AAPM Newsletter May/June 2010 Vol. 35 No. 3

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. 3

MAY/JUNE 2010

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

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he AAPM Annual meeting is just around the corner and many of us are preparing for it. As always there will be an outstanding program. There will be some additional focus on patient safety with special sessions on Sunday and Wednesday that will highlight some of the major issues and efforts related to improvements in safety in the medical use of radiation. In addition, the President’s Symposium will help remind us of why we do what we do. The main focus of my symposium will be seeing the diagnostic imaging and radiation treatment process through the eyes and experiences of the patient and his physician. We too often forget that each patient is going through a most significant period of time in his or her life, which in many cases impacts every aspect of their lives and creates permanent change. Please also join me for the annual AAPM service project, which this year will be Saturday morning at a Philadelphia food bank, putting together meals so less fortunate people can eat.

AAPM Strategic Planning will have completed its first meeting (April 15-16). The primary focus of this group is to develop objectives to achieve the goals of the recently approved AAPM Mission. A list of relevant discussion items that the group is working on are listed at the following site: http://www.aapm.org/meetings/2010StrategicPlanning. asp Included in this issue: p. 4 After some time in planning, the AAPM Administrative Chair of the Board Treasurer p. 7 Council has been formed. Final details are still being resolved, President-Elect p. 9 but many of the standing committees that used to report Executive Director p. 12 directly to the AAPM Board now report to the Administrative Editor p. 15 Council. This will help manage daily activities of these groups Education Council p. 16 and allow the Board to continue to focus on leadership and Professional Council p. 17 guidance of the association. Please see the updated committee Science Council p. 19 tree at the following site: http://www.aapm.org/org/structure/ Leg. & Reg. Affairs p. 22 default.asp?committee_code=AC 2010 Award & Honors p. 24 I recently attended the 2010 CAMPEP Board meeting as AAPM President. It was very nice to see the substantial and continuing growth and organization of the accrediting body for all medical physics education programs. As the 2012-2014 deadlines come near, CAMPEP has provided the necessary structure and guidance to keep programs progressing through the accreditation process. We continue to encourage all programs that provide any graduate or clinical medical physics education to develop a CAMPEP accredited program, alone or in concert with other programs, as soon as possible. One area

ACR Accreditation Website Editor Health Policy/Economics ABR Physics Trustees ORVC Symposium New Professionals SC Person in the News Repeat of History ISEP Report Prevention of Errors WG Announcement

p. 27 p. 31 p. 32 p. 35 p. 38 p. 40 p. 41 p. 43 p. 45 p. 47 p. 47

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continued - AAPM President’s Column of continued discussion is related to how individuals with didactic medical physics deficiencies (have not taken some core medical physics courses) can make these up during a conventional residency program. There is a working group chaired by Richard Maughan that is reviewing AAPM Report 197 (graduate programs in medical physics) to make recommendations on the required core courses that every individual expecting to go on to a clinical career in medical physics must have.

While the list is still being developed, the CAMPEP board reviewed the issue of how many of these courses could be completed during a 2 year residency. The CAMPEP board voted to allow in their guidelines for no more than 2 such core courses to be completed during a 24 month residency.

This is based on recognizing the time and effort required to complete formal core courses and is implied that these courses would occur during the first year of residency. A mechanism will be put in place for any such core courses to be recognized by CAMPEP, either explicitly within an accredited graduate or residency program or a separately accredited course curriculum.

Patient Safety in the Use of Medical Radiation This topic continues to develop with ongoing actions and constant reminders in the newspapers and blogs. Shorter term actions to bring awareness to the community at large, both in imaging and therapy include the CT summit held at the end of April, 2010 that provided specific guidance for all CT team members to understand CT technique, calibration and monitoring, guiding the community toward the highest quality images achieved with the smallest possible dose. Safety in Radiation Therapy – A Call to Action is being conducted June 24-25 in Miami that will bring together experts from across areas of focus in patient safety, manufacturing, regulations and the user community. The meeting will provide concrete guidance on the inherent problems associated with recent medical errors and on the culture of safety, necessary to deliver high quality radiation therapy with an absolute minimum number of adverse events.

Multi-society efforts remain under continued development, working toward consensus and nationally consistent qualifications and accreditation, event reporting and equipment clearance. Individuals involved in the delivery of medical radiation for imaging and radiation therapy must demonstrate competence through nationally recognized and consistent qualifications that guarantee proper education, clinical experience and specialty certification have been achieved. ACR, ASTRO, ASRT, SROA and AAPM all strongly support the passage of the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (“CARE”) Act. With few caveats, the CARE Act would achieve this goal, when properly implemented through the federal Department of Health and Human Services.

Accreditation in its current form ensures that some standards and quality are achieved, however this process for some imaging procedures and all radiation oncology procedures is not required, nor is it consistent between accrediting bodies. ACR, ASTRO and AAPM all endorse that improved and more consistent accreditation models be developed and implemented nationally. The goal is to define the model for national accreditation that would provide robust, safe and high quality care, without creating significant financial or other resource burdens. This will require cooperative partnerships among the associations that are already being developed. One potentially significant aspect of the quality process may include centers for radiologic physics (CRPs), which existed in the 1970s and early 1980s to provide audit and quality review for radiation therapy practices.

This topic was highlighted by Dr. Michael Hagan of the Veterans Administration, at the February congressional hearing on medical radiation. He stated that the accreditation and practice review process would benefit significantly from a technical review and audit process, akin to the work that the Radiologic Physics Center carries out for NCI and practices that participate in clinical trials. The CRP model could provide this type of independent audit service to objectively demonstrate technical competence in general and for specific procedures. AAPM has formed a committee to study the

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continued - AAPM President’s Column concept of reincarnating the CRP model with Saiful Huq as chair. An article detailing the history of the CRP’s is given later in this newsletter. AAPM continues to work with other societies, regulators and legislators to help develop consistent accreditation models based on community consensus practice guidance that recognizes qualified individuals and establishes minimum staffing levels.

There is still no consistent mechanism for reporting potential or actual adverse events in the medical use of radiation. ACR, ASTRO, ASRT and AAPM have all endorsed an action that would create a unified, consistent and national event reporting mechanism/system that could be used by all stakeholders. The system would provide essential data on medical errors to perform trend analysis, assessment, inform the community and to make improvements. Medical physicists are actively engaged in this effort, including work toward developing a consistent terminology/nomenclature to be used in a national reporting system.

The FDA pre market approval and post market monitoring systems have substantial limitations in terms of effectively reviewing all safety and efficacy aspects of devices that use medical radiation.

The FDA has held numerous listening sessions and has recently indicated to manufacturers that the 510K process is going to change. AAPM has continued to dialogue with FDA and others to provide assistance. It is possible that technical assessments performed by experts that are independent of manufacturer and regulatory agencies could provide objective, quantitative and relevant guidance to the clearance and monitoring processes. The AAPM technology assessment institute, possibly in cooperation with other similar organizations is preparing to provide such evaluations.

Each of us holds the ultimate responsibility to do the very best for every patient service we provide.

This is true in R&D, education and in the clinic. Pressure to perform more efficiently or to increase volumes must be secondary to patient safety and high quality care. We do what we do to the benefit of every patient.

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his 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/ This meeting is limited to 325 participants.

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

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ast year, as President of the AAPM, I created four ad hoc committees, which have been discussed in prior newsletter articles. Ad hoc committees are created to focus on a specific initiative, issue and/or concern within an organization, and are usually temporary committees. In this issue of the AAPM newsletter, I summarize the findings of the four 2009 ad hoc committees, and their future.

Ad hoc Committee on the Establishment of a Technology Assessment Institute (TAI) The TAI ad hoc (http://www.aapm.org/org/structure/?committee_ code=AHETAI; chair: Bill Hendee) was established early in 2009, after my visit to the Science Council retreat at which a TAI had been discussed. Since then the ad hoc has been quite busy. The various activities of this AAPM TAI ad hoc included: • Preparation and submission of an AAPM TAI Challenge Grant to NIH (led by Paul Carson as PI).

• Presentation of the AAPM’s views on comparative effectiveness at a May 13, 2009 Federal Listening Session.

• Participation of AAPM members in a special focus session at the RSNA 2009, which provoked discussion about the role of a TAI as a possible adjunct to FDA/CDRH approval.

• Sponsorship of the CT Dose Summit held April 29-30, 2010.

• Sponsorship of the Safety in Radiation Therapy meeting to be held on June 24-25, 2010.

• Meeting, led by Bill Hendee, during the RSNA meeting at which plans for an initial development of a public AAPM website where recommended CT protocols across multiple vendors would be listed.

• Presentation at the FDA’s Public Meeting on Incorporation of New Science Into Regulatory Decision making within the Center for Devices and Radiological Health on February 9, 2010.

• And most recently, is the work of Rock Mackie (University of Wisconsin – Madison) who heads up the Device Assessment arm of the University of Wisconsin new Technology Assessment Institute that is funded through the Morgridge Institute. Dr. Mackie has proposed a highly connected relationship between the UW TAI and the AAPM TAI, including having the AAPM play an oversight role, as well as having an AAPM member sit on the UW TAI advisory board. As a result of this momentum, Science Council is in the process of forming a TAI Committee to complement the other three committees currently under Science Council.

Thus, the future of the ad hoc committee on the TAI is that it is being converted to a standing committee with Bill Hendee as chair under Science Council.

Ad hoc Committee on Quantitative Imaging The ad hoc Committee on Quantitative Imaging (http://www.aapm.org/org/ structure/?committee_code=AHQI; chair John Boone) was created to heighten and broaden the awareness of quantitative imaging within the AAPM, as some activities were already being conducted within Science Council. It was established to assess the role of AAPM and its members in the growing field of quantitative imaging, e.g., as it relates to imaging biomarkers, assessing disease states and/or response to therapy, to determine mechanisms for clarifying quantitative imaging, computer-aided diagnosis, and quantitative image analysis, to determine mechanisms for promoting AAPM and medical physics activities in QI in basic science research, translational research, clinical trials, and ultimately clinical practice, and to further advance the field by interacting with other organizations. AAPM efforts on quantitative imaging have included:

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continued - AAPM Chair of the Board’s Column • The preparation of an AAPM grant submission, led by John Boone, on “the Quantitative Imaging Initiative” which aims to develop, implement, disseminate and ultimately standardize imaging protocols and analysis procedures that capitalize on the quantitative potential of medical images in the modern health care environment.

