AAPM Newsletter September/October 2008 Vol. 33 No. 5 by AAPM Docs

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 33 NO. 5

SEPTEMBER/OCTOBER 2008

AAPM President’s Column

Gerald A. White Colorado Springs, CO

here is an old joke that came to mind as I thought about how I would structure this month’s column. A cement mason has completed a new sidewalk and is standing on his client’s front porch when he notices a group of children playing in the newly finished product. He bellows a long and loud string of epithets and the woman who owns the house chastises him: “ Please, these are only children, have you no regard for them?” to which he replies: “My dear woman, I have great love for children in the abstract, but not in the concrete.” “Landmark”, like “concrete”, offers us the opportunity to contrast (or confuse) the conceptual with the physical, and “landmark” is a word that has been, for me, a focus of rumination since the Houston meeting. Unknown to all but two of the attendees and companions at the meeting, the AAPM 50th was not the only anniversary being remembered. Ten years prior during the last week of July, my wife Cathy and I set out from Florence, Oregon on our

tandem bicycle headed to Yorktown, Virginia. It was a trip filled with landmarks of the concrete kind; Hells Canyon, Yellowstone, Hoosier Pass, water towers of Kansas towns that seemed to recede as we tried to approach, the mammoth hills of Missouri............ . There were also landmarks of the abstract sort; the first crossing of the continental divide that gave us confidence for the next six, the first of many encounters with helpful strangers, learning to match our need for food with the offerings of tiny stores (never read the ingredient list on a packaged Little Debbie Honey Bun). I had the clear feeling that the 50th in Houston had both the concrete and noetic flavors of landmarks. The ever present reminders of the 50 years of history, the pins, banners, history symposia, the charter member reception and the dancers in poodle skirts all provided a concrete temporal landmark for setting our bearings as to where we have been, where we are now. As I reflected on the banquet I had difficulty placing it squarely in either the physical or abstract category. Cleary we were all there physically, but it seemed more than just a gathering to mark the time and place. I had the feeling that it was an entry into the next period of the life of the AAPM and our life with the organization. There were spirits of both formality and collegiality that are difficult to obtain in both temporal and physical simultaneity (exemplified perhaps by

the serving of 3000 bowls of soup at the beginning of the meal, each one warm.) The organization has grown from a hundred or so to nearly 7000 and, until the Houston meeting I had difficulty seeing how the nearly familial relationships among the early AAPM members would transform into the connections among so many of us now. For me, at least the meal shared by 3000 of us was a landmark, a sign that it could be done. We have moved into a new phase of AAPM, a large, nationally recognized institution of course, but also one in which we see ourselves as organizationally serious, setting the course of both the science and the profession of Medical Physics and committing the (see White p. 4) TABLE OF CONTENTS Chair of the Board’s Column Executive Director’s Column Editor’s Column 50th Anniversary Wrap-up Professional Council Report Education Council Report Website Editor’s Column Fellowships, Residencies & Research Awards Working Group Update Ed Council Wkshop Report AAPM Remembrances ACR Accreditation Health Policy/Economics Chapter News ISEP Course Report Task Group Updates Coolidge Award Speech Person in the News Memorial

p. 2 p. 3 p. 5 p. 5 p. 7 p. 9 p. 11 p. 13 p. 17 p. 18 p. 19 p. 23 p. 25 p. 28 p. 30 p. 32 p. 34 p. 38 p. 39

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September/October 2008

Chairwoman of the Board’s Column statement did not have clear action plans. President White will be forming an ad-hoc committee to tackle the development of a new mission statement.

Mary K. Martel UT MD Anderson Cancer Center Here be Dragons

he Board meeting in Houston at the end of our anniversary year’s annual meeting had an “actionitemed” packed agenda. Unknown territory was explored, and some of us tried to ignore the “Here be dragons” sign (see below). Change is often resisted and it can be difficult to move the AAPM organization towards a different direction, but this Board meeting showed promise in effecting some future change. First (not a dragon but a change issue), the Board approved the Code of Ethics, the work of the Ethics Committee under the Professional Council. More information on this topic can be found at http://aapm. org/medical_physicist/ethics.asp. Kudos to Chris Serago and his committee members for this excellent contribution to our society. I urge AAPM members to take a moment to look through this report. Another action item was a motion to adopt a revised mission statement. This motion was defeated after consideration of submitted comments that indicated the revision was perhaps not succinct, and the objectives associated with the mission

The Professional Council put forth a motion to create a new, fourth Council called an Administrative Council. This was also a topic of discussion during the Spring 2008 Board meeting, and a long standing idea. There are a number of administrative committees that answer directly to the Board, which tend to have limited interaction with the Board, and not even through EXCOM unless there is a “crisis.” The idea was to enhance their representation through an “uber-chair” who could meet with EXCOM and the Board on a periodic basis. Some administrative committees should still interact directly with the Board and not be included in the new Council (Finance, Board of Editors, Rules, Audit, Nominating, Ad-Hocs). I had envisioned that a former secretary or a person who has sat on a number of administrative committees would be the first chair of this Council. After brisk discussion at the meeting, the motion was passed, and President White will seek input from other Councils and the Board (and perhaps create an ad-hoc committee). The Professional Council also proposed a motion for an external expert review of its structure and function to help position itself to meet its mission. This motion passed, but only after it was agreed to amend the motion that the review would follow the adoption of a revised mission statement, and that the plan for expenditure first be approved by the Board [gee, I

hope I got that right!]. This external review could be a major step forward for the AAPM as it is likely to lead to long-term strategic planning and a possible reorganization of the AAPM structure. This will undoubtedly be a process that will take place over the next several, or many, years. Besides action items, several important issues were discussed. Board Member-at-large Jean Moran opened discussion on the role of the AAPM as it relates to national funding sources for research. The AAPM Government and Regulatory Affairs Committee (GRAC) does deal with government and regulatory issues, and it was felt that AAPM members in academic centers could and should participate more in the efforts of the GRAC committee. All agreed that this was a good route to seek, and a subcommittee is likely to be formed for this purpose. Finally, the establishment of Professional Degree programs was discussed at the Board meeting. This discussion was precipitated by the draft document from the Working Group on a Professional Doctorate (PD) Degree for Medical Physics (under Education Council), and the extensive debate at the Town Hall meeting at the annual meeting. There are both vocal advocates and critics of the PD degree, and opinions were made known in hallway, cocktail party, and meeting sessions. The reasons against the PD by the critics reminded me of when the mapmakers of olden days drew maps that only reached so far and then wrote “Here Be Dragons” at the edge of their known world. There are fears that the PD will have unexpected impact on other routes into medical physics, including overtaking other pathways,

(see Martel - p. 4)

AAPM Newsletter

September/October 2008

AAPM Executive Director’s Column

Angela R. Keyser College Park, MD AAPM Celebrates in Houston I begin this column just days after returning from AAPM’s 50th Anniversary Annual Meeting in Houston, Texas. For those in attendance, I hope that you found the anniversary festivities fitting of the occasion. I know that the meeting surpassed my expectations. Special thanks to Jean St. Germain, Chair of the Ad Hoc Committee on Golden Anniversary Planning, and John Hazle and Georgeanne Moore, who lead the Local Arrangement Committee efforts. It was especially gratifying to meet Gail Adams, AAPM’s first President, and his wife Reba and discuss how AAPM has flourished as an organization. And, having past Executive Directors Elaine Osterman and my longtime mentor Sal Trofi in attendance added to the occasion. While I did not get to meet all the Charter Members, I am pleased to report that thirteen of the founding members were in attendance including, Gail and Reba Adams, James and Katherine Carlson, Anthony and Gail Cole, James Durlacher, Arnold and Sybil Feldman, Paul and Emma Leigh Goodwin, Robert and Joy Gorson, Morris and Josephine Hodara, James and Helen Kereiakes, Mary Meurk,

Jacques and Florence Ovadia, Robert Schulz, and Robert Shalek. Bob Gorson was awarded the one and only “Perfect Attendance Award” at the 50th Anniversary Gala dinner, in acknowledgement of his attendance at each AAPM Annual Meeting since the beginning of the organization. The presentation of the award to Bob by a group of first time meeting attendees was especially moving. AAPM gave a little back to the Houston community during the celebration. Twenty-four AAPM representatives participated in the Golden Anniversary service project by volunteering their time at the Houston Food bank, where I understand over 600 boxes of food were prepared. Additionally, AAPM sponsored the 2nd Annual Blood Drive and approximately 20 attendees donated to the M.D. Anderson Blood Donor Center. The meeting continues to grow. While we are still doing some cleanup to our records, preliminary numbers show 2,544 scientific registrants, up from 2,297 scientific attendees in Minneapolis in 2007. While the number of exhibiting companies decreased slightly from 134 in 2007 to 131 in 2008, the number of 10’x10’ booth equivalents sold was up from 475 to 486 in Houston. Dues Increase Proposal Voting members will have the opportunity to vote on a dues increase proposal in late Augustearly September. See box on page page 38 for further information. Attention Junior and Student Members The qualifications for Junior membership require that the

individual be a Resident, Postdoctoral Student or Fellow on a full- or part-time basis in a medical physics training program. All Junior Members were sent an email in mid-August with instructions on the process. Junior Members must request that a Full AAPM Member go online and attest that the individual meets the current requirements for Junior membership. In order to remain a Student member after the first year of membership, first students are asked to identify whether they are Graduate or Undergraduate, then: •

•

Graduate Students must request that a Full AAPM Member go online and attest that the individual is a Graduate Student on a full- or part-time basis in a medical physics program. Undergraduate Students must ask their program director to send attestation to membership@ aapm.org stating they are an Undergraduate Student in an academic program in science, engineering or a related field program.

The deadline for the online attestation to be provided is October 1. If you have any questions, please contact Jennifer Hudson at jennifer@aapm. org or 301-209-3365. 2009 AAPM Dues Renewals Dues renewal notices for the 2009 year will be sent out in early October. I encourage you to pay your dues via the AAPM website to reduce administrative costs. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that

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September/October 2008

some chapters have a membership application process. Please only remit dues for chapters of which you are an official member.

(White from page 1)

AAPM Reception during RSNA meeting Reminder! Plan to join your colleagues at the AAPM Reception during the RSNA meeting on Tuesday, December 2, 2008 from 6:00 PM – 8:00 PM at the Chicago Hilton.

Where next? How to anticipate the upcoming terrain? On the cross-country bicycle journey that I mentioned above there was a great advantage in that regard. As we traveled from West to East, we encountered cyclists following the same route from East to West. They had seen our future, and remarkably seen it in the concrete and abstract. The mountain passes, the endless winds of Kansas, the bike chasing dogs of Kentucky were all predicted with clarity, as were the joys of the friendship we would find with other riders and the strength we would develop within and between ourselves as the stages of the journey continued. Sad to say, there is not the same clarity of future for us as an organization as we move forward to 75 years and then 100 years of progress. There are no riders traveling in the opposite direction. We can look at sister societies with the longevity to which we aspire (RSNA for example) and learn from their successes and structural adaptation. We can look at the wider scientific, medical, social and political context in which we find ourselves and engage fully in all of those realms. Most importantly, we must remember the path we have traveled as we cross this next divide. The Houston meeting gave us the foundation to act on the missive of philosopher George Santayana “Progress, far from consisting in change, depends on retentiveness. When change is absolute there remains no being to improve and no direction is set for possible improvement: and when experience is not retained… infancy is perpetual. Those who cannot remember the past are condemned to repeat it.”

