AAPM Newsletter July/August 2009 Vol. 34 No. 4 by AAPM Docs

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 34 NO. 4

JULY/AUGUST 2009

AAPM President’s Column association continues to evolve and solidify its role in the future. Ad Hoc Committee on the Establishment of a Technology Assessment Institute

Maryellen Giger University of Chicago 2009 Ad Hoc Committees of the AAPM

s President of the AAPM, I have the privilege of establishing Ad Hoc committees. I have established three new Ad Hoc committees: the Ad Hoc Committee on the Establishment of a Technology Assessment Institute (chaired by William Hendee), the Ad Hoc Committee on Quantitative Imaging (chaired by John Boone), and the Ad Hoc Committee on the Electronic Presence of AAPM (chaired by Martin Weinhous). In this newsletter column, I attempt to describe the goals and accomplishment of these new ad hoc committees, and, as always, welcome your comments (m-giger@uchicago. edu). The establishment of these ad hocs, my participation at various AAPM meetings/summits/retreats, and my numerous discussions with AAPM members has increased over and over again my acknowledgment and esteem of the AAPM and its members. The dedication, insightfulness, and energy of our members are impressive as our

The TAI Ad Hoc was established early this year after my visit to the Science Council retreat. Much discussion on the TAI (http://www.aapm. org/org/structure/?committee_ code=AHETAI) was had by the initial members of the ad hoc committee including William Hendee (chair), John Boone, Paul Carson, Thomas Rock Mackie, Mitchell Goodsitt, Ehsan Samei and me. Interestingly, a TAI is quite aligned with our U.S. administration’s promotion of “comparative effectiveness” -- demonstrating the visionary strengths of our AAPM Councils. The Ad Hoc Committee on the Establishment of a Technology Assessment Institute was formed with the charge: 1. To investigate the potential need for and methods of establishment of a Technology Assessment Institute (TAI); 2. To determine the range of functions of a TAI relative to imaging, image-guided therapy, and radiation therapy; 3. To determine the range of functions of a TAI in terms of pre- and post-market clearance of systems; 4. To determine the relationship between a TAI with the FDA, NIH, ACRIN, other cooperative groups, etc;

5. To explore funding mechanisms including stimulus funding, industry funding, etc. The first accomplishment of this TAI Ad Hoc was the AAPM submission of a Challenge Grant to NIH, of which I will describe later. First though it is important to relate comparative effectiveness and technology assessment. The Department of Health and Human Services has stated that: “Comparative effectiveness research provides information on the relative strengths and weakness of various medical interventions.” Comparative effectiveness has been a major theme in NIH’s recent stimulus funding request for applications, and the Federal Coordinating Council TABLE OF CONTENTS President-Elect’s Column Editor’s Column Executive Director’s Column Education Council Report Science Council Report Professional Council Report Website Editor’s Report ACR Accreditation Chapter News Leg. & Reg. Affairs Workforce Study Update MUSE Update Health Policy/Economics Persons in the News Memorial

p. 4 p. 5 p. 6 p. 9 p. 11 p. 13 p. 15 p. 16 p. 17 p. 18 p. 19 p. 20 p. 23 p. 24 p. 27

AAPM Newsletter for Comparative Effectiveness Research has been holding “listening sessions” to obtain public comment on comparative effectiveness. I presented the AAPM’s views on comparative effectiveness at the May 13, 2009 federal listening session. Some of those comments are included here. When various medical procedures and/or technologies are available for achieving a given medical intervention, it becomes necessary to compare these procedures for specific groups of patients to optimize the benefit (e.g., earlier detection of cancer in screening procedures; improved targeted dose delivery in radiation therapy) and minimize the cost and/or risk (e.g., reduced radiation dose in diagnostic procedures; minimization of dose to normal tissues and critical organs in therapeutic procedures). Means to perform such comparative assessment studies may include clinical evidence-based outcomes evaluations that require expensive and sometimes lengthy clinical trials involving a substantial number of patients to achieve statistical certainty. However, when well-defined physical or engineering differences exist between products, which do not rely on different anatomic or physiological phenomenon, comparative effectiveness can be determined by assessing technology using quantitative metrics. This will be particularly useful and cost effective in situations where simple modifications of an existing medical technology are introduced or a new technology is available that is changing rapidly in its potential for proving efficacy. In those cases and at those times, relatively inexpensive physical measurements may be most appropriate. Examples of ongoing and future roles of medical physics in comparative effectiveness studies include op-

July/August 2009 timization of radiation dose in computed tomography (CT), i.e., image quality can be assessed quantitatively between different computed tomography (CT) scanners at the same radiation dose levels, providing an objective measure of comparative effectiveness that may not require a clinical trial. An issue that is often ignored in comparing the effectiveness of medical imaging technologies is that there can be large differences in the image quality, ease of use, and other features of devices of a given type that can significantly affect diagnostic accuracy and health outcomes. Another example is the comparative effectiveness of photon therapy versus proton therapy in the treatment of prostate cancer by measuring the dose to the tumor target compared to the rest of the patient’s (normal) tissues. In these situations, comparative effectiveness can be ascertained without “costly” clinical trials, or in advance of such trials. At the federal listening session, I noted, in summary, that it is important to realize that technology assessment studies are a subset of comparative effectiveness studies, that the reach of comparative effectiveness includes both diagnostic and therapeutic procedures and systems, and that medical physicists play a vital role in conducting such studies. The AAPM’s TAI Ad Hoc committee’s submission of a Challenge Grant to NIH was led by Paul Carson and was titled, “Technology Assessment Institute for Medical Imaging and Image Guided Therapy.” The grant notes that assessment of medical technologies in general, and imaging technologies in particular, should determine whether the technologies satisfy four criteria: • Use of the technology is appropriate for the patient’s condition. • There is no other technology or procedure that would yield the nec-

essary information in a safer, more effective and less expensive manner. • The technology is performing at an optimal level. • The individuals operating the technology have the requisite education and experience to use the technology and to interpret its results. Currently there is no center or locus of expertise to assess medical imaging technologies according to these four criteria. Success in meeting these criteria will greatly help assure that the technology will improve patients’ outcomes. The submitted grant has four major projects lead by Jeff Siewerdsen, Ehsan Samei, Mitch Goodsitt, and Paul Carson, and aims to evaluate emerging medical imaging technologies for their potential to satisfy these four conditions of technology assessment. Ultimately, if established, the TAI would include emerging technologies in radiation therapy. Note that reports by a TAI detailing impartial quantitative test results for the various brands and models of imaging devices would be of great assistance to the health care institutions in making their purchase decisions. Ultimately, by helping to address the problem of over utilization of medical imaging and therapy technologies, the technology assessment process is expected to contribute to effective use of healthcare dollars and more efficient delivery of healthcare services to the public. I congratulate all those involved on this submission. Ad Hoc Committee on Quantitative Imaging The Ad Hoc Committee on Quantitative Imaging was established this year with the charge: 1. To assess the role of AAPM and its members in the growing field of quantitative imaging, e.g., as it relates to imaging biomarkers, assessing disease states and/or response to therapy.

AAPM Newsletter 2. To determine mechanisms for clarifying quantitative imaging, computer-aided diagnosis, and quantitative image analysis; 3. To determine mechanisms for promoting AAPM and medical physics activities in QI in basic science research, translational research, clinical trials, and ultimately clinical practice (e.g., at annual meetings, in the Medical Physics journal, etc.) 4. To further advance the field by interacting with other organizations. Many AAPM members have been focusing their efforts on quantitative imaging, including the preparation of an AAPM grant submission, led by John Boone, on “the Quantitative Imaging Initiative” which aims to develop, implement, disseminate and ultimately standardize imaging protocols and analysis procedures that capitalize on the quantitative potential of medical images in the modern health care environment. AAPM has also been interacting with RSNA with their multi-society TQI (Towards Quantitative Imaging) initiative, the Imaging Biomarkers Roundtable, and QIBA (Quantitative Imaging Biomarkers Alliance). Working together, the various organizations have developed a working definition of quantitative imaging that states “Quantitative Imaging is the extraction of quantifiable features from medical images for the assessment of normal (or the severity, degree of change or status of a disease, injury or chronic condition relative to normal). Quantitative imaging includes the development, standardization, and optimization of anatomical, functional and molecular imaging acquisition protocols, data analyses, display methods, and reporting structures. These features permit the validation of accurately and precisely obtained image-derived metrics with anatomically and physiologically relevant parameters including treatment

response and outcome and the use of such metrics in research and patient care.” The Quantitative Imaging Biomarkers Alliance was established in order to unite researchers, healthcare professionals, and industry stakeholders in the advancement of quantitative imaging and the use of biomarkers in clinical trials and practice. More information on QIBA can be found at RSNA.org/ Research/QIBA. AAPM is to be commended for their contribution of physics expertise and support in these efforts to move quantitative imaging from laboratory to clinical trials, and ultimately clinical practice. Ad Hoc Committee on the Electronic Presence of AAPM The Ad Hoc Committee on the Electronic Presence of AAPM was also established this year, and has a developing charge that in draft form includes: 1. To review the state-of-the-art in electronic presence in general, and how such is used by other organizations; and to gather ideas from AAPM stakeholders. 2. Based on the information acquired, to determine if new “methods” and content can enhance the communication and relay of information between and amongst AAPM members, related professionals, schools, government, the press, and the public. 3. Determine the structural changes that would be needed within the AAPM to implement any agreed-upon and approved methods for enhancing communications, including metrics for determining success. While the AAPM has been using email, hosting web-based meetings, informing us through the website, and continuing to go more “electronic”, it is useful for

