AAPM Newsletter March/April 2010 Vol. 35 No. 2

Newsletter

A M E R I C A N A S S O C I AT I O N O F P H Y S I C I S T S I N M E D I C I N E We advance the science, education and professional practice of medical physics

AAPM Column VOLUME President’s 35 NO. 2

MARCH/APRIL 2010

AAPM President’s Column Michael G. Herman, Mayo Clinic

Patient Safety in the Medical Use of Radiation

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any millions of people receive medical radiation annually, either for the diagnosis or treatment of disease. The vast majority of these people benefit from the use of radiation and for many the radiation is part of a life-saving procedure. Rarely, something goes wrong and someone is injured or more tragically someone dies as a result. Recent articles in the New York Times have highlighted some of these cases where things went wrong. These events, while very few and far between suggest quite clearly that we can do a better job. Only months prior, the United States Food and Drug Administration called attention to CT perfusion exam doses that in some cases significantly exceeded expected or recommended dose levels. While the dose levels, procedures and potential impact of errors in imaging vs. therapy are very different, these events prompted the US Congress to convene a hearing entitled “Medical Radiation, an Overview of the Issues”.

The hearing is scheduled before the Subcommittee on Health of the House Energy and Commerce Committee. The memo to the congressional committee states in part that “medical radiation is regulated under a number of authorities across multiple agencies, and the [recent press] articles suggest a multifaceted problem which touches on the oversight of medical devices, oversight of certification and licensing of allied health professionals, oversight of hospitals and physicians, and efforts to improve the quality of health care.” The memo also discusses regulatory authority, limitations and responsibility of federal agencies such as NRC, FDA and CMS, citing MQSA as an example where federal Included in this issue: legislation was used to establish minimum standards. Finally, p. 4 the inconsistency in state regulations for individuals involved in Hearing Update p. 5 the use of medical radiation as well as their practice guidelines Chair of the Board p. 7 is mentioned. This congressional hearing, rescheduled for President-Elect p. 9 February 26th, will review recent issues and publicity in both Executive Director p. 11 medical imaging and radiation therapy uses of radiation. Editor p. 13 There are two panels scheduled, the first of which includes Professional Council p. 15 expert case witnesses. I would like to point out that two of Education Council p. 17 the individuals called to testify as radiation medicine technical Leg. & Reg. Affairs p. 20 experts are AAPM members, Dr. Cynthia McCollough for ACR Accreditation p. 22 CT imaging and Dr. Eric Klein for radiation therapy. The Website Editor p. 23 second panel will consist of testimony from ASTRO, ACR, Health Policy/Economics p. 26 ASRT, MITA and AAPM. Each will have an opportunity to make IAEA/AAPM Report recommendations to Congress and to answer questions from AAPM Member Perspective p. 28 Announcements p. 33 the committee members.

Person in the News p. 34 We all do a very good job through participation on the teams Obituary p. 35 that manage and deliver radiation, keeping adverse event

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continued - AAPM President’s Column rates substantially below a small fraction of one percent. But we must ask ourselves what we can do to make things better and safer. We must work together; physicians, technologists/therapists, medical physicists, dosimetrists, manufacturers and federal and state regulatory and legislative bodies. Two national practical symposia have already been planned to increase awareness of dose and safety measures. A CT Dose Summit is planned at the end of April to provide practical information for users that will help them operate their CT scanners safely and effectively. The summit will include detailed demonstrations of how scan acquisition and image reconstruction parameters should be selected and managed to improve image quality and reduce radiation dose. A second meeting on radiation therapy safety is planned for the end of June to provide the treatment team with the ability to identify and implement safety improvements in their current practice. It is intended to recommend methods to provide operators with greater knowledge and control over the radiation delivery process at the point of care of patients. It is also designed to examine the respective roles of members of the radiation therapy team and determine ways in which they can improve communication and teamwork to ensure safer and more effective treatment of patients in this complex, multi-system modality.

The safest and highest quality patient care is achieved by medical team members who are consistently educated and certified and who follow consensus practice guidelines that meet established national accrediting standards. We can also improve safety by uniformly collecting data on and evaluating our mistakes at the national level. In medical physics we participate in the diagnostic and therapeutic use of radiation. This is through research and development of new devices and techniques, education of academic and clinical medical physicists and providing clinical services in imaging and radiation therapy practice. Each of us has a responsibility to increase patient safety and improve the quality of care. In research and development, this may involve developing software that helps the user recognize potential problems or hardware mechanisms that prevent catastrophic failure. In education it means providing complete curricula in structured environments to guarantee the graduates have the tools to enter the profession. In the clinic we must remain current in quality assurance and technical process and we must be acutely aware of patterns or events that are not right and take action to prevent errors.

The AAPM testimony to Congress contains a number of specific points which, taken together, would offer a reduction in potential and actual adverse events. The first 5 points focus on qualified people following established practice standards.

1. Provide robust, consistent, and financially-stable education, training and clinical experience for the Qualified Medical Physicist in clinical practice. We will continue strong support to meet the goal that candidates must receive structured didactic medical physics education and complete an accredited clinical residency prior to completing the American Board of Radiology radiologic physics exam. We will recommend that CMS reimburse medical physics residency programs in an equivalent manner to physician residencies.

2. Strive for nationally consistent recognition of the Qualified Medical Physicist and equivalent competency for all medical radiation team members through passage of H.R. 3652, “The Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy Act of 2009.� AAPM will remain involved with the Alliance to facilitate consistent national implementation of this act.

3. Provide national practice guidance in radiation oncology and medical imaging based on consensus and consistent minimum quality standards. These standards will recognize qualified individuals, establish minimum staffing levels and define procedure-specific guidance, including process communication.

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continued - AAPM President’s Column 4. Establish a minimum standard for accrediting clinical practices that specifically includes the oversight of dose and quality assurance for medical imaging and radiation therapy technology.

This standard should require that sites have work performed per national practice guidance by qualified individuals with appropriate staffing levels and that there exist additional accreditation requirements for highly specialized procedures.

5. Link CMS reimbursement to practice accreditation for all medical imaging and radiation therapy practices to ensure safety and quality.

Point 6 requests an event reporting system that is consistent and required for all medical radiation events (or potential events). Where this is housed or how it integrates with systems in place at NRC, FDA and some states would have to be defined and will require a partnership between all involved.

6. Create a national data collection system to learn from actual and potential adverse events in the medical use of radiation. The system will allow reporting by medical staff and manufacturers and others in a complete and consistent manner and be searchable to identify patterns, risks and corrective actions and to provide education.

Item 7 represents an opportunity to improve the FDA process. Congress held hearings in 2009 and AAPM has contributed to FDA listening sessions on improvements in the FDA pre-market review and post-market surveillance processes. Technical evaluations provided by an independent entity such as the AAPM Technology Assessment Institute could be used to enhance the FDA process.

7. Improve the effectiveness of product clinical quality, application and integration review in the regulatory equipment clearance process by partnering with the U.S. Food and Drug Administration (FDA), the International Electrotechnical Commission, (IEC) and manufacturers.

In addition to testifying before Congress, leadership from the associations involved in the medical use of radiation, manufacturers and regulatory bodies have meetings planned in the immediate future to coordinate specific safety improvement tasks nationally. Appropriate committees from each society will become engaged as we move forward. The goal of all the societies, federal and state governments and the manufacturers is to improve patient safety in the use of medical radiation. The current awareness represents an immense opportunity for all groups to work together to make a permanent improvement.

Strategic planning Now that the new AAPM Mission Statement and Goals have been approved by the Board, we must develop specific objectives to achieve the goals. To that end a strategic planning committee has been formed. The charge for the committee is to develop and recommend to the Board, the objectives of the AAPM to achieve its Goals that carry out the AAPM Mission and to recommend to the BOD a process to facilitate and implement long term strategy and vision planning of the AAPM. The committee will meet April 15-16.

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Brief Update from Congressional Hearing on Medical Radiation Michael G. Herman, Mayo Clinic

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n Friday February 26th, I presented testimony of behalf of the AAPM to the Subcommittee on Health of the House Energy and Commerce Committee.

While I presented along with other society and association leaders, AAPM members Cynthia McCollough and Eric Klein were both testifying as individual subject experts on the use of medical radiation at this hearing. They each provided important technical education about medical radiation, Eric on radiation therapy and Cynthia on Computed Tomography. I would also like to say that it was an honor to represent our society in a position where the US Congress requested our input to help improve patient safety in health care.

Chairman Frank Pallone opened the hearing (all statements, video and eventually transcripts can be found on the House Energy and Commerce website) with a number of comments, including: ”I know there was concern that by having this hearing, Congress would be sending the message that medical radiation is bad. I would like to assure you, this is not the case. It is important that patients do not stop going to their scheduled treatments, or getting their CT scans when they need them. As mentioned, the benefits that we as a society have gained from [medical radiation] advancements are enormous. But we often forget the fact that we are still dealing with something that is toxic to the human body.” Similar sentiment was echoed by every member of the sub committee who offered introductory remarks, including the parent committee chair, Henry Waxman who added “The mistakes made in these instances, while perhaps not widespread, appear to be more than just random and rare – they are occurring all across the country and in hospitals and physician offices alike. “ and “ our job today is … to understand how to lower the risks associated with radiation in medicine to make it as safe as possible without reducing its many benefits to patients and researchers.”

