AAPM Newsletter March/April 2008 Vol. 33 No. 2

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 33 NO. 2

MARCH/APRIL 2008

AAPM President’s Column

Gerald A. White Colorado Springs, CO

I

can recall as a child the mystery with which Science was endowed.

One of my friends and business colleagues (we both had newspaper routes) delivered the daily paper to an address where the resident was reported to be “A Scientist”.

I can recall my surprise that the house in which such a person lived looked just like other houses in the neighborhood. I am not sure what I expected, other than that it should somehow be different, reflecting what I was sure to have been the exclusive and rare characteristics of the man who lived within. My elementary school career spanned the pre- and post-Sputnik eras. My time was spent in a Catholic school at the height of the Baby Boom years (we had 1600 children attending grades 1-8 in its apogee). Science did not receive much notice in the classroom, certainly not compared to learning Penmanship and Phonics. After the launch of the Russian satellite, there was a halfhearted move towards introducing a Science curriculum—I

remember in the 6th grade feeling that Science had been given some priority, as the teacher had been issued a Science textbook. There were still a few rough edges. The lecture on atoms concluded with the observation that the largest of atoms (the Uranium atom) was about the size of a golf ball, thus enabling Scientists to understand the inner structure of other, smaller less easily visible atoms. Having previously exhausted the school library’s collection of science books, I decided that Sister Mary Lois had a better command of the details of the Council of Trent and the Palmer Method than she did of atomic theory. With years of training in the culture of the parochial school, I was also unwilling to make even a polite inquiry or comment. As the man flows from the child, my Penmanship skills are still lamentable, I am still loathe to offer a contrary opinion when speaking to a nun (I work in a Catholic hospital) and I am still enraptured by the domain of Science.

I am writing this article in the home of my son in Edmonton. It is what they describe here as “getting a bit cold”. The high temperature in the next 5 days is predicted to be -22 ° F. I confess to being excited tonight by looking at the situation through the eyes of a Science person—I went outside to let my body experience the firm dry air at the temperature where Herr Celsius and Herr Fahrenheit agree. How differently we look at common events and

situations, and how important it is that our fellow Americans gain and holds a sense of Scientific literacy, even if the excitement escapes them. There is a long way to go in that regard. A recent paper published in Science examined the acceptance of evolution in 34 Western countries and Japan.

With Icelanders leading the sample in affirming the evolutionary process, the United States fell next to last (just ahead of Turkey). We have had the opportunity to witness a significant politization of Science over the last decade; our National vulnerability to that situation has been enhanced by the declining scientific literacy in the U.S. (those “unsure” of evolution (see White - p. 4) TABLE OF CONTENTS Chair of the Board Column President Elect’s Column Executive Director’s Column Education & Research Fund Editor’s Column Education Council Report Professional Council Report Science Council News CAMPEP News Leg. & Reg. Affairs 50th Anniversary update Health Policy/Economics ACR Accreditation FAQS MOC update AAPM-ISEP Course Report Website Editor’s Report Chapter News Ethic’s Committee Update Person in the News Memorial

p. 2 p. 3 p. 5 p. 6 p. 7 p. 8 p. 9 p. 10 p. 13 p. 14 p. 17 p. 18 p. 19 p. 23 p. 24 p. 27 p. 28 p. 30 p. 30 p. 31

AAPM Newsletter

March/April 2008

Chairwoman of the Board’s Column

Mary K. Martel UT MD Anderson Cancer Center 2012 Initiative Summit Meeting Number 1 written by Mary Martel and Jerry White

W

ith 4 years to go (and counting) until the year 2012, meeting the change in requirements for eligibility to take the ABR certification exam is a challenge. To remind us of what the change will be: “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.” Further, the AAPM Board of Directors passed a motion last spring that supported the completion of a CAMPEP accredited residency as the principle requirement to sit for the boards.

Leadership in the medical physics field convened the first of many summit meetings on January 25 and 26, 2008 in Chicago. Representatives were there from several organizations including the AAPM,

ABR, ACR, CAMPEP, ACMP and the newly minted SDAMPP (Society of Directors of Academic Medical Physics Programs). The goal was that at the end of the summit we would have identified the major impediments to achieving the 2012 goals as well as potential solution pathways. Our working hypothesis was that the leadership of all relevant organizations need to be thoroughly engaged with the process, actively proffering changes in existing processes and procedures, and commits the necessary resources for implementation.

This first summit meeting was intended to be the first and most important waypost on this journey.

After several talks, breakout sessions on specified topics and much further discussion, the group reached consensus on general short term and long term goals. First, it was decided that the number of residency slots needs to be increased dramatically over the next 4 years. This decision was driven by many factors, but in particular, by numbers.

Only 25-30 residents graduate from CAMPEP accredited residencies each year, while 200 plus physicists take the ABR oral exam each year. Clearly the lack of residency slots will be the bottleneck in the near term.

Consensus was reached that, in the long term, professional degree (PD) programs should be developed to meet clinical service demand in our field.

These would likely take the form of a professional doctorate degree, relating to the PhD degree in physics in much the same way as professional degrees in other medical areas (for example, the PhD in Psychology and the Psy.D professional doctorate). This decision was supported by the idea that we need a self-sustaining fiscal model to support clinical training in CAMPEP accredited residency programs. It is envisioned that professional degree programs will fold MS programs with residency training.

2

An action plan for the next 6 months was developed, with reports to be given by our annual meeting time, and progress evaluated in the next summit meeting in the autumn 2008. To meet short term goals, outreach to existing residency programs, both accredited and non-accredited, will take place to determine if accredited residency slots can increase and what the model or mechanism will be to make this happen. This we felt would be the most effective direction to take for rapid progress towards our goal of 150 plus graduates a year from residencies. We anticipate that a number of existing but non-accredited Residency programs will achieve CAMPEP accreditation. In addition, the work done

by TG-133 (Alternate Pathways for Clinical Medical Physics Residencies) will shortly yield a few alternate pathway residency slots that will be used as a “demonstration of concept” that will aid in our near term roll out of more such residency slots.

Likewise, AAPM will embark on an effort to promote CAMPEP accreditation among our existing non-accredited graduate degree programs. Efforts for our long term goal will also happen in parallel. A work group exists in the AAPM with the charge to examine the concept and rationale behind the PD degree, what is the impact of the PD on our field, and how to implement the PD programs. The next step will be a presentation of a “white paper” to the AAPM Board of Directors at the annual meeting, and consequently leading to a task group on the PD that describes the program content.

This column describes the broad strokes of the results of the first summit meeting, and a few details of immediate action we will take. But of course, many other details were discussed which will provide fodder for our future meetings. We intend also to improve communication with the membership with regards to the 2012 issues, so watch for emails, articles and information on the AAPM website.

AAPM Newsletter

March/April 2008

AAPM President-Elect’s Report

Maryellen Giger University of Chicago

M

y first month as President-Elect has been a busy and fulfilling one. My years on the AAPM Board of Directors and as Treasurer with EXCOM have prepared me well, however, there is still so much to learn. So many AAPM initiatives, so many opportunities! The activity in all three of our Councils is so impressive.

My January schedule included presenting at the Southern California Chapter’s Midwinter Symposium, which was on “Image Guidance in Radiation Therapy and Oncologic Diagnosis”.

The educational symposium was well attended by established medical physicists and students, as well as many vendors.

Before presenting my research, I very briefly described some of the new AAPM initiatives, encouraging all to follow the updates via their Chapter Representative on the AAPM Board of Directors and then volunteer! Congratulations on a wellrun, informative symposium.

The next week, I headed to our other coast for BIROW – the Bioengineering and Imaging Research Opportunities Workshop, which was held in Bethesda, Maryland. This was the 5th BIROW. Earlier ones focused only on biomedical imaging research opportunities whereas now the emphasis is on both bioengineering and imaging research opportunities. AAPM has always played a leading role in BIROW, organizing the first scientific program and workshop structure, and continuing as a

sponsoring society. BIROW is partially funded with an AAPM-held NIH grant from NIBIB [the National Institute of Biomedical Imaging and Bioengineering], and over twenty sponsoring/participating societies are involved in its planning The purpose of BIROW is to identify and explore new opportunities for basic science research and engineering development in biomedical imaging, and as related to diagnosis and therapy.

This year’s topic was “Imaging and Characterizing Structure and Function in Native and Engineered Tissue”.

Output from BIROW includes a white paper that is published in MEDICAL PHYSICS, RADIOLOGY, or a leading bioengineering journal. The NIBIB was well represented at the workshop and its leaders consider the BIROW-generated recommendations in their funding initiatives. Another major product of BIROW are the interdisciplinary collaborations between researchers from diverse scientific backgrounds that may arise between BIROW attendees or with one’s own institution’s colleagues in an attempt to push further the envelope of discovery. Congratulations to Gary Fullerton for leading this year’s successful BIROW. For more information, check birow.org.

On January 25 and 26, I attended the “2012 Initiative” meeting during which leaders in AAPM, ABR, ACR, ACMP, and CAMPEP met to discuss and plan for meeting the imperatives of the AAPM recommendation for residency training and the ABR mandate for CAMPEP accredited degree program and residency training as a requirement for Board Certification. While all agreed that action must be taken to increase the number clinical residencies for the training of our future clinical medical physicists, the exact structure and funding mechanisms still need to be decided. Much discussion centered on a “hub and spoke” model, a professional doctoral degree in medical

3

physics, and the timing of board exams.

To avoid redundancies, I refer the reader to other columns in this newsletter.

Later in January, I attended the Science Council Retreat, and then the Education Council Retreat in February. An active travel schedule for a new President-Elect, but it serves also as a great review course in current AAPM issues and as a means to encourage other members to become involved. I look forward to reporting back to you in future issues of the AAPM newsletter.

For these various activities, substantial contributions from AAPM Councils and committees are expected. So check the “committee ads” on the AAPM website for volunteer opportunities, and see how you can become involved, as we “prepare for the future”.

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 (White from p. 1) have increased from 7% to 21% over the past 20 years). In a perverse feedback loop, the changes in the perception and value of Scientific thought also require for propagation the continued denigration of Science as an endeavor, an enterprise with financial and political gains to a variety of entities that reminds us of the Latin roots of the now pejorative term “propaganda”.