July/August 2009 an organization to periodically step back and reassess itself relative to its use of a rapidly-changing technology. What is the extent of the technology? How can we best use the technology to enhance our communication – e.g., between AAPM members, between AAPM leadership and members, between AAPM and our other professional colleagues, to educators, to government, etc.? I thank the members of the EMCC (Electronic Media Coordinating Committee) for their continuing dedication to the AAPM, and see this ad hoc as potentially redefining and/or expanding the charge of the EMCC. As I have progressed through life, I have seen that suboptimal communication has been the cause of most misunderstandings and/or problems. While useful communication will always rely heavily on people, if we can improve the conduit for that communication perhaps the outcome can be more effective. I continue to find my time as your president to be exciting and motivating. Some of these ad hocs are aligned with various aspects of our country’s new administration – especially issues of comparative effectiveness and those related to healthcare in the electronic age. These AAPM ad hocs are still growing, so if you are interested in contributing to them, please email me or the specific ad hoc committee chairs. Thank you.

AAPM Newsletter

July/August 2009

AAPM President-Electâ&#x20AC;&#x2122;s Column

Michael G. Herman Mayo Clinic

o you ever ask yourself why you became a medical physicist? Do your kids or friends ask you that question (or what the heck IS a medical physicist)? Maybe your answer follows one of the primary tenets of the AAPM mission statement: 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 medical services for patients. We are scientists and professionals, critical thinkers and problem solvers, in radiation therapy, radiology, nuclear medicine, research laboratories, universities and other areas focused on the use and application of physics in medicine. We are actively engaged in carrying out one or more of the mission statements above. We are however a small entity within the much larger profession of medical science and health care practice. There are approximately 14 million people that work in the health care industry in the United States. Over 750,000 are active physicians, over 290,000 are technologists

(members of ARRT), while the membership of the AAPM stands at around 7000. We may be a small group, but our impact is farreaching. Our field remains rich with opportunity and challenge. It is dynamic with new science and technology constantly in development. Next generation medicine results from science done by medical physicists. The science is transformed into practical tools that are used with our guidance to provide high quality health care to fellow human beings. We enjoy employment as respected professionals recognized by our peers, regulators, scientific agencies and legislators as experts in the physics and technology of medicine. It really is not about how big we are, or how much we are compensated materially, rather the positive impact each of us can have on improving human health. One challenge facing all of us is health care reform, which has been discussed for decades. With our current health care economics and limitations, our system must change if it is to continue to function and to serve all people who require quality medical care. We have heard talk about the changes that may come. Obamaâ&#x20AC;&#x2122;s administration has allocated billions of dollars toward reform and for example, comparative effectiveness research. Objective analysis is a significant challenge when the stakes are high and the political activists represent very large industry sectors, groups of professionals and special interest constituencies. We must work together with other groups that have similar or related interests and goals and be clear and consistent with our message of the value that the medical

physicist adds to the equation. That equation is objective (and appropriate) utilization of technology to the benefit of the patient. We all have many responsibilities in our professional lives. One important responsibility that each of us has is education; we must remember that we are all teachers and we are all students. Each of us received training in some fashion to become the medical physicist we are today and we continue to learn and grow. Some of us began with scientific degrees in experimental and conventional physics, while others obtained graduate degrees from medical physics programs. Some did post doctoral fellowships in research medical physics and others did residency training. Many years ago, most received training on the job as an apprentice. Our field has remained very strong with a tremendous breadth in scientific scope and intense intellectual power, because of the people (all of us) that have entered medical physics. As we continue to mature as a profession, consistent training has been a focus, especially for clinical practice. Specifically, the framework to allow every practicing clinical medical physicist to receive training in a CAMPEP accredited clinical training program followed by board certification is being put in place. While consistent training is essential to producing competent QMPs, it must be accomplished without closing the door to talented and motivated individuals to enter our field. Continuing education is also very important. Jerry White and I attended the AAPM Promises and Perils of Protons Symposium. This was a very well done meeting where scientific experts and thought leaders

AAPM Newsletter

July/August 2009

Editor’s Column of AAPM membership), I am not sure whether the rest of the membership wishes to continue receiving the hardcopy newsletter or have not taken the time to respond to the email to check-off the opt-out option.

Mahadevappa Mahesh Johns Hopkins University

elcome to the newsletter issue before the annual meeting. This is already the 4th issue, which means we are half way through 2009. As I mentioned in my last column, an email was sent out to all AAPM members announcing the availability to ‘opt-out’ of the print copy of the newsletter. Response has been good, with 1,270 members opting out of receiving the print newsletter. This response provides an opportunity to further reduce the newsletter expense. Even though I received good initial response (18%

plainly focussed on this current and important topic. The AAPM is new to this type of meeting, but based on its success and from the interest within our three councils in providing smaller focused meetings, we are developing a process to facilitate these meetings. With the annual meeting right around the corner, we all know it is impossible to see all we wish to see at the meeting and due to budgets and staffing, some can not attend this meeting at all. Subsets or excerpts from the annual meeting provided perhaps at the chapter or regional level, sponsored by AAPM, could

I wish to reiterate the offering to all AAPM members who have not responded to please do as soon as possible. Your responses will provide me with a clearer picture of how many newsletters will have to be printed next year and respectively provide a better budget estimate. I understand many members prefer to receive the print edition for reasons such as the convenience of carrying the newsletter to read at their leisure, anywhere any time, and my intention is to still provide this for those that would like to continue to receive the printed edition.

Meeting and many articles relating to professional, scientific and educational issues. Finally, I would like to draw your attention to the Persons-in-news articles and wish to congratulate Dr. Azam Niroomand-Rad for having receiving the highest award (Madame Curie) from the International Organization of Medical Physics (IOMP) this year. Having worked closely with Dr. Niroomand-Rad for many years, no one deserves this award more than she does and I wish to congratulate her on this award. I would also like to congratulate all the AAPM members who became Fellows of the American College of Radiology this year. I wish all readers a very happy and relaxing summer and look forward to seeing many of you at the AAPM Annual Meeting.

This issue is reaching the membership just prior to the AAPM Annual Meeting and therefore contains much useful information about the Annual provide excellent additional value and content accessibility to all of us. Look for more about these meetings in months and years to come. We are fortunate to participate in such a dynamic field with the potential to help other people. Medical Physics as a profession doesn’t owe any of us anything. We in fact owe the profession our sincere thanks for making our employment and professional standing as successful as it is. The profession is comprised of each of us. We should each consider paying that debt back to the

profession, to keep medical physics viable for now and for the future. That only happens if we all continue to contribute our resources and our efforts, not only in our daily employment as a medical physicist, but to our profession.

AAPM Newsletter

July/August 2009

AAPM Executive Director’s Column

Angela R. Keyser College Park, MD Remember to Vote! lections for the 2010 Officers and Board Members-At-Large will close on July 8. Make sure to cast your ballot.

2008 Salary Survey The 2008 Salary Survey is available online only. You can download a PDF from the web or have the document emailed to you. If you have any problems, please contact HQ. 2009 Summer School Scholarship Recipients AAPM offers scholarships in the form of a waiver of tuition for the Summer School. This year, there were 37 applications. Congratulations to the ten 2009 recipients: Robin Campos, Jing Cui, Jackeline Esteban, Liang Liang, Holly Lincoln, Geethpriya Palaniswaamy, Bhavin Patadiya, Ben Robison, Omar Wooten and Tianming Wu. In addition, Capintec sponsors two $500 grants to assist with other expenses related to the Summer School. Capintec established these grants to honor the memory of Arata Suzuki, Ph.D., who was part of Capintec for more than 20 years. Holly Lincoln and Jing Cui are the recipients of the 2009 Suzuki grants.

Annual Meeting News Use the online Meeting Planner to generate your personal meeting schedule by compiling sessions, talks and committee meetings you plan to attend into a single chronological document. You must be logged in to the abstract system to use the Meeting Planner. Then, compile your schedule, download the .vcs file to import to your PDA, or print it out as a reference. If the time of your meeting, session or talk changes, the planner automatically updates your personal schedule. Make plans to attend: • 2009 Town Hall meeting on Wednesday, July 29 from 4:00 PM5:30 PM in the convention center. Members of the AAPM Board will be on hand to hear from the membership. • 2009 Annual Business Meeting will follow the Town Hall meeting and will include a discussion of proposed Bylaws changes regarding AAPM membership categories. The proposed Bylaws changes will then be voted on by the membership in the fall. • 2009 Industrial Physics Forum, special sessions planned for Monday and Tuesday on the theme of “Frontiers in Quantitative Imaging for Cancer Detection and Treatment” in partnership with the American Institute of Physics’ Corporate Associates. Selected speakers have been asked to provide handouts for their presentations. The speakers will either provide the handout for posting on the website pre-meeting or at show site, to be posted following the meeting. Please check the Handout site for the progress on submissions.