Much of the testimony from associations (ASTRO, ACR, ASRT and AAPM) was focused on improvements in oversight, education and qualifications, accreditation and event reporting. The AAPM statement concluded with a statement toward increased patient safety and quality through consistent education and certification of medical team members, whose qualifications are recognized nationally, and who follow consensus practice guidelines that meet established national accrediting standards. While each group emphasized different aspects of this message, it was consistent with statements from ASTRO, ACR and ASRT and suggests the CARE legislation is highly relevant, as is practice accreditation. Improving the quality of practice technical review to ensure accuracy and safety was brought up by Dr. Mike Hagan of the VA as he described the process recently used for a full practice review within the VA system, during the question and answer period. Better event reporting was also highlighted by almost all of the 12 witnesses. The common ground represents significant opportunities for multsociety partnerships with government and industrial bodies.

AAPM President, Michael Herman, testifying before Subcommittee on Health of the House Energy and Commerce Committee (Sylvia Johnson Photography)

At the conclusion of the hearing Chairman Pallone stated “this has been incredibly useful and thought provoking”, He suggested that there would be followup questions as well as additional hearings to answer questions before proceeding with further developing legislation.

The events reported in the press have highlighted some of the issues we have known about for some time and that we have worked toward resolving for as long. The national publicity, while very sobering, represents an incredible opportunity for us to partner with our colleagues, manufacturers and the government to make a real difference in improving quality and safety. Much work is already underway.

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AAPM Chair of the Board’s Column Maryellen Giger, University of Chicago

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he mission of the American Association of Physicists in Medicine is to advance the science, education and professional practice of medical physics. And, medical physicists in AAPM come from various careers in research, education, and/or clinical practice.

Recently an AAPM summit was held to discuss the needs for the education and training of qualified medical physicists for careers in the clinical practice of medical physics. I summarize a few of the aspects of that summit in this newsletter article, however, a white paper, which reviews the training of clinical medical physicists and summarizes the various consensus statements, is currently in preparation among the different organizations.

As an association, we have come a long way in the last two years in meeting the challenges of the “2012/2014” requirements; a challenge that we embraced since we value the need for qualified clinical medical physicists. We have agreement on many basic principles, have an increasing number of CAMPEP-accredited graduate programs, and are making large strides for increasing the number of residency programs.

We have established good communications among the crucial inter-related organizations and the individual leadership positions, including those from ABR, CAMPEP, and SDAMPP. However, due to the lack of some details and realization of some potential problems in need of clarification, consensus, and solution, the third 2012/2014 Summit was held on January 20-21, 2010 in Chicago, Illinois. We felt that the only effective way to keep all organizations focused and coordinated was to have the leadership of the various organizations in the same room at the same time to develop consensus and then promulgate the results uniformly to ensure the best possible training of clinical medical physicists.

Note that while the focus of the summit was on the training of clinical QMPs (qualified medical physicists for clinical careers), attendees acknowledged other important medical physics careers, such as those in academia, government, and industry, and the recognition that the training for other careers may have different routes.

The accepted definition of a QMP is an individual who is competent to practice independently one or more of the subfields of medical physics, which are therapeutic radiological physics, diagnostic radiological physics, medical nuclear physics, and/or medical health physics.

Currently there are 25 CAMPEP-accredited medical physics graduate programs (out of 52 total programs). This might be sufficient for the future training of medical physicists. Currently, there are 44 CAMPEP-accredited medical physics residency programs (out of 75 total residencies). Of the 44 accredited residencies, all but three are in radiation therapy. Competition is high to obtain admittance to a CAMPEP-accredited residency program. It is approximated that on average there is 1.6 resident per program, thus yielding about 75 graduating resident per year. Clearly, more residencies are needed but the rate of newly accredited therapy physics residency programs is high.

Various forms of a clinical residency can exist including traditional residencies within an academic teaching hospital, residencies within satellite practices associated with an academic teaching hospital (a hub and spoke arrangement), and residencies with an array of private medical physics practices. The common thread is that all residencies require 24 months of clinical training –

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continued - AAPM Chair of the Board’s Column whether that is, for example, within a two-year residency program or embedded in a combined post doc/residency three-four year program. Funding of such residencies varies with such options including hospital residency funding (that follows that of medical residencies), other institutional funds, association fellowships, and/or private/industrial funds.

Didactic training in medical physics is accomplished within a CAMPEP-accredited medical physics graduate program. However, at times, persons with advanced degrees (M.S. or Ph.D.) in related areas of physics may want to enter the field of medical physics and eventually practice clinically.

These candidates, in the past, have learned the didactic “on the job” at varying degrees of comprehensiveness. In order to standardize this didactic training, the AAPM has established a task group to review the didactic parts of graduate programs (via AAPM Report No. 197), and determine the minimum didactic components. Such didactic training can potentially be accomplished within a CAMPEP-accredited residency program if the program has such didactic training available and if such training does not encroach upon the 24 months clinical training requirement. Residencies without such didactic training components would require their candidates to have acquired such training prior to enrollment in their residencies. Certificate programs that include only the core didactic course could potentially be offered at the various CAMPEP-accredited graduate programs.

Throughout the summit, consensus statements were discussed and most obtained. However, some future discussion and decision-making are needed, especially regarding the route for clinical imaging physicists due to the range of imaging modalities. That is, while graduate programs educate students in both imaging science and radiation therapy, residencies focus on one or the other. However, a topic of discussion was the clinical material to be covered in an imaging physics residency, and subsequently the board exams to be taken, especially in imaging physics. In clinical practice, imaging medical physicists may be responsible for radiography, ultrasound, MRI, and nuclear medicine, and private medical physics practices tend to cover all. However, in an academic center, physicists may be more specialized in one or the other imaging systems. What should be the training route, and what type of board exam is appropriate?

Continuing discussion on residencies included development of a website to maintain clinical training components for those in CAMPEP-accredited residencies, agreement on a single common start date for all residency programs, and ultimate establishment of a match program.

We hope that common announcements will soon appear on the various websites in order to help students and trainees who are interested in becoming a clinical medical physicist understand the requirements. Also, as soon as the white paper is completed, we will inform the membership.

On another note, AAPM is continuing to be quite active in responding to concerns on dose in diagnostic imaging and radiation therapy procedures. The AAPM is hosting a CT dose summit on scan parameter optimization (April 29-30, 2010) and is planning another one focused on radiation therapy safety. More on these summits can be found elsewhere in this newsletter.

The AAPM is looking to collaborate with other associations and agencies (such as the FDA) on technology assessment and comparative effectiveness. On February 9th, an AAPM statement [http://www.aapm.org/publicgeneral/StatementCDRH.asp] was given at the FDA’s Public Meeting on Incorporation of New Science into Regulatory Decisionmaking within the Center for Devices and Radiological Health. I thank Mahadevappa Mahesh for presenting for the AAPM during the great snow of Washington, D.C. that prevented me from attending. More on the AAPM’s involvement will be given in my next newsletter article.

As always, if you have any comments or questions, please feel free to contact me. Thank you.

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President-Elect’s Column J. Anthony Seibert, UC Davis Medical Center Learning the ropes…..

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ow! The last two months have been a whirlwind of activity for the AAPM and EXCOM. Maintaining the pulse and direction of the organization and responding at a moment’s notice to national publicity on excessive radiation dose (CT perfusion) and radiation injuries (New York Times articles) are great challenges, to say the least. Participation by many AAPM members in providing input and the number of communiqués generated over the last month (January-February) have just been overwhelming – an amazing happening when at the height of the release of the New York times articles, there were 150+ emails delivered to my inbox in just 3 hours as I was away from my desk! (one of the ‘benefits’ of being on EXCOM and many other AAPM group / council email lists…). This is an obvious indication that we collectively really care about our profession, and we, as Medical Physicists have a professional duty to respond with a prompt and balanced response. I am very proud as a member of the AAPM that our association has taken a lead role and proactive stance for both diagnostic imaging and therapy physics in these areas. As a member of EXCOM, I am truly in awe of Mike Herman’s and Maryellen Giger’s pro-active efforts in responding to the changing situations and the untold hours of time spent developing consensus documents on the position of the AAPM, grateful for the ability to observe first hand—yes, it will be me in the hot spot next year – and for the opportunity of “learning the ropes.”

And it continues -- 2012/2014, workforce study, licensure, budget ….. One area that we should all be looking towards is the effort being initiated for strategic planning, both short term and long term, in order to gain a better sense of direction and operation for the AAPM and a plan to get us where we need to be in an effective and fiscally doable way. The framework, focus, and goals for the strategic plans have been nicely elucidated by the vision, mission, and goals statements of the AAPM recently adopted by the board of directors in November 2009 (see the website and further information in Mike Herman’s article).

Finally, I would like to thank the Southern California Chapter of the AAPM for inviting me to their mid-winter meeting as President-elect and gracious hospitality during my visit in late January.

Steve Goetsch and Marianne Plunkett put together a marvelous program with many invited speakers that detailed many of the issues important to medical physicists on a local, national, and international level, many of which I have mentioned in this article. The program format and flow of the topics led to great deal of lively discussion – it was fun to participate and witness first hand the involvement of the attendees and the expression of their opinions.

Please contact me through the AAPM website or at jaseibert@ucdavis.edu for any concerns or issues you would like to express regarding the contents of this article or other AAPM directives. As President elect, I am also responsible for committee member appointments, so if you would like to contribute by participating in the many volunteer activities of the AAPM, please let me know.

