AAPM Newsletter September/October 2009 Vol. 34 No. 5 by AAPM Docs

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 34 NO. 5

SEPTEMBER/OCTOBER 2009

AAPM President’s Column

Maryellen Giger University of Chicago

n this column, I would like to update the membership on multiple topics of interest including the AAPM annual meeting, a fourth ad hoc committee, the ABR Summit 2009, and the AAPM Education and Research Fund.

AAPM Annual Meeting The energy and workings of the AAPM were obvious at the annual meeting this past July in Anaheim. As President of AAPM, I was constantly proud and busy. I want to especially thank the various annual meeting program directors/co-directors: for the Scientific Program -- Sabee Molloi /Andrew Karellas [Imaging Program] and Paul J. Keall/Daniel A. Low [Therapy Program]; for the Education Program – Ronald Price/Beth A. Harnness [Imaging Program] and Indrin J. Chetty/ Robin L. Stern [Therapy Program]; and for the Professional Program – Christopher F. Serago/Douglas Pfeiffer as well as Scientific Program

Subcommittee Chairs Gary A. Ezzell and Andrew Maidment, Education Program Subcommittee Chair Matthew Podgorsak, Self Assessment Module (SAM) Organizer Michael Yester, and the Meeting Coordination Committee Chair Melissa Martin. Many thanks also go to Angela Keyser and all the wonderful AAPM staff, whose efforts made the annual meeting as well as all the committee meetings run so smoothly. The annual meeting solidified again that the AAPM is the premier organization for the research, educational, and clinical aspects of medical physics. One of the tasks of the President is to select the topic and speaker(s) for the Presidential Symposium at the annual meeting. This year, the symposium started with welcoming remarks from Gary Becker, M.D., President of RSNA, Fred Dylla, Ph.D., Executive Director and CEO of the AIP, and Bob Doering, Ph.D., Chair of AIP’s Corporate Associates Advisory Committee. Ian Foster, Ph.D. then gave an outstanding presentation on the present and future of computers in medicine. He walked us through the rapid growth of computer technology including aspects of computing power, communication ability, storage capacity, and content. He noted how healthcare is changing from an empirical, qualitative system of silos of information to a model of predictive, quantitative, shared, evidence-based outcomes. Dr. Foster discussed the Grid paradigm

and its role in healthcare information integration, noting the need to make today’s wealth of data useful and transformable into knowledge. I believe that we, as medical physicists, need to be alert to such rapid changes in order to help enable the effective and efficient incorporation of new computer technology into imaging and therapy research and practice. This year, the American Institute of Physics’ Corporate Associates collaborated with the AAPM to bring to our annual meeting the Industrial Physics Forum (IPF), which had as its theme “Frontiers in Quantitative Imaging for Cancer Detection and Treatment”. Various AAPM sessions benefited from this additional support with over ten sessions on imaging TABLE OF CONTENTS Chair of the Board’s Column President-Elect’s Column Executive Director’s Column Editor’s Column Education Council Report Professional Council Report Leg. & Reg. Affairs CAMPEP News Website Editor’s Report ACR Accreditation Travel Grant Report Coolidge Award Recipient Intro. Health Policy/Economics New Professionals Forum Rpt. Image Gently Campaign Update Practice Guidelines SC Report

p. 3 p. 4 p. 6 p. 7 p. 9 p. 10 p. 11 p. 13 p. 17 p. 19 p. 20 p. 22 p. 24 p. 27 p. 29 p. 31

AAPM Newsletter

September/October 2009

in diagnosis and therapy, including topics on nanotechnology, novel proton accelerators, CT, and others. Many thanks to the AIP and APF for enhancing our annual meeting with their attendance and support – allowing for even more diverse scientific discussions and potentially new collaborations. At the annual meeting, many sessions were held in the Joint Therapy/ Imaging tracks, which appear to be growing in movement as imaging physicists and therapy physicists once again merge their research, educational, and professional activities as medical physicists. We also continue to reach out to the next generation of medical physicists with various refresher courses and sessions, including the New Members Symposium & Meet the Experts session and Bill Hendee’s moderated session on “Becoming a Better Teacher” since every medical physicist is a teacher, either formally in the classroom or informally in the laboratory or clinic. It was apparent from these sessions that our new members and future colleagues are eager to learn and participate. Evidenced also at the annual meeting, during which multiple committees, subcommittees, and task groups meet, were the collaborative efforts of the membership; both between AAPM committees as well as with other organizations. If you are not aware of this aspect of the annual meeting, I suggest you visit http:// www.aapm.org/meetings/09AM/ schedule.asp, which gives the listing of committee meeting held this past July. Most meetings are open so members can attend, especially if they are interested in joining and participating in the future. At the annual meeting, we also saw the continued involvement of membership in the AAPM through

the town hall meeting during which anyone can ask any of the members of the AAPM Board of Directors any question! Ad Hoc Committee on 501(c)6 In the July/August issue of the AAPM newsletter, I described three new ad hoc committees of the AAPM. Here I describe a fourth one, namely, the ad hoc committee on 501(c)6 [chaired by Michael Herman; http://www.aapm. org/org/structure/?committee_ code=A501C6]. The charge of this ad hoc is “to evaluate whether the profession of medical physics (and AAPM) requires a 501(c)6 tax structure to effectively achieve our goals. Provide preliminary report to the AAPM BOD in July 2009.” The establishment of this ad hoc created much discussion among members during the annual meeting. It is important to note that this is a “fact finding” committee that arose during my visit to the Professional Council Retreat. Some AAPM members are concerned that in the future, medical physicists may need to move quickly and collectively in a lobbying effort. Currently, the AAPM, a 501(c)3 organization, is primarily a scientific and educational association, and does not come close to reaching it lobbying spending limit. Note also that this ad hoc is evaluating whether or not the profession of medical physics requires a 501(c)6 tax structure. Updates on this ad hoc as well as on the other three ad hoc committees will be given in upcoming newsletters. ABR Foundation Summit 2009 After our annual meeting, Jerry White and I attended the American Board of Radiology Foundation’s Summit 2009, which was cosponsored by the ABR and the National Institute of Biomedical Imaging and Bioengineering

(NIBIB), and was focused on “Medical Imaging: Addressing Overutilization in the Era of Healthcare Reform”. The summit on the overutilization of imaging services for diagnostic and therapeutic purposes included keynote addresses and breakout groups, with attendees representing a variety of medical specialties, societies, boards, and government bodies. Factors discussed included inappropriate imaging due to defensive medicine and/or inaccessible prior exams, physician education deficiencies, selfreferral patterns, patient demands, third-party payment systems, public/ national media, etc., as well as possible consequences such as increased dose, costs, and risks. A white paper is being written to help identify criteria for justification of imaging procedures. AAPM Education and Research Fund Lastly, I would like to mention the AAPM Education and Research Fund. As noted at the Awards and Honors Ceremony at our annual meeting, some of the funding for fellowships and awards for travel, for research, for educating undergraduates about medical physics, etc. come from the AAPM Education and Research Fund. I ask all members to support the Education and Research Fund. In these times of economic limitations, it is difficult to request donations from others, however, we all donate somewhere, so let’s just focus on ones priorities. Is not supporting activities that help ensure the future of medical physics – through research, education, or clinical activities – important? Thank you again for taking the time to read the newsletter. As always, I welcome any comments or suggestions.

AAPM Newsletter

September/October 2009

Chairman of the Board’s Column

Gerald A. White Colorado Springs, CO

The Hat

sit at my keyboard tonight wearing a straw hat, of the type know as a “Panama Hat”. As some of you know, I am no stranger to hats (due to being somewhat of a stranger to scalp hair); ball caps for protection from the sun, and polypro, wool and polarfleece hats for warmth. In my evening ritual, a nightcap is cloth rather than liquid. My hat collection is large, but fundamentally functional rather than fashionable. That has changed recently. I was invited to offer an address at the annual meeting of the Sociedad Española de Física Médica in Alicante, Spain. It was, for me, a remarkable meeting. It began with registration and a meeting bag (well within my experience and comfort zone). But then there was a request for my hat size, a quick measurement to verify and then there appeared a Panama hat as part of the registration material. I looked around and indeed they were atop heads throughout the hall and patio. I sensed that the SEFM meeting was not the place for my Missoula Montana Rhino Bar ball cap (motto: “Grab Your Thirst by the Horn”) and wore the Panama hat for the duration of my stay.

The organizers of the meeting had an interest in learning about the style of practice of medical physics in the U.S., the educational and training process and also about the organization of the AAPM. I talked some about all of these, but our most interesting exchanges were related to the training of medical physicists. I described our current system: a variety of degree pathways, the ABR eligibility and certification process and the regulatory structure of (essentially) 50 states with requirements that ranged from licensure to nothing. The Spanish system is much more organized, with a national exam to gain admission to medical physics programs (very competitive—of the physics graduates who sit for the exam only about 10% are admitted). There is a structured program of both didactic and clinical training that results in the aspirant gaining recognition by the health ministry as eligible for a position as a medical physicist. The output of the programs is more or less matched to the anticipated need in the academic/ clinical facilities. The Spanish process has many fundamental characteristics that we are seeking in our movement toward the 2012/2014 changes in admission to the ABR examination process. I’m considering wearing the hat to future 2012 project planning meetings for inspiration. We also signed an agreement that is intended to bring some Spanish medical physics students to the U.S. for an exchange type experience, and offers the potential for U.S. medical physics students to spend time in Spain. (Hats are not included). The hat traveled with me to a second international invited presentation of this monoglot AAPM Chairman of the Board, this time to the Conferencia Internacional de Física Médica in Havana, associated with a

multi disciplinary oncology conference. I was invited to speak on a topic of my choice (HDR of the prostate) and also to again discuss the education and training of medical physicists. I had the opportunity to meet many interesting and productive medical physicists. We exchanged ideas on how to bring resources of the AAPM to the Cuban and Central American medical physicists (the U.S. embargo presents barriers for the Cuban connections and practice—for example: recently several HDR’s decommissioned at the direction of the State Department when Gamma Med was purchased by Varian). We also discussed staffing levels; interestingly, each hospital with a nuclear medicine facility has a medical physicist. Yakov Pipman and others in the AAPM have done an admirable job of establishing relationships with our medical physics colleagues to the south. Yakov is also quite a good dancer. The Cuban Oncology Community clearly values dancing as a fundamental part of meeting related social functions. For completeness, I also must note that Robert Jeraj, the third member of the AAPM delegation is a fantastic dancer, professional ballroom quality that I have not seen since Scott Dube or Guy Simmons have taken the floor. I (mostly) stood on the sidelines and smiled, wearing my hat. At one point later in the evening, I loaned the hat to one of the Cuban physicists. To my surprise, as he flowed out towards the other dancers, he was immediately surrounded by women and the salsa music. I was surprised. I had been wearing that very hat all evening and had not attracted any notice, but now, the hat seemed to have magic qualities. I could see the hat bobbing up and down in (see White p. 4)