Scientific registrants will find two $10 meal vouchers in their meeting registration bag, good towards lunch on both Monday and Tuesday during the meeting. Make plans to eat lunch in the exhibit hall on these days between 11:00 AM -1:00 PM, and visit with the AAPM exhibitors. For the latest information, go to: http://www.aapm.org/meetings/09AM/ Reducing AAPM’s Impact on the Environment As I’ve mentioned in past newsletter articles, AAPM is a founding member of the Convene Green Alliance, a grass-roots organization initiated by the association and meetings communities in response to the concerns and desires of their members for the environment. AAPM was a featured case study during a recent Convene Green Alliance seminar entitled Connect with Green: How technology is helping associations reach new audiences, save money and protect the environment. Michael Woodward was able to share with the audience numerous ways that technology changes have made a significant reduction to AAPM expenses, including the AAPM online abstract submission process and the online membership directory. AAPM staff members realize the amount of waste created by a single meeting. Most green ideas cost nothing extra, and some even save AAPM money. Our efforts to be more environmentally responsible during the 2009 Annual meeting include the following: • The pocket program will be printed on 30% post-consumer recycled paper with soy-based ink. • The Anaheim Convention Center uses certified shade-grown cof-

AAPM Newsletter fee, cage-free eggs, biodegradable and recyclable utensils, cups and serving plates, and organic catering and concessions items. • Convention Communications, AAPM’s designated door drop partner, has implemented a new initiative. For each company participating in our door drop service, Convention Communications will have a native tree planted in a U.S. ecosystem restoration project to offset the resources used in printing and the carbon used for transportation. • Brede Exposition Services, our official service contractor, produces signs on reusable Sintra plastic. Brede reuses, then recycles miles of carpet. Aluminum and cardboard from the show floor is recycled.

Staff Recognition Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high-performing professionals. The

July/August 2009 AAPM team members listed below celebrated an AAPM anniversary in the first half of 2009. I want to publicly thank them and acknowledge their efforts.

AAPM HQ ANNIVERSARIES Nancy Vazquez Jennifer Hudson Zailu Gao Hadijah Robertson Kagolo Cecilia Hunter Karen MacFarland Lynne Fairobent Lisa Giove Laurie Hayden Onasis Budisantoso Ramy James Amanda Potter Ashleigh Wheelock

13 years of service 8 years of service 8 years of service 8 years of service 6 years of service 6 years of service 5 years of service 4 years of service 2 years of service 1 year of service 1 year of service 1 year of service 1 year of service

AAPM HQ Team…at your service! Lisa Giove joined the AAPM team in 2005 as the Receptionist. Her hard work and dedication was quickly evident, and she now serves as Senior Executive Assistant and the Executive Director’s right-hand! Lisa supports the Executive Committee and Board on governance-related projects, maintains the AAPM Policy Manual, handles elections, and manages the headquarters office at various AAPM association meetings. She is also the HQ liaison to AAPM chapters. Ashleigh Wheelock celebrated her one-year AAPM anniversary early in 2009. As the Customer Service Representative, Ashleigh answers the main phone line, handles general inquiries, and assists with setting up conference calls. She also assists with the Medical Physics journal.

Left - Ashleigh Wheelock, Right - Lisa Giove

AAPM Newsletter

July/August 2009

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ŚĂůůĞŶŐĞƐ ŽĨ WŽƐƚͲƚƌĞĂƚŵĞŶƚ ĂŶĚ ZĞĂůͲƟŵĞ /ŵĂŐŝŶŐ ŽĨ ŽƐĞ ĞƉŽƐŝƟŽŶ ƵƌŝŶŐ WƌŽƚŽŶ dŚĞƌĂƉǇ &ƌŽŶƟĞƌƐ ŝŶ WŚǇƐŝĐƐ /ŵĂŐŝŶŐ ĂƐ Ă ŝŽŵĂƌŬĞƌ EĂŶŽƚĞĐŚŶŽůŽŐǇ ŝŶ /ŵĂŐŝŶŐ ĂŶĚ dŚĞƌĂƉǇ ^ĐƌĞĞŶŝŶŐ͕ ŝĂŐŶŽƐŝƐ͕ ĂŶĚ dƌĞĂƚŵĞŶƚ ŽĨ ƌĞĂƐƚ ĂŶĐĞƌ DZͲ'ƵŝĚĞĚ ZĂĚŝŽƚŚĞƌĂƉǇ /ŵĂŐĞ 'ƵŝĚĞĚ /ŶƚĞƌǀĞŶƟŽŶƐ͗ /ŵĂŐŝŶŐ 'ƵŝĚĂŶĐĞ͕ ĂŶĚ EĞǁ dĞĐŚŶŽůŽŐŝĞƐ ĨŽƌ /ŶƚĞƌǀĞŶƟŽŶĂů WƌŽĐĞĚƵƌĞƐ

DŽƌĞ ƚŚĂŶ ϱϬ ŚŽƵƌƐ ŽĨ ĐŽŶƟŶƵŝŶŐ ĞĚƵĐĂƟŽŶ ŝŶ ŵĞĚŝĐĂů ŝŵĂŐŝŶŐ ĂŶĚ ƌĂĚŝĂƟŽŶ ƚŚĞƌĂƉǇ ƉŚǇƐŝĐƐ ǁŝůů ďĞ ŽīĞƌĞĚ͘ dŚŝƐ ǁŝůů ŝŶĐůƵĚĞ ^ D^ ĐŽƵƌƐĞƐ ĨŽƌ ĚŝĂŐŶŽƐƟĐ͕ ŵĞĚŝĐĂů ŶƵĐůĞĂƌ͕ ĂŶĚ ƌĂĚŝĂƟŽŶ ƚŚĞƌĂƉǇ ƉŚǇƐŝĐŝƐƚƐ͘

ǁǁǁ͘ĂĂƉŵ͘ŽƌŐͬŵĞĞƟŶŐƐͬϬϵ D

WƌŽīĞƌĞĚ ďƐƚƌĂĐƚ ^ƵďŵŝƐƐŝŽŶƐ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ ͻ

&ƵƚƵƌĞ /ŵĂŐŝŶŐ ^ƚƌĂƚĞŐŝĞƐ ŝŶ ZĂĚŝŽƚŚĞƌĂƉǇ dĂƌŐĞƚ >ŽĐĂůŝǌĂƟŽŶ /ŵĂŐĞ 'ƵŝĚĞĚ ZĂĚŝĂƟŽŶ dŚĞƌĂƉǇ dĂƌŐĞƚ ĂŶĚ EŽƌŵĂů KƌŐĂŶ ĞůŝŶĞĂƟŽŶ DŽĚĞůŝŶŐ ŽĨ /ŶƚƌĂĨƌĂĐƟŽŶ DŽƟŽŶ /ŶƚĞƌĨƌĂĐƟŽŶ DŽƟŽŶ ĂŶĚ DĂƌŐŝŶ ƐƐĞƐƐŵĞŶƚ sŽůƵŵĞƚƌŝĐ ĂŶĚ ^ƵƌĨĂĐĞ /ŵĂŐŝŶŐ ĨŽƌ ZĂĚŝŽƚŚĞƌĂƉǇ 'ƵŝĚĂŶĐĞ /ŵĂŐŝŶŐ ĨŽƌ dŚĞƌĂƉǇ ƐƐĞƐƐŵĞŶƚ /ŶŶŽǀĂƟŽŶƐ ĂŶĚ &ƌŽŶƟĞƌƐ ŝŶ DĞĚŝĐĂů WŚǇƐŝĐƐ ^ŵĂůů ŶŝŵĂů /ŵĂŐŝŶŐ ĂŶĚ dŚĞƌĂƉǇ dĂƌŐĞƚ >ŽĐĂůŝǌĂƟŽŶ ŽŶĞ ĞĂŵ d ŽƌƌĞĐƟŽŶ ^ƚƌĂƚĞŐŝĞƐ dƌĂŶƐůĂƟŽŶĂů ZĞƐĞĂƌĐŚ dĂƌŐĞƚ ĂŶĚ EŽƌŵĂů KƌŐĂŶ ĞĮŶŝƟŽŶ

AAPM Newsletter

July/August 2009

Education Council Report Speaking of learning, teaching, and education opportunities, the 2009 Annual Meeting in Anaheim will feature, in addition to the wide array of education courses in diagnostic, nuclear medicine and therapy topics, three timely symposia on Sunday, Monday, and Tuesday.