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Approximately 40 hours of continuing education in medical imaging and radiation therapy physics will be offered. This will include SAMS courses for diagnostic, medical nuclear, and radiation therapy physicists.

www.aapm.org/meetings/2010AM

Joint Program Imaging/Therapy

Imaging Program Scientific Symposia • • • • •

• • •

Advances in CT Dose Reduction and dose measurements Advances in Breast Imaging Advances in MRI Advances in Image Guided Interventions New Trends for Translating Emerging Imaging Technology to Address the Cancer Problem Physics in the Evolution of Contrast Agents in Ultrasound Emerging X-ray Imaging Techniques Advances in Cardiovascular Imaging

Scientific Symposia •

Optimization of MRI for Treatment Planning Real-time Image Guidance for Radiation Therapy Compressed Sensing in Image Reconstruction and Dose Optimization Opportunities for New Investigators: Clinical Trials Research Using Data from Multi-Institutional Clinical Trials Functional MRI for Imaging Tumor Vasculature in Conjunction with Radiation Therapy and AntiAngiogenic Therapies Electron Paramagnetic Oxygen Imaging. The use of Magnetic Resonance Imaging and Spectroscopy for In-Vivo Dosimetric and Verification of Therapy Photon and Proton Beams Latest Developments in Ultrasound Guidance, Monitoring and Treatment in Therapy

• • •

•

•

Therapy Program Scientific Symposia • • • • •

• •

Secondary Cancer Risks The Use of GPUs in Radiation Therapy Machine Learning Techniques for Radiation Therapy Nano-Cancer and Radiation Therapy Multicriteria Optimization to Handle Multiple Tradeoffs in Treatment Planning and Delivery The Science of Quality Improvement Technical aspects of SBRT

Professional Program • • • • • • •

Special Symposium: Patient Safety in Radiation Therapy and Diagnostic Imaging News on licensure Leadership development presentation Negotiation skills PQI session Session for new members to meet the medical physics leaders Historical look at medical physics

•

Practical Medical Physics Scientific Symposia • • • • • • • • • •

Treatment Planning System Algorithms and QA Protons Hands-on ultrasound SBRT Baldrige QA Medical Physics Publishing MR Safety Virtual Simulator CT QA Practical Considerations of PET Developing Rich Learning Experiences for Medical Physics Education

DATES TO REMEMBER March 18:

Meeting Registration and Housing available on-line

By May 13: Annual Meeting Program

available on-line June 10:

Deadline to receive early registration fees

June 23:

Housing reservation deadline

July 8:

Last day to register for SAMs

Continuing Education Program Breast Imaging • Breast MRI • Breast Specific Gamma Imaging • Positron Emission Mammography • Optimization of acquisition parameters in digital mammography • Stereotactic breast biopsy: what the physicist needs to know and do Computed Tomography • SAM - Optimizing CT Dose and Image Quality for Different Patient Sizes • New Technologies for Image Quality Improvement and Dose Reduction in CT Image Quality, Dose, and Quality Assurance for Cone Beam CT. Radiology/Fluoroscopy • Patient Dose and the Modern Angiographic System • Peak Skin Dose Reconstruction and TJC Sentinel Event • Dose and Image Quality in Rotational Angiography • Risks in IR and Establishing a Patient Safety Program MRI • Pulse Sequences and Acquisition Techniques for Breast MRI • Breast MRI Quality Control • SAM - MR Spectroscopy: The Physical Basis and Acquisition Strategies Applications of MRI Spectroscopy in Oncology • Magnetic Resonance Safety and Compatibility Issues at High Magnetic Fields • Parallel Imaging: Technology, Clinical Applications, and Image Quality Issues Radionuclide Imaging • Gamma Camera and SPECT: Routine Quality Assurance Testing • SAM - PET/CT: Technology Updates, Quality Assurance and Applications SPECT/CT: Technology Updates, Quality Assurance and Applications • Nuclear Medicine Accreditation, Acceptance Testing and Annual Surveys Safety/Risk: • Status/Impact of Lowering the Annual Limit from 5-2 rem • Status of the NRC Safety Culture Statement • IAEA Report on the Study of Cataracts in Occupational Workers • IAEA Smart Card Annual Patient Dose Initiative

AAPM Newsletter

March/April 2010

AAPM Executive Director’s Column Angela R. Keyser, College Park, MD Funding Opportunity pplications are being accepted until April 15 for the AAPM 2010 Fellowship for Graduate Study in Medical Physics. The fellowship is awarded for the first two years of graduate study leading to a doctoral degree in medical physics and includes a stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the CAMPEP. Go to http:// www.aapm.org/education/GSFMP/ for more details.

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Upcoming AAPM Meetings AAPM is hosting the CT Dose Summit: Scan Parameter Optimization, April 29-30 in Atlanta, GA. While the event sold out in record time, presentations will be available to AAPM Members via the AAPM Virtual Library shortly after the summit. For more information, go to: http://www.aapm.org/ meetings/2010CTS/default.asp .

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 21-22, 2010, at the Gaylord National right outside Washington, DC. For more information, go to: http://www.aapm.org/meetings/2010ITART/ Philly, when? 2010! AAPM’s 52nd Annual Meeting will be held July 18-22 in Philadelphia, Pennsylvania. Registration will open on March 18, with the meeting program scheduled to be posted online by May 13. AAPM is trying something new this year with the Tuesday night social program.

Philadelphia offers many great restaurants and clubs within walking distance of the convention venue, so this year we’re providing you with a perfect way to meet up with your colleagues before heading off to dinner. The Midweek Mixer will immediately follow the afternoon Tuesday session and will include appetizers and beverages. If you haven’t already made restaurant reservations, we’ll have four reservations desks with concierges ready to assist.

The 2010 AAPM Summer School, Teaching Medical Physics: Innovations in Learning, will immediately follow the Annual Meeting, from July 22 – 25 at the University of Pennsylvania. This 2.5 day program is designed to help medical physicists become better teachers of physicians, graduate students and technologists. In addition to hearing several keynote speakers, participants will engage in work sessions where they will share experiences and learn from one another. Each participant will leave with an action plan he or she has designed to be a better teacher. For more information, go to: http://www.aapm.org/meetings/2010SS/ .

Virtual Library Presentations posted in the Virtual Library include streaming audio of the speakers along with their presentations. A few of the new offerings include: • Presentations made during the 51st AAPM Annual Meeting and 2009 AAPM Summer School • Presentations made during the 2009 CRCPD Annual Meeting on QA/QC for CR/DR Systems for Medical Imaging and Overview of Proton Therapy: Technical and Clinical Perspective • Interviews with prominent medical physicists Access to this valuable online service is FREE for AAPM members, so let technology and the AAPM work for you! Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs. For more information, go to http:// www.aapm.org/meetings/virtual_library/ .

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AAPM wishes to acknowledge and thank the following individuals for their 2009 contributions: Education and Research Fund: Hassaan Alkhatib Waleed H. Al-Najjar John P. Balog Morris I. Bank Gary T. Barnes Jerry J. Battista Areg Bejanian Jose A. BenComo Ishtiaq H Bercha Olivier Blasi Joseph C. Blechinger Frank P. Bolin Giovanni Borasi Arthur L. Boyer Harry S Bushe Carlos A Caballero James E. Carey Dev P Chakraborty Jean Jacques Chavaudra Christodoulos Constantinou Kevin W. Corrigan Edmund P. Cytacki Jerome G. Dare Indra J. Das Alan M. Daus Domenico Delli Carpini Paul M. DeLuca John F. Dicello Lei Dong Anonymous Donor Godwin Dorbu Karl J Farrey Kenneth A. Fetterly Martin W. Fraser D. Jay Freedman G. Donald Frey Stephanie V. Frost Steven Anthony Gasiecki John P Gibbons Steven J. Goetsch David Lloyd Goff Paul N. Goodwin Joseph M. Greco Bennett S Greenspan Madhup Gupta

Per H. Halvorsen Homayoun Hamidian Russell J. Hamilton Joanna M. Harper Chris M. Hearn Joseph P. Hellman Cecilia A Hunter Gulkan Isin Edward F. Jackson Paul J. Keall Angela R. Keyser Shrikant S. Kubsad Roger O. Ladle Lena S. Lamel Joseph Lauritano Edwin M. Leidholdt Qijuan Li David A. Lightfoot Liyong Lin Dale W Litzenberg Jeffrey M. Long Gary Luxton Chang-Ming Charlie Ma Thomas R. Mackie William Malloy Lesley Ann Malone James R. Marbach Christopher H. Marshall Mary K. Martel Rafael Martin James E. McDonough Sharon K. McMillan Matthew A Meineke Albert V. Mesa Jeffrey G. Messinger Ira D. Miller George Mitev Mary E. Moore Jose A Morales Monzon Lee T. Myers David M. Nelson Olabode Thomas Ogunleye Sandra L Paige Brent C. Parker Norris J Parks Kishor M. Patel Douglas E. Pfeiffer Bhaskaran K. Pillai

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Robert J. Pizzutiello Prema Rassiah-Szegedi Chester S. Reft Peter J. Riley Miguel A. Rios Ivan Rosenberg L. John Schreiner Reinhard W Schulte Charles Y. Shang Deborah J. Shumaker Douglas J. Simpkin Larry D. Simpson John P. Skrobola Jerry Soen David P. Spencer Jean M. St. Germain Donna M. Stevens Palmer G. Steward Steven G. Sutlief John W. Swanson John B. Sweet Raymond L. Tanner Russell B. Tarver Michael Tassotto James A. Terry Bruce R. Thomadsen Stephen R. Thomas Kenneth Ulin Sathiyanarayanan K Vatyam Ramasamy G. Virudachalam Steven J. Wang Gerald A. White John D. Willins Robert John Wilson Charles Wissuchek Ellen D. Yorke Ning J Yue James A. Zagzebski Pengpeng Zhang Qinghui Zhang Pengpeng Zhang Jay J. Zheng Timothy C. Zhu

John Hale Memorial Fund Dev P Chakraborty

John R. Cameron Memorial Fund: Frank P. Bolin Jean Jacques Chavaudra Edmund P. Cytacki Anonymous Donor Martin W. Fraser Bennett S Greenspan Jorgen Lindberg Hansen Lena S. Lamel David P. Spencer Ramasamy G. Virudachalam

Hy Glasser Memorial Fund Jerome G. Dare

Doug Jones Memorial Fund Anonymous Donor David P. Spencer

Edward Webster Memorial Fund Jerome G. Dare Anonymous Donor Bennett S Greenspan Joel L. Lazewatsky

Jack S. Krohmer Memorial Fund Jerome G. Dare Jennifer Hann Fisher David Lloyd Goff Edwin M. Leidholdt Olabode Thomas Ogunleye David P. Spencer

John S. Laughlin Memorial Fund Jerome G. Dare Jennifer Hann Fisher Arthur Pinkerton Larry D. Simpson Qinghui Zhang

AAPM Newsletter

March/April 2010

Editor’s Column

Mahadevappa Mahesh, Johns Hopkins University

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his second issue is coming a few days late, even though I could blame it on the snow we received here in Baltimore which resulted in several days of being “snowed in”, but the snow is not the reason for the delay.