In January a study on the effects of cholesterol reducing drug combination -- released by the manufacturer after missing several deadlines for reporting the results – showed the drugs rather than slowing the growth of arterial plaque actually seemed to accelerate it. While slow to publish the results, the pharmaceutical company quickly found the resources to publish (almost daily) two fullpage ads on the benefits of the drugs in national newspapers. Closer to home, an August article in the Journal of Clinical Oncology reviewed the cost effectiveness of proton beam radiotherapy in treatment of prostate cancer, concluding “ Consideration should be given to limiting the number of proton facilities to slow comprehensive evaluation of this modality.” In the same edition, we find an editorial from two prominent proton therapy practitioners who argue that randomized clinical trials comparing x-ray and proton therapy would be unethical. Whole body CT scans for screening symptomatic folks? Mercury in the environment?

Atmospheric changes decreasing the Earth’s albedo? So much will be asked of the Science community and the person in the street-- forums for discussion, decisions on resource allocation, judgment regarding competing claims among those who have a Scientific interest and also those who have an interest other than Scientific inquiry and action, whether it be financial, professional, cultural,

March/April 2008

religious, ego, obsession – the list of distractions is endless.

We must continue to defend the ramparts of the Scientific integrity bastion—by virtue of training and inclination we are in a position to boost the effort to maintain a Scientifically literate public and enhance the level of Science discussion in the cultural and political arena (e.g. the AAAS cosponsored Science Debate 2008 http://www.sciencedebate2008. com). Do not make the mistake of thinking Scientific discussion must be sequestered from the larger community dialog to maintain purity or focus. Scientific thought and inclination must be thoroughly integrated with our cultural and political discourse. In his appendix

to Nineteen Eighty-Four, Orwell discusses the “C Vocabulary” – the scientific and technical parlance in Newspeak. “Very few of the C words had any currency in everyday speech or in political speech. …There was no vocabulary expressing the function of Science as a habit of mind, or a method of thought, irrespective of its particular branches.”

As we Honor the Past, Celebrate the Present and Prepare for the Future we must not flinch from the task to preserve and enhance the Scientific endeavor in the public forum of ideas.

Playing small doesn’t serve the world.

AAPM - 50 Years of Playing Large Golden Anniversary Service Project Houston Food Bank www.aapm.org/meetings/08AM/GenInfo.asp#serviceproj Does your travel schedule allow you to arrive in Houston a day early?

You and your family members are invited: • WHAT: volunteer at the Houston Food Bank • WHEN: Saturday, July 26, 8:00am-Noon.

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.

Go to www.aapm.org/meeting/08AM for more information and to register.

4

AAPM Newsletter

March/April 2008

AAPM Executive Director’s Column School has been changed to Baylor School of Medicine. Remember to also register for the optional hands-on session covering scanner testing, accreditation and shielding calculation to be held on Saturday, June 28 at MD Anderson Cancer Center. The separate registration for the hands-on course is limited to 96 participants.

Angela R. Keyser College Park, MD

AAPM E-Store ew this year! Help celebrate AAPM’s 50th Anniversary by sporting an AAPM polo shirt, coffee mug, lapel pin and t-shirt. For more detail, or to place your order, go to the AAPM 50th Anniversary Gift shop at: http://www.apisource. com/aapm/

N

The t-shirt slogan contest in December was a big hit. There were 132 submissions, with the winning slogan contributed by Tim Stack, Radiation Oncology, St. Alphonsus Cancer Treatment Center in Boise, ID. Congratulations to Tim, and thanks to everyone who participated in the contest.

Summer School Update Make sure to register for the 2008 Summer School by May 16 to take advantage of discounted registration fees. Program Directors Dianna Cody and Osama Mawlawi have put together a full program on “The Physics and Applications of PET/ CT Imaging” to be held June 25 27 in Houston, TX. Due to some challenges negotiating the facility contract, the location of the Summer

50th AAPM Annual Meeting July 27-31, 2008 • Houston, Texas Registration for the 50th AAPM Annual Meeting will open on March 19, with discounted registration available through June 11. 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.

Remember to register for the Golden Anniversary Service Project with the Houston Food Bank.

Also, 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.

Fellowship Opportunity Applications are being accepted for the Fellowship for Graduate Study in Medical Physics until April 15, 2008. Funding awarded for first two years of graduate study in a CAMPEP-accredited program leading to a doctoral degree in Medical Physics. Applications must be received by April 15, 2008. For details, go to: http://www.aapm. org/announcements/Fellinfo_app. pdf

5

Staff News Corbi Foster joined the AAPM team in November as the new Meetings and Programs Manager.

She will manage projects relating to the provision of services to the ACMP. Corbi will also handle the operational aspects of various meetings and conferences planned outside of the AAPM Annual Meeting and Summer School. She has an extensive events/meetings background, most recently working for the National Homebuilders Association.

Jackie Ogburn has been promoted to Education Assistant. In her new role, Jackie joins the Meetings and Programs Department, providing support to the Virtual Library, Online Education and CAMPEP. Ashleigh Wheelock joined the team on February 11 as the new Customer Service Representative . She comes to us with outstanding customer service skills and is currently going to school at night working on her degree.

Amanda Potter will join the HQ team on February 13 in the newlycreated role of State Legislative and Regulatory Affairs Specialist. She will be working with Lynne Fairobent in support of the activities of the Professional Council, focusing on the development of a grassroots program. Amanda holds a B.S. in Biology and most recently worked on state issues for the Maryland Bankers Association.

AAPM Newsletter

March/April 2008

AAPM Education and Research Fund AAPM wishes to acknowledge and thank the following individuals for their contributions to the AAPM Education and Research Fund in 2007: Alkhatib, Hassaan Asprinio, Alfred E. Bailey, Michael J. Bank , Morris I. Barnes, J. Ed Barnes, Maxine Basic, Mario Bell, Clyon Wayne Bernstein, Kenneth J. Bhatnagar, Jagdish Prasad Boccuzzi, Douglas E. Brill, Bertrand A. Bushe, Harry S. Carey, James E. Chamberlain, David K. Chavaudra, Jean Jacques Corrigan, Kevin Craig, Tim Cytacki, Edmund P. Das, Indra Dauer, Lawrence T. Daus, Alan M. Dockter, Arden E. Doi, Kunio Eagle, Anton Fairobent, Lynne Freedman, D. Jay Frey, G. Donald Fricke, Stanley Giardina, Joseph Giger, Maryellen L. Goetsch, Steven J. Goff, David Lee Goodman, Richard Greenspan, Bennett S. Gupta, Madhup Halverson, Per H. Hardy, Peter A. Hare, Mary Z. Harnich, Gayle A. Hazle, John Hellman, Joseph P.

Henzler, Margaret Hevezi, James Holmes, Timothy Hong, Giang T. Hussain, Ishtiaq Jackson, Edward F. Judy, Phillip F. Kawrakow, Iwan Knoche, Jayne M. Kubricht, William Ladle, Roger O. LaFrance, M. Terry LaRosa, Salvatore Lehto, Norman E. Leidholt, Edwin M. Lemen, Lisa Catherine Lightfoot, David Litzenberg, Dale William Mackie, Thomas R. Mah Eugene Mahesh, Mahadevappa Malloy, William Mansour, Nemarallah A. Martel, Mary Martin, Rafael Mather, Kali Kathleen McMillan, Sharon K. McNitt-Gray, Michael F. Meiler, Ronert J. Meineke, Matthew A. Messinger, Jeffrey G. Methe, Brian M. Miller, Jeananne Mitev, George Moore, Mary E. Morales, Monson Jose A. Morin, Richard Murray, James C. Myers, Lee Thomas Niroomand-Rad, Azam Novotny, Josef Noz, Marilyn E.

6

O’Rear, James H. Pedalino, Alberto Perez-Andujar, Angelica Pfeiffer, Douglas E. Pfund, John C. Philip, Jacob S. Ratcliffe, Alisa J. Roa, Dante E. Rosenberg, Ivan Rothenberg, Lawrence Scarbrough, Edward C. Schreiner, L. John Shope, Thomas B. Shumaker, Deborah J. Silver, Michael D. Simpkin, Douglas J. Smith, Rene J. Spelic, David C. Stark, Richard Stenroos, Keith A. Sukovic, Predag Summa, Deborah Sweet, John B. Tassotto, Michael Taylor, David D. Terry, James A. Thomadsen, Bruce Thomas, Stephen Van De Geijin, Johannes VanDamme, James J. Virudachalam, Ramasamy G. Wang, Steven J. Wexler, Marilyn Wheeler, Karen D. White, Gerald A. Willcut, Virgil M. Willins, John D. Wochos, John F. Wong, Roland Yorke, Ellen D. Zink, Frank E.

AAPM Newsletter

March/April 2008

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

I

t has been a surprisingly warm winter so far this year in the Baltimore-Washington area, while some parts of the Midwest are experiencing severe weather – mostly attributable to global warming. I am hoping spring will soon follow as this issue meanders through the print-world and mail-houses before reaching your desk. This issue contains many interesting reports and articles and I would like to draw your attention to a few of the articles of specific interest to me.

At the AAPM leadership level, a flurry of activity has been happening especially with the deadline quickly approaching to implement the changes related to the eligibility to take the board (ABR) certification exam. The AAPM Chairwoman of the Board’s, Mary Martel column on the ‘AAPM 2012 Initiative’ specifically addresses the new requirements and various solutions being discussed.

details on the recommendations and resource materials regarding this campaign, please read the section entitled “Science Council News”.

Ironically, over the holidays I read Shannon Brownlee’s ‘Overtreated – Why too much Medicine is making us Sicker and Poorer’. The award-winning journalist discusses at length the good and bad sides of various medical procedures and the role of medical providers. In this book, I found it to be interesting that the discussion about CT scans, especially multiple and inappropriate scans, took up a major portion of one chapter.

One last article that I would like to comment on is the report of the recently completed AAPM-ISEP course in Bahrain (p-25). These types of courses and workshops play unique roles in establishing

good working relationships among the medical physicists in both developed and developing countries.

Especially during times of economic boom in some developing countries, the medical physics profession still remains in its infancy and is caught off-guard with rapid health-care expansions. I know that AAPM’s support in organizing courses and workshops under the International Scientific Exchange Program (ISEP) is greatly appreciated by the host countries and I feel that these activities provide a platform for showcasing AAPM and its role in solidifying medical physics professions in the developing countries.

