AAPM Newsletter May/June 2009 Vol. 34 No. 3

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 34 NO. 3

MAY/JUNE 2009

AAPM President’s Column

Maryellen Giger University of Chicago Updates on the 2012/2014 Initiative

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ince I last communicated to you via the AAPM newsletter much has progressed within the AAPM on a variety of topics – all related to various aspects of the mission of the AAPM. A major realization that has been noted at various AAPM meetings, workshops, etc, is that we need to better communicate to our members, and especially our students – OUR FUTURE MEDICAL PHYSICISTS. Thus, I decided to devote my column to the 2012/2014 Initiative.

Please recall that the motivation that led to the 2012/2014 ABR requirements for graduate education and clinical training is that patients deserve to be treated in practices/ hospitals/medical centers with appropriately trained clinical medical physicists. And such training should include physics fundamentals, didactic teachings in medical physics, and clinical training, along with acknowledgement of such knowledge via board certification.

AAPM held its second 2012 Summit on February 27-28, 2009 in Chicago. Participants from AAPM, ABR, ACMP, ACR, and CAMPEP worked together to review the status of our training programs and to determine remaining tasks relative to meeting the requirements of the 2012/2014 mandates. The meetings included update presentations, panel discussions, breakout sessions, and determination of next steps.

After Jerry White and I opened the meeting, Michael Herman reported on AAPM 2012/2014 actions and expenditures. Recall that the AAPM Board of Directors had voted to fund the 2012/2014 initiative over multiple years, including the summits as well as writing workshops for residency program directors to help in the completion of CAMPEP applications. I present a summary of the summit here with various comments and estimates.

Geoff Ibbott reviewed the ABR requirements and presented statistics on passing rates on the various board exams, demonstrating the benefit of being trained in a CAMPEP-accredited program. George Sherouse presented workforce projections estimating that perhaps 200-250 new qualified medical physicists may be needed each year. In order to better determine this need, AAPM has contracted with the Center for Health Workforce Studies at SUNY for a two-year study.

James Dobbins presented statistics on degree programs, noting that

there are now 20 CAMPEP-accredited degree programs, and 32 nonCAMPEP programs. As of February 2009, he estimates that there were 636 graduate students (254 per year; roughly 1/3 Ph.D. and 2/3 M.S.), although not all will chose a clinical medical physics career. He also reported on SDAMPP – the Society of Directors of Academic Medical Physics Programs – which is a new society for both graduate and residency program directors. It appears that we will potentially have sufficient numbers of graduating students from CAMPEP academic programs to meet the 2012 mandate.

Bruce Gerbi gave an update on residency programs. There are currently 27 CAMPEP accredited residency programs (24 therapy and 3 imagTABLE OF CONTENTS Chair of the Board Column President-Elect’s Column Editor’s Column Executive Director’s Column Science Council Report Education Council Report Professional Council Report Awards & Honors Website Editor’s Report Leg. & Reg. Affairs Health Policy/Economics ACR Accreditation Chapter Update

p. 3 p. 4 p. 6 p. 7 p. 9 p. 11 p. 12 p. 14 p. 16 p. 17 p. 19 p. 21 p. 23

JMPLSC Update

p. 25 p. 27

Memorial

AAPM Newsletter ing). Thirteen more are currently in the review process (12 therapy and 1 imaging). In addition, he mentioned that there may be 41 potentially more programs, 25 programs that attended the AAPM residency workshop on completing the CAMPEP applications (22 therapy and 3 imaging) and 16 additional ones that have been in contact with CAMPEP. So potentially there will be a total of 74 therapy and 7 imaging medical physics residency programs yielding approximately 90 therapy and 8 imaging trained medical physics per year. While this is still far from the estimated 200-250 new QMPs (qualified medical physicists) needed per year, it does indicate that tremendous progress has been made in this past year. Other methods of increasing this number of clinically– trained medical physicists included professional doctorate of medical physics programs (PDMP) and hub & spoke models of medical physics residencies.

John Hazle reviewed CAMPEP indicating that the CAMPEP review process can take 6-12 months, and thus CAMPEP is looking to increase the number of program reviewers. He also noted documentation will become an increasingly important aspect of the accreditation process as we approach 2012/2014. This is especially relevant to hub & spoke residencies in which a trainee may travel between different medical physics practices during their residency.

After the various presentations, a panel discussion was held including short presentations and many Q & As. Janelle Molloy presented on clinically-oriented M.S. training programs, James Zagzebski presented on Ph.D. training programs in which some students seek a clinical medical physics career and others focus more on research careers, Ehsan Samei presented preliminary results from an ongoing survey on degree programs

May/June 2009 (Ph.D., M.S., and PDMP), Charles Coffey described the components of a PDMP and how it might help the limited residency slots situation, Bruce Gerbi presented challenges of traditional residencies, and Michael Herman discussed distributed (hub & spoke) residencies. In addition, three trainees – Jennifer O’Daniel, Shannon Holmes, and Adam Riegel gave invaluable perspectives.

Discussions during this panel encouraged increased emphasis on differentiation between CAMPEP- and non-CAMPEP accredited programs, with panelists noting the potential extra time needed in residency for those from non-CAMPEP accredited programs. The importance of residency was reinforced again when some noted that students came to their medical physics practice without any clinical experience. Others noted challenges to traditional residencies including insufficient funding and the need for a 2:1 mentor to resident ratio. Many community hospitals or private practices are currently training medical physics unofficially OTJ (on the job). Thus, discussion centered on methods to convert these “training” positions to residencies.

The comments from the current trainees on the panel emphasized the need to better inform current students, noting that students do not really understand the implications of the 2012/2014 mandates. New students enrolling now need to be informed in order to understand if they will be able to satisfy the 2012/2014 requirements, and what will it mean not to have ABR certification. In addition, further clarification of the motivation and components of the PDMP was requested, especially as compared to a M.S. followed by a residency. However, the trainees were encouraged by the increasing number of residency slots.

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After the various presentations and discussions, participants rotated through three breakout areas to develop solutions and consider consequences (in the near future, in ten years, etc). The three breakout areas were Residency (with John Bayouth as leader), Degree Programs (with James Zagzebski as leader), and ABR/Accreditation (with Geoff Ibbott as leader). After these sessions, a task list was compiled and followed by a consensus discussion. Some of the plans are summarized in the following paragraphs.

In response to the critical need to inform current and future students, as well as program directors, AAPM will increase its outreach via multiple means such as letters, a website hot button with FAQs, and a dedicated session at the AAPM annual meeting in Anaheim. AAPM will interact with CAMPEP to create a registry of residency programs, as well as describe the impact of the ABR eligibility requirements, particularly as related to students in non-CAMPEP accredited programs.

A major topic of discussion and planning centered about the differentiation between graduate programs and clinical residences. Statements distinguishing graduate programs and residency programs with respect to clinical exposure/experience will be composed clarifying that clinical components during graduate training do not apply towards residency, but rather that clinical exposure in a graduate program is there to enhance the didactic learning component. In addition, AAPM, in coordination with SDAMPP and CAMPEP, will seek to formalize the didactic component of CAMPEP graduate programs that must be a prerequisite for residency programs; basically for graduates who come to a CAMPEP residency with a degree from a non-CAMPEP graduate program (such as a someone, for

AAPM Newsletter example, with a Ph.D. or M.S. in high-energy physics). Such didactic training might be obtained via a “certificate” program within a CAMPEPaccredited program. In addition, the progress of programs offering the PDMP will be monitored in order to better understand their future role.

Another major set of tasks focused on increasing the number of CAMPEP-accredited residency programs.

AAPM will identify and contact residency programs that might be able to increase the number of residency slots with assistance in funding and/ or administration, as well as large consulting/private practice groups that might be able and willing to incorporate distributed residencies. In

addition, case studies of successful hub & spoke residencies will be made available to other institutions.

Web-based software will be developed/implemented for documenting resident progression through distributed residency rotations.

Also, a feasibility study will be conducted regarding holding a MATCH for residency programs and coordinating the start times of residencies.

I hope through this newsletter article, the reader has gained a greater appreciation of the actions needed to meet the 2012/2014 deadlines.

Please help disseminate this information. AAPM is compiling infor-

May/June 2009 mation for trainees that will be posted on the website as well as noted in the next issue of this newsletter.

