Newsletter
A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 33 NO. 4
JULY/AUGUST 2008
AAPM President’s Column
Gerald A. White Colorado Springs, CO
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few weeks ago I attended several lectures at our local liberal arts college (Colorado College— home of the 2009 AAPM Summer School) held as part of a course and public symposium on Health Care Policy. It was well organized and, interestingly, featured as faculty people who had been associated with Colorado College, all former faculty or alumna(e). We’ve all had the opportunity to read in these pages much about healthcare policy on a very detailed level. CPT codes and descriptors, changes to the Relative Value Scale for codes that effect imaging and oncology, downward pressure on the conversion factor from RVU’s to dollars, etc. All of these are of great importance to us as medical physicists, and we tend to follow changes or potential changes quite closely. I enjoyed the opportunity in the CC symposium to reflect with others on the larger picture of healthcare delivery and financing structure in the U.S.
“Enjoy” is probably not quite the correct verb. As my family, friends and colleagues can tell you I can become overly engaged in discussions of healthcare quality and accessibility issues in the U.S. System. At the final lecture there was a presentation by a highly placed Microsoft executive working on their unified Electronic Medical Record project. He made the remarkable assertion that the U.S. Healthcare System was the best in the world because people traveled from many countries to seek treatment here. I could barely restrain myself to remain quiet until the Q&A (but I did, with the gentle but firm encouragement of my wife who was seated next to me). There are many metrics associated with understanding the quality of a nation’s healthcare system, but travel by the wealthy is not typically one of them. By any of the standard measurements of quality, our system ranks well below those of other industrialized countries. In the 2005 CIA ranking of infant mortality the U.S. falls in 41st place. In the 2003 Organization for Economic Cooperation and Development (OECD) index of maternal mortality (deaths/100,000 births) we rank behind Germany (2.9), Australia (3.2), Norway (3.6), Sweden (4.2), and Canada (4.6) with an index of 8.9. In the World Health Organization (WHO) 2003 ranking of Healthy Life Expectancy (an index that measures not just years of life but rather years of relatively healthy life) we ranked 29th. The
trend is not improving. In a recent analysis of decline in mortality from amenable causes in 19 industrialized countries, (WHO Database) the United States ranked 19th. The list goes on—the only metric at which we excel is cost of healthcare delivery, where we are at the top of the list (by nearly a factor of 2 compared to many industrialized countries) either as a per-capita cost or as a percentage of Gross Domestic Product. Focused on the delivery of care in the high tech healing modalities, we are often insulated from these issues, at least at the organizational level. But certainly those of us who work in the clinic have seen no shortage of patients who appear for diagnosis (see White p. 4) TABLE OF CONTENTS Chair of the Board’s Column President-Elect’s Column Executive Director’s Column 50th Anniversary update Editor’s Column Professional Council Report Education Council Report Leg. & Reg. Affairs Edu. & Res. Fund Report Health Policy/Economics American Board of Radiology Chapter News Medical Reserve Corps BOD Recommendation MOC & TG-127 Update AAPM-IPEM Travel Grant Rpt. AAPM Travel Grant Rpt. Person in News
p. 2 p. 3 p. 5 p. 7 p. 9 p. 10 p. 13 p. 15 p. 19 p. 22 p. 25 p. 26 p. 28 p. 29 p. 31 p. 33 p. 36 p. 39
AAPM Newsletter
July/August 2008
Chairwoman of the Board’s Column
Mary K. Martel UT MD Anderson Cancer Center
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write about two topics for this column: the Presidential Recognition Award from the Society of Pediatric Radiology, and the possible formation of an Administrative Council.
Society of Pediatric Radiology The Society of Pediatric Radiology (SPR) bestowed their Presidential Recognition Award to three charter member societies of the Alliance for Radiation Safety in Pediatric Imaging: the ACR, ASRT and the AAPM. I was honored to accept this award on behalf of the AAPM at the recent SPR annual meeting. The Alliance launched the Image Gently campaign earlier this year [pedrad.org/associations/5364/ ig/] with the goal to change practice by increasing awareness of the opportunities to lower radiation dose in the imaging of children. During the acceptance speech, I recognized several medical physicists with key roles in the lead up to the campaign. First and foremost was Keith Strauss of Children’s Hospital in Boston who has pioneered the development of pediatric protocols in conjunction with Rick Morin of Mayo Clinic and Priscilla Butler, the ACR senior director of breast imaging accreditation. These are key protocols for the image gently initiative. Keith has recently written about the campaign in the March/
April 2008 AAPM newsletter. Keith along with Penny Butler have long been members of the writing group for the Alliance. I also highlighted the work of a newly published AAPM task group called “The Measurement, Reporting, and Management of Radiation Dose in CT” chaired by Cynthia McCollough of Mayo Clinic, which provides up-to-date guidance for the field. We look forward to a continuing and close relationship with the SPR and the Alliance through our AAPM representatives, Keith Strauss, Russ Ritenour and Lynne Fairobent. Administrative Council The concept of a formation of a fourth council called the Administrative Council has been around for years (if not decades). There exist a number of administrative committees (called “other standing committees” in the bylaws). Their work cuts across all other Councils, and they currently report to the Board, with the Secretary as their conduit for motions to place before the Board. Other committees in the AAPM are in a Council structure, and benefit by yearly strategic planning retreats, Council chairs meeting periodically with EXCOM, and Council chairs sitting on the Board (as non-voting members). The Admin committees on the other hand are not as involved with the overall planning process, and the interaction is not as direct with the Board, other than through written minutes of meetings sent to the Board periodically. The current interface with the Science, Education and Professional Council chairs and the Board has evolved through the years to be a highly functional one today. One could debate whether this present structure for the Admin committees is fine as it is, and as
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effective as it needs to be. However, the number of committees has grown over the years, and there are other committees that are currently under other Council structures that would more appropriately be grouped with the other Admin committees. It has become virtually impractical to have effective communication between the Admin committees and the Board. There are several options to improve the communication: the Board could, for example, appoint a Board member to each committee; and/or the annual reports from each committee could be beefed up from their present state; and/ or an Administrative Council could be formed with a Council chair joining the other Council chairs on the Board (and at the table). I am in support of the latter option, and revived this concept in order to open discussion at the recent spring Board meeting. While support of a fourth ouncil gained some traction among Board members, it was decided to first ask the Admin committee chairs to submit more detailed reports for the Board’s consideration. The Administrative Council would not be an easy one to chair. The committees do not have a “theme,” which is otherwise true for the Educational, Professional or Science Council. I would propose the chair to be a former Secretary, and there are several excellent candidates, should they be willing. In the meantime, the Professional Council has taken up the issue of a formation of a fourth Council at their recent retreat. A discussion has begun with the Board and Admin committee chairs on the AAPM website BBS by the Professional Council. I thank the Professional Council and chair Mike Herman for taking the initiative to keep this idea going. We hope it results in a motion to create the new Council.
AAPM Newsletter
July/August 2008
AAPM President-Elect’s Report
Maryellen Giger University of Chicago
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s medical physicists, we work in different “walks of life” -- for example, clinical arenas, industry, education, research, or multiple avenues. It is this diversity of its members that keeps AAPM vital, growing, and contributing to its mission. And the more we understand and appreciate each other, the better off we all become. As my year as President-Elect continues, so does my growth in knowledge on the various lives, activities, duties, and concerns of my fellow AAPM members. Not only am I learning to appreciate more fully my fellow AAPM members, I am also learning to appreciate AAPM’s interactions with other organizations. In April, I attended an RSNA Imaging Biomarkers Roundtable with representatives from various organizations, e.g., academia, NCI, Pharma, and other professional/ scientific organizations. The goal of the meeting was to further communication among the various organizations with various speakers describing their current initiatives for quantitative imaging and discussing future plans. Presentations were given by AAPM members John Boone, Ed Jackson, and Paul Kinahan covering
reports on quantitative imaging and phantoms for CT, MRI, and PET. Discussion topics included the NCI biomarkers consortium, database sharing between academia and Pharma, continuation of the NCIfunded image response assessment teams (IRAT), imaging as primary and secondary endpoints, use of uniform protocols and phantoms in clinical trials, potential lexicon for imaging biomarkers, determination of both anatomical and functional metrics, and translational efforts into the clinical arena. In July, there will be a RSNA-AAPM “Towards Quantitative Imaging” strategic planning workshop in which speakers and attendees will focus on stimulating the development and implementation of more quantitative imaging methods in clinical radiology. Perspectives from both clinicians and radiologists will be given in the areas of cardiology, oncology, neurology, and skeletal disease. Goals include determining what RSNA and AAPM can do together in order to increase awareness and utilization of quantitative imaging in medicine. Stay tuned for an update after the July workshop. In May, once again my understanding of the role of physics in medicine expanded as I performed one of my President-Elect duties with a trip to the CRCPD’s 40th Annual National Conference on Radiation Control in Greensboro, North Carolina. CRCPD is short for Conference of Radiation Control Program Directors. The CRCPD membership mainly includes directors and staff from state and local radiation control programs on all aspects of radiation control, not just medical, federal agencies, and those interested in
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radiation protection. However, for clinical medical physicists, many of the CRCPD members are the state personnel involved in regulating the use of diagnostic x-ray equipment, and those regulating the use of radioactive materials in nuclear medicine and therapy (as well as environmental issues and emergency preparedness and response). While one might initially assume that regulators and regulatees may prefer not to associate with each other, it is the communication between these two groups that can benefit society with respect to diagnostic imaging and radiation therapy. The CRCPD was celebrating their 40th anniversary, and I, as the AAPM’s President-Elect, presented a congratulatory plaque to them in honor of their anniversary. I quickly realized, however, that the most important AAPM contributions to the CRCPD conference were being given by other AAPM members. Melissa Martin and Lynne Fairobent serve as organizational representatives to the CRCPD Board of Directors, and various AAPM members, actively participate on CRCPD working groups. In addition, AAPM, with Melissa Martin as coordinator, conducted an all-day training session on “Radiation Dose and Quality Control for SPECT/CT and PET/CT Clinical Studies” [faculty including Keith Strauss and Fred Fahey] and a half-day training session on “The Use of Imaging in Radiation Therapy” [given by Dan Bourland]. These sessions were extremely well received, and the high regard for and gratitude to the contributing AAPM members were clearly apparent in the comments from various CRCPD members. This appreciation was further demonstrated as Melissa
AAPM Newsletter
July/August 2008 as well as “on the hill” meetings to promote research and education in medical physics.
AAPM recognizes CRCPD’s 40th Anniversary. L - R: Keith Strauss, Melissa Martin, Debbie Gilley, CRCPD Chair, Maryellen Giger and Lynne Fairobent
Martin was honored with the John C. Villforth Lecture Series Award and presented “Forty Years Later: Times are changing or are they?” Since I come from the research arm of the AAPM, this interaction at the CRCPD conference reminded me analogously of NIH workshops I have attended where NIH program officials, reviewers, and grantees all work together to achieve a common goal. Here at the CRCPD, the clinical medical physicists were working with the regulatory officials. Another interesting component of the meeting consisted of state presentations that included professional discussion of radiation control situations and solutions – reminding me of support groups. Throughout various presentations, the presence of AAPM in the working groups was apparent, with members, for example, (White from cover) or therapy having put off (or been denied) more timely access to care, a situation in oncology that is generally associated with dire consequences. But overall, we discuss delivery and financing issues on a very procedure specific level, engaging the broader system only to compete for resources with other expensive modalities. I believe that will soon change. We will all soon be drawn into a larger dialog to be held in this country on the reform of the healthcare system.
So let me close with an encouragement for AAPM members to get involved using a quote that Debbie Gilley (CRCPD Chairperson) used to inspire her members to volunteer – “We make a living by what we get, we make a life by what we give” Norman MacFinan. recognizing the need for “qualified medical physicists” instead of just recognized experts, listening intently as Lynne Fairobent reviewed the history and status of the CARE bill, and learning as Bob Pizzutiello discussed the technical and practical aspects of point-of-care volume (flat-panel) CT scanners. My column here gives the impressions of the CRCPD conference from the point of view of an academic medical physics researcher. For more details on the CRCPD conference, please read Lynne Fairobent’s article, which appears later in this newsletter. It is important to note that CRCPD and other regulatory affairs are not the only government activities for us. As medical physicists, many of us are also involved in NIH workshops and peer-reviewed study sections, The election season will bring what we often call “spirited discussion” on medical delivery issues, and it won’t be about CPT codes. We can anticipate that our colleagues and neighbors will want our opinions and we can hope that we’ll have the opportunity to shape the debate as we speak. To lay the groundwork, this year’s Presidential Symposium at the AAPM annual meeting will feature Dr. Arnold Relman, one of the most thoughtful and outspoken advocates for healthcare reform in America. He is the former
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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 June 30 - Last day to make housing reservations and receive the conference rate. July 7 - On-line registration closes. On-site registration only after this date.
editor of the New England Journal of Medicine, Emeritus Faculty at the Harvard Medical School and prolific author, most recently of “A Second Opinion: Rescuing America’s Healthcare.” Expect a challenging address and peroration (recall in my first newsletter article I warned you about my new thesaurus). Understanding the larger relationship between our medical and scientific work and society at large is essential if we are truly to honor the past, celebrate the present and prepare for the future.
