taken after I have submitted this article).

There are three components to the request:

a. Increased staffing to support the effort: (this has been approved by the AAPM BOD) including a Full Time State Legislative and Regulatory Affairs Specialist, working with Lynne and coordinating the statelevel efforts b. Funds to support the statelevel lobbyists in states identified as good prospects ($300K max per year). We will be active in as many of these states as we can afford. c. Ongoing SC work toward developing legislative language, strategies for implementation and pursuit, and tools for Medical Physicists to use in the future.

3. We have started an educational program to let the membership know about the project (speaking to

AAPM Newsletter AAPM chapters, national meetings, and writing newsletter articles). a. If you know a group that would like a presentation on the CARE Act and/or state licensure please contact AAPM HQ. 4. We are close to finishing a webmap of all states and their licensure and registration status along with information for the Medical Physicist to use (forms, fees, procedures, contacts, etc) Sudarshan Chamakuri and Sam Rhoades have been working with HQ on this task.

5. We have submitted a draft licensure policy to both the AAPM and ACMP for review and change. We hope this will eventually be a joint position statement from AAPM and ACMP. This joint policy will be an important tool when asking other professional societies for support.

Robert Luthmann’s work group crafted the draft.

Now it is time for facing forward once again for the JMPLSC; steadily moving toward our goals.

We had a very productive meeting on November 17th. Here are some of the action items: 1. We have reviewed the language adopted in the 4 licensure states (thank you Danny Landry’s work group, the process involved, and will soon be starting our draft of legislative language and items which will be incorporated into the generic state template (e.g. definition of a Qualified Medical Physicist and the Scope of Practice) this draft will them be sent to the AAPM and ACMP for approval/adjustment. (Terrific presentations on the challenges, successes and recommendations by David Lee Goff (TX), Robert Pizzutiello (NY), and Frank Bova (FL) – as well as insight from Michael Mills).

2. We are investigating a “Licensure by Credential (or Recognition)” option with licensure states - espe-

cially for states with few Medical Physicists, it was determined (with a big help from Martin Fraser) that reciprocity should not be a goal.

3. We are involving the CRCPD in helping define a Qualified Medical Physicist, outline defini-

tions for qualifications to do the work of a Medical Physicist, and define the scope of practice for clinical Medical Physicists through SSRCR (Suggested State Regulation for Control of Radiation). Thank you to David Keys for his research.

This will simplify the states task of crafting language for legislation and help create national regulatory standardization in definitions and scope.

4. We are starting to work on identifying the best states in which to begin these efforts. Including looking at political climates and identifying Medical Physicists interested and willing to be involved in state affairs (licensure and other activities). a. If you think your state would be interested please let me know.

5. Assist and support HQ in the hiring of the State Legislative and Regulatory Affairs Specialist.

6. Work with the State Legislative and Regulatory Affairs Specialist to develop infrastructure needed to move forward; looking at state regulations, Medical Physicists in the state, and state lobbyists 7. Look into ways to allow States and institutions to easily and reliably verify credentials and licensure status for Medical Physicists.

8. Identify other societies (and reference), which presently support Medical Physics licensure. Check into the possibility of incorporating others and seek support (ACRO, ASTRO, etc.) and thanking societies for their existing support (ACR).

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January/February 2008 Thank you for your support in this significant effort. Please thank the following volunteers for their past and future work; it is not possible without their dedication and contribution: Subcommittee Members: Bova, Frank Bruels, Mark Chamakuri, Sudarshan Fairobent, Lynne Fraser, Martin Goff, David Lee Halvorsen, Per Herman, Michael Keys, David Landers, Roy Landry, Danny Limmer, Jeff Luthmann, Robert Masterson-McGary, Mary Ellen Mower, Herbert Pipman, Yakov Pizzutiello, Robert

Volunteers: Amurao, Max Barhorst, Brad Bichay, Tewfik Brateman, Libby Burmeister, Jay Clements, Jessica Davros, William Freedman, D Jay Goff, David L. Rhoades Sam Wissuchek, Chuck Wexler, Marilyn Zarger, Lee Anne

Also published in ACMP Newsletter, 4th Quarter 2007.

AAPM Newsletter

January/February 2008

Radiation Oncology Safety Information System

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Peter Dunscombe, Chair AAPM’s Working Group on the Prevention of Errors in Radiation Oncology

n recent years there has been increasing awareness of the risks to which patients expose themselves when entering a health care system.

In radiation therapy, in particular, there have been many well publicized incidents and possibly many more unpublicized incidents, in which patients have been seriously injured or died as a result of “errors” in the planning and delivery of their care.

Patients rightly expect those of us with responsibility for their care to make every effort to safeguard their well being through the delivery of safe and effective radiation therapy.

