A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 34 NO. 1
AAPM President’s Column
Maryellen Giger University of Chicago
hile I am writing this newsletter article in December 2008, you will be reading it as my first column as President of AAPM in 2009. As Treasurer and then President-Elect, I have learned much from my past five years on EXCOM and I thank greatly the various Presidents who served the AAPM during those years -- Martin Weinhous ‘03, Don Frey ‘04, Howard Amols ‘05, Russ Ritenour ‘06, Mary Martel ’07, and Jerry White ’08, as well as Jerry Allison and Gary Ezzell, who held the office of Secretary, and Mary Moore, the recent Treasurer. They have served the AAPM with great dedication, insight, and skill. I look forward to serving you as the new president of the AAPM, a committed organization entering its second 50 years! The AAPM continues to grow and maintain a major presence in the lives of medical physicists – covering the various scientific, educational, and professional aspects of the multi-disciplinary field of medical physics. The depth and breadth of AAPM involvement is motivated
by its mission statement. This mission statement, while present on the AAPM website, is worth repeating here – “The mission of the Association is to advance the practice of physics in medicine and biology by encouraging innovative research and development, disseminating scientific and technical information, fostering the education and professional development of medical physicists, and promoting the highest quality of medical services for patients”. Currently this mission statement, adopted in 1997, is in the process of being updated in order to reflect the changing role of medical physicists in today’s society. However, the overall mission is being conducted through our eminent scientific journal, Medical Physics; our wellattended annual meeting, summer schools, and special forums; our continuing professional activities for achieving the 2012/2014 board deadlines and licensure expectations; our expanding website; and many other activities. Over the past years during which I have served on EXCOM (the AAPM executive committee) and the BOD (Board of Directors), I have watched the BOD continue to develop their approach for setting the course of the AAPM. Currently, the BOD consists of 37 voting and 8 ex officio, non-voting members. New Board members attend Orientation at the AAPM headquarters in the autumn before their terms begins and learn about
their responsibilities in making policy and governance decisions for the AAPM. Board members have the opportunity to discuss daily on relevant issues of the AAPM via the BBS (bulletin board server). In addition, they electronically receive a Monthly Board Bulletin each month and participate in face-to-face meetings three times a year. Key roles of the BOD are setting organizational direction, providing oversight, and ensuring necessary resources. Many of the BOD members also participate in various committees of the AAPM. I encourage all members to give a positive response if asked to run for next year’s BOD, a very important volunteer effort. The AAPM’s mission is achieved via the three current Councils of TABLE OF CONTENTS President-Elect’s Column Chair of the Board Column Past Chairwoman of the Board Editor’s Column Leg. & Reg. Affairs Education Council Report Professional Council Report Treasurer’s Report Website Editor’s Report ACR Accreditation Health Policy/Economics Licensure Initiative Update ISEP Course Report AASHE Meeting Report FOREM Meetings Update Persons in the News Letter to the Editor
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AAPM Newsletter the AAPM – the Science Council, the Education Council, and the Professional Council. [A new council, the Administrative Council, was created in 2009 and is under development now.] New initiatives and continuing activities from the Councils and their committees/ subcommittees/task groups are brought to the Board either directly or via the budgeting process. In addition, the BOD can directly create new initiatives. Recent multi-year initiatives, which have been discussed in prior issues of the newsletter, include the 2012/2014 initiative and the licensure initiative. At our last BOD meeting, a workforce assessment plan was approved. While the AAPM is thriving and currently economically surviving, it is not sheltered from the current economy. In years past, even though we started the year with a deficit budget, we ended the year without the need to use our investment reserves, mainly due to the success of various AAPM activities (such as our annual meeting and leading Medical Physics journal), increasing membership, admirable and ambitious [but not totally spent] planning by our member volunteers, and a healthy investment track. In addition, in the past, because of our reserves, the BOD felt that the AAPM could commence multi-year initiatives that it deemed necessary for its members. However, as of our last BOD meeting, due to the markets, our reserves had been reduced by approximately 25% [$9.4M to $7M]. Thus, a major point of discussion at our last BOD meeting centered on our 2009 budget. In addition, as we all feel the economic crunch at our own institutions, our volunteer time may be affected. Thus, we can use this time to discuss and reassess our priorities as a growing and effective organization in a time of economical stress. Please email me, or any of
January/February 2009 the BOD members, your concerns, ideas, and/or suggestions. The continued success of the AAPM depends on its volunteers. Many of my past President-Elect columns in this newsletter encouraged members to join various committees/ subcommittees/task groups and become/continue to be involved. Volunteer time is extremely precious, especially in our current economy. I have always been impressed with the enthusiasm of members and the exciting plans of the various volunteers. While it is impossible to quantify the immense amount of volunteer effort, one estimation is to assess the budgeted expenses of volunteer activities, e.g., use of committee conference calls and meetings, task reports, etc. Over the past five years, approximately 55% to 85% of the volunteer plans have conducted! Such dedication by its member volunteers ensures the continued success of the AAPM.
Committee, which I chair, also includes Dianna Cody, Mary Fox, and Robert Gould. We will be composing a slate for President-Elect, Treasurer, and Board members. Please feel free to email any of us your thoughts and suggestions. During my presidential year, I plan to support the various initiatives of my predecessors and the BOD. In addition, I hope to increase the role of AAPM in medical physics research via interactions between members and with funding institutions such as the NIH. Also, I want to assess our responsibility to the public and our website presence in this electronic age. In closing, as we start this new year, please remember to email me [firstname.lastname@example.org] with any suggestions, concerns, and/or thoughts. Happy New Year.
One of the immediate functions of a new President is to work with the Nominating Committee to develop the slate of candidates for election in 2009 and service commencing in 2010. The 2009 Nominating
AAPM Medical Physics Residency Workshop “Organization and Completion of CAMPEP Self Study” February 6-7, 2009 Hyatt Regency Dallas/Fort Worth (DFW) http://www.aapm.org/meetings/ResTrainingWkshp.asp
AAPM President-Electâ€™s Column
Michael G. Herman Mayo Clinic
n my first column as President Elect, I would like to thank you for providing me the opportunity and the honor of serving on the Executive Committee with the leadership of the AAPM. Two-Thousand-Eight was a year of change and challenge. We saw the world economy destabilize, we saw a new United States president elected and we saw a near deficit actual budget for AAPM. Having become accustomed to excellent investment returns, large annual meeting surplus and underbudget-spending, many of us felt uncomfortable as we deliberated the 2009 AAPM budget. To make things more difficult, the AAPM took on major initiatives over the past few years to strengthen the scientific, educational and professional activities of the association and our profession. Finally we failed to support a dues increase, further constraining our flexibility. We must continue to take the necessary steps to meet the challenges of the profession of medical physics. We stand united as physicists in medicine providing the highest quality and safety in patient care through research and development, direct clinical service, and educational activities. The activities of the
three councils of the AAPM are complementary in support of medical physicists who develop new basic and applied science, which is translated into clinic practice for direct improvements in the quality of patient care. Specific medical physics education is required to develop and maintain knowledge and skills for clinical practice and research. Guidelines and standards recognized by legal and regulatory authorities must be maintained so properly trained and qualified individuals perform the duties of a medical physicist, throughout the profession. We will continue to work toward increased accountability and quality as we meet the ABR 2012/2014 challenge. Our JMPLSC is developing mechanisms to allow every state to clearly define the qualified medical physicist. Our steps toward national consistency will lead to productively engaged medical physicists contributing to
increased quality of patient care with reduced errors. In order for medical physics to continue to thrive in clinical practice, the fundamental and applied research and development that creates the technology and procedures must be supported. We have to do all of this in a determined and fiscally responsible manner. This means that the most effective use of all resources is critical. Toward this end, I am charged with appointing committee members who will begin service in 2010. The AAPM functions as well as it does because of all the time and energy that all of you put into it and our coordination with an excellent headquarters staff. An active membership is essential for the AAPM to continue to provide services in support of the medical physicist in research, education and clinical practice. I look forward to working with all of you and I welcome your input.
AAPM Summer School Clinical Dosimetry Measurements in Radiotherapy Colorado College â€˘ June 21-25, 2009 http://www.aapm.org/meetings/09SS/
Clinical dosimetry for radiotherapy covers the most important task in clinical medical physics: getting the dose measured correctly in brachytherapy, external beam therapy and IMRT. Topics include fundamentals, protocols, all forms of instrumentation, and standards. Registration opens March 11.
Chairman of the Board’s Column parking lot, and then eventually to the street with those of us who (somewhat prematurely) looked forward to the life of status and freedom that would open to us with a driver’s license. His often shouted mantra was not, however, timorous. “He who hesitates is lost!”