AAPM Student Meeting Sunday, July 27 9:30 am - 11:00 am Anaheim Convention Ctr Room 213 This is an opportunity for students to meet other students, enjoy a free breakfast, and learn about issues important to students of medical physics.

AAPM Chairman of the Board’s Column

Gerald A. White Colorado Springs, CO

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number of years ago I had the opportunity to visit the Radiation Oncology center in Windhoek, Namibia. My wife and I were, at the time, visiting our daughter who was at a research station in the Namib Desert working on water resource issues. The Cancer Center was located just a few blocks from the guesthouse where we were staying and I gave in to the temptation to take a bit of a busman’s holiday and see if they would entertain a visitor.

I wasn’t sure what to expect at what

was the only Radiation Therapy center in the country, at the time one of the youngest nations in the world. What I found was a very gracious Radiation Oncologist who was willing to take time from what was (by looking at the waiting room) a busy day to offer a view of the clinic to a foreigner who walked in off the street. There was a modern Cobalt-60 machine (the first modern one I had ever seen, my experience being limited to the Picker systems and AECL Eldorado 8 and Theratron 80.) A very active HDR unit, (again, not familiar to me as we were still trying to convince our hospital administration that HDR was an important piece of the cancer therapy armamentarium) and several shelves full of thermoplastic masks (and those made me feel right at home).

The most impressive part of the center was, however, just down the street. A large, well appointed residence for patients who had travelled there for cancer therapy had been created, with

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housekeeper, cook, common areas and private rooms. Nice touch, I thought. Essential part of the cancer care process, I was told. Without this bit of almost unseen infrastructure, the technology in the Cancer Center would have been inaccessible to a large proportion of the population.

I’m pleased to say that, at our clinic, we now have an HDR unit (also very busy) and a new, large guesthouse with a host but as a concession to American Individualism, separate microwave ovens in each room.

Over the years I have reflected on that visit, finding in it relevance to all sorts of subsequent experiences.

Today I’m thinking about the importance of infrastructure, of the importance of what may seem like an amenity but really is an essential.

As Chairman of the Board, I have an unusual vantage point; I can see some (but only a fraction) of the flow of the dynamic AAPM volunteer infrastructure.

Plowing through the paper equivalent of reams of email on AAPM activities, business,

AAPM Newsletter

May/June 2009

problems and opportunities, it’s often a challenge to focus on the importance of being attentive to that infrastructure when overshadowed by the demands of the clinic. But if I think about these connections, they abound. This week I’ll send an ionization chamber off to an ADCL for calibration and have heard from the Calibration Laboratory Accreditation Subcommittee as they work through some current issues regarding the accreditation process.

I’m anticipating a new HDR source in our clinic shortly, and have just reviewed some correspondence from the High Energy Brachytherapy Dosimetry Working Group as they communicate expected standards for source calibration and dosimetry prerequisites for inclusion of HDR sources on the Source Registry maintained by the AAPM. We’ll treat 3-4 HDR patients this week and I’ve seen the

work of the Professional Economics Committee as they meet with other professional societies and CMS to remedy the recent undervaluation of the HDR treatment codes. I could go on. Each of these clinical activities directly related to care in our facility has a tie to an underlying and often unseen activity, removed from our clinic in space and time, some part of the AAPM infrastructure of over 250 committees and workgroups that provides support, guidance, and vision for our work with patients.

Unseen, but vital was a theme of our visit to Namibia. We spent several days in a small research station, Gobabeb, on the bank of the Quiseb River. It is a dry place, with about 2 cm of annual rainfall.

As is universal in the country, the Quiseb is an ephemeral river, dry

and sandy without a drop of water for nearly the entire year. But once a year it rains in the central highlands about 400 miles away. This unseen deluge fills the Quiseb with water and for a few days or sometimes weeks, it flows a meter deep, replenishing the aquifers and providing the infrastructure for life along its banks for the coming year.

Each time I or one of my colleagues performs a clinical task we have the unseen support of AAPM volunteers who have set out the infrastructure, from miles away and time past. Thank you who those who have done that, thank you to those who do it today and thank you to those who will do it tomorrow. It is this preparation that has brought us the scientific and professional strength we enjoy in the present and carry with us into the future.

AAPM President-Elect’s Column that the AAPM Board of Directors took to establish fundamental and consistent definitions for individuals to be recognized as qualified clinical medical physicists throughout the United States.

Michael G. Herman Mayo Clinic Patient Care and the Medical Physics Licensure Initiative

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n this issue I would like to address the concerted effort of the Joint Medical Physics Licensure Subcommittee (JMPLSC). Similar to the 2012/2014 initiative to bring about standardized clinical training for medical physicists who practice in the clinic (addressed in my March-April column and by President Giger in this issue) the licensure initiative is a visionary step

The committee is exploring viable mechanisms to bring about a national standard where anyone who practices clinical medical physics in any of our sub-disciplines will meet or exceed recognized minimum qualifications.

Board certification in the discipline of practice represents that minimum.

This combined with the 2014 requirement that accredited clinical training is required prior to sitting for the American Board of Radiology Physics exams, establishes the consistent quality level for individuals entering the practice of clinical medical physics. However, to ensure that the work of medical physicists is done by qualified individuals for the best interest of the patient, there must

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be a mechanism by which regulators (employers and patients) can identify a qualified individual is doing the work.

One mechanism for doing this is through licensure. This is the process whereby a government agency grants permission to an individual to engage in a given occupation upon finding that the applicant has met predetermined qualifications and has attained the minimal degree of competence necessary to insure that public health, safety, and welfare will be reasonably protected. Carrying this out in all states would establish a minimum qualification and competence nation wide. Licensure is a mechanism used widely and successfully in medicine and other professions. It holds legal recourse if license conditions are not maintained.

The 21 member JMPLSC has been meeting consistently and developing the tools and infrastructure to bring about a national standard for recognizing medical physicists that meet the

AAPM Newsletter standards described above. To be a national standard means being able to influence every state in the country to adopt the same robust qualification and competency expectation for admitting individuals to practice medical physics. While the CARE bills could pass and mandate at the national level that every state recognize the minimum qualifications for those involved in radiographic and radiation therapy procedures, communication of the specific definitions with each state legislative or regulatory body will still have to be made for the federal legislation to be carried out consistently.

Even without the CARE act, the need to establish this standard remains paramount for consistent quality and patient care. The JMPLSC is moving forward developing the skill and tool sets to communicate effectively with regulatory and legislative offices at the state level, and ultimately in every state.

In addition to licensure, the JMPLSC is evaluating the mechanism and feasibility of a national registry of qualified medical physicists that could be recognized by every state. The registry is not a licensure so it would not replace what is already in place or would be put into place. A registry would give states or others a place to go to identify “qualified medical physicists� and it could be used in combination with licensure to recognize a minimum standard consistently across all states.

The registry could record licensure information and might also help with managing reciprocal licensing. The registry represents a secure list of individuals who have met a defined qualification and competence standard to practice medical physics. The verification and attestation process for a registry would need to be understood. The states would have to accept (through agreement or statute) that, outside of licensure, the national registry is the sole list of qualified medical physicists, with no individual states defining lower standards.

We can look at the American Registry of Radiologic Technologists as an example of how licensure and registration can be combined. In all but seven states, radiologic technologists are either licensed or recognized by ARRT registration.

Recently, the JMPLSC, working together with the Conference of Radiation Control Program Directors (CRCPD) Subcommittee of our Government and Regulatory Affairs Committee (GRAC) has been in communication with the CRCPD in exploring the creation and maintenance of a Qualified Medical Physicist National Professional Standards Database (national registry) of individuals who meet the criteria established for a qualified medical physicist. The CRCPD is the group of regulatory individuals in every state that enforce radiation control statutes. While the CRCPD would not credential or qualify QMPs, input information would be based on data provided by certifying boards and licensing agencies for medical physicists.

Whether done through licensure or registration, or both, the infrastructure, education, communication tools and basic standards documents must be established. In either case the mechanisms for initial entrance and maintaining status, as well as reasons why status could be revoked, must be defined and documented. In both cases, the financial structure for the recognition and maintenance process must to be established. And of importance, the minimum acceptable qualifications must be established and communicated repeatedly and across the country, without exception.