• Interactions of various AAPM members with RSNA through their multi-society TQI (Towards Quantitative Imaging) initiative, the Imaging Biomarkers Roundtable, and QIBA (Quantitative Imaging Biomarkers Alliance). Working together, the various organizations have developed a working definition of quantitative imaging that states “Quantitative Imaging is the extraction of quantifiable features from medical images for the assessment of normal (or the severity, degree of change or status of a disease, injury or chronic condition relative to normal). Quantitative imaging includes the development, standardization, and optimization of anatomical, functional and molecular imaging acquisition protocols, data analyses, display methods, and reporting structures. These features permit the validation of accurately and precisely obtained image-derived metrics with anatomically and physiologically relevant parameters including treatment response and outcome and the use of such metrics in research and patient care.”

• The Quantitative Imaging Initiative is ongoing and active in Science Council, with TG-145 in PET/CT, and a Working Group in MR. • Science Council recently formed a Task Group for phantom assessment in CT, which is important to quantitative CT imaging.

• AAPM members will continue interacting at a national and international level with RSNA and other entities, including participation in a Controversy Session at RSNA 2010 on “CAD for Breast, Lung and Colon Cancer: Is this Quantitative Image Analysis for Clinical Practice?”

Thus, the future of the ad hoc committee on Quantitative Imaging is that the enhanced exposure of QI to members of AAPM has been effective and useful, the ad hoc is no longer needed, and the Quantitative Imaging Initiative will continue, as it had been, within Science Council.

Ad hoc Committee on the Electronic Presence of AAPM The ad hoc Committee on the Electronic Presence of AAPM (http://www.aapm.org/org/ structure/?committee_code=AHCEP; chair Marty Weinhous) was also established in 2009.

The ad hoc initially concentrated on the technical means of communications and spent time reviewing and experimenting with various electronic means to communicate, such as Twitter. The existence of the ad hoc made leadership and others more aware of the diversity of both possible electronic means and acceptance (or not) by members. The electronic presence of the AAPM remains a highly important topic for our association and continued efforts should be focused on BOTH the means to communicate and the content of the communication. It was also recognized that we need to get more younger AAPM members involved in this task since many of them have explored the various electronic means of communication.

Thus, with this heightened recognition of need, the ad hoc will end and will transfer its charges to the AAPM standing committee – the EMCC, Electronic Media Coordinating Committee – chaired also by Marty Weinhous.

Ad hoc Committee on 501(c)6 The ad hoc committee on 501(c)6 [chaired by Michael Herman; http://www.aapm.org/ org/structure/?committee_code=A501C6] was the last ad hoc I created, and this grew out of my visit to the Professional Council’s retreat. The ad hoc was asked “to evaluate whether the profession of medical physics (and AAPM) requires a 501(c)6 tax structure to effectively achieve our goals.” From discussions with the chair of the ad hoc an update can be given. As a 501(c) (3) AAPM can commit up to ~$500,000 per year on direct lobbying efforts. To date, our annual lobbying costs have been well under $100,000, and in most years, much less. There is one activity we cannot do as a 501(c)(3) that can be done with a 501(c)(6) and that is to form a political action committee (PAC). Some of our sister societies have a PAC, for example the ACR (~$1M

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PAC contributions per year) and ASTRO (nearly as much as ACR) and these PACs are very small when it comes to health care lobbying. Forming a PAC does allow you to interact with other much larger players in the lobbying arena, to whom you might not otherwise be exposed. The tax status difference is very small and not considered significant. If one does form or become a 501(c)(6), the AAPM would not have to worry about our charter being challenged as to our lobbying scope.

However, at the current time, both a 501(c)(3) (AAPM) and a 501(c)(6) (ACMP) exist that are dedicated to medical physics. The AAPM has almost 7000 members and the ACMP less than 400.

In the past, at this time and at no time in the foreseeable future will the specific tax status of a 501(c)(6) be required for medical physics associations to achieve the goals that we have established. We can continue as we do now, including talking to lawmakers, regulators, and working together with other associations to affect positive change. In some respects the AAPM is seen as a more objective and scientific organization because it is a 501(c)(3). In our recent and ongoing interactions with the United States Congress, while we state our position directly, it is done with the interest of improved medical care. Many of our interactions with state and federal government entities are done from this objective position. It will be in our best interest to continue to develop mechanisms that further the goals of the AAPM, and those of the scientific, educational and professional interests of medical physics.

Thus, the ad hoc committee on on 501(c)6 has completed its tasks and will end.

I thank all the AAPM members who have contributed to these various ad hoc committees. Your dedication to moving the AAPM forward is very much appreciated. I welcome feedback from our members on these ad hoc committees.

Practical Medical Physics Track Highlights: • Radiation Therapy Treatment Planning System Algorithms and Quality Assurance • Practical Issues Related to Proton Therapy Systems • Hands-On Ultrasound Quality Assurance • Setting up a Stereotactic Body Radiation Therapy (SBRT) Program in the Clinic • Using the Baldrige Methodology • Medical Physics Publishing • MR Safety • Radiation Therapy Simulator Quality Assurance • Practical Issues Related to PET Imaging • New Techniques in Medical Physics Teaching

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AAPM Treasurer’s Column Janelle Molloy, Lexington,KY

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his is the first of two articles focused on assisting AAPM members in their decision regarding a pending vote on a dues increase. At their December meeting in 2009, the Board of Directors (BRD) voted to approve a one time $50 dues increase for the 2011 dues year, followed by automatic annual cost of living increases. This requires approval by the general membership.

As you know, the current economic climate, both in general and for medical physicists, is tentative. There are fewer jobs and many of us are working with reduced staffs. Pay raises are scarce and small. And even those who are not directly impacted by the precarious economic environment are justifiably concerned and cautious. Given these circumstances, the AAPM membership deserves ample justification before approving such a significant dues increase.

I will focus in this article on providing an outline of our current financial status. The next article will be devoted to analyzing the potential benefits of the dues increase.

How do we derive our annual budget?

In 2009, the AAPM instituted a new budgeting process. Traditionally, many budget items requested by councils and committees remained unspent at the close of the fiscal year. This is thought to stem from our character as a volunteer organization. As such, certain initiatives, and their associated expenses, are planned but not completed. This trend has been consistent for many years.

The 2010 budget was constructed using a statistical model that predicts the under-expenditure based on previous history. The revised budgeting process requires that the statistical model be incorporated and that the annual budget be balanced (to within statistical uncertainty).

The budget is constructed via a process in which funding requests are forwarded up the committee structure to the council chairs. The Budget Subcommittee convenes in October to construct the annual budget. Council Chairs, as well as other members of the Executive Committee and headquarters staff attend this meeting and construct a proposed budget. This budget is reviewed by the Finance Committee in November. Final approval is required by the BRD and occurs at their meeting at RSNA. What is our current financial status?

2009 total revenue was $7.24M

To put this in context, this was approximately $233k less than was anticipated in the 2009 budget, and was $110k less than the previous year.

Our major sources of revenue are dues, the Annual Meeting, and proceeds from Medical Physics subscriptions. Other significant sources of income include advertising revenue and the Placement Service. In 2009, revenue from dues and Medical Physics remained largely unchanged, while income from the other sources decreased.

What’s driving the decreased revenue?

Annual Meeting: A major source of income from the Annual Meeting derives from booth fees provided by vendors. In 2009, both the number and size of the vendor booths decreased. In addition, companies on average sent fewer vendor representatives to the meeting, and thus the associated registration revenues decreased.

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continued - AAPM Treasurer’s Column Placement Service: The number of listings in the Placement Service has decreased. As we are painfully aware, the job market for medical physicists is depressed. In addition, competing placement services may be impacting the number of job listings sent to our blue book.

Advertising: Although there is no single line item in our budgetary process that tracks advertising specifically, review of this component in several contexts indicates that income from these sources is decreasing.

2009 total expenses were $7.48M

This was approximately $1.8 M less than anticipated in the 2009 budget, but was up from the previous year by $104k. The $1.8 M is attributed largely to our consistent under-expenditure as described above. In addition, at the direction of the BRD, major spending cuts were implemented mid-year. These cuts included the elimination of virtually all face-to-face meetings, reduced onsite staff support at RSNA, elimination of a position at headquarters, and the evolution of the newsletter to an on-line only format.

In 2009, expenses for the Education and Science Councils were both up slightly (i.e., less than $30k total), although these were more than offset by corresponding increases in revenue over 2008. Professional Council expenses increased from 2008 to 2009 by $278k, while associated revenue decreased by $70k. The majority of these increased expenditures were used to support the licensure effort and the Medical Physics Workforce Survey.

What is the status of our reserve funds?

Currently, our unrestricted reserve balance is $7.9 M. This value is down from its peak in 2007 of $9.7 M, but has recovered from its low in 2009 of $6.6 M. The goal of our investment reserves, as defined by the BRD, is that they should be approximately equal to one year’s operating expenses. Reserve funds are invested in a variety of ways, including both fixed income and growth funds. They are spread among various mutual fund vehicles to ensure the greatest return with the least amount of risk. In addition to being subject to the fluctuations in the financial markets, these funds serve as a safety net for AAPM operations which, during the past two years, have run a deficit over the period of approximately $446,000. The BRD is recommending the proposed increase in dues to assist in partially offsetting future deficits.

PROPOSAL TO INCREASE MEMBERSHIP DUES Make plans to attend the Annual Business Meeting on Wednesday, July 21, 2010, in the Pennsylvania Convention Center, Philadelphia, PA, from 5:30 to 6:45 p.m. where members will discuss the Boardapproved proposal to increase membership dues beginning in 2011. The vote of the full membership will take place in August. The proposal includes a onetime $50 increase for Full Members in 2011, with a cost of living the ears eafter.

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President-Elect’s Column J. Anthony Seibert, UC Davis Medical Center The QMP and Ultrasound QC

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n advantage of being a member of EXCOM is that I get to witness first hand the inner workings of the Association as the focal point for the hard working member volunteers and headquarters staff, who collectively keep issues moving forward to benefit our profession in Medical Physics.

In this newsletter article, I am addressing an issue regarding the qualified medical physicist (QMP) in diagnostic radiological physics with respect to clinical ultrasound tasks for accreditation that has re-surfaced as a result of communication by an AAPM member, who also happens to be a current member on the ACR Committee on Ultrasound Accreditation.