AAPM Newsletter
July/August 2008
AAPM Executive Director’s Column
AAPM’s HQ Team at Your Service We are here to be of service to the AAPM membership and strive to provide the highest level of customer service. For a list of specific team members’ and their areas of responsibility, log in to aapm.org and click on “contact” in the upper righthand area. If you do not see pictures of the staff and their individual email addresses and phone numbers, you are not logged in to the site. Please be aware that there are two layers of spam filters on all emails coming through our building-wide mail system. In the event that you do not receive a timely response to an email inquiry, please contact us again. If the issue is not quickly resolved to your satisfaction, do not hesitate to contact me directly. Remember to Vote! Elections for the 2009 PresidentElect and Board Members-At-Large will close on July 9. Make sure to cast your ballot. Annual Meeting News The 2008 Annual Meeting promises to be a fitting celebration for the medical physics profession. Make note of the special 50th Anniversary events described in this article.
The Houston Local Arrangements Committee and the Ad Hoc
WEDNESDAY
Angela R. Keyser College Park, MD
If your travel schedule allows, you and your family members are invited to volunteer for the Golden Anniversary Service Project at the Houston Food Bank on Saturday, July 26 from 8:00 AM-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. You will help by sorting and packing food into boxes for needy families, or by weighing boxes or inspecting cans. Bus transportation will be provided. Pre-registration is required using the form posted online. You won’t want to miss the Meet the Charter Members Reception on Monday, July 28 from 5:00 PM-6:00 PM, just prior to the Awards and Honors. We have heard from the following Charter Members that they plan to attend the meeting: Gail Adams, James Carlson, Carl Collica, James Durlacher, Arnold Feldman, Paul Goodwin, Bob Gorson, Morris Hodara, Mary Meurk, Jacques Ovadia and Robert Schulz.
Committee on Golden Anniversary Planning have planned a special evening to gather in honor of AAPM’s 50th Anniversary. The Night In Gala on Tuesday, July 29 will begin with a 50’s era reception, followed by an elegant dinner and finish with a 10-piece Houston band. There will be plenty of opportunity to reconnect with your AAPM colleagues. For more information, including a listing of the meal options, please visit the meeting web site. In recognition of 50 years of companion support, AAPM will host a Companions’ Reception on Wednesday afternoon from 3:30 PM – 4:30 PM in the Hilton Americas. Don’t forget to make use of the online Meeting Planner to generate your personal meeting schedule by compiling sessions, talks and committee meetings you plan to attend into a single chronological document. You must be logged in to the abstract system to use the Meeting Planner. Then, compile your schedule, download the .vcs file to import to your PDA, or print it out as a reference. If the time of your meeting, session or talk changes, the planner automatically updates
TOWN HALL MEETING.... AAPM’s Board of Directors wants to hear directly from the membership. What should AAPM be working on? How can the organization better serve you? Here’s your chance to be heard. Make plans to attend the Town Hall Meeting on Wednesday, July 30th from 4:00 – 5:50 PM in Room 350 of the Convention Center. 5
AAPM Newsletter
July/August 2008
your personal schedule. Remember, the AAPM Committee schedule is updated frequently, so if you are not using the planner, please check the schedule often.
that, he was developing database applications for a consulting group out of Baltimore. Onasis has his MS in MIS and a BS in Electrical Engineering.
Selected speakers have been asked to provide handouts for their presentations. The speakers will either provide the handout for posting on the website pre-meeting or at show site, to be posted following the meeting. Please check the handout site for progress on submissions.
Part of the success of AAPM HQ operations is our ability to attract
AAPM HQ ANNIVERSARIES Nancy Vazquez 12 years of service Jennifer Hudson 7 years of service Zailu Gao 7 years of service Hadijah Robertson Kagolo 7 years of service Cecilia Hunter 5 years of service Karen MacFarland 5 years of service Lynne Fairobent 4 years of service Lisa Giove 3 years of service Laurie Hayden 1 year of service
I am pleased to announce that we have filled the additional programming position that was approved by the Board in late 2007. Onasis Budisantoso is AAPM’s new Applications Developer, joining the IS Department earlier in May. He comes to us from Legg Mason where he wrote applications using ASP. Net, Crystal Reports and MS SQL in support of their customer relations management system in both Windows and UNIX environments. Prior to
EVERY LITTLE BIT HELPS........
Make plans to attend the 2008 Town Hall meeting on Wednesday, July 30 from 4:00 PM-5:30 PM in the convention center. The first Town Hall meeting was held during the 2007 Annual Meeting in Minneapolis. Members of the AAPM Board will be on hand to hear from the membership. The Annual Business Meeting will follow the Town Hall meeting and will include a discussion of the proposed 5-year dues increase. The dues increase will then be voted on by the membership before the October 2008 renewal process. Staff News Ramy James joined the AAPM team in April as Staff Accountant I. Ramy fills the position recently vacated by Noel Crisman-Fillhart, who is now working in an administrative support position. Ramy brings to AAPM extensive accounting experience and is a CPA candidate.
and retain an excellent team of high-performing professionals. The following AAPM team members celebrated an AAPM anniversary in the first half of 2008. I want to publicly thank them and acknowledge their efforts.
AAPM staff members realize the amount of waste created by a single meeting. Most green ideas cost nothing extra, and some even save our association money. In an effort to be more environmentally responsible: • The 2008 pocket program will be printed on 30% post-consumer recycled paper with soy-based ink. • This year AAPM is providing a complimentary water bottle in every tote bag. We ask that you fill your water bottles from one of the 18 water coolers in the convention meeting space or exhibit halls. Bottled water produces up to 1.5 million tons of plastic waste per year. Your complimentary water bottle will be made from high density polyethylene (HDPE) which is safe for repeated use. • On Sunday in the exhibit hall, box lunch containers will be made from recycled, compostable material. • Brede Exposition Services, our official service contractor, produces signs on reusable Sintra plastic. Brede reuses, then recycles miles of carpet. Aluminum and cardboard from the show floor is recycled. • AAPM convention hotels in Houston conserve energy and water. Unless directed by guests, hotels will launder bed linens every other day and at check-out, and launder towels only when left on the floor.
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AAPM Newsletter
July/August 2008
s you read this Newsletter, you may be starting to pack for our 50th Anniversary meeting in Houston, TX. Most of you will be on a plane rather than on horse back, but the spirit of the West will certainly be with us. Hopefully, you have all looked over the program and identified your favorite sessions and events. We will be fortunate to have with us a number of our Charter members, past officers, including our first President, Gail Adams and past Executive Directors. I owe Gail an apology as I incorrectly identified Ed Siegel as our first journal editor. Our first editor and indeed, the driving force behind founding the journal was Gail Adams. The finances of AAPM were far from the strength of our current situation, and the founding of the journal was a real leap of faith, supported by a visionary Treasurer, Ben Galkin. Ed Siegel was our second editor. We would like to thank those Chapters that have volunteered to share their history with us. We encourage all members to view this year as a time to look forward and backward as stated in our theme. See y’all in Houston.
S AT U R DAY
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VISIT OUR VENDORS.... Plan your time with the Vendors by viewing the 2008 Buyers Guide and Exihibit Hall Floorplan for a complete listing of exhibiting organizations, booth locations, contact and product information. http://www.aapm.org/meetings/08AM
ENJOY LUNCH ON AAPM - Monday and Tuesday Each Scientific Attendee at the Annual Meeting will receive TWO $10 lunch vouchers with their registration materials. This voucher is good for $10 towards your food and/or beverage purchase at any George R. Brown Convention Center food outlet in Hall D-E. One voucher is valid DRIVE for Monday, and one for Tuesday, 2nd ANNUAL AAPM BLOOD Hours: 11:00am 1:00pm only Do you have an extra hour to save a life? Please consider donating bloodCHARTER during the Second Annual AAPM Blood Drive on Tuesday, MEMBER RECEPTION July On 29. Monday, Visit theJulyM.D. Andersonwill Blood Donor Center in the 28 a reception be held in honor of AAPM’s convention between 9:00 am - 3:00 bloodand will Chartercenter members, 5:00pm-6:00pm, just pm. priorUnits to theofAwards be used for patients at M.D. Anderson. Drop in, or contact Karen Honors Ceremony in the convention center. Honor our past, by (karen@aapm.org) to members schedule responsible an appointment in advance. chatting with the for creating and growing the profession. Refreshments will be served.
M O N DAY
Off to Houston.............
T U E S DAY
Jean St. Germain, Chair Ad-Hoc Committee on Golden Anniversary Planning
GOLDEN ANNIVERSARY SERVICE PROJECT HOUSTON FOOD BANK Does your travel schedule allow you to arrive in Houston a day early? You and your family members are invited to volunteer at the Houston Food Bank on Saturday, July 26, 8:00am-Noon. The Houston Food Bank is a certified member of America’s Second Harvest. Registration is free, but you must register by June 30 - no on-site registration for this project. http://www.aapm.org/meetings/08AM/GenInfo. asp#serviceproj
S U N DAY
50th Anniversary Update
2nd ANNUAL AAPM BLOOD DRIVE Do you have an extra hour to save a life? Please consider donating blood during the Second Annual AAPM Blood Drive on Tuesday, July 29. Visit the M.D. Anderson Blood Donor Center in the convention center between 9:00 am - 3:00 pm. Units of blood will be used for patients at M.D. Anderson. Drop in, or contact Karen (karen@aapm.org) to schedule an appointment in advance. 7
AAPM Newsletter
July/August 2008
THERAPY PROGRAM INCLUDES:
Scientific Symposia
Proffered Abstract Submissions
• • • •
• IMRT planning and delivery • Stereotaxy and High Precision Techniques • Brachytherapy • Radiobiology • Monte Carlo Simulations • Measurements and New Dosimetry Techniques • Verification and Quality Assurance • Advanced Techniques and Risk Assessment
Outcome-guided biological treatment planning An interactive session with TG100 Informatics in Radiation Oncology “The Challenge of Research: Bringing Clinical Studies and New Technology into the Clinic” • Control theory and feedback in radiotherapy • From physical to biological optimization
JOINT IMAGING/THERAPY PROGRAM INCLUDES:
Scientific Symposia
Proffered Abstract Submissions
• Targeting using surrogates • MRI in Radiation Therapy: From Simulation to Online Image-Guidance • Small Animal IGRT: Systems and Studies • Image-Guided Therapy: From Fundamentals to New Frontiers • IMRT targeting: from anatomy to physiology • Image Processing and Analysis for Radiotherapy Guidance
• Innovative Frontiers in Medical Physics • Image Guided Radiation Therapy (IGRT) • Functional Imaging and Small Animal IGRT • Target Localization • Imaging for Therapy Assessment • Margin Assessment • Motion Management • Intrafraction Motion and Correction Strategies • Advances in Cone Beam CT
IMAGING PROGRAM INCLUDES:
Scientific Symposia
Proffered Abstract Submissions
• • • • •
• X-ray: Radiography, Breast and Cardiovascular Imaging • Dosimetry, Radiation Protection and Quality Control • Magnetic Resonance, Nuclear Medicine and Ultrasound Imaging • Image Science, Image Display, Processing and Analysis, CAD • Multi-Modality Imaging, Image Registration and PACS • Multi-Detector and Cone Beam CT, Non-Conventional Imaging
Advances in X-ray Imaging Ultrasound for the 21st Century Advances in Cardiovascular Imaging Image Display, Processing and Analysis (CAD) Current and Future research trends in Nuclear Medicine • Seeing the invisible: recent advances in MRI • Advances in breast imaging • Innovations in CT
www.aapm.org/meetings/08AM
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AAPM Newsletter
July/August May/June 2008
Editor’s Column local chapters reporting about their activities and also two reports from the 2007 travel grant recipients who have shared their experience traveling through the UK and Japan, along with many other articles and reports
Mahadevappa Mahesh Johns Hopkins University
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elcome to the 4th issue of the newsletter. By the time you are reading this issue, most of you may be preparing for your trip to attend the 50th anniversary meeting of the AAPM in Houston, Texas. This issue may seem like the meeting’s abstract book, since it is one of the larger newsletter issues published, however it includes many interesting articles. “If you build it, they will come,” similarly, when we ask for articles we are bound to get many. It has happened this time and I am pleased with the response. This issue contains three articles from
In addition, I am pleased to inform you about a new column under the banner “American Board of Radiology (ABR)” which will be published regularly, starting with this issue. The column will be written by the physics trustees of the ABR with the goal of providing informative updates on topics of interest related to board certification. Finally, I would like to draw your attention to the article on the AAPM Education and Research Fund. The article highlights the goals and objectives of the fund and provides a status report on recent awardees. At this time when the association is celebrating its 50th anniversary and the profession is at the point of bigger changes regarding certification and licensure, it has become even more critical for all of us to provide increased support
to the education and research fund to assist in meeting its goals and objectives. As most of you know, similar funds associated with other organizations such as RSNA are strongly supported by its members, which in turn have allowed respective funds to support an even higher number of research and educational activities. I encourage all readers to take time to read the education and research fund report and, if possible, support the fund generously. With all of the recent fare hikes, elimination of certain flights and even peanuts, increased security checks (some airports have installed new body scanners), I wish you all safe and joyful summer travels. I am looking forward to the annual meeting hoping to meet many friends and if you wish to comment or provide any suggestions regarding how we can further improve the newsletter, please feel free to stop me if you see me at the meeting. I wish all of you a very happy summer.