At this time, the subcommittee is moving to influence legislation in 5 states to establish medical physics licensure, as well as exploring how a national registry can compliment this effort. In a recent workshop,

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May/June 2009 the JMPLSC offered a grassroots workshop. This was done on the same weekend as the March board meeting, so many of us had a chance to sit in on much of the workshop. Grassroots, as many of you know, means constituents like each of us, communicating effectively with our legislative leaders (at the state or federal level). In the case of qualifications for medical physicists to practice medicine, it would mean communication with state legislative and regulatory offices. The JMPLSC is developing tools and documents for this communication to be effective.

This and many other actions have been taken by the JMPLSC over the past 2.5 years and there remains much work to be done. I encourage you to review minutes from their meetings (on the JMPLSC website) and to get involved in supporting uniform standards for medical physicists to practice in your state. We know that patients deserve to have imaging and therapeutic procedures under the technical guidance of a properly qualified medical physicist.

AAPM Dues I’ll only be brief on dues this time. The Board of Directors continues to direct initiatives and activities which it believes will improve our profession and the quality of patient care that results, now and in the future. Each year many good ideas come to the board for review and quite a few can not be funded, due to fiscal limits. Regardless of the national or world economy, individuals in our profession continue to work toward improved patient care, through science, practice and education. The AAPM will remain a leader in medical physics, because of member participation through personal work effort and through financial support.

I would appreciate any comments on the above items (or any topic of interest to you). Herman.Michael@ mayo.edu

AAPM Newsletter

May/June 2009

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

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his issue of the Newsletter is shorter than previous issues yet it contains very interesting and important materials that impact all of us in the medical physics field. I would especially like to bring attention to the President’s column which highlights many aspects relating to the ‘2012/2014 Initiative’ and all of the programs that the association is actively developing.

With regards to the publication of the Newsletter, in addition to the steps already taken to reduce the overall Newsletter budget (see Jan/ Feb 09 column), from this point forward I want to offer all readers the option to “opt-out” of receiving the print version of the Newsletter.

Since the printing and mailing is the major cost associated with the Newsletter I strongly feel that giving members the option to “opt-out” from the printed edition is a better choice than stopping the printed edition all together. By the time this newsletter reaches your desk, the AAPM Headquarters Team will have forwarded information to you on how to proceed in expressing your choice. Ideally, if the majority of the members wish to “opt-out” of the printed edition we will be able to stop mailing the print edition. However, previous surveys have indicated that many

members prefer to receive the print version of the Newsletter as it is more convenient to read at their leisure. Some of you have already expressed your interest to “opt-out” from receiving the print edition and therefore it is now important for all of you to select your choice so that it provides a better perspective on the cost while I prepare the Newsletter budget for the next year. The PDF version of the newsletter, along with archives, will always be available on the AAPM website.

Finally, I would like to congratulate all the recipients of the 2009 AAPM Awards and Honors (pages 1415). I am looking forward to the Awards Ceremony and Reception in Anaheim.

SPECIAL REGULATORY SESSION to be held: Tuesday, July 28, 1:30-3:20 The Nuclear Regulatory Commission has recently implemented its National Source Tracking System, an effort that will have significant impact on a number of AAPM members. For the first hour of the session, NRC staff will present information regarding the NSTS, entitled “NRC Overview of the National Source Tracking System,” allowing a substantial amount of time for questions and discussion with attendees. Topics identified by NRC for this session include : • • • •

Deployment and Implementation of NSTS Experience with NSTS MPKI Credentialing Process Potential Expansion of the System User Feedback Questions

It is very important for NRC to hear feedback regarding AAPM member experiences, good and bad, around implementing this system. It is also vital for them to hear our constructive comments concerning potential expansion of the system.

It is not often that NRC staff makes such an effort to hold a dialogue with us, so we should use this opportunity to its fullest.

During the second hour, Debbie Gilley and John Winston will present information regarding efforts by the CRCPD, “CRCPD Response to the Changing Regulatory Environment.” Their highlighted topics include: • • •

Impact of increased controls and security activities on the states (response to NSTS and security enhancements) New or proposed regulations (electronic brachytherapy; Parts F, G, Z) CR/DR inspection protocol

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AAPM Newsletter

May/June 2009

AAPM Executive Director’s Column

Angela R. Keyser College Park, MD Election Processes

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lections for the 2010 Officers and Board Members-At-Large will open on June 17 and will run through July 8. Again this year AAPM will use the Bulletin Board System (BBS) during the election process to allow members to discuss issues of concern with the candidates and the election in general. Be alert for email announcements or your hardcopy ballot.

Summer Undergraduate Fellowship Programs

This year sixty-nine undergraduate students competed for fourteen AAPM Summer Fellow positions (SUFP). The program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. For more information on the program, go to: http://www.aapm. org/education/SUFP/default.asp This year fifteen undergraduate students competed for six AAPM MUSE

(Minority Undergraduate Summer Experience) Summer Fellow positions. The MUSE 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. 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 non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For more information on the program, go to: http://www.aapm.org/education/MUSE/ Students participating in the program SUFP and MUSE are placed into summer positions that are consistent with their interest and are selected for the program on a competitive basis. Each Summer Fellow receives a $4,500 stipend from AAPM. 2009 ASTRO/AAPM Radiation Oncology Physics Residency Training Grant AAPM and ASTRO established this joint program to promote the development of radiation physics residency programs in the US by providing assistance to newly established programs working towards accreditation. Up to $72,000 in total funding will be awarded each year, with individual program grants not to exceed $12,000 each. The deadline for applications is June 15. For information go to: http://www. aapm.org/education/roprtg Upcoming AAPM Meetings Make sure to register for the 2009 Summer School, “Clinical Dosimetry Measurements in Radiother-

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apy” by May 13 for discounted registration. For more information, go to: http://www.aapm.org/meetings/ 09SS/ The program for AAPM’s 51st Annual Meeting will be posted online

by May 14. Remember to register by June 14 to receive discount registration fees.

Immediately following the Annual Meeting, explorers may join their colleagues on a Yosemite Trek organized

by AAPM member Dave Jette, including a two-day ascent of famous Half Dome. For details go to: http:// www.jettes.org/yosemite/ NEW! AAPM and the American Institute of Physics’ Corporate Associates are organizing the 2009 Industrial Physics Forum (IPF) in conjunction with the Anaheim meeting, bringing 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.” Embedded into the AAPM Scientific Program, the IPF sessions will be on Monday and Tuesday, July 27-28. There will be a Welcome 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. There will be 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.

For the latest on AAPM Meetings, go to www.aapm.org and click on “Meetings” in the left-hand list of options.

AAPM Newsletter AAPM HQ service!

May/June 2009

Team‌at

your

The AAPM Accounting Team is hard at work supporting the activities of the Association. Like the IS team, profiled in the last issue, the valuable work of the Accounting team takes place primarily behind the scenes.

Ramy James joined the staff in February of 2008 and serves as Accounting Manager. Ramy has responsibility for daily and monthly accounting functions, including management of general ledger functions, production of financial reports, management of cash and reconciliation of accounts.

Peggy Compton joined the Accounting team in October 2004 as the Accounting Assistant. As a result of her willingness and eagerness to take on a higher level of responsibility, she was promoted to Senior Accounting Assistant at the end of 2007. Peggy processes dues renewals and other cash receipts, records accounts payable, prepares checks and does the invoicing.

Lakea Shirriel, the newest member of the Accounting team, joined the staff in September of 2008 as the Accounting Assistant. Kea is responsible for reconciliations and analysis for the accounting department. She also assists with the processing of receipts, vendor invoices, and billing.

The team together is responsible for handling the receipt and

disbursement of over $7 million annually, including hundreds of transactions monthly. Thousands of dues payments are processed annually, along with meeting registrations for Summer School and other AAPM meetings.

Coming next issue‌.group profile of the AAPM Legislative and Regulatory Affairs team.

AAPM Accounting Department (L - R) - Peggy Compton, Ramy James and Lakea Shirriel

Nobel Laureate Tsien Opens World Congress 2009 on Medical Physics and Biomedical Engineering in Germany Nobel Laureate Roger Tsien, renowned for revolutionizing the fields of cell biology and neurobiology by allowing scientists to peer inside living cells and watch the behavior of molecules in real time, will open the World Congress 2009 together with Federal Minister of Education and Research, Annette Schavan and Hermann Requardt, CEO of Siemens Healthcare Sector, Member of the Managing Board and Chief Technology Officer of Siemens AG. Over 4,000 experts from Germany and abroad will discuss the latest research results in medical engineering, medical physics and bioengineering on September 7 to 12, 2009. Tsien received the Nobel Prize for Chemistry in 2008, together with Osamu Shimomura and Martin Chalfie, for the discovery and development of the green fluorescent protein (GFP).

