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Newsletter

AMERICAN ASSOCIATION OF PHY SICISTS IN MEDICI N E VOLUME 34 NO. 6

NOVEMBER/DECEMBER 2009

AAPM President’s Column

Maryellen Giger University of Chicago

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his is my last newsletter to you as President of the AAPM. The year 2009 has been a busy and productive year, although there is always more to do and more to start. Thank you to all for your participation. Electronic-only Newsletter The November/December 2009 newsletter is in an electronic-only format – partially as a test case and partially as an attempt to curb expenses. Times change and so the AAPM needs to respond. I have been reading the newsletters in its electronic form for quite some time. Future electronic newsletters give us the advantage of active links that may enable us to obtain instant answers and dig deeper into the content. Perhaps someday we will have moving pictures and instant answers to our questions, all within the boundaries of the AAPM newsletter. New Board Members Orientation While going “electronic” may be

tempting, it also has its limitations. For example, when is a webex meeting sufficient in terms of replacing a face-to-case meeting? In recent years, AAPM has hosted the new AAPM Board members in the autumn at the AAPM Headquarters in College Park, Maryland. This year, however, in order to limit the cost, we implemented a webex conference and had each of the new Board members connect over the web. At these Board orientations, powerpoint presentations are given by some of the members of EXCOM [Michael Herman and me], AAPM’s counsel [Murray E. Bevan], the Executive Director [Angela Keyser], Director of Finance & Administration [Cecilia Hunter], and Director of Information Services [Michael Woodward]. In addition, this year Mike Herman and I reviewed various issues that are currently in front of the AAPM Board. This year, while the information and discussions were had, we felt that the electronic “visit” hindered the potential “bonding” between Board members and the AAPM Headquarters –in terms of realizing the amount of personnel and resources available through headquarters and in terms of viewing the physical office space – both which contribute to instilling the tremendous responsibility and function of an AAPM Board member. Thus, as we tread through the electronic age, we need to find a balance between electronic

communication and personal interactions. I look forward to Marty Weinhous’ ad hoc Committee on the Electronic Presence of the AAPM and its findings. Budgeting for 2010 In the days following the Board orientation, the Budget Subcommittee, along with EXCOM and the Council chairs/vice-chairs, met to review the budget submissions from the various AAPM committees/ subcommittees/task groups. Prior to the meetings, AAPM Director of Finance & Administration Cecilia TABLE OF CONTENTS Chair of the Board’s Column President-Elect’s Column Executive Director’s Column Editor’s Column Professional Council Report ACR Membership Benefits TG 142 Leg. & Reg. Affairs ‘09 Summer School Report IOMP World Congress Report Perspective on Healthcare reform ACR Accreditation Website Editor’s Report Chapter News EFOMP Health Policy/Economics New Professionals Forum Rpt. JMPLS Report History Committee Report Persons in the News Letter to the Editor

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AAPM Newsletter

November/December 2009

Hunter incorporated all the budget requests, prepared the overall budget, and ran a statistical predictive model that she had fashioned for the AAPM. Based on expense data from prior years, the model predicts an end-of-year financial status. Such a model is important given that AAPM is a volunteer organization in which proposed activities included in submitted budget requests are not always accomplished due to demands on volunteers’ time, productivity of committees or workgroups, etc. In the beginning of a year, it is often difficult to determine which projects will be completed. However, it may be possible to predict the fraction of efforts that will be successful and, thus, require and use funding. EXCOM had proposed the use of the statistical predictive model for the 2010 Budget Process so that the AAPM Board of Directors could receive a more realistic budget. [In July, the Board had instructed the Budget Subcommittee to produce a budget that had no greater than a 3% deficit relative to the predictive model.] Once the predictive model was run yielding the expected budget expenses and revenues, and the 2010 deficit estimated, Treasurer Mary Moore effectively communicated with the council chairs to prioritize and modify their budgets. I offer great thanks to Mary Moore and Council Chairs John Boone, Per Halvorsen, and Tony Seibert for the tremendous effort they gave prior to the actual Budget Subcommittee meeting in streamlining their budgets in an attempt to reach the goal. Further budget cutting occurred at the Budget Subcommittee meeting with active discussions from EXCOM, the Council Chairs, and the members of the subcommittee. In addition, trend data prepared by President-Elect Herman showed prior usage by activity type/

committee, which proved useful in the budgeting process. Mike discusses his analyses in detail in his column in this newsletter. I thank all the members of the Budget Subcommittee [Treasurer & Subcommittee Chair Mary Moore, Robert Dahl, Maryellen Giger, Michael Herman, Cecilia Hunter, Ramy James, Angela Keyser, Mahadevappa Mahesh, Janelle Molloy, and Ed Nickoloff] and the Council Chairs/Vice Chairs/staff liaisons [John Boone, Per Halvorsen, Melissa Martin, Tony Seibert, Jeff Shepard, Ellen Yorke and Lynne Fairobent], for taking time from their “day jobs” to travel to headquarters and work diligently on this important process. Both the final requested budget and the model-predicted budget will be presented to the Board for approval at its meeting at the RSNA meeting. International Colleagues AAPM’s international activities are increasing as more and more countries recognize the importance of medical physics as well as the role of medical physicists in patient care. Multiple AAPM members traveled to Munich for World Congress 2009 for Medical Physics and Biomedical Engineering. In addition, other members were involved in review courses throughout the world. I recently returned from a visit to Sao Paulo, Brazil where the Brazilian Association of Medical Physics [ABFM] celebrated their 40th anniversary. I directly experienced the gratitude of their association for the support of AAPM in terms of task group reports and visiting review lecturers. [More and more countries are asking for permission to translate AAPM’s task group reports.] I thank my fellow AAPM members, James Balter, Larry DeWerd, Doracy Fontenla, Dan Low, Jatinder Palta, for

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making the ABFM trip such a success. I have included two photos in this newsletter. One photo includes the current president of the ABFM [Paulo Roberto Costa] and the chair of the conference [Homero Lavieri Martins] with me. The other is with all the past presidents of their association. Quite interesting was their celebration of their 40 years – at which ALL past presidents came up one by one to share stories. In general, we need to continue to work with our international colleagues while also making sure medical physics, in terms of clinical care, research, and education, advances in the USA. Strategic Planning It seems that every year we talk about the need for strategic planning but the day-to-day and year-to-year activities of the AAPM, which are also extremely important, take up the bulk of our time and brainpower. A prime example is the AAPM multi-year 2012/2014 Initiative which has had remarkable effects on the growth in the number of CAMPEP-approved medical physics graduate programs and residency programs. The third AAPM 2012/2014 Summit will be held in early 2010. The need for long-term strategic planning appears to increase in times of “crisis” such as now with our economy. This became apparent again during budget preparation time. Basically, if the budget needs to be cut, who decides? What are our priorities for research, clinical care, and education? How should we respond along our mission statement? This was accomplished to a degree by the intense involvement of the Council Chairs and Vice Chairs in the budgetary process. So as I enter 2010, as your Chairman of the Board, I will continue working with the ad hoc committees of 2009, but will also look to establish means for strategic planning. Perhaps having a brainstorming session with past


AAPM Newsletter

November/December 2009

presidents, council chairs, and members would be useful. Please email me your ideas. Thank you And as I close this newsletter entry, I would like to thank two AAPM members who will be leaving EXCOM – Jerry White and Mary Moore. Jerry has been a marvelous role model for me in terms of leadership, knowledge, communication, and thoughtfulness. He will be missed, but I know his email address and phone number! I also want to thank Mary Moore who survived as our Treasurer during one of the worst economic times. Her careful and concerned approach to the financial status of our organization has been greatly appreciated. I have learned much from my six years on EXCOM and hope to exhibit these learned skills as I chair our Board of Directors in 2010. Thank you.

L - R: Paulo Roberto Costa, President of the ABFM and Homero Lavieri Martins, the chair of the conference and Maryellen Giger

Group photograph of all participating association past-presidents

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AAPM Newsletter

November/December 2009

Chairman of the Board’s Column

Gerald A. White Colorado Springs, CO

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here is always just a bit of uncertainty each morning as I ride into the bike parking at the hospital (or into one of the Physicist Parking spots if the weather is bad). I generally have an idea of how the day is likely to go, the level to which there is a match or mismatch of tasks to time allotted or the potential for novelty or routine as the day progresses. But there is also a sense of adventure mixed with apprehension; you just never know what’s likely to fall on the physics desk on a particular day. I’d like to report that every day goes well, with a minimum of stress and conflict, but of course we all know that can’t be the case. The equipment malfunctions that come with a strong flavor of the mysterious at just the worst time, the radiation oncology treatment plan or delivery that was not quite as desired or the call from Radiology that that accreditation application did not go as well as we had hoped… all these can cast a veil over the day. We do have, in our department, a fixture of redemptive quality, no matter how difficult the day seems to be. Just outside of the patient waiting room there is a large bell mounted to the wall. Attached is a plaque

with a short affirmation that each patient who finishes their radiation treatments reads aloud as the staff gathers around them. First the reading, then three loud rings on the bell to mark with hope and gratitude the passage of their experience with us. I’ve seen guys who would make a Denver Bronco linebacker look puny fall to tears as they ring the bell. I’m not always in the hall when the bell sounds, but I can hear it anywhere in the department. No matter what has gone wrong that day, no matter what urgent task is left undone, no matter who I’ve engaged in disagreement, the sound of the bell is a sonic ablution at least for a moment. It’s a portent of all that has gone well, of an optimism founded in the sum of all that we do for our patients. I’ve observed that within the AAPM we often fail to observe what has gone well in our efforts to enhance the endeavor of Medical Physics. Our organizational “day” sometimes seems to be going poorly with disagreements, unanticipated conflicts, resource shortages, a gaggle of Gordian Knots. I wish there were some sort of Bell that I could ring as I leave office, some small affirmative Kaddish that could resonate to remind us all of the strengths, achievements and promise of our Association. I resist the temptation to inventory them here—I direct each of us to look at the Newsletter, the journal Medical Physics, the website at AAPM.org and be filled with our common accomplishments. Three years ago I was advised by one of my (many) wise predecessors, “… there will be a lot of opportunities,

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and you’ll have accomplishments, but you will never finish all that you had hoped to do…” Some colleagues asked me then what I hoped to achieve while in office, some offered suggestions (or directives) in that regard. Perhaps it’s easier to define one’s goals retrospectively rather than prospectively, although only in the arrogant does that assure success. However, I remain taken with the message of the 50th anniversary year, and I hope to have embraced that sprit myself and passed it on to many of you. We have honored the past (what magnificent achievements there have been in the last 50 years), we have celebrated the present (both in the literal sense and also in the energy and commitment we bring to today’s endeavors) and we are prepared for the future (in the great many projects, plans and commitments we are moving forward). And we do this with a collegial commitment to each other; with a commitment to trust, understanding, passion and compassion and above all with a commitment to a unity among differences that makes us stronger as an Association. I hope you can hear me ringing the bell.