J. Anthony Seibert Education Council Chair

he Education Council met on April 17-18 in Denver, in conjunction with a cold and snowy weather front that precluded a couple of members of the Council from making the retreat. Nevertheless, a quorum of members in addition to Lisa Sullivan and Lynne Fairobent from headquarters staff made the event worthwhile and timely for setting goals and directions of the Education Council for the coming years. Mike Herman, representing EXCOM, provided valuable direction from his remote Minnesota appearance (yes, a victim of the weather) in explaining the need to prioritize important issues for the board, by developing clear and concise issues, charge, justifications and backup data for projects, including resources, costs and time commitments. We are in the midst of a great change in the way in which medical physics education is – and will be – taught, delivered, and tested, and the response by the Education Council is crucial in being attentive to the medical physics of the future and ensuring that directives and programs meet the need of the membership in an efficient and costeffective manner.

1. The Education Council Symposium, Sunday July 26 at 11:00 AM, will feature a short 10-15 minute segment of the American Board of Radiology 75th anniversary video, followed by Dr. John Bayouth and faculty colleagues with a one-hour presentation on the content and expectations of the Medical Physics Residency Self-Study Workshop, to be offered again on August 2829, 2009, in Minneapolis. This onehour segment will be a fantastic way for physicists planning on starting a residency program to gain insight into the process and prepare for the upcoming workshop. 2. Are you getting tired of the same-old didactic methods of

teaching? Innovations in Medical Physics Education, directed by Dr. Don Frey, will feature several presentations on new and innovative ways to deliver and teach medical physics topics to a variety of audiences, on Monday afternoon, July 27, from 1:30 – 3:20 PM. A “can’t-miss” if you are needing some insight on how leading teachers are showing the way to more efficient delivery and better understanding of complex physics concepts to a classroom of learners. 3. On Tuesday morning from 10 – 12 noon, under the guise of the “Professional Symposium,” Dr. Bill Hendee will be presenting a recap of the very successful 2008 Physics Teachers Workshop, and with several faculty demonstrate how one can become a better teacher of medical physics using compelling examples of how the experts get the involvement of their students in the process of learning. Bill will also outline the content of the 2010 AAPM Summer

Attendees of the 2009 Education Council Symposium in Denver, Colorado. (back row): George Starkschall (L -R middle row): Perry Sprawls, Will Parker, Mark Rzeszotarski, Melissa Martin, Tony Seibert, Ed Barnes and Eric Dick (L - R front row): Lisa Rose Sullivan and Herb Mower (Photo taken by Lynne Fairobent ).

AAPM Newsletter

July/August 2009

School in anticipation of this great opportunity for medical physicists to strengthen their teaching and learning abilities. In coming newsletters I will discuss in more depth the directives and efforts by the individual committees, subcommittees, task groups and working groups of the Education Council. Finally, a word about the value of our AAPM membership from the perspective of the sponsored education programs …… “Where’s the beef ?” was an oft-heard expression in the mid-1980’s by a spokesperson for Wendy’s restaurants, Clara Peller, touting competitors hamburgers with lots of bun but very little meat, casting doubt on the value of the purchase (except for Wendy’s, of course) (Please NOTE: substitute vegetables, tofu, your favorite food, or “…..” if you are offended by the thought of beef; certainly this is meant to be equal application to all who eat food …..). The members of EXCOM, the Board, and the Council Chairs are sensitive to the perceived value of AAPM membership by its members, whether real or imagined. There are many value-added benefits that we as members either take for granted or simply do not know about. A pertinent example that I want to discuss here is the AAPM Virtual Library, particularly in light of the upcoming jam-packed annual meeting, in which there just isn’t enough time to consume all of the educational, scientific, and professional activities that are available due to multiple simultaneous sessions and/or the need to participate in task group functions and other endeavors. Or, not being able to attend the annual meeting or summer schools

Education Council Working Group (not pictured: Perry Sprawls and Tony Seibert)

or other workshops due to declining travel funds or lack of time. However, at the click of the mouse and entry into the AAPM website as a member, an extensive virtual library collection of educational resources is available around the clock, all year long, fiscally supported by the AAPM membership for the AAPM membership. Go to http://aapm. org/meetings/virtual_library/ and navigate to the specific offerings of interest. The media library, generated in conjunction Blue Sky Broadcast, provides access to events recorded at the Annual Meetings, Summer School, History Interviews, Educators Day, CRCPD conferences, AAPM workshops, and corporate affiliates from 2005 to present. There is an amazing amount of content that can easily be perused and viewed quickly or in depth, at your leisure. I would encourage all of you to take advantage of this extremely valuable feature, which also can serve as a component of Maintenance of Certification. “Try it, you’ll like it” was a saying to an individual looking at a large and enticing amount of food for Alka Seltzer TV commercials beginning in the early 1970’s. With

the expected over-indulgence and indigestion, the response was “I can’t believe I ate the whole thing…..” The Virtual Library is just one of the many things that fill the large and enticing menu of educational, scientific, and professional items offered by membership in the AAPM. You don’t have to ingest everything at once, but only as you need and want to access the resources available to you. So I say again, “Try it, you’ll like it…” and you will realize that there is a lot of valueadd that makes your membership in the AAPM indispensable, really worthwhile and at the same time very digestible.

AAPM Newsletter

July/August 2009

Science Council Report

John Boone Science Council Chair

cience Council hosted the Promises and Perils of Proton Radiotherapy Symposium in Baltimore on May 8-9. This multidisciplinary meeting targeted toward both physicists and physicians proved to have good turn out (197 registrants), and filled two days with provocative talks and panel discussions on the technical, clinical, research and health care financing aspects of proton radiation therapy. We are grateful to Jatinder Palta, Eric Klein, and Chris Rose who organized and ran the meeting, with the expert help of Karen McFarland and other AAPM staff members.

• PRT is less tolerant than photon therapy to uncertainties in both treatment planning and treatment delivery. These uncertainties arise from several sources: Intrinsic basic physics of proton interactions, precision and accuracy in treatment planning and dose calculation approximations, biological considerations, setup and anatomical variations, and internal movements of low and high density organs into the beam path. Organ motion can have a major impact on the proton range, and forces the addition of a distal safety margin, increasing the volume of normal tissue treated. The necessary margins have the potential to reduce the expected benefit of proton treatment in many clinical sites affected by density or motion variations, such as lung, prostate, abdomen, head/neck, and others. • Design of possible clinical trials to evaluate the clinical efficacy of PRT is complicated by the consideration that PRT is (in some respects) in its technological

infancy and the state of the art in PRT will continue to improve over the next decade. Whether comparisons of PRT, which is still going up the technological learning curve, to much more widely understood and optimized photon therapy should be performed now was the subject of debate. • Major discussion on the need, potential value, and benefits of formal prospective clinical trials of PRT versus photon therapy was discussed with much vigor. Issues of equipoise (how to design trials which do not fall into an ethical conundrum in assigning patients to one arm of a clinical trial which someone (the patient, or the physician) may feel leads to inferior care) were discussed and there were many differences of opinion among radiation oncologists and others as to how to address equipoise, trial design, and patient selection in proton RT facilities. Consequently, there were concerns about difficulties in performing prospective clinical trials comparing

Among the many Proton Radiation Therapy (PRT) issues that were presented and discussed at the meeting, a number of take home messages were clear: • PRT has proven potential to reduce integral dose (dose to normal tissues in the patient) compared to photon therapy (including IMRT), and this can potentially reduce the morbidity of RT for many patients, including lowering the risk of radiation-induced secondary cancers. This may be valuable for all patients, but is especially important for pediatric patients.

“Promises and Perils of Proton Radiotherapy Symposium” held in Baltimore, MD on May 8-9; hosted by AAPM’s Science Council.

AAPM Newsletter

July/August 2009

proton with photon RT within individual institutions, since the trial design may potentially be compromised by ethical issues that may bias patient recruitment. â&#x20AC;˘ The financial costs and issues of ethical patient selection (equipoise) at proton RT centers make randomized clinical trials difficult to design. However, there was strong support among many that carefully designed prospective clinical trials (which may not necessarily need to be randomized to answer the

question(s) posed) which compare proton and photon radiotherapy results, efficacy, and toxicity are quite important both to the field (as we try to use our limited resources to best help patients) and to the countryâ&#x20AC;&#x2122;s overall health care policy needs. Towards the end of the meeting there was a consensus amongst the AAPM organizers that the AAPM will continue to work with ASTRO and other societies in radiation therapy to promote the clinical assessment

of proton therapy in comparison with photon therapy. While the exact types of comparison studies which are needed depend on the specific questions asked, it is clear at this point that given the expense of proton therapy, development of appropriate clinical studies to evaluate and document clinical outcome results are warranted.

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AAPM Newsletter

July/August 2009

Professional Council Report

Per Halvorsen Professional Council Chair Focused on common goals: The AAPM and ACMP

he AAPM Professional Council held its annual planning meeting in Virginia Beach, just prior to the ACMP’s Annual Meeting there in early May. For the past few years, we have scheduled our meeting to coincide with the ACMP meeting, so we can develop a closer working relationship and better understand each association’s priorities with regard to professional practice issues. At the last day of our meeting, we were fortunate to have the ACMP leadership join us for an open discussion about our respective priorities for the coming years – it was a very productive conversation which I hope will become an annual tradition. Two concrete examples of the increased collaboration between our associations are: • The AAPM and ACMP cosponsored a daylong session at the ACMP meeting titled “Medical Response to Radiation Incidents” which focused on how medical physicists can assist in responding to radiation incidents.