More information on the Congress is available at: www.wc2009.org

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AAPM Newsletter

May/June 2009

Science Council Report

John Boone Science Council Chair

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he AAPM has historically sponsored two meetings per year, the annual AAPM summer meeting and the RSNA meeting right after Thanksgiving, which is in fact led in large part by the Radiological Society of North America. This year Science Council has taken the lead in putting on a scientific meeting on proton therapy, which will be held May 8-9. At the recent AAPM Board of Directors meeting in Chicago (March 21), there was discussion of a meeting on Imaging for Target Assessment in Radiation Therapy which will be likely be held in 2010.

The Board also discussed and ultimately voted to support AAPM sponsorship of the World Congress of Medical Physics in 2015 in the San Diego area. Science Council is also sponsoring Focused Research Meetings (FOREM’s), which are far smaller events (of perhaps 20-30 scientists) which are intended to be held at University venues, are minimal in cost, and are focused on very specific topics. Despite this recent increased number of meetings, with the exception of the small FOREM meetings, there is no long term effort per se by Science Council towards increasing the number of meetings hosted by the AAPM.

Since I joined the AAPM as a graduate student 28 years ago, the society has evolved and changed substantially, and today there is increased focus on clinical practice (especially in radiation therapy), and on the professional aspects of clinical practice. Education is a necessary component of modern clinical practice due to the need for maintenance of certification, and the educational opportunities offered by the AAPM have been significantly enhanced over the last three decades as well. As the

profession of Medical Physics has become more complicated, lucrative, and hectic, it is only natural that the AAPM rise to the needs of our members who are primarily involved in providing clinical medical physics services. Reflecting these realities in Medical Physics, in 2009, Science Council’s budget is only 20% of the total 2009 budget for the three councils, while Education Council represents 34% and Professional Council represents 45%.

Getting back to the issue raised in the first paragraph in regards to

Self Assessment Module Highlights (SAMs)

Therapy SAMs: SAM Session 1:

Particle Therapy: Issues and Considerations

SAM Session 2:

Dose calculation algorithms in 3D-CRT and IMRT

SAM Session 3:

Image Processing

SAM Session 4:

HDR and LDR Brachytherapy: Everything you need to know Diagnostic Imaging SAMs:

SAM Session 1:

COMPUTED TOMOGRAPHY Optimizing CT Dose and Image Quality

SAM Session 2:

MRI • ACR MRI Accreditation Program Update

SAM Session 3:

RADIONUCLIDE IMAGING • PET/CT: Technology Updates, Quality Assurance and Applications • SPECT/CT: Technology Updates, Quality Assurance and Applications

SAM Session 4:

BREAST IMAGING • FFDM in the Field: Physicist’s Role in the QC of Third-Party Review Work Stations • Digital detector QC, tips and problems

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AAPM Newsletter scientific meetings, Science Council is, given relatively modest resources, seeking to raise the bar in regards to the research activities of medical physics. The meetings mentioned previously are one component of our strategy towards raising this bar.

We recognize that these scientific meetings may not have broad appeal to the mostly clinically-focused AAPM membership, but rather these meetings are intended to keep our society, and its more research-focused members engaged fundamentally in the new scientific developments – some of which will impact the practice of medical physics in five or ten years. I hope, and indeed believe as a board certified medical physicist with clinical responsibilities myself, that those of you who are primarily focused on clinical medical physics

May/June 2009 recognize the importance of nurturing the scientific backbone of our profession with these scientific meetings and other activities as well.

In regards to the AAPM’s standing in the scientific world of Medical Physics, I want to mention a particularly courageous act of the Board last week (council chairs are non-voting members of the Board).

The AAPM annual meeting is a typically lucrative event, and is a significant revenue producer for the AAPM. It turns out that hosting the World Congress in 2015, as was the case in 2000 and 1988, will result in a significant reduction in revenues from the annual meeting, due to the complexities of hosting an international meeting of this

scope. Nevertheless, the Board of Directors voted unanimously, after considerable debate, bid to host the World Congress in 2015 – six years from now. Congratulations to my friends and colleagues on the Board.

They were able to look beyond the current sour economic environment and recognize that the AAPM has a preeminent role in promoting the science of Medical Physics on the world stage. Medical Physics as a scientific discipline and professional was born in North America. It would be an incredibly bad omen for our profession if we, a half century old Medical Physics organization, chose not to sponsor the World Congress, given that significantly younger organizations in Australia (2003), Korea (2006), Germany (2009), and China (2012) have done so.

2009 Professional Program Highlights

• • • • • • • •

Licensure/Registration – A progress report of activities related to licensure and registration of medical physicists in the United States and an update on the status of the CARE bill Professional Development for Women in the AAPM – Strategies to assist the professional development of women Professional Doctor of Medical Physics – Speakers representing academic institutions, CAMPEP, ACR will have a dialogue concerning this issue Innovations in Teaching Education Symposium Regulatory Issues - Representatives from the NRC will present on the National Source Tracking System and will look for a dialogue with AAPM members on this issue. CRCPD will also present on their efforts to respond to the changing environment.

New Member Meet the Experts Symposium – This is an opportunity for members who have recently joined the AAPM to meet senior leaders of the AAPM and to learn about the AAPM MOC – The annual update of current issues related to maintenance of certification PQI session – This session will offer SAMs credit and will discuss requirements for practice quality improvement projects

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AAPM Newsletter

May/June 2009

Education Council Report

J. Anthony Seibert Education Council Chair

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he Education Council is having a mid-April retreat in Denver, Colorado for in-depth discussion and strategizing on the many educational issues and opportunities important to our membership. These include the 2012 / 2014 initiatives for the establishment of medical physics residencies, maintenance of certification issues for diplomats of the ABR, medical physics teaching initiatives, development of syllabi for radiology and radiation oncology residents, international education and outreach, summer school planning, coordination of educational activities with other societies, and many other important issues. Plans and strategies generated from the retreat will be the subject of continuing newsletter topics for the Education Council in the coming months.

Members of the Education Council for 2009 include: Chair: Tony Seibert Vice-Chair: Melissa Martin Committee Chairs: Continuing Professional Development: Ed Barnes Public Education: Mary Fox International Educational Activities: Don Frey

History: Bob Gould Medical Physics Education of Allied Health Professionals: Doug Pfeiffer Medical Physics Education of Physicians: Mark Rzeszotarski Education and Training of Medical Physicists: George Starkschall Web Associate Editor for the Education Council: Perry Sprawls Ex officio members include Maryellen Giger, President of the AAPM, Mike Herman, PresidentElect, and Jerry White, Chairman of the Board.

Staff members who support the council and provide institutional knowledge of and communication channels between the various entities within the AAPM include Lisa Rose Sullivan, Lynne Fairobent, and Cecilia Hunter.

I would like to extend my sincere appreciation to two former committee chairs, including Michael Yester who led the Continuing Professional Development Committee, and Richard Massoth, who was in charge of the Medical Physics Education of Physicians committee. Both served full terms and were extremely effective in leading the charge of their very active committees.

Finally, the Education Council is charged with the responsibility for providing a mechanism and direction to allow its committees, subcommittees and task groups to meet the education goals of medical physicists as outlined in the AAPM mission statement, through the following tasks: 1. Recommend standards for medical physics educational program curricula and promote graduate program accreditation.

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2. Maintain a comprehensive database of graduate programs in medical physics.

3. Promote the establishment and accreditation of clinical residencies in medical physics to ensure a satisfactory level of clinical competence among entry level physicists.

4. Hold education courses at annual meetings and at joint meetings with other societies.

5. Organize and sponsor local and regional workshops and symposia on medical physics topics, including implementation of new techniques.

6. Compile databases containing sources of educational and technical material.

We are cognizant of these directives, and realize that you, the membership, also play an important part in defining the direction of the Education Council so that the efforts culminate in producing products and outcomes that meet your needs. This can be accomplished in several ways – by joining committees, subcommittees, workgroups, or task groups, and by providing feedback through surveys, email, phone calls or in person during the Annual Meeting. I and the members of the Education Council are available for your input and suggestions.

