AAPM Newsletter May/June 2008 Vol. 33 No. 3 by AAPM Docs

Newsletter

A MERIC A N ASSOCIATION OF PHY SICISTS IN ME DI CI NE VOLUME 33 NO. 3

MAY/JUNE 2008

AAPM President’s Column

Gerald A. White Colorado Springs, CO

hysics giveth and Physics taketh away and Physics giveth and Physics taketh away. Reflecting on the efforts of physicists over the last 100 years in applying ionizing radiation to diagnosis and therapy of disease, this pattern seems to have been with us from the beginning. The discovery of electrically produced x-rays and emanations from naturally occurring unstable elements set us on this oscillating road. Deposit energy differentially in tissue and images of bones, rings and bullets appear… malignant tissue dies, all advances but not without a cost. There were efforts to increase the dose available for medical uses (higher specific activities, heated cathodes, rotating anodes) and then efforts to reduce the dose necessary to achieve the desired benefit and increase the efficiency of the collection of information or therapeutic effect. (Intensifying screens, collimated beams, higher energy photons,

electron beams, image intensifiers, then rare earth screens, high quality mammography, beam modeling and CT based isodose calculations.) The window of opportunity for self-congratulatory thoughts on dose reduction was short lived, however. Invasive imaging procedures with high power capacity x-ray tubes and high dose tolerant image receptors, multi-slice CT systems with even higher power x-ray tubes, precision therapeutic delivery systems (3D CRT, IMRT, HDR) with the ability to spare normal tissue have all raised the dose ante yet again. We find ourselves with the opportunity to be in the lead as medicine engages what seems is a Sisyphean task to gain ever more benefit from the deposition of energy in tissue while doing minimal harm. We find ourselves on both sides of the rock and yet, I believe, when we look around we don’t see Hades, we don’t feel punished, we are enthused, we are, if I can be forgiven for the choice of words, energized. Yesterday I returned from a Friday and Saturday of AAPM meetings in Chicago -- Executive Committee, Council Chairs and Board of Directors. There was a level of enthusiasm and energy there also, a level that I would describe as comforting. We talked and argued, grimaced and laughed, focused and wandered – not so much about the science and technology of the rock described above but rather about

the handgrips, greasing the skids, who pushes where and how hard, how big is the rock, and how big is the hill. It was an interesting mix of back office infrastructure discussion and long-term direction setting. How will the AAPM participate more fully in national and international activities that set the standards for the equipment and processes we use? IHE, DICOM, IEC, ANSI, acronyms for organizations with a significant influence on us and our work; soon, we hope to have an even more robust AAPM organizational connection. The 2012 initiative response begins to take shape amidst both optimism and anxiety (two emotions that together can give rise to rapid change). The influence of (see White p. - 2) TABLE OF CONTENTS Chair of the Board’s Column President-Elect’s Column Executive Director’s Column 50th Anniversary update Editor’s Column Education Council Report Physics Education Taskforce Professional Council Report Science Council News Awards & Honors Leg. & Reg. Affairs Health Policy/Economics Chapter News Person in the News Website Editor’s Report Workgroup on Clinical Trials Ethics’ Committee Update Growing ROSIS

p. 2 p. 3 p. 4 p. 6 p. 7 p. 8 p. 9 p. 10 p. 11 p. 14 p. 16 p. 19 p. 21 p. 22 p. 23 2 p. 24 p. 26 p. 27

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Chairwoman of the Board’s Column for a vote soon. And later in the meeting, a subject eliciting ardent dialogue (at least by the Chair) was the formation of an Administrative Council, in order to better interact with ten administrative committees that directly report to the Board. But that’s a topic of a future column with a little more detail about the debate. Mary K. Martel UT MD Anderson Cancer Center

our Board members converged on Chicago this past weekend for the first of three Board meetings this year, and had to brave the Windy City fog and the 3000 canceled American Airline flights. This spring meeting was added for the first time last year in order to devote more time for long-term strategic planning for the AAPM. I note as I begin my third year on the EXCOM that more and more time is spent on open discussion/planning at all Board meetings during the year, as we move away from in-person reports from the Councils and administrative committees. At this meeting, then, the Board was able to spend 6+ hours in extended discussion on a number of topics. For one, a revised mission statement for the AAPM developed by the Professional Council’s Clinical Practice Committee and supported by the Education and Science Council was endorsed by the Board. Look for this mission statement on the AAPM website, to be posted soon. Another topic, a proposed dues increase, was fervently discussed with reference to the financial health of the AAPM, and was ultimately passed by the Board. Since dues increases must be also supported by the membership, look for a call

There were a number of other agenda items, but two stood out as reflecting what may be the changing face of the medical physics field. One is what will the AAPM’s role be as a leader in the development of technology. While many of our members may be involved in areas such as IEC, DICOM, IHE, ANSI etc; the AAPM has no cohesive effort in defining a role for our organization. It was clear from the ensuing Board discussion that this was a very “active” topic and worth exploring further. President White agreed to form an ad-hoc committee to look at what coordinated effort was needed within the AAPM. And the next matter, of course, was the 2012/2014 initiative dealing with the change in ABR eligibility requirements. A task list was presented as developed from a January Summit meeting (see previous newsletter). Reports were presented by John Bayouth, chair of the residency directors’ group and Jim Dobbins, co-chair of the academic program directors’ group, as an update on the status of increasing the number of residency and graduate programs obtaining CAMPEP accreditation. Without going into detail here, we were encouraged to learn that there is great potential in having 100 + residency graduates by the year 2014. Education Council’s Tony Seibert detailed some ideas

that could help overcome some of the identified impediments that institutions are facing in developing residency programs. Various groups within the AAPM have been tasked and will continue to give updates at upcoming Board meetings. The AAPM membership has access to all Board meeting minutes, which may be found on the AAPM website.

(White from front cover) recent Federal imperatives on open access (for publications describing work funded by the NIH) may have an impact on Medical Physics. All diverse issues, appealing, on the surface, to very different constituencies within AAPM. As we all gathered to confer and debate

on these (and other) issues there was a remarkable confluence of energy and interest, seldom a note of a parochial plunge into the often postulated but, I believe, usually illusory differences among ourselves based on professional path. We move forward together on so many endeavors with a refreshing spirit of energy as we honor the past, celebrate the present and 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 now available!

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March/April May/June 2008

AAPM President-Elect’s Report serve a once-renewable three-year term, and then rotate. At the AAPM annual meeting, members can attend many of the (sub-) committee meetings as a “guest” as a means to meet the chair and further understand the goals of the committee.

Maryellen Giger University of Chicago

Getting Involved edical Physics is an evolving field, including new scientific discoveries and developments, new shifting clinical roles, and new educational/training requirements. The AAPM website offers many links to enhance your involvement in these various aspects. Your involvement in the various committees, subcommittees, and groups within the three Councils as well as along the administrative branch helps ensure the continued growth of our association in these areas. Click on http://www. aapm.org/org/structure/ to start examining the various areas of your potential involvement.

Likewise, committee and subcommittee chairs can directly “advertise” available member volunteer positions within the AAPM in the Committee Classifieds at http://www.aapm. org/aapm_advertising/committee_ classifieds/. I encourage ALL chairs to review their committee rosters and post necessary positions. Getting involved as a committee/ subcommittee member is a step towards serving later as committee co-chair or chair. Chairs usually

The AAPM offers many avenues at which you can refresh your scientific, educational, and professional understandings as a medical physicist, including for example, the annual meeting, summer schools, and our journal. The AAPM’s website lists a workshop on “Becoming a Better

Teacher of Medical Physics” and a summer school on “The Physics and Applications of PET/CT Imaging.” Also, throughout this 50th anniversary year, Medical Physics is publishing a range of anniversary papers that illustrate the role of medical physicists and the AAPM in specific developments in medical physics. And efforts on the professional aspects of medical physicists are continuing on the 2012 initiative and the licensure initiative. This year is passing quickly, don’t let it pass you by without getting involved.