REQUEST FOR PROPOSALS to produce WEB-BASED INSTRUCTIONAL MODULES http://www.aapm.org/announcements/webbasedmodules.asp Proposals are solicited for the development of educational content for web-based instructional modules intended primarily for the education of resident radiologists in the basic science underlying medical imaging. This is a joint project of the AAPM and the RSNA, and is directed by a task force of members from both organizations. Creation of a module offers physicists an opportunity to work with our radiology colleagues to make a major contribution to the physics education of radiologists. An honorarium will be paid for each module and up to 3 module proposals may be submitted by a group of potential authors. Deadline for receipt of proposals: July 18 9
AAPM Newsletter
July/August 2008
Professional Council Report Michael G. Herman Council Chair Michael Mills Professional Council Vice-Chair Mission Over the past year, an updated AAPM Mission Statement has been drafted. As with all policies periodic review/revision is required. The draft statement represents a revision which was done to reflect changes in the medical physics profession and to better focus the association on advancing the goals of the AAPM. By the time this newsletter hits your desk/ email, you will have seen the draft and made comments on it, thanks. NRC Responds to AAPM Petition on Training In May, the NRC responded to the AAPM petition requesting that the 2005 rule specifying necessary training and education for radiation safety officers and authorized medical physicists be corrected. NRC stated that the issues raised by AAPM would be considered. Please see Lynne’s column for a detailed update on the petition and other specific government and regulatory issues. Qualifications and Training ABR 2012/2014 is on everyone’s mind and discussed elsewhere in this newsletter. Taken in the larger view, when combined with CARE, licensure and supply and demand issues we see a number of very important activities within AAPM and medical physics occurring. Ultimately, CARE will require certification (or similar), and certification will require graduation from an accredited clinical training program. This defines the standard, high quality pathway to entering the practice of medical physics . The Workforce Taskforce has been reformed to get a better handle on
medical physics supply and demand. This is critical input necessary to direct our efforts on creating more accredited clinical training pathways in the appropriate environments. With TG133 (Alternative Pathways for Clinical Medical Physics Residency Training) receiving approval, there is now a need to take on its implementation. This will happen at academic and private centers that can independently or collaboratively create accredited programs. In the broadest sense, the model must be implemented in all areas where nonaccredited clinical training or on the job training is the current method of education. Efforts will be made to bring the TG133 model(s) to each of these groups, realizing that a substantial number of individuals may well be in the OJT pipeline. There is also significant activity within the Professional Council involving a nationwide grassroots effort to build the infrastructure for licensure for Medical Physicists. This activity was initiated in anticipation of the implementation of the CARE Act within a few years, but is in fact a necessary independent effort to establish effective, uniform communication mechanisms with state officials. The AAPM has approved several hundred thousand dollars to fund this effort through the Joint Medical Physics Licensure Subcommittee (JMPLS) – a bilateral AAPM, ACMP effort. Amanda Potter has joined AAPM staff, and has experience working with grassroots campaigns. The plan is divided into phases, which will involve developing model legislation, identifying key states, selecting lobbyists, and developing a strategy on a state by state basis. A second part of the strategy involves working in concert with the Conference
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of Radiation Control Program Directors (CRCPD) to interact with the Suggested State Regulations Committee to make suggestions that would strengthen definitions and provide for consistency throughout state regulations. The JMPLS is also developing a web based map that for each state indicates, the current laws, licensure and registration processes and current activities summary. We encourage you to participate in your own state’s grassroots efforts.
Economics There is a fix to the “hard wired,” 10.6% cut in the CMS conversion factor used to establish payments for physician reimbursement underway. While medical physicists are not directly affected, if this cut takes place it will impact reimbursement for all hospital and outpatient services as well. Independently, the perceived value of medical physics services (primarily for therapy physics) continues to be reduced as medical physics codes are bundled into reduced value bins by CMS. For imaging physics services, the lack of visibility of quantitative value (assigned CPT codes) is perhaps worse. This strongly supports the need for a work effort study (similar to the Abt study for therapy) to be commissioned to quantify the essential medical physics work done in support of medical imaging procedures. As a beginning, the medical physics consultation (77370) may be billed for certain patient specific imaging services, when requested by a physician and reported by the physicist. Educational material for the use of this consultation code is being developed. In every case, when it comes to economics, educating and collaborating with our physician colleagues is necessary to support the value of medical physics services. The Abt study of medical physicist work values for radiation oncology physics services, Round
III is completed and was published in May of 2008. It supersedes the Abt II study of 2003. The 2008 Abt study measured qualified medical physicist (QMP) work associated with routine radiation oncology procedures as well as some special procedures. Complexities introduced by imageguided radiation therapy supported a general trend toward increasing work effort over the previous studies. High dose rate afterloading brachytherapy with a significant component of medical physicist work was also reported in Abt III. The Abt study data may be used to support qualified medical physicist work force and staffing data. Please see Wendy’s column for additional economics details. Ethics Code The new AAPM Code of Ethics (TG109) was under member review in May. Expected revisions and approval are forthcoming. One topic of discussion in the Committee was related to ethics enforcement versus guidance. It is the expectation of the AAPM that all members follow the ethical guidance provided by the member’s professional associations and institution. Clinical Practice There is a new Subcommittee on Practice Guidelines under the Clinical Practice Committee. The two charges of the Subcommittee on Practice Guidelines are 1) to triage requests to review or participate in the accreditation and certification processes provided by affiliated organizations and thus to provide a standard conduit for these requests and 2) to review AAPM Task Group reports prior to publication, to determine which reports would benefit from an accompanying (clinical) Implementation Guide or might require regulatory interpretation. If findings are affirmative the subcommittee would be responsible for developing/ drafting such guidance/interpretation.
WEDNESDAY
AAPM Newsletter
July/August 2008
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.
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AAPM Newsletter
July/August 2008
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AAPM Newsletter
July/August 2008
Education Council Report of this writing, however, there are still a few open spots. This is a great opportunity to become involved with the current and future directions of teaching methodologies in our profession while adding a SDEP to your portfolio. Again, visit the AAPM web-site for registration information.
Herb Mower Education Council Chair
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his edition of the Newsletter should be reaching you right before our Annual Meeting and Workshop on “Becoming a Better Teacher of Medical Physics” in Houston running July 26-August 1 and August 1-3 respectively. I encourage all who are in attendance at the Annual Meeting to stop by one of our committee subcommittee or working group meetings and see what we are doing for you. If the work of that group excites you, speak to the Chair about your participation or, perhaps, involvement as a “guest” or “spectator” in their upcoming activities. Bill Hendee and the joint RSNA / AAPM Task Group on Physics Education expected to have a couple of ‘examples’ of the web-based modules that we are developing for interactive teaching of radiology residents. If you are interested in what is happening here or wish to be considered for developing a module or two, go to the AAPM web-site and check it out. This is an exciting project and, this year, you have the opportunity to get involved on the ‘ground floor.’ The Workshop in Houston on August 1-3 under the direction of Bill Hendee, Ervin Podgorsak and Herb Mower is filling up. As
The Ed Council under the Education and Training of Medical Physicists is assisting in the formation of a new society to be known as the Society of Directors of Academic Medical Physics Programs. They will be having a board meeting on Monday, July 28th, Noon – 1:30 PM in Room 344A during the AAPM Annual Meeting. The co-chairs of this group are Jim Dobbins and Ehsan Samei. Feel free to contact them for further information or drop by this meeting. The Medical Physics Education of Physicians has split the Curriculum Subcommittee into two groups: Radiation Physics Syllabi for (Diagnostic) Residents with Phil Heintz as Chair and the Physics Curriculum for Radiation Oncology Medical Residents with Robert Price as Chair. The Diagnostic Residents Syllabi committee is meeting Saturday July 26th, 2:00 – 4:00 PM in room 330. This year the Education Council Symposium, to be held 9:30 – 11:00 AM on Sunday July 27th will be under the direction of our History Committee with Bob Gould as Chair. As we celebrate our 50th year, I am sure that they will have something of interest for each of us relative to our history and the growth of medical physics as a profession over the past 50 years. Current Task Groups under the Education Council that will be
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meeting at the Annual Meeting include: • TG 124: Guide for Establishing a Fluoroscopy Credentialing Program for Physicians (meets Sunday, Noon – 2:00 PM in room 333, Mary Moore, Chair) • TG 127: Maintenance of Certification (meets Saturday, Noon – 2:00 PM in room 344A,Michael Yester and Per Halvorsen, CoChairs) • TG 153: Digital Radiography Glossary (meets Saturday, 4:00 – 6:00 PM in room 344, Donald Peck, Chair) The Education and Training of Medical Physicists Committee, George Starkschall, Chair, along with the senior leadership of our Association are actively working on many of issues relative to the 2012 / 2104 initiative. If the “2012/2014 Initiative” doesn’t mean anything to you or sounds foreign, you are not alone. We expect to have a major campaign underway within the next 12 months to bring everyone up to date on this important aspect of our profession. Related to this John Bayouth and Mike Herman are working on identifying those nonaccredited residency programs and helping them towards achieving accreditation. Our new Students and Trainees subcommittee has passed the baton of leadership to Jennifer O’Daniel. They will host a social event as well as a more formal session during the meeting. This formal session will include a review of the residency and ABR requirements for board certification, now, in 2012 and in 2014. This group is dynamic and excited about having you, if one of our ‘younger’ members involved with them.
AAPM Newsletter
July/August 2008
Fulbright Scholar Program for US Faculty and Professionals The Fulbright Scholar Program is offering 38 lecturing, research or combined lecturing/research awards in physics and astronomy during the 2009-2010 academic year. U.S. Fulbright Scholars in over 130 countries around the world enjoy an experience of a lifetime, gaining a broad cultural perspective on their academic disciplines and connecting with colleagues at institutions around the globe. Awards range from two months to an academic year. Faculty and professionals in physics and astronomy apply for awards specifically in their field or for one of the many “All Discipline� awards open to any field. Grants are awarded to faculty of all academic ranks, including adjunct and emeritus. In most countries lecturing is in English, though awards in Latin America, Francophone Africa, and the Middle East may require proficiency in another language. The application deadline for Fulbright traditional lecturing and research grants worldwide is: August 1, 2008 U.S. citizenship is required. For other eligibility requirements, detailed award descriptions, and an application, visit our website at www.cies.org, or send a request for materials to apprequest@cies.iie.org.
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AAPM Newsletter
July/August 2008
Legislative and Regulatory Affairs Column FR notice instructs NRC staff “to attempt to form a Technical Basis for future rulemaking.” AAPM is working with other societies to urge the NRC to move forward with rulemaking that addresses the merits of the AAPM petition. If you have questions, please contact Lynne Fairobent, AAPM’s Manager of Legislative and Regulatory Affairs at lynne@aapm.org.
Lynne Fairobent College Park, MD
MONDAY
NRC Recognizes the Validity of AAPM’s Petition for Rulemaking on T&E On May 14, 2008, the Nuclear Regulatory Commission (NRC) published its decision regarding the 2006 Petition for Rulemaking filed by the AAPM regarding training and experience requirements specified on 10 CFR Part 35 (73FR27773). AAPM is pleased that the Nuclear Regulatory Commission has recognized the validity of the AAPM position. The
CRCPD 40th Annual Meeting The Conference of Radiation Control Program Directors (CRCPD) celebrated their 40th anniversary in Greensboro, NC May 19 -22, 2008. The plenary session featured John Villforth, State Radiological Health Programs: How Did They Mature?; Chuck Hardin, The Birth of CRCPD; Admiral Joseph Krol, DOE/ NNSA, Perspective on Radiation Emergency; and Melissa Martin as the 2008 John Villforth lecturer, Forty Years Later: Times are Changing
or Are They? The session was an interesting mix of the history of state programs and the reasons for the creation of CRCPD, a look forward on the interaction between the federal government through the Department of Energy/National Nuclear Security Administration (DOE/NNS) in emergency response and a discussion on the background of a medical physicist, the role of the states and the medical physicist and a look at are we better off 40 years later. In addition, AAPM presented training on Sunday titled: Radiation Dose and Quality Control for SPECT/CT and PET/ CT Clinical Studies and on Monday titled: Radiation Dose and Quality Control for SPECT/CT and PET/ CT Clinical Studies. AAPM thanks Keith Strauss, Fred Fehay, Tim Turkington, Terry Wong, MD and Dan Bourland for providing the training. Every year this training remains a highlight of the conference and is greatly
The American Association of Physicists in Medicine will honor AAPM award winners during a ceremony followed by a wine and cheese reception during the 2008 AAPM Annual Meeting in Houston, TX 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 Ctr
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AAPM Newsletter
July/August 2008
PHYSICISTS AND DOSIMETRISTS SAVE TIME STUDYING FOR YOUR BOARDS!