• The AAPM and ACMP’s joint effort to promote minimum standards for clinical medical physics, via the Joint Medical Physics Licensure Subcommittee. The group has made excellent progress on several fronts, including licensure initiatives in 5 states, model regulatory language, and exploratory work with the CRCPD. Contact Amanda Potter at AAPM headquarters for more information. Look for the article elsewhere in this Newsletter by Wendy Smith Fuss and the Professional Economics committee, providing an overview of their FAQ resource and other forms of assistance with coding questions. Though the Task Group resides under the Education Council, I’d like to remind you that TG-127 continues to develop resources and to seek clarification on the ABR’s MOC program. Toward that end, an AAPM-operated program for satisfying the MOC’s Part IV (also known as PQI) is almost ready for release. The Task Group hopes to have it available by the Annual Meeting. Mike S. Taylor led the effort to develop this program, which we hope will become the first in a series of PQI offerings through the AAPM. The New Professionals Subcommittee of the Professional Services Committee, is preparing for its first “real” meeting in Anaheim after being constituted last fall. Jessica Clements chairs the subcommittee, and contributed the following:

“While attending the 50th Annual AAPM meeting in Houston last year, I had the opportunity to meet several newer physicists after one of the professional sessions. It quickly became clear to us that it would be beneficial to have a subcommittee devoted to new professionals in medical physics. A few of us got the ball rolling after the meeting to officially start the New Professionals Subcommittee (NPSC). We have a total of nine members with various levels of experience ranging from students and recent graduates to physicists with 10 to 30+ years of experience. Our goal is to support the transition of new professions into the field by providing various informational resources regarding topics of particular interest to those just beginning their medical physics careers. Our first project was to create a “medical physics handbook” in wiki format. The information that we have gathered so far is located at http://wikifull. aapm.org/index.php/NPSC. It includes information on professional topics such as board certification, the AAPM structure, state licensure, regulations, clinical practice, and economic affairs. In addition, we have been working to establish an official mentoring program for new professionals. We hope to regionally match mentors with new professionals that are working without access to a seasoned mentor. The goal is for the mentor to provide support in clinical and professional components of the job as well as moral support, social connections, introduction

AAPM Newsletter

July/August 2009

NEW SOFTWARE DESIGNED BY AND FOR BUSY RADIATION THERAPY PROFESSIONALS RT Workspace software allows you to focus on providing high quality care for patients by streamlining the multi-step treatment planning process. At a glance, everyone on your team has easy access to the secure RT Workspace database. Whiteboards, sticky notes and to-do lists are computerized, notifying team members electronically when it’s their turn to complete assigned tasks. Less revenue is lost due to interruptions and workflow errors. “I honestly think RT Workspace has improved the quality of care we are able to provide at this clinic.” – Candace Bletscher, MS “RT Workspace is my personal work organizer … after using it, I feel like I can’t work without it.” – Michele Wolfe, CMD “With RT Workspace I don’t have to keep calling our dosimetrists and physicists … I don’t know how clinicians can live without it.” – Jon Stella, MD

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AAPM Newsletter

July/August 2009

AAPM Website Editor Report at the Annual Meeting. (How Farhana juggles all her many tasks is a constant mystery!)

Christopher Marshall NYU Medical Center

his is mainly a progress report on issues I touched on previously. A recurring issue is finding things on the website. We are upgrading our search engine by adding a hardware search product made by Google at quite modest cost. This will allow us to index all the website content, including PDF documents for the first time. While the device will start to index the entire site as soon as we plug it in, we have to learn how to best exploit the data it produces. Our webmistress Farhana Khan is taking a training course and will be reporting progress to the EMCC

to medical physics culture and a safe avenue to ask questions. Please join us at the New Member Meet the Experts Symposium during the 51st Annual Meeting (4-5:30 p.m. on Tuesday, July 28, Room 211A), where we will have more detailed information about our projects. We look forward to receiving feedback and any suggestions. Please do not hesitate to contact any of our members-all of our contact information

We still plan to change the way that the website responds when you select a main topic. When fully implemented your main menu selection such as “Government Affairs” will immediately display general information on that topic (such as the material now under “Government Affairs Home”) with no extra click. We believe that such displays will provide greater exposure for topical information, will improve access to embedded links on these topical pages, and will also help new members and members of the public get a better overview of AAPM activities. We have several redesigned pages “in the works” that exploit horizontal tabs to organize content. While this may seem like a minor change, the combination of X vertical menu selections with Y horizontal tabs provides XY visually intuitive navigation paths. The main impediment to progress in this and other areas

is located at http://aapm.org/ org/str ucture/?committee_ code=NPSC.” All these efforts on your behalf are performed by volunteers – your colleagues across the country who give their time and effort after their “day job” hours, in order to help our profession remain vibrant and continue to serve the best interests of patients everywhere. If you have a suggestion, 15

is that the various parties with an interest in these pages are all overcommitted. Navigation issues are often dependent on the way each individual tries to use the website, so we need specific feedback rather than generalized complaints. The Website Editorial Board was specifically selected to act as a conduit to the Councils so I encourage the Committees and Councils to put website issues on their agenda or to just get in touch with me. I plan to also attend as many committee meetings as possible to solicit feedback, and I encourage individuals to use the feedback box, below. Finally – on a separate topic – the AAPM logo and other materials on the AAPM website are legally protected and should not be used in ways that have not been specifically authorized by the AAPM. If in doubt, ask! I hope that you find the Website useful, visit it often, and send me your feedback at: http:// www.aapm.org/pubs/newsletter/ WebsiteEditor/3404.asp

criticism, or (better yet) wish to help your fellow colleagues in this endeavor – just look through the Committee Tree on the AAPM website (www.aapm.org/org/ structure) and identify the relevant Council or Committee/SC/ WG chair. Drop him/her a line and offer your help!

AAPM Newsletter

July/August 2009

ACR Accreditation the accreditation application and QC forms are available for downloading. You can also call the Breast Imaging Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, Iâ&#x20AC;&#x2122;ll present questions of particular importance for medical physicists.

Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs ACR Mammography Accreditation: Frequently Asked Questions Does your facility need help on applying for ACR accreditation? Do you have a question about the ACR QC Manuals? Check out the ACRâ&#x20AC;&#x2122;s accreditation web site portal at www.acr.org; click â&#x20AC;&#x153;Accreditation,â&#x20AC;? then the name of the accreditation program. Most of

Q. The manufacturer of our FFDM unit has a number of different revisions of their QC manual available. Which one should we follow for the medical physicist and technologist QC tests? A. In general, you should use the most current version of the QC manual for the unit installed at the facility. Note that the correct manual version may depend not only on the FFDM unit but also the software version of the unit. For Lorad FFDM systems, you may

use any of the Lorad QC manuals that are applicable to your Lorad model; not necessarily the latest. If there are any questions, check with the manufacturer of your FFDM unit. Q. When we print our computed radiography (CR) images on our laser printer, a small white border appears around the image. Is this acceptable? A. Yes. As long as the border does not obscure clinical information, it is acceptable. Q. May I burn a case on a CD and walk it to the main facility for interpretation? A. Yes. However, it must be saved as an original or lossless compressed file. Check with the FFDM manufacturer to verify the files are being saved accordingly.

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AAPM Newsletter

July/August 2009

Chapter News Southeastern Chapter (SEAAPM) Annual Scientific Meeting and Symposium by: Christine Noelke-Gnaster, Chapter Secretary

he Southeastern Chapter of the AAPM held its 2009 Annual Meeting and Symposium on March 12-14 in Chapel Hill, North Carolina. Over 120 people attended the two events and 36 vendors participated in the exhibit.

and student participation was the highest this year as well. For complete symposium and scientific meeting programs, please visit the SEAAPM website at http://www. seaapm.org. During the annual meeting, the chapter honored its members. Jerry Allison received the prestigious Jimmy O. Fenn Award in recognition of his “outstanding career achievements and leadership in the medical physics profession and contributions to the SEAAPM.”