AAPM Newsletter

November/December 2009

AAPM President-Elect’s Column

Michael G. Herman Mayo Clinic

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he Budget Subcommittee (BS), Council Chairs, New Board Members and EXCOM have just completed the Fall AAPM meetings as I write this. This group of meetings, spanning three days, begins with orientation for the new members of the Board of Directors on Thursday. It provides a jump start with education on the operations and procedures of the AAPM as well as detailed discussion on major initiatives and issues. The EXCOM met Thursday evening, Friday Evening and most of Saturday. The Budget Subcommittee met all day Friday. The major item we discussed in detail was the state of the economy and specifically the AAPM budget. I would like to focus my newsletter column on our budget. The AAPM, in over 50 years has become and remains the leading organization in the world in support of the science, education and clinical practice of medical physics. The primary focus of these efforts is to facilitate and support the best patient care. Overall, the productivity of AAPM councils, committees and task groups has been outstanding, delivering timely publications and

policy that provide guidance to medical physicists, to the public and to government bodies. In the last few years, there has been growth in every aspect of AAPM as our professional, scientific and educational lives become more complex and demanding. At this time, there are over 900 AAPM volunteers and over 24 AAPM headquarters staff participating in scientific, educational and professional activities. More task groups have been formed, more position statements developed, more national initiatives brought forward, new members services have been established and additional outside expert services have been engaged to address specific issues of importance to the AAPM. Some of these programs are directed by the AAPM Board and they commit funds over a period of years to projects of importance. Many of these programs have limited terms and some projects or groups of projects require additional staff at AAPM headquarters and outside contracts. All things considered, we accomplish a lot, with our dues at only $285. Further, we remain highly respected and visible as physicists in medicine. Our expenses however have outpaced our income for some time now. This was not as visible during the years where investment returns were huge, but all too clear when those cushions evaporate. We can not continue to fund all of our activities, without additional sources of revenue. We have to make decisions to cut or delay programs and services, charge for additional services and/or raise dues. While we focused on the 2010 budget at the Fall meetings,

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the larger economic picture will be a significant topic of discussion at the next (few) Board meeting(s). To try to help visualize the trends, I have included some plots of major income sources as well as major expenses of the AAPM from 1996 to 2008. The 2009 year is not complete yet, so it has not been added to the graphs, but the trends continue. The specific details of each plot (difficult to see in the figures) are not as significant as the trends we can readily observe. Our major sources of income, Dues, Annual Meeting, Medical Physics and the Placement Service are not growing much or even declining. We can also see the steep slope for many projects and activities. We can see that in early-mid 2000s there was a steep increasing trend in activity. This was a deliberate action of the AAPM Board to provide incentive and support for committee activity and initiate new programs to benefit AAPM members. As you can see, projects begin and continue to grow, usually due to success, but sometimes due to inertia and they all add expense to the budget. Without trying to decide which projects are most important or most expensive, it is clear that some limits and priorities must be set and that we must consider increased and new revenue streams to maintain the productivity and economic stability of the AAPM. (See graphs on pages 6 and 7) There were two major budget deficit reduction actions taken recently. The first was reducing remaining expenses in 2009 a result of the BOD action at the summer meeting directing the BS and Finance Committee (FIN) to reduce the approved $1.3M deficit 2009 by at least 50%. Immediately


AAPM Newsletter

November/December 2009 about $1M at the BS meeting. Prior to the Fall meetings, all councils and committees were asked to take a hard look at all their requested expenses for 2010. Council and committee chairs were asked to provide priorities and recommended reductions in their programs to achieve the $1M decrease in the 2010 expense budget. Everyone worked very hard and this was done in a very systematic fashion and with everyone working together (over weeks), the 2010 budget was reduced from a $1.8M deficit to $800k deficit, within

Income

following the summer meeting, BS and FIN worked on eliminating all non-essential expenses through the end of 2009. This included converting face to face committee meetings to Webex and teleconference whenever possible, making this newsletter electronic only, etc. These reductions brought the estimated deficit down to around $600,000. If investments continue to recover, the net deficit this year will be near zero. The second directive from the BOD was to bring the 2010 estimated budget closer to a balanced budget. The AAPM is challenged with being a volunteer organization. We always budget activities that exceed our capacity to voluntarily accomplish. From a budget standpoint this makes a balanced budget very difficult

to predict. Cecilia and her staff at AAPM headquarters have developed a predictive statistical model that provides an estimate of expected expense (taking many things into account) for a given budget year. Without going into more detail, the BOD directed the BS and FIN to deliver a 2010 budget that was within 3% (of budget total ~$200k) of balanced (including the statistical estimate).

in a $1.8M deficit. The statistical model prediction indicated that a deficit of approximately $800k would result in a near balanced budget. It was the BOD directive to achieve a reduction to $800k (+$200k or 3%). This meant cutting

The 2010 budget as submitted resulted

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the BOD directed 3% of balanced using the statistical model. This was a very painful process reducing so many requests and eliminating others. None of us wish to suggest that we don’t want members to work on projects, but we must restrict our


AAPM Newsletter

November/December 2009 activities due to limited resources. Remember as well that this budget is not final or approved until the BOD discusses it in detail and votes on it at RSNA. There will be reports from committees with major projects to assess future direction and may impact the budget. There will be input from Council chairs. There will be discussions about what services we might wish to reduce or eliminate, or expand. There will be discussions of the necessity to increase dues to maintain the health and productivity of the AAPM. I encourage you to direct your constructive comments to any and all AAPM board members.

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AAPM Newsletter

November/December 2009

AAPM Executive Director’s Column will be posted in March. The 2010 AAPM Summer School will immediately follow the Annual Meeting, running from July 22 – 25 at nearby University of Pennsylvania. The topic is Teaching Medical Physics: Innovations in Learning with Bill Hendee serving as Program Director. Angela R. Keyser College Park, MD AAPM events during RSNA 2009 he most up-to-date schedule for AAPM meetings during the RSNA meeting is available online at: http://www.aapm.org/meetings/ rsna09/. Make plans to join your colleagues on Tuesday, December 1 from 6:00 PM – 8:00 PM for the AAPM Reception during RSNA at the Chicago Hilton. Thanks to Landauer and RTI Electronics for their financial contributions to offset the costs for this event.

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2010 Meeting Dates AAPM is partnering with ASTRO, ESTRO, RSNA and NCI to host the first biennial meeting to focus on quantitative imaging in radiation therapy: Imaging for Treatment Assessment for Radiation Therapy. ITART 2010 will be held June 2122, 2010, at the Gaylord National right outside Washington, DC. Abstract submission and registration information will be posted in early 2010. The 2010 AAPM 52nd Annual Meeting will be held July 18 – 22 at the Philadelphia Convention Center in Philadelphia, Pennsylvania. The Call for Abstracts will be available online in early January 2010. Registration and housing information

Funding Opportunities Make sure to go online and review the various funding opportunities available through AAPM. The AAPM Summer Undergraduate Fellowship program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a stipend from the AAPM. For more information, go to: http://www. aapm.org/education/SUFP/ The Minority Undergraduate Summer Experience (MUSE) program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institution (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students

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from Historically Black Colleges and Universities, Minority Serving Institutions or non-Minority Serving Institutions to gain such experience and apply to graduate programs in medical physics. For more information, go to: http://www. aapm.org/education/muse/ AAPM and ASTRO will once again partner in support of the ASTRO/ AAPM Radiation Oncology Physics Residency Training Grants. This program was established to promote the development of radiation physics residency programs in the United States, leading to more graduates and more qualified professionals entering the workforce by providing assistance to newly established programs working towards accreditation. Up to $72,000.00 in total funding will be awarded each year. Applications will be accepted from radiation oncology physics residency programs that meet the criteria set forth by AAPM Report #90, “Essentials and Guidelines for Radiation Oncology Physics Residency Training Programs.” For more information, go to: http://www.aapm.org/ education/ROPRTG/ AAPM will soon begin accepting applications for the Fellowship for Graduate Study in Medical Physics. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the CAMPEP. For more information, go to: http://www. aapm.org/education/GSFMP/ 2010 Dues Renewals 2010 dues renewal notices were distributed in October. You may pay your dues online or easily print out an invoice and mail in your payment. Seventeen AAPM Chapters have elected to have HQ collect their


AAPM Newsletter chapter dues. Make sure to check to see if your chapter is participating. If it is, we hope that you will appreciate the convenience of paying your national and chapter dues at one time! Headquarters News Long-time team member Hadijah Robertson Kagolo left in midOctober to join her family business in New York City. Hadijah joined the staff in 2001 and members, exhibitors and staff have come to appreciate Hadijah’s winning personality and attention to customer service. Although she leaves a strong legacy at HQ, we are confident that Kathleen Dwyer, our new Exhibits and Meetings Assistant, is up for the task! Kat joined the team in early October and spent two weeks with Hadijah in an effort to transition the exhibits and registration responsibilities in a seamless fashion. Kat brings to the team valuable hands-on exhibit experience and will attend the 2009 RSNA meeting to meet with the many AAPM exhibitors. I firmly believe that part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of highperforming association management professionals. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2009. I want to publicly thank them and acknowledge their efforts.

November/December 2009

AAPM HQ Anniversaries Lisa Rose Sullivan Penny Slattery Michael Woodward Farhana Khan Peggy Compton Noel Crisman-Fillhart Yan-Hong Xing Tammy Conquest Corbi Foster Jackie Ogburn Cecilia Hunter joined the AAPM HQ team in June 2003, as Director, Finance and Administration. She has put her extensive background of non-profit association management to work guiding AAPM’s financial and administrative functions, ensuring that the leadership is kept fully informed of the financial position of the organization. Cecilia oversees the accounting, legislative and regulatory affairs, and scientific journal activities. She also serves as AAPM’s contact with outside professional service providers, including auditors, legal counsel, and bank

16 years of service 13 years of service 13 years of service 11 years of service 5 years of service 4 years of service 3 years of service 2 years of service 2 years of service 2 years of service affiliations. Cecilia also serves as the staff liaison to the Science Council. Penny Slattery was hired in 1996 as Journal Manager when AAPM began to transition the administrative support of the Medical Physics journal to the HQ offices. She coordinates the processing of manuscripts for the journal and serves as liaison to the publisher, the American Institute of Physics. Penny was instrumental in moving the manuscript submission process online and to the overall success of the journal.

The AAPM Headquarters office will be closed Thursday, November 26 – Friday, November 27, Thursday, December 24 – Friday, December 25 and Friday, January 1. I wish you and your loved ones a happy and healthy holiday season. AAPM HQ Team…at your service! In this issue, I would like to profile two of the team membership who play a significant role in serving the AAPM membership.

L - R: Penny Slattery and Cecilia Hunter

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AAPM Newsletter

November/December 2009

Imaging for Treatment Assessment in Radiation Therapy The first biennial meeting to focus on quantitative imaging in radiation therapy June 21-22, 2010, Gaylord NationalÂŽ Resort & Convention Center, National Harbor, MD Topics to include

ImagIng for target defInItIon How do we define the treatment target? How do we image the treatment target? How are we going to define the treatment target in 20 years?