In fact, I postponed the release of this issue so that I could include an update from our President, Mike Herman, about the US Congress hearing on radiation. In addition to the summary of the hearing, there are many other interesting articles in this issue that are key to our profession.

Recent media articles have highlighted the role of medical physicists and their training and work ethics. I personally feel that this media attention is providing AAPM and its members unique opportunities to take on greater roles in the utilization of radiation in a safe manner with regards to patient care.

Finally, since the newsletter has migrated to an electronic only publication, I have changed the format to a single column and made some other “style” changes while accommodating the same format for the placement of advertisements. The new format remains a work-in-progress while I try out different style formats. I welcome any comments or suggestions for improvement to the new format of the newsletter.

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AAPM Newsletter

March/April 2010

Professional Council Report Per Halvorsen, Newton, MA

Working across Councils on our shared goals

A

s many of you are keenly aware of, medical applications of radiation have been in the mainstream news lately - and not in a good light. This has focused a spotlight on the lack of consistent standards in radiological applications in medicine, but it is also a time of significant opportunity to affect the standards for clinical medical physics practice in the years ahead. Your volunteer colleagues within the AAPM have been working hard to respond to these concerns. This recent activity has reminded me that the three Councils of the Association are highly interrelated and share a common goal – we can not operate as independent entities.

As you’ll recall, a few months ago the mainstream media covered the report of several dozen overexposures from certain CT procedures at a large hospital on the West coast (the FDA has since identified more than 300 cases of such overexposure at 4 hospitals). The CT experts within the Science Council quickly worked to draft a response to the news stories, and circulated the draft to the other Council chairs and others within the Association for input – all in the space of a few days. Within days of the original story in the news, the AAPM had a rational, balanced statement posted on our website. The Science Council is coordinating a scientific meeting on CT dose, scheduled for April.

In late January, the New York Times ran a series of prominent articles describing serious radiotherapy errors and highlighting the inconsistent standards for credentialing of clinical medical physicists.

This time, AAPM President Mike Herman coordinated the AAPM’s response and all three Councils contributed. In follow-up, the three Councils collaborated to modify the program for the Annual Meeting to include a prominent focus on patient safety, and we are working together to organize a summit meeting on patient safety in June.

In short – we are more effective when working collaboratively to solve common problems, and we do so to a greater extent than perhaps many members realize.

Recent activities of the Professional Council In the past few months, your colleagues within the Professional Council have been engaged with the following (and much more): • Federal health care reform legislation • CARE bill to require minimum training & experience standards • CMS’ designation of approved accreditation programs under the 2008 MIPPA law • ABR’s new eligibility criteria in 2012/2014, and the shortage of residency positions • New billing codes and reimbursement rates for 2010 • Workforce study • Ethics curriculum development for graduate programs • Professional licensure and registration initiatives • Promotion of peer review as a practice improvement tool The committees within the Professional Council are engaged on many fronts to respond to each of these issues. Significant efforts by the Professional Economics, Clinical Practice, Professional Services, Ethics, and Government and Regulatory Affairs committees have combined to represent your professional interests relative to these topics.

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AAPM Newsletter

March/April 2010

continued - Professional Council Report See Lynne Fairobent’s Government Relations article on page 17 of this Newsletter, and the eNews updates, for an overview of legislative and regulatory developments. As many of you know, the US Congress scheduled a hearing for February 10th on the use of radiation in medicine, and AAPM President Mike Herman was scheduled to testify. Unusually strong winter storms caused the hearing to be postponed, but look for Mike Herman on C-Span in the near future! Expect renewed interest by Congress in setting strong standards for the qualifications of the personnel who are involved in radiological procedures. 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 23 in this Newsletter by Wendy Smith Fuss and the Professional Economics committee, providing an overview of the 2010 reimbursement schedule and the changes relative to 2009. This team did an outstanding job of keeping us informed about developments in the fall and helping to draft letters to CMS, and they provided an excellent webinar series in early 2010 on the new reimbursement rules.

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 AAPM participated in a collaborative meeting (the “2012 Summit”) with representatives from the ABR, CAMPEP, ACR and others in late January to assess the status of preparations for this requirement and to seek consensus on solutions to the many “loose ends”.

A summary of the meeting should be available shortly.

The Ethics Committee’s Task Group 159 has completed its report describing an ethics curriculum for graduate medical physics programs. The Committee and the Professional Council have approved the report, and it is currently being prepared for publication.

Money matters: As you know, the Association has limited resources and cannot support all projects simultaneously. In November, the Board approved the budget for 2010 with significant reductions in funding for many Council and Committee level activities. I encourage you to look carefully at each Council’s projects and voice your opinion on whether we have prioritized correctly – we are all volunteers, and welcome your constructive criticism and suggestions for how we can do a better job with the resources available to us.

The AAPM supports its mission to advance the science, education and professional practice of medical physics by fostering the education and professional development of medical physicists at various meetings held throughout the year.

A complete list of meetings, including those that are endorsed and cosponsored by the AAPM, can be found at: http://www.aapm.org/meetings/default.asp

14

AAPM Newsletter

March/April 2010

Education Council Report George Starkschall, Houston, TX

O

ne of the tasks in the “job description” of the medical physicist is education. We educate many different populations: our medical physics colleagues, physicians, allied health personnel, the general public.

We lack, however, the wealth of resources that we have available to support our other responsibilities, such as clinical support and research.

A goal of Education Council is to provide the practicing medical physicist with resources that can be used to improve the quality of medical physics education. I want to call your attention to three opportunities associated with this year’s AAPM Annual Meeting in Philadelphia for practicing medical physicists to increase their proficiency as medical physics educators.

The first of these opportunities is the annual Education Council Symposium, to be held on Sunday, July 18, from 11 am to 12:30 pm. The Symposium, organized by Perry Sprawls, is entitled “Effective use of online resources to enrich medical physics education.” The objective of the Symposium is to enable attendees to select and use web-based resources to enhance human performance of learners and learning facilitators. The Symposium is scheduled to consist of the following presentations: “Characteristics and effective use of web-based resources,” “AAPM resources: Increasing effectiveness for the future,” “Effective use of the RSNA/ AAPM modules,” and “Online courses and degree-granting programs.” Speakers will include Perry Sprawls, Jeff Limmer (Chair, On-Line Continuing Education Subcommittee), Bill Hendee, and Brent Liu (Associate Professor, University of Southern California).

The second opportunity is the second annual Innovations in Medical Physics Education symposium. This symposium, organized by Don Frey, will honor and publicize innovations in medical physics education. AAPM members are invited to submit entries to this symposium.

Details are provided on the AAPM web site http://www.aapm.org/meetings/2010AM/ MeetingProgramInfo.asp. Submissions will be reviewed, and the top six will be invited to present a 15-minute talk about their projects at the symposium during the AAPM meeting. A plaque will be awarded to the top-scoring project. If you are not able to submit an entry, please come to hear the innovations at the symposium.

The third opportunity for AAPM members to improve their teaching skills is the 2010 Summer School, “Teaching medical physics: Innovations in learning.” The Summer School, to be directed by Bill Hendee, will be held from July 22-25, immediately after the AAPM Annual Meeting, on The University of Pennsylvania campus. The Summer School, the first on teaching of medical physics in over 30 years, is designed to help medical physicists become better teachers of medical physics. Keynote speakers were selected based on their expertise as educators in physics and medicine. In addition to didactic sessions, participants will engage in work sessions where they will share experiences and learn from one another. Each participant will develop an action plan, designed to make the participant a better teacher. For more information, please visit the Summer School web site: http://www.aapm.org/meetings/2010SS/.

Special thanks are due to Perry, Don, and Bill for their efforts toward improving the quality of medical physicists as educators. Please be sure to place these three events on your calendars when to travel to Philadelphia in July.

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AAPM Newsletter

March/April 2010

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

FDA Unveils Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging Initiative to focus on 3 types of procedures with high radiation doses

O

n February 9, 2010 the U.S. Food and Drug Administration announced an initiative to reduce unnecessary radiation exposure from three types of medical imaging procedures: computed tomography (CT), nuclear medicine studies, and fluoroscopy. These procedures are the greatest contributors to total radiation exposure within the U.S. population and use much higher radiation doses than other radiographic procedures, such as standard X-rays, dental X-rays, and mammography.

“The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years,” said Jeffrey Shuren, M.D., J.D., director of the FDA’s Center for Devices and Radiological Health. “The goal of FDA’s initiative is to support the benefits associated with medical imaging while minimizing the risks.”

The three-pronged initiative the FDA is announcing will promote the safe use of medical imaging devices, support informed clinical decision-making, and increase patient awareness of their own exposure.

The FDA intends to issue targeted requirements for manufacturers of CT and fluoroscopic devices to incorporate important safeguards into the design of their machines to develop safer technologies and to provide appropriate training to support safe use by practitioners. The agency intends to hold a public meeting on March 30-31, 2010, to solicit input on what requirements to establish.