President- Elect: Eshan Samei Secretary: Christine Noelke-Gnaster Treasurer: Ingrid Marshall

This year’s symposium focused on “The Role of Imaging Informatics is Radiation Oncology” and was coordinated by Fang-Fang Yin. The symposium faculty provided outstanding lectures on topics including image management, IT infrastructure and security, treatment imaging modalities, and technological advancements in radiation oncology imaging. The annual scientific meeting immediately followed the symposium with the highest meeting attendance in the chapter’s history. Invited speakers presented sessions covering an array of professional, imaging and therapy topics. The chapter continued the student presentation program that began in 2007. All students presentations were exceptional

Q. Is a radiologist required to be onsite when performing a diagnostic mammogram? A. No. There is no regulation that requires a radiologist to be present during diagnostic mammography. However, the “ACR Practice Guideline for the Performance of Screening and Diagnostic Mammography” recommends that diagnostic mammograms be

“Congratulations” to all awardees. On Friday evening, meeting attendees took a break from the busy meeting schedule for a night out at the historic DuBose House on the UNC-Chapel Hill campus, where they enjoyed socializing with colleagues, friends and family. The chapter business meeting was held on Saturday, after the scientific presentations were complete. Election results for 2009 were announced. The chapter officers and the southeastern chapter’s AAPM Board Representative for 2009-2010 are:

After the business meeting, longtime Treasurer David Gauntt stepped down after 8 years of service to the Chapter. His dedication was remarkable and the Chapter is indebted to him for his commitment. David will continue to serve the Chapter as Database Manager. Jerry Allison being presented with the Jimmy O. Fenn Award

Additionally, the annual SEAAPM Best Publication Award went to Perry Sprawls for his article entitled “Evolving models for medical physics education and training: a global perspective.” Our

performed under direct supervision. Direct supervision is defined as the physician being present and immediately available to furnish assistance and direction throughout the performance of the procedure. Direct supervision may also be accomplished via telemammography as long as the interpreting physician is immediately available. The ACR

Next year’s meeting is being held in Augusta, Georgia. It is tentatively set for March 3-6, 2010. The theme of next year’s symposium will be “Advances in MRI: Applications in Diagnosis and Radiation Therapy.” Mark you calendars and save the date! Please visit our chapter web page for more information and updates.

guidelines are not requirements but are designed as an educational tool to assist practitioners in providing appropriate radiologic care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care.

AAPM Newsletter

July/August 2009

Legislative & Regulatory Affairs 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. Lynne Fairobent College Park, MD

Qualified Medical Physicist Registry - Update

n the previous issue of the newsletter I discussed the concept of a national registry of Qualified Medical Physicists (QMPs). This concept was discussed with the Conference of Radiation Control Program Directors (CRCPD) during their business meeting on May 17, 2009. The Program Directors indicated support for moving forward with a registry and indicated a willingness to use it as a source for verifying credentials of QMPs. During the Sunday Professional Council symposium session at the annual meeting this concept will be discussed further. If you have questions that you would like answered during this session or in general, please submit them to me at lynne@aapm.org. Remember 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

National Source Tracking System (NSTS) Enrollment Issue During the Conference of Radiation Control Program Directors’ meeting in May it became clear that the NRC is moving in the direction of including Category 3 licensed material in the National Source Tracking System (NSTS). NRC staff has prepared a direct final rule which the Agreement States had the opportunity to comment on.(This is a predecisional document at the time of writing this article which means the public has not had the opportunity to review it.) Copies of the CRCPD’s and the Organization of Agreement States letters were provided to those in attendance at the annual CRCPD business meeting. Both organizations do not support inclusion of category sources at this time. Specific reasons cited were: • Absence of quantitative data – there was not quantitative data with respect to the costs of including Category 3 sources in the NSTS, or to the potential benefits gained beyond perfunctory accountability. The states requested that a detailed vulnerability assessment be performed prior to consideration of an expansion of NSTS. Such

an assessment is vital to determine the true level of risk these sources present and evaluating the depth of protection they require. • The Regulatory Analysis of the Final Rule Expanding the NSTS indicates that implementation will require the commitment of additional staff. Agreement States are already investing significant resources in the implementation and inspection of Increased Controls, including fingerprinting. Expansion of the NSTS would further impact the limited resources of the Agreement States as many are facing hiring freezes, furloughs and budget shortfalls. • The memorandum to the Commissioners indicated that the NSTS is “working well”. This seems overly optimistic as it is considered just operational by Agreement State staff due mainly to the number of issues still being indentified for Category 1 and 2 sources. Issues of accessibility and batch loading into NSTS still exist, and many hours are being expended to verify and correct current data. Until the system is operating effectively, it is premature to pursue the inclusion of smaller sources, especially when such an inclusion may result in little to no impact on national security or health and safety. If NSTS is expanded to include Category 3 sources it is anticipated that approximately 1,000 additional licensees will be impacted. Category 3 sources of concern to medical licensees include high-dose rate afterloader sources. Join us Tuesday afternoon at the annual meeting during the professional track session to hear a status report from the NRC and

AAPM Newsletter

July/August 2009

Workforce Study of Medical Physicists Workforce Study of Medical Physicists

in the education, training and practice of medical physics.

by: Center for Health Workforce Studies School of Public Health State University of New York at Albany http://chws.albany.edu/

Survey of AAPM Membership The Center plans to conduct an on-line survey of all AAPM members beginning in June. The survey will include questions on demographics, career paths into the profession, practice characteristics, income, retirement plans, and opinions about the current job market for medical physicists and the future of the profession.

Project Overview

he Center for Health Workforce Studies (the Center), with support from the American Association of Physicists in Medicine (AAPM), is conducting a workforce study of medical physicists. This study is one of the 2009 Presidentâ&#x20AC;&#x2122;s Initiatives. The overarching goal of this project is to determine whether the supply of medical physicists will meet future demand for them, in light of the certification requirements that will be in effect by 2014. Of particular interest is the impact of newly developed education and training programs on the production of medical physicists. Components of this study include:

Key Informant Interviews The Center research team has begun to interview practicing medical physicists, employers, educators and residency program directors to learn more about current issues representatives of the CRCPD on this issue. If you are having any generic problems with the NSTS please contact Lynne Fairobent at lynne@ aapm.org. Bruce Thomadsen named ViceChairman of the NRCâ&#x20AC;&#x2122;S Advisory Committee on Medical Use of Isotopes (ACMUI)

Survey of Medical Physicist Employers The Center plans to conduct a stratified sample survey of medical physicist employers to better understand issues related to the recruitment and retention of medical physicists from the perspective of providers, academic institutions, industry and consultant companies, among others. Assessment of Educational Capacity An important component of the study is the identification of barriers and facilitators to expanding educational capacity, particularly the development of accredited residency training programs and slots. At the spring meeting of the ACMUI, outgoing ACMUI members Ralph Lieto (medical nuclear physicist), Richard Vetter (Radiation Safety Officer) and Subir Nag (Radiation Oncologist) were thanked for their service to the ACMUI. Their replacements have not been names as of the writing of this article. Bruce Thomadsen (therapy physicists) was named

Development of Supply and Demand Models for Medical Physicists in Two Disciplines: Radiation Oncology and Diagnostic Radiology The Center will develop medical physicist supply and demand forecast models for the two medical physics specialties, radiation oncology and diagnostic radiology, taking into account the relevant factors that affect medical physicist supply and demand. Upon completion of each project component, the Center will prepare a summary report describing the findings for that component. In addition, the Center will prepare a final, cross-cutting report that summarizes and synthesizes the findings from all of the project components. The report will present relevant findings, insights, and conclusions. Ultimately, the report will serve as a guide to AAPM to help identify the opportunities and barriers to assuring an adequate supply of medical physicists to meet anticipated demand for their services. For more information about this study, please contact Jean Moore at 518-402-0250 or email her at jmm04@health.state.ny.us

Vice-Chair and replaces Richard Vetter in this capacity. Detailed writeup and the handouts from the spring meeting can be found on the AAPM website under the Government Affairs tab.

AAPM Newsletter

July/August 2009

Minority Undergraduate Summer Experience Update MUSE Students presentation at the NSBP/NSHP annual convention in Nashville, TN by Christopher F Njeh1, Albin Gonzales2, Paul Gueye3 Texas Oncology, Tyler, TX Firelands Regional Medical Ctr, OH 3 Hampton University, VA

he National Society for Black Physicist (NSBP) and the National Society for Hispanics Physicist (NSHP) host their joint annual convention in February of each year. Medical Physics was introduced to the convention agenda in 2003, and this session has gradually increased in popularity with Physics students every year. AAPM has a sub-committee under the education committee called minority and women recruitment subcommittee, chaired by Dr. Paul Gueye; Research Professor at Hampton University. In 2008, AAPM allocated funds to support minority student summer fellowship. This fellowship was named “minority undergraduate summer experience (MUSE)” in Medical Physics. The fellowship is designed to expose minority undergraduate university physics students to the field of Medical Physics by performing research or assisting with clinical service at a Student Mr. Jonathan Baca Miss Lauren Foley Miss Lynda Ikejimba Miss Judith Rivera Miss Korressa Williams Miss Sheena Gause Mr. Horace Lambert

US institution. The ultimate goal is that such exposure will encourage more minority students to apply for graduate studies in Medical Physics. Recipients of the MUSE award are required to present their research findings or their summer experience during the NSBP/ NSHP convention. In 2008, six students were awarded the MUSE fellowship. The name of the fellows and their supervisors are presented in Table 1. A summary of their presentations are given in the following paragraphs. It is interesting to note that the MUSE students had a broad exposure from Imaging physics, to therapy and health physics The Friday afternoon session chaired by Dr. Christopher Njeh was dedicated to student presentations. Roland Teboh, a PhD student from the University of Texas Health Sciences Center at San Antonio kick started the talks. His presentation was entitled “Respiratory motion management for lung radiotherapy via real time tumor tracking.” Mr. Teboh echoed the fact that the success of radiation therapy depends to a large extent on the ability to accurately deliver radiation dose to the cancer cells while