Gerald A. White Colorado Springs, CO
was not a particularly stellar student in High School. (Likewise for my undergraduate experience, but that story is for another column). I had the good fortune to have a constant stream of gifted teachers whose spirit and wisdom I carry with me to this day. I am convinced I received much of that which they taught, but, on reflection, am also aware that I was not particularly successful at convincing them of that fact. In a column for a physics newsletter I should probably offer some reminiscence of Brother Gregory Brendan (Mathematics and Philosophy) or Brother Fidelian (Chemistry and Physics). Today, however, I’m thinking about my Driver’s Ed teacher, not known for his grounding in academic rigor, and always to be addressed by his first name, which was “Coach”. There was quite a bit of a classroom component to the course, disliked equally by teacher and student. But the meat of the learning process was the in-car portion (lab experience, to place it in a science context). Coach had a duplicate brake pedal but no steering wheel on the passenger side of the car, and so it required no small amount of courage and confidence to cruise through the High School
So, then, as I think about so many scientific, literary, historical and philosophical perspectives from my High School career, as I assume the Chair of the Board Gavel from Mary Martel, I am also taken by the imperative of Driver’s Ed. “He who hesitates is lost.” Where are we driving as an Association? Are we cruising in the parking lot or on the highway? Foot on the brake or GPS route finder fully engaged? I think ahead to the next Board of Directors meeting, nearly 40 folks in a room together for a few hours, but grounded in the professional, scientific, educational, political and economic climate of the Country outside of the meeting space. We’ll find ourselves in a time of economic turmoil in the U.S. Certainly this pervasive spirit cannot avoid casting a shadow over the governance of the AAPM as it shadows all of our thoughts. The uncertainty over the direction and rate of the changes in the healthcare system in the country, both in mode of delivery and financing also raises the anxiety level. We’ll find ourselves in a health care policy debate unprecedented since the controversial dawn of the Blue Cross/Blue Shield system or the acrimonious struggle that preceded the creation of Medicare. We’ll find ourselves in the midst of a new national appreciation of the value of Science and Scientists as the new administration appoints serious men and women of Science
to the cabinet and other high level posts. We’ll also find ourselves in collegial cooperation and competition with our sister societies as we all offer educational opportunities to our members and the profession at large. How will AAPM engage these challenges and circumstances? It’s my hope that we will drop the shift into a forward gear and create a mélange of providence and opportunity. Although we look at the current state of affairs surrounding us with anxiety, I am convinced that history will judge this time as a turning point, a time when we traded fear and paralytic caution for vision, a path forward and an allocation of resources to build, to create and to embrace what I think is inevitable serendipity. This may seem like the time to hold back, to retrench or to mark time. In fact, it is not. Within the Association we’ll undoubtedly see spirited debate on our plans for the near and long term future. Let’s hope that we can gain the organizational and governance skills we need to take us further down the road, get Coach to take his foot off that second brake pedal and let us feel the wind in our hair. During the last year we have spoken of “Preparing for the future”. Well, this is the future we have prepared for, let’s embrace it.
Past Chairwoman of the Board’s Column survey validation by an outside expert company. These special efforts add extra expenditures to the budget, but in my opinion, it is money well spent.
Mary K. Martel UT MD Anderson Cancer Center
AAPM Board Meeting at RSNA 2008
ne of the most important tasks of the Board at the endof-year board meeting is to discuss and approve the budget for the organization for the following year. In a nutshell, the process to develop the budget is a nearly never-ending one during the year, and starts at committee level, including at the tier of task group and work group level. The budget passes through the Council Chairs’ hands, then through the budget subcommittee, with the final recommendation for a budget by the Finance Committee to the Board. Obviously, the final budget undergoes an enormous amount of scrutiny by a diverse lot of people. While the budget covers the cost of running our HQ, it also includes the work of the Councils, and “special” projects that the Board has sanctioned over the past several years. Such recent projects include initiatives to: boost medical physics residency/ training slots in preparation for year 2012/2014 ABR criteria changes, explore licensure in preparation for passage of the CARE bill (among other reasons), and supply the AAPM with a workforce model and salary
Normally there is total or near total agreement on approval of the budget; however, this year the budget passed by the narrowest of margins (1 vote by yours truly). The close vote was perhaps due to a number of reasons, but namely the collision of the “usual” deficit budget, the “extra” expenditures as above, and the current sad state of the economy. The close vote has precipitated a scrutiny of the budget process and a possible overhaul of how the budget is thought about and presented. While philosophical discussions on initiatives voted on by present and previous Boards are
always welcome, it is unfortunate that it was the last face-to-face board meeting of the year when a budget needs to be settled within the month. The Executive Committee along with the Council Chairs has embarked on analysis of the budget process, and I am confident that improvements will be forthcoming soon. I would like to thank for one more time the Board parliamentarian, Jerry Allison, for his invaluable and expert guidance that he gave a very novice Chairwoman of the Board over the last year. And I trust that Jerry White, the soon-to-be Chairman of the Board, will lead the 2009 Board with his usual extraordinary wit and wisdom, which unfortunately I will miss out on. Good luck to the 2009 Board; enjoy your time as the three years go by very fast!
On behalf of the American Institute of Physics’ Corporate Associates, AAPM members are invited to attend the 2009 Industrial Physics Forum (IPF). For each of the past 51 years, this forum has brought together industry, academic, and government leaders to examine applications of scientific research to emerging industrial R&D activities. This year’s IPF is themed, “Frontiers in Quantitative Imaging for Cancer Detection and Treatment” and will be held in conjunction with the 51st Annual Meeting of the American Association of Physicists in Medicine (AAPM) on July 26-30, 2009 in Anaheim, CA. Embedded into the AAPM Scientific Program, the IPF sessions will be on Monday and Tuesday, July 27-28. There will be a welcoming reception on Sunday evening, July 26. During each IPF, a special session is dedicated to Frontiers in Physics, addressing the most exciting research going on today, regardless of field. In Anaheim, there will a speakers on next-generation DNA sequencers, on opto-genetics for brain imaging, and on how accelerator and particle physics enable some of the latest medical applications.
Editor’s Column from advertisements and requesting that anyone submitting articles to the newsletter to keep the articles short and concise so as to help keep the page count of each issue to a minimum. I would like to remind everyone once again of this request.
Mahadevappa Mahesh Johns Hopkins University
wish you all a very happy and healthy new year. One of my wishes for the New Year has already come true. I wished for AAPM to continue the support for the print edition of this newsletter. As I mentioned in my last column the newsletter’s parent committee had made a recommendation to the budget subcommittee to discontinuing the printing of the newsletter. My letter of appeal and the opportunity to present my case to the AAPM budget subcommittee was fruitful in restoring the original budget. In fact for the immediate future, the print edition will continue to be mailed to the AAPM membership. In one of my columns last year, I had outlined the steps that I was taking to lower the overall cost of producing the AAPM Newsletter in hard copy. Those steps have included changing the paper that the Newsletter is printed on to a more economical type of paper and switching the actual mailing of the Newsletter from first class to standard. Both of these changes have been well received by the membership and have significantly reduced the overall cost of the Newsletter. More recent steps that I have taken to lower the cost of the Newsletter are greater efforts to increase revenue
Finally, I would like to comment on why this issue is arriving in the middle of January. I made the decision to extend the submission deadline until after the AAPM Board of Directors met during the Radiological Society of North America (RSNA) meeting
and provided a longer period of time for our regular contributors to submit their columns while finishing their holiday shopping. Talking about the RSNA meeting, as usual it continues to be one of the larger medical meetings. Even though there was a slight decrease (~5%), it was barely noticeable with halls beaming with attendees trying to reach far-out places as the meeting space and technical exhibits were expanded. I wish all of you a very happy and productive New Year.
Nowonline……. Selected presentations given at the:
2008 50th AAPM Annual Meeting Houston, TX July 27-31
2008 AAPM Summer School “The Physics and Applications of PET/CT Imaging with optional Hands-On Sessions covering Scanner Testing” Accreditation and Shielding Calculations Saturday, June 28th Baylor College of Medicine Houston, TX June 25-27
2008 AAPM Workshop "Becoming a Better Teacher of Medical Physics" League City, TX July 31 – August 3 “Radiation Dose and Quality Control for SPECT/CT and PET/CT Clinical Studies” Presented at the CRCPD Annual Meeting Greensboro, NC
2008 Physicists of Note Interviews Houston, TX
Xoft, Inc. - AAPM Corporate Affiliate as presented during the 2008 AAPM Annual MeetingAAPM Presentations posted in the Virtual Library include……
x x x
Streaming audio of the speakers Transcription of the audio presentations Slides of the presentations
Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs. http://www.aapm.org/meetings/virtual_library/
AAPM Executive Director’s Column Chapter of which you are already a member!