U.S. Physics Team Brings Home 4 Gold and 1 Silver Medal The United States Physics Team, co-sponsored by the American Association of Physics Teachers (AAPT) and the American Institute of Physics (AIP), earned four gold medals and one silver medal at the 39th International Physics Olympiad held in Hanoi, Vietnam, and was named second place in overall performance. This is only the second time in the history that the U.S. team has earned four gold medals in the Physics Olympiad. AAPM joins with other societies to provide financial support for the team. The U.S. was represented by: • • • • •

Gold Medalist Tucker Chan, Princeton High School, Princeton, NJ; Gold Medalist Danny Zhu, Stuyvesant High School, New York, NY; Gold Medalist Edward Gan, Montgomery Blair High School, Silver Spring, MD; Gold Medalist Joshua Oreman, Harvard Westlake School, North Hollywood, CA; and, Silver Medalist Rui Hu, The Charter School of Wilmington, DE.

resources, financial and intellectual to see us into the future.

It is now the time to assure that those who follow us in 25 and 50 years will look back at this time not just as a landmark of our 50 years past, but as a landmark of their past. We do that now by creating our future, by creating the structure, vision and resources that will take us into the next half century. We do that by honoring the past, celebrating the present and preparing for the future.

(Martel from page 2) and breathing fire on and killing research. Those who are advocates, such as me, see the PD as one of several pathways that will include MS and PhDs in medical physics, PhDs in physics degrees entering a separate residency program. The PD pathway is a sustained fiscal model, we think, for the long run, as students pay tuition for their didactic and residency years. The PD programs are meant to supplement institution-based and affiliate program-based residency programs. The fact it is called a “doctorate” is another rather-large sticking point (mainly to academic PhDs). I suppose I don’t care what it is called, and perhaps a compromise may be needed. In any case, a wideranging discussion ensued at the Board meeting, and though neither an action item was generated nor a vote taken, there was a general sense that further examination of the PD route should continue while objections are being addressed. Stay tuned for report of the Board meeting at RSNA, and please remember that your comments on any of these issues, and any others, may be sent to your chapter rep, any Board Member-at-large, Council Chair and/ or EXCOM member. Well-thought out action items for Board meeting is a way to make progress, into those uncharted territories!

AAPM Newsletter

September/October 2008

Editor’s Column the complete speech of this year’s Coolidge award winner (Dr. Paul Carson) is included in this issue and also few select photos from the meeting (see centerfold).

Mahadevappa Mahesh Johns Hopkins University

returned to work after attending the 50th year anniversary meeting with a lot of cherishable memories. My family and I enjoyed all of the festivities at the meeting especially the grand gala dinner on Tuesday night and the movie ‘My Friend Atom’ played prior to dinner. In spite of the hot weather, the atmosphere at the meeting was cool and enthusiastic. For those who may have missed the awards and honors ceremony,

In this issue, under a new banner called ‘AAPM Remembrances’, are articles written by charter members and an emeritus member from China. The content of the articles are their recollections of their associations with AAPM and its members. Also included in this issue, under ‘Persons in News’, are five AAPM members who recently became Fellows of the American College of Radiology (see page 38). I congratulate all five members for a well-deserved recognition from our physician colleagues. As I have mentioned a few times in the past, in order to keep costs down, I always request a limit of one to two print pages for submitted articles. If a submitted article exceeds the page limit, it will

be still published in the newsletter (abridged), with the full article posted on the AAPM website. It was very shocking to hear the sudden demise of one of our colleagues this summer. For those of us in the imaging field and others, the death of Dr. Hasegawa (see page 39) was sudden and sad. I had the pleasure of knowing him from graduate school and he was well known not only for his scholarly work in hybrid imaging but also for his kind and humble ways. He will be surely missed. Finally, if you are wondering why this issue is coming in middle of September, I made the decision earlier this summer to extend the submission deadline until after the meeting. This extension has allowed me to include post meeting articles and responses.

50th Anniversary Wrap-up

Jean St. Germain, Chair Ad-Hoc Committee on Golden Anniversary Planning “And the band played on……”

ho said physicists don’t dance?? At our Anniversary Gala in Houston, we certainly proved this

adage wrong. People started out enjoying the 50s dance group before dinner and after dinner, they danced the night away to more contemporary music. Many thanks are due to the Houston LAC, John Hazle, and the entire Texas-based group. Particular thanks to Georgeanne Moore from MD Anderson and Karen MacFarland and Lisa Giove of our HQ staff for their work with the Hilton hotel. It was exciting to see our Charter members, our current and past Executive Directors, past and current officers and to rekindle old friendships and start new ones. Pictures from the various events will shortly appear on the web site.

Our web site still has anniversary mementos for sale; so if you still want to purchase these, please visit the web site. There are still Anniversary events occurring during the rest of 2008, including individual Chapter events. If your Chapter wishes to hold a special meeting, copies of the special, historic boards are available from our HQ. Be on the lookout for a special historical summary of the last 10 years prepared by our historian, Larry Rothenberg, along with our journal editor, Bill Hendee, in Medical Physics. This summary complements the 40-year AAPM history published earlier.

AAPM Newsletter

September/October 2008

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AAPM Newsletter

September/October 2008

Professional Council Report Michael G. Herman Council Chair Michael Mills Professional Council Vice-Chair

he recent 50th annual AAPM meeting was a very active one for the Professional Council and its committees. Once again, the professional track had a series of excellent and well attended sessions, including one SAM. An AAPM Code of Ethics â&#x20AC;&#x201C; was approved by the Board. This comprehensive code is based on the premise that the best way to practice ethical medical physics is through good behavior. We would like to thank TG109 and everyone who commented and contributed to developing this code. All members will be notified of the new Code and that AAPM adopts this new Code of Ethics, we as members in good standing agree to abide by this code. A motion to approve a revised AAPM Mission Statement was defeated in the interest of providing a revision that was both visionary and concise. This will be associated with appropriate goals for achieving the mission. The President is organizing a committee to develop the revision. The Council also put a motion for the AAPM to engage an external review of AAPM structure and function (to best meet its mission goals) before the BOD. This motion was passed with the caveat that it be done only after the revised mission statement was adopted. In terms of meeting goals and allowing and BOD to act and efficiently as

our functional the councils as effectively possible, yet

maintaining communication, the PC proposed a motion to form an Administrative Council. The concept has received much discussion over many years and was passed by the Board. At this time, a group will be directed by the President to develop the specific charge and characteristics of this council. The Professional Services Committee continues to coordinate a number of activities that directly or indirectly benefit the membership. Two initiatives that are currently active within subcommittees are the workforce assessment and the professional survey validation. The Workforce Subcommittee must provide essential supply and demand data for all medical physicists, so we can best position ourselves to meet workforce needs, with education and training. The survey validation is important to allow an independent and meaningful review of the AAPM survey data to substantiate its rigor and accuracy. A new Bluebook and Yellowbook are also under development to improve the quality and utility of the products. The Clinical Practice Committee oversees practice related activities. The Joint Medical Physics Licensure Subcommittee has been very active and provided a detailed report to the council and to the BOD. As we continue to prepare for the eventual federal legislative directive to provide licensed or registered medical physicists in all of the United States, the JMPLSC is working on many fronts. These include specifically identifying contacts and current status of licensure/registration in each state,

building the grassroots information necessary to communicate consistent and accurate (medical physics qualification) information to state regulators/legislators, recruiting grassroots volunteers and more. The subcommittee issued a revised professional policy presenting a strong position in support of licensure or formal QMP registration. It is essential that we contribute and indeed lead this effort. If we donâ&#x20AC;&#x2122;t define who a QMP is or how he/she should be recognized, someone else will do it. The Standards/Guidelines Subcommittee is newly formed and responsible for reviewing internal and external documents for clinical practice implications. This will likely be a very important subcommittee as we engage with other societies in the review and development of practice guidance, as well as in our own task group reports. The Vendor Usability Working Group distributed a survey and results are being analyzed to summarize common factors/concerns between medical physicists and our commercial equipment suppliers. The Working Group on Medical Radiation Response has been coordinating education and training that is consistent with national guidelines. This topic is important as medical physicists are looked to in times of emergency where radiation is involved. The Professional Economics Committee hosted outside experts on medical economics at the annual meeting and is evaluating radiation oncology coding quantitatively. The 2008 Abt III Report was reviewed and discussed; this report is available on the AAPM Website. In addition, an Abt study for diagnostic

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imaging work values is underway; the subcommittee responsible for this effort is chaired by Ed Nickoloff. This effort is essential to quantify and attribute the work effort of the imaging physicist accurately and appropriately. A detailed economics report is provided elsewhere in the newsletter by Wendy Smith-Fuss.

SIX MINUTES TO YOU COULD MEAN A LIFETIME TO HER.

The Government and Regulatory Affairs Committee oversees all such activity within the AAPM. Current activity includes a lot of work between the Commission of Radiation Control Program Directors (state regulators) and our own CRCPD Subcommittee to help ensure that state quality guidance is consistent. GRAC is responsible for monitoring affairs and actions with NRC and other government agencies as well. Lynne describes this in more detail in her column. Recent Medicare legislation was passed that requires Centers for Medicare/Medicaid Services (CMS) to develop regulations of expensive imaging procedures. These regulations are expected to link accreditation to reimbursement. It is essential that the QMP be an integral part of any imaging accreditationprocess.Twoorganizations accredit imaging practice/equipment, the American College of Radiology (ACR) and the Intersociety Accrediting Commission (IAC). Medical physicists are fully involved in ACR accreditation and through AAPM, some medical physicists are now involved with the IAC.

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2009 AAPM 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.

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September/October 2008

Education Council Report •

Herb Mower Education Council Chair

am writing this article for the Newsletter as we celebrate our Annual Meeting here in beautiful, if not rather warm and humid downtown Houston. What a great event! The history, the memories, the old friends, the new friends. Truly an experience that all in attendance will remember for many years. Of course, as a part of our Annual Meeting, many of our Task Groups, Subcommittees and Committees held their meetings and reported back on their accomplishments and goals. The Committees brought forward to the Council and we forwarded to the Board: • That EXCOM task the Meeting Coordination Committee with creating a Task Group to study the possibility of the AAPM hosting the 2018 World Congress on Medical Physics and Biomedical Engineering. • That a Task Group be formed to define the needs and potential software solutions to enable webbased tools for self-assessment, exams and educational activities. • That we request voluntary selfidentification of women and minority status on the annual salary survey

That there needs to be a group overseeing SAMs with Headquarters support. Relative to this, the question was raised as to where this belonged? Meeting Coordination Committee? Elsewhere? Highlights in the committee reports included: Continuing Professional Development: The 2008 Summer School was an academic success although not a financial one. The latter was due primarily to a last minute need to change the venue as well as the enrollment being about 20% less than budgeted. Next years school, with a therapy topic, will return to the campus of Colorado College.

is going out to program directors for feedback and the final draft should be circulated by late September. The final version of TG-133 [“Alternative Clinical Medical Physics Training Pathways”] has been approved and it should be on our web-site as you read this article. The Task Group reviewing ‘Doctorate of Medical Physics’ programs has prepared a white paper which is out for review and should be completed by early September. History: The committee participated in the Education Council Symposium at this meeting, presenting a reflection on the charter members of the Association and highlighting some of the contribution of several members of this group. They also noted that we have added two more panels for display at this and future meetings.

The Committee is pursuing the concept of discussing with CAMPEP the feasibility of receiving CECs for members working on various committees of the Association.

The question was raised and they will investigate to feasibility and appropriateness of the AAPM enlisting the services of a professional historian to review, organize and properly document the activities of the Association.

The Committee is also tracking changes in the SAMs process and requirements for receiving credits at our Annual Meetings and hopes to resolve many of the recently raised issues prior to the 2009 meeting.