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.

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AAPM Executive Director’s Column are placed into summer positions that are consistent with their interest. Each Summer Fellow receives a $4,000 stipend from AAPM. For more information on the program, go to: http://www. aapm.org/education/SUFP/ default.asp

Angela R. Keyser College Park, MD

AAPM Salary Survey The AAPM Salary Survey questionnaire was circulated electronically at the end of March. I encourage you to participate in this important data gather exercise. The survey process is managed by the Statistical Research Center of the American Institute of Physics, under the direction of the AAPM Professional Survey Subcommittee. If you have any questions about the form itself, please contact Julius Dollison at (301) 209-3059 or at jdolliso@aip.org. Summer Undergraduate Fellowship Program This year sixty-seven undergraduate students competed for fourteen AAPM Summer Fellow positions. The program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match students with medical physicists. Students participating in the program are selected on a competitive basis and

Election Processes Elections for the 2009 PresidentElect and Board Members-AtLarge will open on June 18 and will run through July 9. Again this year AAPM will use the Bulletin Board System (BBS) during the election process to allow members to discuss issues of concern with the candidates and the election in general. Be alert for email announcements or your hardcopy ballot. Summer School Update AAPM offers scholarships in the form of a waiver of tuition for the Summer School. Congratulations to the six recipients in 2008: Amar Basavatia, Mohamed M Galal, Liang Liang, Jana E. Musgrove, Ping-Fang Tsai, and Stella Veloza. In addition, Capintec sponsors two $500 grants to assist with other expenses related to the Summer School. Capintec established these grants to honor the memory of Arata Suzuki, Ph.D., who was part of Capintec for more than 20 years. Jana E. Musgrove and Stella Veloza are the recipients of the 2008 Suzuki grants. Make sure to register for the 2008 Summer School by May 16 to take advantage of discounted registration fees. 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 ninety-six participants. Annual Meeting News The 50th AAPM Annual Meeting will be held July 27 – 31 at the George R. Brown Convention Center in Houston, Texas. It is exciting to hear from AAPM Charter Members who are making plans to be with us in Houston. Indications are that this will be a fitting tribute to the great history of the AAPM and the medical physics profession. I am personally looking forward to the “Meet the Charter Members Reception” to be held on Monday July 28 from 5:00 PM – 6:00 PM in honor of AAPM’s Charter members, just prior to the Awards and Honors Ceremony in the convention center. What a great way to honor AAPM’s past, by chatting with the members responsible for setting the course for the AAPM. Dates to remember: • Meeting program available online by May 14. • Register by June 11 to receive discounted registration fees. • June 25 is the last date to make housing reservations at the convention rate. Please go to www.aapm.org and click on “Meetings” for the latest information. Teaching Workshop AAPM is holding a teaching workshop, “Becoming a Better Teacher of Medical Physics”, July 31 – August 3 at the South Shore

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Harbour Resort and Conference Center in League City, Texas. This workshop is designed to help medical physicists become better teachers of physicians, graduate students and technologists. In addition to featuring a number of keynote and plenary speakers, participants will engage in several work sessions designed to learn from one another. The objective of the workshop is that each participant will leave with an action plan he or she has designed to be a better teacher. For a full course description and registration information, go to: http://www. aapm.org/meetings/08Workshop/ AAPM E-Store Order your AAPM’s 50th Anniversary items and help AAPM celebrate its birthday. Go to the AAPM 50th Anniversary Gift shop

May/June 2008

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/

at: http://www.apisource.com/ aapm/ . Remember, items will not be for sale during the Annual Meeting, so don’t delay in ordering your items today! Staff News Noel Crisman-Fillhart is transitioning from her position as Staff Accountant I to the newly

created position of Administrative Assistant. In this new position, Noel will provide support to AAPM’s legislative and regulatory affairs initiatives, working with Lynne Fairobent and Amanda Potter.

Professional Program Highlights • • • • • • • • •

Ethics in Medical Physics Practice, Research and Education and the New AAPM Code of Ethics. Bill Hendee will review the need for our association to adapt a formal code of ethics. The draft code of ethics developed by TG 109 will be presented. Professional Comportment – Experts inside and outside of medical physics discuss how YOU look/act/speak professionally. Current Economics Essentials – Technical reimbursement, ASTRO perspective on new technology and the 2007 Abt Medical Physics Work study ABR Update – Current exam status, 2012/2014 datelines and MOC Civil Law, Ethics and the Medical Physicist – The perspective of professional legal and ethical issues medical physicists may encounter in their career will be given by an experienced attorney who is also an experienced medical physicist. Case examples will be discussed. Clinical Practice and Professional Services – Member services, task group professional reviews and the reality of the CARE bill. Meet the Experts – Research and Practice in Imaging and Therapy. Quality and Errors - Quality in Radiation Therapy: what is it and how do you achieve it? Legislation and Regulation – Experts discuss “The Good the Bad and the Ugly” of Regulation in a SAM session. Sam Keen will be featured in the Professional Session on Professional Comportment Monday afternoon, providing insight that each of us must think about. Sam was, in his words, “overeducated at Harvard and Princeton” and was a professor of philosophy and religion at “various legitimate institutions” and a contributing editor of Psychology Today for 20 years before becoming a free-lance thinker, lecturer, seminar leader and consultant. He is the author of a baker’s dozen books, and a co-producer of an award winning PBS documentary, Faces of the Enemy. His work was the subject of a 60 minute PBS special Bill Moyers--Your Mythic Journey with Sam Keen. More information on Sam Keen can be found at: http://samkeen.com/home/. 5

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50th Anniversary Update member. He is not able to attend, but I have excerpted the following from his letter to us.

Jean St. Germain, Chair Ad-Hoc Committee on Golden Anniversary Planning Countdown to Houston!

ne of the highlights of our 50th Anniversary will be the opportunity for our members to meet some of our Charter Members at a special reception for them which will be held immediately before the Awards Ceremony on Monday afternoon. Some of you will remember the first editor of our journal, Edward Siegel, a charter

“Needless to say, I am very gratified by the Association’s growth and its expanding roles, particularly for exploiting the physics involved in radiation therapy and also, to a lesser extent, in diagnostic radiology and nuclear medicine. While clearly the AAPM and its Journal are flourishing, I regret that their scope remains restricted, contrary to the early hopes and visions we had fifty years ago; as is still confirmed by our society’s name and constitution, the neoteric organization was expected to promote the applications of physics and mathematics comprehensively, i.e., to all pertinent facets and specialties of medicine. I had hoped that we, as concerned physicists,

would assume and foster, acoustics, optics, electricity and magnetism, fluid dynamics, temperature and heat, etc. – rather than almost solely as has ensued, to the clinical implications of radiation. (By the way, this view, as you may be aware, is more in keeping with the approach being pursued by the Hospital Physicists’ Association (HPA) of London). I’d be grateful for your conveying my regrets in not being able to be present in Houston and my best wishes for the continued health of the AAPM.” We are also happy to report that Gail Adams, first President of AAPM, and his wife, Reba, will be with us in Houston. I hope that our younger members will take advantage of this unique opportunity. See you there!!!

Practical Medical Physics Highlights • ACR Accreditation in Nuclear Medicine and PET - A Practical Guide • CR Mammography - What You Need to Know • Routine Testing of CR and DR Radiographic Systems • Diagnostic Radiology Resident Education • The Challenges of CT Accreditation • HAZMAT Training Course Part I • HAZMAT Training Course Part II • Introducing Brachytherapy Into the Clinic

2008 AAPM Annual Meeting Dates to Remember: • • •

BY MAY 14 Scientific Program available on-line. JUNE 11 Deadline to receive discounted registration fees. JUNE 25 Housing reservation deadline. 6

In case you haven’t heard! AAPM will celebrate its 50th Anniversary this year. For those of you who remember the 1950’s [and you know who you are], we will start our Gala celebration in Houston with some music and dancing to 1950’s swing. So, work off some calories before dinner by joining us at the pre-Gala reception in Houston. Meet new friends or visit with familiar faces. Be there or be square!