In addition, the FDA and the Centers for Medicare and Medicaid Services are collaborating to incorporate key quality assurance practices into the mandatory accreditation and conditions of participation survey processes for imaging facilities and hospitals. These quality assurance practices will improve the quality of oversight and promote the safe use of advanced imaging technologies in those facilities.

The FDA recommends that health care professional organizations continue to develop, in collaboration with the agency, diagnostic radiation reference levels for medical imaging procedures, and increase efforts to develop one or more national registries for radiation doses.

A dose registry would pool data from many imaging facilities nationwide, capturing dose information from a variety of imaging studies. This registry will help define diagnostic reference levels where they do not yet exist, validate levels that do exist, and provide benchmarks for health care facilities to use in individual imaging studies.

In a bid to empower patients and increase awareness, the FDA is collaborating with other organizations to develop and disseminate a patient medical imaging history card. This tool, which will be available on the FDA’s Web site, will allow patients to track their own medical imaging history and share it with their physicians, especially when it may not be included in their medical records. Additional information on this initiative may be found at: http://www.fda.gov/Radiation-EmittingProducts/RadiationSafety/RadiationDoseReduction/UCM199904.htm

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AAPM Newsletter

March/April 2010

continued - Legislative and Regulatory Affairs AAPM plans to participate in the March meeting. Additional information will be posted in future newsletters.

CRCPD to Pilot Tracking System for Machine-Based Radiation Medical Events The CRCPD’s Suggested State Regulations for Control of Radiation Part X on Medical Therapy contains a provision that requires the reporting of therapy misadministrations. In addition, the feasibility of a national database of such events was discussed at the CRCPD Business Meeting during the May 2009 National Conference on Radiation Control.

Although the overall benefit and safety record for radiation therapy and other radiation procedures is quite high, errors in administration should be tracked for causes and trends. The CRCPD is in the process of staffing a committee to develop a pilot project to collect data on radiation machinebased events from state radiation control programs that will take into account states differences in laws/regulations regarding reporting and confidentiality.

The charges of the Committee are as follows: 1. Develop a definition of reportable events to include radiation therapy using linear accelerators and e-brachytherapy technology, as well as high dose diagnostic procedures such as computed tomography (CT) and fluoroscopy.

2. Develop/maintain a format and mechanism for state programs to provide the committee with details of reportable events.

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AAPM Newsletter

March/April 2010

continued - Legislative and Regulatory Affairs 3. Review submitted reports for completeness and accuracy, and develop notices to the state programs when necessary.

4. Oversee the development and maintenance of a CRCPD database of reportable events.

5. Prepare an annual summary report for the CRCPD Board and the Newsbrief.

6. Provide a verbal report at the Annual Meeting.

The data reporting will be done on a voluntary basis and will be used to inform and educate interested parties on trends, root causes, and methods for improvement.

AAPM plans to work with CRCPD on this important initiative.

Version 3.0 of the International Basic Safety Standards for Protection Against Ionizing Radiation and for the Safety of Radiation Sources (BSS), is available for comment.

Version 3.0 of the International Basic Safety Standards for Protection against Ionizing Radiation and for the Safety of Radiation Sources (BSS) is ready to be commented on by member countries. The draft Basic Safety Standards are based on the recommendations in ICRP 103. The Draft BSS 3.0 can be found on the International Atomic Energy Agency (IAEA) Web Site: http://www-ns.iaea.org/downloads/standards/drafts/ds379.pdf.

The U.S. is developing its member country comments. In order to provide an opportunity for the public to get information on the IAEA and ICRP documents, as well as to comment, the U.S. Interagency Steering Committee on Radiation Standards (ISCORS) will host a public meeting forum on Friday, February 26, 2010. ISCORS is hoping that the forum will yield information useful to inform the development of U.S. Government comments on this IAEA draft General Safety Requirement.

Representatives from IAEA will be in attendance at the public meeting.

AAPM will be present at the ISCORS meeting. If you have any comments that you would like considered by AAPM in preparing their comments, please send them to Lynne Fairobent, Manager of Legislative and Regulatory Affairs at lynne@aapm.org.

This 2.5 day program is designed to help medical physicists become better teachers of physicians, graduate students and technologists. In addition to hearing several keynote speakers, participants will engage in work sessions where they will share experiences and learn from one another. Each participant will leave with an action plan he or she has designed to be a better teacher. There will be plenty of opportunity to interact with the Summer School faculty, who have been chosen for their teaching expertise. The Summer School will take place on the historic and scenic University of Pennsylvania campus. http://www.aapm.org/meetings/2010SS/

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AAPM Newsletter

March/April 2010

ACR Accreditation

Priscilla F. Butler, 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.

The ACR’s new CT, MRI, Nuclear Medicine and PET Accreditation Program requirements for medical physicists and MR scientists went into effect on January 1, 2010. The following questions are actual ones received by the ACR regarding these new requirements. To see more FAQs on this topic, please visit the ACR website.

Q. I am currently completing a Master of Science degree in Health and Safety. This graduate degree combines physical sciences like health physics/industrial hygiene and safety engineering. I Have a B.S. in Nuclear Medicine and have had many courses in anatomy, physiology, biology, radiation biology. I am The Radiation Safety Officer for a medical center and have been a Radiation Safety Officer on agreement state and Nuclear Regulatory Commission licenses. I am the manager of a nuclear medicine department that is ACR accredited in PET. I have over 10 years of documented experience in clinical Nuclear Medicine and over 5 years experience in PET. As a technologist, I am board certified by the NMTCB and registered by the ARRT. After I complete my graduate degree, will I meet the ACR’s nuclear medicine and PET accreditation program’s qualifications under the “Not Board Certified in Required Subspecialty” option?

A. Maybe. The “Not Board Certified in Required Subspecialty” option specifies that the graduate degree is in medical physics, radiologic physics, physics, or other relevant physical science or engineering discipline. Because these qualifications are for medical physicists, the “relevancy” must be to medical physics. A relevant physical science discipline is one that includes at least 3 graduate courses in medical physics. This is consistent with the American Board of Radiology requirements for taking Part 1 of the Radiologic Physics exam. So, if your graduate program includes an adequate number of graduate courses in medical physics, you would meet the qualifications under the “Not Board Certified in Required Subspecialty” option. If it does not, you would not meet the qualifications under that option.

Q. The “Not Board Certified in Required Subspecialty” option requires documentation of 3 years of experience in a clinical environment of that modality. How extensive must this experience be? Full time? Part time? Is any specific number of surveys required?

What kind of documentation is required?

A. The experience may be full or part time. There is no specific number of surveys required.

Appropriate documentation includes copies of annual survey reports within the time period with your name, or letters from supervisors attesting to your clinical experience in that modality.

Q. I fall under the “Not Board Certified in Required Subspecialty” for nuclear medicine and PET. What exactly does the word “experience” refer to in this statement: “3 years of documented experience in a clinical NM/PET environment?” Does it have to be spe-

20

AAPM Newsletter

March/April 2010

continued - ACR Accreditation cifically on performing annual surveys? Or will QC oversight and performance of other tests be sufficient?

A. The experience must include the performance of annual surveys. Only providing oversight of others in the performance of these surveys will not be sufficient.

Q. I am licensed as a medical physicist by the state in which I practice and have worked as a medical physicist for over 20 years. Do I now need to obtain board certification in order to qualify to perform annual surveys at ACR accredited facilities?

A. No. The new criteria do not require that a medical physicist be board certified. Although the new criteria do not specifically address state licensure, if you meet either the “Not Board Certified in Required Subspecialty” or the “Grandfathered” criteria for the modality, you will meet the ACR qualifications to perform annual surveys at accredited facilities.

Q. I am ABR certified in Diagnostic Radiological Physics. Does this certification qualify me to perform nuclear medicine and PET surveys at accredited facilities?

A. No, since it is not in a nuclear medicine subspecialty. However, you will qualify under the “Not Board Certified in Required Subspecialty” option if you can document 3 years of experience in a clinical nuclear medicine/PET environment.

Q. I am ABR certified in Therapy Physics. Does this certification qualify me to perform nuclear medicine and PET surveys at accredited facilities?

A. No, since it is not in a nuclear medicine subspecialty. However, you will qualify under the “Not Board Certified in Required Subspecialty” option if you can document 3 years of experience in a clinical nuclear medicine/PET environment.

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AAPM Newsletter

March/April 2010

AAPM Website Editor Report Christopher Marshall, NYU Medical Center

M

y New Year Resolution is to dig into the amazing amount of data that is available to track use of our website through Google Analytics. Results on “how many hits do we have?” (4 million last year) are impressive but these statistics include random hits from the public in general and from search engines so this does not tell me how well we are serving our members.

Access to the Online Newsletter is of interest because this is a primary means of communication within the AAPM and access is restricted to members only. As the graph shows, the email alert stimulates a substantial number of members to access the Newsletter for a few days but access then dies down as expected. When I make estimates of the fraction of members who access it over the entire period from the day it is announced until the day the next one is announced I come up with a surprisingly low fraction – possibly 25%. I hasten to add that this may be an underestimate for technical reasons that are being addressed, but it seems very unlikely to me that the fraction is as high as 50%. We do not know what fraction read the paper version, so we do not know whether readership declined when the Newsletter went online only, but this is a serious concern. We should have more reliable data soon and I will report back on this in my next report.

I also examined the hits on Mike Herman’s prepared statement to Congress, which is a hot-topic item and not restricted to AAPM members. 3.4K unique page views had been delivered at the time of writing. Of these about 2.5K were from direct hits, possibly by members following their email link, and most of the rest from search engines, possibly from non-members. The effect of the email alert to members is obvious again. I am planning to look next at hits on news items that we post on the website without any email alert.