The accepted definition of a QMP is an individual who is competent to practice independently in 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. While the requirements for achieving QMP status is being raised as detailed in the 2012/2014 initiative, there are areas within each subfield that require specific attention to ensure that current QMPs have the education and training necessary to practice competently in areas that may not be at the forefront of their knowledge base or experience. Through the help of members who are experts in a given area (e.g., clinical ultrasound physics), the AAPM should have a role in defining a curriculum that addresses these needs in official documents and publications generated by task groups or working groups. At the same time it is important that CAMPEP accredited graduate and residency programs develop content and hands-on training to ensure an adequate broad-base of expertise for their students in the specific subfields of study that they may encounter in clinical practice.

Now to the ultrasound physics issue. Historically, clinical diagnostic medical physicists by and large have been outside of the sphere of ultrasound quality control, and most ultrasound users depend directly on manufacturers’ engineers and service specialists to provide the periodic system checks and quality control (QC) reports required for accreditation. Medical physics input into the ACR accreditation process has been attempted for the past decade, with a significant effort by Paul Carson and Jim Zagzebski to propose the use of a QC phantom in the accreditation program in the late 1990’s. As a member of the ACR accreditation committee at the time, I was disheartened to realize that after all of the effort that went into the design and testing of the phantoms, a final vote by the guidelines and technical standards committee reduced all of the physics testing and oversight of the accreditation QC program requirements as optional, stating that there were insufficient numbers of medical physicists who could provide the needed services, and insufficient money, particularly by smaller clinics, to support the cost of phantoms and physics oversight of programs.

Subsequently, the ACR Committee on Ultrasound Accreditation has gone through several reviews of the program, and is revising the requirements for accreditation, with an ongoing discussion about the level of involvement of the medical physicist. Terry Zipper, a medical physicist and member of the committee, is pushing hard for at least a minimum medical physicist supervision of the QC program, but several other committee members feel that the medical physicist involvement and oversight should be optional due to the fact that there are not enough trained physicists to provide the service. Perhaps this is an excuse to avoid having a medical physicist be a required part of the ultrasound accreditation team (like is required in the CT and mammography

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Two opportunities to serve the community during the AAPM Annual Meeting in Philadelphia

Philabundance Service Project (no on-site registration)

Philabundance is the Philadelphia region’s largest food bank and hunger relief organization. AAPM wishes to serve the community by enlisting volunteers who will sort and pack food at a local food bank on Saturday, July 17. This is an excellent opportunity to catch up with colleagues while you work to help others. Transportation will be provided from the Philadelphia Marriott 12th Street entrance promptly at 8:30am Saturday morning. No on-site registration.

Registration is free: http://www.aapm.org/meetings/2010AM/GenInfo. asp#service

American Red Cross Blood Drive

Tuesday, 10:00am-3:00pm Exhibit Hall B Make your appointment online to donate blood. http://www.aapm.org/meetings/2010AM/GenInfo. asp#blood

AAPM GAMMEX 5K Run/Walk (no on-site registration)

Deadline to register is July 1 Tuesday, July 20 • 6:00am start time Fairmont Park - transportation provided http://www.aapm.org/meetings/2010AM/5kRunRegistration.asp

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continued - AAPM President-Elect’s Column accreditation programs) or avoidance for paying extra for these services; regardless, it is in our collective interests as the medical physics community and members of the AAPM to be proactive and to find answers based on a review of the current situation.

Are there enough physicists with appropriate training in ultrasound that could be available for the many sites that are or are considering ultrasound accreditation? Right now, the likely answer is no, particularly given the widespread deployment of US systems in clinics without any other radiological imaging equipment that would otherwise require a medical physicist presence.

However, for clinics and hospitals where there is a diagnostic medical physicist, availability of physics services could and should be offered to provide oversight for the ultrasound quality control program and certainly for accreditation efforts.

So what are the next steps? Assessment of the current situation regarding an estimate of the numbers of medical physicists available to provide ultrasound QC services, defining the minimum US physics knowledge and experience, and outlining the recommended basic procedures and phantoms for QC testing are needed. To this end, I will be proposing the establishment of an ad hoc committee comprised of AAPM members with expertise in ultrasound imaging to investigate and plan a course of immediate action to address these issues, using support and input from the education, professional, and scientific councils, and maintaining communication links with the ACR Committee on Ultrasound Accreditation through the Commission on Medical Physics.

As always, I appreciate any feedback, and your comments and suggestions are welcome.

Until the next newsletter‌‌

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 Executive Director’s Column Angela R. Keyser, College Park, MD New AAPM Report he report of AAPM Task Group 111: The Future of CT Dosimetry Comprehensive Methodology for the Evaluation of Radiation Dose in X-Ray Computed Tomography is now available online at: http://www.aapm.org/pubs/ reports/RPT_111.pdf

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Summer Undergraduate Fellowship Programs This year sixty undergraduate students competed for 7 AAPM Summer Fellow positions (SUFP). The program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. For more information on the program, go to: http://www.aapm.org/education/SUFP/default.asp This year 14 undergraduate students competed for 3 AAPM MUSE (Minority Undergraduate Summer Experience) Summer Fellow positions. The MUSE program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institutions (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For more information on the program, go to: http://www.aapm.org/education/MUSE/ Students participating in the program SUFP and MUSE are placed into summer positions that are consistent with their interest and are selected for the program on a competitive basis. Each Summer Fellow receives a $4,500 stipend from AAPM. Election Processes Elections for the 2011 Officers and Board Members-At-Large will open on June 9 and will run through June 30. Again this year AAPM will use the Bulletin Board System (BBS) during the election process to allow members to discuss issues of concern with the candidates and the election in general. Be alert for email announcements or your hardcopy ballot.

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

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/ Make plans to attend Safety in Radiation Therapy – A Call to Action, to be hosted by AAPM and ASTRO June 24 – 25 in Miami, Florida. This is a must-attend meeting for radiation oncologists, medical physicists, radiation therapists, medical dosimetrists, industry representatives, regulators, hospital administrators and public interest groups. The meeting is endorsed by AAMD, ABRF, ACMP, ACR, ACRO, AHRQ, ASRT, CAPCA, COMP, CRCPD, FDA, NPSF, PULSE, SROA and the Joint Commission.

Don’t delay in registering as the program is expected to sell out quickly. For more information, go to: http://www.aapm.org/meetings/2010SRT/

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continued - AAPM Executive Director’s Column Plans are shaping up quite nicely for AAPM’s 52nd Annual Meeting to be held July 18-22 in Philadelphia, Pennsylvania. The meeting program will be posted online by May 13. Make sure to register before June 10 to take advantage of early registration fees. If your schedule allows, please consider participating in the 2010 AAPM Service Project on Saturday, July 17 from 9 AM – Noon. AAPM members and guests have the opportunity to give back to the community by sorting and packing food at a local food bank, Philabundance. This is an excellent opportunity to catch up with colleagues while you work to help others. Transportation will be provided from the Philadelphia Marriott at 8:30am Saturday morning. Make sure to register in advance as there will be no on-site registration.

Don’t forget, 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/ .

2009 Summer School Scholarship Recipients AAPM offers scholarships in the form of a waiver of tuition for the Summer School. This year, there were 29 applications. Congratulations to the ten 2010 recipients: Yang Cathy Cai, Jennifer Cole, Scott Dodd, Kenneth Homann, Tae Kyu Lee, David Pearson, Leah Schubert and Nikul Sheth.

In addition, Capintec sponsors two $500 grants to assist with other expenses related to the Summer School. Capintec established these grants to honor the memory of Arata Suzuki, Ph.D., who was part of Capintec for more than 20 years. Fanqing Guo and Gosia Niedbala are the recipients of the 2010 Suzuki grants.

Staff News Vivianese Dennis joined AAPM in April as the new Customer Service Representative. Viv brings with her over 20 years of administrative experience and most recently worked in the AIP Executive Offices.

Her responsibilities include answering the main phone line, handling general inquiries, coordinating copyright requests, setting up conference calls and assisting with the Medical Physics journal.

Therapy Physics Continuing Education The Therapy Physics CE series will feature approx. 30 lectures. The program will feature courses on standard therapy physics practices including linac calibration and QA as well as special clinical procedures including volumetric modulated arc therapy (VMAT), accelerated partial breast irradiation (APBI), and SBRT. Additional topics include data flow and management, outcomes-driven IMRT treatment planning, and a physicist’s guide to QUANTEC. 13 13

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AAPM Newsletter

May/June 2010

Editor’s Column

Mahadevappa Mahesh, Johns Hopkins University

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an you believe that this issue is the 3rd issue for 2010? 2010 seems to be flying by! Before you know it, most of us will be in Philadelphia, Pennsylvania for AAPM’s 2010 Annual Meeting. Speaking of the Annual Meeting, while this issue may be a bit lengthy, the columns in it contain indispensable information about the Annual Meeting and other happenings within the AAPM. Please take a few moments to read through this entire newsletter to ensure you don’t miss anything.

In spite of our efforts to reformat the newsletter, recent updates regarding readership for the newsletter (for details see website editors’ column on page 31) show a decline in audience. With all the recent attention drawn to our profession, I am hopeful that the membership will find the articles in the newsletter interesting and pertaining to our profession. As always, I encourage, and at times insist, authors of the columns keep their articles short and focused with the hope of drawing more readers to the newsletter. If you have any feedback or recommendations on how to increase readership, please let me know.

Finally, I would like to congratulate all the recipients of the 2010 AAPM Awards and Honors (pages 24 - 25). I am looking forward to the Awards Ceremony and Reception in Philadelphia.