AAPM Newsletter

May/June 2008

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

his issue of the newsletter includes articles from EXCOM discussing various challenges our field is facing and the initiatives AAPM is undertaking to respond to such challenges. These challenges and initiatives are providing the organization, as we celebrate our 50th anniversary, an opportunity to increase its visibility more in the field of medicine. Consider our organization as the center of the hub for the profession, with these challenges and initiatives like many spokes on a wheel. When properly handled, these will propel the profession at an even faster rate in the near future. In this issue, I would like to draw your attention to one such initiative, ‘Web-Based Instructional Modules’. This announcement from the RSNA-AAPM Physics Education Task Force (page 9) would like to give a heads-up: look for the Request for Proposals (RFP) in June inviting members to apply for developing instructional modules to teach medical physics concepts via images.

For all those who wish to contribute articles for the newsletter, I would like to take this opportunity to provide certain basic guidelines for articles. Short and brief articles are always welcome from a reader’s point of view. In fact, in the newsletter survey, many commented on article length as a reason for just skipping rather than even skimming through the article. Secondly, the cost of printing the newsletter increases proportionally with the number

of pages. As a rule, articles of approximately 750 words will take up one print page, and articles longer than two pages have higher probability of readers skipping the article entirely. Having said that let me stop here to make my column short and brief. Finally, I would like to congratulate all the recipients of the AAPM awards (pages 14-15). I am looking forward to the Awards Ceremony in Houston.

Self Assesment Module Highlights (SAMS) SAM Session 1: • • SAM Session 2: • SAM Session 3 • SAM Session 4: •

THERAPY SAMs: Clinical and Radiobiological Considerations Physics and Dosimetry Considerations Panel Session: kV vs. MV CBCT Panel Session: The Management of Motion: Technologies and Practical Limitations Introduction To: Quality Assurance for Advanced RT TechnologiesThe Challenge for RT Clinical Trials • Image Fusion for Target Denition • Requirements for Addressing Respiratory Motion in Cooperative Group Clinical Trials • Heterogeneity Corrections in Clinical Trials • Credentialing IGRT Verication Techniques for Clinical Trials • TG113: Improving Treatment Consistency and Data Quality for Clinical Trials

DIAGNOSTIC IMAGING SAMs: SAM Session 1: BREAST IMAGING • Film-screen mammography MQSA requirements • Digital detector QC, tips and problems SAM Session 2: PHYSICS AND TECHNOLOGY OF COMPUTED TOMOGRAPHY • CT Accreditation Program: What’s New for 2008 • Design and Performance Evaluation of Cone Beam CT Systems SAM Session 3: THE PHYSICS AND TECHNOLOGY OF MAGNETIC RESONANCE IMAGING • MRI I • MRI III SAM Session 4: RADIONUCLIDE IMAGING • PET/CT: Technology Updates, Quality Assurance and Applications • SPECT/CT: Technology Updates, Quality Assurance and Applications

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Education Council Report

Herb Mower Education Council Chair

he Education Council started the 2008 year with two new committee chairs, a new committee member and two major challenges on its agenda. We welcomed George Starkschall as the new Chair of the Education and Training of Medical Physicists committee and Doug Pfeiffer as the new Chair of the Medical Physics Education of Allied health Professionals committee. Perry Sprawls joined the Council in the newly created position of Assistant Editor for Education to the Website Editorial Board. In addition to our regular concerns, the Council is also actively involved with two special programs: (1) the teaching of medical physics to residents and physicists and (2) the requirements for accredited medical physics graduate and residency programs to meet the 2012 / 2014 requirements to sit for ABR Board Certification. In order to familiarize all members of the Council with these challenges, the Council had a one-day retreat at the end of February. Several important items were discussed. I will try to review these over the course of the next few Newsletters. We first met with Mary Martel and Maryellen Giger in order to have a clear picture of EXCOM’s

perceptions of the goals and direction for the AAPM in the upcoming years. They identified four points that are foremost on EXCOM’s agenda: 1. Communication 2. Understanding the importance of the 2012/2014 initiative 3. Need to increase accredited programs 4. Today is a major turning point in our profession Becoming a Better Teacher of Medical Physics: This is a 2.5 day workshop that will immediately follow the 2008 AAPM Annual meeting. It will be at the South Shore Harbour Resort and Conference Center in League City, Texas, a short distance from Houston. Shuttle busses will be provided late Thursday afternoon, July 31st to transport Annual Meeting attendees to the workshop. The focus will be on the challenges and opportunities of effective teaching of medical physics to various constituents. This program under the direction of William Hendee with the assistance of Ervin Podgorsak and Herbert Mower has assembled some of the top people in the field of educating adults, especially professionals. They will utilize interactive sessions in order to assess the challenges of teaching medical physics. As a part of the program each participant will be expected to complete a selfdirected educational project (SDEP) as outlined in the Maintenance of Certification (MOC) program of the American Board of Radiology (ABR). Other AAPM members on the faculty for the Workshop include: Jay Burmeister, Philip Heintz, Edward Jackson, Mary Martel, Victor Montemayor, Russell

Ritenour, Anthony Seibert, George Starkschall, and Stephen Thomas. In addition we will be joined by Gary Becker, George Nikiforidis and Edward Redish. The announcement, program and registration material are available on the AAPM website (www.aapm.org). 2012/2014 Initiative Financial Assistance: In 2007 the Board approved an expenditure of up to $100,000 to assist clinical residency programs that are developing or upgrading. To this end the Council has approved the allocation of funds for the following: 1. Fall meeting of the 2012 Initiative Group. This is a follow-up of a working group that is actively investigating this challenge on an accelerated track. 2. Workshop for non-CAMPEP accredited residency directors relative to completion of the selfstudy requirement for applying for program accreditation. 3. Workshop for non-CAMPEP accredited academic program directors again addressing the application requirements for program accreditation. 4. Funding for a group of nonCAMPEP residency programs to complete the CAMPEP process 5. Funding for a demonstration “Distributed Residency” program for each of two modules: • A resident from a larger institution going out to a smaller institution • A resident at a community hospital going back to the ‘mother’ institution 6. Assistance in launching a Doctor of Medical Physics Program with acquiring CAMPEP approval.

AAPM Newsletter Although the details of these various grants are not finalized at this point, pending review by the Board at their upcoming April meeting, I would encourage anyone wishing to be considered for a grant under items 4-6 to forward a 1-2 page proposal to me indicating your program objectives, a proposed plan of action, and a budget figure to be considered. Anyone wishing to be considered for participation in either of the workshops noted in items 2 and 3 should also forward to me a 1-2 page request for consideration including a brief description of your program and your sincere intent to apply for CAMPEP approval. Although the exact funding mechanisms and opportunities have not been defined at this point, grants will be made for one-time expenses. Thus, grants will not be considered which are asking for financial support/ stipends for residency positions or other normally

recurring expenses. Our goal is to increase residency programs and opportunities in the next four to six years to meet the requirements to sit for the ABR exam in 2014. Preference will be given to programs addressing clinical residencies for diagnostic medical physics programs as there is a greater need in this area to meet the demands of 2012/2014. Wed-based Training Modules: William Hendee is chairing a Task Group that is gearing up to request proposals from individuals and institutions for the creation of web-based modules to be used in teaching medical physics. The first of these will be for teaching medical physics primarily to diagnostic radiology residents. The Task Group, working in conjunction with the RSNA / AAPM Physics Education Task Force is close to formulating the desired format for these modules. Two are currently

May/June 2008 well under development in order to demonstrate this format. It is expected that in early June we will be putting out a notice for â&#x20AC;&#x2DC;requests for proposalsâ&#x20AC;&#x2122; to those who are interested in being considered to develop one or more of these modules (see below). In the initial offering we hope to have 25 modules completed within the first year with additional modules to follow. In future articles in the Newsletter we will review other actions from the retreat including the upcoming activities for the various committees, subcommittees and task groups. Also many of these items will be discussed at the various committee and task group meetings at the start of our annual meeting in Houston. All of these meetings are open so feel free to drop in on some of them, see what is happening, and provide input as you see fit.