One of the ways we are trying to lever the impact of the website is by feeding selected content out via RSS and to Twitter and LinkedIn. Twitter has the potential to make information “go viral” if it is re-tweeted sufficiently often. Our experience to date is that while Twitter attracts a small following from members and nonmembers, it does not currently provide any leverage for our public messages. However we recently started to feed new career and training position postings to Twitter so that our members can get daily updates without visiting the Bluebook every day. The same updates are available through our RSS feeds. LinkedIn is attracting a significant and growing number of AAPM members and others in our field. There are some very good discussions of potential interest to student members and to others interested in joining our field and I encourage you to click on the LinkedIn icon on our website and sign up for free access. Please also give Twitter a trial if you want daily updates on the posting of new career and training positions, or you can just subscribe to our RSS feeds.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/WebsiteEditor/3502.asp

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AAPM Newsletter

March/April 2010

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

CMS Updates 2010 Payments to Freestanding Centers & Physicians Based On Technical Errors

T

he AAPM website provides recently updated relative value units (RVUs) and 2010 Medicare Physician Fee Schedule payments for all radiation oncology codes. This file reflects technical corrections to High Dose Rate Brachytherapy procedure codes, 3,500 malpractice RVUs and a legislative change to the 2010 conversion factor update. Effective January 1st, the 2010 conversion factor is $36.0846. The 2010 conversion factor is likely to change again based on Congressional legislation and this information will be updated accordingly. To see current 2010 payments for freestanding centers and physicians effective January 1st go to: http://aapm.org/government_affairs/CMS/documents/FinalRule.pdf New MLC-IMRT Treatment Device Code for 2010 Previous to 2010, all IMRT treatment devices were billed utilizing CPT 77334 for complex treatment devices. Due to advances in technology, billing for devices associated with IMRT treatment had become controversial and payers disagreed on the number of devices billable with various technologies. A new procedure code, created by the American Medical Association (AMA), is to be utilized when billing for multi-leaf collimator (MLC) devices used in conjunction with IMRT planning.

77738 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan Effective January 1, 2010, CPT 77338 is reported once per IMRT planning service regardless of the number of documented MLCs. According to AMA guidelines, if a cone-down boost plan requires a new set of MLC devices, a second 77338 may be reported.

Immobilization devices for patients receiving IMRT will continue to be reported with the standard treatment device codes (CPT 77332, 77333 or 77334). CPT 77334 may not be used when billing for MLC-IMRT devices associated with beam shaping (no matter how many gantry angles).

CPT 77738 does not apply to devices used in conjunction with compensator-based IMRT. The reimbursement for 77338 is the same as 77334 under the Hospital Outpatient Prospective Payment System (HOPPS). Use of a single 77338 charge will result in a loss of revenue for hospital outpatient departments. For freestanding centers, however, 77338 receives a higher reimbursement under the Physician Fee Schedule, which will mitigate the decrease somewhat.

CPT Code

APC Group

Hospital Outpatient APC Payment

Freestanding Global Payment

77334

0303

$190.62

$151.56

$88.77

$62.79

77338

0303

$190.62

$478.12

$252.23

$225.89

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AAPM Newsletter

March/April 2010

continued - Health Policy/Economic Issues Hospitals and freestanding centers will realize decreased revenue for MLC-based IMRT patients.

The examples below are based on an IMRT patient with seven MLC treatment devices.

Medicare Hospital Outpatient Prospective Payment System (HOPPS) CPT Code

2010 Hospital Outpatient Payment

Fields Per Patient

2010 Hospital Outpatient Total Payment

77334

$190.62

7

$1,334.34

77338

$190.62

7

$190.62

Medicare Physician Fee Schedule CPT Code

2010 Freestanding Global Payment

Fields Per Patient

2010 Freestanding Global Total Payment

77334

$151.56

7

$1,060.92

77338

$478.12

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AAPM Newsletter

March/April 2010

IAEA/AAPM Report Hugo Palmansยน, Ph.D.

Progress report of an international (IAEA/AAPM) working group on Small and Composite Field Dosimetry

R

eference dosimetry for external beam radiotherapy is at present performed in broad beam reference conditions according to Codes of Practice like IAEA TRS-398 and AAPM TG-51.

With the increased complexity of radiotherapy treatments, however, the reference conditions prescribed in those Codes of Practice are far away from the way such complex treatments are actually delivered. Think for example of IMRT, tomotherapy, stereotactic radiosurgery and scanned proton beam therapy. Each of those modalities is characterised by a distinct way of delivering a dose distribution, different from broad beam deliveries and also very different from each other.

For most of them there is at present a large step from the broad beam reference dosimetry to the dosimetry of a clinical delivery sequence involving large amounts of relative dose data and complex dose calculation algorithms. An additional issue is that numerous modalities are not able to create the broad beam reference conditions prescribed either because the maximum field size is too small or because square field shapes cannot be set. Also dosimeters can be part of the problem since most are not suitable for the entire range of field sizes required.

While several particular solutions have been reported for absolute dosimetry or QA of these complex clinical deliveries and non-standard field sizes, there is no comprehensive approach available ensuring the consistency of dosimetry across treatment modalities. This obviously raises the need for extending the scope of reference dosimetry towards reference conditions that are more closely related to the way these radiotherapy treatments are delivered to the patient as well as to smaller and intermediate reference fields.

An international working group was formed by the IAEA in collaboration with the AAPM, with the aim of publishing an extension of existing Codes of Practice to provide recommendations on reference conditions and reference dosimetry procedures for small fields and composite fields.

A first step in this direction was the publication of a proposed formalism allowing for such an extension . The aim of this publication was to get the ideas of extended reference conditions out and to invite medical physicists and scientists worldwide to contribute to improved knowledge and understanding in this area by discussion and research. This has thus far lead to a number of papers and conference presentations being published by members of the working group - while also other investigators have independently reported research in this area - .

There is a long way to go before the publication of a Code of Practice will be achieved. In particular on reference conditions for composite field dosimetry there is much to be investigated. Many groups are involved in this among which, at present and to our knowledge, research groups from the University of Wisconsin (WI, USA), University of Pittsburgh (PA, USA), MD Anderson (TX, USA), McGill University (Montreal, Canada), Royal Marsden Hospital (London, UK), Stockholm University (Sweden), University of Vienna (Austria), University of Santiago de Compostela (Spain) and the University of Athens (Greece) are investigating ways to define relevant reference conditions for head-and-neck and prostate treatments with high-energy photons, as well as determining correction factors for the use of ion chambers in such composite reference fields by experiments and Monte Carlo simulations. Some of these groups are in particular involved with reference dosimetry for GammaKnife and CyberKnife radiosurgery systems. Both are systems that cannot achieve 10 cm x 10 cm reference fields and in particular for the GammaKnife the maximum field

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AAPM Newsletter

March/April 2010

continued - IAEA/AAPM Report size is way below that (18 mm for the classic type and 16 mm for the newer Perfexion type).

Research groups who are performing research in this area or who feel that they can contribute to the research in this new area of reference dosimetry are welcome to contact members of the working group and if possible to establish a formal link with the IAEA working group.

In the coming year(s), there will be continued research activity by the working group members and the groups mentioned above to generate the necessary knowledge and data for developing a Code of Practice. The IAEA is organizing an international dosimetry symposium during 9-11 November 2010 . Provided a sufficient number of abstracts are received for this topic, a session on small and composite fields will be planned within this symposium as well as a round table discussion. The working group also aims at producing a document by the end of 2010 that will present a comprehensive treatment of static small fields according to the formalism and that will highlight areas of missing data.

1 On behalf of the IAEA/AAPM working group on Small and Composite Field Dosimetry, consisting at present of Rodolfo Alfonso, Pedro Andreo, Roberto Capote, M Saiful Huq, Joanna, Izewska, Jonas Johansson, Warren Kilby, Rock Mackie, Ahmed Meghzifene, Hugo Palmans, Karen Rosser, Jan Seuntjens and Wolfgang Ullrich.

2

Alfonso et al., A new formalism for reference dosimetry of small and non-standard fields, Med. Phys.

35:5179-86 (2008).

3 Bouchard et al., Ionization chamber gradient effects in nonstandard beam configurations, Med. Phys.

36:4654-63 (2009).

4

Rosser and Bedford, Application of a new dosimetry formalism to volumetric modulated arc therapy (VMAT), Phys. Med. Biol. 54:7045-61 (2009).

5

Fraser et al., Characterization of cylindrical ionization chambers for patient specific IMRT QA, J. Appl.

Clin. Med. Phys. 10: 241-51 (2009).

6 Sterpin et al., Full Monte Carlo computation of k correction factors calculated in tomotherapy static and helical deliveries for future ion chamber reference dosimetry protocols of non standard beams, Med. Phys.

36:2615-6 (2009).

7

Chung et al., Advanced techniques to determine plan-class specific reference field correction factors for accurate dosimetry of nonstandard beams, Med. Phys. 36:2731-2 (2009).

8

Langen, Performance-Based QA for Radiotherapy: TG-148 – Tomotherapy Quality Assurance, Med. Phys. 36:2744 (2009).

9 Sauer, Determination of the quality index (Q) for photon beams at arbitrary field sizes, Med. Phys.

36:4168-72 (2009).

10

Caprile and Hartmann, Development and validation of a beam model applicable to small fields, Phys.

Med. Biol. 54:3257-68 (2009).

11

International Symposium on Standards, Applications and QA in Medical Radiation Dosimetry, IAEA Vienna, 9-12 November 2010 (http://www-pub.iaea.org/MTCD/meetings/Announcements. asp?ConfID=38093).