International Educational Activities: This committee is supporting the idea of the AAPM sponsoring the 2018 World Congress as referred to above. They also reported that our 2009

Education and Training of Medical Physicists: The TG-1 report draft [“Academic Program Recommendations for Graduate Degrees in Medical Physics”]

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September/October 2008

international courses are scheduled to be in Turkey and Malaysia. The international aspects of our web portal have been fixed to allow access to the Virtual Library. They also noted that, in 2009 the Brazilian Medical Physics Society is celebrating its 40th anniversary and is recommending that AAPM have a presence at this event. Public Education: Jason Bardi of the AIP Media and Government Relations updated us on the activity within the AIP relative to recent news releases and other items of interest to medical physicists in the past several months. In the last year DBIS (Discoveries and Breakthroughs in Science) has hosted 13 stories related to medical physics. They also put out a couple of releases earlier this year on the 50th anniversary of the Association. The committee reported that it has three brochures relative to the various

sub-specialties of medical physics that are about 95% done and they hope to finish them this year. The committee is also looking into the AAPM sponsoring a couple of spots on NPR. Medical Physics Education of Physicians: This committee reported that TG124 [â&#x20AC;&#x153;Guide for Establishing a Credentialing Program for Users of Fluoroscopic Equipment in Health Care Organizationsâ&#x20AC;?] expects to complete its work this year and have a draft available in the near future. They are also recommending that TG-165 [â&#x20AC;&#x153;Physician Radiological Sciences Educationâ&#x20AC;?] be converted to subcommittee status. Web-Based Modules: Bill Hendee reported that the RSNA / AAPM program for developing webbased educational training modules for

radiology residents had 62 proposals submitted for 30 designated topics. The selection of the group to be asked to do each module was made during the meeting and he is in the process of notifying each group of their status with this project. Council: The Council as a whole has reaffirmed its desire to continue to support programs and activities to assist our members, academic and residency programs meet the challenges and opportunities afforded by the upcoming changes in the requirements to sit for the ABR Board Exams in Medical Physics in 2012 and 2104. Adding to our current initiatives we hope to make available speakers for chapters relative to this timely activity.

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September/October 2008

AAPM Website Editor’s Column provide some form of professsional leverage for the volunteer efforts to develop new Website content, and several creative ideas emerged from discussion of that issue. Many of these would be relatively inexpensive to try out, so they deserve to be tested. I have concluded that I can best serve the Website by actively trying to facilitate the development of new content rather than just waiting for it to arrive. Christopher Marshall NYU Medical Center

he 50th year Annual Meeting is now behind us but we will continue to celebrate the anniversay year on the Website as items become available. We plan to feature a video interview with the Founding Members who attended the Annual Meeting, and we hope to also provide extracts from an historic video interview with founding member Edith Quimby which covers the forty years before the AAPM came into being. I spent much of my time at the Annual Meeting interacting with those committees that are potential generators of new content for the Website. There is no shortage of exciting ideas, but the limiting factor in bringing them to fruition appears to be the mounting workload pressures on our members. Fifty years ago essentially everything was done through volunteer efforts in an environment where employers were relatively tolerant of the use of space and resources to support extramural scientific and professional activities. This paradigm has clearly changed over the past 50 years and our Association has responded accordingly by adding increasing professional support for many of our activities. We may now need to

In the period since my last report, the Website Editorial Board met via a Webex conference call and discussed a broad range of topics, including a preliminary examination of the goals for the website. A long-standing goal has been the development of a “public” website that would potentially support programs that reach out to nonmembers. While we have ideas on how to engineer this component of our website, we need appropriate content, or assurance that this is now flowing fast enough down the

pipeline. We also need to ensure that our efforts in this regard are aligned with the mission and objectives of the Association. We might, for example, have most impact by focussing our first public website efforts around a specific issue, rather than trying to be all things to all people. Just as an illustration of that approach, we might wish to focus on making the ‘public’ case for licensure, which would then require the devlopment of materials suitable for many segments of the non-member community. The AAPM Board, however, must first determine new objectives and priorities of the Association through a revised mission and objectives statement, so we await this with interest. I hope that you find the Website useful, visit it often, and send me your feedback at h t t p : / / w w w. a a p m . o r g / p u b s / newsletter/WebsiteEditor/3305.asp

Mark Your Calendar for BIROW 6 Bethesda North Convention Center January 15-16, 2009

Purpose:

• To identify and explore new opportunities for basic science research and engineering development in biomedical imaging, as well as related diagnosis and therapy. The workshop will provide information and ideas for new investigators, support accelerated development of biomedical imaging as a scientific discipline, and facilitate coordinated imaging research. Experts will speak on selected topics, and discussion will continue in focused breakout groups, poster sessions, and with invited government representatives. “Technologies for Accessible and Cost Effective Medicine” to • include the following topics: Portable Diagnostic and Therapeutic Technologies, Image guided Minimally Invasive Procedures, Addressing Health Disparities and Chronic Disease Management. • The American Association of Physicists in Medicine (AAPM), the Academy of Radiology Research (ARR), the American Institute for Medical and Biological Engineering (AIMBE) and the International Society for Advancement of Cytometry (ISAC).

Theme & Topics:

Sponsored by:

Funding organization: NIBIB

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AAPM Newsletter

September/October 2008

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AAPM Newsletter

September/October 2008

Fellowships, Residencies & Research Awards Summer Undergraduate Fellowships Provide 10-week Medical Physics Experience By Ken Hogstrom

he 2008 Summer Undergraduate Fellowship Program (SUFP) continues to serve the AAPM by helping recruit outstanding undergraduate students into our field. This year marks the 8th year that the AAPM has provided this opportunity for undergraduate fellowships in medical physics. Fellows, primarily recruited through the Society of Physics Students, are selected on a competitive basis. This year there were 70 applicants (double

that of previous years) for the 14 ten-week fellowships. Each fellow, supported by a $4,000 stipend, was mentored by an AAPM member to work in radiation therapy, diagnostic imaging, or nuclear medicine physics on clinical or research projects. The SUFP gives special thanks to the 31 mentor applicants whose offers to mentor were essential to having a successful program. Shown below is a table of the 2008 fellows and their mentors. For more information on the program please visit http:// www.aapm.org/education/SUFP/ default.asp .

2008 Summer Undergraduate Fellowship Recipients

2008 Research Seed Funding Initiative Award Paul Keall and Sabee Molloi, Co-chairs, Joint Working Group for Research Seed Funding Initiative

espiratory gating, tomosynthesis, neuropsychological implications of lead ingestion, CT QA, real-time tracking, biomathematical models, proton therapy and IGRT. What do these topics have in common? They are all being explored by 16 outstanding junior scientists in medical physics who applied for the AAPM Research Seed Funding Initiative awards. 2008 was the first year a formal working group within the AAPM was established (http:// aapm.org/org/structure/default. asp?committee_code=JWGRSF) resulting in a more structured approach to the review. Two awards were given instead of one for the previous years. Congratulations to the 2008 winners, Zejian Liu from Johns Hopkins School of Medicine for “Noninvasive imaging of radiation-induced lung inflammation via peripheral benzodiazepine receptor based nuclear imaging” and Amit Sawant from Stanford University for “4D adaptive radiotherapy using in-room MRI for treating moving and deforming targets”. The successful applicants will each receive $25 000 to further develop their research idea that is expected to lead to AAPM presentations, publications and a larger grant application. For informational and transparency reasons we would like to describe the review process: 1. Four reviewers were assigned to each proposal based on the expertise area of each reviewer. 2. Each reviewer provided a written critique along with a score for

AAPM Newsletter

September/October 2008

each proposal keeping in mind the following key areas: scientific merit (significance, innovation, environment and soundness of approach), funding potential and the background of the investigator. 3. The top six applications were ranked by score. These six applications were then ranked by the entire Working Group. 4. The successful proposals were determined by this ranking. Conflicts of interest were avoided by not assigning reviewers to review grants from their institution, and also by self-disclosure of conflicts with other applications. Thank you to the members of the Joint Working Group for carefully reviewing the applications, and also to Jackie Ogburn at AAPM headquarters whose efforts greatly assisted the review process. We look forward to receiving more interesting proposals, and supporting selected applicants in their quest to advance our scientific understanding in medical physics.

2008 Minority Undergraduate Summer Experience (MUSE) Program

he program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institution (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. Each fellow is supported by a $4,000 stipend. The Minority Recruitment Subcommittee would like to thank all mentor applicants. Your assistance directly contributed to the success of the program.

Winners of the Research Seed Funding Initiative award

Six out of 15 applicants were awarded a fellowship this year. Through D. Ernst, Vanderbilt University has agreed to welcome one student from an underrepresented group every year to gain summer research/clinical experience with the possibility of retaining the student in their program, pending acceptance and performance. 2008 Fellowship for Graduate Study in Medical Physics

he fellowship is awarded for the first two years of graduate study leading to a doctoral degree in Medical Physics. A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year is assigned to the recipient. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP). Additional information on CAMPEP accredited programs can be found at http://www.campep. org The recipient of the 2008 Fellowship for Graduate Study in Medical Physics: Dustin J. Jacqmin of University of Wisconsin-Madison

The 2008 AAPM Minority Undergraduate Summer Experience Fellows Jonathan Baca University of New Mexico Lauren Foley University of Virginia Sheena Gause Francis Marion University Lynda Ikejimba Trinity College Judith Rivera The University of Texas at El Paso Korressa Williams South Carolina State University Horace Lee Lambert, III South Carolina State University

Shuang Luan, Ph.D. University of New Mexico Stanley Benedict, Ph.D. University of Virginia Geoffrey Zhang, Ph.D. H. Lee Moffitt Cancer Center Andrew Maidment, Ph.D. University of Pennsylvania Mark Williams, Ph.D. University of Virginia Steven Brown, Ph.D. Henry Ford Hospital Charles Coffey, Ph.D. Vanderbilt University Medical Center

A big THANKS to our volunteers.... â&#x20AC;˘ Service Project at the Houston Food Bank - July 26: 23 volunteers prepared 612 boxes of food (delivered to local families) â&#x20AC;˘ MD Anderson Blood Drive in Exhibit Hall D - July 29: 20 units of blood collected

AAPM Newsletter

2008 ASTRO/AAPM Radiation Oncology Physics Residency Training Award

he American Society for Therapeutic Radiology and Oncology (ASTRO) in conjunction with the American Association for Physicists in Medicine (AAPM) is pleased to announce that the following programs have been selected to receive the 2008 ASTRO/AAPM Radiation Oncology Physics Residency Training Award. The purpose of the Radiation Oncology Physics Residency Training Program Award is to promote the development of

radiation physics residency programs leading to more graduates and more qualified professionals entering the workforce. This grant is to provide assistance to newly established programs working towards accreditation.

September/October 2008

Award Amount Up to $36,000 in total funding will be awarded by ASTRO and matched by AAPM each year. Individual program grants will not exceed $12,000 each.

2008 ASTRO/AAPM Radiation Oncology Physics Residency Training AwardRecipients Timothy Solberg, PhD

The University of Texas Southwestern Medical Center

Brian Wichman, MS

Kansas City Cancer Center

Indrin J. Chetty, PhD

Henry Ford Health System

James C.H. Chu, PhD

Rush University Medical Center

Chester Ramsey, PhD

Thompson Cancer Survival Center

2008 John R. Cameron Young Investigator Competition Results 1st Place Malik Brunet-Benkhoucha McGill University Low Dose Rate Prostate Brachytherapy: A Tomosynthesis-Based Intra-Operative Post-Implant Dose Evaluation http://www.aapm.org/meetings/08AM/PRAbs.asp?mid=35&aid=8649

2nd Place Michael J. Price MD Anderson Cancer Center The Imaging and Dosimetric Capabilities of a Novel CT/MR-Suitable, Anatomically Adaptive, Shielded HDR/PDR Intracavitary Brachytherapy Applicator for the Treatment of Cervical Cancer http://www.aapm.org/meetings/08AM/PRAbs.asp?mid=35&aid=9284

3rd Place Todd F. Atwood Wake Forest University Bioanatomic MR Imaging for Characterization of Brain Tumor and Radiation Response in the Rat Brain http://www.aapm.org/meetings/08AM/PRAbs.asp?mid=35&aid=8453

AAPM Newsletter

September/October 2008

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AAPM Newsletter

September/October 2008

Working Group Update News from the Working Group on the Prevention of Errors in Radiation Oncology

to the community, have not been clear. This issue is still under active discussion by the working group.