AAPM Newsletter

September/October 2009

AAPM President-Elect’s Column

Michael G. Herman Mayo Clinic

his newsletter is written just after the Annual Meeting in Anaheim and everyone is invigorated with a new list of things to do, papers to read and projects to start/finish. This was another great meeting with many sessions, a lot of interaction time and something going on for everyone. In particular, having our annual meeting combined with the Industrial Physics Forum was a very welcome and successful addition. My highlights at the meeting, along with an unmeasured number of hours in committee meetings and the excellent sessions, reminded me of who we are and why we do what we do: Saturday morning was the 2nd annu(White from p. 3)

a sea of medical physicists, surgical oncologists, medical oncologists and radiation oncologists immersed in a mist of salsa music. Reflection ensued (not much else to do, I wasn’t dancing). Perhaps it was not the hat after all. Perhaps it was the talent and preparation of the wearer. In fact, it was clear to me that the entire group had prepared for salsa just as they had prepared for medical physics. Skilled in both, talented in both; the hat or the title not as enabling as the talent,

al AAPM service project. We took a bus ride to Huntington Beach to work with an environmental group called the Surfrider Foundation. We reviewed the local environment and the fact that almost all surface water within 50-100 miles of this beach flows into the Santa Anna River and is funneled down to Huntington and Newport Beaches. After a (relatively rare) rain, all the stuff left on the streets, in the storm sewers and elsewhere washes down into the ocean. Much of it is disposable plastic, which as it breaks down, becomes a threat to many marine animals. We spent the morning cleaning up plastic and Styrofoam lining the beautiful sandy beach. Occasionally looking up to view 10+ foot surf and people on long boards preparing for the US Open (surfing) to be held later that day and Sunday. Why do we do these things? Because it is the nature of medical physicists to want to help make things better, for the rest of the world and for the future. On Monday evening at the Awards and Honors Ceremony, we celebrated and honored our most prolific and respected members and

preparation and skill. Both Spain and Cuba have offered an example of the value of a medical physics community whose members share a diversity of personal, clinical and research interests, but who also share a commonality of education and training in the science, technology and art of medical physics. As we prepare for the future, I am optimistic that we in the U.S. will continue to embrace the diversity of our basic science training but also insist on a common foundation of

welcomed young rising stars to our field. It was exhilarating to stand on the stage and read or listen to the accomplishments of our esteemed colleagues. Whether you were being recognized as a new AAPM Fellow, a lifetime achievement award winner, a young or junior investigator, a travel or publication award recipient, or the prestigious Coolidge award winner, the theme was common. These people, all medical physicists, care deeply about what they do and they strive continuously to do it better. Some of us are only beginning our careers, while others have given a lifetime of service. All medical physicists’ efforts in our clinics, hospitals, labs, classrooms and elsewhere benefit patients receiving medical care. There were many honest and humble comments made by the awardees, but the one I will always remember was in Ray Tanner’s final sentence at the podium after receiving his achievement award. I think this captures the essence of the effective and respected medical physicist – “ You must be humbly assertive”. Another energizing part of the meeting is bearing witness to the vast collection of intellectual power, profes-

didactic and clinical medical physics training. We can do this for the 2012 and 2014 requirements for CAMPEP accredited degree and residency training, I am confident. About the Salsa training? Luis Fong de los Santos has made the initial training effort at the 2009 Summer School talent night. We have some distance to go. Let me know if you would like to borrow the hat.

AAPM Newsletter sional character and wisdom in any meeting room, or social gathering at the annual meeting. These are great opportunities to catch up with old friends, acquaint with new colleagues or ask that legendary scientist the question you have wanted to ask, face to face! The American Association of Physicists in Medicine provides the home and supporting infrastructure to leverage the collective knowledge and energy of its nearly 7000 member medical physicists. While we all do scientific, professional and educational activities daily, the AAPM facilitates the coordination and amplification of these efforts. These efforts are effective and successful only because of the volunteer members that commit the time and energy to participate in AAPM activities, through our Council and Committee structure. Imagine where we would each be in our professional lives if we had no AAPM Task Group reports or guidance documents to reference in our practice, or our labs. Who would have defined the national consensus for graduate and resident medical physics education and training? We are all responsible for continuing these and many other activities that we and our association accomplish. There remains a significant need for volunteer effort

on many committees. Some openings are posted in the committee classifieds (yellow book) or you can contact the chair person. Although your first choice may not be available, participation on any committee is a good way to get in the door and get started. If you donâ&#x20AC;&#x2122;t have time to participate, then consider donating money to the AAPM or supporting a dues increase to facilitate association activities. Another strength of AAPM is a solid headquarters support staff that has come to recognize our needs and provide infrastructure and expert staffing in areas where medical physicists need it. Most committee chairs know who at AAPM HQ is responsible for assisting them with budgets or activities. We also rely on consultants for specific expertise, such as health care economics, as major changes in the economy and health care models continue to evolve. Finally, we look for common ground with other national and international societies and we collaborate or cooperate when our goals are aligned. We have agreements with some associations (e.g. RSNA) for long term cooperative work and with others we form partnerships for specific action items such as letters to congress or feedback to CMS or NRC. We have started to collaboratively review medical

September/October 2009 physics technical standards with the ACR and are working toward formal agreements with other societies to facilitate cooperation. As is evidenced by our annual meeting, medical physics is a robust, technically challenging and rewarding field that is focused on making medicine better. Many challenges remain and our working environment will continue to evolve. We have to adapt, grow and work together to continue to be effective and respected leaders in high technology medicine. How should we be adapting now? We welcome your input. We need to continue to produce quality reports, educational opportunities and scientific functions, but we also need to be more efficient. We have to meet new challenges head on. We are evaluating our presence in the electronic and digital world, considering smaller regional meetings with annual meeting like content, continuing to work toward structured accredited training, developing a model to predict supply and demand for our services, submitting scientific grants for cooperative research and much more to prepare for and meet the future. Remember each of us must get involved, and make a difference and all the while remain humbly assertive.

2009 John R. Cameron Young Investigator Competition Results 1st Place

2nd Place

3rd Place

Ben Waghorn Medical College of Georgia

Matthew Wronski Sunnybrook Health Sciences Centre

Niranjan Venugopal University of Manitoba

Modeling Myocardial Mn2+ Efflux Rates Using Manganese-Enhanced MRI T1 Mapping in a Murine Myocardial Infarction Model

An Enabling Technology for Very Low Exposure X-Ray Imaging

Shape Matters: Utilization of a Conformal Voxel Technique to Acquire Robust in Vivo Prostate MRSI at Short Echo Times

AAPM Newsletter

September/October 2009

AAPM Executive Director’s Column

Angela R. Keyser College Park, MD AAPM Annual Meeting in Anaheim have just returned from AAPM’s 51st Annual Meeting in Anaheim. While we are still doing some cleanup to our registration reports, preliminary numbers show 2,341 scientific registrants, down roughly 5% from the 2008 50th Anniversary meeting in Houston. While the number of exhibiting companies decreased slightly, the exhibit portion of the meeting remains strong. In this economic climate, many organizations are reporting decreases in attendance as high as 20%. While I am very encouraged by the minimal drop in participation in 2009, I am concerned how the economy will impact the attendance at the 2010 Annual Meeting in Philadelphia.

Attention Junior and Student Members The qualifications for Junior membership require that the individual be a Resident, Post-doctoral Student or Fellow on a full- or part-time basis in a medical physics training program. All Junior Members were sent an email in early September with instructions on the process. Junior Members must request that a Full AAPM Member go online and attest that the individual meets the current requirements for Junior membership.

In order to remain a Student member after the first year of membership, first students are asked to identify whether they are Graduate or Undergraduate, then: • Graduate Students must request that a Full AAPM Member go online and attest that the individual is a Graduate Student on a full- or part-time basis in a medical physics program. • Undergraduate Students must ask their program director to send attestation to membership@aapm.org stating they are an Undergraduate Student in an academic program in science, engineering or a related field program. We recommend that you have your attestation in by October 1st to ensure that your renewal will go smoothly. If you have any questions, please contact Jennifer Hudson at jennifer@aapm.org or 301-2093365. 2010 AAPM Dues Renewals Dues renewal notices for the 2010 year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an official member. APSIT – AAPM Member Benefit Each year AAPM members receive a letter from APSIT, the American Physical Society Insurance Trust, of-

fering a range of insurance products. Many members probably have no idea why they get this letter or what APSIT is. The AAPM belongs to the APSIT through our relationship with the American Institute of Physics (AIP). To help AAPM members understand a bit more about this benefit of membership, I want to explain a bit about ASPIT and its insurance products. The American Physical Society Insurance Trust (APSIT) was established in 1969 by the American Physical Society (APS) to provide members with a convenient source for quality insurance coverage at an affordable cost. The trust has offered Group Term Life insurance to APSIT member society members since February of 1970. Since then, they have expanded their product range and the number of member societies participating. The insurance plans are underwritten by the New York Life Insurance Company, established in 1845 and still a market leader today. New York Life regularly earns the highest ratings for its financial strength from leading rating services and even through the recent economic crisis remained in excellent fiscal health. The plan is administered by a contracted administration company, Herbert V. Friedman, Inc., based in New York. They maintain a website about APSIT at www.hvfinc.com. All of the AIP member societies are APSIT participating organizations and any member of an AIP member society may purchase the insurance products provided by APSIT. The APSIT offers six insurance products: term life, 10 year level term life, disability income, personal accident, hospital indemnity and long term care. Of course, the particular products offered by APSIT may not (see Keyser p. 8)