RSNA-AAPM Physics Education Task Force Web-Based Instructional Modules Bill Hendee, Chair RSNA-AAPM Physics Education Task Force

he RSNA and the AAPM are collaborating on the development of 50 web-based instructional modules on the basic science underlying imaging. The modules will be produced in two phases. Phase 1, which is underway now, will include modules on Radiography, Mammography, Fluoroscopy, Computed Tomography, Ultrasound, Magnetic Resonance Imaging, Nuclear Medicine and Radiation Biology. Phase 2, covering Basic Science and Radiation Protection, will be initiated as Phase 1 is completed.

The modules are intended primarily to help resident radiologists learn the science of imaging through access to web-based instructional materials when and where needed. Assimilation of information in each module should take about 45 minutes, not including the 1520 self-test questions at the end of the module. Each module will be developed by a team led by a physicist and including one or more radiologists. Development teams will be acknowledged as the authors of modules, and will be remunerated for their efforts. A Request for Proposals (RFP) will be released in early June for development of the educational content for the instructional modules, with a response deadline of

July 15. RSNA staff will format the educational content into web-based modules; the development teams are asked only to provide the educational content. Two example modules, one on CT Dose and another on Dose in Interventional Procedures, are being completed, and will serve as models for preparation of modules under the RFP. The RFP offers an excellent opportunity for physicists and radiologists to work together to improve the basic science education of resident radiologists, and to be recognized and remunerated for their contribution. Please watch for the RFP on or about June 1.

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Professional Council Report FTE radiation oncology physicist, the median workload is close to 300 patients per year; this is very close to the standard used by the Canadian government to set employment for medical physicists in Canada. By the time this is published, the Abt III Report should be published on the AAPM website.

Michael Mills Professional Council Vice-Chair

fter digging out from 14 inches of snow on March 7, we have finally turned the corner in Louisville, and it looks like spring has arrived at last! Beginning with some good news, we received confirmation that S. 1042 passed the Senate HELP Committee. Our new best friends should be members of the Senate Finance Committee who will now be charged with ensuring that there is a financial incentive for the Secretary of HHS to enforce the standards they develop. As of today we now have 132 cosponsors on HR 583 and 24 cosponsors on S. 1042 with more to follow soon. Thanks to all who have sent emails and made phone calls to Senate and House members on the CARE legislation. The work is not over and we will need to focus our efforts even stronger in the next few months to get the bills passed and enacted into law. The Abt III Report is complete and the final conference call for the Expert Panel to review the document has been scheduled. The Abt reports document medical physicist effort, work and manpower associated with the range of CPT codes that involve work by medical physicists. For a

My second meeting with the Advisory Panel on Ambulatory Payment Classification (APC) Groups took place March 4-7. There was some discussion about the controversial packaging of radiation oncology imaging and delivery codes. In addition, there was a long discussion about the pricing and reimbursement mechanism for some pricy radionuclide therapies, Bexxar and Zevalin. Again, about ½ of the issues before the Panel concerned either radiation oncology or imaging issues. While it is regrettable that CMS did not accept the unanimous Panel recommendation that imaging and delivery codes not be bundled, we do not expect this decision to be changed. We have an action item for you from the Ethics Committee. TG 109 has a draft code of ethics completed for you to consider. Elsewhere in this Newsletter is an invitation for members to review and submit comments on the draft. I hope you will review the document and make any appropriate comments. The Professional Program of the annual meeting will contain some unique forums and opportunities. We have a commitment from two ASTRO Health Policy Radiation Oncologists, Drs. Najeeb Mohideen and Paul Walner to speak at the

Houston meeting, Economic Forum on Monday, 4-5:30 pm on Reimbursement for New Technology in Radiation Oncology. Plans now are for me to speak on the Abt III survey sometime during the annual meeting. Many of you check the Placement Services section of the AAPM website from time to time. There is a movement to redesign the website with new features and more interactivity. Stay tuned for more to happen in this area. Also, by now, the Professional Information Survey is being performed. Please be sure to participate in this; it only takes a few minutes. Also kudos to all involved, the Committee Classified section is functioning quite well, and I used it myself to put together the Diagnostic Work and Workforce Study Subcommittee (the so called “Diagnostic Abt” subcommittee). The goal of the subcommittee will be to provide the same quality of information for imaging physicist work and workforce that the Abt studies have provided for radiation oncology physicists.

PROPOSAL TO INCREASE MEMBERSHIP DUES Make plans to attend the Annual Business Meeting on July 30, 2008 in Houston, Texas, where members will discuss the Board approved proposal to increase AAPM membership dues for 2009-2013. Detailed information will follow.

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Science Council News working in radiation oncology being slightly younger than those in medical imaging.

John Boone Science Council Chair

cience Council met recently during a snowstorm in St. Louis, MO at Washington University, with Dan Low as host. Over two days, we discussed a number of issues which influence the scientific agenda of the AAPM. We considered developing position papers in regards to proton therapy, CT utilization and dose, as well as computer aided diagnosis. These are all areas which are receiving a lot of attention, both inside and outside our field. Stay tuned for those. In an attempt to better understand the AAPM constituency that Science Council serves, and with Michael Woodward’s help, an analysis of the AAPM membership was performed. I thought that this information is interesting and useful, so I will share it here. The majority 54% of AAPM members are involved exclusively in radiation oncology, while 15% of AAPM members are involved exclusively in diagnostic imaging (Figure 1). A total of 10% of members are involved in both diagnostic and therapy physics, while 20% of our members did not specify a specialty. If the “decline to state” members are reapportioned by ratio to the Rx, Dx, and Both categories, the numbers become 67% therapy, 19% diagnostic, and the remaining 13% as both Rx and Dx. The AAPM has a broad age distribution (Figure 2), with physicists

In terms of education, 49% of therapy physicists hold master’s degrees, while 48% hold Ph.D.’s (Figure 3). For diagnostic medical physicists, 37% hold master’s degrees and 60% hold Ph.D.’s (Figure 4). These numbers, combined with a working knowledge of our field, suggest that many of those in radiation oncology are involved primarily in clinical work, while

residency. This training experience has been suggested by some as a partial response to the American Board of Radiology’s mandate that by 2012, ABR board certification will require a residency. Rock Mackie reported that his institution considered such a degree program, but after more detailed analysis it was decided that such a program would not be financially viable within the University. While the DMP / ABR issue is primarily an issue for Professional and Educational Councils, how the medical physicists

Fig 1: AAPM membership by specialty

diagnostic medical physicists are perhaps more likely to be employed in academic positions.

of the future are trained impacts the scientific mission of the AAPM as well.

The above observations have a bearing on the current discussions of the professional degree “DMP”, Doctor of Medical Physics, which would essentially be two years of training and two years of clinical

Science Council now conducts its business during two retreats per year, and this schedule gives us the necessary time to thoroughly discuss issues before the council. As a result, we no longer convene for extended

Fig 2: AAPM membership by age group

AAPM Newsletter

May/June 2008

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AAPM Newsletter council meetings during the annual meeting, which in the past proved to be perfunctory due to the limited time available. Therefore, this year at the annual meeting in Houston, I will schedule a “town hall meeting” for a small core of Science Council members (chair and vice chairs), where any AAPM member is welcome to come and bring forward issues which are on their minds that are pertinent to the scientific mission of the AAPM. Please come and share your thoughts with us.