SAMs Sessions to be offered during the 2010 Annual Meeting Diagnostic Imaging • SAM Session 1: Computed Tomography Optimizing CT Dose and Image Quality • SAM Session 2: MRI – MR Spectroscopy: The Physical Basics, Acquisition Strategies, and Applications • SAM Session 3: Radionuclide Imaging PET/CT and SPECT/CT: Technology Updates, Quality Assurance and Applications • SAM Session 4: Breast Imaging – Optimization of Acquisition Parameters for Digital Mammography; and Stereotactic Breast Biopsy – What the Physicist Needs to Know

Therapy Physics • • • •

SAM Session 1:VMAT- Overview and Stereotactic SAM Session 2: Accelerated Partial Breast Irradiation SAM Session 3: Data Flow and Management in Radiation Oncology SAM Session 4: Linac Beam Calibration and Commissioning 15 15

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AAPM Newsletter

May/June 2010

Education Council Report George Starkschall, Houston, TX

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ne of my roles as a faculty member in a rather large department is my involvement in the interviewing of candidates for potential faculty positions. Because my department is so large, we frequently have openings in our faculty, so such interviewing is a not infrequent occurrence. In the course of interviewing candidates, I ask candidates many questions about their abilities, interests, and behavior, but I like to ask them three questions in particular about how they improve their competencies in their various roles as medical physicists. The first of these three questions is “What have you done in the past five years to improve your competencies as a clinician?” I get a variety of answers to this question, usually along the lines of “I attended several refresher courses at previous meetings of the AAPM and ACMP,” or “Last year I went to a training session given by Varian (or Philips or Elekta),” or something along those lines. All are perfectly good answers, indicating a conscientious effort to keep up to date with the latest technological developments and improvements in the radiation oncology clinic.

The next question I have asked candidates goes something like “What have you done in the past five years to improve your competencies as a researcher?” Again, I get a variety of answers, with typical answers being something like, “I have been attending scientific sessions and symposia at the past several AAPM (or ASTRO) meetings,” or “I regularly read manuscripts in Medical Physics and Physics in Medicine and Biology,” again all perfectly good answers.

I now have the candidate set up for the final question: “What have you done in the past five years to improve your competencies as a teacher?” More often than not, that question draws a complete blank. What we fail to realize is that techniques and resources for teaching are not static; just like in the research laboratory and in the clinic, teaching methodologies evolve with time. New techniques and new resources are continually being developed and made available to the medical physicist for use.

I urge you to take advantage of opportunities to improve your competencies as a teacher, either by attending one of several presentations provided at the AAPM meeting, or by attending the AAPM Summer School this year, or by venturing out on your own to seek other opportunities.

Removing yourself from your “teaching comfort zone” will make you a better teacher of medical physics, and consequently a better medical physicist.

Diagnostic Imaging Continuing Education The program will include 32 Continuing Education courses in Diagnostic Imaging Physics and Technology. The courses will include: computed tomography, breast imaging, radionuclide imaging, MRI, radiography/fluoroscopy, ultrasound, radiation safety and risk management issues, issues related to accreditation, multimodality imaging and medical informatics. There is a strong emphasis on safety, dose reduction and image quality in this year’s courses.

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Professional Council Report Michael Mills, Louisville, KY

Radiation Safety and Health Care Reform

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New York Times editorial published on January 26 stated: “Medical teams that deliver the radiation must be far better trained than many now are. Surely it should be standard procedure to run a test before the first treatment to be sure the computer is programmed correctly. Once the damage is done to a patient, there is little that can be done to correct it.” Although the specific reference was to two radiation events in New York City area hospitals, the scope of the articles and the space devoted to this issue clearly indicate these events have national, even international implications. This is a sobering perspective; especially for those of us who have dedicated our lives to training the physicist members of these medical teams, and for those who have served on committees that recommend standards of QA practice and procedures. We all like to think we are diligent and careful in our work; we all like to think we are good mentors of those we train. However, that is not what the public now perceives. We must consider: it is one thing to read a QA recommendation in a task group report; it is another thing to read it on the editorial page of the New York Times.

Regardless of your personal perspective on the Health Care Reform Legislation (Reconciliation Act) approved on March 23, it is clear there will be some immediate and future implications for radiology and radiation oncology. The Act raises the imaging equipment utilization rate assumption (the amount of time during office hours that imaging equipment is assumed to be in use) from 50 to 75 percent for imaging equipment costing more than $1 million (CT, PET, MRI, etc.). This change directly impacts the formula used to reimburse imaging procedures, and not in a good way, as you might expect. In addition, beginning in 2013, a 2.9 percent federal excise tax will be charged for all medical devices sold in the United States. This will include large capital equipment such as radiation oncology treatment machines, in addition to the imaging equipment already mentioned. While it is reasonable to question whether this Act will impact the number of patients treated with radiation oncology, the expanded coverage to millions without current health insurance may well increase the number of imaging procedures performed in the US. This expanded coverage coincides with the limitation on the number of medical physicists that will enter the field, consequent to the 2014 ABR requirement that only graduates of CAMPEP residency programs be allowed entry to the profession. Many “baby boomer” medical physicists are retiring.

How will we train enough to meet patient demands? How will we train them “far better than many are now?” Health care reform, the 2014 ABR requirement, and the public demands for increased training of physicists and protection from the public are immense challenges for our profession and for the work of the Professional Council.

Ongoing activities of the Professional Council include: • CARE bill to require minimum training & experience standards • Licensure and registration effort in several key states • CMS’s designation of approved accreditation programs under the 2008 MIPPA law • Medical physics residency program development; especially the development of imaging programs • ABR’s eligibility criteria in 2012/2014 • Medical physics workforce study • Development of the QMP Registry proposal

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May/June 2010

continued - Professional Council Report • New billing codes and reimbursement rates for 2010 • Promotion of peer review as a practice improvement tool • Ethics curriculum development for graduate programs • FDA initiatives and plans for a registry of medical device failures – AAPM involvement Please see Lynne Fairobent’s article (on page 22) for more information about Government Relations issues. Also, see Michael Herman’s article (front cover) about the inclusion of the Government Relations Committee into the newly emerging Administration Council. See Wendy Smith’s article (on page 32) for some key economic and reimbursement issues facing radiation oncology.

The CARE bill, HR 3652 is perceived to have been given a big push by the New York Times articles. The response from the American Society of Radiologic Technologists was published in the New York Times letter to the editor section, the only industry or organization response so acknowledged. It prominently featured the CARE bill as an essential component to address the perceived education and credentialing problem for medical radiation workers. The team continues to do an outstanding job of keeping the AAPM informed about the progress of the bill through the legislative arena.

CPC has been active, holding 2 conference calls in 2010. Activities of note include: Jean Moran has proposed the creation of a new Subcommittee on Women in Medical Physics. This valuable contribution to our members will compliment the Women and Minorities Committee under Ed Council, and deal with professional issues encountered by our female membership. Assisting Jean in this effort are Nicole Ranger, Mary Martel and Joann Prisciandaro. Currently planned activities include a presenter on Negotiation for Women at this year’s AAPM as part of a broader session on Negotiation within the Professional Track. A more extensive presentation is anticipated for 2011, and dedicated conferences and/or regional presentations are being contemplated. If members wish to become involved in this nascent effort, please contact Jean or Martin Fraser, CPC chair.

Dan Pavord, vice chair of CPC, is forming a group to begin drafting competency guidelines for various aspects of the profession, anticipating improvements in safety/quality as well as the regulatory/administrative benefits of such an effort. John Bayouth is assisting in this effort; interested members are directed to Dan, or Martin Fraser, Chair.

The New York Center for Health Workforce Studies of the University at Albany (State University of New York) continues to make progress on the Medical Physicist Workforce Study. The overarching goal of this workforce study is to determine whether the supply of medical physicists will meet future demand for their services and to identify potential strategies to avert future shortages in the profession. Several reports have been delivered to the Workforce Subcommittee for review, including a detailed interview report of a number of stakeholders in medical physics.

Until next time…

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AAPM Newsletter

May/June 2010

Science Council Report John Boone, Sacramento, CA

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he past six months has been an interesting time for the field of medical physics, but the news has not been all good. Last fall there was the revelation that hundreds of CT perfusion patients received “overexposures” at a prominent Southern California hospital, and that story was covered extensively on TV and in newspapers across the United States. Larry King, Oprah, Geraldo, Anderson Cooper and even Sanjay Gupta looked confused and tongue tied, since none of them knows what an x-ray is. Then there were companion papers in the Archives of Internal Medicine which suggested that 29,000 people were essentially killed by having CT scans in 2007, and that the risk of cancer death was 1/270 for 40 year old women undergoing cardiac CT. Again in California, a story from 2008 resurfaced where a 2 year old child was subjected to 150 repeated CT scans of the head due to operator incompetence, leading to a prompt band of erythema around his head and across his face. More recently, the New York Times ran a series of articles which highlighted radiation misadministrations in radiation oncology, including cases which caused excruciating patient deaths. These stories, in general based on facts but often sensationalized, suggest that medical radiation is under siege. Since the vast majority of medical physicists make their living from ionizing radiation in radiation oncology or diagnostic imaging, these stories have a troubling theme that strikes at the pink underbelly of our occupation, even if in most cases the human errors came at the hands of our non-medical physicist colleagues.

For better or worse the spotlight came our way, and the medical radiation world saw distinguished members of our profession testify in congressional hearings and at FDA hearings. The three councils became fully engaged in support of EXCOM, mostly behind the scenes, in addressing the various scientific, educational and professional lapses that this heightened scrutiny has brought to light. EXCOM, the Council chairs and members, and many other AAPM members (tapped for their expertise) experienced Email storms like never before.

Despite some of the painful revelations that these lay news stories highlighted, these past months of scrutiny and response have illustrated to me how well the machinery of the AAPM works. The demands of the 24 hour news cycle required documents to be rapidly written, rewritten and approved by leadership, the written transcript of the congressional testimony of our members was vetted in near real time, with Emails racing in from all time zones all night long. This collection of unpaid volunteers rose to these events, and despite adversity and intimidating circumstances, they performed extremely well and righted the ship in the middle of this storm – all while holding down their day jobs.

In regards to these occurrences, the observations that I have from these past few months include: (a) the organizational structure of the AAPM is well constructed and surprisingly capable of rapid action, (b) times of perceived crisis create an atmosphere where disagreements between actors can be set aside for the greater good, (c) the Professional, Education, and Science Councils have remarkable overlap on many important issues which affect our profession, and finally (d) the combined intellect, personalities and strong working relationships of two EXCOMS (2009 and 2010), supported by key members and a hardworking, capable staff, lead to an AAPM response which was unified, knowledgeable, professional, and every bit the equal (or better) of our much larger and richer sister associations.

If you are an AAPM member who doesn’t know any of the leadership or staff, I wrote this newsletter article for you. While my hand in the above events was minimal, I did witness them, and I want you to know how well this amazingly dedicated collection of people worked together to represent your profession when it came under fire. The issues have not been resolved completely, and

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AAPM Newsletter

May/June 2010

continued - Science Council Report other sensational stories about medical radiation are sure to be published, but the AAPM as an organization has risen tremendously in its esteem in the medical radiation sciences and beyond.