Finally, I wish all of you a warm spring and encourage you to contact me with any comments about this column or the newsletter in general

IGRT Hospital Coding Alert Hospital outpatient departments are strongly encouraged to continue to report charges for all image guidance (e.g., 76000, 76001, 76950, 76965, 77011, 77014, 77417, 77421) and image processing services (e.g., 76376, 76377) regardless of whether the service is paid separately or packaged, using correct CPT codes. The goal is to continue to capture the costs of the packaged image guidance services utilized in radiation therapy procedures in the hospital claims data used to develop future APC payment rates.

AAPM 2008 Summer School The Physics and Applications of PET/CT Imaging

June 25Ͳ27, 2008 Baylor College of Medicine, Houston, TX with separate HandsͲon Sessions Covering Scanner Testing, Accreditation and Shielding Calculations on Saturday, June 28 at MD Anderson Cancer Center

Another article that is of specific interest to me is regarding the ‘Image Gently’ campaign currently in the news among the various medical imaging providers. The campaign’s focus is on CT scans – this topic draws great interest among both the providers and the receivers. For more

www.aapm.org/meetings/08SS 7

AAPM Newsletter

March/April 2008

Education Council Report residency programs and the 2012 initiative and summit.

Herb Mower Education Council Chair

W

e are now into the 2008 AAPM year and it is with pleasure that I welcome to our Education Council team George Starkschall who takes over as Chair of the Education and Training of Medical Physicists Committee and Doug Pfeiffer who assumes the role of Chair of the Medical Physics Education of Allied Health Professionals Committee.

They join the Education Council as we undertake many challenges in a very exciting time in our profession. As I write this in January we are preparing for the upcoming Ed Council retreat where the various leaders of the Council will evaluate the needs and educational goals of the Association for the upcoming years. We do this in cooperation with the AAPM EXCOM to be sure that we are aligning our programs with the needs and desires of the membership.

Many challenges face us as we approach the year 2012 and a lot of thought and effort is being expended to be sure that we are ready for this year. As many are aware, 2012 marks the year when one must have successfully completed a CAMPEP approved graduate program or a CAMPEP approved clinical residency in medical physics in order to sit for the ABR boards. By 2014, the requirement will mandate successful completion of a CAMPEP approved clinical residency in medical physics. To this end, there are two special activities coming before the AAPM: support for emerging clinical

At the July AAPM Board meeting, a sum of up to $100,000 was approved to be used to help establish accredited clinical residency programs. One of the major objectives of the Education Council retreat will be to set up a program to meet this need. We will then notify the membership of the details of the program and how you can apply for financial support for your developing program in meeting this objective.

Recently EXCOM has notified key people on the AAPM leadership team about an upcoming ‘2012 summit.’

This will have taken place between the time of writing this article and the time that you read it. The summit will undoubtedly address many facets of the 2012 challenge including affiliated clinical residency programs as being formulated and proposed by Mike Herman and his task group and the possibilities and challenges relative to a Doctor of Medical Physics program as being reviewed and evaluated by Charlie Coffey and his task group.

Bill Hendee and his task group on developing web-based physics education modules is also hard at work and will be meeting with its RSNA counterpart group in the first quarter of 2008. Their goal is to develop guidelines to be used as they put forward requests to groups interested in developing web based modules to be used primarily, in the initial stages, as a training tool in teaching radiology residents the physics associated with their profession. These modules will undoubtedly look at teaching medical physics in a completely different format than that historically employed as well as bringing the teaching activities into an interactive electronic medium.

Another recently formed task group within the Education Council, under the joint leadership of Jim Dobbins and

8

Ehsan Samei, is looking into organizing a society of directors of academic medical physics programs. This group will be investigating the establishment of a new society to promote better coordination between academic medical physics programs, to foster the establishment of best practices, to monitor the production of students relative to job market, to help new programs get started and to serve as a voice for academic program directors.

The work of this task group will be particularly beneficial for those involved with our various academic programs in medical physics.

I have had the opportunity of working with Bill Hendee and Ervin Podgorsak on the upcoming workshop on “Becoming a Better Teacher” to be held following our Annual Meeting in Houston, Texas. Guest faculty at the workshop will include representatives from the ABR and the RSNA. This three-day experience will challenge attendees in a manner to develop and hone their skills as they investigate the challenges of teaching medical physics to our peers and our colleagues in radiology and radiation oncology. Registration material for this event is available on the AAPM website.

These are just some of the many new programs that are on the agenda for the Education Council in 2008. Each of these task groups and projects hopes to complete its basic work within the coming year, a truly challenging goal but one we feel is well within the capabilities of the many dedicated members of our Association who are devoting their time and talents. If you are interested in being a part of any of these programs, I encourage you to contact those identified above. Also use our new “Yellow Pages” to check into opportunities to become involved with these or other programs within the various task groups, sub-committees and committees of the Council.

AAPM Newsletter

March/April 2008

Professional Council Report

Michael Herman Professional Council Chair

Professional Program 2008 Annual Meeting he Professional Program at the 2008 meeting will turn our focus toward ethics and communication. A number of sessions will be dedicated to professional medical ethics beginning at the national level and focusing on medical physics ethics in practice, education and research.

We will review the new AAPM code and present interactive discussions of cases, dilemmas and solutions.

There will be a special session on professional communication, among medical physicists, between medical physicists and others as we practice. We will continue the highly successful meet the expert series following the new members’ symposium. The series on quality/ errors will continue again this year.

Updates on CARE, Licensure, MOC, and Professional Services will round out the program.

T

Ethics While we’re on the topic, the Ethics Committee and TG109 continue to work diligently on a new Code of Ethics. This is a monumental effort and essential as our profession

continues to mature and become more complex. One major completed piece is the revised Complaint Procedure (PP-21A), which provides a detailed pathway with a neutral, objective and confidential process to follow for receiving and taking action on any potential or alleged violation of AAPM ethical policy. We should all pay attention to our actions, for what might seem to be a minor or innocent departure might in fact be or lead to something much more significant and unintended.

Committee classifieds Committee classifieds have been in use now for a few months. We urge all committee, task group, working groups, etc. to use this mechanism to connect with interested and talented medical physicists. If you have comments on this process please send them to us. The goal is to improve communication and efficacy in allocating volunteer effort. The committee classifieds system will be revised and integrated into the new placement services process is developed.

Legislation and regulation The Consistency Accuracy Responsibility and Excellence bill continues to move forward and there is hope that it can be passed before elections dominate the country. We have used our CAPWIZ software to make communication with senators and representatives very easy for all of us. I hope you have taken advantage of the tools and communicated with your legislative leaders, supporting these bills. The Joint (ACMP-AAPM) Medical

9

Physics Licensure Sub Committee efforts were nicely summarized in Mike Mills column in January. By the time you read this newsletter, we should have announced the new legislative/regulation staff member as part of this effort. This individual will provide critical support to all of the ongoing and downstream work related to our legislative and regulatory challenges. AAPM remains committed to providing the necessary tools and resources to facilitate effective communication for implementation of this essential legislation. Additional detail on current legislative and regulatory affairs is in Lynne’s column.

Economics Professional Economics remains very active with a focus in Wendy’s column this month on recent activities in Medicare reform.

The third Abt study for radiation oncology physics services is under review and nearing completion for distribution later this year. The initial work on performing a first Abt study for imaging physics services is still in it’s early stages and volunteers to work on the project are still needed.

Please apply through the posted committee classified.

AAPM Newsletter

March/April 2008

Science Council News Medical Physicists Key to “Image Gently” Success Campaign aimed at prudent pediatric imaging continues strong national push Keith Strauss, AAPM Representative to the Alliance for Safety in Pediatric Imaging

S

ince the Jan. 22 inauguration of the Image Gently campaign, the message from the four charter members of the Alliance for Safety in Pediatric Imaging — the Society for Pediatric Radiology, the ACR, the American Society of Radiologic Technologists and the American Association of Physicists in Medicine — has been directed at the nation’s radiologists and radiologic technologists.

But medical physicists, as the goto experts on the technical aspects of imaging, also have key roles in ensuring the campaign’s success.

That’s the word from medical physicists E. Russel Ritenour, Ph.D., past chairman of the board of the American Association of Physicists in Medicine, and James M. Hevezi, Ph.D., chair of the ACR Commission on Medical Physics.

Throughout its anticipated run, the Image Gently campaign will underscore one key point: Children may be more sensitive to radiation received from medical imaging scans than adults, and cumulative radiation exposure to their smaller bodies could, over time, have adverse effects. Therefore, radiologists who perform imaging exams on children are urged to:

• Significantly reduce, or “childsize,” the amount of radiation used • Scan only the indicated area • Scan once: Multi phase scanning (pre- and post-contrast, delayed exams) is rarely helpful • Involve your medical physicist to review your adult and pediatric CT protocols.

• Work with technologists to implement changes “Radiation sensitivity is a relatively new finding,” Ritenour said, “but recent scientific presentations and refresher courses have made it more familiar to medical physicists.”

As the Image Gently campaign continues its national push, he said, “A lot of medical physicists are now getting contacted by physicians for consultation. We are heartened to see this important, updated information reach the nation’s imaging teams.”

The Image Gently campaign emphasizes the judicious use of pediatric imaging. “First, children have higher sensitivity to radiation,” Hevezi said. “Second, the software in scanners automatically compensates for higher than necessary technique,” leaving the radiologist with an excellent image, but no corresponding feedback.

“Third, this higher than necessary technique may produce no immediate, measurable, biological indication of any kind. The effects might not be seen for decades.”

The issue of radiation safety is indeed important, but Ritenour and Hevezi urge perspective.

“CT has tremendous medical uses that have opened new doors and replaced many dangerous,

10

invasive techniques,” Ritenour said. “Ultimately, we are trying to use CT in the best way possible by minimizing the risk and maximizing the benefit.”

“If there is good reason for doing the examination to extract the diagnostic information to help the patient, then certainly, the risk associated with not doing the examination is greater than the small risk of doing the examination,” Ritenour said.

The answer is teamwork. The Image Gently campaign encourages radiologists to involve medical physicists in reassessing pediatric CT techniques. “Medical physicists are uniquely qualified to aid the radiologist and technologist in adjusting or developing protocols to image the pediatric patient,” Hevezi said. “Using objective measurement tools, medical physicists can establish techniques that produce the best image quality at the lowest radiation dose.”