ImagIng for treatment assessment What can anatomical treatment assessment tell us? What can biological treatment assessment tell us? Are we forgetting normal tissue? Dates to remember

Image quantIfIcatIon How important is image quantification? How can we improve image quantification? What are broader coordinated initiatives to improve image quantification?

early regIstratIon opens

Industry, regulatory Issues

more InformatIon

What is industry perspective on imaging as a biomarker? What are regulatory issues to qualify imaging biomarkers?

http:/ www.aapm.org/ meetings/2010ITART/

Sponsoring Organizations

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January 4, 2010

abstract submIssIon opens January 11, 2010


AAPM Newsletter

November/December 2009

Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

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his is my 18th column since I started as editor for the Newsletter and my last column for this year. Looking back, these past 3 years have gone unbelievably fast and a lot of things have happened on the way. We celebrated the 50th anniversary of our association and we now are marching towards the next milestone. When I say many things have happened, one area of special note to me is the Newsletter. As economic times have gotten tougher, we constantly tried to tighten the belt in terms of the expenses relating to the Newsletter. First, we moved away from glossy paper to a less expensive paper and soon followed with a change in the way that the newsletter was mailed. Early in the year the newsletter was mailed via first-class mail and we changed that by using regular mail only. In addition, we provided all readers the option to “opt-out” from receiving printed copies (nearly 20% of the membership did choose this option). As I began to write this column, I reread my column from the Nov-Dec 2008 issue and found that in that issue I was discussing the process of appealing to the AAPM Board of Directors to restore the budget for

the printed version. However, this time I have news to share with all of you… the newsletter will go online only starting with this issue. The process of this decision occurred as follows. The AAPM EXCOM had to trim expenses for this year and requested all committees to trim their budget. It is at that point that I suggested the option to go on-line for the Nov-Dec issue only, hoping the EXCOM would not demand more cuts in the 2010 Newsletter budget. However, since the AAPM EXCOM is facing a significant budget deficit, they were forced to take exhaustive measures to rein in the ever expanding AAPM budget for next year and as part of these budget cuts, I had to agree with the decision to go online-only for the Newsletter. I tried for a long time to provide members with the option to receive the printed edition but the time has come to go electronic only and rather than gripping over a lost cause, I will embrace this as a new opportunity to try out new features with the electronic version of the Newsletter. Two immediate and obvious changes are that there will be less time between the submission deadline and the on-line publication date and the Newsletter will now appear in full-color. Although the Newsletter will only be available electronically, the format will remain the same. I request that articles still be of limited size and laid out in similar fashion as with the print version. However, in order to not to loose any advertisement revenue and provide additional value to advertisements, we will allow our corporate advertisers to include enhanced PDF’s (i.e., direct

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links to websites and full color ads). The decision by the association for the Newsletter to go electronic only may cause some “discomfort” to some AAPM members, but I feel that there have been “signs on the wall” from past years. With the current budget deficit that the association is facing, this seems to be the right time to accept this decision. While pondering this column, I was reminded of reading a story by a famous Sufi poet. The story goes like this – ‘A wise king summons his wise men and orders them to come up with a saying that cannot be too long and one that would stabilize his inner state – by bringing joy when he is unhappy and remind him of sadness when he is happy and able to carry with him all the time. The wise men, after lengthy deliberations, returned to the king and presented him with a small box. In side that small box there was a ring, and inside the ring was inscribed: This too shall pass.’ As we are juggling with the budget cuts and monetary constraints due to prevailing economic conditions, I find this statement very comforting. As this is the last issue of this year, I’d like to thank Ms. Nancy Vazquez for all of her work on the Newsletter and Ms. Farhana Khan for her help in establishing a presence on the AAPM website. I would like to express my sincere thanks to Angela Keyser and the headquarters’ staff, the Newsletter Editorial Board and the Executive Committee for their help and advice. Finally, I would also like to thank my wife and kids for their cooperation in this task. As this issue arrives at your desk, we are entering the holiday season and I wish you and your family a very happy holiday season.


AAPM Newsletter

November/December 2009

Professional Council Report • •

Per Halvorsen Professional Council Chair Working to secure a strong profession in turbulent times s most of you are keenly aware of, this is a time of heightened uncertainty about the near-term future of our profession, but also a time of significant opportunity to affect the standards for clinical medical physics practice in the years ahead. All the volunteers within the Professional Council are working hard to respond to these challenges and opportunities. By coordinating our efforts within the AAPM with those of other professional societies, regulators and legislators, we are hopeful that we will weather the current storm and obtain stronger standards that will benefit the patients we serve, and protect our profession.

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Some of the many factors at play are: • Federal health care reform legislation • Proposed cuts in Medicare reimbursements • CARE bill reintroduced on Capitol Hill • 2008 MIPPA law requiring accreditation of “advanced imaging” centers • ABR’s new eligibility criteria in 2012/2014 • Requirements by some private insurers for accreditation of

imaging and radiation oncology centers Workforce supply (in particular availability of diagnostic residency positions) Professional licensure initiatives

The committees within the Professional Council are engaged on many fronts to respond to each of the aforementioned factors. Significant efforts by the Professional Economics, Clinical Practice, Professional Services, and Government and Regulatory Affairs committees have combined to represent your professional interests, and the Association’s position, relative to each of these topics. See Lynne Fairobent’s Government Relations article on page 15 in this Newsletter, and the eNews updates, for an overview of legislative and regulatory developments. The Professional Council, Excom, Licensure subcommittee and others are monitoring the federal legislative process and have provided information to Capitol Hill staffers and other societies in an effort to include minimum standards for medical physics coverage and medical physicist qualifications in any new laws. The CARE bill, HR 3652, would instruct the Health and Human Services division to implement regulations to require a minimum level of education and training for health professionals involved in imaging and radiation therapy procedures. We have drafted model regulatory language for the HHS to consider in the event that the CARE Act becomes law. Look for the article on page 31 in this Newsletter by Wendy Smith Fuss and the Professional Economics

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committee, providing an overview of the proposed cuts in Medicare reimbursement and our efforts to inform the Medicare advisory committees in the hopes of moderating some of these proposed cuts. The proposed reductions in reimbursement for HDR, IMRT, and SRS procedures are particularly severe. The ABR’s new eligibility criteria, requiring a CAMPEP-accredited residency by 2014, coupled with the MIPPA requirement for accreditation of advanced imaging centers, have caused concern about the supply of Board-certified diagnostic medical physicists and the availability of residency programs. The Professional Services committee is overseeing a Workforce Study conducted in collaboration with SUNY with the aim of answering these types of questions – the study coordinators will soon distribute a survey to the AAPM membership, and your answers will be key to the study’s success. Please take the time to complete the survey and return it in a timely fashion. The Joint Medical Physics Licensure subcommittee has shown good progress in their efforts in the 5 target states, as well as with the broader effort of strengthening minimum professional practice standards. They will deliver a “mid-course assessment” to the Board in November on the best path forward – this group has developed significant expertise in the professional standards arena, and their report will provide important insight for the Association as we decide how to prioritize our limited resources. As we work to strengthen professional practice standards in regulatory and legislative requirements, the


AAPM Newsletter work of the Practice Guidelines subcommittee is increasingly important. This group reviews each draft Task Group report for its potential impact on clinical practice with an eye on how outside entities may use Task Group recommendations to mandate certain practices. Though this is explicitly not the intent of AAPM Task Group reports, regulators and legislators look to the AAPM reports as authoritative reference documents, and the Practice Guidelines reviews ensure that any such impact on our profession will serve to strengthen, not unduly burden, the medical physicist’s ability to support high quality patient care. Money matters: As you know, the Association has limited resources and cannot support all projects simultaneously. We just completed

a difficult budget session with Excom, Budget Sub-committee and the Council Chairs working together to eliminate approximately $1.0M from the 2010 budget – this inevitably required us to defer many worthy, well-designed projects for implementation in future years. We worked collaboratively to prioritize all projects and ensure that our Association’s money is spent carefully, on projects that will have the most significant impact on our profession and provide core services to our members. I encourage you to look carefully at each Council’s projects and voice your opinion – we are all volunteers trying earnestly to represent the membership’s overall priorities, and welcome your constructive criticism and suggestions for how we can do a better job with the limited resources available to us.

November/December 2009 In the same context, I’d like to remind you once again that all these efforts on your behalf are performed by volunteers – your colleagues across the country who give their time and effort after their “day job” hours, in order to help our profession remain vibrant and continue to serve the best interests of patients everywhere. If you have a suggestion, criticism, or (better yet) wish to help your fellow colleagues in this endeavor – just look through the Committee Tree on the AAPM website (www.aapm. org/org/structure) and identify the relevant Council or Committee/SC/ WG chair. Drop him/her a line and offer your help!

DATES TO REMEMBER December 2009

2010 Annual Meeting website activated. View the site for the most up-to-date meeting and abstract submission information.

January 6

Web site activated to receive electronic abstract submissions.

March 3

Deadline for receipt of 300 word abstracts and supporting data.

March 18

Meeting Housing and Registration available on-line.

By April 20

Authors notified of presentation disposition.

By May 13

Annual Meeting Scientific Program available on-line.

June 10

Deadline to receive Discounted Registration Fees. http://www.aapm.org/meetings/2010AM/

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AAPM Newsletter

November/December 2009

ACR Membership Benefits to AAPM Members association designed to preserve the strengths of each by combining resources and expertise, eliminating redundancies, and streamlining areas of endeavor in which there was overlap. The new association is off to a promising start and will continue to grow in power as a voice for radiology within the USA and throughout the world.

A

James M. Hevezi Chair, ACR Commission on Medical Physics

s a long-time member of the AAPM and the current chair of the ACR Commission on Medical Physics, I would like to offer the following observation - the expertise and perspective that the medical physicist community contributes to the practice of radiology is so valuable to the ACR/ARRS that the importance of your participation in its deliberations and work cannot be overstated. Both the AAPM and the ACR/ARRS play important roles in the way our profession develops, how radiology affects the field of medicine, and the impact of outside forces upon our specialty. On July 1, 2009, the American College of Radiology and the American Roentgen Ray Society took part in a strategic integration forming a new

The Commission on Medical Physics (one of 20 commissions within the ACR operating structure) provides information and advice to the Board of Chancellors and Council Steering Committee on a variety of medical physics topics as its committees pursue initiatives in the fields of economics, education, government relations, quality and safety, and human resources. The JACR, a Medline indexed publication, runs a regular medical physics column. The Medical Physics Caucus convenes at the ACR Annual Meeting (AMCLC) to present recommendations regarding medical physics policy and opinion to the ACR Steering Committee. Opportunities to contribute and participate in these and other important activities are available to all members.

The College works locally through its state chapters and nationally/ internationally through the parent association. On behalf of the American College of Radiology/ American Roentgen Ray Society, I invite all medical physicists to join the oldest and largest radiological association in the country; to participate in its activities, to meet and work with your colleagues, to stay informed on the issues of professional significance to all of us, and to help shape the future of the radiology. For modest annual dues, the ACR provides a variety of benefits and opportunities to its members including:

• • • • • • •

Medical Education Credits Accreditation Programs Professional Credentialing Committees and Working Groups Public Speaking Networking Publications

For more detailed information, please take a look at the brochure on the ACR website: http://www.acr.org/SecondaryMainMenuCategories/mbr_chapter/ MbrBrochureMedPhys.aspx

Task Group 142 - QA of Medical Accelerators by Eric E. Klein Chair of TG-142

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he AAPM Task Group 142 report: Quality assurance of medical accelerators was recently published (Med. Phys. Volume 36, Issue 9, pp. 4197-4212, September 2009). The Therapy Physics Sub-

committee of Science Council HAS approved this report, AND it is recommended THAT physicists adopt the recommendations of TG-142 as they supersede the recommendations of Table II (linear accelerator QA) of TG-40. This NEW report makes specific recommendations regard-

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ing technologies that were adopted after the release of TG-40 (MLC, newer wedge systems, asymmetric jaws, imaging systems, and respiratory systems) along with specific recommendations for procedures such as SRS, SBRT, TBI and IMRT.


AAPM Newsletter

November/December 2009

Legislative & Regulatory Affairs the Rocky Mountain Compact, which is NV, NM, and CO. Again Class A, B and C waste is accepted for disposal. The Clive, UT facility, operated by Energy Solutions accepts waste from the rest of the United States but is limited to Class A waste.