AAPM Newsletter

September/October 2009

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

returned to work after attending the annual meeting (Anaheim, CA) with many cherished memories. The weather in the Los Angeles area during the meeting was so nice; it made my family ask me why I did not go to school or search for jobs in that area. Anyway, that is a different story, if I had gone to graduate school in an area with such nice weather throughout the year, there is a good chance that I would have spent more time learning how to surf the “ocean waves” rather than “surf the web” for more medical physics knowledge (☺). Continuing on the subject I have been addressing in my previous columns regarding how AAPM members receive the newsletter, casual conversations I had at the AAPM meeting make it evident that there is a silent majority among the membership that enjoys reading the newsletter in the printed version and a vocal minority that believes there is no need for the print version. I am with the silent majority and believe that there is still a need for the print version; however, I also believe that there are few more members who have not made up their mind, one way or the other, and in this column I am writing to those

members who have not updated their profile on their membership page of the AAPM whether to “opt out” from receiving the printed version or continue to receive both the printed and electronic versions. If you have not yet updated your profile, I urge you to please do so as soon as possible. You may do this by going to www.aapm.org, click on “My AAPM” from the table of contents on the left side of the page and then “My Member Profile”. As I was working on the budget for 2010, I also found that we mail nearly 16% of printed versions of the Newsletter to international addresses and the postage costs make up more than 25% of the total mailing costs. Therefore, I am requesting our international members to consider switching to the electronic version only. This does not imply that I am forcing all international members to switch to the electronic version only but am simply reminding you to please pick your choice, if you have not yet done so, by updating your profile. As a result of the current tally of members who have switched to receiving the electronic version only, I have been able to request a lower Newsletter budget (by nearly 20%) for 2010. Also the expenses for the newsletter will be adjusted for each issue based on the number of newsletters printed and mailed. As the number of members who “opt out” from receiving the printed version increases, I believe the discussions regarding the total elimination of the printed version will take place again. For now, AAPM will continue to provide the printed version to any member that wishes to receive one.

During the AAPM meeting in Anaheim, I was approached by many members who expressed complete satisfaction with the current layout of the Newsletter. A common theme of many of the conversations that I had was from individuals that expressed the enjoyment that they get from reading the printed version and that they would not be happy with an electronic version only. I would like to request that if you were one of those individuals that had this discussion with me during the Annual Meeting, please send me your comments regarding your preference for the print version, by writing to me directly or to AAPM headquarters. By doing so, it will support my effort to continue providing print versions in the immediate future. By the way, in order not to lag behind the ever-expanding mode of communication tools and to test new and emerging technologies, all members of the Electronic Media Coordinating Committee (Marty WeinhousChair) asked us to open a twitter account. My twitter account is http:// twitter.com/mmahesh1 and I welcome any interested members to check it out. This issue of newsletter is reaching the membership later than usual because I made the decision earlier this summer to extend the submission deadline until after the meeting. This extension has allowed me to include post meeting articles and responses. Finally, I am inviting local AAPM chapters to submit articles about their activities and also invite members to submit articles that are of interest to the readership by the submission deadline date of September 28th so that the last issue of 2009 (Nov-Dec) issue will arrive on time.

AAPM Newsletter

September/October 2009

(Keyser from p. 6)

meet your own personal needs. The premiums are usually very affordable and the coverage provided is quite competitive with other providers. Additionally, because the members of AIP member societies, as a group, typically have a higher education, live conservative lifestyles and so on, the group rate provided can be far better than other group plans. An additional benefit of APSIT is that representative of the member societies themselves sit on the governing board and make decisions about the types of plans provided and other matters. I was asked to serve as a member of the APSIT Board beginning in 2009. So, if you get a letter or informational pamphlet from the APSIT, you now know where it came from and why you received it. While it remains your decision as to whether any of the insurance products provided suit your own financial needs, I encourage everyone to take advantage of the offered products that are right for you. To learn more about other benefits of membership, please see our benefits of membership website: http://www. aapm.org/memb/default.asp U.S. Physics Team Brings Home 4 Gold and 1 Silver Medal The United States Physics Team earned four gold medals and one silver medal at the 40th International Physics Olympiad held in Merida, Mexico in July, tying for second place in overall medal count. AAPM joins with other societies to provide financial support for the team. Traveling to Merida, Mexico for the 40th International Physics Olympiad were: • David Field, of Andover, MA, a sophomore at the Phillips Andover Academy in Andover, MA; • Bowei Liu, of Freemont, CA, a sophomore at Mission San Jose

High School in Freemont, CA; Marianna Mao, of Freemont, CA, a senior at Mission San Jose High School in Freemont, CA; • Anand Natarajan, a senior at The Harker School, San Jose, CA; • Joshua Oreman, a senior at Harvard Westlake School, Los Angeles, CA; • Paul Stanley, Academic Director, Dobson Professor of Physics and Astronomy at Beloit College; • Warren Turner, Senior Coach, Assistant Professor at Westfield State, College in Massachusetts. The three graduating seniors will be going to Harvard (Marianna), MIT (Joshua), and Stanford (Anand) next year.

•

AAPM HQ Team… at your service! Back in 2000, AAPM’s leadership made a decision to increase the level of AAPM activity in the legislative and regulatory affairs arena. Since that time, AAPM’s interactions within the science and science policy communities has continued to increase. AAPM has a great HQ team who are working hard along with numerous AAPM volunteers to represent AAPM and the medical physics profession.

Lynne Fairobent joined the AAPM team in 2004 as Manager, Legislative and Regulatory Affairs. She works with AAPM volunteers to interact with Congress, federal agencies and other policy makers. Lynne also coordinates efforts with other sister organizations. She is also serves as a liaison to the Professional Council. Amanda Potter celebrated her oneyear AAPM anniversary early in 2009. As the State Legislative and Regulatory Affairs Specialist, Amanda gathers and disseminates information on the activities of the state legislatures and state agencies on issues related to the medical physics profession. She is also working with volunteers to develop and implement a grassroots program for AAPM. Beginning in 2005, Noel CrismanFillhart served as Senior Accounting Assistant on the AAPM HQ team. In 2008, Noel transitioned to a new role within the office and is now an Administrative Assistant, supporting the Legislative and Regulatory Affairs team. She also coordinates the AAPM E-News process and assists with the AAPM Placement Service.

L - R - Noel Crisman-Fillhart, Amanda Potter and Lynne Fairobent

AAPM Newsletter

September/October 2009

Education Council Report tained in each – I think you will agree that they are fantastic resources.

J. Anthony Seibert Education Council Chair

everal task groups and a sub-committee report commissioned by the Education Council have completed their assigned duties over the past year, with timely publications available (or soon to be available) on the AAPM website to provide guidance for the Medical Physics community as well as our associated professions. Recent notable efforts include TG 1, “Academic Program Recommendations for Graduate Degrees in Medical Physics” chaired by Bhudatt Paliwal from the Education and Training Committee (ETC), Task Group 133, “Alternative Clinical Medical Physics Training Pathways for Medical Physicists” chaired by Mike Herman through the Medical Physics Residency Training and Promotion Subcommittee of ETC, and the “Diagnostic Radiology Resident Physics Curriculum, 2009” report chaired by Phil Heintz reporting to the Medical Physics Education of Physicians committee. There is a tremendous amount of volunteer effort and time spent by the members of these groups, and I sincerely thank them and especially the chairs for their diligence and work in getting these reports to the approved and published stage. I encourage all of you to read and take advantage of the extensive wealth of information con-

Rapid changes occurring in our profession, however, often result in online published content that is out of date or significant fractions of a given report that are not relevant, thus requiring at periodic intervals the need to reconstitute another task group to revise the previous effort, and resulting in a significant delay in getting contemporary information available. Recognizing the need for more frequent updating of these documents, combined with all-electronic publication, the Education Council has adopted a strategy of forming working groups or subcommittees within the council, committee, and subcommittee structure whose tasks are to provide an ongoing review and refresh of reports that are published and posted on the AAPM website. One example is the recently formed working group “Didactic Graduate Education of Medical Physicists” with a charge to update the Report #44 document as necessary and to develop an essentials document in describing the recommended program curriculum. Richard Maughan is the chair of this working group. Upcoming changes in education and teaching methods for Medical Physicists has spawned a new subcommittee under ETC, “Medical Physicists as Educators” chaired by Jay Burmeister with a global charge to oversee the development and support of programs and directives that will assist medical physicists become better teachers of medical physics. Similarly, with the publication of the revised curriculum for Diagnostic Radiology Residents, the next charge of that subcommittee is to devise methods to coordinate physics principles with clinical activi-

ties, and to expand the available clinical teaching resources for physicists (for example, use of the web-based learning modules now under development). Ultimately, the delivery of clinically-relevant physics instruction to the residents in an enhanced and efficient format, with input from both the radiologist and the physicist as a team is the goal. A secondary task is to revise the curriculum at three-year intervals or more frequently as needed to reflect the state of the clinical practice in terms of physics instruction. The final word in this month’s column is realize that there are many opportunities for medical physicists in nonclinical positions such as academic physics departments, regulatory agencies, industrial laboratories, and industrial support positions among many others. The recent effort on ensuring enough residency positions in 2014 for the certification process has potentially caused us collectively to lose sight of these opportunities. George Starkschall, chair of the Education and Training of Medical Physicists Committee, has suggested the idea of forming a subcommittee to promote non-clinical careers for medical physicists, which would provide students information about such careers and inform them of success stories of medical physicists in these various walks of life. I personally agree with his suggestion, even though it is somewhat orthogonal to the massive efforts of the AAPM for promoting residencies to prepare students for clinical careers. Please let me know what you think, and I will pass those comments on to the Education Council during discussions on this topic. Until the next newsletter……