Mentor Dr. Shuang Luan: University of New Mexico Dr. Stanley Benedict, Univ of Virginia Health Sys. Dr. Andrew Maidment; Univ of Pennsylvania Dr. Mark B. Williams, University of Virginia Dr. Stephen Brown, Henry Ford Hospital Dr. Geoffrey Zhang, H. Lee Moffitt Cancer Ctr, Dr. Charles Coffey, University of Vanderbilt

sparing surrounding healthy tissue. Respiratory induced organ motion present a significant challenge in the treatment of lung cancers. If unaccounted for, the motion can lead to radiotherapy delivery that under-irradiate the tumor and overradiate surrounding normal tissues. Mr. Teboh presented preliminary data of a tracking system that is being developed at the University of Texas at San Antonio. He was able to demonstrate some of the potential benefit of the tracking system as compared to the current conventional techniques. Jessica Johnson from South Carolina State University, presented on “Linear accelerator quality assurance using clinical treatment delivery” They evaluated clinical treatment delivery to a phantom in attempt to evaluate accepted mechanical quality assurance requirements. GafChromic EBT film was used to assess the dose distribution for pelvic irradiation. Three clinical setup were studied: 4 field box, 4 field whole pelvis and 5 field IMRT. All films were scanned, digitized and analyzed using a Vidar Dosimetry film scanner and Radiological Imaging Technology software. The measured dose distribution was evaluated by determining the dose difference between an accurately delivered treatment and a mechanically modified treatment delivery. F-test and Chi-Square tests were used to analyze the dose differences. The 4-field box distribution was the most sensitive technique in detecting changes in mechanical parameters. Sheena Gause from Francis Marion University, presented on “image guided radiation therapy applied to breast cancer patients” Image Guided Radiation Therapy

Table 1:2008 Muse Fellows

AAPM Newsletter (IGRT) has become the most advanced method used to evaluate and correct for tumor motion. Because cancer tumors are constantly moving within the body, difficulty arises when trying to administer radiation to the tumor volume. The exact location of a tumor may change between the time of a CT scan and actual treatment. 3-D IGRT offers greater precision for targeting and treating cancer by allowing the patient to be imaged in the treatment position during the actual time of treatment. This technique allows therapists to correct for internal organ movement. This method may be beneficial in that it results in less radiation to healthy tissues, fewer side effects, and possible reduction in the number of radiation treatments needed. Breast cancer patients will benefit from this study if the lung and cardiac toxicity can be reduced by IGRT. Horace Lambert from South Carolina State University, gave a talk on “Implementing dynamic arc radiation therapy (DART) in the treatment of prostate cancer”. He argued that effective treatment of prostate cancer sometimes inadvertently delivers high amounts of radiation to the organ at risk such as the bladder and rectum.

He postulated that DART may be more effective than IMRT and 3D conformal radiation therapy in reducing the dose to the organ at risk. They found DART to be more efficient and required fewer monitor units than IMRT. Judith Rivera from University of Texas at El Paso, presented on a small animal contrast infusion system for micro-CT. She presented another angle to issues of small animal model studies. For example, mice hearts are 200 times smaller than that of human and beat 7 times as fast and hence non-invasively obtaining cardiac CT images in these small animals proves difficult since it requires both high spatial and temporal resolution in order to achieve high contrast in cardiovascular structures. A contrast infusion system was built with the capabilities of injecting small amounts of contrast medium at either a high flow rate over a short period of time or at a constant low flow rate over an extended period of time. Preliminary results are promising however, the resulting images from the scans demonstrated that the ventricle/muscle signal ratios were nearly twice as high for the new system compared to “Fenestra” injection system.

July/August 2009 Lynda Ikejimba from University of Pennsylvania gave a talk on the breast cancer risk estimation using parenchymal texture analysis in digital breast tomosynthesis. Mammographic parenchymal texture has been shown to correlate with genetic markers of developing breast cancer. Digital breast tomosynthesis (DBT) is a novel tomographic x-ray breast imaging technique in images of the breast are reconstructed from multiple source projections acquired at different angles of the x-ray tube. Compared to digital mammography (DM), DBT eliminates breast tissue overlap, offering superior parenchymal texture visualization. Ikejimba and colleagues hypothesize that texture analysis in DBT could potentially provide a better assessment of parenchymal texture and ultimately result in more accurate assessment of breast cancer risk. They found that in the overall, the DBT texture features demonstrated stronger correlations with breast percent density than DM features (P < or = .05). Korresa Williams From South Carolina State University presented on the “in-vitro technetium uptake study to explain the killing effects of the FGNR and FGR virus on both U-251 and 9L cells” They conducted an in-vitro study on both rat (9L) and human (U-251) cells to compare the killing effects of the cold virus (FGNR and FGR) in both cell types. They studied the cell survival with both types of virus and also recorded the uptake of technetium in the cells. They found that the virus worked better in human tumors grown in mice than on rat tumors grown in rats. The technetium study showed higher uptake in human cells. Nana Aba Mensah-Brown from University of Wisconsin presented on “Pre-ejection Periods (PEP) Associated with Different Cardiac Disease States in the Human Fetus.”

AAPM Newsletter

July/August 2009

Pre-ejection period (PEP) is the combined measure of electromechanical delay and isovolumetric contraction of the cardiac ventricles. Important electrophysiological intervals and ventricular function associated with cardiac compromise, arrhythmias or structural heart disease can be measured using simultaneous fMCG and doppler ultrasound, which assesses the magnetomechanical function of the fetal heart. PEP measured in normal control fetal groups differ significantly from groups in which cardiac compromise, arrhythmias and struc-

tural heart disease exist. Their study sheds light on these variables Joy Epps university of South Carolina presented “Quantitative analysis of some radioisotopes in local well- water samples.” Ms. Epps argues that groundwater plays a significant role for the transportation of radionuclides through the ecosystem. Therefore the investigation on the radioactivity concentrations in groundwater present an interesting topic to many disciplines such as radiochemistry,

environmental health physics and hydrogeology. They collected well water samples from around Orangeburg, South Carolina, and condensed from 2 liters to 120 ml. The prepared samples were counted with a HPGe gamma spectrometer. Some of the radionuclides analyzed include uranium, radium and potassium. Six more students have been awarded AAPM MUSE fellowship for 2009. We look forward to listening to their present at the 2010 NSBP/NSHP convention in Washington, D.C.

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.

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AAPM Newsletter

July/August 2009

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant AAPM Posts Coding FAQS

id you know that the Professional Economics Committee (PEC) responds to AAPM member coding inquiries? The opinions referenced are those of members of the PEC based on their coding experience and they are provided, without charge, as a service to the profession. They are based on the commonly used codes in radiation oncology, which are not all inclusive. You may submit your coding question in writing to PEC chair Jim Goodwin at James.Goodwin@vtmednet.org The PEC has updated the list of Coding Frequently Asked Questions

(FAQs) on the AAPM website. The revised Coding FAQs updates the 2005-2007 list of questions and includes 2008 and 2009 coding inquiries to date. You may access the Coding FAQs at: http://aapm.org/government_ affairs/CMS/Coding.asp In addition, if you are a member of the American Society for Radiation Oncology (ASTRO) you may submit coding questions in writing to the Code Utilization and Application Committee. This Committee is a resource available to AAPM members who are also members of ASTRO. We encourage AAPM members who belong to both organizations to submit their coding questions to this Committee. Coding inquiries

are responded to in 60-90 days. You may submit your coding questions to ASTRO at: http://astro.org/HealthPolicy/ C o d i n g Q u e s t i o n s / CodingQuestionForm/index.aspx The PEC recommends that AAPM members always check with local insurance carriers, as policies vary by region and that the final decision for coding of any procedure must be made by the physician and/or facility, considering regulations of insurance carriers and any local, state or federal laws that apply to the facility and physicians’ practice.

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AAPM Newsletter

July/August 2009

Persons in the News

he American College of Radiology (ACR) recognized six AAPM members as New Fellows of the ACR during their Annual Meeting and Chapter Leadership Conference held in Washington DC, May 2-6th, 2009. Following is a brief biography sketch of the newly- elected Fellows:

Libby Brateman was awarded fellowship for her service on ACR committees and in educational programs and service in professional activities within Florida. Dr. Brateman is Associate Professor of Radiology and Affiliate Professor of Nuclear and Radiological Engineering at the University of Florida, where she is involved in the CAMPEP-accredited Medical Physics Graduate Program. She is active in the ACR Mammography Accreditation Program. She has been involved in written and oral ABR examinations for medical physicists and radiologists and is a member of the AAPM RRPSR Subcommittee of the Medical Physics Education of Physicians Committee and the AAPM Ethics Committee. Mahadevappa Mahesh is actively involved in a number of ACR activities. He is currently the chair of the Physics Panel for Diagnostic InTraining (DXIT) Exam and chair of the Government Relations within the Commission of Medical Physics in ACR. In addition, he is the co-editor for the Physics Columns for the Journal of American College of Radiology (JACR) and editorial board member for JACR. He has also served as Councilor-at-large at the ACR annual meetings for the past three years. Dr Mahesh is Associate Professor of Radiology and Cardiology at Johns Hopkins University School of Medicine and is the Chief Physicist at the Johns Hopkins Hospital. He is also active within the AAPM and serves as the editor of this newsletter and is also a fellow of the AAPM.