This possible project would explore a more quantitative approach to assigning severity levels.

by Peter Dunscombe

4. Development of severity metrics. This possible project arose in some email correspondence after the meeting. The potential or actual severity assigned to an incident is usually made on a less than rigorous basis and this can hinder analysis.

If you have comments on these initiatives, or any other aspect of the work of the Working Group on the Prevention of Errors, please let myself or any other member of the WG know.

he Working Group (WG) met for two hours on Sunday, 27th July in Houston prior to the annual meeting. The full Minutes of the meeting can be viewed on the AAPM website. For convenience a brief summary of our future plans are given here. As a reminder, one of the goals of this WG is to assist in the development of a comprehensive database of errors in radiation oncology from which we hope to identify processes/ procedures that can be modified to prevent similar errors from happening in the future.

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1. Development of a glossary/ taxonomy for incident reporting and learning in radiation therapy. There are several initiatives in North America and worldwide to design and construct databases of incidents. The contents of these databases will be of far greater value to the community if they can be coalesced (ideally) or at least compared with one another without ambiguity. The ability to proceed in this direction will be facilitated by the use of a common language.

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AAPM Newsletter

September/October 2008

Education Council Workshop Report session entitled: “Assessing Assimilation of Knowledge.”

Herb Mower Education Council Chair “Becoming a Better Teacher of Medical Physics”

or many, immediately following the AAPM meeting in Houston was a hasty departure to more normal climates, less humidity, and lower temperatures. For about 120 hardy souls, it was off to League City, Texas for the 2008 Ed Council Workshop: “Becoming a Better Teacher of Medical Physics.” What a thrilling and dynamic experience! Bill Hendee pulled together an outstanding group of speakers and facilitators who were dynamic and enlightening. The opening speaker was Dr. Ed Redish of the University of Maryland who spoke on “How People Learn Physics.” This was an excellent and most informative presentation which prepared us all for the remainder of the workshop. Drs. Gary Becker of the American Board of Radiology and Russ Ritenour followed with a presentation on “Comparing How Physicists and Physicians Learn.” Dr. Victor Montemayor of the Middle Tennessee State University spoke on “Understanding and Engaging Your Audience: Lessons Learned from Undergraduate Physics Education.” Drs. Stephen Thomas and Kimberly Applegate (University of Indiana) followed up on this with a plenary

the

improve their teaching skills and abilities.

The second full day started with a keynote address on: “Knowing What to Teach” presented by Drs. Tony Seibert and Ervin Podgorsak. Dr. Phil Heintz discussed: “A Physics Curriculum for Radiologists” and Dr. George Starkschall followed with: “A Physics Curriculum for Radiation Oncologists.” Drs. Jay Burmeister and Ed Jackson rounded up the curriculum discussions with: “A Physics Curriculum for Physicists.” Dr. George Nikiforidis of the Patras University School of Medicine (Patras, Greece) rounded out the presentations with: “Teaching and Learning Through Collaboration.”

Overall the Workshop was very successful. Several recommendations were made as to the future direction so that the momentum would not be lost. These are going to the Education Council for review and, hopefully, implementation in our 2009 program. Among the suggestions were: repeat this workshop, prepare ‘4-hour’ or ‘one-day’ versions of the workshop that can be delivered at the chapter or local area, expand to the next level in the process, ‘how to’ programs for implementing educational sessions in the clinical setting employing modern A/V and computer techniques. I hope that, by the next edition of the Newsletter we will have selected the appropriate Workshop for next year.

Following each series of keynote addresses and plenary presentations the group divided into eleven sections for lively discussions on the materials presented. The final activity of the Workshop was on Sunday morning when each participant was challenged to prepare a SDEP (Self Directed Educational Program) for implementation during the next six months on something that would

All the participants expressed their thanks to Lynne Fairobent and Karen MacFarland of the AAPM Headquarters Staff for their support of the Workshop. Lynne was our ‘outstanding’ note taker and Karen handled all of the logistics and arrangements.

Thank you Education and Research Fund Donors. Without your generous contributions, AAPM would not be able to do the following: • support Fellowships for Ph.D. candidates in Medical Physics; • support clinical residencies; and, • provide seed money for research. For more details about the AAPM Education and Research fund and to learn how you could make a donation, please visit: http://www.aapm.org/education/documents/ EdFundAnnualReport2007Web.pdf

AAPM Newsletter

September/October 2008

AAPM Remembrances the AAPM and the AIP Center for the History of Physics have DVD copies stored in their archives for future historians.

Brief Recollections of a Charter Member by Robert Owen Gorson

am very grateful to be one of the charter members to make it to the Golden Anniversary of the AAPM. In fact I am the only member who will have attended all 50 AAPM meetings from the first one in 1952 when John Hale and I represented the radiological physicists of Philadelphia. I have served on well over 30 scientific and professional organizations and their committees during my career of nearly 60 years but the AAPM is the only Society whose every meeting I enjoyed, which proves that I have always considered the AAPM to be my primary professional home. I have served the AAPM in numerous capacities including being its 10th president and working on its many committees and councils. But by far the activities I most enjoyed and I am most proud of are the videotaped interviews I conducted of over 110 leaders in the medical physics and radiology world during my 17 years tenure on the AAPM History Committee. Many others contributed, John Cameron in particular. This history project continues to the present. Every person interviewed had fascinating, often amusing, stories to relate and memories to share with not only the interviewers but with all of those who choose to view the videotapes, now on DVDs, in the future. Both

Unfortunately 30 of those interviewed to date have passed on. One of them, Ted Webster, who received the Coolidge Award during the AAPM Silver Anniversary, closed his remarks by saying, “I am looking forward to our Golden Anniversary. With a little bit of luck I will make it!” He missed it by just three years. I certainly do not expect to be present at our 75th Anniversary, but I am grateful for the opportunities I had to date and the role I played in preserving and sharing many fond memories of great conversations with my friends and colleagues.

Recollections and Comments by Warren K. Sinclair

ounger AAPM members may not realize that the AAPM was originally conceived primarily as a professional group rather than a scientific society. I believe it was only at the end of my term as the 2nd President that I and some others recognized we would need a scientific society to give us focus, keep us together and enable us to meet. Accordingly John Hale as the next President drew up an (initially modest) scientific program for our next year. Scientific programs have

developed subsequently into the sophisticated programs AAPM has today. It may also be of interest that AAPM had a journal outlet before Medical Physics was initiated by Gail Adams in the 1970’s. Before then, starting in my term in 1961-62, conversations I undertook at that time with Joe Rotblat in London resulted in AAPM becoming affiliated with the journal Physics in Medicine and Biology of which he was the Editor. The Canadian Physics group joined also with PMB sometime later. By our agreement with Rotblat (later a Nobel Prize Winner) any U.S. papers submitted to PMB were sent directly to me as the U.S. Editor. I processed them (i.e. had them reviewed by appropriate, mostly AAPM colleagues), edited them myself, suitable for PMB and then submitted them to Rotblat for final publication. He commented to me several times on his admiration for the way this was done. (Actually at that time I think U.S. publishing practices were more rigorous than the British.) After some years as the U.S. Editor of PMB I was replaced by John Hale, who had to perform this task without the advantage of the personal relationship I had had with Rotblat and others at PMB. A third item that I would like to comment on is the letter that Ed Siegel wrote in the AAPM Newsletter (50th Anniversary Update) concerning the continued narrow focus of AAPM on radiation therapy, diagnostic radiology and nuclear medicine. It is true that our title implies a wider clinical remit and perhaps many initially hoped for this wider

MEMORIES.....

AAPM Newsletter

September/October 2008

scope. But one hopes the AAPM is not closed to a new physical modality developing an application in medicine and would welcome the chance to acquire the appropriate membership to foster it. Perhaps a future program committee could even envisage a symposium addressing such possibilities. I deeply regret that I am unable to attend the 50th Anniversary program and wish to extend my congratulations to all AAPM members and especially my charter member colleagues, most particularly Gail Adams as our first President and Bob Gorson, who has attended all 50 meetings!

Unforgettable Events with AAPM and IOMP in the last 28 years by Nan-Zhu Xie

ublished below is an abridged version of recollections of the close interactions of Prof Xie, a pioneer medical physicist in China with the AAPM and its members. For detailed article, we invite readers to visit AAPM website at www.aapm. org/pubs/newsletter/references/ 3305XieArticleFull.pdf 1981 Inviting Dr. John R. Cameron (President of AAPM, 1968) to visit China attending the Establishing Meeting of the Chinese Society of Medical Physics (CSMP) and giving lectures on Medical Physics in Guangzhou, Shanghai, Hangzhou, and Beijing for 4 weeks. 1983 I was invited to attend the 25th Annual Meeting of AAPM by Dr. Nagalingam Suntharalingam (President of AAPM, 1983) in New York meeting Drs. Sternick, Fullerton, St. Germain and many AAPM members. 1983 I invited Drs. Ned Sternick and Andrew Wu going to Guangzhou Medical College to give lectures on

Professor Xie (fourth from left) with Bill and Jeannie Hendee during their visit to China MRT, CT, and Radiotherapy on beautiful White Swan Hotel by the November 1983 and touring in side of Pearl River in Guangzhou. Drs. Shanghai and Beijing. James B. Smathers, David Goodenough, Frank B. Atkins, K.Y. Cheung, Kuang 1984 I was invited to go to Boston, Y. Chen and many Chinese Colleagues New York, and Washington, D.C. with presented articles on QA testing of the President of Guangzhou Medical medical imaging and radiotherapy. Dr. College Dr. Lin and Vice President Sternick, the Co-President of the QA Dr. Liu to sign the Agreement of Conference, representing Dr. Orton Cooperation between Tufts University from IOMP, gave a congratulatory – Medical School and Guangzhou speech during the Opening Ceremony. Medical College for teaching and That was the first QA International scientific exchanges. Conference held in China. It introduced 1991 AAMP & IOMP leaders Drs. new high-tech QA testing to Chinese John Laughlin and John Cunningham medical physicists, biomedical engineers and many AAPM members Drs. and medical doctors and improved the Melvin Siedband, Raymond Wu QA programs carried out in China by visited Guangzhou Medical College the Chinese Government. and helped me build up the IOMP– 1998 In 1998, I invited Drs. Hendee AAMP library in Guangzhou. and Siedband to visit Guangzhou 1992 Since 1983, I had been Medical College to give lectures on working on Magnetic Resonance in Medical Imaging & Radiation Therapy Medicine (MRM) in China researching, and tour in Guangzhou for six days. teaching and writing books on MRI, They were warmly welcomed by MRA, and MRS. Chinese radiologists, medical physicists and medical doctors. After the meeting, 1993 I attended the AAPM Annual Dr. & Mrs. Hendee and I flew to Xian, Meeting in Washington D.C. I met touring for two days and enjoying many old AAPM friends, including this famous old city. Then we flew to some members from Taiwan. I was Beijing to lecture and tour for six days. very happy to tour the White House Dr. Hendee was especially welcomed and Washington learning more about by the head of Peking Hospital and the history of the United States. gave a lecture of Functional MRI. He 1994 “The ‘94 Asian and Pacific met the famous Professor Guozhen Li International Conference on QA Testing Technology” was held at the (see Xie - p. 27)

AAPM Newsletter

September/October 2008

ACR Accreditation a 2-year pilot project regarding the use of appropriateness criteria in the medical imaging decision making process and its effect on the quality and cost of imaging. For more information, see http://www. acr.org/HomePageCategories/ News/ACRNewsCenter/ SummaryofHR6331.aspx.