Lynne Fairobent College Park, MD NRC Meeting on the Impact of Lack of Disposal Capacity on Radioactive Materials Used in Research (74 FR 39716, http://edocket.access. gpo.gov/2009/pdf/E9-18947.pdf)

O

n October 7th NRC held a meeting to gather information to assess the effect of a lack of access to low-level waste (LLW) disposal facilities on those who use radioactive sealed sources or materials in conducting research such as universities and hospitals. This meeting was a result of direction by the Commission to the NRC staff to seek input from stakeholders on specific examples of research that is not being conducted because of either the cost or lack of disposal. Background. The Barnwell, SC facility operated by Energy Solutions became a compact-only facility as of July 1, 2008. It now accepts Class A, B and C LLW from the three states that comprise the Atlantic Compact, which are SC, NJ and CT. The Richland, WA facility operated by U.S. Ecology, is the host state for the Northwest Compact consisting of WA, HI, AK, OR, ID, MT,WY, and UT. It also accepts waste from

The Texas Commission on Environmental Quality has granted a license to Waste Control Specialist for a LLW site near Andrews, TX. The Texas Compact comprised of TX and VT may begin receiving waste in late 2010. The Compact Commission will control additional access. In its comment letter, [note link to PDF of AAPM comments] AAPM stated that: • Research and medical institutions are currently safely and securely storing material that cannot be transferred to existing waste disposal sites. • Although onsite storage is safe, it poses challenges to licensees and institutions. Storage space may be unavailable or costly to maintain. In some institutions, space that could be used for research laboratories may have to be converted to storage areas for waste. Increased amounts of waste in storage may cause unnecessary radiation exposure, result in increased possession limits and costly enhanced security requirements, thus decreasing the dollars available for research. • Although access to the existing disposal capacity is restricted to those fortunate licensees located in a compact state, there is no “true” shortfall in disposal capacity. However until the

15

current compact system is revisited, uncertainties about future access to disposal facilities will remain. AAPM urges development of a uniform, integrated LLW disposal policy to address the high costs of available disposal options and limited access to existing disposal sites for medical and research facilities. In conclusion, it is AAPM’s opinion that waste storage has diminishing returns and it will become more difficult for research review committees to continue to support medical research proposal with a cost that cannot be easily measured. It is hard to put storage in perpetuity into grant expenses. Because of this, research review committees may be discouraging any research that does not have a disposal option and we as a society may be suffering from future beneficial medical treatment because research cannot be conducted. Medical and research institutions need reliable and affordable access to disposal, as well as cost predictability for future disposal.

The letter submitted by AAPM is listed on the AAPM website. All other comments submitted to NRC can be found at www.regulations.gov search on Docket ID NRC–2009– 0346.


AAPM Newsletter

November/December 2009

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AAPM Newsletter

November/December 2009

2009 Summer School Report Is beer a good dosimeter? by Robin Miller and William Parker

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f you attended the recent summer school in Colorado Springs, CO at Colorado College on Clinical Dosimetry Measurements in Radiotherapy, you would know the answer. Dave Rogers and Joanna Cygler orchestrated a thorough review of all things dosimetry. Over 350 attendees listened to more than 25 expert faculty over four and a half

days! This essential summer school delved into the mysteries of BraggGray cavity theory and uncovered the tricks of the trade for efficient implementation of TG51. If you missed this school, be sure to check out the virtual library to brush up on these topics and so much more. Also the proceedings in book and/ or CD format can be purchased through Medical Physics Publishing. Never attended a Summer School? You are missing out on a unique way to focus your understanding on

2009 Summer School Participants

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a particular topic, have unequalled access to the faculty to discuss and reason out the nuances of physics topics and network with your colleagues in an informal setting. Next year’s summer school will be held immediately following the AAPM annual meeting in Philadelphia between the 22-25 July, the topic will be Teaching Medical Physics: Innovations in Learning. Save the dates.


AAPM Newsletter

November/December 2009

IOMP World Congress Report News from the IOMP World Congress Munich, Germany, September 7-11, 2009 by Ishmael Parsai, Donald Frey and William Hendee

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hree delegates from AAPM attended the IOMP World Congress (WC) meeting held in Munich, Germany this year. In addition to many scientific sessions attended by over 3500 medical physicist and biomedical engineer participants from around the globe, the theme of the meeting was mostly related to the education of medical physicists worldwide and much brainstorming on how the existing resources of the organization may be used to further enhance the educational mission of organization. A summary of occurrences at the WC important to the AAPM members is reported below. In start of the council meeting, President Allen reported that now with 80 adhering national organizations and nearly 18000 members worldwide, the IOMP is a very relevant entity. As a major objective to enhance the education of medical physicists around the world, the IOMP has started construction of a new website which is designed to become a resource for education. To this end, IOMP has supported the development of the EMITEL project (European Medical Imaging Technology e-Encyclopedia for Lifelong Learning) and will allow fast access to the online medical physics encyclopedia, which will soon be freely available. The makeover of the MPW bulletin

is another step taken by IOMP as a renewed commitment to further expand resources in education of medical physicists. No longer in pages of MPW reports of committees are reflected and those are replaced by articles, relevant information materials aimed to provide educational resources for medical physicists. William Hendee, chair of the IOMP publication committee announced at the council meeting the recommendation of the committee that the MPW be distributed only electronically starting in 2010. Ishmael Parsai who has served as the editor of MPW for the past 9 years has agreed to stay on and see the transition of MPW to digital from paper copy. He along with other committee chairs of IOMP was acknowledged by the incoming president Nuesslin at the IOMP council meeting by being awarded a plaque appreciating their contributions. To better serve the world community, the IOMP has divided the world into seven federations encompassing countries with close borders. EFOMP has long been a regional organization to serve the requirements of medical physicists in Europe, SEAFOMP in SE Asia, AFOMP in the Asia-Pacific region and ALFIM in Latin America. Under guidance and support of IOMP, new societies are forming in the middle-east (MEFOMP) and Africa (FAMPO) and of course the AAPM which is viewed as both national and a regional society. A very important issue presented to the council related to development of a bill of rights for biomedical scientists and engineers. With

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the potential for discrimination of scientists in the modern era, IOMP decided in 2008, to codify its position by developing a Bill of Rights, which has now been accepted by IOMP, IFMBE and IUPESM. In addition to this, a motion was moved by Barry Allen that IUPESM recognizes the right of scientists worldwide to attend scientific conferences and the exchange of scientific information be free of political status of countries. This motion was also passed unanimously. The IOMP has also taken a stand on the issue of plagiarism in 2008, and many journals have already published the IOMP’s position as editorials. In the IOMP council on this day, work of Bill Hendee in write-up of the first draft for both, the Bill of Right for scientists, and the Plagiarism document was recognized. Related to decision making process within the IOMP a new change proposed by the ExComm has now been implemented. That is the ExComm now proposes to assign voting rights to the chairs of the Science, Education and Training, and Professional Relations committees, subject to Council approval. Other items discussed during the meeting included: Formation of a new History subcommittee to develop a collective memory of IOMP activities over the years. This committee is chaired by Azam Niroomand-Rad, a previous IOMP president. Status of recognition of the Medical Physics profession by the International Labor Organization (ILO) has not been changed. The medical physics profession is still listed in the ISCO-


AAPM Newsletter 08 (International Classification of Occupations) under Unit Group 2111 along with other physicists and astronomers. The only change is that they have placed a paragraph defining medical physics profession under medical physics job category. For the upcoming meetings, the council voted Brazil to be the site of the ICMP 2011 and CANADA the site of WC2015. The next IOMP World Congress (WC) meeting in 2012 is to be held in China.

November/December 2009

ACMP 2010 Annual Meeting JW Marriott, San Antonio Hill Country Resort • San Antonio, Texas May 22 – 25, 2010 You won’t want to miss the ACMP annual meeting next year in San Antonio at the brand new JW Marriott. The JW Marriott San Antonio Hill Country Resort & Spa offers the beauty of the Texas Hill Country combined with nearby city and resort luxury conveniences. Some highlights of the 2010 meeting: • Update on NRC’s Internal and External Safety Culture • All day session on Regulatory Requirements necessary to serve as RSO in a Medical Facility • Will include Mammography, Diagnostic and Radiation Oncology Physics sessions For more information on the meeting in the months ahead, go to www.acmp.org. For more information on the San Antonio area, go to www.visitsanantonio.com. For more information on the JW Marriott, go to www.jwsanantonio.com

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AAPM Newsletter

November/December 2009

Perspective on U.S. Healthcare Reform

Reform of Health Care in the U.S.: Is the Canadian Model a viable Answer? by Ervin B. Podgorsak McGill University, Montreal, Canada

A

merican medical physicists have much respect for the quality of Canadian medical physics but, like the American public in general, have a very poor opinion of the Canadian health care system. The two views are obviously contradictory, because it is difficult to envisage that medical physics could flourish in a poorly functioning health care system. Since the high quality of Canadian medical physics is not in question, one may conclude that the poor perception of the Canadian health care system must be a myth and misconception. The American approach to health care is full of contradictions. On the one hand, the U.S. defines the world standard in attainable quality of medicine and, on the other hand, in contrast to the situation in other developed countries, access to health care services is severely curtailed for many residents of the U.S., and the cost of the U.S. health care system is extremely high. Americans have very diverse views on how to improve the performance of their health care system but they generally agree on two important points: (1) there is an urgent and long overdue need for a reform of the U.S. health care system and (2) the reform that is finally agreed upon must not emulate the Canadian approach to health care delivery and financing. While the need for health care reform in the U.S. is obvious considering the excessive cost of health care services and problematic access to the health care system, the outright rejection of the Canadian approach to health

care is unfortunate and misguided. American news media and special interest groups have succeeded in completely discrediting the Canadian health care system in the eyes of the American public, painting it as impractical, of poor quality, and economically unsustainable. Yet, facts show a different picture. It is true that the Canadian health care system suffers serious problems with access to physicians and high technology equipment; however, in comparison with the American system, it nonetheless produces better results and, in addition, is socially and morally just, equitable, and significantly cheaper. Before 1970 both the U.S. and Canada used a private multi-payer health insurance system and both spent annually about 5% of the gross national product (GNP) for health care. Since the early 1970s, when Canada introduced its nationalized single payer health care system and the U.S. continued with its cumbersome multi-payer privatized health insurance system, the annual health care cost has increased steadily each year in both countries. However, the increase was significantly larger in the U.S. compared to Canada, resulting in current annual expenditure of 16% of GNP for the U.S. compared to 10% of GNP for Canada. Yet, in Canada all legal residents, irrespective of their employment, social, health, and wealth status, have automatic health insurance, while in the U.S. 15% of the population (close to 50 million people) are without health insurance and about the same number of people are seriously underinsured. Furthermore, medical bills are blamed for about 70% of all personal bankruptcies in the U.S., while

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in Canada no personal bankruptcies are attributed to medical debts. The Organization for Economic Cooperation and Development (OECD), a closed club of 30 countries, most of them developed, provides useful statistics on the development of individual member states as well as averages for the whole group. The U.S. and Canada are OECD countries and their OECD rankings based on several health care indicators provide an interesting glimpse on the actual and relative strengths of health care delivery and outcomes in the two countries. In terms of health care cost both countries are above the OECD average of 9% of GNP per year; however, the U.S. is in a league of its own at 16 % while four of the 30 OECD countries, at about 11% or higher, rank above Canada’s 10%. In per capita parityadjusted health care cost dollars per year the U.S. at $7300 almost dou-

bles Canada at $3900.

One could expect that, with its significantly higher health care expenditure, the U.S. would outperform Canada on standard health care indicators such as life expectancy at birth, infant mortality, and maternal mortality at birth, but such is not the case. Canada outperforms the U.S. on all basic non-monetary health care indicators and, since the population age distribution is similar in the two countries, a conclusion can be made that the difference in performance results from the difference in the organization and financing of the health care systems in the two countries. Rather than rejecting the Canadian health care model which during the past 40 years became one of the most cherished defining characteristics of


AAPM Newsletter Canada, Americans would be served better, if they studied the model and accepted its basic tenets of universality and public administration. By adopting the Canadian model and increasing the support of the single payer system to 12% of the GNP from the current Canadian level of 10%, Americans could easily solve the accessibility problem plaguing the Canadian model. This would result in a well supported, efficient, and socially just health care system that would provide a universal and timely access for all Americans and, in addition, would cost no more per year than their current inequitable private multi-payer system that costs 16% of the GNP. Many critics of the Canadian health care system argue that the system is inefficient, bureaucratic, and too costly at 10% of annual GNP compared to the OECD average of 9%. Of course, the bureaucratic excesses of the publicly run health care system could and should be curtailed to save money and increase efficiency; however, in comparison with the U.S. private system which consumes about 25% of health care cost on bureaucracy, the Canadian public system which spends only about half that rate for administration is a model of efficiency and frugality. Canadian problems with waiting lists for non-emergency procedures and access to high technology equipment could be addressed effectively with a relatively modest increase in public funding. Unfortunately, Canadian politicians, responding to public’s aversion to taxation, zero in on cost rather than performance of the Canadian health care system. Similarly to the U.S., albeit to a lower level, as a society Canada decided to give better-than-OECD-average remuneration to its health care workers and this choice invariably will result in a higher-than-average

GNP cost percentage for its health care system. However, the Canadian approach of paying above average salaries and simultaneously keeping health care cost close to the OECD average of 9% results in rationing of health care services through a restricted access to medical educational programs, insufficient staffing levels, shortages of medical staff, as well as a poor distribution of high technology equipment. The ill-advised method used by Canadian governments to control health care cost throws the important indicators that deal with access to health care services shamefully below the OECD average and results in waiting lists, delayed or denied diagnostic and therapeutic procedures, as well as a bad reputation for the Canadian health care system. There is nothing magic about the current 10 % of the GNP level; Canada can afford to spend 11% or even 12% of the GNP annually to bring the health care access problem under control. Unfortunately, Canadian politicians have for years adamantly refused to recognize this fact and allowed the Canadian health care system to flounder as a result of inadequate financial support. To solve the health care access problems in the U.S. and Canada, no elaborate and costly studies, committees, and commissions are required. What the two countries need are reasonable and achievable standards and goals for their health care systems and adequate government support to meet the standards and achieve the goals. For non-monetary health care indicators, matching the OECD average should be the minimum standard, and exceeding the OECD average should be the goal.