We should all be proud of the Executive Committee, the AAPM Staff, and the many dedicated AAPM members for their decisive actions over the past few months. And for you minimally engaged AAPM members, if you ever wanted to see yourself on CSPAN, there are ample volunteer positions in the AAPM for you!

2010 Professional Program Summary

• Licensure/Registration – 2010 progress report of activities related to licensure and registration of medical physicists in the United States • HAZMAT Training - Mandatory training for transportation of hazardous materials • Negotiation Tactics for Medical Physicists - Professional development skills for negotiations by medical physicists • International Symposium - The status of medical physics in developing countries: achievements and needs. Presentation in conjunction with the IAEA and the IOMP • Workforce Study Report - Center for Health Workforce Studies Team & AAPM study of supply-demand issues that impact radiation oncology and radiology • New Members Meet the Experts Symposium – This is an opportunity for members who have recently joined the AAPM to meet senior leaders of the AAPM and to learn about the AAPM • Enhancing the Medical Physicist/Patient Relationship - Professional development addressing medical physicist interactions with patients • PQI session – This session will discuss practice quality improvement projects

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Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

Verify your Inspector’s Credentials

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o you verify the credentials of individuals from the state or federal agency when they are at your facility? If not, you might want to do so.

On April 6, 2010, the State of Texas sent a letter to Industrial Radiographer Radiation Safety Officers informing them that there have been two separate, yet similar, incidents involving unidentified persons posing as radioactive materials inspectors working for the State of Texas. In both instances, the licensees stated that the individuals impersonating state inspectors approached radiography crews and attempted to conduct inspections of the crew’s operations.

Based on the specific questions asked of the radiographers, it appears that the impersonator(s) have knowledge and familiarity with industrial radiography.

Remember, you have the right to have the right to ask for proof of the inspector’s credentials. As a minimum, all Federal and State inspectors carry documentation complete with a photograph, physical description, and signature. In Texas, they have a badge and the official shield of the Texas Department of State Health Services. (Note, other states may also have some type of shield or badge.) If you are unfamiliar with someone who claims to be acting for an Agency, you should ask to see this credentialing document. You should not accept any other form of identification from someone claiming to be an Agency inspector. You can also call the office to verify the inspector’s identity.

Three New NRC Commissioners Chairman Jaczko swore in William D. Magwood, IV and William C. Ostendorff as NRC commissioners on April 1, 2010 in a ceremony at NRC headquarters. A third new commissioner, Dr. George Apostolakis, a professor of nuclear science at MIT, will be sworn in April 23 to bring the agency to its full complement of five commissioners for the first time since 2007.

The Honorable William D. Magwood, IV was sworn in as a Commissioner of the U.S. Nuclear Regulatory Commission (NRC) on April 1, 2010, to an initial term ending on June 30, 2010 and a reappointment term ending June 30, 2015. Mr. Magwood has a distinguished career in the nuclear field and in public service. He was the longest-serving head of the United States’ civilian nuclear technology program, serving two Presidents and five Secretaries of Energy from 1998 until 2005. Before joining the NRC, Mr. Magwood founded and headed Advanced Energy Strategies, a company that provides strategic advice to domestic and international clients. Previously, Mr. Magwood served as the Director of Nuclear Energy with the U.S. Department of Energy (DOE), where he was the senior nuclear technology official in the United States Government and the senior nuclear technology policy advisor to the Secretary of Energy. Under Mr. Magwood’s leadership, the Office of Nuclear Energy (ONE) encouraged a new consideration of nuclear power technology in the United States. Among other efforts, he led the creation of the “Nuclear Power 2010” initiative, which remains the cornerstone of U.S. industry’s exploration of building new nuclear power plants to provide for the Nation’s future energy needs, and led efforts that reversed the decline in American nuclear technology education. Prior to that appointment, Mr. Magwood served 10 years as the Associate Director for Technology and Program Planning in ONE from 1984-1994. Mr. Magwood was also a strong advocate of international technology cooperation and served as Chairman of both the Generation IV International Forum and the Organization for Economic Co-operation and Development (OECD) Steering Committee on Nuclear Energy. Before his DOE service, Mr. Magwood managed electric utility research and nuclear policy programs at the Edison Electric Institute in Washington, D.C. Before that, he was a scientist at Westinghouse Electric Corporation in Pittsburgh, Pa., where he analyzed radiological and hazardous waste disposal, treatment, and handling systems. Mr. Magwood holds a bachelor’s degree in physics and English from Carnegie-Mellon University. He also holds an M.F.A. degree from the University of Pittsburgh.

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AAPM Newsletter

May/June 2010

continued - Legislative and Regulatory Affairs Mr. Ostendorff has a distinguished career as an engineer, legal counsel, policy advisor, and naval officer. Before joining the NRC, Mr. Ostendorff served as the Director of the Committee on Science, Engineering and Public Policy and as Director of the Board on Global Science and Technology at the National Academies. Mr. Ostendorff came to the National Academies after serving as Principal Deputy Administrator at the National Nuclear Security Administration from April 2007 until April 2009. From 2003 to 2007, he was a member of the staff of the House Armed Services Committee.

There, he served as counsel and staff director for the Strategic Forces Subcommittee with oversight responsibilities for the Department of Energy’s Atomic Energy Defense Activities as well as the Department of Defense’s space, missile defense and intelligence programs. Mr. Ostendorff was an officer in the United States Navy from 1976 until he retired in 2002 in the grade of captain.

During his naval career, he commanded an attack submarine, an attack submarine squadron and served as Director of the Division of Mathematics and Science at the United States Naval Academy.

Mr. Ostendorff earned a bachelor’s degree in systems engineering from the United States Naval Academy and law degrees from the University of Texas and Georgetown University. He is a member of the State Bar of Texas.

Dr. Apostolakis holds a Ph.D. in Engineering Science and Applied Mathematics from Caltech. His research interests include methods for probabilistic risk assessment of complex technological systems; risk management involving several stakeholder groups; decision analysis; human reliability models; organizational factors and safety culture; infrastructure security; and risk-informed and performance-based regulation. Dr. Apostolakis has received several awards and honors, most recently the Tommy Thompson Award, Nuclear Installations Safety Division, American Nuclear Society in 1999. Dr. Apostolakis is Editor-in-Chief, Reliability Engineering and System Safety, An International Journal, Elsevier Science Publishers, England; Founder and Secretary, International Association for Probabilistic Dade Moeller Gaithersburg MD Safety Assessment and Management; Radiation Safety Member and Former Chairman, Advisory Las Vegas NV Academy Committee on Reactor Safeguards, U.S. Nuclear Regulatory Commission; Member, International Nuclear Technology Commission of the Federal States of Baden-Württemberg, Bavaria, and Hesse, Are you a Medical Physicist, RSO, assistant RSO, or Germany; and a member of the editorial Authorized User responsible for radioactive materials and boards of several journals.

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The NRC has five-year terms, each staggered one year apart. Magwood was confirmed to a term that ends June 30 of this year, and reappointed for a term to expire June 30, 2015. Ostendorff’s term will end June 30, 2011. When Apostolakis takes office, it will be for a term ending June 30, 2014.

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Continuing Extension Act of 2010,” H.R. 4851 – Extension of Medicare Physician Payments Last night the Senate and House passed the “Continuing Extension Act of 2010,” H.R. 4851, which was immediately signed into law by the President. The legislation included among other provisions an extension of the Medicare Physician Update

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AAPM Newsletter

May/June 2010

Congratulations to the recipients of the following awards, achievements and honors in 2010!

William D. Coolidge Award is presented to: David W.O. Rogers, Ph.D.

Award for Achievement in Medical Physics is presented to: Benjamin R. Archer, Ph.D. Laurence Clarke, Ph.D.

Honorary Membership is presented to: Gary J. Becker, M.D.

The following are named Fellows in 2010 for their distinquished contributions to the AAPM: Rupak K. Das, Ph.D. John J. DeMarco, Ph.D. D. Jay Freedman, M.S. Per H. Halvorsen, M.Sc. Sanford L. Meeks, Ph.D. Moyed Miften, Ph.D. Sabee Molloi, Ph.D. Sasa Mutic, M.S. Michael K. O’Connor, Ph.D.

Arthur J. Olch, Ph.D. Mark Oldham, Ph.D Christopher G. Soares, Ph.D. Wolfgang A. Tome, Ph.D. Richard J.Vetter, Ph.D. Charles E. Willis, Ph.D. Ning J.Yue, Ph.D. X. Ronald Zhu, Ph.D.

All of the award, achievement and honor recipients will be recognized during the 2010 AAPM Annual Meeting in Philadelphia, Pennsylvania at the Awards and Honors Ceremony and Reception.

Please join us in congratulating all of the recipients: DATE: Monday, July 19, 2010 TIME: 6:00 PM PLACE: Ballroom B, Convention Center

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AAPM Newsletter

May/June 2010

Congratulations to the recipients of the following awards, achievements and honors in 2010!

Farrington Daniels Paper Award (dosimetry) is given for: “Ionization chamber gradient effects in nonstandard beam configurations” by Hugo Bouchard, Jan Seuntjens, Jean-Francois Carrier, and Iwan Kawrakow Medical Physics 36, Number 10/4654-4663

Sylvia Sorkin Greenfield Paper Award (non-dosimetry) is given for: “Fixed gantry tomosynthesis system for radiation therapy image guidance based on a multiple source x-ray tube with carbon nanotube cathodes” by: Jonathan S. Maltz, Frank Sprenger, Jens Fuerst, Ajay Paidi, Franz Fadler, and Ali R. Bani-Hashemi Medical Physics 36, Number 5/1624-1636

AAPM-IPEM Medical Physics Travel Grant is presented to: Lu Wang, Ph.D.

AAPM Regrets to announce that the following members have passed away since our last Annual Meeting: Gail D. Adams, Ph.D. - Talent, OR Joseph C. Blechinger, Ph.D. - Bloomfield Hills, MI Charles Colbert, Ph.D. - Yellow Springs, OH Han-Sheng Jin, Ph.D. - Jersey City, NJ Charles A. Kahlig, M.S. - Keller, TX Amos Norman, Ph.D. - Woodland Hills, CA Lester Skaggs, Ph.D. - Chicago, IL W. Robert Van Antwerp, M.S. - Bel Air, MD If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honors Ceremony at our upcoming Annual Meeting. We respectfully request the notifi cation via e-mail to: 2010.aapm@aapm.org Please include supporting information so that we can take the appropriate steps.