AAPM Newsletter

September/October 2009

Professional Council Report

Michael D. Mills Professional Council Vice-Chair

he Governmental and Regulatory Affairs Committee (GRAC) is busy monitoring and responding to a number of large issues. Much attention is being given to the current shortage of Tc-99m. Letters supporting establishment of a domestic source for Mo-99 generators have been written to a growing number of parties. Via GRAC, AAPM has been a signatory on these letters after offering constructive amendments to them. Representatives Edward Markey and Fred Upton have introduced the â&#x20AC;&#x153;The American Medical Isotopes Production Actâ&#x20AC;?, which contains language similar to that in letters that AAPM signed. We are still getting and responding to requests for more information on this, so if you regularly are involved with radioactive materials, either clinically or in research, and have information regarding the impact of the shortages, please let Lynne Fairobent or Doug Pfeiffer know about this. The Nuclear Regulatory Commission is currently working to streamline the process for registering individuals and sources in the National Source Tracking System, which tracks Category 1 and Category 2 sources. They spoke during one of the sessions at the Annual Meeting in Anaheim and

were on hand to get individuals into the system on the spot. It is likely that this system will be expanded to include Category 3 and some Category 4 sources at some point in the future due to Congressional pressure. If and when this happens, it will impact almost every user of radioactive sealed sources. GRAC is monitoring this and will provide information as it is available. We are also working to ensure that the rules are as minimally intrusive as possible. GRAC is also working with the NRC as they consider bringing personnel dosimetry standards into closer agreement with the ICRP 103 report, which limits the annual dose to 2000 mrem rather than 5000 mrem, annually. In addition, a subcommittee is being formed to work on lobbying for research funding on Capitol Hill, so that the organizations providing grant funds, such as NIBIB and NCI, are themselves adequately funded. The winds of change are blowing from Washington, and the Economics Committee (ECON) anticipates changes to the 2010 Medicare payment systems and additional health care reform legislation. There are bills before Congress that would substantially reduce funding for Medicare and Medicaid Services. ECON is considering the creation of a Webinar later this year or early next year to provide information and education on changes to Medicare policy and payments to the entire AAPM membership. ECON will research the cost and potential benefit of this initiative. Also, ECON is working on an update for the Reimbursement Roadshow for 2010. This comprehensive lecture on the place of medical physicists in

national economic health care policy is available for presentation to AAPM Chapter Meetings, provided speaker travel costs are provided. Please see the column by Wendy Fuss Smith in this issue for additional information on economic matters that concern medical physicists. The New York Center for Health Workforce Studies of the University at Albany (State University of New York) continues to make progress on the Medical Physicist Workforce Study. 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, and to develop a model for supply and demand for medical physicists for the foreseeable future. Additionally, one component will serve to validate the AAPM Professional Information Survey. Ned Sternick serves as Chairman of Medical Physicist Workforce SC and John Swanson chairs the Survey Validation SC. As of this writing, the Workforce Survey is being finalized with input from all Subcommittee members and also with input from AAPM leadership. Several models for survey validation have been proposed, and progress is being made to finalize the methodology. The Diagnostic Work and Workforce Subcommittee has made substantial progress on the conceptually difficult problem of measuring the work of the imaging medical physicist. Unlike therapy physicist work, imaging work is much more involved with machine service, regulations, and education as well as radiation protection. There are few patient-specific special procedures that involve substantial effort from the imaging physicist. Ed Nickoloff, chair of the Subcommit(see Mills p. 15)

AAPM Newsletter

September/October 2009

Legislative & Regulatory Affairs interventional radiology (IR) procedures are the correct treatment, providers are, where appropriate, urged to:

Lynne Fairobent College Park, MD

Treat kids with care: • Take time out: stop and child size the technique • Step lightly on the fluoroscopy pedal and limit fluoroscopic time as much as possible • Consider ultrasound or, when applicable, MRI guidance

Image Gently™ – Step Lightly

See related article by Keith Strauss in this issue. 2009 Associations Advance America Honor Roll

n August 24th, the Alliance for Radiation Safety in Pediatric Imaging launched the next phase of the Image Gently™ Campaign: Step Lightly: Safety in Pediatric Interventional Radiology (www.imagegently.org). This phase is designed to help providers use the lowest dose necessary to perform interventional procedures on children and maintain the quality of patient care. AAPM is a proud co-founder of Image Gently™. Phase III, with its Image Gently Step Lightly theme, extends to interventional providers, reminding them that children are more sensitive to radiation than adults. When

The Alliance for Radiation Safety in Pediatric Imaging was named to the 2009 Associations Advance America Honor Roll in recognition of its Image Gently™ campaign. Only eight programs were selected for the 2009 Associations Advance America Honor Roll. The Image Gently™ campaign was identified as an example of the vital role associations play in making America a better place to live. The Associations Advance America Awards are presented by the American Society

of Association Executives to recognize associations that propel America forward--with innovative projects in skills training and development; ethical, technical or professional standards; economic development; business and social innovation; information and knowledge creation; public education and information; civic and community volunteer activities; and citizenship and democracy enhancement. AAPM is a proud cofounder of the Alliance for Radiation Safety in Pediatric Imaging. NRC Requests Comment on Impact of Lack of Disposal Capacity on Radioactive Materials Used in Research (74 FR 39716, http://edocket. access.gpo.gov/2009/pdf/E918947.pdf) NRC is holding a public meeting October 7th in Rockville, MD to gather information to assess the effect of a lack of access to low-level waste (LLW) disposal facilities on those who use radioactive sources or materials in conducting research such as universities and hospitals. The purpose of this information gathering is to identify important research that

Attention AAPM Chairs! The 2010 Committee Appointment process is well underway. Please review your current and 2010 committee rosters. If you would like to make any new appointments to your committee, we strongly encourage you to utilize AAPM’s Committee Classifieds: http://www.aapm.org/aapm_advertising/committee_classifieds/

AAPM Newsletter

September/October 2009

has been impacted and/or stopped because of a lack of disposal options for radioactive sources or materials. Comments will be accepted until October 20, 2009. Because of anticipated interest, the meeting will be Web cast. Please check the NRC public Web site at http://www.nrc.gov/public-involve/public-meetings/index for the meeting and Web cast details. The staff is requesting that persons consider and address questions, that can be found on the AAPM website at: http://www.aapm.org/pubs/ newsletter/references/3405Legislativ eArticleFull.pdf, as remarks are developed and provided. If you have comments you would like AAPM to consider, please send them to Lynne Fairobent, Manager of Legislative and Regulatory Affairs at lynne@aapm.org before October

5, 2009. NRC Announces Selection of Susan Langhorst, Ph.D. to the Advisory Committee on the Medical Uses of Isotopes (ACMUI) The Nuclear Regulatory Commission today announced selection of Susan M. Langhorst, Ph.D., as the radiation safety officer representative on the Advisory Committee on the Medical Uses of Isotopes (ACMUI). The ACMUI was established in 1958 and advises the NRC on policy and technical issues related to the regulation of the medical use of radioactive material. Dr. Langhorst currently serves as the radiation safety officer for Washington University and Medical Center in St. Louis, Mo., and is on the faculty at the Mallinckrodt Institute

of Radiology. She has nearly 10 years experience managing NRC licenses, which involve medical research and the clinical use of radioactive material as well as radiation-producing machines in nuclear medicine and radiation oncology. She has worked with physician residency programs in radiology, including nuclear medicine, cardiology and radiation oncology, and the medical physics residency program in radiation oncology. Langhorst holds a bachelorâ&#x20AC;&#x2122;s degree in nuclear engineering from the University of Missouri-Rolla, and she earned her masterâ&#x20AC;&#x2122;s degree and doctorate of philosophy in nuclear engineering and health physics at the University of Missouri-Columbia.

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AAPM Newsletter

September/October 2009

News from CAMPEP and the University of Texas Southwestern Medical School. The imaging residency at Henry Ford Hospital was the new imaging residency. Stony Brook University Medical Center was accredited for residencies in both imaging and therapy.

John D. Hazle President, CAMPEP

uch focus in the medical physics educational community for the last couple of years has been on the looming 2012 and 2014 changes in the American Board of Radiology requirements for sitting for the boards. Several summits, town hall meetings and open discussions have taken place and the groundwork for meeting these goals is getting clearer. CAMPEP has been actively engaged in these discussions and has held annual strategic planning meetings for the last three years with this topic as a major point of discussion. Iâ&#x20AC;&#x2122;m happy to report that CAMPEP has seen significant activity in the accreditation of residency programs during 2009. There are now a total of thirty-two (32) accredited residency programs in North America, including nine (9) new programs! Of these, twenty-eight (28) are therapy, one (1) is imaging and three (3) offer both therapy and imaging. We also accredited the Irish Radiation Oncology Residency program in Dublin as a first foray into international waters. The new radiation therapy physics programs are at Duke University, Kansas City Cancer Center, Rush University, Scott and White Clinic, University of California at San Francisco, University of Pennsylvania,

At this time there are approximately 10 programs in the accreditation application process. Based on interest at the residency program application development workshop hosted earlier this year by Drs. Art Boyer and John Bayouth, we anticipate that as many as another twenty-five (25) programs could seek accreditation in the next three years. While the activity in accreditation of graduate programs is not at the level of residencies, we continue to see graduate programs seek accreditation. There are currently twentyone (21) programs, three of which started their accreditation in 2009. The new graduate programs are at Columbia University, University of Cincinnati and the University of Victoria. There are approximately seven (7) programs in various stages of seeking accreditation. Another major area of discussion has been the refinement of criteria for progression through the educational process in preparation for sitting for the boards. CAMPEP recently communicated clarification of some of these steps with our program directors and on the web page. In summary, we addressed the interpretation of undergraduate expectations, remediation of graduate work for graduates of non-CAMPEP accredited programs entering residencies and the timing of remediation of graduate deficiencies. The expectations for undergraduate preparation have been refined to include a degree in physics, en-

gineering or other hard science. If the degree is not in physics, three upper level physics courses or their equivalent should be completed, corresponding to a minor in physics. The goal here is to make sure that the graduate candidate is prepared for the rigors of physical science graduate work. For graduate education, the students are expected to complete the material in AAPM Task Group Report #79. A graduate programs approach to covering this material is the core of the CAMPEP review. Therefore, completion of a CAMPEP-approved graduate degree, M.S. or Ph.D., implies that the student has successfully completed these materials and is ready to move on in the next step of their education, the clinical residency. Candidates entering a residency program through a CAMPEP accredited graduate program should have no deficiencies to remediate and should be prepared to immediately immerse themselves in learning the practical application of their previous training in a clinical setting. Residency candidates from non-CAMPEP accredited programs or with other physical science degrees will be required to remediate deficiencies prior to completing their clinical training. If substantial didactic education is needed, additional time in the residency may be required. This expectation is being communicated to residency program directors and will be strictly enforced for residents starting after July 1, 2012. This requirement is integral to the agreement for the ABR to accept two-year CAMPEP accredited residencies in lieu of three years of on-the-job training. The preferred means of remediating

AAPM Newsletter

September/October 2009

There are currently 21 CAMPEP accredited graduate programs. The programs in bold are new for 2009. Columbia University