Fig 3: Radiation oncology physicists by degree status

May/June 2008

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.

Fig 4: Diagnostic Physicists by degree.

AAPM Newsletter

May/June 2008

Congratulations to the recipients of the following awards, achievements and honors in 2008! William D. Coolidge Award is presented to: Paul L. Carson, Ph.D. Award for Achievement in Medical Physics is presented to: Kenneth R. Kase, Ph.D. and James M. Galvin, D.Sc. AAPM-IPEM Medical Physics Travel Grant is presented to: Jean Moran, Ph.D.

AAPM Medical Physics Travel Grant is presented to: Jun Deng, Ph.D.

Honorary Membership is presented to: Allen S. Lichter, M.D. Sylvia Sorkin Greenfield Paper Award (non-dosimetry) is given for: “Functional imaging of cerebrovascular activities in small animals using high-resolution photoacoustic tomography” by Sihua Yang, Da Xing, Quan Zhou, Liangzhong Xiang, and Yeqi Lao

Medical Physics 34, Number 8/3294, 2007 Farrington Daniels Paper Award (dosimetry) is given for: Computation of the glandular radiation dose in digital tomosynthesis of the breast” by Ioannis Sechopoulos, Sankararaman Suryanarayanan, Srinivasan Vedantham, Carl D’Orsi, and Andrew Karellas

Medical Physics 34, Number 1/221, 2007 14

AAPM Newsletter

May/June 2008

Congratulations to the recipients of the following awards, achievements and honors in 2008! The following are named Fellows in 2008 for their distinquished contributions to the AAPM: Muthana S. A. L. Al-Ghazi, Ph.D. John A. Antolak, Ph.D. Sam Beddar, Ph.D. Stanley H. Benedict, Ph.D. Dianna D. Cody, Ph.D. Henry T. Heaton II, M.S. David J. Keys, Ph.D. X. Allen Li, Ph.D. Robin A. Miller, M.S.

Norbert J. Pelc, Sc.D. Robert A. Phillips, Ph.D. David R. Pickens, Ph.D. Jeffrey V. Siebers, Ph.D. Chris C. Shaw, Ph.D. Raymond K. Wu, Ph.D. Yan Yu, Ph.D. Yunping Zhu, Ph.D.

All of the award, achievement and honor recipients will be recognized during the 2008 AAPM Annual Meeting in Houston, TX at the Awards and Honors Ceremony and Reception. Please join us in congratulating all of the recipients: DATE: TIME: PLACE:

Monday, July 28, 2008 6:00 PM Auditorium B, Level 3 George R. Brown Convention Center

The 2009 Call for Nominations and Applications is available on the AAPM Web site at: http:://www.aapm.org/org/callfornominations.asp#nominations or you can get to this via the AAPM Home page under “What’s New.” Please note that the deadline to receive completed nominations and applications is: October 15, 2008.

AAPM Newsletter

May/June 2008

Legislative and Regulatory Affairs Column National Academies of Science/ National Research Council (NAS/ NRC) issues report on “Radiation Source Use and Replacement”

Lynne Fairobent College Park, MD

Senate Health, Education, Labor and Pensions (HELP) Committee passes S. 1042 CARE legislation out of committee

n Thursday, March 13, 2008, the Senate HELP committee voted to move forward the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill, or CARE bill (S. 1042) out of committee. I would like to thank all of the AAPM and ACMP members that have responded to the various “Calls 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. The next major effort will be focused on the Senate Finance committee and having S.1042 voted on by the full Senate. This will be followed by a push in the House.  If you have questions, please contact, Lynne Fairobent, AAPM’s manager of Legislative and Regulatory Affairs at lynne@aapm.org.

The NAS/NRC completed a study requested by the Congress to address concerns that devices containing cesium-137 and other high-risk radionuclides could be stolen for use in a terrorist attack, i.e., as a potential ingredient for a dirty bomb. The committee that wrote the report was asked to examine the uses of highrisk radiation sources and to identify lower-risk alternatives. The overall conclusion reached by the Panel was that “the U.S. government should take steps to promote the replacement of radioactive cesium chloride radiation sources, a potential “dirty bomb” ingredient used in some medical and research equipment, with lower-risk alternatives.” Copies of Radiation Source Use and Replacement are available from the National Academies Press; tel. 202334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu/ catalog.php?record_id=11976. This study was sponsored by U.S. Nuclear Regulatory Commission.

This study, including a summary of all five findings and recommendations, is posted at the following site: http:// www.aapm.org/pubs/newsletter/ references/3303LegislativeArticleFull. pdf The Nuclear Regulatory Commisison (NRC) is already addressing many of the issues raised by the National Academies and its recommendations. The Radiation Source Protection and Security Task Force, mandated by Congress in the Energy Policy Act of 2005, is analyzing potential impacts of so-called “dirty bombs” and radiation exposure devices, the potential for replacing cesium chloride sources, and alternative technologies for radioactive sources. Report of the NRC’s Independent External Review Panel to Identify Vulnerabilities in the U.S. Nuclear Regulatory Commission’s Materials Licensing Program” On October 2, 2007, the Commission chartered the Independent External Review Panel (the Panel) as part of the U.S. Nuclear Regulatory Commission’s (NRC) Government Accountability

Continuing Education Highlights Therapy Physics Continuing Education The Therapy Physics CE series will include 33 sessions. Of note, the program will feature a lecture on cellular and molecular biology for the medical physicist, and courses related to functional imaging in planning and assessment of response. Additional lectures in the areas of IMRT, IGRT, adaptive RT, proton therapy, clinical measurements, radiation safety and other important aspects of clinical therapy physics will be offered. Diagnostic Imaging Continuing Education The program will include 32 Continuing Education courses in Diagnostic Imaging Physics and Technology. The courses will include: computed tomography, breast imaging, radionuclide imaging, MRI, radiography/ fluoroscopy, ultrasound, radiation safety and risk management issues, issues related to accreditation, multimodality imaging and medical informatics. There will be 8 hours of SAMS that include: MRI, breast imaging, computed tomography and radionuclide imaging.

AAPM Newsletter Office (GAO) Action Plan (SECY07-0147 see link: http://www.nrc. gov/reading-rm/doc- collections/ commission/secys/2007/secy20070147/2007-0147scy.pdf). This report provides the Panel’s observations and recommendations. The Panel’s membership includes Thomas E. Hill, Benjamin W. Nerud, and Michael T. Ryan. The Panel conducted seven meetings over the last 6 months in accordance with the requirements of the Federal Advisory Committees Act. The Panel gathered information from NRC and Agreement State staff, interested stakeholders, and members of the public. During each session, the Panel allotted time for input from members of the public and other interested stakeholders. Appendix A provides a list of definitions of terms used in this report. A copy of the Panel’s full report can be found at: http://www. nrc.gov/reading-rm/doc-collections/ commission/slides/2008/20080318/ independent-external-review-panelfinal-report.pdf.