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AAPM Newsletter

May/June 2010

continued - Legislative and Regulatory Affairs (SGR fix) until May 31, 2010. This action avoids the imposition of a 21.2 percent cut to Medicare physician payments. Note, the Senate approved the measure by a vote 59 yeas to 38 nays.

The previous extension to the Medicare Physician update expired on April 5th, 2010, but the Centers for Medicare and Medicaid Services (CMS) directed Medicare carriers to hold any bills and not process them for 10 days allowing time for Congress to act. It is expected that CMS will process bills submitted prior to today as if the SGR provision had not expired.

Thus no physicians should experience any cut in payment.

The House and Senate continue to work on a larger tax extenders bill H.R. 4213, the “American Workers, State, and Business Relief Act of 2010,” which includes a provision to extend the Medicare Physician payment update (SGR fix) until September 30, 2010. Indications are that Chairman Levin of the House Ways & Means Committee may release a new version of this legislation in the next two weeks including new revenue raising provisions as there were objections to using the pay-fors included in the Senate passed bill. We would expect final action on this legislation before the end of May and before the current SGR fix expires on May 31, 2010.

A summary of the Continuing Extension Act of 2010 as passed follows below: • • • • • • • • •

Extension of Unemployment Insurance Programs - Extends Federal Unemployment Programs retroactively, including the Emergency Unemployment Compensation Program, through June 2, 2010.

Extension of COBRA Assistance - Extends eligibility for 65% subsidy for COBRA premiums through May 31, 2010 and provides transition relief for individuals who lost their jobs between March 31, 2010 and the date of enactment.

Extension of Medicare Physician Update - Extends current Medicare payment rates for physicians (preventing a 21.2% payment reduction) through May 31, 2010.

Clarification of Health IT Incentives - Ensures certain doctors in outpatient facilities are eligible for health IT payments under Medicare and Medicaid.

Extension of Poverty Guidelines - Extends current provision maintaining 2009 poverty guidelines through May 31, 2010 (to prevent a lowering of the poverty line).

Extension of National Flood Insurance Program - Extends provision through May 31, 2010.

Satellite Television Extension - Extends the copyright license used by satellite television providers through May 31, 2010.

Compensation for Furloughed Employees - Provides compensation for federal employees furloughed during March 1st and 2nd as the result of the lapse in expenditure authority from the Highway Trust Fund.

Extension of Small Business Administration Programs - continues funding for loan programs that provide small businesses with the capital they need to succeed and grow. The bill extends funding to reduce or eliminate fees under the Small Business Administration’s 7(a) loan guarantee program and the 504 loan program through May 31, 2010.

NRC Launches National Source Tracking System Blog NRC has launched a National Source Tracking System Blog! This Blog will be a way for the NRC to communicate upcoming events and important information regarding the NSTS with their user community. In the coming months, they will be providing information on topics such as: • Annual Inventory Reconciliation • Certificate Renewals • Tips on NSTS Usage If you have questions, concerns, comments, please let them know! Their help desk is available to assist with any problems you may have. You can contact them by phone, toll free, at 1-877-6716787 or via email at NSTS.Help@nrc.gov.

This blog will be updated regularly, so please check back often!

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AAPM Newsletter

May/June 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. The grandfathering option requires that the medical physicist have conducted surveys of at least 3 units (in the applicable modality) between January 1, 2007 and January 1, 2010. Must these surveys be of ACR accredited units?

A. No. It is not required that these surveys be of ACR-accredited units. However, the surveys must include all tests required in the accredited modality for the annual survey (as of January 1, 2010).

See below for a list of the specific tests for each modality.

Q. The grandfathering option requires that the medical physicist have conducted surveys of at least 3 units (in the applicable modality) between January 1, 2007 and January 1, 2010. May these be of the same unit surveyed 3 times over a 3 year period?

A. Yes, as long as the surveys include all tests required in the accredited modality for the annual survey (as of January 1, 2010). See below for a list of the specific tests.

Q. What is meant by a CT “survey” with regards to the “Grandfathered” requirements for medical physicists?

A. The surveys must be the ones that ACR requires the medical physicist to perform annually on accredited units. However, the surveys do not have to be performed on accredited units. Each survey must include the tests (as applicable to the system tested) currently required by the ACR (as of January 1, 2010). For CT, these would be: • Alignment light accuracy • Alignment of table to gantry • Table/gantry tilt • Slice localization from scanned projection radiograph (localization image) • Table incrementation accuracy • Slice thickness • Image quality

1. High-contrast (spatial) resolution

2. Low-contrast resolution

3. Image uniformity

4. Noise

5. Artifact evaluation

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AAPM Newsletter

May/June 2010

continued - ACR Accreditation • CT number accuracy and linearity • Display devices 1. Video display 2. Hard-copy display • Dosimetry

1. Computed tomography dosimetry index (CTDI)

2. Patient radiation dose for representative examinations • Safety evaluation

1. Visual inspection

2. Audible/visual signals

3. Posting requirements

4. Scattered radiation measurements • Other tests as required by state or local regulations Q. What is meant by a MRI “survey” with regards to the “Grandfathered” requirements for medical physicists?

A. The surveys must be the ones that ACR requires the medical physicist to perform annually on accredited units. However, the surveys do not have to be performed on accredited units. Each survey must include the tests (as applicable to the system tested) currently required by the ACR (as of January 1, 2010). For MRI, these would be: • Magnetic field homogeneity • Slice position accuracy • Slice thickness accuracy • Radiofrequency coil checks • Soft-copy display (monitors) Q. What is meant by a nuclear medicine “survey” with regards to the “Grandfathered” requirements for medical physicists?

A. The surveys must be the ones that ACR requires the medical physicist to perform annually on accredited units. However, the surveys do not have to be performed on accredited units.

Each survey must include the tests (as applicable to the system tested) currently required by the ACR (as of January 1, 2010). For nuclear medicine, these would be: • Intrinsic uniformity • System uniformity • Intrinsic or system spatial resolution • Sensitivity • Energy resolution • Count rate parameters • Formatter/video display • Overall system performance for SPECT systems • System interlocks • Dose calibrators

1. “Test” measurement of battery voltage (if applicable)

2. Zero adjustment (if applicable)

3. Background adjustment

4. Accuracy with NIST traceable standard

5. Linearity

6. Geometry

7. Constancy test

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May/June 2010

continued - ACR Accreditation • Thyroid uptake and counting systems

1. I-123 capsule or long-lived standard calibration check

2. Count of background

3. High voltage/gain checks

4. Energy resolution

5. Chi-square test Q. What is meant by a PET “survey” with regards to the “Grandfathered” requirements for medical physicists?

A. The surveys must be the ones that ACR requires the medical physicist to perform annually on accredited units. However, the surveys do not have to be performed on accredited units. Each survey must include the tests (as applicable to the system tested) currently required by the ACR (as of January 1, 2010). For PET, these would be: ACR-approved phantom tests Dose calibrators

1. Constancy test

2. Linearity

3. Accuracy with NIST traceable standard

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AAPM Newsletter

May/June 2010

AAPM Website Editor Report Christopher Marshall, NYU Medical Center

I

continue to learn about the use of our website through the statistical data acquired by Google Analytics but at this stage I have more questions than answers. Our IS group maintains additional tracking data and with their assistance we were able to substantiate my preliminary finding about the number of members who access each online Newsletter.

This number is less than 1000. While the number kicked up by about 10% after the paper version ceased publication last year, did we lose significant readership?

I looked at the source of the large volume of traffic to our website. About 50% comes directly (presumably from members, who know our URL) and 15% from referring sites such as RSNA. The remainder comes via the familiar search engines, which I first assumed to be traffic coming from “the public.” However when I drilled into this data I discovered that the searches are quite specific, suggesting that most of this additional traffic is from individuals who are already familiar with our organization or at least with medical physics.

I therefore suspect that many are members or in allied fields. Amongst the remainder it was intriguing to note one unusual source of traffic – a link from one of the recent New York Times articles. This produced about 200 hits. This may seem surprisingly small given the readership of The Times and the nature of these articles, but maybe some were journalists or legislators digging deeper. Numbers alone do not tell the full story, and I am still digesting these observations. Are there implications for the potential value of the website for “public education” purposes? Should we be targeting narrowly or broadly defined audiences? If so which? In an attempt to target one specific audience we changed the “Public and General” section to “Public and Media” and added a new “Media” contact page with links to our public position statements. Tracking data shows that we subsequently generated a few hits on this page and although no media enquiries resulted this was over a very short period. As very wise man once said: “When you don’t know, you do experiments” and there is clearly much to be learned.

We do know which sections of the website attract the most traffic, such as the Annual Meetings pages, the Reports section, and the Placement Service pages. Improvements to the latter are “in the works.” We are also working with the Students and Trainees SC on an update to the student section.

You may have noticed that the IS staff has taken further steps towards “personalizing” the website. If you are a member of a chapter, and if that chapter posts its meetings on the website through the chapter link, you will see personal announcement about your next chapter meeting under your greeting line. You will also receive personal notices of upcoming committee activities if you are a member of that committee. You must, of course, be logged in to see these messages.

I hope that you find the Website useful, visit it often, and send me your feedback at: http://www.aapm.org/ pubs/newsletter/WebsiteEditor/3503.asp

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The 2010 AAPM election will open for online voting on June 9, 2010. Paper ballots will be mailed to members who have no e-mail address or a bad e-mail address and members that have opted out of online voting.

The deadline to submit your vote electronically or by paper ballot will be June 30, 2010.

AAPM Newsletter

May/June 2010

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

How Will Health Reform Impact Radiation Oncology & Radiology?

Health care reform legislation has been signed into law, marking a momentous and historic occasion, aimed at overhauling the $2.5 trillion U.S. health system. The final outcome will have a rippling effect on health care as we know it, radiation oncology and radiology included.

One thing most people don’t appreciate is that while there are a number of specific reforms in the legislation, the bill mostly contains general policy statements or directives. Health reform legislation is a framework that must be interpreted by government agencies, including the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS), which provides the specific enforceable policies and regulations. Therefore, the impact of many provisions will not be known for some time.

Below are some key provisions that may have an immediate impact on your practice and patients, while others have a much longer time frame before they will take effect--many not until 2014.