University of Cincinnati

Duke University

University of Florida

East Caroline University

University of Kentucky

Louisiana State University

University of Manitoba – CancerCare Manitoba

McGill University

University of Oklahoma

University of Alberta – Cross Cancer Institute

University of Texas at Houston – M. D. Anderson Cancer Center

University of British Columbia University of Calgary – Tom Baker Cancer Centre

University of Texas at San Antonio

University of California at Los Angeles

University of Wisconsin

University of Chicago

Vanderbilt University

University of Victoria

Wayne State University

There are now 32 CAMPEP accredited residency programs in North America (list below). Thirtyone of these are therapy programs and four are imaging (Cross Cancer Institute, UT M. D. Anderson Cancer Center and Stony Brook University Medical Center both have therapy and imaging residencies). We also accredited the Irish Radiation Oncology Residency Program in therapy physics this year. Cross Cancer Institute – University of Alberta (Imaging and Therapy)

University of Chicago Medical Center (Therapy)

Duke University (Therapy)

University of Iowa (Therapy)

Henry Ford Health System (Imaging)

University of Louisville School of Medicine (Therapy)

Kansas City Cancer Center (Therapy)

University of Michigan (Therapy)

London Regional Cancer Program (Therapy)

University of Minnesota Medical School (Therapy)

Mayo Clinic (Therapy)

University of Nebraska Medical Center (Therapy)

McGill University (Therapy)

University of Pennsylvania (Therapy)

The Ottawa Hospital Cancer Center (Therapy)

University of Texas M. D. Anderson Cancer Center (Imaging and Therapy)

University of Florida (Therapy)

Rush University (Therapy)

University of Texas M. D. Anderson Cancer Center – Orlando (Therapy)

Scott and White Clinic (Therapy) Stanford University (Therapy)

University of Texas Southwestern Medical Center (Therapy)

Stony Brook University Medical Center (Imaging and Therapy)

University of Toronto (Therapy)

Thomas Jefferson University Hospital – Bodine Cancer Center (Therapy)

University of Wisconsin (Therapy)

Tom Baker Cancer Centre (Therapy)

Virginia Commonwealth University (Therapy)

University of California – Irvine Medical Center (Therapy)

Washington University School of Medicine (Therapy)

University of California at San Francisco (Therapy)

Irish Radiation Oncology Residency Program (Therapy)

Vanderbilt University Medical Center (Therapy)

AAPM Newsletter (Hazel from p. 13)

graduate deficiencies is in a CAMPEP accredited graduate program. However, CAMPEP will allow the residency program directors to assist in the remediation by offering specific classes to meet deficiencies in their graduate education. The details of how a residency program will be accredited to provide this graduate education are currently under development. In other words, classes that cover specific components of TG79 will have to be developed, their content documented and the process described for assessing the student’s mastery of the material. One other topic regarding residency programs has come up several times and I would like to make CAMPEP’s

position clear. The issue is whether residents could complete their clinical education at a site remote to the accredited institution. The answer is a resounding YES! CAMPEP accreditation is a process that includes reviewing all facets of the program that will eventually award the certificate. The physical resources of the home institution are but one factor in this review. Therefore, it is perfectly acceptable for a program to provide clinical education at multiple physical sites, in fact this is already occurring. The program will only need to document the resources at each satellite, and how any required experience on equipment that a satellite does not have will be accommodated, and the credentials of the supervising medical physicist

September/October 2009 at each satellite. Our goal is to ensure that all candidates entering residency programs have the required prerequisite graduate education as stipulated by the AAPM prior to starting the clock for their two-years of structured clinical training. Therefore, the American Board of Radiology can be assured that the graduate of a CAMPEP accredited residency has the necessary undergraduate, graduate and clinical education to sit for their examination as demonstration of minimal competency to independently practice clinical medical physics. See the listings of CAMPEP accredited graduate and residency programs on page 14.

(Mills from p. 10)

tee, is leading the development of a new type of survey instrument to measure the unique work profile of the imaging physicist. There are plans to test the survey instrument among a pilot group of imaging physicists this fall. These efforts are coordinated with the overall Workforce effort being performed by the State University of New York. TG 159 is nearing completion of its report. The charge of the task group is to recommend an ethics curriculum for medical physics graduate programs and residencies. An email survey of these programs conducted in 2007 indicated that about 50% of the programs were offering a formal ethics course. TG 159 plans to resurvey the programs prior to completing their report. Please see columns by Wendy Fuss Smith and Michael Herman for other aspects of challenges and progress concerning the Professional Council.

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.

“One ought, every day at least, to hear a little song, read a good poem, see a fine picture, and if it were possible, to speak a few reasonable words.” - Johann Wolfgang von Goethe (1749-1832)

AAPM Newsletter

September/October 2009

PHYSICISTS AND DOSIMETRISTS SAVE TIME STUDYING FOR YOUR BOARDS!

Certification Radiotherapy Review Courses Dosimetry Boards Written Physics Boards (ABR & ABMP) Oral Physics Boards (ABR & ABMP) 20 Hour Intensive Weekend Course No-Nonsense Instruction Comprehensive Study Guides One-On-One Follow Up Internet Class Bulletin Review Boards Estimated Time Savings In Excess Of 100 Hours

SYMPOSIA: Target Delineation & Critical Structure Course Radiation Oncology Nursing Course CT Anatomy & IGRT Course Radiation Safety Officer Course

* iÊxÇ{®ÊÓÎÓ ÓÎäxÊUÊ/ Ê ÀiiÊnÈÈ®ÊxÎÇ ÓÓää >ÝÊxÇ{®ÊÓÎÓ Ó{äxÊUÊÜÜÜ°>ÀV« ÞÃ VÃ° iÌÊUÊÜÜÜ°} L> « ÞÃ VÃÃ ÕÌ Ã°V

AAPM Newsletter

September/October 2009

AAPM Website Editor Report Onasis Budisantoso to fine tune the interface but we should have replaced our old search engine by the time that the Newsletter is released in print. Once it is there, please use it and send me your comments via the feedback box located at http:// www.aapm.org/pubs/newsletter/ websiteEditor/3405.asp.

Christopher Marshall NYU Medical Center

ur new “Google-in-a-box” search engine was plugged in and indexed our site, including PDF documents for the first time. My immediate opinion is that it does a much better job than our current search engine. At the time of writing our webmistress Farhana Khan is working with our Applications Developer

You may have noticed the change in main panel display when you select “AAPM”, “Members” or “International” as forecast in my last report. Others will be rolled out as I work through revisions of the corresponding main menu pages. We have introduced horizontal tabs for the International/Exchange Scientist page and we will be introducing them throughout the site. We are experimenting with a drop-down menu of shortcuts to replace the shortcut list in the top

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right of the homepage to allow faster access to popular topics. These initiatives address navigation issues. Discussion at the Annual Meeting was once again about reaching out to the “public” through the web. As a result of a discussion with the Media Relations Subcommittee under Jeff Limmer’s chairmanship I will meet in September with our staff and our AIP media representative Jason Bardi with the objective of establishing a permanent “virtual press room” on the website. The Web Site Subcommittee under Sugata Tripathi’s chairmanship has launched an initiative to revise the material under our Public and General section that was previously released as printed brochures. These have been migrated to the committee wiki to assist in that process. The intent is to bring them up-to date in HTML format. (Both Subcommittees report to the Public Education Committee of Ed Council.) It seems to me that we should use all available vehicles if we want to make our story know to the public, such as Wikipedia, Facebook, Twitter etc. You can now follow “aapmhq” tweets if you subscribe to Twitter – this is an experiment at this time. Incidentally, a link to the full presentation at the Annual Meeting President’s Symposium was immediately “tweeted” by the speaker, Ian Foster, and can be viewed at www. slideshare.net/ianfoster/aapm-fosterjuly-2009 thus demonstrating how rapidly and inexpensively information may be disseminated these days….if we have the tools to find it.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/ websiteEditor/3405.asp

AAPM Newsletter

September/October 2009

We are pleased to announce the recent merger of Comprehensive Physics Services, Inc. (CPSI) and Global Physics Solutions (GPS).

Medical Physics Services: : /--)22)/.).' ##%03!.#% %23).' : (%1!08 ,).)#!, (82)#2 400/13 : )!'./23)# 4#,%!1 %$)#).% /.24,3).' : ##1%$)3!3)/. 1/'1!- 400/13 : $4#!3)/. 1!).).' : !.#%1 %.3%1 %2)'. 4),$

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-4,3)0,% $/2)-%318 !.$ 0(82)#2 %$4#!3)/. #/412%2 #,)%.32 !.$ !22/#)!3%2 #!. count on GPS to lead the way with total solutions expertise.

AAPM Newsletter

September/October 2009

ACR Accreditation to CMS by August 31, 2009. (See http://www.cms.hhs.gov/center/ physician.asp.) CMS plans to issue final rules by November 1, 2009.

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 accreditation? In each issue of this newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR’s accreditation web site portal (www.acr. org; click “Accreditation”) for more FAQs, accreditation applications and QC forms. Q. What is MIPPA and when will it go into effect? A. Section 135 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) policy is a condition of payment for the technical component (TC), or acquisition of the image, and covers the equipment, the technologists, and the supervising physician. The law includes a provision requiring providers of advanced diagnostic imaging services (ADIS) to meet comprehensive accreditation standards. ADIS are defined as MRI, CT, and nuclear medicine/PET and specifically exclude x-ray, ultrasound, and fluoroscopy. Proposed rules were released in early July 2009. Comments were due

Since Section 135 deals only with the physician fee schedule, it does not relate to hospital services. Therefore, it is important to note that hospitals are not required to meet the comprehensive accreditation requirements by 2012. In addition MIPPA only applies to providers of diagnostic imaging services and does not apply to CT scans performed for radiation oncology treatment planning purposes. Q. What organizations will be approved to accredit facilities providing MRI, CT, and nuclear medicine/PET services? A. This is unknown at this time. Accrediting organizations are allowed to submit applications to CMS after the final rules are published. CMS plans to approve accrediting organizations by January 1, 2010. The ACR has long, successful history of accrediting MRI, CT, and nuclear medicine/PET facilities and will be submitting an application to CMS for approval. Keep an eye on www.acr.org for more information as it becomes available. Q. What standards must the accrediting organizations set? A. According to the proposed rules, the accrediting organization must set standards for: •

Qualifications for medical personnel who are not physicians but who furnish the TC. This includes medical physicists.

•

Qualifications of medical directors and supervising physicians (including training and continu-

ing education related to the advanced imaging services) •

Requiring facilities to - Establish and maintain a QC program to ensure the technical quality of diagnostic images - Ensure the equipment meets performance specifications - Ensure the safety of personnel

Q. When must eligible facilities performing MRI, CT, and nuclear medicine/PET diagnostic exams be accredited? A. By January 1, 2012.