The overall conclusion of the Panel was that NRC has a clear record of success regarding health, safety, and environmental protection and has performed these functions in an excellent manner. Because of the changing environment resulting from the threat of malevolent actions, such as those demonstrated by U.S. Government Accountability Office (GAO), security must be upgraded as a fourth cornerstone to NRC operations. (See report GAO-07-1038T  July 12, 2007 http://www.gao.gov/docsearch/ abstract.php?rptno=GAO-07-1038T.) Appropriate security of radioactive materials requires seamless control and coordination among all stakeholders including the NRC (including import/ export authorizations), the Agreement States, license applicants and licensees, and many commercial companies involved in managing radioactive materials. The ultimate goal of this coordinated effort is to achieve

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May/June 2008

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3. Evaluate the apparent “good faith presumption” that pervades the NRC licensing process. (Observations and Recommendations 1 and 8)

The Panel has addressed each of the specific areas listed in its charter, as follows: 1. List (with explanations) of vulnerabilities concerning the NRC’s licensing and tracking programs for import, export, specific, and general licenses (GL). (Observations and Recommendations 2, 3, and 6) 2. Validate the Agency’s ongoing byproduct material security efforts. (Observations and Recommendations 0704-5731AAPM_08SolidWterAd:AAPM 3 and 4)

4. Evaluate the Agency’s Pre-Licensing Guidance; Licensing Procedures and Licensing Process; License Possession Limits; and License Reviewer Training and Oversight. (Observations and Recommendations 1, 3, 5, and 7) This article, including a summary of all eight recommendations, is posted at the following site:http://www.aapm. org/pubs/newsletter/references/ Ad3303LegislativeArticleFull.pdf 1/17/08 11:19 AM Page 1

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May/June 2008

Health Policy/Economic Issues United Healthcare Denial of Radiation Oncology Image Guidance Codes Resolved Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant

nited Healthcare will require all facilities performing diagnostic imaging to obtain appropriate accreditation by third quarter 2008 in order to continue receiving reimbursement for many imaging procedures. The deadline had previously been March 1, 2008. However, recent data from the insurer indicates that overall, less than half of the health planâ&#x20AC;&#x2122;s imaging providers have yet to complete the process. An AAPM member recently reported that United Healthcare was denying reimbursement of CPT 77014 Computed tomography guidance for placement of radiation fields because their facility was not accredited by the American College of Radiology (ACR). The AAPM Professional Economics Committee contacted the ACR and American Society for Therapeutic Radiology and Oncology (ASTRO) to assist AAPM in resolving this issue. The AAPM supports imaging accreditation but denying payment for image guidance performed by radiation oncology is unwarranted. ASTRO contacted United Healthcare and objected to inclusion of radiation oncology image guidance procedures (e.g. 76950, 76965, 77014, 77417, 77421) as part of the requirement for diagnostic imaging accreditation. The ACR agreed that this was an â&#x20AC;&#x153;unintended consequenceâ&#x20AC;? of the imaging accreditation requirement and petitioned United Healthcare to exclude radiation oncology image guidance codes from the list of imaging accreditation CPT codes. â&#x20AC;Ż

Image guidance is used in the placement of radiation therapy fields, interstitial brachytherapy radioelement application and localization of target volume for the delivery of radiation therapy. The issue has been resolved and United Healthcare has removed all radiation oncology image guidance codes, including 77014, from their imaging accreditation requirement. In order to comply with the United Healthcare deadline and ensure

reimbursement for diagnostic imaging services is not compromised, the ACR recommends that facilities begin the accreditation process immediately. United Healthcare has recognized the ACR and the Intersocietal Accreditation Commission (IAC) as acceptable accrediting organizations for medical imaging, and has designated the following modalities as falling under the mandate: CT, CTA, MRI, MRA, PET, nuclear medicine/ cardiology and echocardiography.

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AAPM Newsletter

May/June 2008

Chapter News RAMPS Update 2008 Gig S Mageras, New York, NY

he Radiological and Medical Physics Society of New York celebrates its 60th anniversary this year. RAMPS is the earliest organization of medical physicists in the U.S. Originally called the “New York Millicurie,” physicists associated with medical institutions in the metropolitan NY region initiated meetings to compare instrumentation and measurements of the quantity of radioactivity in solutions for medical use. The clinical uses of iodine-131 and other radionuclides were being actively explored and agreement on the amount of activity being administered was essential, at a time just prior to the availability of megavoltage x-rays and electrons. This year also marks the 40th anniversary of Raphex.

event, used throughout the U.S. through the courtesy of RAMPS and the AAPM. RAMPS has recently updated its web site, URL http://chapter.aapm. org/RAMPS/, which now includes information on past and upcoming events. Klaus Hamacher has kindly volunteered to be webmaster, while Jussi Sillanpaa has volunteered to be photographer at RAMPS events, which can be viewed on the RAMPS web site. The first RAMPS educational event of 2008 was the Failla Award and Memorial Lecture, in honor of Gioacchino Failla (1891-1961) and his contributions to the field of radiation and medical physics research. The Failla Award is given by the Greater New York Chapter of the Health Physics Society (GNYCHPS) and RAMPS, and is awarded to a distinguished scientist

Dr. Cunningham (left) receiving the 2008 Failla Award from Gig Mageras

In 1968, RAMPS appointed a committee to prepare a radiological physics exam, in order to assist the training of residents. The exam was administered on a voluntary basis to radiological residents in NY City. The response was so enthusiastic that the exam has become an annual

in the medical physics or health physics field. This year’s Failla Award went to John R. Cunningham, whose career in medical physics coincidentally began in 1948, the same year that RAMPS was founded. Dr Cunningham gave a stimulating and illuminating talk on

“The Way It Was,” describing some of the developments in radiation therapy and medical physics between 1931 and 1967, among them, the development of the Failla radon generator (1931), the first clinical use of a betatron (1948) and cobalt units (1951) for radiotherapy, early conformal radiotherapy and patient positioning (1955-1959), and the first computer devoted to radiotherapy (1967). The lecture was well attended and enthusiastically received by attendees, with numerous questions and comments following the lecture. Early this year, the NYC Police Department’s deputy commissioner for counterterrorism and Mayor Bloomberg submitted proposed legislation to the City Council requiring anyone possessing a biological, chemical, and radiological detector to obtain a permit from the police. Rationale for the proposal was that the police department would eventually be chasing an excessive number of false alarms and there would be unwarranted public anxiety. At a public hearing on the proposal, there were extensive concerns voiced that it would affect and interfere with detectors currently used by industry, research, colleges, medical centers, public health, and environmental control professionals, among others. Because of this, the original proposal has been revised to define detectors that would be exempted. However, the list of exemptions is incomplete in numerous ways, and to this end, RAMPS, GNYCHPS and other professional organizations have sent letters to Mayor Bloomberg. RAMPS, in its letter, noted that some types of radiation detectors used by

AAPM Newsletter

May/June 2008

Winners of the 2008 Sal Vacirca Young Investigators Symposium. Left: Wenli Wang (MSKCC), Middle: Reshma Munbodh (MSKCC), Right: Hong F. Xiang (Mt. Sinai)

hospitals are not exempted, such as fixed portal radiation detectors and waste monitoring detectors. A more generic concern is that the proposal seems counter to advertisements and placards throughout NYC repeatedly urging the public to report suspicious situations using the oft stated slogan, “If you see something, say something.” In February, RAMPS conducted its Young Investigators’ Symposium in honor of Sal Vacirca. Nine young investigators from institutions in the NY area gave oral presentations which were evaluated by a panel of judges. The three highest scoring

contestants were as follows: first place went to Wenli Wang (Memorial Sloan-Kettering) speaking on “Quantitative validation of compartment kinetics model for hypoxia via FMISO PET imaging.” Second place went to Reshma Munbodh (Memorial SloanKettering) speaking on “Dosimetric and anatomic indicators of late rectal toxicity after high-dose intensity modulated radiation therapy for prostate cancer.” Third place went to Hong F. Xiang (Mt. Sinai) speaking on “Quantitative analysis of interfraction patient setup offsets and anatomic deformations in headand-neck IMRT by deformable

registration of kV/MV projection images.” Congratulations to the winners! Upcoming events are as follows: on March 18, Jean M. Moran (Univ. Michigan Ann Arbor) speaks on “Technique evaluation for partial breast irradiation: Does IMRT provide an advantage?” On April 7, there will be a Joint Symposium honoring Dr. C. Clifton Ling / RAMPS Spring Symposium. On May 20, there will be a “point/ counterpoint” presentation and panel discussion on the risks of exposure from CT exams. Event details are available at the RAMPS web site.