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AAPM Newsletter

May/June 2009

Professional Council Report tacts and relationships is requiring the work of the entire Workforce Subcommittee.

Michael Mills Professional Council Vice-Chair

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irst let me report some news about the contract with the New York Center for Health Workforce Studies of the University at Albany (State University of New York). As you recall, 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. Additionally, there will be an estimation of demand and supply for all the subspecialties of medical physics. Also, one component will serve to validate the AAPM Professional Information Survey. The work has now begun in earnest under the leadership of Ned Sternick, Chairman of Medical Physicist Workforce SC and John Swanson, Chair of Survey Validation SC. Several face to face meetings have taken place and interviews for many categories of stakeholders are being identified and set up. Types of stakeholders interviewed will include those in positions of organizational and professional leadership, those responsible for training programs both accredited and not, CAMPEP representatives, representatives from benchmark institutions, employers of various categories, and other stakeholders. Setting up these con-

Recently, AAPM held a Summit to address the 2012/2014 initiative for CAMPEP-accredited training.

Some consensus thoughts from the meeting include the following: Currently there are about 25 residency slots available in the United States.

It is generally agreed we need between 150 and 200 slots annually.

The two most reasonable solutions appear to be distributed residencies and formalization of existing OJT positions. Under the distributed residency plan, community-based hospitals and medical physics contractor groups might choose to become affiliate clinical programs of existing CAMPEP residency programs, which would take ultimate responsibility for management of the resulting “hub and spoke” program. Alternatively, such groups might consider seeking independent CAMPEP accreditation of their existing OJT training programs. There was agreement that at some future date, graduation from a CAMPEP-accredited medical physics degree program should be a prerequisite for entry into a CAMPEP-accredited residency program.

Corollary to that, there was a great deal of discussion regarding the establishment of a formal mechanism by which CAMPEP-accredited degree programs could offer supplemental coursework to individuals who already hold a MS or PhD level degree in a suitable specialty other than medical physics, such as physicists and related scientists, and then issue a “Certificate of Equivalence”.

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This Certificate would provide an entry path into the field for those that did not earn a CAMPEP-accredited degree. There was some mention, but not a lot of discussion or support for distance learning. There is significant concern that the number of Imaging Residencies is lagging and may not be sufficient in 2014. A residency match program for applicants was discussed at some length, but no decision to conduct a match was made. The Professional Medical Physics Doctorate program was discussed in some detail. The concept remains controversial, with concerns including the overall role of research respecting such training and the impact on the existing workforce of MS and PhD medical physicists. On the other hand, some positives include the potential enhanced stature of the profession, improved clinical training, and the ability to attract students into the field. It was noted that the Vanderbilt Board of Trust recently approved a PDMP program under the direction of Charlie Coffey, and that student recruitment was underway for the fall semester.

From the Joint Medical Physics Licensure Subcommittee: The licensure/registration effort by the AAPM and ACMP has taken a big step. After careful consideration of quality, services to be provided, and cost, the Joint Medical Physics Licensure Subcommittee (JMPLSC) has selected a single national firm to help in the lobbying efforts at the state level and work with HQ, the JMPLSC, and the state captains/committees. Earlier, the JMPLSC asked for RFPs, held phone interviews, and had the field narrowed to two firms with the op-

AAPM Newsletter portunity to clarify responses and resubmit a final document. After reviewing these documents and discussing pros and cons, the JMPLSC workgroup for the selection of a lobbyist firm selected Bevan, Mosca, Giuditta & Zarillo, P.C. Angela Keyser will be working on the contract (and an independent law firm will be representing us in reviewing the contract since the Bevan Group is presently the counsel for AAPM). The cost of the one-year contract is $200K plus expenses (still being negotiated), for 5 states at one time and the cost will be held at this level for the duration of the initial contract. The five targeted states are Michigan, Massachusetts, Missouri, Ohio and Pennsylvania. Details of services, costs, and the contract are available at AAPM Headquarters. Please see Michael Herman’s column for additional information and perspective on JMPLSC activities. Also, the

JMPLSC conducted a Grassroots Training session in Chicago, which coincided with the weekend of the Excom, Council Chairs and Board meetings. The consensus was meetings such as this are very necessary if we are to achieve our goals of licensure in the target states. The session was both well attended, and very well received.

There are two issues that the Economics Committee is working on at the moment. One is the revaluation of the new HDR codes under the Physician Fee Schedule. A working group of ASTRO and AAPM representatives has been established and has met with CMS. Wendy Smith has submitted an article for this month’s newsletter discussing this. We are also working on revising practice expense data for several codes that are going through the RUC process.

May/June 2009 Please see the columns by Michael Herman, Lynne Fairobent and Wendy Fuss Smith for additional issues and information concerning the Professional Council.

The 2010 Call for Nominations and Applications is available on the AAPM Web site at: http://www.aapm.org/org/ callfornominations.asp Deadline: October 15, 2009

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AAPM Newsletter

May/June 2009

Congratulations to the recipients of the following awards, achievements and honors in 2009!

William D. Coolidge Award is presented to:

Award for Achievement in Medical Physics

Willi A. Kalender, Ph.D.

is presented to: James Deye, Ph.D. Lawrence Reinstein, Ph.D. Raymond Tanner, Ph.D.

AAPM-IPEM Medical Physics Travel Grant is presented to: Lili Chen, Ph.D.

Farrington Daniels Paper Award (dosimetry) is given for: “LiF:Mg,Ti TLD Response as a Function of Photon Energy for Moderately Filtered X-ray Spectra in the Range of 20 to 250 kVp Relative to 60Co” by April Nunn, Stephen Douglas Davis, John Micka and Larry DeWerd Medical Physics 35, Number 5/1859-1869

Sylvia Sorkin Greenfield Paper Award (non-dosimetry) is given for: “An MRI-Compatible Transurethral Ultrasound System for the Treatment of Localized Prostate Cancer using Rotational Control” by: Rajiv Chopra, Nicole Baker, Vanessa Choy, Aaron Boyes, Kee Tang, David Bradwell and Michael Bronskill Medical Physics 35, Number 4/1346-1357

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AAPM Newsletter

May/June 2009

Congratulations to the recipients of the following awards, achievements and honors in 2009!

The following are named Fellows in 2009 for their distinquished contributions to the AAPM: Kenneth R. Hoffmann, Ph.D. Paul J. Keall, Ph.D. Dimitris N. Mihailidis, Ph.D. Martin J. Murphy, Ph.D. Nikos Papanikolaou, Ph.D. Matthew B. Podgorsak, Ph.D. Ehsan Samei, Ph.D. Stephen M. Seltzer, M.S. X. George Xu, Ph.D.

James M. Balter, Ph.D. Thomas R. Bortfeld, Ph.D. Geoffrey D. Clarke, Ph.D. Allan F. deGuzman, Ph.D. James T. Dobbins III, Ph.D. Lei Dong, Ph.D. John P Gibbons, Jr., Ph.D. Philip H. Heintz, Ph.D. Patrick D. Higgins, Ph.D.

All of the award, achievement and honor recipients will be recognized during the 2009 AAPM Annual Meeting in Anaheim, California at the Awards and Honors Ceremony and Reception.

Please join us in congratulating all of the recipients: DATE: TIME: PLACE:

Monday, July 27, 2009 6:00 PM Marquis Ballroom of the Anaheim Marriott

AAPM Regrets to announce that the following members have passed away since our last Annual Meeting: Arnold Feldman, Ph.D. - Peoria, IL Vito Fodera, PhD - Brooklyn, NY Richard Moore, Ph.D. - Chubbuck, ID Joseph Nanus, M.S. - Pagosa Springs, CO Rainer Schmidt, Ph.D. - Hamburg

If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honors Ceremony at our upcoming Annual Meeting.

We respectfully request the notification via e-mail to: 2009.aapm@aapm.org Please include supporting information so that we can take the appropriate steps.