Karl Prado was awarded ACR Fellowship for his long-standing support of the medical physics profession. Most prominent are his contributions to the American College of Medical Physics, where he chaired the Standards Committee and was a member of the Board of Chancellors, and most recently, for his leadership role in the Texas Radiological Society. Dr. Prado has been instrumental in increasing the visibility of medial physics in the Society. He chaired the Physics Section and is now ACR Councilor from Texas. He is an Associate Professor of Radiation Physics and Deputy Chief of Clinical Services at UT M.D. Anderson Cancer Center.

of California Davis, a fellow of the AAPM, and current chair of the AAPM Education Council.

J. Anthony Seibert has been an active member of the ACR, participating on the Guidelines and Standards Committee of the Commission on Medical Physics for the past 10 years. He has co-chaired the development of ACR guidelines for security and privacy, digital mammography, and digital radiography, writes clinical physics questions for the ACR DXIT examination, has served on the Ultrasound accreditation committee, and has interacted with the Dose Registry efforts of the college. Dr. Seibert is a Professor of Radiology at the University

Palmer Steward obtained his PhD from UC Berkeley in 1968, has served on the faculties of Washington University and St Louis University, is currently the RSO of Genesis Medical Center in Davenport, Iowa, and the physicist at the Iowa City Cancer Treatment Center. He is a fellow of the AAPM, has served on the CAMPEP Board of Directors, currently serves on the CAMPEP Continuing Education Program Review Committee, and he has been active in local chapters of physicist and clinician organizations and associated educational programs.

Christopher Serago is an Associate Professor at the Mayo Medical School working at Mayo Clinic in Jacksonville, Florida. Dr. Serago has been active within the ACR as a member of the physics committee of the Florida Radiological Society. He has also been active within Florida as a past President of the Florida AAPM chapter and served as the chapterâ&#x20AC;&#x2122;s representative to the AAPM board of directors. Dr. Serago currently chairs the AAPM ethics committee and chaired the task group which wrote the AAPM code of ethics. He is the current vice-chair of the ACMP.

ACRâ&#x20AC;&#x2122;s 2009 Fellows - (inset picture - Karl Prado), L-R: Christopher Serago, Tony Seibert, Palmer Steward, Libby Brateman & Mahadevappa Mahesh

AAPM Newsletter

July/August 2009

Persons in the News

Professor Azam Niroomand-Rad, Ph.D., DSc. receives the IOMP’s Marie Sklodowska-Curie Award

particularly in developing countries. Prof. Azam has published numerous articles and book chapters, and is Co-Inventor of a US Patent for designing a novel stereo tactic method for treatment of spine lesions. She has a distinguished research record, a major area of her research being in radiotherapy physics. Dr Azam is a fellow of the AAPM and has received several awards including the 2006 AAPM “Award for Achievements in Medical Physics.”

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he International Organization for Medical Physics (IOMP) has awarded the Marie Sklodowska-Curie Award to Prof Azam NiroomandRad this year. The Awards will be presented at the World Congress on Medical Physics and Biomedical Engineering, to be held at Munich, Germany, on September 7-12, 2009. Prof. Azam Niroomand-Rad, is the immediate past President of the IOMP, former Director of Clinical Physics in the Department of Radiation Medicine and retired Professor of Radiation Medicine at Georgetown University Medical Center, Washington D.C., USA. The award recognises the major contributions she has made to the field of medical physics and the international healthcare community through her activities in education and training, research and the advancement of the medical physics profession internationally. Prof. Niroomand-Rad has been very active over many years in a range of education, teaching and teaching programmes around the world as well as in her own institutions. She is dedicated to promoting and developing the medical physics profession,

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AAPM Newsletter

July/August 2009

LAST MINUTE REMINDERS: AAPM Student Meeting

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Sunday, July 27 9:30am - 11:00am Room 210A, Convention Center

Wednesday, July 29 4:00pm - 5:30pm Ballroom C, Convention Center

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2010 AAPM Awards & Honors Committee &DOO IRU 1RPLQDWLRQV DQG $SSOLFDWLRQV $OO QRPLQDWLRQV PXVW EH UHFHLYHG E\ 2FWREHU William D. Coolidge Award: This award recognizes an AAPM member for an eminent career in medical physics. $$30 $ZDUG IRU $FKLHYHPHQW LQ 0HGLFDO 3K\VLFV This award recognizes AAPM members whose careers have been notable based on their outstanding achievements.

AAPM Fellows - ONLINE SUBMISSION PROCESS ONLY: http://www.aapm.org/memb/nominate/ The category of )ellow is established to honor members who have made signiÂ¿cant contributions through one or more of the following: Â&#x2021; Service to the AAPM Â&#x2021; The advancement of medical physics Nnowledge based upon independent original research or development Â&#x2021; Medical physics educational activities especially in regard to the education and training of medical physicists medical students medical residents and allied health personnel Â&#x2021; Leadership in the practice of medical physics

AAPM-IPEM Medical Physics Travel Grant: This grant is made annually to a U.S. AAPM member who shows evidence of an active scientiÂ¿c career in medical physics. The purpose of this grant is to promote communications and professional partnerships between U.S. AAPM members and IPEM members from the United Kingdom.

http://www.aapm.org/org/callfornominations.asp#nominations

AAPM Newsletter

July/August 2009

Memorial Shortly after joining the U. of C., Dr. Skaggs was put in charge of developing radiation therapy facilities at the Argonne Cancer Research Hospital, the first medical facility to use radiation to treat cancer when it opened in 1953. (The hospital is now part of University of Chicago Medical Center.) Lester Skaggs, Ph.D. 1911-2009

ast week the medical physics community lost a pioneer.

Lester Skaggs, Ph.D. passed away on April 3, 2009 at the age of 97 of complications from renal failure. In a career that spanned almost 70 years, his contributions were not only numerous but enduring. A leader and innovator in the truest sense of the word, Dr. Skaggs’s work in the field of medical physics over the course of his career is inspiring for young and established medical physicists alike. Our sincerest condolences to his family, friends and colleagues. From the “Chicago Tribune”: Lester Skaggs helped develop the detonation device for the first atomic bombs as a physicist with the Manhattan Project and then turned his attention to pioneering medical applications for radiation. A professor at the University of Chicago from 1948 to 1997, Dr. Skaggs, 97, died of complications from renal failure Friday, April 3, in Mercy Hospital and Medical Center, U. of C. spokesman John Easton said.

Along with colleague Lawrence Lanzl, Dr. Skaggs built a linear accelerator, called the Lineac, for medical applications. The Lineac took eight years to finish and cost $450,000. Completed in 1959, the machine was used for 34 years to treat patients from all over the country. The Lineac was an extension of pioneering work in medical radiation Dr. Skaggs and Lanzl did beginning in 1945. With colleagues from the University of Illinois, they used a high-energy radiation betatron to treat a physics graduate student with a brain tumor, said Lanzl’s wife, Elisabeth, a graduate student who participated in the work. Although the student died, the treatment shrunk his tumor and was documented in articles that advanced the understanding the medical uses of high-energy radiation, Elisabeth Lanzl said. Dr. Skaggs designed and built an early analog computer to measure radiation dose to various issues in the early 1960s. In the 1970s, he, with colleague Franca Kuchnir, developed a method to produce neutrons for radiation therapy. After retiring from the U. of C., Dr. Skaggs spent five years working on a neutron-therapy 27

facility at a hospital in Riyadh, Saudi Arabia. Raised on a farm in Missouri, Dr. Skaggs rode a horse three miles to his one-room schoolhouse. In high school, he and a friend built a radio, seeding his fascination with technical machinery, said his daughter Margaret Skaggs. He got a bachelor’s degree in chemistry and a master’s in physics form the University of Missouri, then studied nuclear physics at the University of Chicago, completing his doctorate in 1939. He worked briefly at Michael Reese Hospital and with the Department of Terrestrial Magnetism at the Carnegie Institution in Washington, then decamped for Los Alamos to take part in the top secret Manhattan Project. The mission given him and colleagues was to develop a virtually fail-safe fuse for the atomic bomb. The trick was to set off the bomb in a way that allowed the plane that dropped it fly away safely. The team came up with a detonation device triggered in relation to its distance from the ground. During his tenure at the U. of C. Dr. Skaggs lived in Park Forest. Dr. Skaggs’ wife, Ruth, died in 2005. Survivors include a son, John; a daughter, Mary Anderson; a sister, Lillian Foster; and three grandchildren. AS POSTED IN MDPHYSICS.COM

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

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

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

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