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AAPM Newsletter
NRC has developed guidance on recommended instructions that licensees should give I-131 therapy patients who are about to be released from licensee control and who will or may have contact with infants and young
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NRC issued Regulatory Issue Summary (RIS) 2008-11, “Precautions to Protect Children Who May Come in Contact with Patients Released After Therapeutic Administration of Iodine-131,� dated May 16, 2008. This RIS was developed as part of NRC’s decision to deny a Petition for Rulemaking submitted by Peter Crane (PRM-35-18) which requested that NRC revoke the patient release criteria in 10 CFR 35.75. In the Federal Register Notice (73FR29445) NRC stated: “In conclusion, NRC finds that the arguments presented in PRM–35– 18 do not support a rulemaking to revoke the patient release criteria in 10 CFR 35.75. Reverting to the 1997 patient release criteria would impose unnecessary regulatory burden and is not warranted for the protection of public health and safety. To address the petitioner’s concern for exposure to children and infants, NRC has prepared a RIS and additional guidance which will be issued to all NRC medical use licensees, and to the Agreement States, concurrent to the resolution of this petition.
period would be for two to seven days following treatment. No Federal Register notice was published as NRC believes that this is informational and does not represent a departure from current regulatory requirements. To view other Regulatory Issue Summaries, go to the NRC public website at http://www.nrc.gov/ reading-rm/doc-collections/gencomm/reg-issues/ .
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NRC Denies Petition for Rulemaking by Peter Crane and Issues a Regulatory Issue Summary (RIS) 2008-11.
children. The guidance also suggests that licensees consider hospitalization for patients whose living conditions may result in contamination of infants and young children. The specific period of time for patients to follow these recommendations would be determined by the physician, depending on the amount of iodine-131 administered; typically, this
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July/August 2008
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AAPM Newsletter
July/August 2008
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AAPM Newsletter
July/August 2008
AAPM Education & Research Fund Report
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he AAPM Education & Research Fund, under the oversight of the Development Committee, Chaired by Paul M. DeLuca, is pleased to report on the progress of the various projects funded by or through the Fund. The Development Committee was created in 1989 by the AAPM Board of Directors with the following goals. • To support Fellowships for Ph.D. candidates in Medical Physics at CAMPEP-accredited institutions. Currently there are 17 institutions eligible to receive these awards. (The goal was to raise initial funds in the amount of $500,000.) • To support clinical Residencies, including seed money for research. Twenty-two institutions are now accredited by CAMPEP and are eligible for these funds. (The original goal was $1.5 million to support this effort.)
Oncology from 1993 through 2007. All Residencies are supported by matching funds from the host institution. Beginning in 2005, under the auspices of the AAPM Science Council, an annual grant of $25,000 has been awarded to new investigators as “seed” money to stimulate their research. Recipients must be within 5 years of having received the PhD degree and shall not have been the recipient of grants greater than $50,000. In 2008, two recipients will be selected to receive these grants, with a total outlay from the Education Fund of $50,000. Status Report on Recent Awards We asked recent recipients of AAPM awards to provide us with a brief summary of the status of their work.
All monies donated to the AAPM Education and Research Fund are irrevocable gifts, and are tax deductible. While the initial fundraising campaign in 1993-1995 did not reach its original goal, the Fund has grown to more than $1.1 million and the Development Committee continues to seek ways to grow the Fund further.
Dr. Marco Carlone was the recipient of the 2007 AAPM Research Seed Funding Award. He is a Medical Physicist at the Cross Cancer Institute in Edmonton, Alberta, Canada. His research project, Study of RF interference between a medical linear accelerator and an MRI, is well underway and Dr. Carlone sums up his work to date as follows:
What has been done so far? Beginning in 1992, the Development Committee actively sought renewable funding to sponsor residencies and fellowships in medical physics. In addition to awards directly from the AAPM Education Fund, both RSNA and ASTRO have generously supported residencies and fellowships through the AAPM Education & Research Fund. Varian Medical Systems also supported two residencies in Clinical Radiation
“Recently, several groups in North America and Europe have proposed integrating a medical linear accelerator and an MRI. One of the technical problems that must be overcome when integrating these devices is the RF interference between the two. It is well known that medical linear accelerators emit Radiofrequency (RF) noise that can affect certain electronic components such as pacemakers and defibrillators. Certain publications,
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such as AAPM TG 34 ‘Management of radiation oncology patients with implanted cardiac pacemakers,’ recognize the presence of RF noise in medical linear accelerators due to the operation of the pulsed power modulator. The mechanisms, and a detailed description of the frequency power spectrum, however, have never been well quantified. When integrating a linear accelerator and an MRI, RF noise due to the medical linac will be picked up by the MRI receiver coils and will interfere with the reception of the RF signal from the tissue sample being imaged and thus degrade the image forming process. This research project is focusing on identifying, explaining, and quantifying the source of RF noise due to a medical linear accelerator. We employ antennas that are sensitive to either electric or magnetic fields, and that have a calibration factor such that the electric and magnetic field strengths can be accurately measured. As well, we have measured correlations between the time and frequency characteristics of the RF noise measured, and the corresponding pulsed power modulator current and voltage characteristics. Our results indicate that for RF noise generated by a medical linear accelerator, magnetic field noise is present only in the low frequency range (< 1 MHz) and that electric field RF noise dominates above this frequency range. Further, good correlation between both the electric field measurements and the modulator charging current and magnetron pulse current has been observed in both time and frequency domains. The magnetic field measurements correlate well with the pulse forming network voltage.
AAPM Newsletter These correlations indicate probable mechanisms for RF noise generation. Despite this, there are also certain regions of the measured RF power spectrum that do not correlate to any observable functional characteristics of the pulsed power modulator. We hypothesize that a resonance phenomenon may be responsible for the unexplained RF signals. To investigate this, we are employing a SPICE based simulation method to simulate the modulator charging and discharging circuit. An experimental medical linear accelerator modulator (based on a Siemens MD2 linear accelerator) has been assembled and is operational. This modulator can now be used to study the resonance phenomena, and to assess methods to control the frequency of RF noise or to minimally shield the RF generating components of the linear accelerator. We hope that these results will identify methods to facilitate integration of a linear accelerator and MRI without interference between the two devices.
Dr. Marco Carlone - 2007 AAPM Research Seed Funding Award Recipient The funds provided by the AAPM for this research project have been invaluable in constructing the experimental linear accelerator modulator , and making it operational. This tool will provide a unique experimental apparatus for studying RF generation from a medical linear accelerator.” Dr. Todd Pawlicki of UC San Diego received the AAPM/ASTRO
July/August 2008 Residency award in 2007. writes:
He
“I joined the faculty at UC San Diego in September 2006. One of my first charges was to establish a Medical Physics Residency Program. Our first step in that charge was to obtain funding for our Residency program. We were in the process of applying for the AAPM/ASTRO Residency Award during the time of discussions with our hospital program funding. It was helpful for our hospital administrators to know that external financial recourses were available to assist in program start-up. We were finally successful in securing on-going funding for two resident positions. As of July this year, the UC San Diego Medical Physics Residency Program will be beginning its second year. Our first resident will complete his first year and our second resident will matriculate into the program in July 1, 2008. Since securing program funding from the hospital, the AAPM/ASTRO Residency Award has been used for continued program start-up activities such as starting a medical physics library in our department, recruitment for our second residency position, and program administrative support. Finally, the AAPM/ASTRO Residency Award will be used to help defer the cost of the CAMPEP accreditation process. We plan to apply for accreditation in spring 2009. The AAPM/ASTRO Residency Award is an essential component in starting new Residency programs. The start-up costs and CAMPEP accreditation fee can be substantial in the eyes of hospital administrators. The award is invaluable in helping support those costs as well as demonstrating the importance of Residency programs to administrators.”
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Scott & White Memorial Hospital in Temple, Texas, was also awarded an AAPM/ASTRO Residency in 2007. Dr. Boyer explained how Scott & White developed its residency program: “When Dr. Arthur Boyer joined Scott & White Memorial Hospital in 2005, the Chair of the Radiology Department, Dr. Gill Naul, agreed to fund the initiation of a Radiation Oncology Physics Residency. On November 29, 2006, Dr. Bruce Gerbi confirmed that CAMPEP would entertain an application from Scott &White for a Physics Residency. The Senior Staff and Staff of the Physics Division began planning the program. It was agreed that both diagnostic and therapy physicists would participate in the program in recognition of the strong imaging emphasis in the current practice of radiation oncology. An initial outline and draft of a Self-Study, required as a part of the application for accreditation by CAMPEP, was initiated in the spring of 2007. The American Society for Therapeutic Radiology and Oncology (ASTRO) in conjunction with the American Association for Physicists in Medicine (AAPM) selected the program at Scott & White Memorial Hospital to receive the 2007 Radiation Oncology Physics Residency Training Award. The Radiation Oncology Physics Residency Training Program at Scott & White officially began under the direction of Dr. Boyer in the Fall of 2007. Using a portion of the funds from the award, a Program Administrator, Ms. Alexandria Smiley, was recruited to Scott & White in September 2007. Rebecca Weinberg, Ph.D. who graduated from the CAMPEP accredited program at the Graduate School of Biomedical Science and the M.D. Anderson Cancer Center in Houston, Texas, entered the program as its first Resident in October 2007. Ms. Smiley helped draft the Self-Study document
AAPM Newsletter and prepare it for submission. Funds from the Award were used to apply for accreditation when the SelfStudy document was submitted to CAMPEP in February 2008. Funds from the Award were used to recruit the second Resident at Scott & White, Junfang Gao, Ph.D., who is scheduled to begin in July 2008. The Radiology Department will continue to provide the support for the Physics Residents through 2009 when CAMPEP accreditation is anticipated. At that point, Scott & White will apply for funding for resident stipends from the Centers for Medical Services (CMS). Meanwhile, the participating staff of the Physics Residency Program continue to refine and improve the program structure, procedures, and documentation.” Dr. S. Cheenu Kappdath at the UT M.D. Anderson Cancer Center in Houston received the RSNAsponsored Medical Physics Residency Award for 20062008. Dr. Hazle, supervisor of the residency reports: “Dr. Kappadath completed his residency in October 2007 focusing in nuclear medicine physics. With a solid background in radiological physics from his twoyear tenure in Dr. Chris Shaw’s lab, his completion of the residency with a focus in nuclear medicine physics made him a highly sought after “double-Boardable” medical physicist. We had an opening on our faculty and hired him to support our growing clinical research program in nuclear medicine, primarily in positron emission tomography (PET). Dr. Kappadath will also provide support for the x-ray and nuclear imaging clinical research resources in our new Center for Advanced Biomedical Imaging Research slated to open in mid-2009. The AAPM Fellowship provided Dr. Kappadath with the funding to
pursue this unique opportunity to develop a clinical understanding of the principles he was already familiar with. We expect Dr. Kappadath to be a key component of our developing program in Personalized Medicine.” An AAPM/RSNA two-year Fellowship was awarded to Matt Vanderhoek at the University of Wisconsin in 2005. He writes: “Currently, I am in my 3rd year of a graduate program in medical physics at the University of Wisconsin - Madison. The RSNA/AAMP Fellowship Award helped finance my first two years of graduate school, for which I am very grateful. I do not really have a “career” yet since I am still in graduate school. However, the fundamentals of medical physics that I learned in my first 2 years of graduate school (supported by the fellowship) are providing and will continue to provide me with an excellent foundation for my research in the use of PET imaging for assessment of treatment response in chemotherapy patients and in my future career as a medical physicist.” Bart Lynch at the University of Florida is the latest recipient of a two-year AAPM/RSNA fellowship Mr. Lynch writes: “In the past year, I have worked to further understand the impact of breathing motion on delivered dose distributions for lung cancer patients. Primarily, we have used dosimetric parameters related to the incidence of radiationinduced pneumonitis as our metrics to compare 3D and 4D dose distributions. In the next year, we hope to investigate different margin calculation methods.” Medical Physics residencies supported by the Varian/AAPM Residency Award for 20052007 went to several residents at Washington University Radiation
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July/August 2008 Oncology Department, Division of Medical Physics, under the direction of Dr. Eric Klein. Dr. Klein reports: “At the initiation of this award our program, accredited since 1997, had been reduced in the number of positions (from 4 to 2). This award allowed us to re-expand our program. The following details the success of the graduates/current residents who we supported with the help of this award; Mark Wiesmeyer, Ph.D. (completed program in 2006) is currently an Assistant Professor at the Virginia Commonwealth University and is now certified by the ABR. Anna Kress, M.S. (completed program in 2007) is a physicist at the Dr. H Bliss Murphy Cancer Centre in St. John’s, NL, Canada. Dharani Rangaraj, Ph.D. (completed program in 2007) is an Instructor at Washington University in St. Louis, MO. Hui Zhao, Ph.D. is a current Resident who will graduate in July of 2008.” The members of the AAPM Development Committee ask for your support of these valuable research efforts. In this our 50th year, AAPM has much to celebrate, the least of which is the contribution to science made by recipients of grants from the Education & Research Fund. We are asking all AAPM members to make a contribution to the Education & Research Fund this year - a response envelope is included in this Newsletter. Or, go to www.aapm. org and click on the Ed Fund logo on the top right corner of the page. Let’s all help continue this tradition of supporting the future generation of Medical Physicists.
AAPM Newsletter
July/August 2008
Health Policy/Economic Issues and not under the radiation treatment delivery codes, per se.