Angela R. Keyser College Park, MD AAPM E-News APM is now sending out html electronic news called the AAPM E-News every three weeks. This new means of communication began late in 2007, with the goal to provide news stories and links of interest to the medical physicist, as well as important announcements from the AAPM. We hope that you will see value in this new method of communication with the AAPM membership. If you have information that you would like to include or comments about the new program, please send to 2009.enews@aapm. org .
2009 Dues Payments 2009 renewal notices were sent in October and November, with payments due by March 1. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on “Pay Your 2009 Dues Online.” Remember, you can pay Chapter dues with your AAPM dues for any
The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301-209-3396. Meeting News The 2009 Summer School will be held June 21 – 25, at Colorado College. The program entitled “Clinical Dosimetry Measurements in Radiotherapy” is organized by Program Directors David W.O. Rogers and Joanna Cygler. Registration will open on March 11. Summer School Scholarships are available, with an application deadline of February 20. Make note to register by May 13 to take advantage of the discounted registration fees. The 51st AAPM Annual Meeting will be held July 26 - 30 at the Anaheim Convention Center, 800 West Katella Avenue in Anaheim, California. The abstract system will open in early January, with the submission deadline of March 4. Heading the program development efforts are Imaging Scientific Program Director Sabee Molloi, with Andrew Karellas serving as Imaging Co-Director. Paul Keall is Therapy Scientific Program Director, with Dan Low serving as Co-Director. The Education Program is headed up by Imaging Education Program Director Ron Price and Therapy
Education Program Director Indrin Chetty and Co-Director Robin Stern. Professional Program CoDirectors are Chris Serago and Doug Pfeiffer. Meeting information is continually updated online, with the full program scheduled to be posted by May 14. Please go to www.aapm. org and click on “Meetings” for the latest information. The online registration process is scheduled to open on March 18, with discounted registration until June 10. Consider Participating in AAPM’s Summer Fellowship Programs Please consider participation as a mentor in AAPM’s Summer Undergraduate Fellowship Program (SUFP) or Minority Undergraduate Summer Experience Program (MUSE). The SUFP is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a stipend from the AAPM. Both student and mentor applications are due by February 2. For details, go to: http://www.aapm. org/education/sufp/ The MUSE program is designed to expose minority undergraduate university students to the field of medical physics by performing
AAPM Newsletter research or assisting with clinical service at a U.S. institutions (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 nonMinority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For details, go to: http://www.aapm. org/education/muse/ . The deadline for applications is February 6. Funding Opportunities Make sure to check out the funding opportunities online at aapm.org: • Applications are being accepted until January 15 for the RSNA/AAPM 2009 Fellowship for Graduate Study in Medical Physics. Go to http://www.aapm.org/education/ RFGSMP/ for more details. • The 2009 – 2001 AAPM Support for Clinical Residency in Imaging consists of a $36,000 award to one institution for support of a clinical residency in imaging physics. The application deadline is February 3. Details online at: http://www.aapm. org/education/ClinicalResidency/ • The 2009 Research Seed Funding Initiative provides start-up funds for research-oriented medical physicists. Two $25,000, one-year awards will be made in 2009. For details, go to: http://www.aapm.org/education/ ResearchSeed/ . Deadline for receipt of applications is February 16.
January/February 2009 AAPM HQ service!
Along with the continued growth in the Annual Meeting, the number of AAPM sponsored meetings continues to increase, with each of the councils holding additional meetings throughout the year. As we see the availability of the volunteer hour shrinking, many non-technical, program-related tasks previously handled by volunteers are now migrating to the HQ team. While all the members of the AAPM HQ team play an important role in the meetings and programs processes, the major responsibilities are handled by the Meetings and Programs Department. Lisa Rose Sullivan joined the staff in November 1993 as Projects Coordinator. She was one of the original five Maryland staff members hired when the AAPM HQ offices relocated from NY to College Park, Maryland. Lisa was promoted to Exhibits and Scientific Program Manager in 1998 and then to Director, Meetings and Programs in 2005 in acknowledgement of her increased responsibility in the meetings and programs area. Lisa oversees the meetings and programs operations and the provision of services to ACMP and CAMPEP.
Nancy Vazquez joined the HQ team as the 6th staff person back in 1996, serving as the Receptionist. She was promoted to Programs Manager in 1998 and took on the responsibility of managing the registration processes for the various AAPM-managed meetings. In 2007, the production of the AAPM newsletter was brought in house, with Nancy working directly with Editor Mahesh to produce the bi-monthly publication. Nancy is also the staff liaison to the Awards and Honors Committee and plans the yearly Awards and Honors Ceremony and Reception. Karen MacFarland, AAPM’s Meetings Manager, joined AAPM in 2003. Karen handles the meeting negotiations and logistics for many of the association meetings that are scheduled throughout the year, including the Annual Meeting and the Summer School. Corbi Foster joined the team at the end of 2007 as Meetings and Programs Manager, serving as the staff lead on American College of Medical Physics (ACMP) activities. In 2009 Corbi will manage the meeting logistics for other association meetings throughout the year, including council meetings and the Review Courses. When she started in 2001, Hadijah Robertson Kagolo was AAPM’s Programs Assistant. In 2006 her title
• For information about the 2009 ASTRO/AAPM Radiation Oncology Physics Residency Training Grant, go to: http://www.aapm.org/ education/roprtg/ . This joint program was established to facilitate the development of radiation oncology physics residencies across the United States and Canada. The deadline for applications is June 15. AAPM Meetings Department (top L - R) - Karen MacFarland, Corbi Foster, Nancy Vazquez (bottom L - R) - Laurie Hayden, Hadijah Robertson Kagolo, Jackie Ogburn & Lisa Rose Sullivan
AAPM Newsletter was changed to Meetings Assistant, to better reflect her increasing responsibilities with the AAPM Annual Meeting. Hadijah serves as the go-to person for the meeting exhibits processes. She also provides support for the Online Placement Service. Laurie Hayden joined the team early in 2007 as the Customer Service Representative. Later that
same year, she was promoted to the newly created position of Programs Assistant, providing assistance with the meeting program development and abstract submission processes. When Laurie was promoted in 2007, Jackie Ogburn was hired to fill our Customer Service Representative position. In 2008, Jackie was promoted to the newly created position of Education Assistant.
January/February 2009 She is the main point of contact for questions regarding CAMPEP and AAPM grants and funding opportunities. Jackie also provides support for the Online Continuing Education and Virtual Library elearning programs. Coming next issue….group profile of the AAPM Information Services team.
Legislative & Regulatory Affairs
Lynne Fairobent College Park, MD NRC Releases SECY-08-0184 Strategy for CsCl Sources
n December 10th the NRC made publically available the staff ’s paper detailing their recommendations to the Commissioners regarding the future of Cesium Chloride (CsCl) sources. The Nuclear Regulatory Commission staff has recommended a continued emphasis on improving the security of cesium chloride radiation sources instead of replacing or banning them, citing their beneficial uses in medicine and industry and the lack of effective alternatives at the present time. This paper reflects in part the information and recommendations obtained during the public workshops on CsCl and comments received in response the Request for Comments
on the Security and Continued Use of Cesium-137 Chloride Sources and Notice of Public Meeting; NRC-2008-0419] [See 73 FR 44780 (July 31, 2008) and 73 FR 5580 (September 26, 2008).
a technical basis for rulemaking. This option initiates a path forward toward further enhancing security of CsCl and resolving the impediments identified by the stakeholders.
The staff paper, “Strategy for the Security and Use of Cesium-137 Chloride Sources” (SECY-080184) and the Advisory Committee on Medical Use of Isotopes (ACMUI) report on cesium chloride irradiators, are available on the NRC Web site at this address: http://www.nrc.gov/reading-rm/ doc-collections/commission/ secys/2008/ or through the NRC’s ADAMS online document system using access code ML0830400770.
The staff would continue to work with domestic and international partners to respond to a changing risk environment as well as to promote technological developments. Under this option, the Commission would issue a Policy Statement to delineate the Commission’s emphasis on security for CsCl sources, and specify the Commission’s vision for future developments in the safe and secure use of CsCl sources. The Policy Statement would reflect the Commission’s desire to facilitate additional actions aimed at reducing the risk of CsCl and work toward solutions to challenges which need to be addressed in order to support a potential phase out. In addition, NRC would conduct, in cooperation with Federal, State, and international partners, a number of specific actions to continuously assess and enhance the security program, including protective strategies, evaluation and response to threats, and encouragement of technological developments for alternative forms of CsCl.