Person in the News

ichard Morin, Ph.D., was recently elected as SecretaryTreasurer for the American Board of Radiology. Dr Morin is currently serving the ABR as Assistant

Executive Director for Primary Certification and is one of the three physics trustees nominated by the AAPM. As the Secretary of the Board, Dr. Morin will be responsible for all records of the American Board of Radiology, including examination data, certificates issued, and other transactions of the Board of Trustees. As the Treasurer of the Board, Dr. Morin will be responsible for maintaining true and accurate accounts of all the financial transactions of the Board.

Dr. Morin was also elected as Chair of the Board of the recently formed the American Board of Imaging Informatics (ABII). The ABII board is charged with setting policy for the imaging informatics in medicine certification program and overseeing the operations of the ABII. Dr. Morin is a Fellow of AAPM, and is a Past President. He is currently the Brooks-Hollern Professor of Radiology at Mayo Clinic, Jacksonville, Florida.

AAPM Newsletter

May/June 2008

AAPM Website Editor Report

Christopher Marshall NYU Medical Center

he Website is celebrating the Golden Anniversary Year of the AAPM with a “new look” and with new features that we hope you will enjoy. Credit, as always, goes to the staff who make all of this happen, and particularly to our webmistress, Farhana Khan. Farhana is responsible for bringing the digital images from past meetings to the membership through the Flickr feature on the Website. This year we have added scanned images from the historic archives. The images that you will see on the home page are a rotating subset of all the images that are available for viewing. We recently ran images from 1969 - the last AAPM annual meetings held in parallel with the RSNA, before it was moved to the summer as an independent meeting. If you want to visit or revist the “way we were” for this or other years you can access all available images through the Flickr interface. You can also comment on the images – if you find unlabled images, perhaps of yourself, feel free to label them and become part of our historical archive yourself. (You will be asked to register for a free Flickr account the first time that you do this.) Several members have sent comments to me requesting that we add RSS

feeds to the website – which we had on the agenda for some time. I am happy to report that this feature is now in place and we will be interested in getting your feedback about its utility. For those of you new to RSS, it can assist you to get the latest news from you favorite websites without having to visit each one of them separately, and the technology is supported by the latest browers and by other free and commercial software. We have included a primer on RSS on the Website. Some members have complained about excess broadcast emails from AAPM, while others have requested that we send more – perhaps as a summary email listing hot topics. It is therefore impossible to please everyone by using broadcast email as means of contact. This is a more general issue – communication with members is the lifeblood of any organization but we need to avoid being intrusive. We provide

the option for you to opt out of some communications through your online profile (accessible through “MY AAPM” on the Website if you are logged in), but this can mean that you are “out of the loop”. RSS allows you to “opt in” to the latest news on the Website but is essentially nonintrusive – you access it if and when you choose to do so. It therefore has the potential to provide a similar service to broadcast emails but in a much less intrusive manner, so we encourage all of you who already use RSS feeds to subscribe to ours and for those who are new to RSS to dive in and test its utility and help us develop the array of technologies we will need to serve the membership as we look forward to the next 50 years. I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/ WebsiteEditor/3303.asp

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

www.aapm.org/meetings/08SS 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 Newsletter

May/June 2008

Workgroup on Clinical Trials Update Getting Credentialed for Advanced Technology Clinical Trials: One Physicist’s Experience Charles Able, AAPM Work Group on Quality Assurance for Clinical Trials

lthough I’ve been a medical physicist for twenty years in the community setting, I have had limited experience with national clinical trials until relatively recently. I joined Wake Forest University School of Medicine several years ago to head its regional practice in High Point, North Carolina. I was approached by our medical director to become credentialed so that our department would be eligible to enroll patients on RTOG 0-0117, a 3D conformal external beam lung protocol. That was 2005 and since that time I have endeavored to educate myself about the process and structure of national clinical trials and the groups which sponsor them. I recently was asked “can we submit patients on the new RTOG High Risk Prostate IMRT Protocol.” This seemed like a good opportunity to create a diary of my experience to inspire all the other seemingly overworked physicists to feel confident in taking the lead in a seemingly daunting effort to get a department up and running on an advanced technology clinical trial. First, I needed a copy of the protocol (RTOG 0521). I got this from the RTOG website. September 10, 2007 (2 hours) I printed and read the protocol to determine the registration requirements for the protocol. Also I needed to understand the credentialing process for the IMRT component since we were already credentialed for

3DCRT. This required an IMRT facility questionnaire, submission of an IMRT “dry run” case to the Image-guided Therapy Center (ITC), and successful completion of an IMRT phantom study with the Radiological Physics Center. I contacted the RPC to get on the waiting list for the pelvis phantom. I was told they would contact me in two weeks and if we were prepared they would send me the head and neck phantom due to the availability of those phantoms. Successful completion of the head and neck phantom study would lead to broader credentialing of our group for any IMRT study due to the difficulty of the treatment geometry. I read the protocol in its entirety to understand the dosimetric and treatment planning specifics. September 14, 2007 (20 minutes) I completed the facility questionnaire which included information about our facility experience with IMRT including our quality assurance procedures and acceptability criterion. September 18, 2007 (1.5 hours) A CT data set using a previously treated prostate patient’s dataset was created. I structured the dataset (contour naming, creating structures, etc.) according to the information contained in the protocol. The medical director was informed that the dataset was ready to be contoured. We would wait until we were notified that we passed the benchmark before completing the planning of this clinical dry run case. September 20, 2007 (5 minutes) Following receipt of an email, I called the RPC to coordinate

the mailing of the head and neck phantom. While I was confident in our ability to accurately deliver IMRT treatment I was a bit anxious because I had sat through more than one presentation in the past that indicated a rather high failure rate (≈ 33%) for first time submissions of this phantom. Therefore, I placed our name on the two month waiting list for the pelvis phantom. September 24, 2007 (20 minutes) We received the head and neck phantom from the RPC today. I verified the contents of the case and reviewed all the instructions. September 25, 2007 (2.5 hours) I reviewed the instructions again and filled the phantom with water and checked for leaks. We scanned the phantom on our PET/CT Simulator. The setup and scanning instructions seem relatively straight forward. The image dataset was sent to our treatment planning system (Varian Eclipse). I began to contour the required structures including the eight TLDs imbedded in the phantom insert. September 26, 2007 (3.0 hours) I completed the contouring of the structures today. This included the contouring of planning structures designed to increase the effectiveness of the inverse optimization process in meeting the prescription dose-volume histogram (DVH) requirements. After a first pass at optimization I realized that I had contoured the organ at risk (OAR) incorrectly. It turns out that the diagram of the cross section of the phantom insert is somewhat misleading. A more graphical representation would be much more helpful.