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AAPM Newsletter

March/April 2010

AAPM Member Perspective Muthana Al-Ghazi, Ph.D.

A Medical Physicist Goes to Iraq

I

n late September 2009, I received an invitation from Dr. Tahseen Al-Rubai, a radiation oncologist practicing in Baghdad, Iraq and affiliated with the International Medical Corps (IMC) and Dr. Hilal Al-Saffar, president of the Iraqi Cardiothoracic Society to attend the International Scientific Conference on Health Research to be held in Baghdad, Iraq (December 12 -1 5, 2009). This conference is the annual scientific conference of the Iraqi Ministry of Health. Dr. Al-Saffar chaired the conference scientific committee. I was honored indeed to receive such an invitation and immediately accepted. Thus began my preparation for this activity.

The journey to the Iraqi capital started with a 13 hours flight from Los Angeles to Paris, followed by a six hours flight to Amman, Jordan, an overnight stay in Amman, and a 90 minutes flight to Baghdad where we landed at this city’s international airport in the afternoon of December 10, 2009. We were driven to the Al-Rasheed hotel, the conference venue, in downtown Baghdad after completion of the customary entry formalities.

Pre-Conference Workshops: There were 12 pre-conference workshops each of three hours duration on December 12&13.

These workshops were on a wide range of health issues that the Iraqi healthcare system is responsible for. Each workshop was moderated by two individuals and had a panel of 4-5 persons and approximately 25-30 attendees.

I was responsible for moderating the workshop, “Cancer in Iraq: Current Practice and Future Requirements” along with Dr. Al-Rubai. We were capably assisted by our five panelists who represented various cancer sub-specialties (surgical and medical oncology, pathology, etc.). This workshop was attended by 25 persons from various regions of Iraq and all cancer related subspecialties, including two medical physicists. There were five formal presentations. I gave a presentation on the status of medical physics in Iraq (more about that later). This left ample time for discussion and attendee participation. The responsibility of the moderators and panelists of each workshop was to draft a set of recommendations for presentation at the main conference.

Our workshop on cancer generated a set of 10 recommendations. The main ones are to establish major oncology units in each of the 18 population centers comprising Iraq’s governorates, complete with modern radiation oncology facilities and employing a multidisciplinary approach to cancer management in the country. Another major recommendation was to develop the necessary trained human resources to staff such facilities. A report on the workshop was presented in the final day of the conference in the presence of Iraq’s Minister of Health, His Excellency Dr. Saleh Al-Hasnawi. I also attended a workshop on Iraqi medical societies chaired by Dr. Al-Saffar.

The Conference: The main conference formally started on December 14 under the patronage of the minister of Health, Dr. Al-Hasnawi who gave the opening speech. There were several hundred attendees from throughout Iraq, US and UK. There were also attendees from some other countries, Lebanon was one of them. The Royal College of Physicians and Surgeons (UK) and IMC were well represented as was WHO. The total number of research papers presented over the two conference days exceeded 30 papers on a wide range of topics concerning health issues in Iraq ranging from quality of life for Iraqi college students, unsafe abortion, maternal health, patient safety, health care economics, etc. A young faculty ophthalmologist from the University of Tennessee (Dr.

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AAPM Newsletter

March/April 2010

continued - AAPM Member Perspective Sarwat Salim) gave an interesting lecture on volunteer opportunities for young physicians in the developed world to help their counterparts in developing countries.

I had the privilege of co-chairing a scientific session during the main conference, along with Dr. Emad Al-Mashat, an Iraqi cardiologist trained in Iraq, UK and US. A paper presented at the session I co-chaired dealt with a comparison of the frequency of caesarian section delivery in Iraq vs.

UK and US. It turned out that this frequency is a statistically significant 7% lower in Iraq (18% in Iraq vs. 25% for US & UK). The reasons for this are quite unknown. A comment was made in jest that this may be due to Iraqi newborns being better behaved than their counterparts in the US and UK! Towards the end of the conference there was a session in which workshop groups presented their recommendations on their respective topics. Dr. Al-Hasnawi was present during presentation of workshop recommendation and received copies of them.

Medical Physics Course: I was asked to give a series of lectures on medical physics at the Oncology and Nuclear Medicine Hospital in Baghdad. I presented nine lectures, each of two hours duration over three days as outlined in the table below: Day 1: 12/16/09 1. Interaction of Radiation with Matter 2. Measurement of Absorbed Dose 3. Radiation Dosimetry Protocols: AAPM TG-51 & IAEA TRS-398 Day 2: 12/17/09 4. Dose Distribution and Scatter Analysis 5. Corrections for Tissue Inhomogeneities 6. Field Shaping, Skin Dose and Field Separation Day 3: 12/18/09 7. Commissioning of 3D Radiotherapy Treatment Planning Systems 8. Acceptance Testing and Quality Assurance of Simulators and CT-Simulators 9. Introduction to Conformal, Intensity Modulated and Image Guided Radiotherapy The course was started with a pre-course quiz which was repeated upon completion of the course as part of the course evaluation. I am looking forward to receiving the course evaluation.

This course was attended by approximately 40 physicists and radiation oncologists who came from throughout Iraq, braving very challenging travel conditions. All were keen discussants and asked many thoughtful questions. Each attendee received a CD with approximately 200MB of information. The contents of the CD consisted of copies of the lectures, selected relevant AAPM and IAEA reports, some recent RSNA and ASTRO refresher courses and a few RTOG anatomic atlases. It is hoped that these documents are useful to our Iraqi colleagues in improving the practice of medical physics and radiation oncology in Iraq.

The hospital has two modern linacs, a CT-simulator and a treatment planning system. They are embarking on modernizing their radiotherapy practice and have started using 3DCRT. Iraqi Medical Physics Society (IMPS): This project has its origin back in 2005 when Dr. W.R. Hendee, editor of Medical Physics offered subscription to 100 medical physicists in developing countries gratis. At that time, one physicist from Iraq was listed as one of the recipients. In late 2008, a chance contact between Dr. Azam

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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?

Image quantIfIcatIon

Dates to remember

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

January 4, 2010

abstract submIssIon opens January 11, 2010

AAPM Newsletter

March/April 2010

continued - AAPM Member Perspective Niroomand-Rad and an Iraqi physicist residing in Jordan was brought to my attention. Contemporaneously, Dr. Amod Saxena, Chair Emeritus of Radiation Oncology (Rush Medical College, Chicago) was invited by IMC to deliver a course of lectures in Baghdad. I took all this information and began e-mail communication with some medical physics colleagues in Iraq through the limited initial contacts. I have presented a preliminary report on IMPS at a special session held at the ACMP Annual Meeting in Virginia Beach in June 2009 that dealt with facilitating an international certification board for medical physicists (IBMP). Since that time this effort has progressed significantly. This progress is credited to Dr. Nabaa Naji, a faculty member in the Medical Physics Unit, Department of Physiology, College of Medicine, Al-Mustansiriya University in Baghdad, along with Dr. Al-Rubai. Dr. Naji has been a With Drs. Al-Rubai and Naji (1st & 2nd from left) outside the Baghdad champion of medical physics in Iraq. So far, she has gathered Oncology and Nuclear Medicine Hospital over 70 members from across Iraq, and with Dr. Al-Rubai have initiated a draft of the IMPS constitution. The draft is now in a semi-final form having gone though several revisions. Upon the recommendation of Dr. Al-Saffar, who is also the deputy president of Iraqi Medical Societies, IMPS will initially be a committee within the already established Iraqi Oncology Society (IOS). This will facilitate IMPS initial inauguration until such time that it is formally registered with the appropriate Iraqi authorities. The advantage of this approach is to integrate Iraqi medical physicists with the national medical community. Drs. Naji and Al-Rubai have been busy establishing IMPS links with their Middle Eastern counterparts. IMPS is already a member society of the Middle East Federation Of Medical Physics (MEFOMP). Dr. Naji serves as Iraq’s councilor to MEFOMP. MEFOMP was formally inaugurated as an IOMP chapter at WC2009 in Munich last September. Dr. Naji is also a member of a MEFOMP scientific committee that is translating ICRP-105 (on radiation safety) into Arabic. We look forward to the official inauguration of IMPS soon. I have made my Iraqi colleagues aware of the opportunities available to them visà -vis membership in the AAPM through the Partner-in-Physics (PIP) program as well as the many resources that the AAPM offers on its website (e.g. international portal, access to reports, etc.)

This was a very satisfying experience for me, both, personally and professionally. In my 32 years absence from Iraq, many things have changed. There is one singular constant that stayed the same as I have known it; namely the personal warmth and hospitality of Iraqis remained of the first order. I felt very privileged indeed to be a recipient of this hospitality.

Iraq, the cradle of civilization, where writing was invented in 3750 BC and the first code of common law (The Hammurabi Codex) was enacted in 1750 BC, is embarking upon a journey of modernization to regain its rightful place amongst the community of nations. I am hopeful that this will happen in very short order and that peace and prosperity will prevail throughout its territory. Iraqi medical physicists are keen on being integrated into the international medical physics community. The AAPM and IOMP have an important role to play in this regard.

I am indebted to Drs. Al-Rubai, Al-Saffar, Naji and many others for facilitating my visit to Iraq.

IMC sponsored the visit. Members of IMC, in Iraq and the US, the names are too numerous to list here, have been extremely helpful in making the arrangements. I am also grateful to the Iraqi Ministry of Health who hosted the conference and the staff of the Baghdad Oncology and Nuclear Medicine Hospital for providing the venue for the medical physics course.

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OnLine Continuing Education Program Earn Continuing Education Credits........ http://www.aapm.org/education/default.asp AAPM Members have the opportunity to earn CAMPEP approved Medical Physics Continuing Education Credit (MPCEC) for successfully passing quizzes associated with informational sources such as journal articles, AAPM Virtual Library presentations, task group reports, and other publications.