There are 3 options for the Commissioners to consider and the staff recommended Option 1 which follows: Option 1. Enhance security and issue a Commission Policy Statement under Option 1, both the fundamental elements of security and the normalcy of CsCl use in all three modes of application (i.e., blood irradiation, bio-medical research, and calibration) are maintained. This option recognizes that significant impediments exist to any potential phase out of CsCl and that there is insufficient information available to develop
Specific actions to be conducted by
AAPM Newsletter the NRC staff to enhance security: • Assess implementation of voluntary hardening program for blood and research irradiators and consider making it a requirement for existing devices through rulemaking. • Attain industry consensus for new blood irradiators to be delivered with hardening. There are two vendors of blood irradiators in the U.S. A limited number of new units are ordered each year. Both vendors have expressed intent informally to harden new units. Thus, a consensus can be realistically achieved. • Work with NNSA and DNDO on potential hardening (to increase delay) for CsCl calibrators and assess potential security enhancements. • Continue to monitor the threat environment and issue new security requirements as may be necessitated by emerging risks. • Assess whether additional requirements are needed (e.g. tamper-proofing) through the ongoing enhanced security rulemaking process. Consider using this rulemaking to seek stakeholder input on strategies to mitigate the insider threat. • Interact with IAEA and other international partners to promote and enhance CsCl security. • Engage Federal partners in the (a) the development of a common Federal agency set of criteria for dispersibility and other material properties as it relates to mitigating the consequences of an RDD, and (b) anticipatory research for less soluble/dispersible forms of Cs-137, preceded by risk and cost-benefit analyses for reducing consequences from the current use of CsCl. • Develop a strategy for endof-life management of CsCl sources. The staff would develop a Commission Policy Statement that would address the following issues:
January/February 2009 • Articulate current security requirements and processes for performance evaluation, monitoring, and improvement. This would re-emphasize for the public the current state of security requirements. • Articulate the Commission’s role in ensuring public health and safety and promoting common defense and security for radioactive materials under NRC jurisdiction. • Articulate the uses of CsCl. • Articulate why alternative forms would be desired. • Encourage active development of alternative forms. • Articulate the role and need for continued involvement from Federal partners and stakeholders in security enhancements and technology development to reduce the risks of high activity CsCl sources. • Define the role of risk and cost/benefit in regulatory decision making. The implementation period for Option 1 is relatively short. Some of the actions can be started immediately, such as for the security of the largest sources and additional actions continuing for two years for remaining high risks CsCl sources. All actions, except long term research, under NRC lead could be completed within two years. Advantages of Option 1: • Prompt actions, security activities are consistent with current NRC program planning. • No impact on blood irradiation practices. • Uninterrupted continuity of bio-medical research. • Adherence to current calibration practices. • Low cost impact to government and licensees. • Consistent with the majority of stakeholder feedback.
• Policy Statement would provide clear articulation of the Commission’s policy. • Could spur the development of alternative forms/technologies by industry. • Would solicit further stakeholder input for additional technical information and solutions to current impediment. • Would allow continued active stakeholder input. • Would engage Federal partners in the (a) the development of a common Federal agency set of criteria for dispersibility and other material properties as it relates to mitigating the consequences of an RDD, and (b) anticipatory research for less soluble/dispersible forms of Cs-137 that includes a cost-benefit analysis of reducing consequences from the current use of CsCl. Disadvantages of Option 1: • The current form of CsCl would not be changed. • No apparent economic incentive for private industry to develop alternative chemical forms of CsCl. • The actions taken are not in full in accordance with some report recommendations (e.g. NA report). AAPM will continue to monitor this issue and once the Commissioners vote on the staff recommendations will make the result available to members. Thank you to all who provided responses to the AAPM survey on the use of CsCl sources as this information was critical in providing information to the NRC and is reflect in AAPM’s comments and the report of the ACMUI. AAPM’s comments can be found at: http://www.aapm.org/government_ affairs/documents/AAPM_final_ comments_CsCl_10-15-08.pdf
Education Council Report Melissa Martin will be the incoming vice-chair of the council, and will be a valuable resource to the Council by way of her significant knowledge of the inner workings, long standing experience, and commitments to the AAPM.
J. Anthony Seibert Education Council Chair Change….. he buzz word of the 2008 presidential campaign is also reverberating in the AAPM and the Education Council…… a new chair, an upcoming deadline pertinent to recent medical physics graduates and experienced physicists who have not yet applied for board certification, educational reform in the curriculum, and new directions in teaching.
A new council chair. I am very honored and excited to serve as the next Education Council chair for the AAPM, look to tackle the challenges ahead and make progress to the benefit of the association and its members. I am also very appreciative of the active and progressive leadership that Herb Mower has provided over the last six years, and recognize that these are very big shoes to fill in terms of all he has done for the Council in particular, and the AAPM in general. There are significant efforts necessary to maintain the momentum and inertia, and I look to you, the membership, to assist by providing feedback and suggestions to the Education Council and its committees, subcommittees, and task groups to keep things moving forward and providing content and services that you request and need.
2012 – 2014 Initiatives. The council is actively preparing for the 2012 initiative, which will require significant changes in the current infrastructure of training and residency programs in medical physics. To that end, there has been financial support provided for several workshops and demonstration projects for non-CAMPEP accredited academic program directors to assist in self study and completion of the CAMPEP process. Other initiatives include funding for demonstration of a “Distributed Residency” program. These and other programs jointly pursued with the Professional Council and Excom are to promote the increase in the number of certified Medical Physics Residency Programs. A two day workshop directed by John Bayouth, accompanied by seven other well-known medical physicist faculty is planned in early February in Texas; information can be found at http://www.aapm. org/meetings/ResTrainingWkshp. asp. This is the beginning of many events that will focus on meeting the challenges of 2012 – 2014, with many more updates in the coming year. The updated diagnostic radiology resident physics curriculum is nearly complete, thanks to the tremendous effort of Phil Heintz and the subcommittee who have worked very diligently to finalize the document. Comments at the recent
RSNA meeting indicated the need for a “reduced scope” outline for diagnostic radiology resident training curriculum, due to the length and breadth of the current document. The committee has decided to create a two-tiered approach, with a section on the minimum material a radiology resident should know about physics, as well as the full outline including learning objectives, clinical applications and clinical problem solving that fellows and radiologists should know in terms of “lifelong” learning. The final document is to be submitted in the spring of 2009. Becoming a Better Teacher of Medical Physics, a workshop initiated and organized by Bill Hendee and Herb Mower at the end of the 2008 annual meeting in Houston, will continue as part of the 2009 annual meeting in Anaheim. A two hour focus session designed and organized by Bill will recap the extraordinary information presented at the first workshop. Included are the ideas that were generated as a result of interactive discussion amongst the participants, where we are today in terms of “how and what” to teach, and a glimpse of the 2010 summer school curriculum that will expand the ideas and practical methods that can make us more innovative teachers and better learners. These efforts are focused on the recognition that there is little or no attention given to this important subject in the training or residency programs for medical physicists. By attending the 2008 symposium I was very impressed with the syllabus and excellent outside speakers who provided the attendees with a perspective on teaching that we have been sorely lacking, and learned many ways in which I can become a more effective teacher. The Education and Training of Medical Physicists
Committee, chaired by George Starkshall, will be taking an active role in this effort as well. For those who were not able to attend the 2008 workshop and are interested in becoming a better teacher of Medical Physics, I strongly recommend that you plan on attending the special session at the 2009 Annual Meeting to see and hear the buzz, which will also serve as the gateway to the 2010 summer school. Bill has been working closely with the American Association of Physics Teachers and has developed many contacts from which a wealth of expertise and insight on teaching can be recruited. Many thanks go to both Bill and Herb on their past, present, and future contributions to this worthwhile effort. Education Council directives for 2009 There are many other ongoing activities within the council, which will be the subject of future newsletter articles. Please feel free to contact me to discuss the abovementioned topics or other educational issues that are important to you. In closing, I wish to thank all of the members of the Education Council, its committees and task groups for their contributions of time, knowledge and effort, and I sincerely look forward to continued progress in the coming years.
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Innovations in Medical Physics Education • Call for Submissions The Education Council of the AAPM is sponsoring a symposium to honor and publicize innovations in Medical Physics Education. AAPM members are invited to submit a one page description of innovative medical physics educational activities for radiology residents, radiation oncology residents, medical physicists, technologists or others. The projects can be scientific research, novel teaching strategies – team teaching or adult learning efforts, novel educational materials – lectures, websites, or other innovations. The top six submissions will be invited to present their projects at the symposium during the 2009 AAPM annual meeting in Anaheim, CA. Each speaker will be allocated 15 minutes. The top project will be presented a plaque. Additional honorable mention plaques may be awarded. Unfortunately no travel support is available. The deadline for submissions is February 28, 2009. Selected submissions will be notified by March 15, 2009.