ACR Accreditation: Frequently Asked Questions for Medical Physicists by Priscilla F. Butler, M.S. Senior Director, ACR Breast Imaging Accreditation Programs

Does your facility need help on applying for accreditation? In each issue of this newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR’s accreditation web site portal (www.acr. org; click “Accreditation”) for more FAQs, accreditation applications and QC forms. Q. What is the Medicare Improvements for Patients and Providers Act of 2008? A. The Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331), that was passed by the US Congress this summer (after overriding a presidential veto), includes a number of provisions. Among the most important, it repeals a statutorily mandated 10.6 percent physician payment cut, which was to become effective July 1, as well as an additional 5 percent cut set for Jan. 1, 2009, and instead extends the current payment rate for the rest of 2008 and a 1.1 percent update through 2009. The bill also provides funding for the implementation of

Q. What does the Medicare Improvements for Patients and Providers Act of 2008 have to do with accreditation? A. The legislation calls for providers of advanced diagnostic imaging services (MR, CT, PET, and nuclear medicine) to be accredited by 2012 in order to receive payment for the technical component of those services. Previously, the only federal quality and safety standards for medical imaging regarded mammography and were called for by the Mammography Quality Standards Act. Mammography has been proven to decrease breast cancer mortality. The MQSA standards have undoubtedly raised the quality of mammography being performed nationwide. Yet, these patient protections had not been extended to other imaging exams, until now. Q. Will the ACR apply for approval by the CMS to accredit facilities who perform MR, CT, PET, and nuclear medicine procedures? A. Yes. As the nation’s oldest and most experienced medical imaging and radiation oncology accrediting organization, the ACR will complete the process to become a deemed accrediting body for the Medicare program and work with the Centers for Medicare and Medicaid Services (CMS) to provide the accreditation services that the new law requires. The ACR has a long history of providing accreditation for diagnostic imaging

and radiation oncology services dating back to 1963. The federal government has previously recognized ACR accreditation as meeting the highest standards. In 1994, the ACR became the only national accrediting body for mammography accreditation approved by the U.S. Food and Drug Administration (FDA) under the Mammography Quality Standards Act. More recently, the ACR was named the accrediting organization for all U.S. Dept. of Veterans Affairs radiation oncology facilities. In addition to mammography and radiation oncology, the ACR currently has programs to accredit MRI, CT, nuclear medicine, PET, ultrasound, stereotactic breast biopsy and breast ultrasound. ACR accreditation is an efficient process of both self-assessment and independent external audit, based on the ACR guidelines and technical standards, which assesses the qualifications of personnel, policies and procedures, equipment specifications, QA activities, patient safety, and ultimately the quality of patient care. ACR accreditation requires that the physicians supervising and interpreting medical imaging meet stringent education and training standards. ACR accreditation also requires that the imaging equipment is surveyed regularly by qualified medical physicists (or MR scientists) to ensure that it is functioning properly, and that the technologists administering the tests are appropriately certified. The purpose of these programs is to set quality standards for practices and help them continuously improve the quality of care they provide to their patients. ACR staff will meet regularly with members of Congress, congressional staff, and CMS officials and publicize any developments on the ACR website (www.acr.org) as the Medicare accreditation process moves forward.

AAPM Newsletter

September/October 2008

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AAPM Newsletter

September/October 2008

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant 2009 Policies & Payments for Hospital Outpatient Departments Released by CMS

he Centers for Medicare and Medicaid Services (CMS) published the 2009 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The proposed rule includes a 3.2% increase to Medicare payment rates for most services paid under the HOPPS in 2009. CMS projects that hospitals would receive $28.7 billion in 2009 for outpatient services furnished to Medicare beneficiaries. In the past, the increase in Medicareâ&#x20AC;&#x2122;s payment for outpatient services has not been specifically tied to the quality of health care. The law now requires that the annual HOPPS payment inflation update be reduced by 2.0 percentage points for hospitals that do not meet quality reporting requirements. In order to receive the full HOPPS payment update for services furnished in 2009, hospitals must report data in 2008 on seven quality measures of emergency department and perioperative surgical care. The majority of radiation oncology procedure codes would realize slight increases in hospital payments, however, low dose rate (LDR) brachytherapy (APC 312) and stereotactic radiosurgery treatment delivery (APCs 65, 66, 67 & 127) have payment reductions slated for 2009. Proton beam therapy (APCs 664 & 667) would realize a 13% increase and medical physics codes 77336 & 77370 in APC 304 receive a 3.4% increase in 2009 payments (see table below).

Summary of 2009 Proposed Radiation Oncology HOPPS Payments APC

Description

CPT Codes

2008 Payment

2009 Proposed Payment

N N 65 66 67 127 299

N/A N/A Level I SRS Level II SRS Level III SRS Level IV SRS Hyperthermia & Radiation Treatment

77417 77421 G0251 G0340 G0173, G0339 77371

$0 $0 $1,056.75 $2,870.64 $3,929.70 $8,055.08

$0 $0 $995.33 $2,654.40 $3,664.34 $7,607.56

Payment Change 2008 to 2009 $0 $0 ($61.42) ($216.24) ($265.36) ($447.52)

$369.40

$382.47

$13.07

3.5%

$90.63

$91.71

$1.08

1.2%

$141.19

$146.60

$5.41

3.8%

$183.94

$192.63

$8.69

4.7%

$99.21

$102.59

$3.38

3.4%

$250.16

$261.89

$11.73

4.7%

$863.82

$900.50

$36.68

4.2%

$542.29

$522.14

($20.15)

-3.7%

$743.81

$754.18

$10.37

1.4%

$347.65

$363.05

$15.40

4.4%

$1,154.31

$1,194.63

$40.32

3.5%

77520, 77522

$816.59

$924.55

$107.96

13.2%

77523, 77525

$977.09

$1,104.88

$127.79

13.1%

300 301

303 304

305

310

312 313 412 651

664 667

Level I Radiation Therapy Level II Radiation Therapy Treatment Device Construction

77470, 77600-77620 77401-77404, 77407-77409, 77789 77406, 77411-77416, 77422,77423, 77750 77332-77334

Level I Therapeutic Radiation Treatment Prep Level II Therapeutic Radiation Treatment Prep Level III Therapeutic Radiation Treatment Prep

77280, 77299 77300, 77305, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77310, 77315, 77321, 77327, 77328 55876, 77295, 77301, C9728 77761, 77762, 77763, 77776, 77777, 77799 77781, 77782, 77783, 77784

Radioelement Applications Brachytherapy IMRT Treatment Delivery Complex Interstitial Radiation Source Application Level I Proton Beam Therapy Level II Proton Beam Therapy

77418, 0073T 77778

Percentage Change 2008 to 2009 0% 0% -5.8% -7.5% -6.8% -5.6%

APC reassignments for 2009 are highlighted in bold

CMS is proposing to reassign interstitial device codes 55876 & C9728 for placement of prostate and non-prostate markers, respectively, into APC 310 yielding a 365% increase in 2008 payment. CMS proposes to continue paying for LDR prostate brachytherapy

services using the composite APC methodology implemented in 2008. The 2009 proposed payment for APC 8001 is $3,515.60, a 2.4% increase in 2008 payment. In addition, CMS is proposing to expand the composite APC model to one new clinical area in 2009, multiple

AAPM Newsletter

September/October 2008

imaging services. Under the proposal, CMS would make a single payment for multiple imaging services described by procedure codes in one of three imaging families: ultrasound, CT and CTA, MRI and MRA. CMS proposes to create 5 imaging composite APCs to differentiate payment for imaging services with contrast and without contrast (see table below). For example, if a hospital performs a CT without contrast during the same session as performing CT with contrast (i.e. the same imaging modality), then the hospital would receive payment for the CT with contrast composite APC 8006. CMS proposes to maintain the packaged status of radiation oncology imaging guidance services for 2009. CMS states that while they are aware that some of the radiation oncology guidance codes describe relatively new technologies, they do not believe that beneficiary access to care would be harmed by packaging payment for these services. For quality reporting, CMS is proposing to add four (4) imaging efficiency measures that must be reported in 2009 in order for hospitals to receive the full market basket update in 2010. CMS invites public comment on the proposed imaging measures. The proposed measures are: • OP-8: MRI Lumbar Spine for Low Back Pain • OP-9: Mammography Follow-up Rates • Op-10: CT Abdomen- Use of Contrast Material

• Op-11: Thorax CT- Use of Contrast Material

mandates a positive 1.1% update for 2009.

A complete summary of the proposed rule and impact tables is on the AAPM website at: http:// w w w. a a p m . o r g / g ove r n m e n t _ affairs/CMS/default.asp

Independent Diagnostic Testing Facility Issues

The final rule will be published by November 1st, with an effective date of January 1, 2009. CMS Publishes 2009 Medicare Physician Fee Schedule Proposed Rule

MS published the 2009 Medicare Physician Fee Schedule (MPFS) proposed rule. The MPFS specifies payment rates to physicians and other providers, including freestanding radiation oncology clinics. Conversion Factor The MPFS was created by Congress and is updated annually to set the Medicare payment rates for more than 980,000 physicians and nonphysician practitioners (NPPs) who bill Medicare for the services they furnish to beneficiaries. The proposed rule indicates that payment rates for all physicians’ services would be reduced across-the-board by 5.4% in 2009, a reduction required by the statutory formula that takes into account substantial growth in overall Medicare spending. The Medicare Improvements for Patients and Providers Act of 2008 was enacted into law on July 15, 2008, which averts the 5.4% reduction in the MPFS proposed rule and

CMS is also proposing to improve the quality of diagnostic testing performed by physicians and NPPs in their offices by requiring them to enroll as suppliers of these services and to meet certain quality and performance standards, including applicable Federal and State licensure, health and safety requirements that currently apply to independent diagnostic testing facilities (IDTFs). CMS is proposing to make the standards effective January 1, 2009 for newly enrolling suppliers, but to allow existing suppliers until September 30, 2009 to come into compliance. The proposal specifically seeks public comment about whether these standards should apply to all diagnostic services or to a subset of services such as those that require more costly testing and equipment, imaging services generally, or only advanced imaging techniques. The rule as currently proposed would have the sweeping effect of requiring essentially any physician or NPP office that performs diagnostic imaging services—including radiologistowned and non-radiologist owned imaging offices—to enroll in Medicare as an IDTF and be subject to IDFT performance standards. Practice Expense RVUs CMS will continue to implement the new “bottom-up” practice expense methodology. For 2009, the practice expense relative value units (PE RVUs) will be calculated on the basis of a

AAPM Newsletter blend of RVUs calculated using the new practice expense methodology weighted by 75% and 25% of the 2006 PE RVUs for each code. The majority of radiation oncology codes increase under the new practice expense methodology and these procedures will receive additional increases in PE RVUs in 2009. The medical physics consultation codes (CPT 77336 & 77370), however, realize significant reductions under the new practice expense methodology. Initial reductions in the medical physics PE RVUs were implemented effective January 1, 2007 and these reductions will continue during 2009, the third year of the four-year transition period. Potentially Misvalued Services The Medicare Payment Advisory Commission (MedPAC), Congress and other stakeholders have expressed considerable concern regarding accurate pricing under the MPFS. In response, CMS proposes to create a process to update the prices for high cost supply items every two (2) years. CMS states that they will focus on supplies that cost more than $150. CMS reports that observers have raised concerns that there may be inequities between specialties in the current coding and payment system regarding the extent to which there are opportunities for additional coding and payment for services performed on the same day. CMS plans to perform a data analysis of non-surgical CPT codes that are often billed together to determine if there are inequities in MPFS payments. CMS may consider developing proposals to either bundle additional services or expand the application of the multiple procedure payment reduction to additional procedures. Lastly, CMS has identified methods for the American Medical Association’s Relative Value Update Committee