Ritenour identifies several “straightforward things we can do right away” to help lower pediatric dose levels without compromising image quality. “We can reduce milliamperage. We can decide if fewer slices than standard protocol are acceptable. When provided the right information by a medical physicist, a radiologist can assess if a modification in techniques will impact the image quality. In many cases, it may not change it,” he said. Marilyn Goske, M.D., chair of the Alliance for Safety in Pediatric Imaging and chair of the Board of Directors of the Society for Pediatric Radiology, noted that imaging centers and hospitals can

AAPM Newsletter

now access scientifically validated protocols to compute appropriate mAs for age groups, independent of the age of the CT scanner or manufacturer. These CT protocols — pioneered by Keith Strauss, MSc of the American Association of Physicists in Medicine, in conjunction with Richard L. Morin, Ph.D., and Priscilla Butler, M.S. ACR Senior Director of Breast Imaging Accreditation Programs — are designed to result in a radiation dose that is approximately equal to or less than an adult CT dose for the same procedure. They are available on the www.imagegently.org Web site.

“The new CT protocols provide a simple method to allow any hospital with any CT scanner to impact the radiation protection of children by ensuring that the dose they deliver to children is ‘child-sized,’ said Strauss. Medical physicists should prepare to measure standard CTDI doses on their institution’s CT scanners. These baseline doses allow the calculation of the proper ‘child-sized’ techniques from correction factors provided in the CT protocols. Even further dose reduction is encouraged as long as the resulting image quality satisfies diagnostic needs.”

Technical background and additional guidance is provided in the new AAPM Task Group 23 report, “The Measurement, Reporting, and Management of Radiation Dose in CT, ” chaired by Cynthia McCollough, Ph.D. The appendix includes manufacturerspecific tables with age- or sizebased techniques; the report is available at www.aapm.org/pubs/ reports/RPT_96.pdf.

As the Image Gently campaign increases awareness, Ritenour said

medical physicists who do not routinely work with CT may be asked to assist radiologists and other physicians. These medical physicists, he said, can find ample information about radiation doses on scanner screens and in manuals.

Utilizing these data — along with tissue weighting factors — medical physicists can help radiologists understand effective dose levels.

March/April 2008

materials, including information on optimizing CT protocols in pediatric patients. The campaign is partly funded by an unrestricted educational grant from GE Healthcare.

Imaging stakeholders can visit the Image Gently Alliance Web site (www.imagegently.org) for the latest research and educational

SOLID WATER. SOLID SOLUTION...GAMMEX.

CTG SOLID WATER

®

IS THE TISSUE MIMICKING MATERIAL OF CHOICE OF MEDICAL PHYSICISTS AROUND THE WORLD. It is designed for electron and/or photon beam calibrations, including relative ionization, depth dose measurements and absolute calibrations without the need for complicated correction or scaling factors or cumbersome water tanks. Slabs come in a wide range of sizes and thicknesses. A Certificate of Conformance, which includes data on the following parameters measured at 18MeV electrons and 6Mv photons, is included with each slab: • Measured % depth ionization for electrons and photons relative to water • Calculated linear attenuation coefficient relative to water • Measured physical density • Calculated elemental composition • Calculated mass electron density • Calculated electron density A radiograph is also provided, which demonstrates that the slab purchased is free from voids and contaminants.

For more information about CTG Solid Water, contact Gammex today at 1 800 GAMMEX 1 (426 6391).

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

11

GAMMEX-RMI BROADWAY BUSINESS CENTRE 32A STONEY STREET LACE MARKET NOTTINGHAM NG1 1LL +44 0115 9247188 FAX: +44 0115 9247189 EMAIL: SALES@GAMMEX.COM

GAMMEX-RMI GMBH FRANKFURER STRASSE 15 D-35390 GIESSEN GERMANY +49 641 250 9176 FAX: +49 641 966 2642 EMAIL: DESALES@GAMMEX.COM

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

AAPM Newsletter

March/April 2008

Tools of the Trade

1298-21, 09/07

Featuring independent bias and range control on two channels, powerful, intuitive color touchscreen interface, super-low 1 fA resolution, and built-in chamber library for real-time dose display – the NEW SuperMAX is all that you want in a next generation reference grade electrometer. To learn more, visit supermax.standardimaging.com

www.standardimaging.com 800.261.4446 / 608.831.0025

QA SOFTWARE

EXRADIN ION CHAMBERS

12

PHANTOMS

BEAM QA

ELECTROMETERS

BRACHYTHERAPY

AAPM Newsletter

March/April 2008

News from CAMPEP Treasurer), Geoff Clarke, Richard Maughan, Ervin Podgorsak and Tim Solberg. The Graduate Education Program Review Committee is chaired by Ed Jackson, the Residency Education Program Review Committee by Bruce Gerbi and the Continuing Education Review Committee by Bruce Thomadsen.

John Hazle President, CAMPEP

C

AMPEP continues to be actively involved in accrediting new programs, re-accrediting existing programs and developing a strategy for meeting the 2012 and 2014 ABR requirements for examination.

Before diving into that, I would first like to thank Palmer Steward for his six years of dedicated service as an AAPM representative to the CAMPEP Board. Palmer retired from the CAMPEP Board on December 31. Palmer was an active member of the organization and could always be counted on to look squarely at any issue. He gave us honest and unbiased input on all debates.

Replacing Palmer as an AAPM delegate to the Board is Bill Hendee.

Bill brings a wealth of knowledge related to medical physics, and the teaching of medical physics. We look forward to having him on our leadership team as we move forward to address several issues strategic to not only CAMPEP, but the profession of medical physics.

As a reminder, the rest of the CAMPEP Board includes Peter Dunscombe (Vice President), Marlene McKetty (Secretary-

In 2007 we accredited new graduate programs at the University of Manitoba-CancerCare Manitoba and the University of Chicago. The program in Manitoba is directed by Stephen Pistorius and the program at Chicago is directed by Maryellen Giger. Congratulations to both for achieving this recognition of their excellent programs. The graduate programs at the University of Wisconsin and the University of Texas Health Science Center at Houston - M. D. Anderson Cancer Center were reaccredited. These programs are all accredited through 2012.

New radiation Oncology Physics residency programs at Ottawa Hospital, Stanford University, University of California – Irvine, University of Iowa and Virginia Commonwealth University were also accredited last year. The program in Ottawa is directed

by Brenda Clark, the program in Irvine by Mathew Al-Ghazi, in Iowa by John Bayouth and at VCU by Nesrin Dogan.

Congratulations to these programs that are accredited through 2012.

We also continue to see high demand for CAMPEP approved continuing medical physics education credits.

This program is very active and we continue to work on ways to make it more user friendly. Many

13

thanks to Michael Woodward and the AAPM Headquarters staff for development of the CE interface.

Finally, I want to encourage anyone out there interested in pursuing accreditation of a graduate or residency program to let me know.

CAMPEP can provide guidance, sample self-studies and other help in achieving your goal.

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

March/April 2008

Legislative and Regulatory Affairs Column

Lynne Fairobent College Park, MD Politics 2008 ell funny season is upon us in DC. It is the season of the Presidential election year. As such, it is anticipated that not much will be accomplished in Congress after June of this year. Now some might say not much happens anytime.

W

Given the political climate, at the January 15, 2008 meeting of the Alliance for Quality Medical Imaging and Radiation Therapy, it was decided that a second virtual march on Capitol Hill was needed.

It is critical to do so in order to keep pressure on Congress and to keep the Consistency, Accuracy, Responsibility

and Excellence in Medical Imaging and Radiation Therapy (CARE) legislation (S. 1042 and H.R. 583) on the forefront. Especially important is contacting the members of the Senate Health, Education, Labor and Pension (HELP) committee to urge them to move the legislation forward to a vote in the Senate. Members of the Senate HELP committee are: Democrats - Edward Kennedy (MA), Christopher Dodd (CT), Tom Harkin (IA), Barbara A. Mikulski (MD), Jeff Bingaman (NM), Patty Murray (WA), Jack Reed (RI), Hillary Rodham Clinton (NY), Barack Obama (IL), Bernard Sanders (I) (VT), and Sherrod Brown (OH).

Republicans: Michael B. Enzi (WY), Judd Gregg (NH),Lamar Alexander (TN), Richard Burr (NC), Johnny Isakson (GA), Lisa Murkowski (AK), Orrin G. Hatch (UT), Pat Roberts (KS), Wayne Allard (CO), and Tom Coburn, M.D. (OK).

I would like to thank all of the AAPM and ACMP members that have responded to the Call for Action and contacted their Congressional representatives. If you have not done so, it is not too late go to: http://

capwiz.com/aapm/home/ and follow the instructions for calling or emailing your members. If you have contacted your members, please follow up and ask what action have they taken based on your request.

NRC Proposed Rulemaking on Transportation of Radioactive Material in Quantities of Concern On January 4, 2008, the NRC published notice (73 FR 826) of three public meetings to seek public comment to enhance the development of the technical basis to support rulemaking to revise NRC regulations on the security requirements for the transportation of Radioactive Material in Quantities of Concern (RAMQC). The goal of this enhanced participatory process is to ensure effective security measures are in place for the protection of radioactive material shipments given the post-September 11, 2001, threat environment. NRC issued orders in 2003, 2004 and 2005 which required additional security measures during transportation. The following key points were based on the January 23rd meeting.

Key Points from NRC: • NRC doesn’t usually engage stakeholders at this stage of rulemaking process, but is really interested in stakeholder comments and recommendations to establish technical basis.

• Looking to codify requirements covered in the Orders but is open to alternatives and looking to stakeholders for input on this.

• Involves materials mainly used in industry, medical and academic and to a small extent waste and reactors.

• NRC does not regulate transportation alone and share it with Department of Transportation (DOT), Department of Homeland Security (DHS), states and Tribal governments.

• NRC has broad authority to regulate transfer of material and DOT has the authority to regulate commerce.

• NRC has the authority over the shippers and the licensees not the commercial carriers that move the material, regulating carriage by road and rail it is the responsibility of DOT. • NRC does not have jurisdiction over carriers so they intend to regulate the licensees (shippers) who engage carrier services and will hold them accountable for carrier compliance.

14

AAPM Newsletter

March/April 2008

• Should NRC regulate increased security for transportation under common defense and security or health and safety? This is important because if NRC regulates under common defense and security, the Agreement States have no say in the regulations. Currently the orders applying to Category 2 RAMQC were issued under health and safety. It was suggested that the NRC define the process for determining what is regulated under common defense and security vs. health and safety.

• Scope of applicability limited at this point to only Category 1 and 2 radioactive materials*.