Professional Council Report
Michael Mills Professional Council Vice-Chair
am sure by now that many of you know the medical physics community suffered a tragedy in Mumbai. Sam Jeswani, PhD, served as Director of Customer Relations for TomoTherapy, and was traveling on business in India when the attack occurred. Sam was one of 6 US citizens that perished in the attack. I knew Sam as one of my closest personal contacts within the TomoTherapy organization. Sam was a true gentleman in every sense of the word. He was gifted with a sensibility and compassion that is rare in any community. My dealings with Sam were always marked with sensitivity and understanding, and I always looked forward to seeing him at the various professional venues. My thoughts and wishes for comfort go out to TomoTherapy, Samâ€™s family and friends, and all others, like myself, who find their lives were encouraged because Sam was there as a colleague and friend. He will be missed. As most of us realize, the 2012/2014 initiative is bringing a sense of rapid change to our profession. Regrettably, we have only a little knowledge about the demand and supply of therapy physicists, and even less knowledge respecting diagnostic and nuclear
medicine physicists. The AAPM Board of Directors met at the RSNA to discuss a contract with the New York Center for Health Workforce Studies of the University at Albany (State University of New York). The purpose of the contract is to address the current complexity of medical physics with respect to our training programs and pathway to board certification. In addition, there will be an estimation of demand and supply for all the subspecialties of medical physics. Finally, one component will serve to validate the AAPM Professional Information Survey. The work would be scheduled and budgeted over two years in order to minimize the impact of this project on the AAPM overall budget. As this project has been a Board priority for a number of years, the Board of Directors supported the project for 2009 and 2010. The Medical Physicist Workforce Subcommittee, Ned Sternick, Chair, will be directing the Workforce Survey. It will be important for all stakeholders to be recognized and all impact factors to be evaluated and included in the final scope of work. The Workforce Survey may reveal challenges and changes within the profession consequent to transformation in regulatory, technological and reimbursement patterns. All of these factors will be important to evaluate in order to predict workforce dynamics and provide for the future education and training of medical physicists. The Survey Validation Component will be directed by the Survey Validation Subcommittee, which is a peer to the Medical Physicist Workforce Subcommittee. The
Survey Validation Subcommittee is currently without a chair. Another item for discussion by the Board concerned the ongoing efforts and focus of the Joint Medical Physics Licensure Subcommittee. Conceptually, the Board supported the view that the JMPLSC served a larger vision than licensure per se. Rather, the JMPLSC efforts are focused toward properly preparing the profession to assist regulators and legislators to define educational and credentialing standards for medical physicists. Specific requirements will include completion of a CAMPEP approved residency program, ABR Board Certification, and licensure in those states that require it. As this represents a critical ongoing effort central to the professional interests of medical physics, the Board elected to continue previously committed levels of support for the JMPLSC. There was a fall retreat of the JMPLSC to develop a plan to introduce a professional medical physics licensure bill in 5 states. The selected states are Massachusetts, Michigan, Missouri, Ohio and Pennsylvania. These states were selected based on membership density, legislative relationships, regulatory agency relationships, state radiological society relationships, and member willingness to serve on a state committee. This is a first step in a national effort that has as a goal to have licensure or registration for medical physicists in all 50 states and territories. As of the writing of this article, there is still no action for the Congress on the CARE Bill. Although some remain optimistic there may yet be action on this before the end of this Congressional session, it now
appears more likely the CARE Bill will need to be reintroduced with the new Congress in January. Please see the articles by Wendy Smith and Lynne Fairobent for other issues of importance within the Professional Council. Of particular interest is the significant reduction in payment for the new high dose rate (HDR) brachytherapy procedure codes mentioned in Wendyâ€™s column. Members and corporate affiliates can look forward to receiving a hard copy of the AAPM Code of Ethics in early 2009. Please review and save for future reference.
The American Society of Radiologic Technologists would like to encourage AAPM Members to review their list of meetings and consider submitting an abstract. For additional information and abstract submission guidelines, please visit: https://www.asrt.org/applications/ GeneralOnlineAbstracts/StartAbstractEntry.aspx
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In 2008, the most significant deviation from budget occurred due to delayed implementation of the Councils and Committees planned activities. In particular, the Board’s initiative for licensure, and the 2012-2014 initiative to increase CAMPEP-accredited residencies. Delayed Committee activities resulted in approximately $750,000 of the variance. Both the Annual Meeting and the Medical Physics
Journal netted a slightly higher than budgeted revenue. The Journal had higher than budgeted advertising and subscription income, while the Annual Meeting generated higher registration and exhibit revenue. Once again, all of the Executive Committee’s discretionary funds were not spent, which resulted in about $65,000 as a positive variance from budget.
s of mid-December 2008 we anticipate that income and expenses from operations will be at a break-even point. While the 2008 budget as approved by the Board of Directors included a significant deficit, we estimate this deficit will not materialize. As is illustrated in Table l, a number of categories of expenses are significantly below the amounts budgeted. While we do not specifically budget for gains and/or losses on our reserves, we are required through Generally Accepted Accounting Policies to include these in our financial statements. In the past several years we have been fortunate in that unrealized gains have added to the reported total income for the year. The same will not true for 2008. Our investments have been negatively affected by the decline in the stock market in 2008. At the time of this writing, our losses are $2.6 million. Figure 1 is an historical representation of the Society’s reserve position.
Hopefully, in the interval between writing this article and its publication, we will see an improvement in the value of these assets. AAPM’s Investment Advisory Committee, Chaired by Mark Bruels, is carefully monitoring the situation.
January/February 2009 Table 2 - 2008 Comparison of Estimated Revenue & Expense with Budget
2009 Budget First, I want to extend my thanks to the various councils, committees, task groups, and working groups for submitting their budget requests by the appropriate deadlines. The first draft of the 2009 budget contained a deficit of almost $2 million. Therefore, each line item was scrutinized and reviewed extensively by members of the Budget Subcommittee and Council Chairs last October. Along with me, the subcommittee members and attendees included Sherry Connors, Bruce Curran, Robert Dahl, Maryellen Giger, Mike Herman, and Melissa Martin. Angela Keyser (Executive Director) Lisa Rose Sullivan (Director, Meetings and Programs), Lynne Fairobent (Manager, Legislative & Regulatory Affairs), Cecilia Hunter (Director, Finance and Administration) and her staff from the headquarters office made substantial contributions to this effort. We also had substantial participation from the Council Chairs, and from our 2008 President, Jerry White, which made the Subcommittee’s job much easier. I am grateful to all of them for their hard work in putting this budget together. Funding for the two new major initiatives begun last year was continued in the 2009 budget. These projects include a Professional Council/Joint Medical Physics Licensure Subcommittee effort for state licensure for medical physicists in
response to the anticipated passage of the CARE Bill in Congress. The licensure effort required the addition 1.5 FTE to headquarters staff in 2008. In addition to these indirect costs, direct expenses for this effort in 2009 are budgeted at $344,000. The second project, entitled the “2012 Initiative”, is the Association’s response to the ABR’s additional education and training requirements for members to qualify to sit for their certification exam. The 2012 Initiative includes $137,500 to increase support for emerging CAMPEP-accredited residency programs in 2009. The 2009 budget also includes a new two-year project approved by the Board of Directors in November, to hire a professional firm to conduct a formal assessment of medical physics manpower needs and an independent salary survey. The cost of this project in 2009 is $113,550. The 2009 Operating Budget, as approved, reflects a deficit of $1,326,431, which includes projected revenue of $7.5 million and projected expense of $8.8 million. Table 2 shows the complete budget by program area. Figure 2 is a comparison of the actual results from 2007; the estimated actual and budgets for 2008; and approved 2009 budgeted revenue and expenses.