This is a Commission on Accreditation of Medical Physics Education Programs (CAMPEP) approved program. For each quiz successfully taken, a member will earn 1 MPCEC. Each MPCEC is equivalent to a Category 1 credit.

To successfully earn the credit, a participant: • Must correctly answer 8 out of the 10 questions.

• Cannot attempt the same quiz in the same 24-hour block; you must wait a day before attempting the same quiz.

Upon completion: • AAPM transfers the credits earned by you to CAMPEP on a daily basis.

• To view credits, sign onto CAMPEP at: http://cec.campep.org/ Current quiz sets are available in the following categories: PACS: Diagnostic Radiology: • Diagnostic • Cardiovascular • Imaging • Computed Tomography • Digital Radiography Radiation Protection: • Magnetic Resonance • Brachytherapy • Mammography • Radiation Protection • PACS • Radiography • Radiation Protection Radiotherapy: • Radiography • Image-guided • Ultrasound • Imaging General Medical Physics • Intensity-modulated Radiotherapy Nuclear Medicine: • Radiation Protection • Radiation Protection • Stereotactic • Brachytherapy Members wishing to participate in the On-Line Continuing Education program have an opportunity to do so at a cost of $50 Questions about On-Line Continuing Education can be sent to Jeff Limmer Chair, AAPM On-Line Continuing Education Subcommittee olce@aapm.org

AAPM Newsletter

March/April 2010

Announcement

Victor Gurvich, Ph.D. Chairman of SEAMP EXCOM and CEO

S

ociety of Euro-American Medical Physicists (SEAMP) is a newly created international organization that unite primarily American physicists from Europe and former Soviet Union. However, SEAMP is open for any healthcare professional in radiation therapy, diagnostics, nuclear medicine and related fields regardless of the country of origin. Now we established seven committees, have branches in Canada, Russia, Israel, Germany, Estonia, Lithuania, Ukraine, and Poland and would be happy to create new ones. The representatives of other countries are very welcome. Our team comprised of highly qualified clinical physicists, researchers, radiation oncologists, radiologists, radiobiologists, designers and developers of medical equipment and test tools. Briefly, SEAMP is an International network of highly qualified professionals in radiation medicine united by similar interests, background and traditions.

Membership in SEAMP is free and may give a lot of opportunities in any kind of professional activity. You can read about SEAMP mission, team, amenities and membership from our web site http://seamp. org . There are different suggestions about possible activities of our Society, but any of us can obtain additional resources for many kinds of endeavors, good professional advice and new friends in the USA and abroad. Join us now!

Announcement

Barbara Sandow, Chair, IUPAP Working Group on Women in Physics Jackie Beamon Kiene, Admin., IUPAP Working Group on Women in Physics

T

he International Union of Pure and Applied Physicists (IUPAP) Working Group on Women in Physics, which supports women in physics in developing countries announces that they have received funding to launch a seventh round of the IUPAP/UNESCO program to fund the attendance of women from developing and eastern European countries at regional conferences and schools this fall. They expect to be able to fund 20 women between $700 and $800 US each at a maximum.

Applications for these grants should be received no later than April 6, 2010. Recipients will be chosen by the IUPAP Working Group on Women in Physics by mid April, and we will notify everyone by the end of April 2010.

Only women physicists from Eastern Europe or developing countries may apply. Due to limited funding, those who have received a grant in the past, under this program, are not eligible for a second grant.

Those interested in applying for a grant should submit the following information, via e mail as a WORD document only or as text within the e mail. PLEASE DO NOT SEND AS A PDF FILE. 1. Complete contact information including name, address, e mail and phone number.

2. Years since your PhD (or undergraduate degree for graduate students) was granted.

3. Brief description of the conference or workshop you wish to attend (including date of conf., place to be held, & website if available) and if you will be making a presentation.

4. Brief statement of how attending the conference will enhance your career.

5. A breakdown of the amount of money (maximum $700/800 US) required to attend (Ex: Airfare, registration fee, meals).

6. One Letter of recommendation.

Send all information to Jackie Beamon Kiene at, beamon@aps.org by April 6, 2010.

IUPAP’s Working Group on Women in Physics website: http://www.iupap.org/wg/wip/index.html

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AAPM Newsletter

March/April 2010

Person in the News Hevezi Appointed to CMS’ MEDCAC Group

J

ames Hevezi, Ph.D. past Chair of the AAPM Economics Committee, has been appointed to the new Medicare Evidence Development and Coverage Advisory Committee, an advisory group to the Centers for Medicare and Medicaid Services. The MEDCAC will be used to supplement CMS’ internal expertise and ensure an unbiased and contemporary consideration of innovative technology and science as grounds for reimbursing Medicare/Medicaid providers. Hevezi’s term began on January 1, 2010 and runs for 2 years, renewable if the MEDCAC group is renewed. The first meeting of the group will be held in Washington DC and evaluate the various radiotherapy methods of treating prostate cancer.

Hevezi is the current Chair of the ACR’s Commission on Medical Physics and serves on the ACR Board of Chancellors. His nomination to the post was supported by AAPM, ACR and ACRO. He is a fellow of the AAPM and the ACR.

AAPM and ASTRO will host Safety in Radiation Therapy – A Call to Action June 24-25, 2010 Miami, FL This meeting is being presented in cooperation with, AAMD, ABRF, ACMP, ACR, ASRT, CRCPD, NPSF and SROA

This conference will be interactive and is intended to provide the treatment team with the ability to examine their current treatment process to identify and implement safety improvements. It is intended to examine the treatment delivery systems involved to identify methods to provide operators with greater knowledge and control over the radiation delivery process at the point of care of patients. It is also designed to examine the respective roles of members of the radiation therapy team and determine ways in which they can improve communication and teamwork to ensure safer and more effective treatment of patients.

Finally, meeting participants will contribute directly to the solutions that improve radiation therapy practice.

At the completion of this program, attendees will be able to: Evaluate the quality assurance process for each technique/procedure used in their clinical practice • Understand the roles and responsibilities of each member of the radiation therapy team in the quality and safety process.

• Recognize technical and clinical conditions that precede adverse events in the radiation therapy process • Understand how the radiation therapy community of clinicians, professionals, manufacturers, regulators and advocates cooperate to improve quality • Understand and be able to apply technical and operational improvements available now and in the future to improve the safe delivery of radiation in the treatment of cancer.

Audience: radiation oncologists, medical physicists, radiation therapists, medical dosimetrists, industry representatives, regulators, hospital administrators and public interest groups

Meeting information: http://www.aapm.org/meetings/2010SRT/ 34

AAPM Newsletter

March/April 2010

Obituary

Harold J. Lasky, MD

O

n October 15, 2009 the medical physicists lost a significant friend and AAPM honoree, Dr. Harold J. Lasky, to lung cancer at the age of 87. After an M.D. from the University of Texas he came to Chicago for an internship and residency at Michael Reese Hospital. For most of his career, which only ended in early 2009, he was engaged in private practice in Chicago. Dr. Lasky was always trying ways to discover improvements. In the 1960’s he became increasingly concerned with achieving effective breast cancer diagnosis. At that time the quality of many mammograms was low and the dose high. He tried many methods and modalities to improve the process. He led in the use of firm compression in mammography. He also led in the understanding that screening mammography would only be an effective tool if adequate image quality was routine.

Dr. Lasky’s interest in successful mammography screening lead the IL Rad Society to develop a system to assure image quality. Dr. Lasky was central to the creation of this “Illinois Program”.

The program was a voluntary accreditation with minimum standards of image quality achieved below a maximum dose as well as the usual accreditation items of suitable equipment and documented training of the radiologist & technologist. The image quality called for both a clinical image and the image of a “standard” phantom item. For a new, voluntary program the cost of the standard had to be low. No commercial phantom part was found at an acceptable price.

An “Illinois Standard” was developed and eventually patented by Dr. Lasky. This standard was handled like a mammography marker; that is, it was pasted on the breast and appeared in the mammographic clinical image. The volunteer radiologist who evaluated the clinical image also checked the visibility of the targets in the standard. The cost of manufacturing the standard was paid for by a small grant from the Illinois Chapter of the American Cancer Society. It was necessary to publicize the accreditation with outreach/training to radiologists, referring physicians, mammo technologists and potential screening patients. The overall effect was to demonstrate an accreditation program which providers saw as desirable and achievable, at the same time patients and the wider community saw it as assurance of a quality screening.

The success of IL program allowed the ACR to initiate the strong national program of accreditation as we know it. The major changes from the Illinois program included charging the providers for the accreditation process including the purchase of a modified commercial phantom. The phantom images are now read by physicist readers who, along with the clinical image readers, are nominally compensated. The required Q.A. program requires an initial, and annual detailed physics evaluation. The initial operation of the national program was subcontracted through the IL Rad Soc and actually run from Dr. Lasky’s office. After about two years the ACR moved the program to the ACR headquarters in Reston.

The mammography accreditation program, particularly with the federal MQSA, pushed accreditation from a minor position to the forefront of ACR activities. Accreditation of the other modalities in Radiology is becoming more important. The mammography program may also prove an important model for other medical disciplines. The mammography accreditation caused Diagnostic radiological physics to experience a significant jump in professional recognition and demands. For example, the number of candidates for ABR diagnostic radiological physics certification increased as a result of the mammography accreditation program. The impact on radiological physics was a direct result of Dr. Lasky’s insistence that good Mammography required good radiological physics support.

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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) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390

PRINT SCHEDULE • The AAPM Newsletter is produced bimonthly.

• Next issue: May/June • Submission Deadline: April 8, 2010 • Posted On-Line: week of May 3, 2010