• Rulemaking Schedule ○ Comments due by 2/8/08 ○ Prepare technical basis - Spring 2008

○ Publish Proposed Rulemaking - Spring 2009 ○ Publish Final Rule – 2010

Radioactive Material of Concern Values (Category 1 and 2) Radioactive Material

Category 1 Terabequerels Curies (Ci) (TBq) 60 1,600 60 1,600

Category 2 Terabequerels Curies (Ci) (TBq) 0.6 16 0.6 16

Americium-241 Americium241/Beryllium Californium-252 20 540 0.2 5.4 Curium-244 50 1,400 0.5 14 Cobalt-60 30 810 0.3 8.1 Cesium-137 100 2,700 1 27 Gadolinium-153 1,000 27,000 10 270 Iridium-192 80 2,200 0.8 22 Plutonium-238 60 1,600 0.6 16 Plutonium-239/Beryllium 60 1,600 0.6 16 Promethium-147 40,000 1,100,000 400 11,000 Radium-226 40 1100 0.4 11 Selenium-75 200 5400 2 54 Strontium-90 (Yttrium1,000 27,000 10 270 90) Thulium-170 20,000 540,000 200 5,400 Ytterbium-169 300 8,100 3 81 Terabequerels are the official value to be used for determining whether a material is a Category 1 or Category 2 quantity. Curies are provided for practical usefulness only and are rounded after conversion.

If you did not provide comments by February 8th, NRC will continue to accept them and will be considered if practicable to do so. Additional details can be found at: http://www.nrc.gov/about-nrc/regulatory/rulemaking/frn-trans-of-rmqc. pdf and http://www.nrc.gov/security/byproduct/orders.html.

ATTENTION AAPM CHAPTERS! You too can have the panels commemorating AAPM’s 50th Anniversary displayed during your meeting! That’s right, the AAPM HQ Office has created 4 pop-up panels depicting AAPM’s history that we’ll ship to you and include a return shipping label.

Contact Karen MacFarland or Lisa Giove for additional information.

15

AAPM Newsletter

March/April 2008

THERAPY PROGRAM

Scientic Symposia

Proffered Abstract Submissions

• • • • • •

• • • •

Outcome-driven treatment planning From physical to biological optimization Control theory and feedback in radiotherapy Informatics Translating new technology into the clinic New approaches in quality assurance

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

IMAGING PROGRAM

Scientic Symposia

Proffered Abstract Submissions

• Future Development- Technology, Applications • Advances in MRI, CT, Ultrasound and Nuclear Imaging • Digital X-ray Imaging- Radiography, Fluoro, Vascular • Innovations in Breast Imaging

• Digital Radiography, Fluoroscopy, Angio, Cardiac • CT, MRI, Nuclear, Ultrasound, Optical, Breast Imaging • Image Processing, Display, Visualization • Functional Imaging, Image Analysis, CAD • Multi-Modality Imaging, Registration & Fusion • Image Quality Evaluation, QC, Dosimetry

JOINT IMAGING/THERAPY PROGRAM

Scientic Symposia

Proffered Abstract Submissions

• MRI in radiation therapy: from simulation to online image-guidance • Tomographic imaging in radiation therapy • Image registration • Targeting using surrogates • IMRT targeting: from anatomy to physiology • Small animal image-guided radiation therapy

• • • • • • •

Target deÀnition Image guided procedures and interventions Portal imaging Cone beam CT Imaging for therapy assessment Small animal imaging Nanotechnology applications

www.aapm.org/meetings/08AM

16

AAPM Newsletter

Jean St. Germain, Chair Ad-Hoc Committee on Golden Anniversary Planning “Congratulations to all AAPM members on our 50th Anniversary”

Souvenir Items By the time you read this, you will have received a special AAPM souvenir

March/April 2008

for the 50th Anniversary. AAPM member, Tim Stack, was the clear winner in our T-shirt contest with his “Top Ten List”. Please visit the AAPM gift shop on our web site to see Anniversary items for sale.

These items will not be sold during the annual meeting.

so inclined. Please make plans to join us in Houston.

2008 Annual Meeting There will be special sessions at the Annual Meeting to commemorate our Anniversary, including the opportunity to meet with some of our charter members. Our gala celebration will be held in our headquarters hotel and will include music and dancing for those members

Chapters The panels prepared for our anniversary in 2006-2008 will be available as a portable exhibit for use in chapter meetings and will hopefully enable all members to participate in our anniversary. For information, please contact Karen MacFarland at our headquarters.

AAPM Web Site The AAPM web site will feature a special section on our anniversary.

Please come and look around for old or new friends.

2008 AAPM Annual Meeting Dates to Remember: • • • • •

MARCH 19 MARCH 19

BY MAY 14 JUNE 11 JUNE 25

Meeting registration scheduled to open.

Housing registration scheduled to open.

Scientific Program available on-line.

Deadline to receive discounted registration fees.

Housing reservation deadline.

AAPM 50th Anniversary Products • • • •

$2 $5 $30 $11

- lapel pin - coffee mug - polo (black or white) - t-shirt with the “Top Ten Ways to Know You’re a Medical Physicist”

OR all four items for $44 Available through the AAPM on-line Gift Shop only, and will not be for sale at the annual meeting in Houston. http://www.apisource.com/aapm/ 17

AAPM Newsletter

March/April 2008

Health Policy/Economic Issues Bush Signs Medicare Reform Bill, Delays 2008 Physician Cuts Through June Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant

P

resident Bush signed into law on December 29, 2007 legislation preventing steep cuts in Medicare payments to physicians, providing 15 months of additional funding for the State Children’s Health Insurance Program (SCHIP) and maintaining the current payment policy for brachytherapy sources provided in the hospital outpatient setting for six months.

The bill represents $5.3 billion in new spending over five years, offset primarily with an 18-month freeze in inpatient rehab facility updates beginning April 1st, and an adjustment in the Medicare Advantage (MA) stabilization fund.

The Senate approved the Medicare, Medicaid and SCHIP Extension Act of 2007 on Dec. 18, 2007 with House passage coming one day later.

Physicians and freestanding radiation oncology centers had been scheduled to receive a 10.1 percent cut in Medicare payments beginning January 1, 2008. The new law instead provides a 0.5 percent update through June 30th. Updated payment rates for 2008 have been posted to the AAPM website at: aapm.org/government_ affairs/cms/2006healthpolicyupdate. asp

is passed prior to June 30th, the payment rates from July 1 through December 31, 2008 will revert and reflect the 10.1 percent reduction in payment that was including the Physician Fee Schedule final rule.

Another legislative provision mandated that Medicare continue to pay for brachytherapy sources

based on hospital charges adjusted to cost through June 30, 2008.

Brachytherapy sources provided in the hospital outpatient setting had been slated to receive fixed, prospective payment based on each source provided effective January 1, 2008.

Piranha Dose Probe

Input Dose Image Intensifiers Scatter and Leakage

Non-Invasive mAs Probe mA and mAs

The Piranha is �self-contained� all-inone multi-function meter for X-ray QA. The standard detectors are built-in.

Communication is made very easy by built-in Bluetooth and USB. With its long-life battery you can count on it to last even during the busiest day.

Light Probe

Illuminance and Luminance

Graphical Display

Remote & wireless display

*ÍŠOÎ?ӊǑҿ̢WČş 9 ҉BZ 2" 4Í˝Í?Ó…ŇżJÎ?ÍŠT έ $Î?Ó…SŇ•Čş

If you look for something that is simple and accurate, small and light, smart and fast - then chose the Piranha!

RTI Electronics, Inc.

The American Medical Association said it is “disappointed� with the six-month payment patch, urging Congress to pursue a longer term solution when members return from the year-end recess. Unless legislation

1275 Bloomfield Ave, Bldg. 5, Unit 29A, Fairfield, NJ 07004, Phone: 800-222-7537 www.rtielectronics.com sales@rtielectronics.com

18

AAPM Newsletter

March/April 2008

ACR Accreditation ACR your new address (as well as any other pertinent changes, such as the Practice Site and/or ModalitySpecific Supervising Physician or contact) so that you will be appropriately notified when it is time to renew your accreditation.

ACR Stereotactic Breast Biopsy Accreditation: Frequently Asked Questions for Medical Physicists Does your facility need help on applying for stereotactic breast biopsy accreditation? Do you have a question about the ACR Stereotactic Breast Biopsy QC Manual? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation,” then “Stereotactic Breast Biopsy.” Most of the stereotactic breast biopsy accreditation application and QC forms are available for downloading. You can also call the Diagnostic Modality Accreditation Information Line at (800) 227-0145. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. We have a mammography unit that is used solely for stereotactic breast biopsy. The unit is not MQSA certified. During the course of these procedures, we take mammographic images.

Because our unit is not MQSA certified, what restrictions exist on the mammographic images we may perform during such procedures?

A. Because stereotactic breast biopsy is currently excluded from FDA regulation, units that are used solely for stereotactic breast biopsy do not have to be MQSA certified. However, these uncertified units must not be used to perform conventional mammographic examinations. Uncertified units may be used to produce mammographic images only if they meet all of the following conditions: 1. The mammographic images obtained are an integral part of the stereotactic breast biopsy procedure.

2. Facilities must not separately for these bill mammographic images. They must bill only for the stereotactic breast biopsy procedure.

Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs

3. If the mammographic images obtained as part of the stereotactic breast biopsy procedure result in the cancellation of the procedure (e.g., lesion or calcifications no longer seen, calcifications are determined to be in the skin), the facility must not report nor bill the attempted procedure as a mammogram, but rather as a canceled procedure.

4. If the procedure is canceled for reasons described in 3, FDA strongly recommends that the findings (or absence of findings) be confirmed by an immediate follow-up study performed on an MQSA-certified unit. See the FDA Policy Guidance Help System (www.fda.gov/CDRH/ MAMMOGRAPHY/guidance-rev. html#pghs) for more information.

Q. We will be moving our stereotactic breast biopsy unit to a new room. Do I need to provide any information to the ACR? A. No. If you are only moving the stereotactic breast biopsy unit to a different room within the same facility, you do not have to notify the ACR. However, if your entire facility is moving to a new location, please provide the

19

Q. We will be moving our stereotactic breast biopsy facility to a new address. Do I need to provide any information to the ACR? A. Yes. If your entire facility is moving to a new location, please provide the ACR the date of your move and your new address (as well as any other pertinent changes, such as the Practice Site and/or Modality-Specific Supervising Physician or contact) so that you will be appropriately notified when it is time to renew your accreditation.