Graphs of the sources of revenue and expense for 2009 are shown on the following page as Figures 3 and 4. Highlights of the 2009 budget are as follows: Sources of Revenue for 2009 • Membership income is expected to provide $1.5 million, or approximately 20% of anticipated income. • The Placement Service generates just about $300,000, which is 4% of the total. • Our Annual Meeting, scheduled for Anaheim in 2009, is budgeted to generate $2.5 million, and together with a large therapy Summer School will account for approximately 42% of the total. • The publication of our scientific journal, Medical Physics, also provides a significant income stream. In 2009, Journal revenue is expected to total $2.0 million, representing 27% of total revenue. Sources of Major Expenses for 2009 • Requests for project funding from the councils and committees for 2008 include the following: – Education Council -- $843,500, which includes funding for the 2012 Initiative; – Professional Council -- $1.4 million, which includes the licensure effort
AAPM Newsletter – Science Council -- $563,500; and Other Committee activities -$252,000 – Support for member inquiries and requests, as well as maintenance of our web presence, accounts for just under $500,000. – Organizational and governance expenditures are will total $395,000 in 2009. – Expenditures for our professional development activities, including the Annual Meeting, Summer School and participation in RSNA, are budgeted to total $2.0 million in 2009. – Medical Physics expenses will total $1.33 million next year. – Administrative expenses include legal services, insurance, auditing, credit card merchant fees, and HR services provided by AIP. These will total approximately $1.2 million in 2009. – Other miscellaneous categories of expenses include management services provided to sister organizations, membership dues for AAPM to participate in other societies, contributions to support programs of other societies, and
other miscellaneous expenses. In 2009, these expenses will take about 3% of the overall budget. There is considerable concern that it may be necessary to curtail some of our very worthwhile activities in 2009 due to the planned deficit. Coupled with the significant loss in
our reserve fund and the failure of the vote to increase dues, the Association is not in a favorable position to sustain all of the planned programs. Unlike the 2008 budget, which the Board felt could be supported by withdrawals from our reserves, the expected financial climate in 2009 requires us to re-evaluate our financial health frequently during the year and to adjust fund allocations accordingly. The Finance and Investment Advisory Committees are keeping a close watch on revenue streams and investments and will advise the Board of Directors as necessary. The next scheduled Board meeting is March 21, 2009, at which time I will provide an update of our finances to the Board of Directors. Please email any questions, concerns or comments concerning the budget to me at firstname.lastname@example.org.
AAPM Website Editor Report
Christopher Marshall NYU Medical Center With the RSNA meeting behind us we are focusing on website issues for 2009. Prior to the RSNA we acted on a suggestion from a member of the Website Editorial Board and brought all links to RSNA and related AAPM activities together on one page and included a brief statement about the relationship between the AAPM and the RSNA. We will continue with that practice in 2009. We still have a few legacy issues from 2008 including the long-promised video of an interview with our Charter Members from the summer meeting: a direct link to this will appear on the home page in December and remain there through January 2009. After that you can access it through the AAPM/History and Heritage link. The rest of my comments are directed to AAPM committee members. As announced by email, the IS group added a Wiki tool to help each committee do its work. You can access this tool from the top of your committee listing in the committee tree, next to the links to the committee website and to the committee group email tools. Further information about the use of the Wiki tool is available on the Wiki Main Page: http://wiki.aapm.org/ (but please log
in to the website before using this link.) You can also access the Wiki Main Page from your Committee Wiki by selecting Main Page from the left menu. Once on the Wiki Main Page you are encouraged to add to the discussion of the Wiki. Click on “Discussion” to view comments made to date, and click on the “[+]” symbol next to “Discussion” to add your own feedback. This approach will be much more effective than sending an email to me or to your preferred contact in the IS group because it will allow us all to work collaboratively to refine this great new tool. You can currently add to the website content using your Committee FTP folder, the traditional Committee Website (accessed through a content management tool), the new Wiki tool and also through BBS discussions. It will become difficult to keep track of committee activities if your materials are scattered over these entities, so some “rules of the road” are in order. The EMCC spent time on this issue at the RSNA meeting and this should result in formal policies. Until these are approved I strongly urge you to follow these interim guidelines: 1. Committee websites are not intended as an alternative to the main AAPM website for publishing content or links to programs to the membership or beyond. If you need to do this, please contact me. 2. Make someone on your committee responsible for oversight of your website content and have them report at your meetings. 3. Use whatever tools work best for you purpose, but consider creating links to content that has been generated using your other website tools.
4. Restrict content to the members of your own committee except when you need to have others review it. The content management system and the Wiki tools allow you to toggle access permissions. 5. Post all your committee minutes on your traditional Committee Website but toggle permissions so that they can be read by all the membership (except for any Executive Session minutes). I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/ WebsiteEditor/3401.asp
AAPM Summer School Tuition Scholarships and Grants Scholarships in the form of waiver of tuition for the AAPM 2009 Summer School are being offered for applicants who are early in their careers in medical physics. In addition to the above, two $500 grants to assist with other expenses related to the AAPM Summer School are being sponsored by Capintec, Inc. www.aapm.org/09SS
Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs ACR Stereotactic Breast Biopsy Accreditation: Frequently Asked Questions for Medical Physicists Does your facility need help on applying for stereotactic breast biopsy accreditation? Do you have a question about the ACR Stereotactic Breast Biopsy QC Manual? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation,” then “Stereotactic Breast Biopsy.” Most of the stereotactic breast biopsy accreditation application and QC forms are available for downloading. You can also call the Diagnostic Modality Accreditation Information Line at (800) 227-0145. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists. Q. We recently replaced the detector on our stereo unit. The state requires us to notify them within 60 days of a replacement part on the stereo unit. Do we need to notify the ACR as well as the state? A: No. We do not require you to notify us when you replace a part on a stereo unit. Q. Our facility has a mammography unit with an addon stereotactic biopsy device. Should we shoot the phantom the same way we usually do for the mammography unit?
A. No. In order to expose the phantom, you must set up the equipment with the stereotactic biopsy device in place. Please refer to the Testing Instructions.
A. Yes. However, do not cover the center portion of the dosimeter with tape. Using 2 small pieces of tape, only tape the ends of the dosimeter to the phantom.
Q. We have a prone stereotactic breast biopsy table. May we tape the phantom to the breast support when we produce the images for image quality evaluation?
Q. I shot the phantom image with the dosimeter as described in the Testing Instructions. Should I submit this image to ACR even though the test objects are obscured by the dosimeter?
A. Yes. However, be careful not to cover the test objects with the tape. Q. We have a prone stereotactic breast biopsy table. May we tape the dosimeter to the phantom so it does not fall off during exposure?
A. Yes. One phantom image with the dosimeter and one (or more) phantom images without the dosimeter are required for accreditation. It is normal for the test objects to be covered by the dosimeter.
Mark your calendar! The American College of Medical Physics Annual Meeting will be held May 2-5, 2009 Virginia Beach, Virginia On-line Registration and Hotel reservations will be available in January. For more information go to: www.acmp.org
Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant 2009 CPT Code Changes
ffective January 1, 2009 there will be 3 new CPT codes to report for high dose rate (HDR) brachytherapy procedures based on the number of channels: CPT 77785 ( 1 channel); 77786 (2-12 channels); and 77787 (over 12 channels). The 2008 HDR brachytherapy codes (77781-77784) were based on the number of source positions or catheters. For a list of all relevant new, revised and deleted CPT codes for 2009 go to: http://www.aapm.org/government_ affairs/CMS/documents/ 2009CPTCodeChanges.pdf Medicare Publishes 2009 Payments & Policies for Freestanding Cancer Centers The Centers for Medicare & Medicaid Services (CMS) recently published the 2009 Physician Fee Schedule final rule, which effects payments to physicians and freestanding cancer centers. The 2009 conversion factor is $36.0666, a 5.3% reduction from the 2008 conversion factor due to provisions in the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Other key final rule decisions include: • Significant 2009 payment reductions to new high dose rate (HDR) brachytherapy procedure codes 77785-77787 for freestanding centers. • Continued reductions to medical physics codes 77336 & 77370 under the new “bottom-up” practice expense methodology. • Continued increases to medical physics intensive IMRT planning code
77301 under the new “bottom-up” practice expense methodology. • Medicare carrier-pricing for stereotactic radiosurgery code 77371, commonly known as “Gamma Knife.” Effective January 1st, Medicare will not assign relative value units (RVUs) for this procedure. Each jurisdictional Medicare carrier will determine a payment rate for 77371 in 2009. • CMS did not adopt their proposal to require all physicians that provide diagnostic imaging services to enroll as an Independent Diagnostic Testing Facility (IDTF). For a complete summary of the 2009 final rule go to: http:// w w w. a a p m . o r g / g o ve r n m e n t _ affairs/CMS/documents/ 2009PhysicianFeeFinalSummary. pdf For a list of 2009 radiation oncology payments & impacts go to: http:// w w w. a a p m . o r g / g o ve r n m e n t _ affairs/CMS/documents/ 09PhysicianFeeSummaryTable.pdf Changes to the Medicare Hospital Outpatient Prospective Payment System in 2009 The Centers for Medicare & Medicaid Services (CMS) recently published the 2009 Hospital Outpatient Prospective Payment System (HOPPS) final rule, which effects payments to hospital outpatient departments. HOPPS 2009 payments are based on hospital claims data from CY 2007. Stereotactic radiosurgery, proton beam therapy and brachytherapy procedures will be subject to decreased payments in 2009. All other radiation oncology procedures will realize payment increases (see table 1).