Within this environment of increasing emphasis on safety, the American Association of Physicists in Medicine established a Working Group on the Prevention of Errors in Radiation Oncology. This group has met regularly over the past few years with the aim of developing strategies directed at minimizing the risk of untoward events compromising the health of radiation therapy patients. Several strategies are under discussion and you can learn more about these from the minutes of our meetings which are posted on the AAPM website. A proposal that has come up several times is the development of a shared database of incidents to which interested centres could contribute.

Of course, the reason that we need to share information on such issues is that radiation therapy is actually a very safe procedure and the experience of individual centres with actual or potential incidents is very limited.

However, by sharing our experience, in a structured manner, not only will we be alerted to possible failure

points in the radiation therapy system in general but we should also be able to develop procedures for enhancing patient safety at the local level.

Sharing information on patient safety within a structure specifically designed for radiation therapy was pioneered by the European ROSIS (Radiation Oncology Safety Information System) group. The AAPM’s Working Group determined that the most logical and efficient approach to the database issue would be to explore collaboration with the existing ROSIS project.

The ROSIS project (www.rosis. info) commenced in 2001 with the developers being Dr. Ola Holmberg, Copenhagen, Denmark, Dr. Tommy Knöös, Lund, Sweden, Mrs. Mary Coffey and Ms. Joanne Cunningham, both of Dublin, Ireland. Throughout its evolution, the project has been supported by the European Society for Therapeutic Radiology and Oncology (ESTRO).

Approximately 75 centres are currently registered with ROSIS, including some in North America, and upwards of 1,000 reports of incidents have been entered. As experience is gained with data entry and analysis, the database and user interface continue to be developed.

This innovative project has certainly been successful, with many participants, and constitutes a major step forward in the area of patient safety in radiation therapy.

At the annual meeting of the ESTRO, the AAPM correspondent, Peter Dunscombe, met with the four ROSIS developers to explore the possibility of transatlantic collaboration. The five of us present agreed to proceed. Responses from

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the AAPM’s Working Group, when informed of this recent development, have been positive. The next step is for the Working Group to examine the structure of the ROSIS database and to offer suggestions as to what changes, if any, might facilitate its adoption in North America. Following that, the intention is for the ROSIS group and North American representatives to meet and agree on the design of the next version of the database which, if all goes according to plan, would be released in about a year’s time.

This is a highly innovative project and a potentially unique example of international co-operation in the area of patient safety. However, it is not without its challenges. Agreeing to a structure which reflects the views and priorities of the participants will entail many interesting discussions. Having accomplished that step, encouraging comprehensive and meaningful disclosure of sensitive, incident related information, particularly in a somewhat litigious environment, will also be an obstacle to be overcome. At some future stage, perhaps once initial discussions have taken place, the North American radiation oncology and radiation therapy communities will need to be invited to contribute their input.

Radiation therapy is a very safe medical procedure but we can always do better. Collaboration and participation in the ROSIS project is one approach that should enable us to further enhance the already high level of safety for cancer patients.

AAPM and Doyle Printing Green Partners

AAPM Newsletter

January/February 2008

Persons in the News

William R. Hendee Ph.D. Gold Medalist – Radiological Society of North America (RSNA)

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illiam R. Hendee, Ph.D., distinguished professor of radiology, radiation oncology, biophysics, and community and public (Left - R. Gilbert Jost, M.D., RSNA President 2007; Right - Jeannie Hendee, health and former dean of the gradwife of William R. Hendee) uate school of biomedical sciences at the Medical College of Wisconsin in Milwaukee was awarded the RSNA Gold Medal at the 2007 RSNA meeting in Chicago. The award announcement included the following, “RSNA is proud to present its gold medal to Dr. Hendee, a tireless scientist, educator, collaborator, and advocate of quality healthcare.”

Some of Dr. Hendee’s past achievements include; former AAPM President and recipient of William D. Coolidge Award and winner of the 2006 gold medal from the American Roentgen Ray Society.

Willi Kalender, Ph.D. European Latsis Prize Winner

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illi Kalender, Ph.D. was recently awarded the European Science Foundation’s Latsis Prize which in 2007 was dedicated to the field of medical imaging. Dr. Kalender, a recent AAPM board member and AAPM Fellow, was awarded this prize in recognition of his achievements in developing, testing and establishing spiral CT. He is currently the chairman of the Institute of Medical Physics at the University of Erlangen in Germany. He is alumnus of the University of Wisconsin, Medical Physics program. Dr. Kalender’s main area of research is in the area of volumetric spiral CT. His other research interests include radiation protection and development of quantitative diagnostic procedures to assess osteoporosis.

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Editor

Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115

Editorial Board

Priscilla Butler, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390

PRINT SCHEDULE • • • •

The AAPM Newsletter is printed bi-monthly.

Next issue: March/April Submission Deadline: January 23, 2008 Postmark Date: February 20, 2008

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