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AAPM Newsletter

May/June 2009

AAPM Website Editor Report

Christopher Marshall NYU Medical Center

S

ometimes I just have to say “No” to what may seem to be reasonable requests. Many such requests, in effect, read “We have - or more typically plan to have - great things on our committee homepage and we want a ‘button’ on the AAPM home page as a direct link to that content.” Others read “Please update the information on [some committee] homepage” or “Please customize [some committee] homepage to make it easier to use.” Every council, committee, subcommittee, workgroup and task group in the AAPM Committee Tree has (or can quickly initiate) a website, a Wiki and a simpler ‘Wiki Lite’ that may be accessed from the Tree (under AAPM on the main menu). Each of these nodes could potentially host information of interest to members, but we would need 585 direct links from the AAPM home page (at my last count) to access each of them directly. Editing and customizing committee sites would also be an impossible task for the IS staff.

The AAPM website is designed to serve two distinct purposes.

One is to serve the interests of the membership as a whole, which also includes promoting the work of the AAPM to non-members. The second

is to facilitate the work of AAPM committees by providing them with tools to develop and archive materials on a collaborative basis.

The committee nodes constitute a subdivision of the AAPM site that serves this second purpose.

They are for the sole use of the respective committees and simple management tools are provided so that committees can manage them themselves. By default, each committee chair has edit rights for that committee, but this can be re-assigned. Click on “Admin” on the committee website to start the content management system and edit that site. A link to instructions for uploading to the site is available in the help menu of the content management system and under each committee membership list in the committee tree. The AAPM IS staff will answer questions and Michael Woodward holds training sessions at each annual meeting.

It should be self-evident that any given committee node has very limited value as a vehicle for informing the general membership.

No member is likely to click through to all 585 nodes just to see what is there. The target audience is the committee members who need to do their collective work and a limited number of members with specific interest in the work of a committee (such as those seeking to join that committee). AAPM members should be aware that the material on committee websites is often in draft form or may be outdated and is not formally “published” by the AAPM. Committees can avoid membership access to draft and outdated materials by restricting access to most materials, although minutes of meetings should be accessible to all AAPM members.

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The work of most committees should result in information that needs to be disseminated to AAPM members as a whole and possibly to a wider audience. This requires that content be migrated from committee websites to the main AAPM website for “publication.” Please contact me as this stage approaches. We will work with you to take your content, format it to meet the style and standards of the main AAPM website and provide access to it through the menu structure. The published version will then reside on the main site and not on the committee site, so it is wise to then “unpublish” drafts on your committee website but retain them in the committee archive. This involves a few clicks using the content management system.

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/3403.asp

AAPM Election The 2009 AAPM election will open for online voting on June 17, 2009.

Paper ballots will be mailed to the following members: • Those with no e-mail address • Those with a bad e-mail address • Those that have opted out of online voting.

The deadline to submit your vote electronically or by paper ballot will be July 8, 2009

AAPM Newsletter

May/June 2009

Legislative & Regulatory Affairs acknowledgement of the registry to verify board certification.

Lynne Fairobent College Park, MD Qualified Medical Physicist Registry

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he American Association of Medical Physicists (AAPM) and the Conference of Radiation Control Program Directors (CRCPD) board have been discussing the need to have one location where state regulators and human resource officers can validate the qualifications of those practicing medical physics. This registry would complement AAPM’s and the American College of Medical Physics’ (ACMP) efforts to increase the number of states that license medical physicists. We recognize that the number of qualified medical physicists in some states is just too low to support a licensure law. The registry is a concept that once initiated would allow those states to benefit from a single source to verify qualified medical physicists in their state. This registry would fill the gaps for those states.

In an effort to predict the future, CRCPD, AAPM and ACMP believe that the healthcare revolution will look to improving quality of healthcare as well as cost reduction activities. If the future reforms require qualification of healthcare workers for reimbursement, the registry could be used to meet that requirement. We would work towards Joint Commission and Centers for Medicare & Medicaid Services (CMS)

The concept for the registry is for CRCPD to purchase the current boards’ certification list and the state licensure lists for medical physicists.

Each year CRCPD would again purchase the list of new board certified medical physicists and update the list.

The initial start up and maintenance costs would be paid by AAPM through a contract. The Registry would be the property of CRCPD and accessible through the CRCPD web site.

This is the initial concept for the registry, as we see the potential to expand and provide additional data to the list as our needs increase.

For example we may be able to add Mammography Quality Standards Act continuing education documentations to the registry or identify qualified medical physicists to support the radiation response volunteer corps.

This is being further discussed with the Program Directors during the CRCPD business meeting during their annual meeting in May. Stay tuned for additional information as this concept is further defined. If you have questions, please contact Lynne Fairobent at lynne@aapm.org.

National Source Tracking System (NSTS) Enrollment Issue Based on discussions with the Nuclear Regulatory Commission (NRC) regarding concerns related to security of personal information in the NSTS, we received the following from NRC. NRC stated: “Please be assured that there has been no breach of personal information for any applicant to the National Source Tracking System (NSTS). Soon after the initial deployment of the NSTS program, it was discovered that some users were not flowing through the enrollment

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system properly. Specifically, electronic information submitted by NSTS enrollees was getting “stuck” within different parts of the system designed to ensure that the NSTS program remained a highly secure system. This problem has since been fixed and all enrollees can be assured that no personal information provided by enrollees ever left the NSTS system. From the very beginning of the enrollment process in October, 2008, all personal information has remained within the same highly secure database accessible to only those personnel who have the proper training, clearances, and the need to see the data due to the nature of their job.

All personal information submitted in paper form through the regular mail has remained in the NRC’s possession since its receipt.

VeriSign is the NRC’s contractor for management of the credentialing process and they are bound by strict requirements to ensure proper control of all information submitted by applicants of a personal nature. We are confident that those requirements are being satisfied. The particular requirements can be viewed in Federal Information Security Management Act.” If you are having any generic problems with the NSTS please contact Lynne Fairobent at lynne@aapm.org.

NRC Recognizes the Canadian College of Physicists in Medicine Under Part 35 NRC has finished its review of the certification process for Radiation Oncology Physics of the Canadian College of Physicists in Medicine and has granted them recognized status as of January 2009 under the requirements of 10 CFR 35.51(a). Details can be found at: http://www.nrc.gov/ materials/miau/med-use-toolkit/specboard-cert.html.

AAPM Newsletter

May/June 2009

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AAPM Newsletter

May/June 2009

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant AAPM Meets with CMS to Discuss HDR Brachytherapy Provided in Freestanding Cancer Centers

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APM Chairman of the Board Jerry White and Professional Economics Committee consultant Wendy Smith Fuss, as members of the Joint HDR Brachytherapy Working Group, met with key leaders of the Centers for Medicare and Medicaid Services (CMS) on March 9, 2009 to discuss the practice expense inputs of the 2009 High Dose Rate (HDR) brachytherapy codes. The Joint Working Group provided both short-term and longerterm recommendations to correct inputs and avert significant HDR brachytherapy payment reductions under the Medicare Physician Fee Schedule.

Joint Working Group Chair Martin Keisch, M.D. educated CMS on the clinical effectiveness of HDR brachytherapy and stressed the variability of cost of the renewable Iridium-192 source based on the number of patients treated in a freestanding cancer center. Dr. Keisch also advised that HDR brachytherapy is cost-effective compared to other cancer treatments and reported that HDR brachytherapy is the standard of care for uterine cancer. Other members of the Joint Working Group, which included Leland Rogers, M.D. and Brad Prestidge, M.D., discussed patient access issues, the impact to practice, and potential changes to patient care, including the use of more expensive cancer therapies if providers do not offer HDR brachytherapy.

Members of the Joint Working Group focused on details of the practice expense inputs included in 2009 HDR brachytherapy codes 77785, 77786 & 77787. Jerry White discussed medical equipment that was omitted from the inputs and focused on medical physicists participation during treatment delivery. Wendy Smith Fuss discussed the continued technical error regarding the 5-year “useful life” of the renewable source.

The Joint HDR Brachytherapy Working Group made the following recommendations to CMS: • Correct the Useful Life of the Renewable HDR Iridium192 Source to 1 Year.

• Include Omitted Medical Equipment in the Practice Expense Inputs for HDR Brachytherapy Procedure Codes 77785-77787.

• Implement a Temporary HCPCS “G” Code to Allow Office-Based Catheter Placement.

• Develop Office-Based RVUs for Existing Catheter Placement Codes.

• Correct the Staff Type and Revise Staff Time for the Intra-Service Work of Medical Physicists and RNs. • Add Pre-Service Work Time for Medical Physicist Preparation of the HDR Remote Afterloading Equipment.