James Hevezi, Ph.D. Fair Oaks Ranch, TX Supervision Requirements Medical Physicists
T
for
he presence of the medical physicist during conventional, 3D, or IMRT radiation treatment delivery is not necessary for reimbursement. The procedure codes covering these services appear in the CPT coding manual under 77401-77416 and 77418. Treatment activities by the medical physicist such as setup review and consultation with the therapist or radiation oncologist is covered under the continuing medical physics consultation (CPT 77336)
supervision of both the medical physicist and the radiation oncologist. The radiation oncologist bills for this service under the stereotactic treatment management codes (CPT 77432 or 77435). The work of the medical physicist is included in the relative value units (RVUs) for these procedures (CPT 77371-77373). Both the medical physicist and radiation oncologist must be immediately available at the treatment console during treatment delivery. Personal supervision requirements mean that a SRS/ SBRT treatment delivery cannot ensue if either professional is not available during a particular treatment fraction.
With the advent of new and more complex technologies, â&#x20AC;&#x153;personal supervisionâ&#x20AC;? is now required for both the medical physicist and radiation oncologist in order to receive Medicare reimbursement for certain procedures. Personal supervision means that the physician and medical physicist must be in attendance in the room during the performance of the procedure. Personal supervision is required for all High Dose Rate (HDR) brachytherapy procedures (CPT 77781-77784). HDR brachytherapy should not proceed without the presence of either professional.
For Medicare patients in the hospital outpatient setting, utilize HCPCS code G0173 or G0251 for linear accelerator-based SRS/SBRT treatment delivery and HCPCS code G0339 or G0340 for robotic SRS/SBRT treatment delivery. In a freestanding center, treatment
With the advent of Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT), part of the treatment requires personal
Table 1: Stereotactic Radiation Treatment Delivery Codes CPT/HCPCS Code
Hospital Outpatient
77371 SRS treatment delivery, complete course of treatment of cerebral lesion(s) consisting of 1 session; multi-source Cobalt 60 77372 SRS treatment delivery, complete course of treatment of cerebral lesion(s) consisting of 1 session; linear accelerator based 77373 Stereotactic body radiation therapy, treatment delivery, per fraction to 1 or more lesions, including image guidance, entire course not to exceed 5 fractions *G0173 LINAC SRS complete course of therapy in one session *G0251 LINAC-based SRS delivery *G0339 Robotic linear accelerator radiosurgery, first fraction *G0340 Robotic linear accelerator radiosurgery, fractions 2-5
X
X X X X X X
*These HCPCS codes are typically used for Medicare hospital outpatient coding only.
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Freestanding Radiation Oncology Center X
AAPM Newsletter
delivery of these procedures utilizes new CPT codes 77372 and 77373. Cranial treatments with Cobalt60 (e.g. Gamma Knife ®) utilize CPT 77371 in both a hospital or freestanding setting (see Table 1 on p. 22.) Medicare Administrative Contractor (MAC) Reform Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant
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he Centers for Medicare and Medicaid Services’ (CMS) mission is to ensure health care security for beneficiaries. A major component in achieving this mission is the successful administration of Original Medicare, or Fee-forService (FFS) Medicare. Medicare Contracting Reform (section 911 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003) is a major component in achieving this mission. Section 911 mandates that the Secretary for Health & Human Services replace the current contracting authority to administer the Medicare Part A and Part B FFS programs with the new Medicare Administrative Contactor (MAC) authority. Through the implementation of Medicare Contracting Reform, CMS hopes to establish a premier health plan that allows for comprehensive, quality care and world-class beneficiary and provider service. Between 2005 and 2009, CMS will be conducting full and open competitions to replace the contractors that currently perform claims processing and related functions for the Medicare program with new MACs that will perform many of the same tasks, but will do so more efficiently.
Central to the implementation of the contracting reform is the creation of new jurisdictions to be administered by the MACs. CMS designed the new MAC jurisdictions to balance the allocation of workloads, promote competition, account for integration of claims processing activities, and mitigate the risk to the Medicare program during the transition to the new contractors. The new jurisdictions reasonably balance the number of feefor-service beneficiaries and providers. These jurisdictions will be substantially more alike in size than the existing fiscal intermediary and carrier jurisdictions, and they will promote much greater efficiency in processing Medicare’s billion claims a year (see Table 2 below). With changes to the states grouped in the revised
July/August 2008
jurisdictions and assignment of new Medicare Administrative Contractors, radiation oncology departments should be aware of possible changes to their local coverage determinations (i.e. medical policies). Under Medicare Contracting Reform, many of the new MACs are consolidating and revising local coverage determinations from the old Part A fiscal intermediaries and Part B carriers, which require an open public comment period. Be on the look out for draft policies under review and closely examine them to make sure that there have been no changes to coverage policies that impact your facility. You may contact Lynne Fairobent at AAPM (lynne@aapm.org) if you would like the Professional Economics Committee to review draft policies in your Medicare jurisdiction.
Table 2: Medicare Administrative Contactor Jurisdictions for part A/B Jurisdiction 1 American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands 2 Alaska, Idaho, Oregon and Washington 3 Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming 4 Colorado, New Mexico, Oklahoma and Texas 5 Iowa, Kansas, Missouri and Nebraska 6 Illinois, Minnesota and Wisconsin 7 Arkansas, Louisiana and Mississippi 8 Indiana and Michigan 9 Florida, Puerto Rico and U.S. Virgin Islands 10 Alabama, Georgia and Tennessee 11 North Carolina, South Carolina, Virginia and West Virginia 12 Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania 13 Connecticut and New York 14 Maine, Massachusetts, New Hampshire, Rhode Island and Vermont 15 Kentucky and Ohio
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MAC Palmetto GBA (Palmetto) National Heritage Insurance Corporation (NHIC) Noridian Administrative Services (NAS) Trailblazer Health Enterprises (Trailblazer) Wisconsin Physicians Services Health Insurance Corporation (WPS) TBA TBA May 2008 TBA TBA TBA TBA Highmark Medicare Services, Inc. (HMS) National Government Services (NGS) TBA TBA
AAPM Newsletter
July/August 2008
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AAPM Newsletter
July/August 2008
American Board of Radiology The Personal Data Base (PDB) for ABR Diplomates – An MOC Organizer: by: ABR Trustees in Radiologic Physics G. Donald Frey, Medical Nuclear Physics Geoffrey S. Ibbott, Therapeutic Radiologic Physics Richard L. Morin, Diagnostic Radiologic Physics
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he advent of Maintenance of Certification (MOC) for medical physicists in 2002 introduced a new paradigm whereby the American Board of Radiology (ABR) and its diplomates would, from that time forward, engage in continuous communication over the lifetime of the certification. Previous to this, the interaction between the diplomates and the ABR was quantized to events associated with the various exams (Part 1, Part 2, and the oral) and, in effect, ended once the lifetime certificate was issued. With time limited certification and the MOC requirements, contact will be on a frequent basis and certainly no less than annually. As a reflection of this communication outreach, the Radiologic Physics Trustees of the ABR are initiating a series of columns in the AAPM Newsletter with the intention of providing informative updates on topics of interest in the arena of initial
certification (IC) and MOC. The focus of this leadoff article will be to highlight the functionality of the Personal Data Base (PDB) that has been offered to each diplomate entering MOC. As we are all aware, the key to management of our increasingly active professional lives is the big “O” – Organization. It was the intent of the ABR to assist in this aspect through establishment of the PDB as a functional tool that would guide the diplomate through the various components of MOC and help to organize each step in the process. Upon notification of successful completion of the oral exam (or upon voluntary entry into MOC for lifetime certificate holders – an act that we strongly encourage), each diplomate is given access to their password-protected PDB. The technical aspects of this data base are maintained by the ABR with the responsibility for effective use of the PDB residing with the diplomate. Once you log in to your PDB (email ID plus personally-selected password), you have access to the full vista of MOC as it applies to you. Should it be needed, you can review the requirements of each of the 4 MOC components (Professional Standing, Lifelong Learning & Self Assessment, Cognitive Expertise, Practice Quality Improvement). You can view your personal 10-year cycle timeline and access your progress through automatic accounting built in to compare completed activities with the requirements of each component. You can input your CME or SAM credits as you
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receive them. Importantly, as added functionality, you are able to sign up (free) for The CME Gateway that is a cooperative effort initiated by the RSNA and ACR to provide a one-stop resource for monitoring one’s CME credit. Currently, the SNM, ARRS, SIR, ASNR, SPR, and CAMPEP are participating in this “virtual database” that allows automatic transfer of CME credits to your PDB. The advantages are two-fold: 1.) your CME credit from Gateway member organizations will appear automatically in your PDB (self-entry not required), and 2.) those credits will be regarded by the ABR as authenticated, meaning that in the low probability you are audited (a requirement of the ABMS), you will not have to produce any further evidence (e.g. certificates) for those credits. In addition, through your PDB you can: a) attest to yearly completion of your PQI activities; b) when the time comes, attest to your professional standing or, for those to whom it is applicable, update your licensure status, c) view the timing opportunities for the cognitive exam; d) update your contact information; and, e) pay your annual MOC fee. We urge you to become a frequent visitor to your PDB files to ensure that they remain up-to-date. At the end of the 10-year cycle, your status will automatically be transmitted to the ABR for ascertainment as to successful completion of the MOC requirements. We are confident that all diplomates will recognize the organizational benefit to be derived through effective use of their PDBs.
AAPM Newsletter
July/August 2008
Chapter News Southwest Chapter of AAPM (SWAAPM)
Queretaro, Mexico (co-sponsored by the AAPM) was another success. Please keep an eye on the chapter webpage to look for the next joint meeting, which everyone is welcome to attend and participate in.
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n April 18 – 19th, the SWAAPM had their Spring 2008 meeting at the Omni Hotel in Downtown Austin, TX. Topics ranged from Nanoscience in Medicine and multi-modal imaging for therapy to current hot topics in both diagnostic radiology and radiotherapy. An extremely spirited discussion during the professional symposium centered on issues associated with ABR and CAMPEP policies regarding the board exams as well as the emergence of medical physics doctorate programs. Many thanks to our invited speakers and to the 26 vendors in attendance for their continued support. To view some of the scientific, educational and professional presentations given at the Spring meeting, please visit the chapter website at: http://chapter. aapm.org/swaapm/
The Young Investigators Symposium had an impressive turnout with 27 trainees (students and residents) in attendance of the meeting and 16 presenters. 1st place went to Courtney Buckey, 2nd place to Patricia Tynan, 3rd place to Teboh Roland, and 4th place to Drosoula Giantsoudi. Amazingly, all hailed from The University of
George Starkschall gave a presentation on professional doctorate programs leading to a Doctorate in Medical Physics (DMP). Texas Health Science Center at San Antonio. Congratulations to these Young Investigators and to the fine program in San Antonio. The finance committee allocated $6,000 of chapter funds in support of the Gala Night festivities at the AAPM 50th anniversary celebration. Under the guidance and recommendation of our Latin American Relations Committee, the chapter also decided to offer $5,000 in travel awards to the national meeting in Houston to assist members of our neighbors in the Federación Mexicana de Organizaciones de Física Médica (Mexican Federation of Medical Physics Organizations, or FMOFM), to attend the meeting this July. The most recent joint SWAAPM/ FMOFM meeting last Spring in
Congratulations to the SWAAPM chapter’s newly elected officers for 2008: President: R. Jason Stafford, Ph.D. 2008-2009 President-Elect: Kyle J. Antes, M.S. 2008-2010 Secretary: Dawn Cavanaugh, Ph.D. 2008-2010 Treasurer: Russell B. Tarver, M.S. 2008-2010 AAPM Board Rep: John Gibbons, Ph.D. 2008-2010 Many thanks to both our Past-President; Geoffrey Clarke, Ph.D. (2008-2009) and the Chapter Web Master; Timothy Blackburn, Ph.D.
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Hold the date! The SWAAPM Fall 2008 meeting will be held in New Mexico at the Hyatt Tamaya Resort & Spa October 23rd – 25th. This will be a joint meeting with the Rocky Mountain chapter. Thank you to Phil Heintz and local chapter president, Steve Jones, for their assistance in local arrangements and organization of the meeting. Southern California Chapter (SCC) Hosts All Day Meeting by: Steven Goetsch, Education Chair Marianne Plunkett, Past President Brad Krutoff, Chapter President
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he Southern California Chapter hosted its annual Midwinter Workshop at the Sheraton Universal Hotel in Los Angeles, CA on Friday, January 11, 2008. The topic of the workshop this year was “Image Guidance in Radiation Therapy and Oncologic Diagnosis.” We were honored to have President-Elect Maryellen Giger fly in from Chicago to update us on national AAPM affairs and to give an address titled “CAD for Detection of Breast Cancer.” Faculty for this year’s meeting included Olivier Gayou from Allegheny General Hospital, Pittsburgh, Ben Harris from Kaiser Permanente, Portland, Oregon, Paul Petti from Washington Hospital Fremont, CA and Robin Stern from UC Davis. Local AAPM-SCC speakers included Nzhde Agazaryan from UCLA,
AAPM Newsletter
July/August 2008
Chapter News Steve Jiang from UCSD, and Shirish Jani from Sharp Memorial Hospital San Diego. Topics covered frameless extracranial radiosurgery, imageguided radiotherapy, IMRT quality assurance with EPID and diode array, adaptive radiotherapy and the new Gamma Knife Perfexion Model. Four of the Platinum vendors gave 10 minute presentations as well. About 120 people attended the all day meeting. The meeting was well supported by seven Platinum sponsors and twelve Gold sponsors, along with a registration fee for attendees. Continuing Education Units were granted by CAMPEP, MDCB and ASRT. Medical physics and radiation therapy students attended for free. Talks from each of the speakers are being collected in Powerpoint and Adobe Acrobat PDF format and will be posted on the Educational Materials tab of the chapter web page. The Midwinter Workshop is an annual event which has been held for close to 25 years and should be held approximately the same time next year. Physicists from all over the country are always welcome to attend. Southeastern Chapter (SEAAPM) Annual Scientific Meeting and Symposium by: Jun Duan, Chapter President Christine Noelke-Gnaster, Chapter Secretary
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he Southeastern Chapter of the AAPM held its 2008 Annual Meeting and Symposium on March 27-29 in Birmingham, AL. Over 90 people attended the two events and 32 vendors participated in the exhibit.