Have the physicist evaluate the moved unit, and submit the new physicist report to the ACR. Q. What quality control data do we need to submit for accreditation?

A. As part of accreditation, you must submit a copy of your medical physicist’s most recent equipment survey for each unit used for stereotactic breast biopsy. The ACR also recommends that routine quality control (QC) be performed by the technologist on all stereotactic breast biopsy units used for breast imaging. See the Stereotactic Breast Biopsy Program Requirements (www.acr.org/ accreditation/stereotactic/stereotactic_ breast_reqs.aspx) for details.

Q. More and more often, facilities that have digital stereotactic breast biopsy equipment have gone totally

AAPM Newsletter March/April 2008 !!0- .EWSLETTER !D PDF 0-

20

AAPM Newsletter filmless, removing all chemical processing. How can I best perform the collimation assessment when wet processing of film is unavailable?

3.

Polaroid Corporation provides sheet film that can be adapted for this use.

A revised test equipment list is shown in the chart below.

A. Several alternatives to standard screen-film and processing could be used for this test: 1.

CR cassettes may be substituted for screen-film cassettes 2.

ISP – GAFCHROMIC XR-QA film is a self developing radiochromic film. This film may be cut to size and exposed directly without the need of a cassette.

Q. I have a Hologic MultiCare Platinum stereotactic breast biopsy unit. The manufacturer specifies a maximum compression force of only 1215 lbs under power drive. Is this acceptable?

Required Test Equipment

-

March/April 2008

of at least 25 lbs (and between 25 to 40 lbs under power drive).

Although the Hologic MultiCare Platinum’s automatic compression only reaches a maximum of 15 lbs, manual compression can provide nearly 30 lbs of compression force.

Your facility should watch to see that these numbers do not change significantly over time (both during compression and over the years), and that the compression meets the manufacturer’s specifications.

A. Yes. The 1999 ACR Stereotactic Breast Biopsy Manual recommends a maximum compression force

Four coins Tape One or two mammography screen-film cassettes and sheets of mammography film, OR ISP – GAFCHROMIC XR-QA cut to appropriate size, OR Polaroid film Ruler with mm scale

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

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

21

AAPM Newsletter

March/April 2008

Gold Standard

“Ion Chambers for Critical Acceptance testing and dose diodes for QA Consistency tests.”

ACCU-PRO™ Multi-Purpose Analyzer BEST TECHNOLOGY FOR SUPERIOR PERFORMANCE For Radiography, Fluoroscopy, Mammography, CT, Dental, and Survey

Ion Chambers kV Sensors Ion Chambers

mA/mAs Sensors

Dose Diodes

The new ACCU-PRO™ accepts the full range of Radcal’s Gold Standard Ion Chambers, Dose Diodes, kV sensors and mA/mAs sensors, for all your measurement needs.

www.radcal.com 426 W Duarte Rd • Monrovia, CA 91016 • p 626 357-7921 f 626 357-8863 • sales@radcal.com

22

AAPM Newsletter

March/April 2008

Maintenance of Certification Update MOC Update Michael Yester Per Halvorsen

A

s those members that have obtained ABR certification since 2002 are aware, ABR certification became time limited as of that year. This came about as an action of the American Board of Medical Specialties (ABMS) which the ABR is a member of. As part of the recertification process a Maintenance of Certification (MOC) process was instituted by the ABMS and programs for each member group must be approved by the ABMS. So as regards to ABR physics Diplomats, ABR Physics Trustees are responsible for the MOC program for physicists, but the program must be approved by the ABMS. When the initial program was announced, there were significant concerns about some of the elements of the program for physicists and a Task Group (TG-127) was initiated in November of 2005 to work with the ABR Physics Trustees. The charge of the TG is:

1. Act as a resource and liaison with the ABR trustees to provide information on MOC to AAPM members, 2. Provide information/suggestions on activities that meet MOC requirements, 3. Insure that educational activities are available to members.

The TG is chaired by Michael Yester and Per Halvorsen.

There have been several noteworthy events that have occurred since last year and so it seems fitting to provide an update and take stock of the current status of MOC. One aspect of the ABMS mandated program involves Lifelong Learning and Self Assessment. In particular the Self Assessment part is fulfilled by completing 20 Self Assessment Modules (SAMs) - an average of two a year (at least one a year).

These modules have to be approved for

Category 1 credit, have duration between one-and-a-half to two hours and at least five multiple choice questions are to be asked that must be answered by the attendee. There is no pass/fail but each attendee must be furnished information on how well the attendee answered each question relative to other participants and be given feedback – reason for the correct answer as well as references.

Through the efforts of the Task Group, AAPM staff, Mark Rzeszotarski, and the speakers, eight SAMs were presented at the 2007 Annual Meeting.

Four of these involved Radiation Therapy topics, two in Diagnostic Imaging, one in Nuclear Medicine, and one related to shielding for CT and PET. The model chosen to satisfy the assessment of knowledge obtained was the use of Audience Response software and hardware. Each individual participant could respond to a question anonymously and then see a distribution of responses for each answer. Although there were a few glitches, the outcome was favorable. Attendees seemed to like the audience response paradigm.

As a result, more SAM sessions will be presented at the 2008 annual meeting.

Stay tuned for more information.

These sessions (except for the Diagnostic Imaging session on Digital Mammography) were recorded and will be available as a SAM module within the Virtual Library soon. It was expected that these would have been available in December, but unforeseen logistics and configuration issues slowed the process.

These will run similar to the presentations given at the meeting: questions will appear, an answer will be selected, and then the correct answer, comparison to others, and references and discussions.

For the On-line version, category 1 credits will not be available; however, as the question structure does not fit the necessary requirements dictated by CAMPEP. Notice of availability will be

23

sent out at the appropriate time.

One issue in many individuals’ minds has been the other part of the Lifelong Learning segment, namely the Continuing Education credits.

Originally the requirement was 500 category 1 credits over the ten year period with 15 credits allowed for Self-Directed Projects (SDEPs).

Through efforts of TG-127, category 2 credits were allowed to fulfill half of the 500 credits. Recently it was announced by the ABR that the Continuing Education requirement was reduced to 250 category 1 credits over 10 years (no Category 2 credits) with SDEPs still accounting for 15 credits each. Although every effort will be made to provide all individuals in the MOC program with the latest changes, it is advisable to periodically check the ABR MOC Radiological Physics section of the web site: http://www.theabr.org/RP_ MOC_Req.htm.

Efforts relating to other activities that would be recognized as Category 1 credit are underway, and Category 1 credit will be given for reviewing manuscripts for Medical Physics.

The one final item of note relates to Part 4 of the MOC requirements. Practice Quality Improvement (PQI) sessions were provided at the 2007 Annual meeting. The Introduction session is on the Virtual Library as part of the 2007 Annual meeting. A session like this is part of the PQI requirement. TG-127 has mapped out the workings of an initiative within AAPM to develop a PQI program for members to satisfy the requirements of Part 4. Members will be kept apprised of this as it becomes available.

The Task Group will continue to address the issues as they arise, but it appears that the MOC program has become fairly stable at this time. There is a TG-127 forum under the BBS forum on the AAPM website that is monitored on a routine basis.

AAPM Newsletter

March/April 2008

AAPM-ISEP Course Report Report on the AAPM International Scientific Exchange Program (ISEP): Diagnostic and Therapeutic Physics Current Practice, Recent and Future Advances Manama, Kingdom of Bahrain, November 18-22, 2007 Muthana Al-Ghazi University of California, Irvine

T

he AAPM-ISEP one week course/workshop on Diagnostic and Therapeutic Physics was held successfully in the city of Manama, the capital of the Kingdom of Bahrain November 18-22, 2007.

The venue was the Gulf Hotel. The course/workshop was sponsored by the AAPM-ISEP and was also endorsed by the Education and Training Committee (ETC) of the International Organization of Medical Physics (IOMP). Local sponsorship was provided by The Bahrain Ministry of Health, Bahrain Defence Forces Hospital and The University of Bahrain. Local vendors and organizations also contributed to the sponsorship of this activity.

The objectives of this course were to discuss the fundamentals of diagnostic and therapeutic physics as it applies to the practice of medicine, to present current state of the art technology and their medical applications and future trends.

The target audience are medical and health physicists, radiologists, radiation oncologists, academics interested in the applications of physics in medicine, radiologic technologists, radiation therapists, students and allied healthcare professionals.

Another major objective of this activity is to raise

the professional profile of medical physics in Bahrain by encouraging the formation of a national medical physics organization.

There were over 100 attendees from 12 countries in the region (Cyprus, Iran, Iraq, Jordan, Kuwait, Lebanon, Saudi Arabia, Sudan, Turkey, United Arab Emirates, Yemen and the host country Bahrain). Attendees from Iraq, Jordan, Lebanon, Sudan and Yemen were sponsored by our hosts. Honorary guests were also invited from Kuwait, Saudi Arabia and United Arab Emirates. The attendees were split approximately evenly between locals and those from the neighbouring countries alluded to above. It should be noted that this is only the second time that an ISEP course has been offered in the region in the past decade.

Dr. Najeeb Jamsheer, a Consultant Radiologist and Advisor to the Bahrain Minister of Health was Chair of the Local Arrangements Committee (LAC), while Mr. Adel Mohammed, Chief Physicist at the Salmaniya Medical Complex was the Host Director. AAPM faculty were Drs. Robert Gould (U. of California, San Francisco, UCSF), Faiz Khan (U. Minnesota), Adel Mustafa (New York Medical College, NYMC), Jatinder Palta (U. Florida), Michael Yester (U. Alabama) and the author of this report. A novel innovation introduced in this course was to invite participation of local faculty to emphasize the exchange nature of ISEP programs. Local faculty were Dr. Hakima Al-Hashimi, a Consultant Paediatric Radiologist at the Salmaniya Medical Complex and Assistant Professor at the Arabian Gulf University Medical School, Dr. Lama Sakhnini, a Physics

24

Professor at The University of Bahrain and the Host Director, Mr. Adel Mohammed. They presented on their clinical and research activities.

The titles of their presentations are listed in the course website indicated below. My Co-Director, Dr. Azam Niroomand-Rad, was not able to participate.

The program consisted of 29 lectures on various aspects of the applications of physics in medicine, and three workshops (one each on diagnostic, therapy and nuclear medicine).