Medicare Payment Changes Hospital outpatient department payments. The health care reconciliation bill cuts another $10 billion in hospital payments in the form of “negative market basket updates.” Medicare payments for hospital outpatient services will be reduced from the current market basket update by 0.3% for 2014, 0.2% for 2015-2016, and 0.75% for 2017-2019.

Equipment utilization rate assumption. The imaging equipment utilization rate assumption is increased from 50% to 75% for diagnostic imaging equipment costing more than $1 million effective January 1, 2011. The current utilization assumption rate for linear accelerators is 50% and remains unchanged. This change will significantly alter reimbursement for CT and MRI. This assumption has an inverse relationship with payment, so as the utilization rate assumption increases, payments decrease.

Initial reform language would have also targeted nuclear medicine and PET but the final legislation will avert payment reductions for these technologies because the equipment cost is typically less than $1 million. In addition, the final legislation alters the current CMS policy of 90% equipment utilization rate that was implemented on January 1, 2010 and phased-in over a four year period. For 2010, the equipment utilization rate will remain at approximately 62.5% for diagnostic imaging equipment over $1 million as set in the final rule. Significant payment reductions to CT and MRI could negatively impact freestanding imaging centers, especially those in rural areas. Repercussions could include the shifting of diagnostic imaging to hospitals, which may affect patient access to medical imaging and potentially higher costs for the Medicare program overall. Alternatively, lower reimbursement for these advanced imaging modalities may decrease their attractiveness in the self-referral setting and decrease overall expenditures for unnecessary examinations. From a medical physics perspective it may decrease the overall number of these imaging systems and thus have a downward influence on the demand for medical physics services.

Multiple procedure payment reduction. The diagnostic imaging multiple procedure payment reduction on single-session imaging to contiguous body parts increases from 25% to 50% on July 1, 2010.

Geographic payment differentials. The national average “floor” on Medicare’s geographic payment adjustment (commonly known as the GPCI) for physician work expired at the end of 2009. The law re-establishes that floor in 2010. In 2010 and 2011, Medicare will also reduce the GPCI adjustment for

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AAPM Newsletter

May/June 2010

continued - Health Policy/Economic Issues

physician practice expenses in rural and low-cost areas. Physicians in 42 states, Puerto Rico and the Virgin Islands will benefit from these geographic payment adjustments.

Independent Payment Advisory Board. The legislation establishes the Independent Payment Advisory Board that will develop and submit proposals to Congress aimed at extending the solvency of Medicare, slowing cost-growth, improving quality of care and reducing national health expenditures.

Advisory Board proposals would be automatically implemented unless Congress acts in opposition.

Proposals to modify payments will be effective for years 2015 and beyond (2020 for hospitals).

Center for Medicare and Medicaid Innovation. Establishes by January 1, 2011 a Center for Medicare and Medicaid Innovation with the purpose to test innovative payment and service delivery models to reduce Medicare expenditures.

Self-referral. Effective January 1, 2010, physicians who have an ownership interest in specified imaging equipment (CT, MRI and PET) are required to disclose ownership and provide a list of other service locations to patients needing imaging services.

Medicare prescription drug coverage. Medicare patients whose prescription expenses reach the Medicare Part D coverage “doughnut hole” ($2,700 to $6,150) in 2010 will receive a $250 rebate.

During the next 10 years, the beneficiary coinsurance rate for this coverage gap will be narrowed in phases from the current 100% to 25% in 2020.

Patient Protections Insurance market reforms. The legislation includes several provisions meant to protect patients’ access to affordable coverage.

• Dependent children will be allowed to remain on their parents’ health insurance up to age 26.

• Existing insurance plans will be barred from imposing lifetime caps on coverage.

• Insurers will be prevented from canceling insurance retroactively.

• Insurance plans cannot exclude coverage for pre-existing medical conditions for children under age 19.

• Beginning in 2014, insurance plans are prohibited from denying coverage for pre-existing conditions.

• Beginning in 2014, group and individual plans will be required to cover routine costs of participation in certain clinical trials by qualified individuals. This requirement applies to all clinical trials that treat cancer or other life-threatening diseases.

Preventive and screening benefit expansions. In 2011, cost-sharing for preventive services will be eliminated in Medicare and Medicaid. Copayments will be eliminated for Medicare beneficiaries for certain preventive services, and incentives will be available to encourage Medicare and Medicaid beneficiaries to complete behavior modification programs. In the private sector, beginning in 2010, health plans will be required to provide a minimum level of coverage without cost-sharing for preventive services such as immunizations, preventive care for infants, children and adolescents, and additional preventive care and screenings for women.

Other Provisions of Interest Comparative effectiveness research. The legislation creates a non-profit Patient Centered Outcomes Research Institute. The Institute will conduct research and disseminate findings with respect to the relative health outcomes, clinical effectiveness, and appropriateness of medical treatments, services and items. The legislation prohibits the Institute or HHS from mandating coverage, reimbursement, or other policies for any public or private payer. However, the government may use comparative clinical effectiveness research in coverage decisions if such use of the research is through an iterative and transparent process. New comparative effectiveness requirements, including more stringent clinical trials, may slow or decrease the introduction of new and innovative technology.

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continued - Health Policy/Economic Issues

Health information technology. Beginning in 2013 health insurance plans must implement uniform standards for electronic exchange of health information to reduce paperwork and administrative costs.

Tax on medical devices. Beginning in 2013, a 2.3% federal excise tax will be charged for all medical devices sold in the U.S., including large capital equipment like linear accelerators.

Medical liability protection and grants. The HHS is authorized to award five-year demonstration grants to states to develop, implement and evaluate alternative medical liability reform initiatives, beginning in 2011.

Overall, the health reform legislation restructures medical reimbursement to favor primary care.

Since Medicare is a budget neutral payment system, increased reimbursement will come from procedure-based specialties, like radiology and radiation oncology. For example, all physicians in family medicine, internal medicine, geriatrics and pediatrics whose Medicare charges for office, nursing facility and home visits comprise at least 60% of their total Medicare charges will be eligible for a 10% bonus payment for these services from 2011–2016. The cost of these bonuses are funded through across-the-board reductions to all codes under the Medicare Physician Fee Schedule through a modification to the conversion factor.

In addition, Congress did not address the flawed sustainable growth rate (SGR) formula used to determine the annual update (conversion factor) under the Physician Fee Schedule. Separate legislation is anticipated later this year to avert the 21.2% cut to physicians and freestanding centers.

AAPM will continue to monitor implementation of health reform. Medical physicists should voice any concerns they may have regarding how cuts in reimbursement will affect the access of patients to important imaging tests and therapeutic treatments. Remember health reform legislation is not set in stone. There will be additional opportunities in the future to introduce revisions to the health reform legislation.

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AAPM Newsletter

May/June 2010

ABR Physics Trustees Report

Geoffrey S. Ibbott, Richard L. Morin, G. Donald Frey and Stephen R. Thomas

Reflections on Recent Publications about Radiation Errors

A

series of articles in the New York Times during January and February 2010 identified a number of serious and tragic accidents involving radiation therapy treatments and CT studies. (1) The articles were well written and thoroughly researched, and pointed out with startling clarity that while radiation offers ever greater potential to cure or alleviate the suffering from disease, the advanced technologies also offer new and sometimes unexpected ways to do harm. The articles also raised concerns regarding the qualifications and credentials of medical physicists who are responsible for assuring the technical performance of radiation therapy treatment equipment.

One of the accidents described by the articles involved the treatment of a patient at one of the hospitals in New York City. The patient was being treated using Intensity-Modulated Radiation Therapy (IMRT). As employed at this hospital, the technique uses a multileaf collimator (MLC) to modulate the intensity of the radiation beam. The procedure requires that the MLC leaves move during treatment, so that only part of the target volume is treated at any one time. The radiation dose is “painted” on the target volume through as many as 100 segments, generally from 5 to 7 different directions. The accident described by the Times article occurred when the physician requested a change in the treatment plan, to try to improve the dose distribution. This change was requested after the patient had received several treatments without incident. The new plan was prepared and was transferred to the treatment machine through another computer system, called a “record-and-verify” network; a system in common use in the US. However, a computer error occurred during the transfer, and as a result, only part of the treatment plan was transferred.

The operator did not recognize the ramifications of the reported error message and approved the transfer. Consequently, when the patient was next treated, the MLC failed to move and the entire target volume was treated while the beam was on. As a result, the patient received roughly seven times the intended dose. The patient was treated with this incorrect plan on three consecutive days, at which point the physicist performed the required quality-assurance procedures. The QA procedures revealed the error and the patient’s treatment was terminated. However, the huge dose received during the final three treatments led ultimately to the patient’s death.

Another radiotherapy accident was described by the articles as being discovered during a routine audit by the Radiological Physics Center (RPC). A new treatment machine was installed at a hospital in Florida in 2005. At the time of commissioning, a physicist calibrated the output of the accelerator, but made a mathematical error that resulted in the beam delivering 50% more radiation than intended. The physicist then set up the instrument to be used for daily output checks.

This QA instrument was dedicated to the particular accelerator. This procedure unfortunately ensured that the 50% error continued to exist undetected. It was not until the visit by the RPC that an independent measurement was made, and the error was detected. By that time, the machine had been in use for 10 months, and 77 patients had been treated. No further news reports have been published so the consequences of the increased dose are not known.

In both of these cases, as well as in several others described in the Times articles or elsewhere, a key factor seems to have been a failure to implement the QA program appropriately. In the first case, there were at least several failures that contributed to the accident. At the start, the patient was apparently treated with a plan that the radiation oncologist considered inadequate.

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May/June 2010

The reason for this has not yet been made public, but it might have been that there was a rush to start treatment, and insufficient time was spent on achieving an acceptable plan. Likewise, there appears to have been a rush to develop an alternate plan, which might have contributed to the oversight that led to acceptance of a corrupted data transfer. No reason has yet been made public for not performing the physics QA measurement until after the third treatment, but it is common for such measurements to be made after hours, when the treatment machines are free.

This might lead physicists to postpone such measurements until a batch of several measurements can be made at one time, or until time is available from other tasks and from personal activities.

Similarly, we do not yet know if the radiation therapists who were operating the accelerator for these treatments noticed that the MLC was not moving as it should have been. Treatment machines of the type used typically give a clear indication of the MLC operation.