CMS will continue the current 2008 policy of packaging image guidance procedures in 2009. This policy impacts CPT codes 76950, 76965, 77011, 77014 and 77421. There is no separate payment for image guided radiation therapy in 2009 as these payments are packaged into the primary procedure. It is extremely important that hospitals report all HCPCS codes and all charges for all services they furnish, whether payment for the services are separately paid or packaged. Other key provisions in the final rule include: • New APC group assignment for placement of interstitial device codes 55876 & C9728 that results in a 360% increase in 2009 payment. • Continuation of composite APC 8001 for LDR prostate brachytherapy. • New composite APCs for multiple imaging services (ultrasound, CT/CTA & MRI/MRA). • Changes to the “bypass list” to include the costs of packaging image guidance codes. • Continued brachytherapy source payments based on hospital charges adjusted to cost. • 2.0% reduction in 2010 payments for hospitals that do report data on 11 quality measures in 2009, including 4 new imaging efficiency measures. For a complete summary of the 2009 final rule go to: http:// w w w. a a p m . o r g / g o v e r n m e n t _ affairs/CMS/documents/ HOPPS2009FinalSummary.pdf For a list of 2009 radiation oncology payments & impacts go to: http://aapm.org/government_ affairs/CMS/documents/ HOPPS2009FinalSummaryTable.pdf
(Table 1) 2009 Radiation Oncology APC Payments
APC reassignment for 2009 are highlighted in bold
IGRT Hospital Coding Alert Hospital outpatient departments are strongly encouraged to continue to report charges for all image guidance (e.g., 76000, 76001, 76950, 76965, 77011, 77014, 77417, 77421) and image processing services (e.g., 76376, 76377) regardless of whether the service is paid separately or packaged, using correct CPT codes. Medical Physicists should check with their department or hospital billing staff to ensure that they are aware of the need to report these charges. The goal is to continue to capture the costs of the packaged image guidance services utilized in radiation therapy procedures in the hospital data used to develop future APC payment rates.
Licensure Initiative Update JMPLSC Chooses National Firm Pathway for Licensure Initiative by Jeffrey P. Limmer, Chairman, Joint Medical Physics Licensure Subcommittee and Amanda Potter, AAPM State Legislative and Regulatory Affairs Specialist
fter the Joint Medical Physics Licensure Subcommittee’s (JMPLSC) meeting in October, some issues were raised that prompted AAPM headquarter staff to seek legal counsel. In the process of answering these issues, AAPM’s counsel, Bevan, Mosca, Giuditta & Zarillo (Bevan) noted that they had a robust government affairs arm in their firm and at that time expressed an interest in talking to the JMPLSC and AAPM staff regarding representing AAPM and ACMP in their licensure efforts. The week before Thanksgiving, Bevan gave a presentation and answered JMPLSC member’s questions on how a single government relations firm can handle lobbying in multiple states. After that presentation, the JMPLSC decided to look further into the possibility of changing how the licensure bills would be lobbied in the five identified state legislatures. On a conference call December 9, 2008, the JMPLSC voted unanimously to pursue lobbying efforts in the licensure initiative through a national government relations firm rather than continue pursuing individual lobbyists for each state. It is anticipated that there will be a cost difference between engaging a national firm like Bevan and the cost of running a five state initiative with individual lobbyists in the range of $100, 000. It should also be noted that with a national firm engaged,
the AAPM staff time will be more effectively used since there will be one primary point of contact to manage, instead of five separate relationships. Another positive attribute for using a national firm is that a national firm could make it easier to expand into other states as they can utilize additional contacts in other states. There is also more flexibility to shift focus and lobbying efforts to other states if one or more states currently being pursued prove to not be favorable to licensure at this time. The previously established deadline to have lobbyists signed to their contracts by the end of the year will be modified to accommodate a Request for Proposal (RFP) process. Additional national government relations firms will be invited to the RFP process for this initiative for a minimum of three firms for comparison purposes. Bill introduction deadlines will have to be taken into account as the new deadline is established to ensure that the deadlines for return on the
RFP do not hinder the ability to have the licensure bill introduced in any state in the 2009 legislative sessions. The next steps are for the AAPM’s headquarters staff to draft an RFP to circulate to the JMPLSC for review and to identify additional firms to send the RFP. At this time, all states will cease to individually interview the lobbyists recommended by Stateside Associates and a letter from the JMPLSC Chairman and the State Captain will be drafted to send to each of the lobbyists on the list. The purpose of the letter is to explain to the lobbyists identified the decision about the pathway the JMPLSC wishes to pursue and to preserve the relationship if a subcontracted lobbyist in a particular state is needed. Tentatively, all RFPs should be submitted and a decision made by the end of January. If you have any questions regarding the recent JMPLSC decision or the licensure initiative in general, please contact the JMPLSC’s Chairman, Jeff Limmer (Jeffl@aspirus.org) or AAPM’s Amanda Potter (Amanda@ aapm.org).
S Save the Date...The AAPM Science Council is proud to announce A Symposium on the Promises and Perils of Proton Radiotherapy May 8 - 9, 2009 • Baltimore, MD
Proton facilities are rapidly proliferating in the United States. This AAPM Science Council Symposium will address issues such as; current clinical practice and machinery, future developments in delivery and planning, and operational startup and ongoing costs. Controversies related to planning and treatment uncertainties, the question of clinical trials, and biological questions such as RBE and secondary neutrons, will also be presented. Program Chairs: Jatinder Palta, PhD, University of Florida, Eric E. Klein, PhD, Washington University and Christopher Rose, MD, Valley Radiotherapy Associates Medical Group
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International Scientific Exchange Course Report International Symposium on Advances in Diagnostic Imaging Physics May 4-7, 2008 Algiers (Algeria) by Habib Zaidi Geneva, Switzerland
he International Symposium on Advances in Diagnostic Imaging Physics was held in May 4 – 7; 2008 in Algiers (Algeria). This workshop is internationally recognized as the International Scientific Exchange Program (ISEP) funded by the American Association of Physicists in Medicine (AAPM), with additional financial support provided by the International Organization of Medical Physics (IOMP), the Nuclear Research Center of Algeria and local sponsors. The ISEP Course is organized annually by the AAPM in different developing countries. This is the first time it was held in Algeria. The attendance comprised professional medical physicists, medical imaging and nuclear medicine physicians, radiation oncologists, technologists involved in diagnostic imaging, biomedical engineers, and university professors from physics departments interested in medical physics. The purposes were two fold: one was to create an opportunity for the medical physicists, bio-medical engineers, and physicians from Algeria, and other countries to gather together and to learn from each other’s experiences. The other was to promote clinical medical physics as a profession and to foster closer collaboration between physicians and academicians in Algeria. The workshop was intended for professionals where renewed faculty specialized in diagnostic imaging, PET/CT, molecular imaging, radiation
oncology, medical informatics, and radiation physics presented their experience in didactic settings, so as to maximize the learning experience for the participants of the workshop, to inspire further collaborative research and developments within Algeria and internationally, and to improve the quality of patient care through closer involvement of medical physicists. This course included lectures and workshops on various aspects of the applications of physics in medicine, emphasizing diag-nostic imaging techniques and radiation treatment of cancer. The AAPM faculty included Profs. Adel Mustafa (New York Medical College, New York, USA; workshop director), Mahadevappa Mahesh (Johns Hopkins University School of Medicine, Baltimore, USA), John Boone and Anthony Seibert both from the University of California Davis (CA, USA) and Habib Zaidi (Geneva University Hospital, Geneva, Switzerland). Additional lectures were given by local faculty. A small industrial show took place nearby the auditorium. After the opening of the meeting by the local supervisor, Dr A. Mellah, Director of the Nuclear Research Centre of Algiers and representatives from the ministries of Health and Energy, respectively, the meeting started with an opening lecture by Prof. B. Mansouri head of the Algerian
national medical imaging program. This was followed by series of basic and advanced lectures dealing with all aspects of diagnostic imaging physics and instrumentation and their application in radiation therapy. The full scientific program can be consulted on the workshop web site. After 4 inspiring days, the course came to a close on Wednesday May 7, 2008; leaving behind some remarkable teachings and countless wonderful memories. The organizing committee did an excellent job from looking after accommodation for participants coming from outside the capital and from nearby countries to lunches, online English to French translation, etc. The educational program was remarkably executed, as witnessed by all participants. The conference drew some of the widely known experts in diagnostic imaging physics and it was no surprise that the lectures delivered were of great quality. All invited speakers for delivering brilliant lectures and providing plenty of valuable handouts. ISEP 2008 would not have been at all if it weren’t for all individual participants and representatives of external organizations, with special thanks extended to the main promoters of AAPM workshops (AAPM and IOMP) and the local host (Nuclear Research Center, Algiers) in addition to all local sponsors.