Details of the program, including lecture topics, speakers and members of the organizing committee are available at the website: http://www. moh.gov.bh/ISEP/.

Credit for developing this very informative website goes to our hosts.

Each of the attendees was given a CD containing PDF files of the lecture presentations and an attendance certificate at the conclusion of the course. They also filled out a course evaluation form. Statistical analysis of these evaluations is ongoing at the present time. The results will be reported to the appropriate AAPM committees. The overall picture is a positive one and it appears that the course achieved its objectives.

Twenty-one copies the textbook, “The Physics of Radiation Therapy� were distributed amongst attendees courtesy of the publisher, Lippincott Williams and Wilkins and the author, Dr. Faiz Khan, who was on hand to personally autograph each copy. The distribution of copies of the book insured that all countries represented at the course obtained an equal number of copies to the extent possible. Recipients of the textbook were asked to make it available to their colleagues at home, along with the course material.

AAPM Newsletter The opening ceremony was chaired

by Dr. Ja’afar Tareef, Director of Public Health at the Bahrain Ministry of Health and member a of the LAC. He introduced the Under Secretary for the Minister of Health, Dr. Abdul Aziz Hamza, a Consultant Plastic Surgeon. Dr. Hamza welcomed the attendees. This was followed by the Host LAC Chair welcome, Dr. Jamsheer. The AAPM introductory remarks were presented by the author of this report and a photo opportunity followed. The course program then commenced in earnest.

either already established or at an advanced stage of planning. As of writing of this report (January 2008), Bahrain, Jordan, KSA and UAE have active national medical physics organizations. This meeting emphasized the need for regional communication, coordination and cooperation as well the need to form a Middle East chapter of IOMP. There was a quorum to do so as the IOMP chapter requires three national medical physics societies.

The lectures were held at the Gulf Hotel Auditorium. This is an impressive venue that houses the Gulf Convention Centre, an international standard conference centre. The workshops were held on the afternoon of Tuesday, November 20 at the Salmaniya Medical Complex. This is a comprehensive and well-equipped tertiary care facility that includes a one thousand bed hospital. It serves as the referral facility for the country as well as the teaching hospital for the Arabian Gulf University Medical School. The workshop dealt with linac calibration, diagnostic quality assurance (CT, MR, mammography) and nuclear medicine quality assurance of SPECT and related equipment. There were a total of 83 attendees at the workshops almost, evenly divided amongst the three concurrent activities.

The afternoon of Wednesday November 21 was reserved for visiting the science research and teaching laboratories of The University of Bahrain. While there, attendees were charmed by the infectious enthusiasm of professors and students explaining their teaching and research activities in physics, chemistry and biology as well as collaborative research across disciplines. Research topics discussed were magnetic memory devices, bio-magnetism, optical properties of cells, high precision liquid chromatography as well as other topics. The laboratories are modern and well-equipped, as is the university. A noteworthy observation is the fact that female students, amazingly, make up in excess of 90% of the total number of students in the Faculty of Science!

Females are also reasonably well represented amongst the science faculty.

On the evening of Monday November 19, a meeting was arranged to discuss development of national medical physics societies in the region. This was attended by delegates from Bahrain, Jordan, Kuwait, Lebanon, United Arab Emirates (UAE), Kingdom of Saudi Arabia (KSA), as well as Dr. Adel Mustafa and this author. We learned that Jordan, UAE, KSA and Bahrain all have national medical physics societies,

Coffee and lunch breaks were opportunities for attendees to interact with faculty informally. One social activity was the “Gulf Night Out” on Tuesday evening. This was held outdoors at the Gulf hotel, the venue of the conference. It featured an impressive array of Middle Eastern and international cuisine and entertainment. Dignitaries from the Ministry of Health as well as our local hosts were in attendance to

25

March/April 2008 insure that delegates had an enjoyable time. This was indeed the case.

Dr. Aysha Jaber, a Consultant Radiologist at the Bahrain Defence Forces Hospital, and LAC member, worked relentlessly to insure that all arrangements are in place. Mr. Mahdi Al-Sahlawi and his staff efficiently managed registration activities and audiovisual arrangements.

Mr. Hamed Al-Hamad of the Ministry of Health Public Relations Department facilitated travel and visa arrangements for international attendees, along with Dr. Jamsheer.

Mr. Ja’afar Mattar organized the diagnostic and nuclear medicine workshops.

Bahrain is known as the “Land of Eternity”. It is the site of the ancient civilization of Dilmun whose rich history and culture parallel those of Mesopotamia. Indeed, Gilgamesh, King of Uruk in Babylonia (c. 2700 B.C.) and the first known author, mentions it in his epic (known by his name) in which he details his travels in search of immortality.

Our hosts spared no effort to create an environment that exuded the warmth of legendary Middle Eastern hospitality. They rolled out the red carpet like no other and treated us royally. To them we are particularly grateful. The attendees were very eager to learn and asked

Dr. Robert Gould, AAPM Faculty, conducting mammography quality assurance during the diagnostic workshop.

AAPM Newsletter

March/April 2008

AAPM faculty - Drs. Jatinder Palta, Muthana Al-Ghazi and Robert Gould (4, 5, 8 from left to right) with most LAC members very good questions. As one would expect, useful information was shared in both directions and was a learning experience for all. This course afforded us the opportunity to make lasting new friendships and renew longstanding ones. Wonderful memories of this experience will certainly be lasting.

Acknowledgements: The success of an activity of this kind is due to the efforts of many. Those of the local and AAPM faculty and our hosts have been outlined in the body of the report. Thanks are also due to the International Educational Activities Committee (IEAC), International Affairs Committee (IAC),

26

ISEP Committee and Middle East SubCommittee (MESC) of the AAPM for their help. ETC of the IOMP endorsed the program. The AAPM and IOMP are acknowledged for their support of ISEP programs.

AAPM Newsletter

March/April 2008

AAPM Website Editor Report

Christopher Marshall NYU Medical Center

W

hat’s in a name? In May of last year a subcommittee of the Medical Physics Education of Physicians Committee released their Diagnostic Radiology Residents Physics Curriculum through the Website. This important document is the result of close collaboration between the AAPM and other partners and it should influence the teaching and examination of diagnostic radiology residents for many years. Although direct links to the content were distributed to program directors nationwide, several complaints reached me in December to the effect that members of the radiology community were unable to find this item on our Website by navigating through the menus or by using the search function. I found this puzzling because the navigation path (Education/Curricula and Teaching Aids) appeared (to me) to be self-evident and searching on “Curriculum” found it immediately as number one in the list. Further investigation showed that different groups and individuals referred to this document inconsistently, using names such as “physics curriculum for diagnostic radiologists”. One lesson is, of course, to try simple search terms first, but another is for

us all to recognize that the name that committees attach to documents does influence our ability to find them again on the Website. As an example of this inconsistency, if you click on Education/Curricula and Teaching Aids from the home page you will find the aforementioned document and also the ASTRO/ AAPM Recommended Radiation Physics Curriculum for Radiation Oncology Resident Physicians, which is its equivalent for Radiation Oncology Physics in substance – but not nearly so in name.

What’s to be done? We are considering the need for a new search engine (and when fiscal prudence allows us to get one) and we are also considering the ways that we can better exploit meta-tags to optimize searching. However, this is also an overt appeal for committees and their councils to consider their choice of names when presenting items for publication on the Website, and a warning that I will now be much more aware of this issue when items are presented.

Problems like these have developed over many years so they are not easily reversed, but feel free to use the feedback link if you have

a comparable general issue (or any other) to report since we can only fix things if we know they are broken.

For urgent issues, however, contact our web-mistress (Farhana) or myself by email.

The feedback link at the end of this article is a small experiment in making the Website a two-way means of communication with members and I assure you that I do read all items posted, and have replied to them in most cases. One member noted that my editorial is published both on the Website (under “What’s New”) and also in the Newsletter, suggesting that this is overkill. It is intended as an experiment – we can publish items about a month earlier on the Website than in the Newsletter, but there is evidence that a significant fraction of the audience prefer the printed word, so I am using both vehicles at this time but may change this later.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www.aapm.org/pubs/ newsletter/WebsiteEditor/3302. asp

Mark your calendar!

American College of Medical Physics Annual Meeting Seattle, Washington • May 3 - 6, 2008 For details see: www.acmp.org Discounted registration fee deadline is: April 2, 2008

27

AAPM Newsletter

March/April 2008

Chapter News Upstate New York Chapter of AAPM honors Arthur Burgess, Ph.D. and John R. Cunningham, Ph.D., OC with its Lifetime Achievement Award Ken Hoffmann and Steve deBoer Buffalo, NY

O

n October 4, 2006, the Upstate New York Association of Physicists in Medicine (UNYAPM) presented its Lifetime Achievement Award to Arthur Burgess, Ph.D., at its Fall Meeting at Rochester General Hospital in Rochester, New York. Dr. Burgess was Professor of Radiology at Brigham & Women’s Hospital in Boston, Massachusetts at the time of his retirement. He received the award in recognition of his contributions to the field of diagnostic medical physics throughout his distinguished career.

In the early 1980’s, Dr Burgess first quantified the absolute performance of human observers and showed that the scope for improvement (vis a vis ideal observers) was very limited as human observers have a relatively high efficiency that exceeded 80% or so. But, Dr Burgess is primarily known for his pioneering work in Alternate Forced Choice (AFC) methodology as an alternative to the more traditional Receiver Operating Characteristic (ROC) methods. Dr Burgess has applied AFC methods to make major advances in our understanding of some of the limitations of medical imaging. Most recently, Dr Burgess was able to quantitatively show, and also theoretically explain, that contrast detail curves in mammograms have a positive slope whereby larger mass lesions are more difficult to detect than smaller mass lesions. As part of the award ceremony, he presented “Mass detection in mammograms: breast density effects”.

At the meeting, there were 6 other scientific presentations and two vendor presentations. Vikas Patel of SUNY Buffalo presented results from 3D multi-view vessel reconstruction.

Dmitriy Akselrod of SUNY Upstate Medical University discussed mAs modulation for pediatric patients.

AP Krishnan and Brian Whitney of the University of Rochester respectively presented modeling cancer dispersion using MR diffusion tensor imaging and low intensity focused ultrasound tissue ablation.