CONGRATULATIONS!! Congratulations to the four winners of the: New for 2009 Visit the Vendors Program that took place during the Annual Meeting in Anaheim. Each winner listed below has won free registration to the 2010 AAPM Annual Meeting to be held in Philadlphia, PA: Chang-Heon Choi Chang-Heon Choi Vrinda Narayana Vrinda Narayana Mauro Tambasco Mauro Tambasco MartyWeinhous Weinhous Marty

AAPM Newsletter

September/October 2009

2008 AAPM Medical Physics Travel Grant Report Jun Deng, Ph.D. Department of Therapeutic Radiology Yale New Haven Hospital (Travel completed June 2009) Shanghai, China t was not a trivial task to visit China in June 2009 when H1N1 flu has been widely reported worldwide since early May and the situation in China has been carefully monitored by the government to avoid potential epidemic. Fortunately, my whole travel schedule was not affected at all when we landed at Shanghai Pudong International Airport with no passengers showing any flu symptoms.

My 2008 AAPM medical physics travel grant started with Fudan University Cancer Hospital. I was warmly welcomed by the chair of Department of Radiation Oncology, Dr. Zhen Zhang and chief physicist, Dr. Zhiyong Xu, who showed me around the institution first prior to my lecture. My talk entitled imageguided radiation therapy: technical advances and clinical considerations was well received and sparkled long-time discussions on a variety of issues associated with clinical implementation of IGRT at this institution. During my visit, I was surprised to learn that while there were 40 physicians, 10 physicists, and more than 50 therapists on staff, about 600 patients were treated daily on 5 Elekta linacs, including the latest Elekta Synergy, with machines running from early morning till late evening, sometimes even to the next day early morning. Later on, I realized that this was quite typical in China for a Radiation Oncology Department located at a large centralized city, such as Shanghai, Chengdu and Beijing

I visited this time. There were two major reasons for this: one was due to the huge population in China, and the other was the so-called large-city phenomenon, i.e., cancer patients all flooded into large cities for a better environment, much more available resources and expertise, and hopefully a better treatment. Since there were no dosimetrists in China right now, physicists would spend most of their time running treatment planning and have to do QA at late night or during weekends. Chengdu, China At Chengdu, I visited two institutions: first Sichuan University West China Cancer Center and then Sichuan University Key Laboratory of Radiation Physics and Technology. Located at southwestern part of China, Chengdu is the capital city of Sichuan Province, a city full of cultural and historical heritage. Sichuan University West China Cancer Center is the largest cancer hospital in China with over 5000 beds and considered as one of the best cancer centers nationwide. Similar to the settings in Fudan University Cancer Hospital, it has 4 Elekta linacs including Synergy for IGRT, and treats 500 patients per day. According to Dr. Nianyong Chen, director of cancer center, who hosted me and gave me a tour of his center, with 8 more Elekta linacs slated to be added in the new cancer center, they strived to be the leader in IGRT practice in China. As a member of AAPM TG131, I mentioned the possibility of establishing a strong tie between a US institution and a Chinese institution and training of Chinese medical physicists in the US. Dr. Chen expressed strong interest in participation in this initia-

tive, and hoped to collaborate with Yale Department of Therapeutic Radiology for this matter. After my presentation, I had an open discussion with the physics team, most of who had Master and PhD degrees and were very eager to do research. Their questions ranged from Monte Carlo treatment planning, image quality of kV-CBCT vs. MV-CBCT, to tumor motion management for liver and lung lesions. I was quite happy to be able to offer them some suggestions on journal publication and future collaboration. I was also greatly impressed when Dr. Chen outlined their next steps for IGRT practice, and Dr. Shen Bai, the chief physicist, detailed his plans on the IGRT QA and implementation of VMAT on Elekta Synergy. My second stop at Chengdu was Sichuan University Key Laboratory of Radiation Physics and Technology, where Dr. Qing Hou was the director and my host. This was primarily a research center with no clinical activities. However, Dr. Hou has been advising PhD and Master degree students on radiation physics and radiation therapy for many years. During my visit, I had the privilege to evaluate their in-house treatment planning system called PhoenixPlan and MLC, both of which have been commercialized and applied clinically in China now. We discussed possible improvement for their TPS and some other issues associated with MLC, such as leaf positioning accuracy and checking mechanism, practicality for electron as well as photon collimation, clearance for clinical operations, contamination associated with current design, and possible tumor tracking mechanism etc. I suggested running Monte Carlo simulations on current leaf design to determine the appropriateness for electron collimation.

AAPM Newsletter Beijing, China Beijing was the last stop of my whole trip where I spent a few days visiting two highly-respected institutions in China: Peking University Key Laboratory of Medical Physics & Engineering and Chinese Academy of Medical Sciences Cancer Hospital. While my host at Peking University, Professor Shanglian Bao, was out of country for an international conference during my visit, I received a surprisingly warm welcome from his wife, Professor Pingfang Xu and his team members. As a premier research and development site on medical physics and biomedical engineering, several teams were working in parallel and collectively on a variety of research projects on CT, MRI, PET and SPECT. During my visit, I had the privilege to tour their prototype open-bore MRI scanner and learned of their latest developments on SPECT and PET design and implementations. We also discussed the new concept, biologically-guided radiation therapy (BGRT) and how BGRT could be incorporated into routine clinical practice in the near future. Later on, I had a candid discussion with Professor Bao via email on how to maintain a continual development for the medical physics program developed solely by him many years ago. We both agreed that a closer collaboration with the radiotherapy community would be needed in order to further enhance their research on medical physics. As a premier cancer hospital in the field of radiation oncology as well as a research powerhouse on medical physics in China, I was very happy to visit the Department of Radiation Oncology at Chinese Academy of Medical Sciences Cancer Hospital, chaired by Dr. Yexiong Li. My host, Dr. Jianrong Dai who was the chief physicist, gave me a brief tour of the clinic before my lecture

on image-guided radiation therapy. Based on my observations, in terms of clinic environment and resources, there was not too much difference between this one and the two institutions I visited earlier on, i.e., Fudan University Cancer Hospital and Sichuan University West China Cancer Center. However, according to Dr. Dai, besides clinic responsibilities, a variety of innovative research projects were actively pursued and well supported by the department and the hospital. My presentation on IGRT was well received and generated some heated discussions among the audience. I mentioned several possible directions for IGRT in the near future at the end of my talk, such as BGRT, adaptive IGRT, 4D tumor tracking and delivery etc. Dr. Zhihao Yu, one of the most respected radiation oncologists in China, asked several interesting questions as to the benefit of IGRT, any clinical evidence for its possible benefit, and whether IGRT would be better than the other modalities such as IMRT. I echoed my concerns about the clinical implementations of IGRT and the scarcity of clinical data available in supporting the

September/October 2009 superiority of IGRT. This concluded my two week visit to five different institutions in China. This busy trip, full of joy and educational experience, was indeed an invaluable experience to me and my future career development. During this trip, I not only met so many wonderful colleagues in China and learned a lot about their clinical practices and research projects, but also shared my experiences with them on Monte Carlo treatment planning, IMRT, IGRT and kV-CBCT dosimetry. I am sure I will cherish this experience for the rest of my life. Finally, I would like to express my sincere gratitude to Professors Zhen Zhang, Nianyong Chen, Qing Hou, Shanglian Bao, and Jianrong Dai for their valuable time and warm hospitality. I would also like to thank AAPM for awarding me with this travel grant, which enabled me to visit some of the top research and clinical facilities in China and meet with many Chinese colleagues in my field. I am also greatly grateful to Dr. Charles Lescrenier for his generous support of this grant, without which it would be impossible for me to finish this wonderful trip to China.

(From left to right) Yibao Zhang, Dr. Li Gao, Dr. Jiangrong Dai, Dr. Zhihao Yu, me, and Dr. Junlin Yi at Chinese Academy of Medical Sciences Cancer Hospital, June 2009.

AAPM Newsletter

September/October 2009

Introduction of William D. Coolidge Award Recipient

The following is an introducation of Willi Kalender, Ph.D. by colleague Mark Madsen, Ph.D.

t is my honor to introduce this yearâ&#x20AC;&#x2122;s William D. Coolidge Award recipient, Professor Doctor Willi A. Kalender. Willi was born on August 1st, 1949 in a small farming community in Germany where he was raised on a dairy farm. He attended the University of Bonn majoring in math and physics and after graduating, he entered the Medical Physics program at the University of Wisconsin in Madison where he received his PhD 1979. Willi worked in the research laboratories of Siemens Medical Systems from 1979 through 1995, but remained very active in academics. In 1988 he was appointed as the head of the department of Medical Physics at the University of Erlangen and had adjunct appointments at other universities. In 1995 he departed Siemens to become full professor and director of the newly established Institute of Medical Physics at the University of Erlangen where he still reigns.

The scientific achievements of Willi Kalender are truly outstanding. His accomplishments are documented in over 200 peer reviewed papers, 400

plus abstracts, 18 book chapters and 4 books. He holds more than 20 patents pertaining to diagnostic imaging and has been the principal investigator on numerous industry and government grants totaling many millions of dollars of support. He has made substantial contributions in primary research areas that include the application of Monte Carlo techniques to diagnostic imaging, spiral (helical) CT, QCT bone mineral/mass assessment, cardiac CT, and CT dose reduction. Willi is widely acknowledged as the originator and developer of spiral CT. The advent of spiral CT rescued the modality which was in decline and it is no exaggeration to say that it changed the practice of medicine. The initial papers he authored on spiral CT published in 1990 have been cited more than 800 times and a Pubmed search on the topic of spiral (helical) CT produces more than 10,000 articles. Spiral CT was developed with aim of expanding the diagnostic capabilities of CT imaging and Willi led the way in exploiting this new technology. Cardiac CT has been an area of concentrated investigation for Willi as evidenced by the more than 30 publications he has contributed on this topic which include a Medical Physics paper authored by Marc Kachelriess from his group that won the 2002 Greenfield award. The reduction of radiation dose in diagnostic imaging is also an area where Willi has made major contributions throughout his career. From his earliest paper in 1979 on dose reduction to his most recent in Medical Physics article in 2009, he has led the way in making efficient use of radiation dose to produce quality diagnostic images.