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November/December 2009 Forty years ago, recognizing that health care should not be treated like an ordinary market commodity, Canada introduced nationalized health care and proved beyond doubt the societal benefits and inherent fairness of the principles of universality and public administration in health care. Unfortunately, to date it did not quite complete the job. Sufficient funding to ensure a flawless operation without waiting list and shortages of staff and high technology equipment was not provided and this caused a chronic malaise that permeates and discredits the whole Canadian health care system despite its proven underlying strengths. The U.S. is on the verge of a drastic reform of its health care system. With courage and commitment to reform, it could adopt the Canadian health care model and, with adequate funding, make it work in a fair, efficient, and universal manner without increasing the current cost of the American health care. The benefits to both the U.S. and Canada would be significant: the U.S. would achieve universality of health care coverage as well as an improvement in its health care indicators without increasing the current health care cost and Canada would finally see a good example on how to manage its own, fundamentally sound, health care model to function the way it was meant to function.


AAPM Newsletter

November/December 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 qualifications must a medical physicist meet in order to provide services to an ACR accredited facility in CT, MRI, Nuclear Medicine and PET? A. Effective January 1, 2010, the American College of Radiology CT, MRI, Nuclear Medicine and PET Accreditation Program requirements for medical physicists and MR will change. The new requirements are critical for several reasons. First, the current requirements for medical physicist/MR scientist initial qualifications, continuing experience, and continuing education vary significantly across accreditation programs. They recommend but do not require board certification for medical physicists and provide no other educational or experience requirements when the individual is not board certified. Revising the current

ACR Accreditation initial qualifications to include board certification or appropriate degree and experience requirements will strengthen the accreditation programs and bring them into line with the existing ACR Practice Guidelines and Technical Standards for each modality. Revising the continuing experience criteria so they are uniform across the programs will ensure that essential personnel stay current and connected with the modalities for which they provide service. The modifications to continuing education criteria will actually provide more flexibility to medical physicists/MR scientists as they choose curricula to fulfill their own needs as well as accreditation requirements. Second, language added to address the use of medical physicist assistants clarifies the levels of supervision and accessibility qualified physicists must provide to guarantee expert guidance and oversight. In each program, the qualified medical physicist/ MR scientist is responsible for the conduct of all surveys of the imaging equipment. The medical physicist/MR scientist may be assisted by properly trained individuals in obtaining data. These individuals must be approved by the medical physicist/MR scientist in the techniques of performing tests, the function and limitations of the imaging equipment and test instruments, the reasons for the tests, and the importance of the test results. In CT and MRI the medical physicist/ MR scientist must be present during the surveys. In Nuclear Medicine and PET, the medical physicist must be present or in general supervision of properly trained assistants (and accessible by phone) during the surveys. In all imaging modalities, the medical physicist/MR scientist must review, interpret, and approve all data and provide a report of the

22

conclusions with his/her signature. For more information go to the ACR modality accreditation page at www. acr.org/accreditation.aspx. Third, these modifications are necessary to promote the ACR goals for quality and safety as the ACR prepares the accreditation programs for approval by the Centers for Medicare and Medicaid Services (CMS) under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The CMS final regulations (expected shortly) will require eligible facilities performing MRI, CT, and nuclear medicine/PET diagnostic exams to become accredited by January 1, 2012. CMS plans to approve accrediting organizations by January 1, 2010. (Hence, the effective date of January 1, 2010 for these new requirements.) The accrediting organizations must set standards for qualifications for medical personnel who are not physicians but furnish the technical component of medical services. This includes medical physicists. Once the CMS regulations go into effect these criteria could potentially negatively impact a large number of individuals providing medical physics services and an even larger number of facilities. Also there are currently individuals who are providing medical physics services to facilities which have not yet applied for accreditation. Consequently, a grandfathering provision is essential in these revised requirements so that individuals currently providing these services are not disenfranchised and there is an adequate supply to provide medical physics services to facilities that must be accredited. For more information go to the ACR modality accreditation page at www. acr.org/accreditation.aspx. See qualifications on next page.


AAPM Newsletter

November/December 2009

New Requirements for Medical Physicists/MR Scientists in ACR CT, MRI, Nuclear Medicine and PET Accredited Facilities (revised) Effective January 1, 2010 Program CTAP

Initial Board Certified Certified in Diagnostic Radiological Physics or Radiological Physics by the American Board of Radiology; in Diagnostic Imaging Physics by the American Board of Medical Physics; or in Diagnostic Radiology Physics by the Canadian College of Physics in Medicine OR Not Board Certified in Required Subspecialty

Continuing Experience Upon renewal, 2 CT unit surveys in prior 24 months

Continuing Education Upon renewal, 15 CEU/CME (1/2 Cat 1) in prior 36 months (must include credits pertinent to the accredited modality)

Upon renewal, 2 NM camera surveys in prior 24 months

Upon renewal, 15 CEU/CME (1/2 Cat 1) in prior 36 months (must include credits pertinent to the accredited modality)

 Graduate degree in medical physics, radiologic physics, physics, or other relevant physical science or engineering discipline from an accredited institution, and  Formal coursework in the biological sciences with at least - 1 course in biology or radiation biology, and - 1 course in anatomy, physiology, or similar topics related to the practice of medical physics  3 years of documented experience in a clinical CT environment OR Grandfathered Conducted surveys of at least 3 CT units between January 1, 2007 and January 1, 2010 NMAP

Board Certified Certified in Medical Nuclear Physics or Radiological Physics by the American Board of Radiology; in Nuclear Medicine Physics by the American Board of Medical Physics; in Nuclear Medicine Physics by the Canadian College of Physics in Medicine; or in Nuclear Medicine Physics and Instrumentation by the American Board of Science in Nuclear Medicine OR Not Board Certified in Required Subspecialty  Graduate degree in medical physics, radiologic physics, physics, or other relevant physical science or engineering discipline from an accredited institution, and  Formal coursework in the biological sciences with at least - 1 course in biology or radiation biology, and - 1 course in anatomy, physiology, or similar topics related to the practice of medical physics  3 years of documented experience in a clinical NM environment OR Grandfathered Conducted surveys of at least 3 NM units between January 1, 2007 and January 1, 2010

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AAPM Newsletter Program NMAP-PET

November/December 2009 Initial

Continuing Experience

Continuing Education

Board Certified Certified in Medical Nuclear Physics or Radiological Physics by the American Board of Radiology; in Nuclear Medicine Physics by the American Board of Medical Physics; in Nuclear Medicine Physics by the Canadian College of Physics in Medicine; or in Nuclear Medicine Physics and Instrumentation by the American Board of Science in Nuclear Medicine OR Not Board Certified in Required Subspecialty

Upon renewal, 2 PET camera surveys in prior 24 months

Upon renewal, 15 CEU/CME (1/2 Cat 1) in prior 36 months (must include credits pertinent to the accredited modality)

Upon renewal, 2 MRI unit surveys in prior 24 months

Upon renewal, 15 CEU/CME (1/2 Cat 1) in prior 36 months (must include credits pertinent to the accredited modality)

 Graduate degree in medical physics, radiologic physics, physics, or other relevant physical science or engineering discipline from an accredited institution, and  Formal coursework in the biological sciences with at least - 1 course in biology or radiation biology, and - 1 course in anatomy, physiology, or similar topics related to the practice of medical physics  3 years of documented experience in a clinical PET environment OR Grandfathered Conducted surveys of at least 3 PET units between January 1, 2007 and January 1, 2010 MRAP Medical Physicist

Board Certified Certified in Diagnostic Radiological Physics or Radiological Physics by the American Board of Radiology; in Diagnostic Imaging Physics or Magnetic Resonance Imaging Physics by the American Board of Medical Physics; or in Diagnostic Radiology Physics or Magnetic Resonance Imaging Physics by the Canadian College of Physics in Medicine OR Not Board Certified in Required Subspecialty  Graduate degree in medical physics, radiologic physics, physics, or other relevant physical science or engineering discipline from an accredited institution, and  Formal coursework in the biological sciences with at least - 1 course in biology or radiation biology, and - 1 course in anatomy, physiology, or similar topics related to the practice of medical physics  3 years of documented experience in a clinical MRI environment OR Grandfathered Conducted surveys of at least 3 MRI units between January 1, 2007 and January 1, 2010

MR Scientist

 Graduate degree in a physical science involving nuclear MR (NMR) or MRI  3 years of documented experience in a clinical MRI environment

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AAPM Newsletter

November/December 2009

AAPM Website Editor Report

Christopher Marshall NYU Medical Center

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hen I logged onto my laptop this morning to draft this report, my Google Desktop RSS gadget noted a “Tweet” from AAPM reflecting a new posting under “What’s New” on the AAPM Website. My Outlook email program had also picked up the same information because it is set to report on RSS feeds from our site. This is not to endorse either product but rather to demonstrate how easy it is to keep on top of announcements from the AAPM using software or apps that you may already use or that can be readily downloaded to operate on any platform including smart phones. You can use such tools to automatically aggregate information from multiple sources and deliver it to you in a form that best suits your own lifestyle. This trend towards “personalizing” the web, so that selected information comes to you, represents a fundamental shift from the old paradigm where you had to go and find it – and it is both an opportunity and a challenge for the AAPM. Another challenge is to provide new opportunities to communicate with other members of the AAPM. To this end we now have an official LinkedIn presence [Link to http://www.linkedin.com/

ups?gid=2006026&trk=fulpro_ go&goback=%2Eanh_2144770] as an addition to our ongoing experiment with Twitter.

you prefer to have it sent to you by email or to access the archive you will need to use the link under the Publications menu.

When you visit the AAPM Website you should notice that our IS staff has added more personalized features under the heading “AAPM Events that pertain to you...” under your name. Additional personalized information can be found under “My AAPM”. You must, of course, be logged in to access these features.

Finally a reminder. The content of the AAPM website is protected under our terms of use [Link to http:// www.aapm.org/terms.asp] . If you would like to copy this content to use to produce some other web-based application please ask us first!