Jubei Liu and George Cernica of Roswell Park Cancer Institute respectively discussed movement in extracranial stereotactic radiation therapy and Gamma Knife beamlets and planning. Informational vendor lectures were presented by Michael Davis, Ph.D. of Varian Medical Systems on dynamic adaptive radiation therapy and by Roger Szafranski of Accuray on the Cyberknife.

The fall 2007 meeting of the Upstate New York chapter of the AAPM was held on October 10th at Roswell Park

Cancer Institute in Buffalo, NY. John R. Cunningham, O.C, Ph.D., was the recipient of the Lifetime Achievement Award this year. Dr. Cunningham is well known for co-authoring the book “The Physics of Radiology” as well as for his pioneering work in the early days of cobalt teletherapy. Some of his most influencial work was in the development of treatment planning algorithms and the use of computers and CT images in the planning of radiation therapy treatments. Dr. Cunningham’s presentation, “An Historical Look at Computerized Radiation Planning,” took us back to the beginnings and through the early history of use of the computers in radiation planning. He described the origins of radiation planning algorithms and how many algorithms can be traced back to common roots.

The description of the use of the programmed console (PC) in the mid 1960’s was nostalgic for some and surprising for others. It was truly inspiring to be reminded what was accomplished given the available computer power.

Dr. Arthur Burgess (2nd from right) receiving the UNYAPM Lifetime Achievement Award from Harish Malhotra, Ph.D., president of the UNYAPM (left) and Secretary/Treasurer Ken Hoffmann, Ph.D. (right).

28

AAPM Newsletter Matthew Podgorsak, Ph.D. of Roswell Park Cancer Institute, Buffalo, NY and Jake Van Dyk, M.S., of London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada gave invited talks. In his talk, “The promise, principles, practice and pitfalls of proton therapy,” Matthew gave an excellent comprehensive and very coherent overview of proton therapy, walking us through the basics up through the arguments for use of proton therapy. Jake presented “To Err is Human: Lessons Learned from Accidents in Radiation Therapy,” reviewing what we have learned as we have moved forward in radiation therapy and how we are now adjusting our protocols and procedures to avoid accidents in the future at the national and international level. Both talks would be ideal for presentation at the national meeting, providing information and insights for students as well as seasoned medical physicist. During the vendor session, Tim Nicholson of VisionRT and Ken Cashon of .decimal presented informative introductions to their companies’ products. In the proffered paper session, Anitha Priya Krishnan, presented “A Computational Model of Cancer Cell Spread in the Brain Based on MR Diffusion Weighted Imaging”, describing her work with Walter O’Dell at the University of Rochester.

As part of the conference, Dan Bednarek, Ph.D, walked us through the Museum of Radiology and Medical Physics on the University at Buffalo campus. Prior to the meeting, the attendees had the opportunity to visit the museum, with Dan Bednarek providing the tour and Jack Cunningham providing firsthand insights into a number of the items in the collection. The collection contains over 500 artifacts including

March/April 2008

Dr. Cunningham receiving the Lifetime Achievement award from Steve deBoer, past president of the UNYAPM. a large number of x-ray tubes, glass plate radiographs, spark-gap voltage meters, early generators, hand-held and direct-view fluoroscopes, darkadapting goggles, radiographic positioning devices, a stereophotofluorographic unit and viewers, a wood-interspaced curved Potter-Bucky grid, and assorted

radiation meters. The museum also houses a library of some of the seminal literature of the field with Roentgen-ray books dating from 1896.

(Contact Dan Bednarek at 716-8984193 or bednarek@buffalo.edu for information about the museum)

Jack Cunningham (left) with Dan Bednarek (right) during the tour of the Museum of Radiology and Medical Physics on the University at Buffalo campus.

29

AAPM Newsletter

March/April 2008

AAPM Ethics’ Committee Communication Issues for the Ethics Committee Chris Serago, Chair Ethics Committee and Per Halvorsen, Co-Chair Ethics Committee

F

rom time to time the AAPM Ethics Committee (ET) is contacted by a member about another member’s possible ethical violation. The contacts are well-intentioned with the goal of correcting a perceived incident or situation of poor ethical behavior.

When ET receives such a contact, we always remind ourselves that our primary purpose is to encourage good ethical behavior of our members. We will attempt to resolve or mediate in a confidential manner questionable ethical situations between members.

Historically, most ethical contacts are resolved confidentially. As a last resort, ET will consider some form of disciplinary action against a member.

Occasionally, there are issues brought to our attention that ET can not address.

Some issues brought to the attention of ET pertaining to a questionable standard of practice of medical physics would be more appropriately handled by another agency, or are simply outside the purview of ET or the AAPM in general. The AAPM is not a credentialing or licensing body such as the ABR or a State licensing authority.

Being a member of the AAPM does not confer upon a person any status that she/he has met a standard to practice medical physics. Practice issues are usually more appropriately addressed by contacting a credentialing or licensing body.

The AAPM publishes information in its directory that is self-reported by their members, but the AAPM does not independently verify that information.

The accuracy of the member’s personal information depends upon the honesty

of the person entering it. An excerpt from a disclaimer in the directory states “The information included in this Directory…..is provided by individual members and is not verified by any employee or volunteer of AAPM.” The process of the AAPM is quite similar to other professional organizations such as ASTRO, RSNA, etc. Nonetheless, a dishonest report of ones credentials is an example of poor ethical conduct.

ET will only consider issues involving AAPM members. Allegations of ethical misconduct by members outside the AAPM are outside of our purview. ET will not act on an anonymous contact, because ET is not an investigative body. We do not have the authority to perform investigations into alleged substandard practice of medical physics or alleged acts of ethical misconduct, which would require discovery of information inside a member’s work place. The committee can only act on information and evidence that is voluntarily provided to ET. Therefore, reporting persons will have to provide

that information, and anonymity is consequently not possible.

Some issues clearly belong within the criminal or civil legal jurisdiction.

Physical assault, discrimination, or sexual harassment are certainly examples of poor ethical behavior, and they may also be violations of the law. These should be reported to local authorities for prosecution in a civil or criminal court, not to ET. ET will defer action on any contact if there is any civil or criminal legal action, or if other administrative action has been filed, or if any such action is anticipated.

On the other hand, verbally abusive behavior may be an example of ethical misconduct, but not a trespass of criminal or civil law, and therefore a matter that ET can consider.

To end on a somewhat different note, TG 109 is working diligently on a new code of ethics for the AAPM. In that we hope to describe a comprehensive code of conduct that all members should strive to emulate. A draft version is available for members to review. (serago.christopher@mayo. edu)

Person in the News

Vijayan R. Aroumougame, PhD, MBA Fellowship in the American College of Healthcare Executives (ACHE)

D

r. Aroumougame was awarded fellowship in the American College of Healthcare Executives (FACHE) for his contributions, expertise and leadership qualities

30

in healthcare management, clinical activities, education and patient care.

Dr. Aroumougame is a Chief Medical Physicist for Saratoga Hospital Radiation Oncology Center in Saratoga Springs, New York. He is also board certified in healthcare management, a premier credential among senior healthcare executives. He serves on the Board of Association of Northeastern New York Healthcare Executives, New Technologies Committee of ACCC and several other healthcare committees, and continues to promote medical physics and radiation oncology among his healthcare executive colleagues.

AAPM Newsletter

March/April 2008

Memorial helped develop dynamic therapy techniques for treating the chest wall, the head and neck, selectively blocking the spinal cord, shielding the lens of the eye, and other sensitive organs. This concept was expanded to include dynamic field shaping during rotational treatments in the abdominal and pelvic area.

Kenneth A. Wright, M.S. 1919-2008

O

n January 7, 2008 the AAPM lost one of its Charter members, Kenneth A. Wright. It is difficult to describe this man, his activities, his influence on those entering the field of medical physics and his contributions to the field over the years. Ken’s area of expertise was high energy electrons especially in the clinical environment. Ken joined the staff of the High Voltage Research Laboratory at MIT in 1947 and was involved with the MIT / Lahey Clinic radiation therapy program from its inception in 1949 until 2002. Working with Robert J. Van de Graaff and John G. Trump, he was instrumental in bringing the Van de Graaff accelerator into the clinical arena for both photon and electron therapy. Ken’s contributions in this area included conformal rotational therapy techniques, dynamic selective normal organ protection and total skin irradiation.

Recognizing the difficulties in rotating a heavy accelerator around a patient, Ken helped develop the technique of immobilizing a patient on a rotating platform positioned in front of the accelerator. With this geometry and employing synchronous motors, he

Ken was also one of the early pioneers in the field of total skin electron with special emphasis on the treatment of Mycosis Fungoides.

This evolved into Lahey Clinic’s role as one of the major centers in the world for treating this disease.

Again, Ken helped develop a unique treatment method, one where the patient was transported beneath the electron beam, rather than requiring the multiple fields used with most linear accelerator applications.

Other areas of academic interest included investigating the sterilization of biological tissues as blood products and bone grafts.

Ken also participated in various studies relative to food sterilization and preservation. In later years he became involved with the use of radiation in the sterilization of waste products and sludge.

Ken’s activities with the AAPM started pre-AAPM with involvement in the Boston Medical Physics Group, later to become the New England Chapter of the AAPM. Ken was a Charter member of the Association and served on many committees and task groups over the years. His most notable contributions were in the radiation therapy committee and as chair of the Radiological Physics Centers committee.

Ken received the ‘Award for Achievement in Medical Physics’ in 1998.

31

Ken contributed to the training of many medical physicists including Edward W. (Ted) Webster, Basil S. Proimos and Herb Mower.

Ken held undergraduate degrees from Haverford College (1941) and MIT (1947) and a Master’s Degree from MIT in 1955.

Ken’s recreational activities included skiing, sailing and working with silver.

Ken was an accomplished silversmith and was an active skier and sailor right up into this century. Ken enjoyed racing in sailing events and served as Commodore of the Sandy Bay Yacht Club. He also served on the Board of Overseers at the DeCordova Museum and Sculpture Park.

Ken is survived by his wife of 60 years, Marguerite “Peg” (Fleming), their four daughters: Margo Dudley, Winifred McGowan, Amy Wright and Carolyn Wright, six grandchildren and two greatgrandchildren.

Herbert W. Mower Burlington, MA

AAPM and Doyle Printing Green Partners

Editor

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

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

PRINT SCHEDULE • • • •

The AAPM Newsletter is printed bi-monthly.

Next issue: May/June Submission Deadline: March 19, 2008 Postmark Date: April 14, 2008

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