Williâ&#x20AC;&#x2122;s leadership contributions include his participation in medical physics organizations around the world, the organization of scientific meetings, his service on editorial boards and the translation of his research successes into business enterprises. Willi is a long time member and contributor to the AAPM. He became a fellow of the AAPM in 2002, served on the board of directors from 2005-2007 and continues to serve as a member of the CT Subcommittee of Science Council. In addition he has consistently presented refresher courses at the AAPM and RSNA for the past 2 decades. Other organizations that Willi has participated in include the ICRU where he chairs the committee on the Quantitative Aspects of Bone Densitometry (ICRU Report 81), the European Congress of Radiology and the Bavarian Center of Excellence for Medical Imaging & Image Processing. Willi currently sits on the editorial boards of 5 scientific journals. In addition to all of this activity, his research has resulted in the formation of 4 commercial companies providing products for surgical navigation, PET radiopharmaceuticals, quality assurance phantoms and micro-CT instrumentation. Beyond the scores of invited talks Willi has given around the globe, he has visiting professorships at Stanford and the University of Wisconsin. In addition, he has built the Institute of Medical Physics at the University of Erlangen into a world class educational facility that has few peers. Willi became the first and only director of IMP in 1995. From then until now, more than 37 advanced degrees have been awarded with many of those under his direct

AAPM Newsletter

Dr. Maryellen Giger and Dr. Willi Kalender during the 2009 Awards Ceremony supervision. Already, many of these students have themselves become major contributors in their respective fields leaving an enduring legacy that will persist long into the future.

major awards that Willi has received. These include the 2007 International Stephen Hoogendijk Award, the 2007 European Latsis Prize for Science, and the 2008 City of Remscheid RöntgenPlakette. All of these attest to a record of achievement that has only accelerated in recent years. His accomplishments within the medical physics scientific, professional and teaching community are truly outstanding and rank with the very best that has been produced in our field. On behalf of the AAPM Awards and Honors Committee, I am very pleased to present to you the recipient of the 2009 William D. Coolidge Award, Willi A. Kalender.

It would be remiss to ignore other

September/October 2009 Coolidge Award Acceptance Speech by Dr. Willi Kalender Dr. Kalender did not come to the ceremony with a prepared speech so we therefore do not have anything to print. I would like to say that his acceptance speech was “a short and lively response” that seemed to be enjoyed by all in attendance.

AAPM Newsletter

September/October 2009

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant 2010 Proposed Rule Has Devastating Impacts to Freestanding Centers

he Centers for Medicare and Medicaid Services (CMS) recently released the 2010 Medicare Physician Fee Schedule (MPFS) proposed rule, which contains several practice expense proposals that will significantly reduce reimbursement to the technical component (TC) and global payments to freestanding and community-based cancer centers, while slightly increasing payments to radiation oncologists. AAPM has grave concerns regarding the practice expense proposals and the estimated 19% cuts in Medicare reimbursement for radiation oncology services. These cuts would mean that Medicare payment for certain radiation therapy treatments will be reduced by up to 53%. Cuts of this magnitude would be devastating to cancer care and may result in many freestanding and community-based cancer centers, especially in rural areas, closing their doors to treating cancer patients. Of particular concern is a change to the utilization rate from 50% to 90% for all medical equipment that costs more than $1 million. This proposed policy accounts for at least one quarter of the cuts to radiation therapy in the proposed rule and significantly impacts external beam, IMRT and stereotactic radiosurgery treatment delivery. This policy stems from concerns raised by the Medicare Payment Advisory Commission (MedPAC) and others regarding the volume growth of diagnostic imaging

services over the past several years. CMS cites a March 2009 MedPAC report that discusses diagnostic imaging and data on utilization rates for CT and MRI, but then inexplicably applies the equipment utilization policy to radiation therapy. Further, CMS is proposing to use the recently collected AMA Physician Practice Information (PPI) survey data to establish Medicare payments starting January 1, 2010. Using the survey data will result in significant redistributive effects on Medicare payments, which favors primary care specialties. And although radiation oncology practice expense per hour is proposed to increase from the current rate, a significant reduction to TC and global payments will occur. In the proposed rule, CMS did not revise the practice expense inputs or make relative value (RVU) adjustments to the new HDR brachytherapy codes (CPT 77785-77787) as recommended by AAPM and other stakeholders last December. Instead, the Agency has referred this issue back to the AMAâ&#x20AC;&#x2122;s Relative Value Update Committee (RUC) for revaluation in October. CMS proposes to utilize medical physicist professional liability insurance premium data as a proxy to update the malpractice expense RVUs for technical component services in 2010. CMS notes that medical physicists are involved in complex services such as IMRT. Based on the complexity of these services, CMS believes that medical physicists would pay one of the highest malpractice premium rates of the entities furnishing TC services and that using this data as a proxy (in the absence of actual premium data) to

develop malpractice RVUs for TC services would be more realistic than the current approach. The premium data indicate that medical physicists have very low malpractice premiums relative to physicians, which results in a 1.0% reduction to radiation oncology payments beginning in 2010. Based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 21.5% decrease to the 2010 conversion factor to $28.32. AAPM anticipates that Congress will avert the 21.5% decrease to the conversion factor slated for January 1st 2010 (and provide a slight increase to the conversion factor). However, if Congress does not pass legislation the 2010 conversion factor would reduce all payments by an additional 21.5% with a total negative impact of 40% for radiation oncology. In addition, CMS is proposing to remove drugs from the SGR calculation used to determine the annual update of the conversion factor. While the proposal would not change the projected negative 21.5% update for services during 2010, CMS projects that it would reduce the number of years in which physicians are projected to experience a negative update. AAPM will submit comments to CMS by the August 31st deadline. To read a complete summary of the proposed rule and to review impact tables go to: http:// aapm.org/g overnment_affairs/ CMS/2010HealthPolicyUpdate.asp 2010 Policies & Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) published the 2010 Hospital Outpatient Prospec-

AAPM Newsletter proposed payment of $746.68, is a significant 57.3% reduction in the 2009 New Technology APC payment of $1,750.00 per fraction. CMS states that they believe they have sufficient claims data to propose reassignment of CPT 0182T. Based on hospital claims data for 0182T, CMS states that its hospital resource costs are similar to those of other services assigned to APC 313.

tive Payment System (HOPPS) proposed rule. The proposed rule includes a 1.9% increase to Medicare payment rates for most services paid under the HOPPS in 2010. The majority of radiation oncology procedure codes would realize slight increases in hospital payments, however, low dose rate (LDR) brachytherapy (APCs 312 & 651) and stereotactic radiosurgery treatment delivery (APCs 65, 66, 67) have payment reductions slated for 2010. Medical physics codes 77336 & 77370 in APC 304 receive a 2.0% increase in 2010 payments (see table on pg. 26).

•

Other key CMS proposals include: •

Reassign Category III CPT 0182T for High Dose Rate (HDR) Electronic Brachytherapy from New Technology APC 1519 to APC 313 Brachytherapy. The 2010

•

Pay separately for each of the brachytherapy sources on a prospective basis, with payment rates to be determined using the 2008 claims-based median cost per source for each brachytherapy device. Continue packaging of radiation oncology imaging guidance services for 2010.

September/October 2009 •

CMS is not proposing any new composite APCs for 2010 so that they may monitor the effects of the existing composite APCs on utilization and payment, including LDR prostate brachytherapy and multiple imaging services.

A complete summary of the proposed rule and impact tables is on the AAPM website at: http:// aapm.org/g overnment_affairs/ CMS/2010HealthPolicyUpdate.asp The final rule will be published by November 1st, with an effective date of January 1, 2010.

AAPM Newsletter

September/October 2009

SUMMARY OF 2010 PROPOSED RADIATION ONCOLOGY HOPPS PAYMENTS APC

Description

CPT Codes

2009 Payment

2010 Proposed Payment

N N 65 66 67

N/A N/A Level I SRS Level II SRS Level III SRS

$0 $0 $952.38 $2,579.82 $3,803.23

127 299

Level IV SRS Hyperthermia & Radiation Treatment Level I Radiation Therapy

77417 77421 G0251 G0340 G0173, G0339 77371 77470, 77600-77620 77401-77404, 77407-77409, 77789 77406, 77411-77416, 77422,77423, 77750 77332-77334

300 301

Level II Radiation Therapy

303

Treatment Device Construction Level I Therapeutic Radiation Treatment Prep

304

305

310

312

Level II Therapeutic Radiation Treatment Prep Level III Therapeutic Radiation Treatment Prep Radioelement Applications

313

Brachytherapy

412

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

651

664 667

$0 $0 $894.46 $2,504.87 $3,506.81

Payment Change 2009 to 2010 $0 $0 ($57.92) ($74.95) ($296.42)

Percentage Change 2009 to 2010 0% 0% -6.1% -2.9% -7.8%

$7,641.69 $373.21

$7714.02 $384.64

$72.33 $11.43

0.9% 3.1%

$93.88

$93.00

($0.88)

-0.9%

$152.05

$156.50

$4.45

2.9%

$188.16

$192.65

$4.49

2.4%

77280, 77299 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77315, 77321, 77327, 77328

$114.70

$116.96

$2.26

2.0%

$255.69

$266.15

$10.46

4.1%

55876, 77295, 77301, C9728

$892.90

$921.22

$28.32

3.2%

77761, 77762, 77763, 77776, 77777, 77799 77785, 77786, 77787, 0182T 77418, 0073T

$430.66

$297.70

($132.96)

-30.9%

$733.25

$746.68

$13.43

1.8%

$410.83

$424.21

$13.38

3.3%

77778

$866.17

$808.27

($57.90)