This year’s symposium, coordinated by Richard Popple, focused on “Emerging Technologies in Radiation Therapy: Impact on the Community Practice Medical Physicist.” The symposium faculty provided outstanding lectures on topics including Monte Carlo based treatment planning, stereotactic body radiotherapy, image-guided radiation therapy, motion management, and functional imaging, etc. The annual scientific meeting immediately followed the symposium. Invited speakers presented sessions covering professional, imaging and therapy topics. This year, the chapter continued the student presentation program that was started last year. Travel grants were awarded to students from each of the six medical physics training programs within the SEAAPM region to present their research work in the scientific meeting. All student presentations were excellent. For complete programs of the symposium and the scientific meeting, please visit the SEAAPM website at http://www.seaapm.org. During the annual meeting, the chapter honored its best. Perry Sprawls received the prestigious Jimmy O. Fenn Award in recognition of his “outstanding
Perry Sprawls is giving acceptance speech for the Jimmy O. Fenn Award. career achievements and leadership in the medical physics profession and contributions to the SEAAPM.” Additionally, the annual SEAAPM Awards for Best Publications were presented. The Best Publication in Imaging Physics went to Sankararaman Suryanarayanan, Andrew Karellas, Srinivasan Vedantham, Ioannis Sechopoulos, and Carl D’Orsi for their article “Detection of Simulated Microcalcifications in a Phantom with Digital Mammography: Effect of Pixel Size” (Radiology 244(1): 130137 2007). The Best Publication in Therapy Physics went to Rebecca M. Seibert, Chester R. Ramsey, Dustin R. Garvey, J. Wesley Hines, Ben H. Robison, and Samuel S. Outten for their article “Verification of Helical Tomotherapy Delivery (see SEAAPM p. 28)
Congratulations to the SEAAPM chapter’s newly elected officers for 2008: President: President-Elect: Past-President: Secretary: Treasurer: AAPM Board Rep:
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Jun Duan 2008-2009 Sha Chang 2008-2010 Robin Miller Christine Noelke-Gnaster David Gauntt Ivan Brezovich (Term starts January 1, 2009)
AAPM Newsletter
July/August 2008
Medical Reserve Corps The Medical Reserve Corps: An Opportunity for Medical Physicists to Volunteer in Their Communities
by John J. Lanza, MD, PhD, MPH, FAAP with information from MRC website
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he mission of the Medical Reserve Corps (MRC) is to improve the health and safety of communities across the country by organizing and utilizing public health, medical and other volunteers. The MRC was founded after President Bush’s 2002 State of the Union Address, in which he asked all Americans to volunteer in support of their country. It is a partner program with Citizen Corps, a national network of volunteers dedicated to ensuring hometown security. Citizen Corps, along with AmeriCorps, Senior Corps, and the Peace Corps are part of the President’s USA Freedom Corps, which promotes volunteerism and service nationwide. MRC units are community-based and function as a way to locally organize and utilize volunteers who want to donate their time and expertise to prepare for and respond to emergencies and promote healthy living throughout the year. MRC volunteers supplement existing emergency and public health resources. They are NOT first responders. MRC volunteers include medical and public health professionals such as physicians, nurses, pharmacists, dentists, veterinarians, epidemiologists, and could include medical and health physicists. Many community members—interpreters, chaplains, office workers, legal
advisors, and others—can also fill key support positions. MRC units may have specific areas that are targeted to strengthen the public health infrastructure of their communities by increasing disease prevention activities, eliminating health disparities, and improving public health preparedness. Public health preparedness encompasses preparation and response activities involved with natural and manmade disasters. Currently, there are over 731 MRC units and more than 153,000 volunteers nationwide. Due to the need to have radiation health and safety professionals available to support local, state, and federal responders after a radiological incident or event, in 2007, the Homeland Security Committee of the Health Physics Society adopted the project of recruiting health physicists into their local MRC units. Medical physicists would also clearly be beneficial members of their local MRC. Examples of how medical physicists could be used after a radiological incident/event would include: 1. Acting as consultants to public health officials regarding human health effects from radiation exposures; 2. Providing contamination screening services at Community Receptions Centers; 3. Assisting in collecting bio-assays at Alternative Medical Treatments Sites; and, 4. Being the liaison between hospital emergency personnel and public health authorities in identifying and triaging radiation exposure victims. Each MRC will provide benefits to volunteers including: 1. The opportunity to serve your community during times of need; 2. Education and training availability
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including learning about the Incident Command System; 3. Participation in table-top and field exercises; and, 4. First access to vaccinations and other medications during a biological event or disease outbreak (as well as your immediate family members). This is a great opportunity for medical physicists to learn about disaster preparedness activities in their community and to be part of a response effort to mitigate the effects of natural or man-made disasters. You can find out more information on the Medical Reserve Corps and can find your local unit by visiting the MRC website at: http://www. medicalreservecorps.gov
(from page 27 - SEAAPM ) Using Autoassociative Kernel Regression” (Medical Physics 34(8): 3249-3262, 2007). Congratulations to all awardees. On Friday evening, meeting attendees took a break from the busy meeting schedule for a night out at the Birmingham Botanical Gardens, where they enjoyed socializing with colleagues, friends and family, as well as the dinner and live music. The chapter business meeting was held on Saturday following the Scientific Meeting. Members in the business meeting decided to hold next year’s annual meeting and symposium in North Carolina. The theme of next year’s symposium will be image informatics. Please visit our chapter web page for more information and update. We hope to see you at next year’s SEAAPM meeting in North Carolina.
AAPM Newsletter
July/August 2008
Board of Directors Recommends Dues Increase AAPM Members for 2012/2014 and the increased educational and training requirements being instituted by the ABR.
Mary E. Moore, Treasurer Philadelphia, PA
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t its Spring meeting in Chicago, the AAPM Board of Directors passed a motion to recommend to the membership a five-year series of modest dues increases. Their rationale is based on the current status and future outlook for the Association’s finances. AAPM Financial Situation Current Status and Future Outlook Since 1994, AAPM has experienced a significant gain in its Unrestricted Reserve Balances. From slightly more than $1 million, reserves have grown to an estimated $8.6 million at the end of 2007. This balance just meets the Board-approved policy of maintaining reserves at one year’s budget plus an amount sufficient to cover long-term liabilities. While AAPM experienced unrealized losses in its investment portfolio in the years 1991-2001, over the long-term these have been re-gained. In preparing the 2008 draft budget, it became apparent that it would be necessary to withdraw from these reserves in order to fund two very important initiatives for the membership. These initiatives include the activities of the Joint Licensure Subcommittee and its efforts to obtain licensure; and efforts to prepare
Together, these two items will require the expenditure of over $600,000 in 2008. The current budget cannot support these efforts from the general operating funds of the Association. These efforts will also require continued funding in the years between now and 2012/2014, requiring a long-term solution. Efforts at generating additional sources of non-dues revenue are underway; however, it is essential that the incremental dues increases passed by the membership in 2001 and extending through 2007 be continued. The AAPM is dependent on three major sources of revenue: Membership Dues, the Annual Meeting, and Medical Physics. While there are other sources of revenue that are significant when combined, individually they are very small. Investment income has tended to provide a significant source of the surplus over the past several years; however, this income exists on paper only. The stock market could easily trend downward over the next several years, depleting the value of the investment portfolio and, hence, it is AAPM’s policy not to include investment gains and losses in the budgeting process. An examination of the three major sources of revenue projected for 2008 shows the following: 1. Membership Dues are budgeted at $1.4 million and are based on the dues rates in effect for 2007, the final year of the increases approved by the Membership in 2002 for the five-year period 2003 through 2007.
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This source is 20.5% of the total budget. Dues have increased from $185 prior to 2003 to $285 in 2007 for full members. This represents an increase of approximately 54%. 2. The Annual Meeting has two major sources of revenue, registrations and exhibits. It is budgeted in 2008 to generate $2.4 million in total revenue, or 34.3% of the total. Registration fees could not cover the costs of the meeting if not for the fees paid by the exhibitors. Estimates show that the breakeven registration fee without exhibits revenue would be about $850. Both registration and exhibit fees are priced to be competitive with other organizations. It is especially important that AAPM remain competitive when courting the same exhibiting companies as related societies. Exhibit revenues have increased steadily each year for several years due to new exhibitors and to increases in space rentals by existing exhibitors. It is anticipated that this source of revenue will continue to increase for a few more years, however, it is AAPM’s practice to budget conservatively and this year for the first time the “actual” revenue earned in 2007 is being used rather than following a pre-existing formula that budgeted 10% less than actual for the next year. Exhibit fees were increased last year and will continue to be monitored to make certain AAPM remains competitive. 3. The Medical Physics Journal also has two major sources of revenue, advertising and subscriptions; both of which are market driven and monitored each year with AIP rates as a guide. The Journal now accounts for just under $2 million in annual revenue, or 28% of the total. It contributes a net of just under $800,000 at the present time,
AAPM Newsletter
July/August 2008
Amounts in thousands Governance Councils and committees Headquarters operations Administration Totals
$2,634
however, caution in budgeting for future income is tempered by the realization that the potential exists for paper subscriptions to be replaced by online-only versions. These three sources together account for over 82% of AAPM’s income and must support all programs, whether or not they generate revenue or are no-fee services. For each of the past three years, budget deficits in the range of a half million dollars were approved by the Board of Directors. However, not all planned projects were completed, and AAPM benefited significantly from gains in the stock and bond markets with its investment portfolio. Anticipated expenses continue to increase each year. In 2008 alone, committees and councils have requested a significant increase in staffing, three FTE positions have been approved, along with two other staff added in late 2007 to support partners for whom
MONDAY
2003 $67 548 1,830 189
2007 $ 161 1,294 2,347 315 $4,117
Diff $ 94 746 517 126
Percent 240% 236% 128% 167%
$1,483
156%
we provide management services. There is no way to meet these goals without increasing revenue. The table below highlights just a few of the program expenses during the past five years. The increases above were not typical in the years prior to 2000. However, membership needs have grown and our Members find it increasingly more difficult to donate volunteer hours. They look to staff to perform many tasks that in the past were done on a volunteer basis. There is also a greater need for continuing education and monitoring of professional interests. There is a sense among the membership that the Association now has a financial reserve and a competent staff to expand services. While this is good, it must be controlled to avoid drawing down reserves and creating a financial crisis in the future.
A balanced, long-term approach to both generating revenue and controlling expenses is needed. Programs will be periodically reviewed to weed out those that are no longer relevant and both dues and non-dues sources of revenue must be evaluated to keep pace with expenses in order to sustain the AAPM in the future. The proposal is for Full dues to increase by $15 annually for the next five years. This item is on the agenda for the Annual Business Meeting in Houston, where comments, questions and recommendations will be solicited from the members in attendance at that meeting. Following the meeting, all comments will be summarized by the Secretary and sent to the membership for a vote. In accordance with the By-law change passed last year, a dues increase requires the vote to be open to all Members eligible to vote. This vote will be conducted electronically following the meeting.