Photograph showing AAPM faculty: Professors Mustafa Adel, Habib Zaidi, Mahadevappa Mahesh, John Boone and Anthony Seibert with local organizers from Algeria.
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Sustainability and The Medical Physicist Sustainability and The Medical Physicist by Nicole T. Ranger, M.Sc. The trouble with our times is that the future is not what it used to be - Paul Valéry, French poet, essayist and philosopher
he Association for the Advancement of Sustainability in Higher Education (AASHE) Biennial Expo and Conference was held November 9-11 in Raleigh, NC and I was fortunate to be able to participate as a volunteer and attendee. If one follows news reports and public policy, it is clear that sustainability is, to quote a colleague, a “hip and happening” topic. But what is sustainability? In its broadest sociological context, sustainability can be defined as living (individuals) or operating (institutions) in a manner in which the consumption of natural resources occurs at a rate at which they can be replenished, so that the needs of the current generation are met without compromising the needs of future generations. Whether we are speaking of energy, food or other consumables, it is clear that we as a society have been living and continue to live in an unsustainable manner and if we maintain the current status quo, we will soon reach a critical point. The reasons are varied and include: exploding worldwide population levels, decreasing availability of natural resources (not the least of which are food and water), negative impacts on the environment and biodiversity as a result of man-made pollution and the potentially devastating effects of unchecked global warming. What does sustainability have to do with health care ? The answer is,
a lot. In 1996, a global initiative entitled Heath Care Without Harm (HCWH) was launched shortly after the EPA announced that the incineration of medical waste was a leading source of dioxin pollution. HCWH’s mission: “To transform the health care sector worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment”. What are some of the things that we as medical physicists can do to help our institutions implement sustainability initiatives ? • Join your hospital sustainability committee if one exists and if one doesn’t suggest that one be formed. • Lobby your administration to commit to green building practices that are compliant with the US Green Building Council’s LEED (Leadership in Energy and Environmental Design) certification standards. • Establish policices to ensure that (when safe) medical devices that are not in use are turned off and not consuming power unnecessarily. • Ensure that decomissioned equipment and devices are disposed of appropriately using reputable companies that will
ensure the equipment is reused (in under-resourced areas), repurposed (upgraded when possible to extend the useful life cycle), or recycled (for parts), and that they do not end up in a land-fill. • Recommend the purchase of electricity originating from alternative energy technologies that do not pollute the environment and contribute to global warming. What can the AAPM and affiliated organizations do ? • Work with the manufacturing sector to promote the design of more energy-efficient medical devices. • Promote a dialogue and information sharing between medical physicists (and other interested 3rd parties) regarding sustainability initiatives underway at their facilities. Medical physicists can and should take an active role in promoting sustainability, to not do so would be to miss an opportunity to be proactive, rather than reactive in addressing these important public policy issues. It is not only the right thing to do, it also increases the visibility and status of the medical physics profession within our respective spheres. The time to act is now, because, to quote Paul Valery, The best way to make our dreams come true is to wake up.
2009 AAPM Grant and Fellowship Offerings Research Seed Grant • Support for Clinical Residency in Imaging Medical Physics Grant • ASTRO/AAPM Radiation Oncology Physics Residency Training Grant • The Fellowship for the training of a doctoral candidate in the field of Medical Physics • The AAPM Summer Undergraduate Fellowship • The AAPM Minority Undergraduate Summer Experience (MUSE) Information and applications are available at: http://www.aapm.org/education
AAPM FOREM Meetings By Daniel Low, Ph.D. Washington University
he Science Council of the AAPM has developed a mechanism for researchers to organize small, focused scientific meetings. While the AAPM annual meeting offers an opportunity for a broad array of scientific discussions and topics, the Science Council believes that there is a need for independent meetings that allow in-depth discussions of narrowly-focused scientific subjects. These meetings will be hosted by one or more AAPM scientists and will typically involve 20-40 participants. The precise format of the meetings will be up to the organizer. Any member of the AAPM will be entitled to be an organizer of a FOREM meeting, but the Science Council decided to organize the first two meetings, to gain an understanding of the organizational challenges and costs of the FOREM meetings. The topic of the first FOREM meeting was the conformal irradiation of small animals (Small Animal Konformal Irradiation). The format of the meeting was by invitation to allow participation by the groups that were most active
in the development of the new field of small-animal conformal irradiation. The goal of the meeting was to have each group understand the general design challenges and proposed applications of this new technology. The meeting was scheduled for 1 ½ days, May 1 and 2, 2008 at Washington University at a lecture facility located within the Medical Center. Participants were from Washington University, Princess Margaret Hospital, Johns Hopkins, Stanford, the University of Wisconsin, the University of Toronto, and the University of Western Ontario. We learned too late that the University of North Carolina and the University of Arkansas were also developing small animal irradiators, so representatives from their groups did not attend. Karen MacFarland and Cecilia Hunter of the AAPM assisted with the logistical planning of the conference. The first day started with each group that has been involved in designing and fabricating a small animal conformal irradiator presenting technical details and operational characteristics of their unit. Next, representatives from most of
SAKI FOREM conference attendees.
the groups presented example radiobiological projects that involve the use of conformal small animal radiation. We had a nice conference dinner between the two meeting days, and the second day started with discussions on the dose distribution calculations, treatment planning, and dose verification. There was then a discussion on the integration of functional imaging with conformal small animal irradiation. Finally, we discussed how to extend the conference initiative into the future and it was decided that the best way to proceed was to begin a task group on “Small Animal Image-Guided Irradiation”, SAIGI) for which Patricia Lindsay was drafted as chair (thanks Patricia!). Regarding organizing the meeting, the main lesson learned was that I should have delegated more of the organizational responsibilities to local staff and/or students. Thankfully Karen and Cecilia were there to help! Overall, the first FOREM meeting went very well. AAPM support was excellent and the Science Council hopes that this format will help scientists organize more small scientific meetings that meet the AAPM science council goals.
Person in the News
arlos de Almeida, Ph D, a Fellow Member of the AAPM, and a practicing Medical Physicist in Rio De Janeiro, Brazil, has been recently awarded the Gold Medal of the Society of Radiation Oncologists of Brazil. Dr. Almeida received his Ph D, under Dr. Peter Almond, at the University
of Texas / MD Anderson Cancer Center in 1979. He is a Diplomat of both the ABR and ABMP. During the last three decades he has had a distinguished career in Brazil as a professional Medical Physicist, an educator and a scientist. He is an internationally recognized Medical Physicist and has participated actively in several organizations, namely AAPM, IOMP, IAEA, WHO and PAHO.
own international members has been recognized with this Gold Medal. Congratulations, Carlos !! by Nagalingam Suntharalingam, Ph.D.
Dr. Almeida has received national merit awards in recognition of his outstanding services in promoting Medical Physics in Latin America, and particularly in Brazil. AAPM is very proud that one of its
Letter to the Editor Connections with Physics Teachers This letter was submitted by Dr. William R. Hendee regarding his meeting with the officers of the American Association of Physics Teachers. In early November 2008, I attended the quadrennial meeting of Sigma Pi Sigma, the Physics Honor Society, held at FermiLab near Chicago. This gave me an opportunity to meet with Sigma Pi Sigma officers and with Warren Hein, Executive Officer of the American Association of Physics Teachers and Lila Adair, President of the AAPT. We agreed that it would be highly desirable to develop a working relationship between the AAPT and the AAPM, so that we can encourage physics students to consider careers in medical physics, as well as benefit from the experience of dedicated physics teachers in improving our own abilities as teachers. As you know,
the latter topic was the purpose of the 3-day AAPM workshop held in August after the Houston annual meeting.
All of the contact information for the AAPT section officers, including phone numbers and e-mail addresses, is available on this website.
One way to move this relationship forward could occur at the AAPM chapter level. Chapters could encourage participation in their meetings by physics teachers and students from colleges and universities in the regions served by the chapters. Among the more stimulating talks at the August workshop were those by physics teachers who were not members of the AAPM â€“ they were able to give us very insightful guidance in ways to teach successfully. This could occur as well at the chapter level by adding a physics teacher or two to chapter programs.
I hope you will follow-up on my suggestion of contacting regional AAPT sections as you plan chapter activities for the next year. If you do, I would appreciate your letting me know what you are doing. It would be nice to have a couple of successes that we could use as demonstration models for other chapters.
There are 47 regional sections of the AAPT, and they overlap very nicely http://www.aapt.org/Sections/ findsections.cfm
by William R. Hendee, Ph.D.
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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: email@example.com phone: (301) 209-3390
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