Although CMS appeared sympathetic to the issues presented, it is not likely that they will issue a Technical Correction Notice in 2009 to correct the useful life of the Iridium-192 renewable source. There appears to be no short-term remedy

by CMS unless they create a HCPCS code for brachytherapy catheter

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placement in the office setting.

It is probable that CMS will include the AAPM & Joint Working Group recommendations in the 2010 Medicare Physician Fee Schedule proposed rule, which is subject to public comment. CMS could provide changes to the practice expenses inputs based on public comment that would likely increase the HDR brachytherapy relative value units (RVUs) and payments. However, changes to HDR brachytherapy RVUs would not be implemented until January 1, 2010.

MIPPA Accreditation Provisions On July 15, 2008, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) was enacted making changes to the Medicare program. Specifically, MIPPA mandates that beginning January 1, 2012 any entity that performs the technical component of advanced diagnostic imaging services (including a physician’s office) will be required to have received accreditation from a national accrediting agency approved by the Secretary of Health and Human Services. The MIPPA requirements apply only to physician office and freestanding imaging centers. They do not apply to hospital based imaging procedures.

The legislation requires providers of advanced diagnostic imaging services, inclusive of nuclear medicine, magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET), obtain accreditation as a condition for Medicare reimbursement by 2012. The portion of the legislation requiring accreditation states: • Accreditation programs must ensure physicians and staff maintain the proper level of training and education

The Secretary of Health and Human Services must designate accrediting organizations by January 1, 2010. The accreditation organizations must have criteria to evaluate medical personnel, medical directors, supervising physicians, equipment, safety procedures, and quality assurance programs.

Although not set in stone, CMS will likely choose the American College of Radiology (ACR) and the Intersocietal Accreditation Commission (IAC) since both organizations have extensive experience accrediting imaging entities under current requirements by private insurers and some states. In the case of the ACR, the mammography accreditation program is a federally recognized program under the Mammography Quality Standards Act and administered by the Food and Drug Administration (FDA). Both are national nonprofit organizations that provide a peer review process of accreditation designed to evaluate and accredit diagnostic imaging facilities.

In addition, MIPPA also establishes a two-year, voluntary demonstration program to test the use of appropriateness criteria for advanced diagnostic imaging services by January 1, 2010.

The voluntary program would collect data regarding physician compliance with criteria to determine the appropriateness of advanced diagnostic imaging services furnished to Medicare beneficiaries. The Secretary may not allow prior authorization to be used under the demonstration program.

Physics Fellows of the ACR Class of 2009 Congratulations to the following AAPM members on becoming ACR Fellows in 2009: Libby F. Brateman, Ph.D. Mahadevappa Mahesh, Ph.D. Karl L. Prado, Ph.D. J. Anthony Seibert, Ph.D. Christopher F. Serago, Ph.D. Palmer G. Steward, Ph.D.

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The future of physician-office-based advanced diagnostic imaging will be played out under the accreditation provisions of MIPPA, initially under a two-year pilot program, and eventually under accreditation provisions that will be applicable to all by 2012.

The provider community, as represented by certain specialty societies, prefers the accreditation approach over the prior authorization approach to quality and cost control.

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AAPM Newsletter

May/June 2009

ACR Accreditation In general, fiber images with breaks mean that the entire length is not visible and they should not be given the full point. However, if there is only 1 break in the fiber and the break is smaller than the width of the fiber, you may give it a full score as long as the full length of the fiber is visible.

Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs ACR Accreditation: Frequently Asked Questions for Medical Physicists Does your facility need help on applying for ACR accreditation? Do you have a question about the ACR QC Manuals? Check out the ACR’s accreditation web site portal at www.acr.org; click “Accreditation,” then the name of the accreditation program. Most of the accreditation application and QC forms are available for downloading. You can also call the Diagnostic Modality Accreditation Information Line at (800) 227-0145 or the Breast Imaging Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Q. In scoring the phantom image, the image of the smallest visible fiber does not appear to be intact; it appears to have a single, tiny break in the middle. However, the entire length of the fiber is visible.

May I score this fiber as a whole fiber?

A. Maybe. The phantom image review instructions say to: “Count each fiber as 1 point if the full length of the fiber is visible and the location and orientation are correct. Count the fiber as 0.5 point if not all, but more than half, of the fiber is visible, and its location and orientation are correct.”

Q. In scoring the fibers in the phantom image, 1 of the fibers is almost entirely visible but not quite. May I score this fiber as a whole fiber?

A. Maybe. The phantom image review instructions say to:

“Count each fiber as 1 point if the full length of the fiber is visible and the location and orientation are correct. Count the fiber as 0.5 point if not all, but more than half, of the fiber is visible, and its location and orientation are correct.”

Because of the small variability that may occur in the length of the fibers within any phantom, some leeway is allowed. You may score a fiber as a full point if its visible length is within ±2 mm of the length of the largest fiber. If the fiber image is shorter than 2 mm of the length of the largest fiber (but is longer than 50%) you must score it as 0.5 point.

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Diagnostic Imaging Continuing Education The program will include 32 Continuing Education courses in Diagnostic Imaging Physics and Technology. The courses will include: computed tomography, breast imaging, radionuclide imaging, MRI, radiography/fluoroscopy, ultrasound, radiation safety and risk management issues, issues related to accreditation, multimodality imaging and medical informatics.

There will be 8 hours of SAMS that include: MRI, breast imaging, computed tomography and radionuclide imaging.

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AAPM Newsletter

May/June 2009

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AAPM Newsletter

May/June 2009

Chapter Update Southern California Annual Midwinter Workshop by Steven Goetsch, Education Chair Brad Krutoff, Chapter President Marianne Plunkett, Past President

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he Southern California Chapter hosted its annual Midwinter Workshop at the Sheraton Universal Hotel in Los Angeles, CA on Friday, January 23, 2009. The topic of the workshop this year was “Innovative Techniques in Radiation Therapy and CAMPEP Role in Medical Physics.”

We were honored to have PresidentElect Mike Herman fly in from Minnesota to speak on the diverse roles of medical physics in modern medical practice. Faculty for this year’s meeting included Geoff Ibbott, Director of the Radiologic Physics Center, who gave a talk on “Advanced Technologies in Radiation Therapy: The Case for Credentialing” and also gave an update on CAMPEP activities on behalf of John Hazle, who could not be with us. Dave Shepard from Swedish Hospital in Seattle gave a talk on his implementation of the Elekta VMAT system while Chuck Mayo from Boston gave a talk on his hospital’s implementation of the similar Varian RapidARC system. Mel Astrahan from USC reported on his work with the linear-quadratic-linear radiation biology model and Katherine Kaufman from the Los Angeles County Department of Health gave a talk on Los Angeles County’s plans for a radiologic terrorist event. Five of the Platinum vendors gave 10 minute presentations as well.

About 110 people attended the all day meeting. The meeting was well supported by seven Platinum sponsors and fourteen Gold sponsors, along with a registration fee for attendees.

Continuing Education Units were granted by CAMPEP, MDCB and ASRT. Medical physics and radiation therapy students attended for free. Photographs of the meeting are available now at the chapter web page: www.aapmscc.org Talks from each of the speakers are being collected in Powerpoint and Adobe

Acrobat PDF format and will be posted on the Educational Materials tab of the chapter web page. The Midwinter Workshop is an annual event which has been held for close to 25 years and should be held approximately the same time next year.

Physicists from all over the country are always welcome to attend.

L - R: Geoff Ibbott (Radiologic Physics Center), Rock Mackie (University of Wisconsin) and Mike Herman (Mayo Clinic)

Practical Medical Physics Track Highlights • • • • • • •

ACR Accreditation in Nuclear Medicine and PET - A Practical Guide Using and Contributing to Shared Quantitative Imaging Resources Routine Testing of CR and DR Radiographic Systems Practical Issues Related to ProtonTherapy Systems Clinical Implementation of Newer Radiation Therapy Technologies ACR Accreditation for MRI - Role of the Medical Physicist Setting up a Stereotactic Body Radiation Therapy (SBRT) Program in the Clinic • Practical Application of Beam Calibration Protocols • Quality Assurance for Ultrasound Units used in Radiation Therapy: How to Apply TG-128 and TG-154 in the Clinic

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Joint Medical Physics Licensure Subcommittee Report “Why is grassroots training necessary?” by Robert Pizzutiello, Vice Chairman, Joint Medical Physics Licensure Subcommittee (JMPLSC)

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ederal and state legislation is affecting AAPM and ACMP and the profession of medical physicists more than ever before.