(RUC) to undertake to assist in identifying potentially misvalued services including review of: the fasting growing procedure codes; Harvard-valued procedure codes; and practice expense RVUs. CMS is not proposing changes for 2009, however, IMRT may be scrutinized by the RUC due to the high growth in utilization and several other radiation oncology codes may be reviewed, as they were valued based on Harvard data. Physician Self-Referral & AntiMarkup Issues As finalized in the 2008 MPFS final rule, the anti-markup provision applies to the technical components (TCs) or professional components (PCs) of diagnostic tests that are either purchased from an outside supplier or are performed outside of the “office of the billing physician or other supplier.” CMS is concerned that physicians who profit from their own self-referrals may be a cause of the significant increase in utilization of diagnostic testing. For 2009, CMS is proposing two alternatives for revising the antimarkup provisions to clarify the language of the provisions and address public concerns and comments. In addition, CMS is seeking comments regarding any other possible approaches that would address their concerns regarding overutilization motivated by the ability of a physician or physician organization to profit from diagnostic testing services not actually performed by or supervised by a physician who should be considered to “share a practice” with the billing physician or other supplier. A complete summary of the proposed rule and impact tables is on the AAPM website at: http://www. aapm.org/government_affairs/

September/October 2008 CMS/default.asp The final rule will be available by November 1st with all policies and payments being finalized and effective on January 1, 2009. AAPM will alert its members on key changes in policy and the final payment rates for 2009.

(Xie from p. 22) to talk about research of MRI with acupuncture. Dr. Hendee was invited to give a lecture on Medical Imaging at Peking University and dined with the Vice President of the University. After celebrating the 40th Anniversary of the founding of Guangzhou Medical College on Noveber 8, 1998 with Dr. and Mrs. Sternick, who is an Honorary Professor of GMC. I flew to Chicago to attend the RSNA Meeting. There I met Drs. Hendee, Orton, Lanzl, Goodenough, Ibbot, Hasegawa, and discussed how to organize the International Conference on Medical Imaging, Medical Physics and Precision Radiation Therapy (ICMIMPPRT) to be held in Guangzhou on October 4-6, 1999. 2007 I invited Dr. and Mrs. William Hendee to visit China in May to lecture on his new book, “Medical Physics, 2006.” We went to Zhejiang University in Hangzhou, Wuhan University, Taishan Medical University, Peking University and Tsinghua University (5 famous Chinese Universities) to give lectures and toured in West Lake, Wuhan Yangtze River Cruise, Taishan and the Great Wall. This was a 15-day long trip lectures and warmly welcomed by the five universities. 2008 I feel honored to be invited to attend the 50th Anniversary Annual Meeting of AAPM when I am 83 years old. I have the chance to meet many many AAPM old friends. I write this

paper to remember AAPM and IOMP in the last 28 years. Thank you!

AAPM Newsletter

September/October 2008

Chapter News Upstate New York Chapter of AAPM (UNYAPM)

he UNYAPM spring 2008 meeting at Rochester General Hospital on May 22 showcased a record number of research presentations as well as strong support from our growing list of industry sponsors. The research topics covered a broad spectrum of both hardware and software innovations. Daryl Nazareth from Roswell Park Cancer Institute began the research presentations with an interesting foray into the future of IMRT treatment optimization, applying massive parallel processing and a genetic algorithm to search for optimal beam angle configurations for multiple-shot IMRT. The preliminary results demonstrate a marked improvement in DVH outcomes compared to the unaided human experts, but highlights also the areas where continued development is warranted. This talk was followed by another project from Roswell Park, this time taking 3DCRT beam angle optimization a step further by including also a more accurate Monte Carlo approach for computing the treatment planning dose distribution. Now with two computationally intensive tasks – dose calculation and parameter optimization – going on simultaneously, supercomputing resources and efficient algorithm development become paramount. Their initial results demonstrate the feasibility of the approach given a ‘reasonable’ time frame of roughly 24 hours, but expected hardware improvements and further parallelization should bring this computational time down to an even more manageable several hours. Robert Ambrosini, an MD/PhD candidate at the University of

Rochester, then presented his work on computer-aided detection of brain metastases from conventional MR scans. Through a fairly straightforward approach using a model of the appearance of an ideal, 3D spherical tumor, he reduced the detection task to a single parameter describing the match between their model and features of tumor candidates. The results look promising, especially in light of the lack of brain cancer CAD success storied in the literature. Changing focus from software to hardware, Andrew Kuhls-Gilcrist from the University of Buffalo presented a follow-up to his talk of last year’s meeting wherein he discussed the potential benefits, from a theoretical point of view, of using a solidstate intensifier for X-ray imaging. This year, concept became reality as he demonstrated high resolution images from a prototype system that not only matched well the theoretical predictions but also indicated that he is able to greatly ameliorate instrumentation noise that plagues conventional systems at fluoroscopic X-ray intensities. Analysis of dose exposure during follow-up and treatment of the spine linked the next two presentations. Kerry Greene-Donnelly from SUNY Upstate Medical University in Syracuse looked at the cumulative radiation exposure in patients with repeated X-ray (radiostereometric) analysis following disk replacement surgery. She found that by optimizing to high kV, tolerable doses could be maintained with an image quality that is acceptable for delineating implanted markers that monitor vertebral motion. Acceptable cumulative exposure was achieved even with up to 60 image

acquisitions over a 2-year follow-up time period in these patients. Looking now at higher doses associated with IMRT, Osama Hassad and his team at Roswell Park posed the question of whether blocks of the spinal cord can be eliminated in the treatment of head and neck cancers using both IMRT and a lower supraclavicular anterior field. In brief, their results show that through judicious IMRT planning, 10mm and even 20mm field misalignments can be tolerated without the need for the spinal cord block. These findings should help alleviate a common concern among clinicians of the need to not shield areas of possible disease yet ensure a safe spinal cord dose in the case of small positional errors in the radiation beam. Developing works at Roswell Park were highlighted in the final talk and a poster presentation. Jonathan Schmitt tuned the audience into their plans for development of an optical guidance system for patient alignment in breast RT, while Thomas Stanley has begun looking at the effect of using tungsten shields in high dose-rate brachytherapy applications. We will be on the lookout for progress in these areas of research in upcoming chapter meetings. The program then turned to the keynote speakers and presentations. UNYAPM past-president Harish Malhotra first shared his experiences in developing, commissioning and implementing a SBRT program with state-of-the-art technology, then turned the podium over to our international guest, Professor Jake Van Dyk. Jake was asked merely to teach us all about the past, present and future of medical physics in 40 minutes or less, and he pretty much accomplished that with a special emphasis on his own Canadian perspective and with a bit of flare to boot. We will have to see whether his

AAPM Newsletter

September/October 2008

Chapter News visions for the future of biologically moderated radiation therapy will hold true. Closing our meeting was a special ceremony recognizing Debra Koch, M.S. for her prolonged and steadfast service to the UNYAPM chapter and to medical physics in general. The award, named in honor of the late Frederick Faw, honors those who through their enthusiasm and efforts are able to maintain a high standard of excellence in the UNYAPM and promote its continued growth and outreach, as exemplified by Dr. Faw in the early days of the UNYAPM. This award is not dictated by a particular time line but rather is resurrected in special circumstances to honor those special individuals, such as Debra, with exemplary service and commitment.

Southern California Chapter Names 2008 Norm Baily Award Recipients by: Steven Goetsch, Education Chair Bradford Krutoff, President Marianne Plunkett, Past President

he Fourteenth Annual Norm Baily Student Awards were given at a Southern California Chapter meeting held at the UCLA Faculty Center on May 29, 2008. The Norm Baily awards were sponsored this year by an educational grant from Computerized Medical Systems, Inc. Two talks were given by Jeffrey Powell from Elekta and by Charles Y. Shang from Lynn Cancer Institute on 3D visualization for treatment planning.

A near record number of eight students entered this year’s competition. The winners of this year’s awards are: Erin Angel: “Novel tube current modulation algorithms for reducing radiation dose to breasts in thoracic CT.” Her advisor is Michael McNittGray. The second winner was Nicole Detorie and her talk was “Motion correction for respiratory-gated PET using sonogram registration.” Her advisor is Magnus Dahlbom. The third winner is Robert Ochs and his talk was “Software for bronchoscopic treatment planning and analysis of the central airways.” His thesis advisor is Matthew Brown. Each student is working on a doctorate in the UCLA Biomedical Physics program. Other students submitting abstracts were: Jennifer Cho, Sherry Liu, J. Tyson McDonald, Adam Turner and Yang Wang. Each of these students will receive a $50 gift certificate in appreciation of their efforts. The awards include a certificate from Chapter President Bradford Krutoff (GLAHS VA) and an award of $500. These awards are given in memory of the late Professor Norm Baily of the University of California San Diego.

Photo: (left to right), Steve Goetsch, Erin Angel, Robert Ochs, Marianne Plunkett, Nicole Detorie and Brad Krutoff.

AAPM Newsletter

September/October 2008

International Scientific Exchange Program Course Report AAPM ISEP Radiotherapy Course in Prague in June 2008 by: Eugene Lief European Affairs Subcommittee

teaching course on radiotherapy sponsored by AAPM ISEP took place in Prague (Czech Republic) on June 16-20, 2008. Lectures and practical sessions were delivered by Drs. J. Novotny (Czech Republic), G. Marinello and R. Rosenwald (France), R. Suwinski (Poland), B. Mijnheer (Holland), D. Fontenla, T. R. Mackie, and E. Lief (US). The course was organized by Professors Josef Novotny and Ginette Marinello. 52 attendees arrived from many countries mostly from Europe but also from other continents including Australia. There were also two attendees from the US who very much helped to initiate and maintain useful discussions after the talks. During 5 days of intensive lectures, hands-on classes, and facility demonstrations the lecturers presented a broad spectrum of advanced methods of radiotherapy, advanced technology, and day-to-day practice of Medical Physics. Main topics were IMRT, IGRT, Radiation Protection, Radiobiology, Advanced Imaging, Treatment Planning, and Delivery, Radiosurgery, and Quality Assurance. It was a pleasant surprise to see that many European countries have advanced technology for radiation therapy; however, it is often located only at a limited number of central facilities and not available for many peripheral institutions. Sometimes, few medical physicists who have access to the best available technology in some countries do not have “critical mass”

of educated colleagues sufficient for discussions and perfection of the treatment techniques. Therefore, it is extremely important to integrate all practicing medical physicists from those countries in the world community. The course definitely served this purpose. The lectures covered many important subjects on Advanced Methods in Radiation Therapy. Hands-on classes were held in informal atmosphere allowing better information exchange. Attendees had a chance to exchange their experience and present their methods of work. Such small group classes allow better communications when attendees are not afraid to ask questions in front of the audience. There was also a course dinner in the middle of the week where all attendees could informally communicate with their colleagues from other countries as well as the lecturers. Probably, for future courses this event should be held earlier in the week to establish more informal and productive atmosphere of interaction as early

in the course as possible. It could be substituted by the icebreaker if it is well-attended. At the end of the course, the organizers distributed anonymous evaluation forms. The results of evaluation anonymously done by the participants after the course indicated high level of lecturing. All grades were between 1 and 3 on a 5-grade scale with 1 being the best and 5 – the worst. Many participants commended usefulness of the class and suggested repeating it periodically. Some critical comments suggested shorter lectures, better coordination of subjects between the speakers, and more emphasis on the latest topics and advanced subjects. Although, some other attendee’s criticism is questionable (like requirements to provide lunches and color printouts, which would have increased the tuition fee), there is definitely some room for improvement in future. As we gain experience in organizing such classes, we get better feeling of what the attendees really need.