September 27, 2007 (4.0 hours) I corrected the OAR structures and

AAPM Newsletter

restarted the inverse optimization process. I was able to make progress more quickly. The plan needed continued refinement. October 1, 2007 (3.75 hours) I continued to refine the treatment plan until all constraints had been met. One question that came up when analyzing the plan was should we calculate using heterogeneity corrections? A call to the RPC confirmed that we should use a homogeneous calculation for the phantom planning. The plan was then sent to our standard phantom for IMRT QA setup/processing. October 4, 2007 (1 hour) We performed IMRT QA on a flat phantom and diode array which is our normal process for all IMRT patient plans. One change that was required involved the prescribed dose. The RPC request a dose delivery of 6.6Gy to the PTV in a single fraction which would saturate

our detectors on the diode array so we reduced the dose for IMRT QA delivery to 3.3Gy to the PTV. October 5, 2007 (1.75 hours) We performed a chamber calibration of the 6MV photon beam. Using the results we delivered 300 cGy to the standard RPC TLD set. We then proceeded to setup the head phantom for treatment delivery. Since we used a different isocenter than that obtained at the time of scanning we shifted the phantom to the treatment isocenter based on the coordinates provided in the treatment plan. We delivered the treatment to the phantom. The phantom was drained, disassembled and packed for shipping. October 9, 2007 (3.5 hours) It was a time consuming process to compile and complete all forms, print the required isodoses, and produce color copies (3) of IMRT QA results and the treatment plan. In addition,

May/June 2008 we sent the IMRT phantom plan to the ITC electronically (FTP) which went smoothly. I verified that all documents were included, organized and mailed to the appropriate institutional address. The phantom work is complete, hopefully. December 11, 2007 (6 hours) I received a phone call from the RPC stating that our phantom irradiation passed and that we are approved to enroll patients on the IMRT protocols. We then completed the beam placement, inverse optimization, and plan evaluation of the RTOG 0521 protocol IMRT plan we started earlier. After satisfying the protocol requirements, we exported the plan to the ITC electronically and also printed and sent certain documents as hardcopy in the mail. We are currently awaiting approval to submit patients on this specific protocol.

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AAPM Newsletter Summary The time required to complete this task was approximately 30 hours. I was actually surprised how long it took because doing each piece when I had periods of free time was not particularly difficult or stressful. In our community hospital-based radiotherapy department, the physicist is tasked with credentialing for clinical trials. I must say that having a single clearing house for all communication and data submission would have simplified things. This is primarily because the RPC and the ATC required some of the same paperwork and also required that some information be sent as both

May/June 2008 hardcopy and electronically. I understand that part of the mission and reason for the Advanced Technology Consortium is to create a single omnibus conduit for all data to flow to the cooperative clinical trial groups. This needs to be better implemented. I believe that all physicists in all clinics can play an important role in maintaining the validity of clinical trial data critical to the advancement of the practice of radiation oncology. We can do this in part by performing the credentialing work that enables the eligibility of our institution and our physician

colleagues to enroll patients on national clinical trials. Although there is an upfront time commitment, the process is not difficult if we choose to make it an overarching priority as a medical professional. Postscript: The RPC was notified about the unclear diagram of the phantom insert and is considering a revision. It has been reported to the RPC by others who have undergone this credentialing process that it takes between 8-40 hours to complete. To learn more about the mission of the RPC, please go to http://rpc.mdanderson.org/rpc/ and for the ATC, see http://atc.wustl.edu/.

AAPM Ethics’ Committee Communication Chris Serago Ethics Committee Chair

APM members are invited to review a draft version of the Code of Ethics and submit their comments. This draft is the work of TG 109. The charge of TG-109 is to write a more comprehensive Code of Ethics, consolidating previous AAPM ethics policies into a unified document. Please go to: http://www.aapm.org/announcem ents/DraftAAPMCodeofEthics.asp for the latest version of the code. One reason for the creation of a Code is that existing AAPM ethics polices are applicable specifically to medical physicists, and do not encompass other member types. The membership of the AAPM is diverse and growing more so, including health physicists, regulators, vendors, physicians, scientists, engineers, or other health care professionals.

also do not directly address research, education, or business ethical issues. This new Code of Ethics has four major sections: professional conduct, research ethics, education ethics, and business ethics. These sections follow the Principles of the Code which are core values intended to aid all members and affiliates to act in an ethically professional manner. This Code of Ethics will replace existing AAPM policies: Ethical Guidelines for Vacating a Position (PP 4-B); Ethical Guidelines for Reviewing the Work of Another Physicist (PP 5-C); Guidelines for Ethical Practice for Medical Physicists (PP 8-D); and Ethics Complaint Procedure (PP 21-A).

AAPM and Doyle Printing Green Partners

Another reason for the new code is that existing AAPM ethics polices

AAPM Election The 2008 AAPM election will open for online voting on June 18, 2008. Paper ballots will be mailed to the following members: • Those with no e-mail address or • Those with a bad e-mail address • Those that have opted out of online voting. The deadline to submit your vote electronically or by paper ballot will be July 9, 2008.

AAPM Newsletter

May/June 2008

AAPM Workgroup on Prevention of Errors in Radiation Oncology Growing ROSIS Ola Holmberg, Copenhagen, Denmark Mary Coffey, Dublin, Ireland Tommy Knöös, Lund, Sweden Joanne Cunningham, Dublin, Ireland Peter Dunscombe, Calgary, Canada Eric Klein, St Louis, USA

he AAPM’s Working Group on the Prevention of Errors in Radiation Oncology has commenced a dialogue with the developers of the Radiation Oncology Safety Information System (www.rosis. info) with a view to promoting widespread participation in this open incident reporting/learning system by North American cancer centres. The ROSIS system, in existence since 2003, already fulfills a unique need in the area of patient safety with over 1000 incidents from 75 centres entered to date. The utility of ROSIS would be further enhanced, with clear benefits to radiation patients worldwide, if greater participation could be obtained. This was the primary motivation behind a meeting held at the ESTRO offices in Brussels on Sunday and Monday, 3rd and 4th February 2008. In attendance were Mary Coffey, Ola Holmberg, Tommy Knoos (three of the original ROSIS developers) and Peter Dunscombe (representing the AAPM Working Group). The fourth ROSIS developer, Joanne Cunningham, was unable to attend as was Eric Klein who, although sponsored, encountered scheduling difficulties. However, Eric was able to join the meeting by telephone towards the latter part of the second day.

There were two main items to be covered. The first was a business plan to take ROSIS into the future. It was recognised that funding for further development and expansion was an issue. Programming capacity needs to be expanded and resources for data review and analysis need to be in place. A preliminary budget was established and various strategies for identifying possible sources of support were discussed. The long term aim is to make ROSIS self financing and the appropriate means by which this might be achieved will be the subject of future discussions. Of particular concern to many potential participants are issues of confidentiality, data integrity and security. It was recognised that such issues will have to be addressed in a very thorough and formal way to satisfy future users. Costs are involved here and these were estimated for the purposes of budget development. The final topics included in the business plan discussion were governance and direction. Many individual cancer centres and larger jurisdictions are recognizing the importance of incident reporting carried out in a structured manner which facilitates learning. Not only is it inefficient for those of us in the radiation treatment community to individually develop incident reporting/learning systems for local use but such developments could well impede the sharing of experience. For ROSIS to adequately meet the need of those institutions and organizations committed to the use of incident databases ROSIS will have to

include interested parties in future design activities. This could be through the mechanisms of an Advisory Panel or Users’ Meetings. The latter part of the first day and all of the second were taken up with reviewing the current structure of the ROSIS database. The system has been in use for five years and the developers, with input from users, have been able to identify opportunities for enhancement. It was noted, during these discussions, that the AAPM’s Task Group 100 were carrying out a Failure Modes and Effects Analysis so their efforts shared the ROSIS aim of making radiation therapy safer. The next version of the database and user interface will not be greatly different from the current one so the transition should be easy for current users. However, it is hoped that the information entered will facilitate interpretation of the details of the incident and hence simplify the learning objective of the ROSIS system. As more input from users is received, ROSIS will be further developed and new versions can be expected in the future. It is difficult to exaggerate the importance of this initiative for patient safety. There is no comparable global effort in any other branch of medicine. With increased participation in ROSIS we will be able enhance the safety of the environment in which patients receive radiation treatment for cancer. A relevant and interesting document from the UK has just been published. You can access it at https://www.rcr. ac.uk/index.asp?PageID=149&Publ icationID=281

Editor

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

Editorial Board

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

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