PRESIDENT’S SYMPOSIUM: SCIENCE, MEDICINE, AND SOCIETY Don’t miss the 2008 AAPM President’s Symposium entitled “Science, Medicine and Society” and the talk entitled “Technology and the Crisis in the U.S. Health Care System” to be given by invited speaker Arnold Relman of Harvard Medical School. This special symposium will take place on Monday, July 30, 2008 from 10:00 AM - 12:00 PM in Auditorium B of the George R. Brown Convention Center. 30
AAPM Newsletter
July/August 2008
Maintenance of Certification & TG-127 Update by: Michael Yester, Ph.D. Birmingham, AL
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ask 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. As a reminder the MOC process consists of four parts as established by the ABMS:
â&#x20AC;˘ Part 1 relates to Professional Standing. â&#x20AC;˘ Part 2 relates to Lifelong Learning and Self-assessment. â&#x20AC;˘ Part 3 relates to Cognitive Expertise. â&#x20AC;˘ Part 4 relates to Performance in Practice Evaluation. The intent of this article is to provide an update on the MOC program and AAPM activities relating to this. Part 2 This part has undergone a number of changes and as reported in a recent newsletter, the current requirement of this section as relates to Continuing Education is 250 category 1 credits over 10 years with SDEPs (Self-Directed-Educational Projects) 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 check the ABR MOS Radiological Physics section of the web site periodically http://www.theabr.org/ RP_MOC_Req.htm. A second ingredient of Part 2 relates to SAMs (Self-Assessment Modules) and consists of educational modules to provide individual assessment and direction for further educational activities. These modules must be approved for category 1 credit and thus count towards the 250 credits noted above, also. The requirement is a total of 20 SAMs within the ten year period with at least 1 per year and a maximum of four in a calendar year. Such modules were presented at the 2007 Meeting and this year there will be another 8 modules presented at
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AAPM Newsletter the Annual Meeting (four in Therapy and four in Imaging). The topics for the SAM presentations are: • Imaging: MRI, Breast Imaging, PET/ CT and SPECT/CT, and Computed Tomography • Therapy: Stereotactic Body Radiation Therapy, kV vs MV CBCT, Management of Motion, and QA and The Challenge of Clinical Trials. As last year, the sessions are open to all attendees, but to obtain SAMs credits it is necessary that an individual register for the SAM session(s) of interest. Please note that the SAM sessions are open to everyone, but only those pre-registered for the audience response technology will be eligible to receive an interactive response unit. Questions will be asked during the SAM sessions, and participants must answer each question in order to receive certification. There is no pass/fail; the fundamental idea is to assess knowledge gained during the session. For those individuals unable to attend the meeting, the sessions will be captured as part of the Virtual Library and will incorporate time for the individual to answer the questions and feedback will be provided. The modules presented will be available on-line within the Virtual Library in December or January. Although there were some logistic issues and other unforeseen problems last year that caused some delay, it is expected that the process will proceed more smoothly this next year. Due to CAMPEP requirements, in order to get CE credit for a SAM presentation viewed on-line, it is necessary to answer 10 questions within the OCE portal (On-Line Continuing Education) section of the website. The questions presented during the presentation as part of the SAM module will be used with extra
July/August 2008 questions used to complete the 10question requirement. So viewing a SAM module on-line will count as a SAM credit and as CE credits if one views the module and then goes to the OCE section and answers questions for CE credit. Part 4: Practice Quality Improvement. Concerning Part 4, Michael Taylor and Per Halvorsen lead a subgroup of the TG that has put together a proposal for meeting this requirement that takes into account the role of a physicist in the clinical environment. Additional staff at AAPM headquarters is being hired
to assist in this effort among other web-related activities. In August there will be a PQI summit relating to Radiation Safety and development of PQI modules relating to that topic and information that can be used by an individual to set up a PQI on this subject. There is a section of the BBS part of the AAPM web-site that is dedicated to MOC. Per Halvorsen updates the site as needed and checks the site for questions and concerns that arise. That area and the ABR website given above are good repositories for upto-date information.
IOMP List of Medical Physics Specialists Colin G. Orton, IOMP Science Committee The IOMP is producing a list of medical physicists who are willing to serve as consultants for specific medical physics assignments, either in their own country or abroad. The consultancies may be an IOMP task or a technical cooperation activity of an organization which has requested the IOMP for names of medical physicists for a specific mission. If you are willing and able to volunteer for such an activity, please visit the IOMP website at: http://www.iomp.org and click on the “IOMP Specialist” list tab where you can download a copy of the application form and submit the completed form to Michael Stabin at: michael.g.stabin@Vanderbilt.edu
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AAPM Newsletter
July/August 2008
2007 AAPM-IPEM Travel Grant Report Professor George Sandison, School of Health Sciences, Purdue University
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ow, what a ride! I’d taken a sabbatical leave year from Purdue University starting the beginning of July 2007 and spent most of that time on opposite sides of the globe, England and Australia. It seemed that fitting in two weeks for a seminar tour of the UK as part of the honor for receiving the 2007 AAPM-IPEM Medical Physics Travel Grant was going to be easy. After all, everything was leaning my way. I’m originally from Liverpool, England, a city that is home to the Beatles, world class soccer teams and a peculiar local accent known as “Scouse.” All my siblings, my parents, and about half a million other souls still reside in this 2008 European Capital of Culture plus I have friends abounding in the city and on the island at large. Yes, easy as eating pie, except life comes at you hard, fast and without warning sometimes. A family crisis, encountering sick parents and a career related opportunity all colluded to force a change in my award travel plans from Fall 2007 to Spring 2008. Nevertheless, all went smoothly in the end and the tour was a great success. I’ve had interest in proton therapy for a long time and this interest has recently been focused on problems concerning the treatment of lung cancer using this modality. How should we be doing true 4D proton therapy and may we take advantage of the time dimension to improve optimized intensity modulated therapy? Aspects of this question, together with scattered neutron dose to a fetus and prostate cryosurgery comprised the six seminars given
in part fulfillment of the award requirements. First I visited the Clatterbridge Center for Oncology (CCO) in Bebington, England, which is the second largest dedicated cancer center in England. There I was hosted by Professor Alan Nahum to deliver the seminar entitled “Proton Therapy in Motion?”. Obviously a pleasant experience judging by the big smile on my face in the picture below! Clatterbridge has the only proton therapy treatment center in the U.K., a low energy facility that treats eyes exclusively. However there is great interest in acquiring funding for a high energy proton treatment facility by Clatterbridge and I met with the center’s Chief Executive Officer, Mr. Darren Hurrell, to discuss the opportunities presently available. The CEO attended my seminar and I hope he was educated as to the potential of this modality and the cutting edge
Figure 1: Professor George Sandison delivering the seminar “Proton Therapy in Motion?” at the Clatterbridge Center for Oncology, UK. research that would be translated into the clinic by the time their proton facility is built. Alan is an expert in Monte Carlo calculations and radiation dosimetry who has an increasing
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profile in biological modeling of radiation therapy treatment. In fact I arrived a few days before the annual international course he organizes on Radiobiological Modeling in Radiotherapy at the CCO. (see www.ccotrust.nhs.uk or contact Alan directly for details on the 2009 course, alan.nahum@ccotrust.nhs. uk ). Not only did Alan host me for the seminar at one of his busiest times of the year but he had kindly been my sponsor for a long stay at Clatterbridge in 2007 as part of my sabbatical. Alan’s boss and Director of the Medical Physics Department at Clatterbridge is Dr. Philip Mayles. Somewhat coincidentally, I had two prior connections with Philip but I had never spoken with him until my stay. First, his wife Helen and I completed our M.S. degrees together in radiation physics as applied to medicine back in 1978-9 at St. Bartholomew’s Medical College, University of London. Second, Dr. Paul Mobit became one of my postdoctoral research associates after completing his Ph.D. under Philip’s and Alan’s co-mentorship when they were all employed at the Royal Marsden Hospital. Yes, the world of medical physics is a small one! My second seminar entitled “4D-CT for Proton Therapy” was delivered to the Radiotherapy Department of Weston Park Hospital, Sheffield, England. There I was hosted by the Head of Radiotherapy Physics Dr. John Conway. Sheffield is beautifully situated in the Pennine Mountain Range that is the backbone of Britain. It was famous for its steel from the fourteenth century until that industry declined in the 1970’s and now boasts education and medicine as its major employment industries. The ancient Pennines have only two passes to be
AAPM Newsletter negotiated close to Sheffield, Snake Road Pass and Woodhead Road Pass. I took the wrong one, Woodhead, that swung me far north of my target. There is no turning back on this narrow road. Worse still there are no sign postings; why waste money posting a sign when there is no turning off ? Dazzling natural beauty was the salve to my irritated mental state and I soon relaxed into mountainside views of splendid valleys and lakes unraveling before me with each turn of the road. It taught me to get lost more often around Sheffield and then enjoy the trip. I’d started early and so fortunately arrived only a few minutes late for my meeting with John. Actually this was quite a miraculous feat since getting around hospital buildings in the UK is now a high security event with electronic keys cutting off non-patient areas from visitors. John gave me a tour of the clinic, treated me to lunch, and hustled so the seminar was well attended by a large cross section of staff.
Next was a trip to Oxford where I was hosted by Ms Elizabeth Macaulay to deliver a seminar entitled “Secondary Neutron Dose to the Fetus from Proton Radiotherapy of the Mother.” Interestingly, there are no specified radiation dose limits to the fetus of a mother undergoing radiation therapy treatment. I compared the scattered neutron dose equivalent between proton beam passive scattering systems and scanning systems to each other and to high energy x-ray treatments. Elizabeth took me on a tour of the Churchhill Hospital radiation therapy facilities and over the plans for the new facilities in the process of being built as part of a new hospital complex costing over 200 million pounds sterling. Courtesy of Dr. Chris Gibson, Director of Medical Physics and Clinical Engineering, we three then
July/August 2008
ate lunch at the University of Oxford’s old observatory building located within the grounds of the newest of the Oxford Colleges, Green College. This very attractive College was established in 1979 and is 730 years younger than the first, University College established 1249. Green is devoted to those students in the medical disciplines and boasted Regis Professor of Medicine Sir Richard Doll as its first Warden. He, along with another Medical Research Council scientist Sir Austin Bradford Hill, published in 1950 the first article describing an epidemiological study linking lung cancer with a major causative agent, smoking. A rest day saw me spending my leisure time in the oldest British museum, the Oxford Ashmolean Museum. Initially based on a private collection of Elias Ashmole it was opened to the public in 1683, and now contains incredibly rare and incomparable works of art and craft including two Stradaveri violins and a guitar among the master musical instrument collection. Then later I toured the Bodleian Library complex which houses an astounding number of ancient medieval books and manuscripts in its oldest part. This part was finalized in 1488 as a gift to Oxford University by Humphrey, Duke of Gloucester, who was younger brother to King Henry V. The Bodleian, named after Sir Thomas Bodley, a Fellow of Merton College in the late sixteenth century, is Oxford University’s oldest and main research library and is featured in several scenes of the Harry Potter movies as the Hogwarts’ library. From Oxford I traveled to the University of Surrey, Guildford, to join my host Dr. David Bradley in the Centre for Nuclear and Radiation Physics, Department of
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Physics. I arrived just in time to deliver my seminar on “Contemporary Problems in Proton Therapy” to the graduate medical physics students and faculty. Then I spent another hour chatting in a freestyle format with the students answering any questions they had. Mostly their interest lay in jobs, clinical training and further education at the Ph.D. level. Some were interested in my thoughts on the best medical physics programs to apply for in the USA. Later I was treated to lunch at the faculty club by David and we were joined by Emeritus Professor Nikolas Spyrou and Professor Andrew Nisbet, Head of Medical Physics at the Royal Surrey County Hospital. We chatted about the exciting and ground breaking research being pursued at Surrey University including plastic radiation detectors, proton microbeam tomography, determination of trace element analysis using neutron activation, and the use of proton induced x-ray excitation (PIXE) for determining the metabolism and pathology of disease. Proton work is carried out at the university’s ion beam analysis and accelerator facility and following lunch David took me on a grand tour. One of the highlights of this tour for me was the ongoing construction of an 11 million pounds sterling nanobeam charged particle facility that is to be dedicated in part to cellular radiation damage studies looking at mechanisms for the bystander effect. David and I also stumbled across a mutual friend and colleague in our conversations, Dr Suprakash Roy. He is an Indian scientist based in Calcutta who is expert in neutron bubble detectors and had previously spent two summers on Visiting Professorships with me doing the work on scattered neutron dose equivalent to a fetus from x-ray and proton radiation beams. David had
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also worked with him several times in Calcutta. Yes, the world of medical physics is a small one! My visit to the prestigious Institute of Cancer Research and Royal Marsden Hospital was hosted by Professor Steve Webb. Steve is not only an outstanding and accomplished medical physicist but also a serious artisan and musician. He has built copies of renaissance stringed instruments including copies of the Sellas guitars in the Ashmolean Museum. In the photograph shown he is playing one of several renaissance copy guitars that he built, this one being a lot smaller than the 180 cm string length Tieffenbrucker copy he built to exact scale from the design of the original bicycle-sized one housed in the Royal College of Music. Steve organized a full day of meetings with various leadership teams and a “meet the professor” session for graduate students as well as my lunch time seminar entitled “Time and MotionEnemy and Friend.” The Institute of Cancer Research and the department led by Steve is the home of British expertise in dynamic therapy and 4D procedures so I was happy to provide in detail some of my thoughts on the topic relating to proton therapy and also covered the most recent work of Zhao Li and Ryan McMahon, Ph.D. Candidates in the School of Health Sciences at Purdue University. This seminar was very well received and, I learned, an appropriate precursor to the visit of Dr. Thomas Bortfeld,
Professor Steve Webb building his own version of string theory! MGH and Harvard Medical School, an acquaintance who was also to speak on the topic of proton radiation therapy the following week since he was invited to give the Institute’s 2008 Haddow Lecture in recognition of his many scientific contributions to radiation therapy physics research. Yes, the world of medical physics is a small one! The last seminar of this series entitled “Treatment of Prostate Cancer Using Cryosurgical Freezing” was delivered to the Department of Medical Physics and Bioengineering, University of London, and I was hosted by the Head of the Department Professor Andrew Todd-Pokropek. This department is strongly focused on imaging problems related to medicine and I felt members would be interested in the imaging problems of ultrasound for cryosurgical procedures and the benefits of using x-ray CT guided procedures instead. I am an alumnus of the University of London and upon touring and meeting with various faculty members to discuss
July/August 2008 their research I learned several were intimately familiar with the Medical Physics program from which I had graduated. It felt good to have a feeling of belonging and I even reminisced with Andrew about spending time writing up my M.S. project around the corner in my girlfriend’s apartment on Gower Street. This project centered on the evaluation of the first commercial SPECT machine (J and P Engineering, manufacturer). Andrew shocked me when he revealed he was the designer of the first prototype for that machine. Yes, the world of medical physics is a small one! I’d like to thank the AAPM and IPEM for the financial support and opportunity to interact with prominent medical physicists in the UK. Hopefully this experience will result in some future collaborations reaching across the Atlantic. I’d also like to thank all my hosts for their graciousness and kindness while participating in this event. Finally, I’d like to thank my many past graduate students, post-docs and scientific collaborators whose work and role in the research presented was formally recognized at the beginning of each seminar. Even though the world of medical physics is a small one, it is a beautiful one filled with some of the finest people one could ever hope to meet. My wish is that the 2008 award recipient of the AAPM-IPEM Travel Grant has as much fun as I did.