Hands out -1.9 Usefulness - 1.5

Clarity - 1.6

Length - 1.8

Fig. 1. Anonymous overall course evaluation by the participants: 1 is the best, 5 is the worst.

AAPM Newsletter

September/October 2008

Course participants on the background of the Prague Castle. Course organizers did a very good job in arranging the class and advertising it. For the first time AAPM awarded course organizers with special plaques in recognition of their important hard work. Ironically, due to the last minute decision and bad weather, the plaques could not be delivered to the course instructors from the US before they left to Prague. Therefore, the plaques were forwarded to Prague where they were held at the airport customs for several days and eventually brilliantly “rescued” by one of the course organizers. I think, this tradition (awarding the organizers but not the last minute shipment) should be continued in future, as we have to appreciate the enormous amount of work that the organizers do. I was very touched to see how Professor Novotny took personal care of the participants, personally meeting the instructors at the airport and driving them to hotels, making sure that everybody gets course materials, tickets, food, and everything else. Partly success of the course is due

to a long experience in various professional event organizations in Prague. After the famous “velvet revolution”, this city was very much open to the West, and Professor Novotny was in charge of many courses administered by IAEA, ESTRO, and other organizations. As the radiotherapy class is over, the European Affairs Subcommittee

in coordination with International Scientific Exchange Programs Committee is preparing a Diagnostic Physics class in 2011. We hope that it is going to be as good as the one in Prague. All the suggestions regarding the program and organization process are very welcome. course dinner.

Dr. Fontenla presents AAPM Awards to the local organizers – Professors Ginette Marinello and Josef Novotny.

AAPM Newsletter

September/October 2008

TG 133 Update Task Group 133 â&#x20AC;&#x201C; Alternative Pathways for Clinical Medical Physics Training by: Mike Herman â&#x20AC;&#x201C; TG133 Chair

ask Group 133 has been approved and (should be) published to the AAPM website at this time. The effort was devoted to reviewing current mechanisms for providing clinical medical physics training and recommending pathways that would increase (dramatically) the number of CAMPEP accredited clinical training pathways. Patient care and our profession deserve the services of properly trained and qualified medical physicists. The ABR 2012/2014 initiative provides additional incentive. Medical physicists are entering practice through a variety of pathways with widely varying clinical regimens. Figure 1 below demonstrates this. The percentages in the boxes indicate what fraction of individuals receive training by a given pathway according

Figure 2 various mechanisms by which ALL of these (with the exception of mentorless training) can become CAMPEP accredited. This can be done by providing documentation of the quality training already being done and supplementing the training through affiliations where necessary. The task group provides detailed examples of all necessary materials to develop a CAMPEP accredited clinical training program

Figure 1 to a survey done by the Medical Physics Residency Training and Promotion subcommittee (MPTRP). These are not equivalent pathways at the current time. TG 133 describes

through any of the pathways. Please note that a significant fraction of training now (2008) occurs in an on the job (OJT) environment. If this is quality training, providing

documentation and structure for accreditation is straight forward. In figure 2, all pathways lead to accredited clinical training. The number of accredited residency programs is growing at a steady rate and nonacademic programs are also following the TG133 models. It is anticipated that through the mechanisms listed, the profession will achieve the goal of providing the highest quality clinical medical physics training to all medical physicists entering clinical practice (CAMPEP accredited clinical training plus ABR certification). The Professional Doctorate (also listed) is a pathway that is being evaluated separately by a working group within the MPRTP and has been reported separately. If we are providing clinical training for taking care of patients, the only way to do this is consistently in a structured and accredited manner. Each current pathway can accomplish this and our patients deserve it. Please refer to the full TG133 report posted on the AAPM website (and under reports), or contact any member of this task group or the MPRTP or CAMPEP.

AAPM Newsletter

September/October 2008

TG 109 Update AAPM Code of Ethics Approved by Chris Serago - TG 109 Chair

t the annual meeting in Houston, the Board of Directors (BOD) approved a code of ethics for the AAPM. The code was previously approved by the Ethics Committee (ET) and Professional Council (PC). The code was drafted by task group 109, and also been reviewed by AAPMâ&#x20AC;&#x2122;s legal counsel. TG-109 solicited comments from the general membership, ET, PC, and the BOD. Some of the text below is directly from the code. The charge of TG-109 was to write a comprehensive code of ethics for members and corporate affiliates of the AAPM, consolidating previous AAPM ethics policies into a unified document. The new code replaces the following AAPM policies: Ethical

Guidelines for Vacating a Position (PP 4-B); Ethical Guidelines for Reviewing the Work of Another Physicist (PP 5-C); Guidelines for Ethical Practice for Medical Physicists (PP 8-D); and Ethics Complaint Procedure (PP 21-A).

code of ethics are core values to aid all members and affiliates act in an ethically professional manner. The code includes Guidelines that are intended to assist members and affiliates to interpret and implement the Principles.

The code of ethics is not a set of laws, but standards of ethical conduct by which all members and corporate affiliates are expected to abide. The Principles of the

The full text of the code of ethics may be found on the AAPM website under Medical Physicist/Code of Ethics.

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AAPM Newsletter

September/October 2008

Introduction of William D. Coolidge Award Recipient

The following is an introducation of Paul Carson, Ph.D. by colleague Brian Fowlkes, Ph.D.

had the privilege this year on 50th anniversary of the AAPM to introduce 2008 recipient of the William D. Coolidge Award, Prof. Paul L. Carson. Paul is not only on his brilliant academic with substantial contributions to the AAPM, but a loving husband, devoted parent, distinguished colleague and long-time friend to some many people in our scientific community and beyond. Paul began his higher education at Colorado College in 1961 along with a summer research opportunity at the University of Denver in 1962. But his interests in physics also led him east to Columbia University in 1964 to study astrophysics and Harvard University (1965-66) for high energy physics, and finally to the University of Arizona for his MS and PhD in 1969 and 1972, respective, studying low energy nuclear physics. During his undergraduate years we almost lost him to political science but fortunately for us physics did catch hold and he was soon hooked for life. Paul is foremost a scientist. Beginning his academic appointments at University of Colorado in 1971, he discovered medical physics as a response to an advertisement by a then young Bill Hendee, who would also go on to receive the Coolidge

Award. Paul rose to Associate Professor and pioneered studies in ultrasound imaging including the development of one of the first ultrasonic CT systems, an area of research that perhaps is just now reaching a point where technology can make its use a practical reality. These were foundation years for him with research projects on ultrasonic characterization of fetal lung and liver maturity, areas now evolving as technology progresses to the point of parametric imaging with ultrasound. There are still pieces of equipment in our lab at the University of Michigan today that are â&#x20AC;&#x153;Colorado vintage.â&#x20AC;?

with x-ray mammography and now tomosynthesis images to collocate tumors for easier examination. Similar ultrasound methods were also applied in prostate ultrasound and with the rapid evolution of 3D/4D one can anticipate seeing the early research that Paul spearheaded finding widespread clinical application. His research efforts in microbubbles for diagnosis and therapy have led to several developments in ultrasonically-triggered liquid droplets that locally produce bubbles. These developments are just some examples of the forward thinking that has characterized Paulâ&#x20AC;&#x2122;s contribution to medical ultrasonics.

From those early days came collaborations with Chuck Meyer and Tom Chenevert that would transition with Paul to the University of Michigan where he has been ever since. Paul founded the Basic Radiological Sciences Division in the Department of Radiology and later was named the first Collegiate Professor of Basic Radiological Sciences. Through the years, Paul has been a constant source of inspiration and energy and in July 2006, on the 25th anniversary of our division, our former students and colleagues returned from all around to celebrate what he started.

Paul is an accomplished author with over 150 peer-reviewed publications and over 60 contributions in textbooks and published standards. He has been recognized and supported by those in his field and made a fellow of the AAPM, AIUM, ACR, ASA and AIMBE. His list of recognitions by all of these scientific organizations is a testament to his innovation and academic contributions and service to so many. He is especially appreciated by all of us that have benefitted as his graduate students and postdoctoral fellows.

At the University of Michigan, Paul has maintained a high level of academic research being in the top 5% of grant recipients from the National Institutes of Health for the past 25 years. He has worked on the quantification of color Doppler to provide additive diagnostic information in the evaluation of breast cancer. His research group worked with GE to develop 3D ultrasound that could be directly displayed in conjunction

But to the AAPM, Paul is best known as a tireless volunteer, devoting countless days of his time over the years to help this organization develop and maintain its premier position among medical physicists in so many areas. As you probably know he served as president of the AAPM in 1987. By his side has always been his wife Pat who has missed almost as few AAPM annual meetings as Paul. All of us who have worked with Paul know his dedication to this organization. For over 30 years, Paul has been a steady contributor to the

AAPM Newsletter AAPM in a wide range of roles and his efforts continue to this day. Fortunately for other organizations, he has been able to share his time as well with lists of contributions that rivals his efforts on behalf of the AAPM. His work with the AIUM, ACR, IEC, RSNA and AIP demonstrate his dedication to our discipline and his understanding that such volunteer efforts are essential to the advancement of medical physics.

His unselfish commitments have also gone beyond just the science to community activism through many outlets including his church where he recognized mankind’s impact on the environment before gas hit $4/ gallon. Despite the time commitment that a highly successful academic career demands, Paul has been a devoted husband to Pat and father to his daughter Cari and son James. And

September/October 2008 the generational evolution continues as Paul and Pat are proud grandparents to the children of James and Cari’s families. Pat and their children, some of their grandchildren and Paul’s siblings were able to help him celebrate his accomplishments at this year’s 50th anniversary of the AAPM. So congratulations to Paul L. Carson, the 2008 recipient of the William D. Coolidge Award.

Coolidge Award Acceptance Speech by Dr. Paul Carson to more focused, sometimes less intense, roles is something good for much of our generation and, I believe, for me.

Paul Carson, Ph.D. 2008 AAPM Coolidge Award Recipient

hank you, Brian, very much for that insightful, history. I appreciate your being here. In addition to following some of my career paths, Brian has been such a large part of my later career, and a good example for it. He has taught me how easy and productive good collaboration is. I’ve been very comfortable in turning over direction of the Univ. of Michigan Basic Radiological Sciences Division to his leadership after his selection by our division faculty and Chair of Radiology. He is also now head of our ultrasound group. I hope to continue as a productive, full time faculty member and researcher for up to another decade, but helping others take on leadership roles and transitioning ourselves

Thank you, President White. Its good to receive your congratulations as representative of the current AAPM Leadership and a representative from my own medical physics alma mater, the Univ. of Colo. Medical Center. Its also a pleasure to see other good friends, in AAPM leadership roles and on the podium here today. The AAPM is in good hands under you four, Jerry White, Mary Martel, Mary Ellen Giger, Marty Weinhous, and others. I appreciate the Awards and Honors Committee’s positive judgment of my role in AAPM and your concurrence in that. I wanted to thank our local hosts for this wonderful meeting. I am a relatively knowledgeable observer of Texas and Texans in frequent visits to relatives and in living 10 of my first 13 years only 80 miles from the Texas border. Medicine, medical research and medical physics are very strong here. For other keen cultural observations, talk to me later. The AAPM has been one of my two professional homes (a position

shared about equally with an ultrasound specialty society). Brian went over some memories, but my years of presidential succession were pretty special. The Executive Committee in my presidential year included Ken Case, Gary Barnes, Ed McCullough, Elaine Osterman, and Jean St. Germain (figure 1) Jim Purdy was two years before me and gave me encouraging advice to vigorously pursue my goals for imaging in the AAPM. He did not point out that many of the proposals should receive a great deal of grease on the skids.