-6.7%

77520, 77522

$703.38

$713.34

$9.96

1.4%

77523, 77525

$840.56

$933.16

$92.60

11.0%

APC reassignment for 2010 are highlighted in bold

AAPM Newsletter

September/October 2009

New Professionals Forum Report

Jessica Clements New Professionals Subcommittee Chair

he New Professionals Subcommittee (NPSC) was developed in 2008 to support the transition of new professional into the field by providing various informational resources regarding topics of particular interest to those just beginning their Medical Physics careers. With the breadth of the field, the size of the medical physics community, and the rapid expansion of new technologies in medical field; we hope to broaden new professional’s horizons of all the resources available from the AAPM and the field itself. One of our first projects is to provide some of this information in the AAPM newsletter where we hope to address some of these topics, and this is the first installment of this effort. If there is a particular subject that you would like to know more information about in an upcoming column, please email the SC—we would really like to hear from you! Our first topic is the development of a new mentoring program. Medical physics is a field of constant technological advancement and growth. The mentorship program is a way for experienced physicists to assist in the professional development of new members of the field, and open communication between the newer and more seasoned generations of physi-

cists. The program has been designed to support new professionals working in the field of medical physics. The goal is to provide support in all professional components of the job as well as moral support, social connections, introduce the medical physics culture, and an alternative avenue to ask questions. The mentor and new professional can accomplish this relationship as they see fit (phone, email, meeting in person on a regular basis, etc.). The mentor will ensure there are open lines of communication with the new professional and will not be liable or responsible as a supervisor for the activities of the new professional. Applicants may be graduate students, residents, or new professionals not yet board certified in the area to be mentored. Mentorship is limited to AAPM student, junior, and full members. Each mentor shall be a qualified medical physicist and a full or emeritus member of the AAPM. Each mentor shall have work experience at a university, hospital, other clinical facility or a radiological industry. Ideal mentors will have board certification and at least 5 years of full-time work experience in the specialty area of the new professional they are mentoring. Each new professional and mentor applicant must complete the provided respective application and ensure that it is returned with all additional supporting documentation for consideration in the program. Additional documentation required for mentor applicants is a self statement that describes their interest in mentoring a new professional. Additional documentation for new professional applicants includes a

self statement that should contain a description of their current work environment and need for mentorship. Applicants will be screened and selected based on match criteria between new professional and mentor applicants. Once a match has been made, both applicants will be notified and introduced to each other. Both parties are responsible for open and honest communication. The onus is upon the new professional to communicate needs or requests for help to the mentor. The mentor is responsible for a timely and professionally reasonable response. The new professional is also solely responsible for any actions taken, even when under the advisement of the mentor. The agreement between the mentor and new professional does not constitute a supervisor/subordinate relationship and each party is bound only by their willingness to participate. It is expected that the mentor and new professional will agree to a communication method and frequency that is acceptable to both. Please watch for application information and materials on the NPSC page of the AAPM website as well as in the “Yellow Book.” Please feel free to contact the SC with any questions, concerns, or general comments.

AAPM and Doyle Printing Green Partners

AAPM Newsletter

September/October 2009

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AAPM Newsletter

September/October 2009

Image Gently Campaign Update

Image Gently™ Reminds Interventional Radiology (IR) Providers to “Step Lightly” Medical Physicists Serve Vital Role in Underscoring the ALARA Message

by Keith Strauss, AAPM Representative to the Alliance for Safety in Pediatric Imaging

o underscore the importance of medical physicists in the ongoing Image Gently™ campaign, Keith J. Strauss, MSc, FAAPM, FACR, director of Radiology Physics & Engineering at Children’s Hospital Boston, recounts an experience in 2005, in his department. “Our new interventional chief predicted we would have problems with our yet-to-be-installed new interventional fluoroscopic equipment because of his negative experience with the same equipment at his last hospital,” Strauss recalls. “He told us the image quality on children was terrible — the worst he’d ever seen. He was unaware that a lead engineer from the imaging company and I had spent an entire week sharing knowledge and working out a new set of anatomical programs configured specifically for children. After initial acceptance testing and the first week of clinical imaging were finished, our new chief declared, ’By far, these are the best fluoroscopic images I’ve ever seen on children.’ The lesson is clear: By working together, imaging teams can significantly improve image quality while managing radiation dose.”

The experience, says the Harvard Medical School clinical instructor, highlights the need for medical physicists “to roll up their sleeves, get involved with imaging vendors and clinicians, and help optimize the configuration of equipment to meet the preferences of their radiologists.” By working with clinical team members and the vendor’s representatives, medical physicists can help achieve the Image Gently goal of providing high-quality images while properly managing radiation doses during interventional procedures on children.

radiologists and radiologic technologist team members — are encouraged to visit the Image Gently Web site (www.imagegently.org) and factor this information into their clinical decision-making. The new online resources include:

Launched in January 2008, the first phase of the Image Gently campaign saw the Alliance for Radiation Safety in Pediatric Imaging (ARSPI) — today representing 44 medical organizations and serving more than 500,000 health care providers worldwide — reach out to general radiologists, radiologic technologists and medical physicists. On Feb. 3, 2009, Phase II broadened the message to include pediatric specialists and parents. Phase III, with its Image Gently Step Lightly theme, extends to interventional providers. The campaign reminds that when IR procedures are the correct treatment for disease or injury, providers are, where appropriate, urged to:

•

Downloadable slide presentation for use by providers to teach their staff methods to reduce dose and maintain quality. Radiologists are encouraged to give this talk locally Downloadable checklist of dose reduction steps the team can review for each patient Downloadable outline of dose reduction and quality maintenance steps to take in the department Patient brochure including answers for parents about IR procedures. Providers can use this as a guide to communicate concerns and benefits of interventional procedures to patients.

Take time out: stop and child size the technique Step lightly on the fluoroscopy pedal Consider ultrasound or MRI guidance when applicable

Medical physicists have played a central role in the Image Gently campaign from the beginning, particularly in regard to the creation of the materials for the Web site. These materials can provide valuable information regarding radiation safety, quality assurance and the optimal use of the fantastic imaging and interventional tools available to physicians to better care for their patients,” said Terry Yoshizumi, Ph.D., associate professor, Department of Radiology at Duke University Medical Center.

Now with phase III underway, providers of interventional radiology have access to new online teaching materials and checklists for interventional procedures on children. Medical physicists — along with

“Interventional radiology procedures save lives, speed healing and decrease pain, but since children are more sensitive to radiation received from imaging scans, we need to … help lower their cumulative exposures,”

• • •

AAPM Newsletter

September/October 2009

said Marilyn Goske, M.D., chair of the Alliance for Radiation Safety in Pediatric Imaging, past Board Chair of the Society for Pediatric Radiology, and Silverman Chair for Radiology Education, Cincinnati Children’s Hospital Medical Center. On March 3, 2009, the National Council on Radiation Protection & Measurements reported that IR exams contribute the third largest radiation dose in medicine, following CT and nuclear medicine procedures. Medical physicists can help meet Image Gently objectives. “Twenty years ago, a typical interventional unit had a few fluoroscopic operating modes,” Strauss says. “Today it may offer more than a dozen, but this flexibility doesn’t help if it isn’t fully harnessed.” In the January 2006 and December 2008 issues of Radiology, the results of collaborative work between an imaging equipment manufacturer and medical physicist

were reported. Patient radiation doses during voiding cystourethrography, a common diagnostic examination in children under five years of age, were reduced by a factor of 10 — with no loss of image quality. While that particular fluoroscopy unit was not interventional, Strauss notes, this achievement shows the potential for major gains, and the tremendous potential within imaging equipment that may go untapped when imaging teams do not call upon medical physicists for their specialized know-how. Once medical physicists do make modifications to imaging equipment for children, testing is essential using “child sized phantoms prior to first clinical use,” Strauss says. “Medical physicists should consider providing in-service training on radiation protection to team members, on operational aspects

of any modified equipment,” says Yoshizumi. Both physicists add that others may also wish to consult with, and contribute to, a popular pediatric medical physics users’ listserv by writing “subscribe” to “Wayne State University LISTSERV Server (15.5)” at LISTSERV@lists.wayne.edu. A Pediatric Interventional Networking Group is being formed by medical physics and interventional radiology professionals who are interested in the technical and policy aspects of radiation dose management in the setting of interventional pediatric radiology. Join the group by singing up at http://www.safety.duke.edu/ radsafety/drdl/default.asp. Health care providers are urged to visit the Image Gently Web site (www. imagegently.org) and pledge to do their part to “child-size” the radiation dose used in children’s imaging.

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AAPM Newsletter

September/October 2009

Practice Guidelines Subcommittee Report The Review of Task Group Reports by the AAPM Subcommittee of Practice Guidelines by Maria F. Chan, Ph.D., Subcommittee Chair

he AAPM Subcommittee of Practice Guidelines (SPG) was formed at the end of 2007 under the direction of the Clinical Practice Committee of the Professional Council of the AAPM, chaired by Per Halvorsen. Now, Per Halvorsen is the Chair of Professional Council and Martin Fraser is the Chair of Clinical Practice Committee. The SPG consists of 15 members, 2 consultants (Beth Schueler and David Vassy), and is co-chaired by Maria Chan from Memorial Sloan-Kettering Cancer Center and Joann Prisciandaro from University of Michigan. One of the specific charges of the SPG is to evaluate draft Task Group (TG) reports prior to publication for their potential impact on the professional practice environment. So far, the SPG has reviewed more than 14 AAPM TG and Work Group reports and will continue to serve the AAPM members. Some of the TG reports published by the AAPM present a wide range of comprehensive performance tests or QA processes for a particular radiological modality. Limited by available resources and given the range of clinical uses, full-time clinical physicists from medium and small centers often find it difficult to determine the minimum subset of a complete

TG report to follow to ensure consistent high quality patient care and procedure maintenance. Furthermore, state regulators have, in some instances, unfortunately adopted entire sections of TG reports as regulatory requirements despite the clarification in all TG reports that such use would be inappropriate. Therefore, the SPG was also charged with exploring the concept of Minimum Practice Recommendations (MPR). The MPRs would be intended to provide the AAPM members with a set of requirements for basic standards of medical physics practice that AAPM would consider necessary for all types of clinical practice sites where the scope of service covered by a given MPR is performed. These MPRs would not be designed to replace extensive clinical practice guidelines, TG reports, or review

articles, but rather to describe minimum common standards. In the Professional Council’s view, the establishment of MPRs is an important expression of AAPM’s mission to disseminate knowledge, in order to maintain a high common standard in medical physics practice. In attempt to work toward this goal, the SPG held a half-day meeting in New York City in March to re-affirm their mission and standardize their reviews of TG reports, and to further refine the MPR concept. We hope to have one or two “pilot” MPR documents ready for review by the end of 2009. We would appreciate your input as this concept matures – feel free to contact any member of the SPG with suggestions or concerns.

At the SPG meeting from left to right are James VanDamme, Vladimir Feygelman, Joann Prisciandaro, Maria Chan, William Breeden, Renée Larouche, Ingrid Marshall, and David Vassy. Weimin Chen is our camera man and unfortunately, not present in this picture.

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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The AAPM Newsletter is printed bi-monthly. Next issue: November/December Submission Deadline: September 28, 2009 Postmark Date: week of November 2, 2009