This is the first Newsletter that will not be printed. We have made it faster to access the current edition by a single click on the Newsletter icon on the AAPM Home Page. If

I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/ WebsiteEditor/3406.asp

Now online…

Selected presentations given at the:

2009 AAPM Annual Meeting Anaheim, CA, July 26-30 2009 AAPM Summer School “Clinical Dosimetry Measurements in Radiotherapy” June 21-25, 2009 • Colorado College 2009 CRCPD AAPM Training QA/QC for CR/DR Systems for Medical Imaging and Overview of Proton Therapy: Technical and Clinical Perspective Columbus, OH Physicists of Note Interviews • Anaheim, CA - 2009 AAPM Corporate Affiliate - Vendor Presentations as presented during the 2009 AAPM Annual Meeting Landauer, Inc. and Xoft, Inc. www.aapm.org/meetings/virtual_library/ 25


AAPM Newsletter

November/December 2009

Chapter News Southwest Chapter of AAPM (SWAAPM) by Dawn Cavanaugh

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he SWAAPM chapter is noticing a wonderful increase in its chapter participation and the building of its community. We have recently reinstated the Shalek Award and are working on many other items to help bring everyone together including many great ideas on updates to the website in order to create better communication between members of the chapter. As the number of CAMPEP programs is increasing, we are noticing more and more student and resident participation, which is always promising for the field of Medical Physics. On October 9th – 10th, the SWAAPM had their Fall 2009 meeting at The University of Texas M. D. Anderson Cancer Center in Houston, TX. Topics ranged from Patient Safety in Interventional Radiography to Tomotherapy QA with many current hot topics in both diagnostic radiology and radiotherapy. A feature of this meeting was a session devoted to Proton Therapy with Michael Gillin, Wayne Newhauser, and Radhe Mohan presenting. This was followed by an informative panel discussion on the current state of proton therapy. During the professional symposium Brian Wichman shared his experience of obtaining CAMPEP accreditation of a non-university based Residency Program in radiation therapy physics, and Mary Martel reviewed the updates for the 2012 and 2014 ABR exam requirements. The meeting was a great success with 155 attendees: 65 medical physicists, 48 students, 6 medical physics residents, 10 medical dosimetrists, and 26 vendors. This

was the first year that SWAAPM offered MDCB continuing education credits and we look forward to continue partnering with our medical dosimetry colleagues in the future. Many thanks to our invited speakers and to vendors for their continued support! To view some of the scientific, educational and professional presentations given from the Fall meeting, please visit the chapter website at: http:// chapter.aapm.org/swaapm/ The Young Investigators Symposium had an impressive number of applications for both the spring and fall meeting this year. The Spring meeting had accepted all presenters and divided the presentations into two rooms that ran simultaneously. The Fall meeting limited the number of presenters to 10 students or trainees. For the fall meeting Young Investigator’s Symposium there were 22 applications from which to choose. The top 10 Students presented with 1st place going to John Ely from LSU-Mary Bird Perkins Cancer Center, 2nd place to Brad Lofton from The UT M. D. Anderson Cancer Center, 3rd place to Brian Taylor from The UT M. D. Anderson Cancer Center and 4th place to Olivier Blasi from LSU-Mary Bird Perkins Cancer

Center. Congratulations to both the spring and fall participants of the Young Investigators Symposium, to their bright futures, and participation in the Medical Physics Community. During the past year, the SWAAPM has used its excess funds in a manner consistent with its charter. Specifically, the SWAAPM paid for two practicing physicists and three students from South America to attend the national AAPM meeting held in Houston. This was a competitive grant with an award sufficient to cover travel, registration and hotel expenses. Additionally, the SWAAPM made a donation in the amount of $5500 towards expenses for the evening reception during the 2008 AAPM annual meeting. Hold the date! The SWAAPM Spring 2010 meeting will be held in Baton Rouge, LA at Louisiana State University Lod Cook Conference Center and Hotel March 5–6. Ken Hogstrom has organized an exciting meeting that will include clinical radiotherapy sessions on electron therapy and general radiotherapy accelerators, joint therapy and imaging sessions on secondary cancer risks and medical use of synchrotron radiation, and a professional session focused on public education, residency programs, and the medical physicist manpower. Invited speakers outside the chapter to-date include

Congratulations to the chapter’s newly elected officers for 2009: President:

Kyle J. Antes, M.S.

2009-2010

President-Elect:

Peter Balter, Ph.D.

2009-2011

Secretary:

Dawn Cavanaugh, Ph.D.

2008-2010

Treasurer:

Russell B. Tarver, M.S.

2008-2010

AAPM Board Rep:

Russell B. Tarver, M.S.

2009-2011

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AAPM Newsletter

November/December 2009

Bill Hendee, Michael Mills, and Dimitris Mihailidis. The Friday night dinner will recognize winners of the Young Investigators Symposium and the Shalek Award, awarded to one who has made significant impact on the field of medical physics through research, education, or professional service. The meeting will be followed by an exciting social event Saturday afternoon! Many thanks to both our PastPresident; Jason Stafford, Ph.D. (2008-2009), The past AAPM Board Rep, John Gibbons, Ph.D., and the Chapter Web Master; Timothy Blackburn, Ph.D. From left: Rani Al-Senan, Frank Goerner, Teboh Roland, Joy Witzel, Cecilia Lee, Dr. Chenyu Shi and Mrs. Shi. (UTHSC-San Antonio graduate students & faculty).

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AAPM Newsletter

November/December 2009 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.

The American Association of Physicists in Medicine and The Center for Health Workforce Studies solicit your participation in A MEDICAL PHYSICS WORKFORCE STUDY AAPM has contracted with the Center for Health Workforce Studies to conduct a workforce study of medical physicists. As part of the study, the Center is conducting an on-line survey of certain AAPM membership categories. Unlike the annual AAPM member salary survey, this survey asks about career paths into the profession, practice characteristics, retirement plans, and opinions about the current job market for medical physicists and the future of the profession. The overall goal of the study is to determine whether the supply of medical physicists will meet future demand for them in light of the new ABR certification requirements. Online access to this survey is available through the AAPM website. In return for your participation you will be automatically entered into a drawing for one of the following prizes to be awarded in January of 2010.

First Prize: Kindle: Amazon’s 6” Wireless Reading Device

Second Prize: Garmin nüvi 760 4.3” Widescreen Bluetooth Portable GPS Automobile Navigator

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Third Prizes: 100 -$5.00 Amazon gift cards


AAPM Newsletter

November/December 2009

EFOMP

AAPM Strengthens Ties with EFOMP by Herb Mower, Ed Council Chair, Retired

Recognizing these common concerns, EFOMP hopes to explore having joint sessions with the AAPM at their 2011 Annual Meeting. Although in the early phases

of consideration, this is something that the Education Council will be working on in the next few years. As things progress, we sill keep you informed through the Newsletter.

F

or many years the AAPM has interacted with the European Federation of Organizations for Medical Physicists. For many years EFOMP served as a meeting place for the representatives of the various European medical physicist groups. Starting in 2007 they added a scientific program and turned this meeting of the representatives of the various organizations into an actual Annual Meeting. During the past two years the relationship with EFOMP has strengthened with presentations by the AAPM Education Council at the 2007 and 2008 EFOMP meetings. At the joint EFOMP / World Congress meeting this year Tony Seibert and I had the opportunity to meet with Wolfgang Schlegel and Marta Wasilewska-Radwanska. During the past couple of years we have learned that many of the challenges facing us are very similar to those of our European colleagues. As we face the challenges of recognition of qualified medical physicists from state to state, they face the same problems when moving from country to country. As more states institute licensure, this recognition is apt to become more problematic. The member societies of EFOMP are also very interested in developing ‘common’ educational programs, both didactic and residency programs, for medical physicists. Thus they are very interested in our curricula, our residency formats, and our accreditation process for these programs [CAMPEP].

L - R: Tony Seibert, Marta Wasilewska-Radwanska, Wolfgang Schlegel and Herb Mower

The American Association of Physicists in Medicine cordially invites you to attend the AAPM Tuesday Evening Reception at RSNA during the 2009 AAPM / RSNA Meeting Tuesday, December 1, 2009 6:00 pm - 8:00 pm Waldorf Room, Chicago Hilton Chicago, Illinois light hors d’oeuvres AAPM gratefully acknowledges the following co-sponsors for their contributions to this reception: Landauer, Inc.

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AAPM Newsletter

November/December 2009

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AAPM Newsletter

November/December 2009

Health Policy/Economic Issues

Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant AAPM Submit Comments to Medicare Regarding 2010 Proposed Rules

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he AAPM Professional Economics Committee (PEC) has had a very busy regulatory season reviewing multiple Medicare proposed rules and their impact on medical physics procedures and submitting comment letters, including recommendations to the Centers for Medicare and Medicaid Services (CMS) that benefit the practice of medical physics. In the September/October 2009 issue of the AAPM Newsletter, we provided highlights of key issues contained in two Medicare proposed rules. In this issue, we summarize the key comments and recommendations made by AAPM in our formal written comments to CMS. Medicare Physician Fee Schedule (MPFS): For 2010, CMS proposes sweeping changes to their practice expense proposals that negatively impact the technical component and global payment of radiation oncology services. The total impact of the 2010 practice expense proposals to radiation oncology is negative 17%. CPT 77336 Continuing medical physics consultation has significant practice expense RVU reductions under the current “bottom-up” practice expense methodology and the 2010 proposals further reduce reimbursement by 43% from 2009 payment. Other innovative technologies like IMRT and stereotactic radiosurgery (SRS) would realize cuts in excess of 40% for 2010 if these proposals are implemented. AAPM has grave concerns because cuts of this magnitude

would harm cancer care, limit access to HDR brachytherapy, IMRT and SRS procedures to Medicare beneficiaries especially in rural areas, and may lead to the elimination of freestanding and communitybased cancer centers. For 2010, CMS proposes to change the equipment usage assumption from the current 50% usage rate to a 90% usage rate for equipment priced over $1 million. This proposal stems from concerns raised by the Medicare Payment Advisory Commission (MedPAC) and others regarding the volume growth of advanced diagnostic imaging services over the past several years. This proposal significantly impacts external beam, IMRT and SRS payments in 2010 and the overall impact to radiation oncology is negative 5.0%. AAPM strongly objected to the extrapolation of the equipment utilization proposal to radiation therapy. CMS should not apply the 90% utilization rate to medical equipment priced over $1 million and used for therapeutic radiation oncology (CPT codes 7726177799). For 2010, CMS proposes to use new practice expense per hour values from the American Medical Association (AMA) Physician Practice Information Survey (PPIS) for all Medicare recognized specialties that participated in the PPIS for payments effective January 1, 2010. CMS estimates that this proposal will negatively impact radiation oncology by 12%, with payments for cancer treatments reduced by up to 53% (i.e. 77401). Given the magnitude of the resulting payment changes, AAPM is disappointed

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that CMS did not propose to phasein the changes over a period of years, especially since practice expense RVUs based on the new “bottom-up” methodology are still being phased-in through 2010. AAPM recommended that CMS delay use of the AMA Physician Practice Information Survey (PPIS) data because it does not provide an accurate reflection of practice expenses incurred by radiation oncologists. If CMS implements the AMA PPIS data effective January 1st, AAPM implored the Agency to transition the proposal over several years and blend the AMA PPIS data with the current radiation oncology supplemental survey data. Effective January 1, 2009, CMS established three new procedure codes for HDR brachytherapy, CPT 77785, 77786 and 77787, with interim relative value units (RVUs). The HDR brachytherapy interim RVUs yielded payment decreases of 46% to 67% in 2009. The 2010 practice expense proposals would further reduce HDR brachytherapy payments to freestanding cancer centers. CMS has requested that the AMA’s Relative Value Update Committee (RUC) consider these CPT codes for additional review. AAPM recommended that CMS ensure that the revised HDR brachytherapy direct practice expense inputs include: •

a correct useful life for the HDR Iridium-192 renewable brachytherapy source (ER060) by changing the useful life to one (1) year with an annual cost of $45,326. Alternatively if CMS is not able to establish a useful life of one year, CMS should consider separate payment for the HDR Iridium-192 source under the Medicare Physician Fee Schedule


AAPM Newsletter

November/December 2009

utilizing HCPCS code Q3001; •

omitted medical equipment costs for HDR brachytherapy procedure codes 77785-77787, including but not limited to a 1) Well Chamber with Iridium-192 Calibration Capability, 2) Area Radiation Monitor, 3) HDR Afterloader Guide Tube Connector Set, 4) Pulse Oximeter (CPT 77786 and 77787 only), 5) Cardio-Respiratory Monitor (CPT 77786 and 77787 only), and 6) Prostate Brachytherapy Mattress (CPT 77787 only);

new preservice time for each of the HDR brachytherapy codes (77785, 77786 and 77787) to prepare the HDR afterloading equipment for treatment; and

corrected and revised intraservice nonphysician clinical staff types and times to reflect the Nuclear Regulatory Commission regulations.