Fig 1. - 1987 AAPM Executive Committee The AAPM has served all of my family well, as a surrogate family vacation and cosmopolitan experience. I remember particularly well the summer schools at Boulder, Santa Barbara, Raleigh Durham,

AAPM Newsletter

September/October 2008

Portland, LaCross-Wisconsin, Ann Arbor, New London and the Atlanta Hilton watermelon competitions at an annual meeting. I understand many in the AAPM are beginning to think again of the benefits of offering activities at the annual meeting oriented toward family members of each of several age groups. This Coolidge Award has had my respect for a long time. The recipient at the time of my presidency of the AAPM, 21 years ago, was Gordon Brownell, MIT professor of Nuclear Engineering and physicist in radiology at Massachusetts General Hospital (figure 2). He was well known for his role in developing positron imaging and PET and became a member of the Institute of Medicine and Nat. Academy of Sciences. While CT seemed to me to take off immediately (10 years maybe), it was over 50 years from Brownell’s early work to PET reimbursement. (There’s a reason for mentioning that, which might become apparent later.)

age, but not so! I will return to the issue of how long our obligations extend to society and individuals. Bill is part of a series of medical physicists, starting with his mentor, Jack Krohmer and soon branching extensively under Bill to many other medical physicists, including an early one, Ed Chaney, and a recent one, Bill’s son Eric Hendee. With as little as six years per academic generation, a professor can generate a large and deep academic family in his or her lifetime. Many here will remember our daughter Cari, from past AAPM

They both went to Rice University here in Houston and are here with their three children (figure 5) for this occasion and to visit friends and both their families. James went on for his doctorate and postdoc in computational biology here at Baylor Medical School.

Fig. 5 - son, James, and family James in particular has enjoyed the AAPM fun runs (figure 6). It would be nice to give the runs a little higher scheduling priority. Its cold and dark in Calgary at 5:30 am.

Fig. 3 - Bill Hendee with wife, Jeannie Hendee 1989 William D. Coolidge Recipient summer schools and meetings. Cari is here today. She, her husband, Matt Dietz, and their two children (figure 4) live in Edwards, CO where she has taught middle school science. Fig. 2 - Gordon Brownell, 1987 William D. Coolidge Recipient A most influential person in my career is my medical physics mentor, Bill Hendee (figure 3). In 1971, Bill took a chance on a nuclear physics graduate with no medical physics training. He gave me lots of freedom and responsibility, good advice, and introductions to many volunteer activities. I hope to continue working to deserve his faith and contributions. That may sound disingenuous at my

Our son James and his wife Lena are now from Richland, Washington.

Fig. 4 - daughter, Cari, and family

Fig. 6 My sister Karen of San Antonio, who guided much of my first 8 years or so, in Tucumcari, NM, is here, as is my wife, Pat and my brother, David, and his wife Anne from Boulder (figure 7). Also Pat’s cousin Brenda from Houston is here.

Fig. 7

AAPM Newsletter Pat Carson (figure 8) , whom many of you know as a long term participant in AAPM meetings, has done far more than her share of keeping a good environment for our family of four. Without her steady efforts, a sense of accomplishment and pleasure in life would have been very hard for me to realize.

Fig. 8 - wife, Pat Carson Lets move to a discussion of family priorities as opposed to those of work. I have often thought about the choice of emphasis between those immediately close and those you can touch in greater numbers, often less directly. A primary contribution of several religions including Hindu, Buddhist and Christian has been the repeated teaching that the large movements of government and other powers are not as important as our interactions in making life loving and caring on the individual level at all time. That approach worked for Ghandi and Mandella, -- not as well for others, but nothing’s perfect. Contrary to that teaching of primary attention to personal interactions, -- I have given most of my effort to the more global and abstract, primarily through research. That is where I have thought the greatest good for the greatest number of people could be accomplished. I still believe that. This emphasis on global, longer term effects, could have been a disaster in the family, my own psyche, and even

professionally. However, my family filled in many of the holes in life that this somewhat removed approach would have left without the family’s considerable contributions and understanding. The balance between immediate benefits to patients -- and longer term effects on possibly many more people through research is a personal one. However, I would argue for adequate resources for the longer term effects, even if the results require 50 years or more. In our organization and profession, working for the greatest good for the most people usually corresponds to the greatest power and recognition and at least reasonable remuneration for ourselves and our loved ones. The ease of achieving that good balance between helping others -and having interesting and rewarded work is a major reason most of us are in medical physics. As a big bulge of us are reaching traditional retirement age, I wish to encourage young and old to work toward a society in which those reaching traditional retirement age are encouraged to consider what they can do to make life more livable for others. Many of us owe more attention to our spouses and families. But we still are obliged to leave a future of humanity and life on earth - better than it would be otherwise. The older generations’ work might include passing on to younger generations much of the decision making. We can apply our wisdom, skills and arguments - to help shape human life, the environment and a confidence that problems can be overcome rationally. This can be done in our professional capacities, where we have a wealth of experience, or in new areas that will be stimulating and challenging.

September/October 2008 Remember Dr. McCoy? “What am I, a doctor or a moon shuttle conductor?” 41 years ago McCoy’s diagnose-and-fix-all device helped set a vision of the future of medical diagnosis and treatment. His all -purpose medical device looks a lot like what? – That’s right, a compressed ultrasound transducer and electronics. Over the past three decades, exploratory surgery has been replaced by imaging. Other procedures have been changed to make them more effective treatment, with less disruption of our lives. After laparoscopy came angiographic intervention, and RF and cryoablation. We will have therapeutic ultrasound. That ultrasound will do imaging, thermal therapy, targeted drug delivery and precise incisions (histotrypsy) without breaking the skin. Soon all we will need to complete reduction of invasiveness is an energy form that can penetrate even air and bone. That is, places where ultrasound can’t reach, without much damage to surrounding tissues. Hmmm. We’ll have to work on that one. Maybe xrays, radionucleids and protons can be used for treatment. Thanks to the AAPM and our AAPM friends and colleagues for your role in making our lives interesting and, hopefully productive. I’m glad all of you could be here to share the celebration and some of these thoughts, and to get to know me and my family better.

AAPM and Doyle Printing Green Partners

AAPM Newsletter

September/October 2008

Persons in the News radiation oncology physics. Mr. Halvorsen is Director of Medical Physics for Alliance Oncology’s Northeast region. He is an active surveyor for the ACR Radiation Oncology Accreditation Program as well as a member of the ACR’s Radiation Oncology Accreditation Committee. He is also active within the AAPM as Chair of the Clinical Practice Committee and At-Large Member of the Board of Directors. AAPM members who were awarded fellowship in the American College of Radiology in May 2008 L to R: L to R: Cynthia McCollough, Jerry White, John Boone, Wayne Hedrick and Per Halvorsen.

he American College of Radiology (ACR) recognized five AAPM members during their annual meeting in Washington, DC in May 2008. Following is a brief sketch of some of the members: John M. Boone has participated in a number of ACR activities including the design of the thoracic imaging accreditation process, and more recently in the radiography and CT dose registry programs. Dr. Boone

is Professor and Vice Chairman of Radiology at UC Davis Medical Center, and he is also a fellow of the AAPM and Society of Breast Imaging. He currently serves as the Chair of Science Council for the AAPM. Per H. Halvorsen was awarded fellowship for his significant contributions to ACR programs and activities and his efforts to promote minimum practice standards in

AAPM Dues Increase Voting on the proposed dues increase for 20092013 opened on August 27, 2008. Paper ballots will be mailed to members who have no e-mail address or a bad e-mail address and members that have opted out of online voting. The deadline to submit your vote electronically or by paper ballot will be September 24, 2008.

The other members included Jerry White – AAPM president and a fellow of AAPM who has served on various committees including as Chair of Economics subcommittee within Commission of Medical Physics, Cynthia McCollough from the Mayo Clinic Rochester, MN and Wayne Hedrick from Ohio.

AAPM Newsletter

September/October 2008

Memorial Hendee at the University of Colorado and his Ph.D. in Medical Physics at University of Wisconsin, Madison in 1984 under mentorship of Charles Mistretta. Bruce joined University of California, San Francisco (UCSF) Department of Radiology in 1986, and had served as the Director of the UCSF Physics Research Laboratory until his untimely death.

Bruce H. Hasegawa, Ph.D. 1951 - 2008 by Youngho Seo, PhD Assistant Professor UCSF Physics Research Laboratory Department of Radiology and Biomedical Imaging University of California, San Francisco

n May 22, 2008, the medical physics and nuclear medicine communities lost a brilliant investigator, an excellent educator and a devoted mentor, and above all a true friend, Bruce H. Hasegawa, Ph.D., died suddenly of a massive hemorrhagic stroke at the age of 56, just one month away from his 57th birthday. During his short life, Bruce imparted a tremendous legacy that would not only touch the lives of many colleagues but also unknowingly impact the lives of many patients who would come to benefit from Bruce’s superb research accomplishments. Bruce was born on June 21, 1951 and grew up on an almond farm on the outskirts of Fresno, California. Bruce had a diverse educational background in basic sciences with multiple degrees in Mathematics, Physics, Radiology Sciences, and Medical Physics. He earned his M.S. in Medical Physics under William

His distinguished research career at UCSF was highlighted by his pioneering work combining SPECT functional imaging with CT anatomical imaging to produce the first combined dual-modality imaging system, SPECT/CT. This invention would spark a revolution in the medical imaging equipment industry which also led to the eventual development of the dual-modality PET/CT and PET/MRI. His research areas included x-ray imaging for medical diagnostics, development of nuclear medicine imaging instrumentations, tomographic reconstruction algorithms of radionuclide imaging data, small animal SPECT/CT imaging, and many other research areas in medical physics and bioengineering. As a university educator, Bruce was dedicated to improving the Medical Physics curriculum at UCSF to better prepare students for the biomedical imaging field. He had been deeply involved through his teaching and research with the UCSF/ UCB Joint Graduate Program in Bioengineering, which now boasts one of top biomedical imaging programs in the country. He was a Co-Chair of the Program for the first several years, and continuously influential throughout his tenure as faculty member for the Program.

Bruce was also a prolific writer during his career, publishing widely popular papers mostly in dual-modality imaging. His textbook entitled “The Physics of Medical X-Ray Imaging”, subtitled “The Photon and Me: How I saw the Light” is still regarded among the classic books in medical imaging literature. Behind his brilliant mind lay a simple man who appreciated life’s simple pleasures. Bruce was genuine, kind, generous, humble, sensitive and thoughtful. Bruce enjoyed good food, classical music, opera and even rock and roll. Bruce often demonstrated his appreciation for faculty colleagues and staff members through simple gifts of food, flowers or sometimes lollipops and the occasional dim sum or jerk chicken parties. Bruce’s untimely departure was painful to many of us. We not only lost a remarkable scientist, but also a true friend who cared about us. We will always cherish the legacy of his brilliance, the impact of his work on the medical imaging field and the positive influence he had on the lives of his students, postdocs and colleagues. The wonderful memories of Bruce will be sustained in all of us for years to come. Dr. Hasegawa’s family has generously requested that donations in Bruce’s memory be made to the UCSF-Dr. Bruce Hasegawa Memorial Fund, PO Box 45339, San Francisco, CA 94545-0339.

Editor

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

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

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