AAPM and ACMP members with a solid understanding of grassroots will be called upon to support the legislative and regulatory goals of AAPM and ACMP. A clear understanding of grassroots will enable members to effectively help state legislative efforts as well as any federal legislative or regulatory issues that may arise. AAPM and ACMP would then be able to successfully mobilize the membership to act and hopefully prevent any pending legislation from adversely affecting the interests of the medical physics profession including academic funding and research initiatives.

For example, last summer AAPM and ACMP saw how the Medicare Improvements for Patients and Providers Act (MIPPA) created a significant and positive impact on

diagnostic medical physics. The Act requires accreditation of all facilities providing high-tech imaging modalities by 2012 to qualify for Medicare reimbursement. The enactment of MIPPA supported our profession’s commitment to quality and resulted in many facilities seeking professional medical physics support for the first time.

The medical physics profession was fortunate with this legislation that the grassroots involvement from the AAPM and ACMP membership was minimal yet yielded a favorable outcome.

However, on February 24, 2009 President Barack Obama announced that health care reform is a high and near-term priority for him and his administration. Clearly the cost of health care will be a primary concern and AAPM and ACMP needs to maintain pressure on legislators so that quality does not suffer by any potential health care cost cuts. If legislation were to be proposed that affected the medical physics profession, AAPM and ACMP would need a network of members trained in grassroots to represent our interests and voice our concerns. Specifically, the

Consistency, Accuracy, Responsibility and Excellence Act (the CARE Act) is poised for re-introduction in the current congressional session and would affect the practice of every therapeutic, diagnostic and nuclear imaging medical physicist in the country.

To influence state and federal legislation that affects health care and our profession, grassroots training must happen now and must become a part of the culture of the AAPM and ACMP membership at-large. This is an immediate need – to preserve the quality of health care and the role of the medical physicist within the US health care system as well as protect funding for any future innovations from research in the medical physics field. Given the brief time allowed for scrutiny of the economic recovery legislation, we should be prepared for a similar fasttrack regarding health care reform.

AAPM and ACMP must be prepared to act effectively and efficiently on legislation that impacts our profession. If we wait for legislation to be introduced before training the membership, AAPM and ACMP will miss the window of opportunity to influence important legislation that will affect each medical physicist.

AAPM Summer School Clinical Dosimetry Measurements in Radiotherapy Colorado College • 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. Topics covered will include fundamentals of dosimetry, theory and application of AAPM dosimetry protocols (TG51-accelerators, TG61-x rays, TG43-brachytherapy), IMRT dosimetry, primary standards and the dosimetry chain to the clinic, instrumentation from ion chambers to MOSFETs and everything in between. There will be plenty of opportunity to interact with the Summer School faculty during this 4.5 day meeting in the Pike’s Peak region of scenic Colorado.

Registration closes on June 5

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Playing Small Doesn’t Serve the World. Let’s Play Large.

2009 Service Project: Beach Clean-Up with The Surfrider Foundation Saturday, July 25 8:00 am - Noon The Surfrider Foundation is a non-profit environmental organization dedicated to the protection and enjoyment of the world’s oceans. Does your travel schedule allow you to arrive in Anaheim a day early? Join your colleagues on a California beach for a little community service, a little physics chatter, a little sun. A bus will depart from the Anaheim Convention Center promptly at 8:00 am. Please pre-register (at no cost): http://www.aapm.org/meetings/09AM/GenInfo.asp#serviceproj

Third Annual AAPM Blood Drive Tuesday, July 28 10:00 am - 3:00 pm UC Irvine Medical Center has the only Level I Trauma Center in Orange County and transfuses an average of 1000 units of blood each month. Blood collected during the AAPM blood drive will be used by UC Irvine patients. Please mark your calendar to visit the Blood Mobile in front of the Anaheim Convention Center on Tuesday.

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Memorial

Arnold Feldman, Ph.D. 1924 - 2009

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rnold Feldman, affectionately known to his friends and colleagues as “Arne,” died in Peoria, Illinois on January 23, 2009. He was a charter member of the AAPM and participated in most of its meetings from the first to the 50th.

Arnold was born on April 12, 1924 in Allentown, PA where he was raised with his two brothers Bob and Fred. He attended Pennsylvania State University and received a B.S. degree in Physics in 1944. Upon graduation, Arnold was directed by his physics professor to a job as a technician in the “Manhattan District” Project in New York City in the gas diffusion research unit for separating Uranium isotopes in the Columbia S.A.M. Laboratory. Nine months later he was drafted into the Army. But, because of his recent experience, he was reassigned back to the Manhattan Project in New York City and then transferred to the Los Alamos Laboratories a few months later. There he worked with Larry Lanzl under Neddermeyer and Kerst in the development of atomic bomb implosion technology.

After discharge from the Army, Arnold attended Cal-Tech, receiving his M.S. degree in Physics in 1948. Arnold’s career

in medical physics began by chance when he answered an ad by Marvin Williams who invited him to the Mayo Clinic. There he learned to operate the Failla Radon Plant and participated in the treatment of thyroid cancer with Iodine 131. In 1951, Arnold applied for a job in the Radiology Department at the University of Colorado Medical School where in 1960 he earned his Ph.D. in Physiology (Radiation Biology). In 1962, he exchanged jobs with Eric Hall for a year in Radiotherapy as a NCI Special Fellow at the Churchill Hospital in Oxford where he became involved with the development of compensating filters in radiation therapy using LiF dosimetry.

Arnold rejoined Marvin Williams at the Mayo Clinic in 1964 where, as Arnold described it, “everything was done gracefully.” After Marvin retired, Arnold joined radiation therapists William Powers and Carlos Perez at Washington University, St. Louis, for five years. This was an exciting period in radiation oncology with high energy accelerators replacing Co-60 teletherapy units and the development of computerized dosimetry. Among associates he recruited was Andre Demidecki who helped develop applications of low-melting alloys for radiation field-shaping. At Bob Shalek’s invitation in 1973 Arnold became the first visiting scientist to the RPC (Radiologic Physics Center) at the MD Anderson Hospital. During this time he and Bob were major contributors to drafting NCRP Report 69 on X-ray Dosimetry.

After working in academic radiotherapy centers for 25 years, Arnold took a major change in direction by joining a private radiation therapy group in Peoria under Dr. Irving. J. Wigensberg whom he had met at Washington University. He joined the group in

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1973 and remained until his retirement some 26 years later. Arnold enjoyed very much “working in the trenches” as he put it. But he also worked on a number of self-selected unfunded projects with a volunteer associate (Dr. John Friem).

Together they published several papers and a book - Medical Physics Handbook of Units and Measures.

Arnold was a member of many scientific and professional societies including the AAPM, ACMP, ACR, RSNA, ASTRO, SNM, ARS, HPS, HPA and BIR and he worked diligently on many of their committees including the AAPM History, Ethics, Awards Selection, Membership and Teaching committees. He was chairman of several. Arnold served as AAPM secretary (1979-81) and received the first AAPM Award for Achievement in Medical Physics (1996). He was also honored as a fellow of the AAPM, the ACMP and the ACR. Arnold was truly the perfect gentleman and a scholar with a broad range of interests. He was well liked by all who had the pleasure of working with him.

He was always polite, very patient, modest and soft spoken and he served as a role model on how to communicate effectively with personnel who had no training in medical physics. Arnold downplayed his many achievements, saying during an interview in 1991 that “everyone stands on everybody’s shoulders.” Arnold will be long remembered with fondness by all privileged to have known him. I am grateful to have been one of those so honored for over 50 years.

Arnold is survived by his wife, Sybil, his son by his first marriage, Ethan, his stepchildren Lou Anne Davidson, Tracey Lance, and Tim Hesh and five grandchildren.

Robert O. Gorson Columbia, SC

Editor

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

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

PRINT SCHEDULE • • • •

The AAPM Newsletter is printed bi-monthly.

Next issue: July/August Submission Deadline: May 20, 2009 Postmark Date: week of June 29, 2009

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