For 2010, CMS proposes to use the medical physicists’ premium data as a proxy for the malpractice premiums paid by entities providing technical component (TC) services. CMS believes that the use of this data will better reflect the level of malpractice premiums paid by entities providing technical component services than the current charge-based malpractice RVUs or crosswalks to the malpractice premium data of physician specialties. AAPM opposes any policy that would make the technical component malpractice value zero. The current CMS proposal virtually eliminates existing TC malpractice RVUs. It is important that the cost of medical physicist’s professional liability insurance be captured in the resource-based malpractice RVUs for technical services, however, this should be in addition

to other malpractice costs incurred by freestanding and communitybased cancer centers. AAPM recommended that CMS consider actual malpractice premium data purchased by freestanding centers, in addition to medical physicists premium liability insurance, when calculating resourcebased malpractice RVUs for technical component services. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires that beginning January 1, 2012, Medicare payment may only be made for the technical component (TC) of advanced diagnostic imaging services for which payment is made under the fee schedule to a supplier who is accredited by an accreditation organization designated by the Secretary. AAPM recommended that CMS ensure that qualified medical physicists (QMPs) are recognized and required to support accreditation programs mandated under the new Medicare legislation for advanced diagnostic imaging services. Accreditation criteria should require that a QMP supervise the process that determines image quality and patient dose / exposure. It is imperative that any accreditation criteria reflect the role of medical physicists in facility and program accreditation. Hospital Outpatient Prospective Payment System (HOPPS): Since January 2008, Medicare has packaged radiation therapy image guidance procedures performed in the hospital outpatient setting, therefore, there is no separate Medicare payment for image guidance services. AAPM remains opposed to this policy and strongly supported the APC Advisory Panel’s August 27, 2008 recommendation that CMS provide separate payment for

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radiation therapy guidance services for two (2) years and reevaluate the packaging proposal for 2011 hospital outpatient proposed rulemaking. CMS did not implement the Panel’s recommendation and proposes to continue its packaging policy in 2010. AAPM recommended that CMS closely monitor the impact of packaging image guidance on the quality of Medicare beneficiaries cancer care and to provide transparent and meaningful data associated with the packaging policy, which allows stakeholders to determine if reimbursement for image guidance technology is reasonable and appropriate. Effective January 1, 2009 In the 2009 hospital outpatient final rule, CMS removed all radiation oncology codes that did not meet the empirical criteria for inclusion on the Bypass list. The changes to the Bypass list results in the loss of outpatient procedure claims utilized to determine payment rates for radiation oncology and continues to negatively impact payment for some radiation oncology ambulatory payment classifications (APCs). The AAPM supported the American Society for Radiation Oncology (ASTRO) recommendation that CMS add CPT 77470, 77295, and 77328 to the Bypass list for 2010. Further, AAPM encouraged CMS to establish an appropriate methodology that utilizes to the greatest extent possible multiple procedure claims for rate setting by creating pseudo-single claims. The Medicare final rules will be published on or about November 1st with an implementation date of January 1, 2010 for finalized payment policies and hospital outpatient payments. To access the complete AAPM comment letters, go to the AAPM website at http://www.aapm.org/government_affairs/CMS/default.asp


AAPM Newsletter

New Professionals Forum Report from looking back at my first years as a Medical Physicist and determining what I did right and what I might have done better. For those that are pressed for time and need the abridged version; “Be a sponge and open your mind and talents to every task you can get involved in.” For those with more time, read on.

Russell Tarver New Professionals Subcommittee Member Lessons from my first years

L

November/December 2009

ife is full of ‘if I had only…’ and ‘I wish I hadn’t…’. With the second column from the NPSC, I hope to provide a little advice to those of you that have recently, or are about to enter the field. This advice comes

There is insufficient space here to provide a comprehensive guide for new physicists, but hopefully a few well placed nuggets will yield dividends down the road. For your first job I recommend finding a group of 3-5 physicists if possible, that is a sufficiently large number that personality clashes (if they exist) won’t define your working environment. It’s also large enough to have varied

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experiences and perspectives. However, it’s not so large that you’ll be relegated to a small subset of the spectrum of physics duties. While the dosimetry component of my first job didn’t seem glamorous at the time, it gave me a good grasp of the planning process as well as an understanding of the duties of dosimetrists and therapists: your contemporaries. Spend time in dosimetry and simulation, and on the treatment units if you can. If your center has hardcopy data books, spend a few months doing hand calculations when you check charts. This will give you a clinical perspective on what the data actually represents. Don’t take the data at face value; ask your seniors how it was generated and what data collection


AAPM Newsletter

November/December 2009

was necessary. Often the values in a data book weren’t directly collected, but were calculated. If you’re a diagnostic or other specialty Physicist, I’m sure there are corollaries. Get involved and contribute to your professional societies. If you can manage it, attend one or two meetings a year. These are excellent places to not only learn about new technologies and techniques, but also to renew old acquaintances and make new ones. Make a thorough pass through the vendor hall, making sure to at least understand what each vendor is providing and how it might be different from the competition. You never know when you might be asked to implement a new technology or solve a problem. Avoid complacency. The enemy of good is better, but so is ‘good enough’. Often we accept the status quo since it’s been good enough so far. Continually look for projects that can increase the safety, accuracy, quality, efficiency, or your chosen metric in your clinic. Be careful in this. In these days of busy schedules and limited resources you need to decide where your best return on investment is, so be certain there is value in a project beyond its mere accomplishment. Cultivate the relationships between you and your vendors, engineers, and peers. Your vendors are a resource for information. Know the vendors for your major equipment. Utilize their expertise, but don’t needlessly abuse their time. Your engineers can have a huge impact on the smooth functioning of your clinic. Again, learn from them when you can and don’t require great effort on their part with limited clinical benefit. Make it a habit to be aware of what work they are performing on your machines. When they finish their work always make sure to discuss what was done, why it needed to be done, and determine what extra work you must do to insure that your

machine is still within specs. Verify their work since you’ll be responsible if it’s not done right. Your peers are an integral part of your work environment. Try to understand how your job affects theirs and vice versa. Physicists are generally well respected in the community, but that respect is hard to regain once lost. Know your limits. I can’t stress this enough. Be willing to step outside your comfort zone and learn, but don’t be afraid to speak those three words… “I don’t know”. Your transition from the ‘newbie’ to a seasoned and respected professional will only be hampered by offering incorrect answers. The more your co-workers see that you are confident in your answers, and willing to research to find the correct answer

when unsure, the more they will respect you and your answers. If you give an ‘I don’t know’ answer, be sure to follow up and give them an answer. If you don’t have good record keeping skills, learn them. My memory is no longer up to the task and I’ve learned to keep notes on anything I think important or likely to be needed again; sadly, I can’t always remember where I put them. Don’t ignore the regulatory component of your job. A senior physicist will usually handle these responsibilities, but that doesn’t mean you can’t learn your state’s requirements and have a cursory knowledge of regulatory agencies and rules. And finally, always remember who the final recipients of your efforts are.

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AAPM Newsletter

November/December 2009

Joint Medical Physics Licensure Subcommittee Report

Licensure Effort Update by Jeff Limmer, Chair

G

reetings! I would like to share with you some of the progress we (dozens of volunteers) are making in our subcommittee (under the AAPM Clinical Practice Committee, Chair Martin Fraser). We receive many questions from membership regarding the subcommittee’s work. All of these questions are valid and important. I hope to address some of these questions for you and at the end of the article talk about re-evaluation.

It is for the benefit and safety of both the patients and the general public, it is essential that the role of medical physics be both defined and protected by law. It is important to patients and our profession that we work toward this aim / goal independently of CARE Bill passage and to have State rules where Medical Physics services are performed only by qualified individuals.

ing the AAPM and ACMP Scope of Practice). Response: In late 2006, the ACMP merged its Medical Physics Licensure efforts with the AAPM’s Medical Physics licensure efforts into the Joint Medical Physics Licensure Sub-Committee (JMPLSC). The Joint Subcommittee reports to the ACMP: Commission on Credentials and the AAPM: Clinical Professional Committee

There are presently several varieties and degrees of legal status for medical physicists in the United States:

The charge of this joint subcommittee is to make available resources to aid the adoption of Medical Physics professional licensure* in the United States of America.

First, how did we get to this point? There are many tools and resources, which have been painstakingly developed over time, in place which allow for this effort. I would like to thank many for working on these important documents. • • • • •

Joint (AAPM / ACMP) Scope of Practice Joint position statement on licensure Joint definition of a Qualified Medical Physicist Joint charge to the JMPLSC Significant resources (both human and financial)

Why Licensure? The level of complexity involved in medical imaging and radiation therapy is such, that it is necessary that physicists with special training, education, and experience should be a part of the team providing these procedures. Not many people outside our profession know what we do or who we are. Like it or not, if we do not help define who performs these tasks, others will define it for us. We need to be at the helm of our own ship.

• • • •

4 states have licensure defining most aspects of Medical Physics The NRC has defined an Authorized Medical Physicist The FDA has defined a Mammography Physicist Many states do not require registration or licensure of Medical Physicists Many states require a registration of Medical Physicists. ○ Many require certifica tion or other demonstration of education and experience in order to be registered, some do not. ○ Registration may not ap ply in all areas of Medical Physics

What are the AAPM / ACMP Regulatory Goals? • •

Establish some form of Licensure for Medical Physicists in as many states as possible. Work with the CRCPD to define a Qualified Medical Physicist for State regulations. (using the AAPM and ACMP Definition) Define duties which require a Qualified Medical Physicist (us-

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(*to bring about standards and guidance for qualifying medical physicists to practice (with or without the CARE Bill) through licensure or through a similar mechanism) • • •

Coordinate the efforts of the AAPM and the ACMP toward a common position and strategy Develop recommended minimum standards for state licensure laws. Develop recommendations containing background information, suggested strategy, and a suggested Medical Physics Licensure Act and Rules, for use by medical physicists and others engaged in promoting the passage of medical physics licensure laws

It is important to patients and our profession that we work toward this aim / goal independently of CARE Bill passage and to have State rules where Medical Physics services are performed only by qualified individuals. Where are we in the process? We are now in Phase Three of a Three-Phase process:


AAPM Newsletter

November/December 2009

Phase One (late 2006-2008): • Attain a joint AAPM / ACMP Charge • Attain a joint Scope of Practice • Review of present State regulations (Licensure and Registrations) Phase Two (2008-2009); • Recommend a template for States to use when writing legislation • Identify target states and lobbyists Phase Three (2009-present) • Help develop or recommend development of specific tools / guidelines / handbooks / support for State adoption of regulations What is included in the legislative template given to state legislatures and supported by the lobbyists?