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. 35
AAPM Newsletter
July/August 2008
2007 AAPM Travel Grant Report Sonja Dieterich, Ph.D., Stanford University Cancer Center
O
n April 13th, my husband and flew 11.5 hours from San Francisco to Tokyo in bright sunlight and crossed the dateline. For the next two weeks, our internal clocks continued to be confused regarding what day of the week it was. Because we missed the last Shinkansen (High speed) train, we took a night train to Hiroshima. I woke up early in the morning to study the countryside passing by. Japans’ mountain ranges reach the coast and reminded me very much of the coastal ranges in California. The cherries were still in bloom in some places. Freshly flooded rice paddies and country gardens passed by, and soon we reached our destination city of Hiroshima.
Hiroshima After finding our way to the hotel in Hiroshima and eating a quick breakfast, we walked to the Abomb dome, the ruin of the former industrial exhibition building in Hiroshima which was not entirely flattened because the blast hit it from almost directly above. Twisted metal girders provide a strong visual as to how devastating the event was. From the dome, we crossed the river to Peace Memorial Park. The lush, green space is filled with memorials to the atomic bomb victims. We first saw the Children’s Peace Memorial. Children from all over Japan collected the funds after hearing the story of a girl who died from radiation-induced leukemia several years after the event. We saw a group of children visiting, bringing garlands of folded paper cranes expressing their wish for
peace. The garlands are collected and displayed in kiosks around the memorial. We then went to the Peace bell, a traditional Buddhist temple bell rung by visitors. On the way to the A-bomb museum, we passed the memorial to the Korean victims of Hiroshima, mostly prisoners of war working in this former garrison town. The cenotaph in memorial of all the victims stands on a plaza in front of the museum. Next to the cenotaph is a grove with Phoenix trees transplanted here. These Phoenix trees were seemingly burned completely by the heat wave emitted from the bomb, but to the surprise of survivors they sprouted green again within 8 weeks of the event, giving hope to rebuild. We spend several hours in the Peace museum. The first part is dedicated to the history of Japanese militarism before WWII and the atomic bomb development in the USA. The life and work of Hiroshima inhabitants before the bomb is explained. On the mezzanine level, the fates of the Hibakusha (bomb survivors) are
The A-bomb dome (Hiroshima Peace Memorial) is a UNESCO World Heritage Site. The atomic bomb exploded almost directly above the building at about 150 m distance. It was the closest structure to withstand the explosion.
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told. About 100,000 people in Japan and abroad are officially recognized as Hibakusha. Providing healthcare for them is a continuing challenge. The second floor of the museum is dedicated to Hiroshima’s mission to peace in the world, mainly by speaking out against the continued existence and development of nuclear weapons. A pillar shows letters of the Mayor of Hiroshima to all Ambassadors to Japan of any country which are send at each nuclear weapons test, expressing the wish and hope of the citizens of this town for abolishment of nuclear weapons in the world. The third level of the museum shows artifacts of the event and the fate of people who “met with the bomb,” as they themselves say. There is a piece of concrete wall with glass splinters deeply embedded in it. A wall of a house stained by streaks of black rain marks the fallout zone. The front steps of a bank directly below the hypocenter with the shadow of a person sitting there forever burnt into the granite is a reminder to the 80,000 who perished instantly. Clumps of clay roof tiles molten together give an impression of the immense heat. Narratives of people, many of them schoolchildren, who died from severe burns and/ or radiation sickness explain the suffering of the 60,000 who died in the aftermath. What a contrast in the afternoon when we took a ferry to the island of Miyajima, which is both a Shinto and Buddhist holy island. The 16 m tall O-torii of the Itsukushimajinja Shinto shrine standing in the sea marks the place and frames the backdrop of Hiroshima city. The
AAPM Newsletter
July/August 2008
Daisho-in temple, center of the Shingon sect of Buddhism, whose founder, Kobo Daishi, is enshrined there, contains many beautiful works of art. I especially enjoyed hearing about the annual ceremony to honor old kitchen knives which cannot be used anymore; the ceremony takes place on my birthday, which incidentally is also International Womenâ&#x20AC;&#x2122;s Day. Kobe - Mitsubishi Gimbaled Linac at IBRI On Wednesday, the Shinkansen train took us at a speed of 285 km/h (180 mph) to Kobe (yes, the place where the famous beef is from), where we visited IBRI. Tokihira Yamamoto, postdoc at Stanford, had helped me in arranging this visit. Mr. Sato, an employee of Mitsubishi, gave us a tour of the first gimbaled linac installed in a clinical setting. The senior engineer for Mitsubishi, Mr. Yasunobe Suzuki, and the ExacTrack project engineer from Brainlab, Mr. Thomas Jelinek, explained the technical aspects. Acceptance testing and commissioning was in full swing. The gimbal part of the technology has not passed the strict regulatory requirements by the Japanese Ministry of Health yet. The hospital hopes to treat the first patient in mid-May, although without using the gimbal itself. I was very impressed by the 11-ton machine and liked the sleek integration of technology in a mechanically very robust and stable frame. I look forward to following the further development of the technology. After a hike in the lush and steep forested hills which confine the city of Kobe into a narrow sliver between them and the Inland Sea, we spend the evening in the internationally known Sone Jazz Club to listen to some very good jazz by a Japanese band.
The Osaka University Radiation Oncology team, including physician, physicists and technicians, hosted a dinner in celebration of the first Medical Physics CE lecture series. My husband and I enjoyed the good company, excellent Japanese food and the view from the 14th floor overlooking the 1976 Osaka World Exhibition site.
Osaka University On Thursday, we visited Osaka University Hospital. There was only Japanese signage, but since Radiation Therapy Departments are typically found in the basement, we narrowed down our search very quickly. The department has two Siemens linacs, a CT, conventional simulator, a remote after loader for brachytherapy and a Cyberknife. We were shown around by Dr Takahashi, Dr. Koizumi and Dr.. Iori Sumida, a medical physicist. I learned that TLDs are considered an outdated technology which was replaced by glass dosimeters in this department. These glass dosimeters are mainly used for invivo dosimetry of the urethra in prostate cancer treatments. Over coffee, we had a conversation about the role of medical physics in Japan, because I was surprised to see a medical physicist in the department. Until recently, the profession was virtually unknown in Japan. All the services of medical physics, dosimetry, and radiation therapy were performed by trained technicians. However, after several medical events leading to adverse
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health effects and even deaths the need for change was recognized by the Japanese government. Now, about 100 medical physicists have started to work in major hospitals in larger Japanese cities such as Osaka. Still, considering Japan has about 130 Million inhabitants, it is a fairly small number. The educational pathway to become a medical physicist has yet to be worked out. Osaka University is one of a few hospitals spearheading the effort to create a medical physics graduate study curriculum for Japan. At the same time, efforts on continuing education for the RTT staff are increased. Osaka University has instituted a lecture series on medical physics for department staff. Sumida-San and I had the honor to share the first lecture in the series. Sumida-San spoke about the design of a binary attraction-repulsion model for prostate implants using iodine. I followed with a lecture on differential dose planning with focus on how to apply it to Cyberknife treatment planning. Hyogo Heavy Particle Center Friday morning, we met with Brian Minezaki to go to the
AAPM Newsletter
July/August 2008
AAPM regrets to announce that the following members have passed away since our last Annual Meeting: Ralph M. Adams, B.A. – Salem, OR E. Carl Chamberlain, M.S. – Reno, NV Cassius Clay, M.S. – Augusta, GA Margarete Ehrlich, Ph.D. - Chevy Chase , MD Lawrence Fitzgerald, Ph.D. - Summerfield , FL C. Craig Harris, M.S. – Durham, NC Bruce Hasegawa, Ph.D. - San Francisco , CA Ernest O. Jones, Ph.D. - Pagosa Springs , CO Prasanna K. Kumar, Ph.D - West Bloomfi eld , MI Arlene Lennox, Ph.D. - Batavia, IL James Edgar Nunnally, B.S. - Tyler, TX Harvey Picker, M.S. - Camden, ME Dimitrios Smocovitis, M.Sc. - Windsor , ON CANADA Egilda Witherell, B.S. – Wayland, MA Kenneth A. Wright, M.S. – Cambridge, MA
If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honor Ceremony at our upcoming Annual Meeting. We respectfully request the notification via e-mail to: 2008.aapm@aapm.org Please include supporting information so that we can take the appropriate steps. Hyogo Heavy Particle Center. Our tour guide for the day, Dr. Takashi Akahi, turned out to be a former SLAC postdoc. We were first shown a model of the heavy particle center. It has two treatment rooms equipped with a proton gantry, and three rooms without gantry for heavy-ion treatments. The beam angles available for heavy ions are 45 degrees, 90 degrees and 0 degrees. We were able to see the 0 degree treatment room. The facility is currently treating > 600 patients per year. The patients have to pay for the $30,000 treatment out-of-pocket, because there is no insurance reimbursement yet. About 200 patients/year are needed to cover the operating costs for the facility. In addition, most patients
will stay in a small housing facility on site for the several weeks of treatments because the site is located relatively far from major population centers. Intermission After such a high dose of physics, we decided to take a break and explore the sights of Japan. We saw Himeji Castle (seen in the movie “The last Samurai”), the former capital Kyoto with its magnificent temples and Imperial Palace, and continued east toward Hakone, where we stayed for two days in a traditional Japanese hotel (Ryokan) with excellent food and on-site hot spring bath (onsen). Mt Fuji was hiding from us in the clouds, but we enjoyed the time in Hakone nonetheless.
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Yokohama Cyberknife Center On Friday, April 25th, we took the train from Tokyo to Yokohama, a harbor city of 3.5 million people not far from the capital. In Yokohama, we visited a small, privately owned clinic which also has a Cyberknife treatment facility. Dr. Kengo Sato is the main neurosurgeon there and was just recently joined by Dr. Tatewaki from Hokkaido. The center is treating ~700 brain and H&N patients per year with one Cyberknife machine, running from 8 am to 10 pm. Treatment planning is done by the physicians with advice from the medical physicist, Dr. M Inoue. Dr. Inoue spends most of his time on quality control and documentation required by the regulatory agencies. He has written a comprehensive QA
AAPM Newsletter
July/August 2008
Person in the News
M
elissa Martin was selected by the Conference of Radiation Control Program Directors (CRCPD) as the 8th John Villforth Lecturer. This is one of the CRCPD highest recognitions. The lecture series was established in 2001 to honor Mr. Villforth’s steadfast support of state radiation control agencies as a working partner with the FDA/CDRH in the protection of the American people from unnecessary exposure to electronic product radiation, radioactive materials (especially radium), and protection of the environment from radioactive contamination.
program recording all required data for all QA processes based on Excel VBA. In addition to recording and processing QA data, the program also flags outstanding QA issues. This proved to be an elegant way to keep track records and store data all in one place. The site is looking forward to start body stereotactic radio surgery once the Japanese government has given permission to do so. The radiation oncologist associated with this center, Dr. Inoue, will be visiting Stanford starting June 2007 to prepare for the upgrades in technology by working with our physicians and physicists. 2nd Japanese Cyberknife Research Meeting in Tokyo We concluded the trip by attending the 2nd annual Cyberknife Research Meeting in Tokyo starting Saturday afternoon. Most of the afternoon was scheduled for discussion of clinical case studies for brain and H&N cases. One hour was dedicated to QA and QC issues. Dr. Inoue from Yokohama introduced his
North Carolina in May 2008. Mr. Villforth was present for this year’s tribute and to present the award to Melissa.
Melissa Martin and John Villforth at the 40th Annual Meeting of the CRCPD.
Melissa is a Fellow of AAPM and a Past Treasurer. She is currently the president of Therapy Physics, Inc. a medical physics consulting firm in Gardena, California.
She gave the lecture titled, “Forty Years Later: Times are changing or are they?” at the 40th annual national conference on radiation control in Greensborro, QA program and some work on determining kQ using a variety of detectors. After my presentation on “Cyberknife Error Pathways”, the distributor for Accuray Japan gave a presentation on new rules and regulations concerning radiation devices in Japan. For the first time, the Japanese health insurance will reimburse hospitals for safety and QA work for radiation therapy devices provided the hospitals meet certain conditions. Summary During this trip, I visited a wide variety of clinical settings with different radiation treatment delivery systems. However, I found many striking contrasts. First, even though Japan is technologically on the leading edge as a country, the implementation of technology in medicine is saddled with a time delay of several years caused by the processing time of regulatory permissions of the Ministry of Health. Evidence-based medicine and very advanced research studies
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are common, but despite being the inventors of modern quality control practice in the industrial sector, QA by a qualified technical professional is underdeveloped. The physicians are very aware of the issue and are doing their best in training the available radiation therapy staff; hopefully, reimbursement changes will help drive rapid change in this area as well.
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
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