When we were working to developing the language to propose as a generic codification template we learned from the successes and challenges of the four states that have licensure. Some important components are: • Definitions • “Scope of Practice” language • Licensed Medical Physicist • Limited permits • Grandfathering The Sections of the document include; 1. Purpose and scope 2. Definitions 3. Definition of “practice of medical physics” 4. Use of the title “licensed medical physicist” 5. <State board> for medical physics 6. Requirements and procedures

or professional licensure 7. Provisional license 8. Exemptions 9. Licensure without examination 10. Continuing education requirements 11. License term and renewal 12. Enforcement 13. Ethical Guidelines 14. Separability What is the difference between a national registry and state licensure? National Registry and State Licensure: • Both licensure of the profession and the national registry gives the states, individuals, institutions, etc. a mechanism to relatively easily identify who has achieved board certification. • The licensure of the profession provides for penalties and con-

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© Radiological Imaging Technology, Inc. May, 2009

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AAPM Newsletter sequences not only for those that fail to obtain the license to practice but also those that are incapacitated in some fashion or fails to provide the level of quality care that is expected of a licensed professional. Therefore licensure provides a greater degree of protection for the patient and the quality of the service. How were the original states chosen? When choosing the initial states to start work on licensure we used these criteria: • Influence with state radiological society • Influence with state legislators • Support of state regulatory agencies • Willingness to serve ○ As a point person ○ On a state committee • Number of medical physicists in that state The five states which scored highest on the criteria score were: Missouri, Ohio, Pennsylvania, Michigan, and Massachusetts. Please visit the AAPM website for an updated map of the states and information on each state regarding registration, licensure, etc. http://www.aapm.org/government_ affairs/licensure Significant progress is being made in each state and some are to the point of bill submission and legislative leader sponsorship. Since I am writing this in September any details I type will be very much out of date by the time you read this. Why a lobbyist? Certainly state Medical Physics support and volunteerism is crucial but lobbyists are needed to have the most favorable outcome. There are many “on the scene” tasks and “in the mo-

ment” tasks that need the attention of a lobbyist. Once the bill is introduced, they help make sure it is picked up and passed by keeping it on the calendar. A lobbying firm was retained in 2009 and they are making great progress in the short time they have been working for us. Will there be a course evaluation? It is important, for many reasons, to periodically and objectively look at the environment, direction, and goals of any endeavor. The JMPLSC is presently performing a Course Evaluation this fall and the report will be sent to the ACMP Board of Chancellors and the AAPM Board of Directors. We will analyze the most effective strategy to achieve the stated goal of: “The practice of clinical medical physics is performed by Qualified Medical Physicists (QMP) with consistent minimum standards across the country.” The recommendation may be the present course or it may be an altered course. Some of the items to be addressed and explored in this evaluation: • How are present federal healthcare reforms potentially affecting Medical Physics? • Is state-by-state licensure (AAPM/ACMP directive in the Charge) the best overall route to ensure consistent minimum standards and an effective use of our member’s funds? • Estimated time horizon for the project with an estimate of likely annual costs for the project until completion. • What is the plan for the states that (both tried and failed or it “just won’t happen) will not or cannot adopt state licensure? • Clarify the distinction between National Registry and Licensure Again, I want to thank the many,

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November/December 2009 many people who through prior action have, or through present action are making this possible. It has been over three years since I started as Chair. Starting in January 2010 Robert Pizzutiello, present ViceChair, will assume the Chair. When we started in late 2006 it seemed to be a daunting task and, while there has been significant progress, the task is no less daunting today. The volunteers involved in the project are active and prepared to help the profession move forward.


AAPM Newsletter

November/December 2009

History Committee Report

AAPM History Committee On-line Interviews of Prominent Medical Physicists by Lawrence N. Rothenberg

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he AAPM History Committee has conducted interviews of prominent medical physicists which can be viewed through the AAPM website. The interviewees include major award winners, retiring AAPM Officers, a panel of AAPM Charter Members, and others who have been extremely active members of the Association.

To view the interviews, go to www. aapm.org and select “AAPM”. Then select “History & Heritage”. There you will see “Physicists of Note” and the years 2005 through 2008 listed. The 2009 interviews will be added soon. When you select a given year, the list of interviews for that year will be shown. Then choose “view interview” for the one you would like to watch. Since 2005 the interviews have taken place at the AAPM Annual Meeting and have been conducted by Robert Gould – History Committee Chair

and Lawrence Rothenberg – AAPM Historian. Before 2005, more than 100 History Committee video interviews were produced by Robert Gorson, who used his own video equipment to capture the videos. A few other AAPM members assisted Bob with the interviews. All of those earlier interviews are available on DVD from the AAPM Headquarters.

AAPM History Committee On-Line Interviews 2005 – 2009 2005 Seattle, WA Interviewer: Lawrence N. Rothenberg Lowell L. Anderson Radhe Mohan G. Donald Frey Kunio Doi 2006 Orlando, FL Interviewer: Lawrence N. Rothenberg Howard I. Amols Lawrence E.Reinstein Jatinder Palta Melissa Martin 2007 Minneapolis, MN Interviewers: Robert G. Gould, Lawrence N. Rothenberg Ervin B. Podgorsak - Gould Marilyn Stovall - Rothenberg E. Russell Ritenour - Gould Frances Harshaw - Rothenberg Priscilla Butler - Gould

2008 Houston, TX Interviewers: Robert G. Gould, Lawrence N. Rothenberg Mary K. Martel - Rothenberg Arthur L. Boyer - Gould Christopher H. Marshall - Rothenberg Panel – Charter Members – Gould and Rothenberg Morris Hodara, MS Paul N. Goodwin, PhD, FAAPM Mary L. Meurk, BA, FAAPM James C. Carlson, MS Robert J. Schulz, PhD, FAAPM Gail D. Adams, PhD, FAAPM James G. Kereiakes, PhD, FAAPM 2009 Anaheim, CA Interviewers: Robert G. Gould, Lawrence N. Rothenberg Willi Kalender – Rothenberg Gerald White – Rothenberg John Boone – Gould Herbert Mower – Gould

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AAPM Newsletter

November/December 2009

Persons in the News

Dr. William Hendee receives Honorary Doctorate from University of Patras, Greece

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n September 15, the University of Patras in Patras, Greece honored William Hendee, Past President of the American Association of Medical Physicists and Editor of Medical Physics, with the degree of Honorary Doctorate in Science. In bestowing this recognition, Rector Stavros Koubias acknowledged Dr. Hendee’s many contributions to scholarship in medical physics and his international efforts to improve education and practice in medical physics.

Dr. Gary Fullerton was given an Award of Merit of the International Union for Physical and Engineering Sciences in Medicine (IUPESM)

D

uring the last triennial World Congress for Medical Physics and Biomedical Engineering, held in

L - R: Rector Stavros Koubias (Professor of Electrical Engineering), William Hendee and Dean George C. Nikiforidis (Professor and Chairman of Medical Physics)

Munich, Germany September 2009, Gary Fullerton, past-President AAPM received the IUPESM Award of Merit for outstanding achievements in Physical Sciences in Medicine, in recognition of “a distinguished career exerting significant impact on the science and practice of Medical Physics”. Dr. Fullerton became the eighth medical physicist world-wide to be honored with this award since its inception more than 20 years ago. The IUPESM (www.iupesm. org) represents more than 100,000 medical physicists and biomedical engineers world-wide. Since 1988 the organization presents the IUPESM Awards of Merit every third year. Originally, the award was only in Medical Physics, but since 1997 it was extended to two triennial

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awards to recognize a medical physicist and a biomedical engineer. Dr. Fullerton was recognized for his many roles in international medical physics as President of the World Congress for Medical Physics and Bioengineering in San Antonio 1988, Secretary General of the IOMP, 1997 – 2003, Secretary General of the IUPESM, 1997-2003 and IUPESM Delegate to the International Council for Science (ICSU) in Egypt in 2000.  It was during the ICSU Assembly in Cairo that IUPESM was elected to full ICSU membership to represent health care in international health programming at the highest levels of international scientific cooperation.


AAPM Newsletter

November/December 2009

Letter to the Editor Registration vs Licensing by Jeff Masten

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istening to the debate inside the AAPM about licensing, registration and the future direction of the clinical practice of medical physics, it occurred to me that the membership might benefit from a short discussion of the real, and legal, differences between these approaches. What follows is a comparison and a contrast of some aspects of registration versus a license. What is a license? To listen to someone off the street, a license is just another government imposition of some rule or regulation on the private sector. The classic example is how many hours of standing in line does it take to get your driver license renewed, or obtain one in the first place. Or a hunting license, or a building permit, or any of a dozen other examples you might run across during the week. Those examples, however, don’t fully illustrate the real meaning of a license. A technical definition might be that a license is a government grant of specific legal rights and obligations to the holder of that license. Notice in particular that it is a grant of certain rights by some government, whether it’s municipal, state or federal. There are several consequences that follow immediately from that fact. First, since it is a grant of some specific right by a government, it is property in the fullest legal sense of that term. Since it is property, it cannot be taken away from you without Due Process of law, and that in turn is guaranteed by both the state and U. S. Constitutions. In

other words, once that license has been granted, it cannot be restricted or taken away without notice and a hearing, with all the attendant legal rights and appeals. Second, if the State proposes to do something or take some action against a license holder, then it is the burden of the State to prove its case. This is largely the reverse of what is true in the situation of a registrant on some list. Third, since a license grants a right to do something, it ipso facto limits or prohibits the ability of others to do that same activity. For example, you need a license to practice medicine or law. In the United States one can self-medicate to a certain extent, and one can certainly represent one’s self in court, but that’s as far as it goes. If you want to represent someone else you need a license to practice law. If you want to perform surgery on someone else, you need a license to practice medicine, and doing either activity without that license is a crime. Licensing, in other words, defines a market and the licensing authority is the one who applies some set of previously agreed upon rules to determine who gets into that market. At this point we are in a better position to understand the difference between a license and a registry. A registry is simply a list. It can be maintained by either a public or private entity. A registry confers no right although it may impose certain obligations as a precondition to being on that list, and as such registration is not property protected by either state or federal Constitutional guarantees. It may attest to the registrant

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possessing certain qualities, but it is still in the end simply a list. Now that we have contrasted these two approaches, a couple of consequences are immediately apparent. One is the fact that a list can easily morph into a license if you consider it for one moment. You may have thought I was somewhat dismissive in the description of a registry as “just” a list because we can impose tough requirements on any registrant before they’re eligible to be on that list. If the registrants are concerned about arbitrary action by the registry, we can attach rules and appeals, and rights to be heard as a part of the business of managing that list. But then what have we created? The question is easy to answer if you look at the definition of a license. The only issue is whether there is governmental involvement (remember that Constitutional guarantees of due process do not attach to private action, only government). Without government involvement in some manner, this modified list approach has no teeth because there is no threat of prosecution to enforce it although civil penalties might be available. On the other hand a small state might argue that the license approach is far too expensive for it to successfully implement. An attractive alternative for such a state might be to require any person practicing some activity must be on a registry (either federal or state), and no other persons can engage in that activity except those who are registered. The danger here is that what we have created is a stripped down license possibly without the protections ordinarily afforded those holding a license. This might seem


AAPM Newsletter like an exceedingly fine point, but it’s your livelihood that is at issue here. Second, and I personally believe it’s at least as significant, is that the choice between a registry and a license will dictate the future of clinical medical physics for the

foreseeable future. To understand this, simply consider the business

model – engineering has registered professional engineers and that has been successfully implemented in all 50 states over the years. Law

November/December 2009

and medicine, on the other hand, are self-governing professional societies and that has been an effective approach for over 200 years. One direction is based on registration, the other on a license. For my part I strongly believe that the practice of clinical medical physics is a profession in the fullest sense and that it is therefore best governed in the law/medicine model. The risk to the public is far too high to simply let the market

decide as it does in the example of the registered professional engineer. To put it bluntly, to protect the public we need to be able to strictly regulate who gets in, and who needs to be let out. To protect ourselves, we need to have the right of review and appeal that is a part of the guarantees attached to a license.

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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) PRINT SCHEDULE

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 42

The AAPM Newsletter is produced bi-monthly. Next issue: January/February Submission Deadline: December 10, 2009 Posted On-Line: week of January 4, 2010

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AAPM Newsletter November/December 2009 Vol. 34 No. 6  

AAPM Newsletter November/December 2009 Vol. 34 No. 6  

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