In medicine, we tend not to fully appreciate that any staff member, regardless of training, qualifications, or experience, is susceptible to error, so we don’t consistently implement procedures to detect and mitigate such errors. In the second case described above, however, the hospital (according to their own press release) had anticipated the risk of error by a staff member, and had written policies calling for a second physicist to check any important measurements made by a member of the physics staff. The hospital admitted that in this case, their own policy was not followed, and no one had checked the work done by the first physicist. Any independent check, even (in this case) a simple calculation by hand, would have detected the error.

These two errors demonstrate several common and error-prone situations in radiation oncology departments today. First is that many departments are understaffed and the existing staff frequently work in stressful situations. Measurements are postponed, consoles are not attended to, and second checks are not made, in part, because everyone is too busy. Relegating important QA measurements to the end of the day, when staff are tired and eager to go home, leads to rushing and inattention to detail.

Second is that there may need to be a change in culture in some departments. Observations of the working environment show that, in some departments, the radiation therapists are permitted to read magazines and eat or drink at the treatment consoles. These activities can distract the therapist from his or her duties, and allow errors such as the first one described above to be overlooked. Physicists may not always pay sufficient attention to the clinical work, and sometimes postpone important measurements until a more convenient time.

What are the solutions to these problems? Several authors have pointed to the airline industry as a model to be adopted by the medical field. In fact, some medical practices have already adopted techniques used by airlines and other industries, with notable success. (2) The use of checklists has been described; even where staff believe they understand the procedures well, a checklist helps to make sure that even when rushed, important steps are not overlooked. (3) A scheduled “time out” has been employed in some surgical practices, in which all participating staff stop all other activities and focus on the procedure to be done, with the intent of discovering potential errors before they occur.

Such practices might need to be employed in radiation oncology. It certainly appears appropriate to re-evaluate the number of staff members required, and perhaps even to publish standards for staffing, to replace those publications that became irrelevant years ago. (4) Other standards should be considered, particularly one requiring that new linear accelerators be checked by an independent measurement before clinical use.

The American Board of Radiology is contributing to the improvement of patient safety through its certification and maintenance of certification processes. The mission of the ABR is “to serve

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AAPM Newsletter

May/June 2010

patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill and understanding essential to the practice of diagnostic radiology, radiation oncology and radiologic physics.” To assure that a diplomate has maintained the requisite standard of knowledge, skill and understanding required that a new process called Maintenance of Certification (MOC) be implemented. Diplomates of the ABR now receive time-limited certificates and must demonstrate, over a ten-year cycle, that they have maintained or enhanced six essential competencies: medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. By successfully achieving the expectations of the MOC program, diplomates demonstrate their commitment to continuous quality improvement, professional development, and quality patient care. It is expected that implementation of this comprehensive MOC program will encourage diplomates to improve their focus on safe and appropriate treatment delivery and help to reduce the probability of future errors.

Bogdanich, W. (2010) “THE RADIATION BOOM: Radiation Offers New Cures, and Ways to Do Harm” http:// www.nytimes.com/2010/01/24/health/24radiation.html,and http://www.nytimes.com/2010/01/27/ us/27radiation.html . Accessed 2/5/10.

Botney, R. Improving patient safety in anesthesia: A success story? Int J Rad Oncol Biol Phys 71:S182186 (2008) Gawande, A, The Checklist, The New Yorker, December 10, 2007.

Inter-society Council for Radiation Oncology (ISCRO). Radiation oncology in integrated cancer management.

Philadelphia: ISCRO; 1991.

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AAPM Newsletter

May/June 2010

Report of 2010 ORVC Spring Educational Symposium Jian Wang, President of ORVC

T

he 2010 Spring Educational Symposium of Ohio River Valley Chapter recently was held on Saturday, March 6th, at the University of Cincinnati Vontz Center for Molecular Studies. The Spring Meeting is dedicated to medical physics education. It is an opportunity for the graduate students, post-doctoral researchers, and residents within the Chapter to present their research.

The meeting program consisted of one Keynote Address and 11 student/trainee presentations.

The meeting attracted about 100 participants and over 20 vendor sponsors, both of the numbers are record highs for our Chapter.

Suggested by our Chapter members, starting from this year, our Keynote Address was named as James G. Kerieakes Keynote Lecture to honor our distinguished Chapter member James G. Kerieakes, Ph.D., FAAPM. Dr. Kerieakes is a professor emeritus of the University of Cincinnati and a pioneer of medical physics. He served as president of AAPM and received its highest awards, the William D. Coolidge Award and the Gold Medal.

He had served various committees within the AAPM and other societies and received numerous awards.

The meeting was honored with the attendance of Dr. Kerieakes and his wife Helen Kereiakes.

The first James G. Kerieakes Keynote Lecture was delivered by Cedric X. Yu, D.Sc., FAAPM. Dr. Yu is the endowed Carl M. Mansfield professor at the University of Maryland, and he gave a wonderful Keynote Address entitled “IMAT: Principles and Historic Perspectives.” Dr. Yu presented various aspects of Intensity-Modulated Arc Therapy (IMAT), including its history, principles, clinical implementation and QA, and future development directions. Dr. Kereiakes presented the plaque of James G. Kereiakes Keynote Lecture to Dr. Yu (Photo 1).

Eleven abstracts selected by the Executive Board of the Chapter were presented in the meeting. Each speaker was awarded a travel grant. A panel of judges was appointed to select the top three best presentations.

Serving on the Judge Panel, were Ishmael E. Parsai, Ph.D., FACRO of the University of Toledo, Jerome G. Dare, Ph.D., FAAPM, professor emeritus of the Ohio State University, and Gregory E. Madison, M.S. of the Center for Cancer Care in WV. There were many strong presentations, with the followings taking the top honors: Qingya Zhao of Purdue University with “Impact/ effect of respiratory motion in proton beam therapy with uniform scanning”, Jordyn

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Photo 1: James G Kereiakes Keynote Lecture plaque was presented to Dr. Yu L to R: Jian Z. Wang (President), Michael S. Gossman, (President-Elect), Cedric X. Yu and James G. Kereiakes

Photo 2: The ceremony of top presentations.

L to R: Michael S. Gossman (President-Elect), Zhibin Huang (3rd place), Ishmael E. Parsai (Judge), Qingya Zhao (1st place), Jordyn Detwiler (2nd place), Gregory E. Madison (Judge), Jerome G. Dare (Judge), Jian Z. Wang (President)

AAPM Newsletter

May/June 2010

continued - Report of 2010 ORVC Spring Educational Symposium Detwiler of University of Toledo with “Dosimetric Comparison of Three Multi-Lumen Brachytherapy Applicators with the Original MammoSite® Balloon Used in Partial Breast Irradiation (PBI)”, and Zhibin Huang, Ph.D. of the Ohio State University with “How Early Can We Predict the Outcome for Cervical Cancer during Radiation Therapy?”. Qingya Zhao was awarded the 1st Place of Best Presentations - the ORVC Award, with Jordyn Detwiler and Zhibin Huang taking 2nd Place (IsoAid Award) and 3rd Place (Q-FIX Award) (Photo 2). The awards were named after the entity providing sponsorship for it.

The Symposium concluded with our Chapter Business Meeting. Items discussed including Chapter By-Laws revision, medical physicist state licensure, financial report and the Chapter fall meeting.

Michael S. Gossman, M.S., President-Elect, briefly summarized the rationale of Chapter ByLaws revisions and the ongoing poll for approval. We urged the chapter members to vote on this important Chapter document. Chapter Board Representative Howard Elson, Ph.D., updated the members regarding the state licensure of medical physicists and his survey on this issue at the beginning of this year. Michael Lamba, Ph.D., former Secretary/Treasurer and Rebecca Richardson, M.S., current Secretary/Treasurer, gave a report regarding the Chapter’s current financial standing. The Chapter treasury remains healthy as a result of good turnouts from the recent meetings. Jian Wang, Ph.D., President, briefly discussed the arrangement of the Chapter fall meeting and will solicit a hosting institute and decide the date shortly after this meeting.

On the evening of March 5th, a night-out of the symposium was organized for our Chapter members, which was sponsored by Varian Medical System, Inc. Before the night-out event, Chapter members had the opportunity to join the Varian Brachytherapy User Meeting held earlier in the evening. The clinical forum was titled “Ohio River Valley Learning Symposium for Accelerated Partial Breast Irradiation (APBI) Latest Treatment Solutions and Rational” and hosted by Varian Medical Systems, Inc. In conclusion, I would like to extend a big thank you to President-Elect Michael S. Gossman, M.S. his outstanding efforts securing vendors and financial backing for the meeting as it was instrumental in the success of the Symposium. Rebecca Richardson, M.S. (Secretary/Treasurer) and Michael Lamba, Ph.D. (former Secretary/Treasure) both deserve acknowledgement for their tireless work coordinating the meeting arrangements and on-site details at the University of Cincinnati. Matthew Meneike, Ph.D. (Past President) and Howard Elson, Ph.D. (Chapter Board Representative) also provided valuable guidelance and contribution to the success of this meeting. Finally I would take this opportunity to acknowledge the generous support of the following corporate participants: Platinum sponsor: Varian; Golden sponsors: Isoaid and WFR Aquaplast/Q-fix; Silver sponsors:

Acceletronics/RadParts/TheraView, Best Industries/CNMC Company, BrachySciences, IBA Dosimetry, Integra/Radionics, IsoRay, LACO, Nelco Worldwide, Nucletron, Philips, PTW, Resonant Medical, Siemens OCS, Sun Nuclear, Tomotherapy

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New Professionals Subcommittee Report Russell Tarver, New Professionals Subcommittee Member Advice for the First-Time Weekend Consultant

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s a young professional, you may be interested in contract work on the side (moonlighting). This is an opportunity to supplement your income, but there are issues to consider. It will be impossible to cover all the necessary material here, but hopefully this article will prompt you to consider aspects of consulting you might not have seen.

My first piece of advice: before accepting any consulting work, verify that doing so is not in conflict with your primary employer’s policies. Second: make sure you know what you’re getting into; avoid accepting a job that is out of your scope of practice or knowledge. The potential employer has expectations of competent and knowledgeable execution of duties. I can’t stress this enough… do not put yourself into the position of having to either explain that you can’t do the job you committed to, or doing a poor or incorrect job of it.

Occasionally the opportunity to perform an annual survey, shielding survey, or other work that requires further analysis or report writing might present itself. It will be tempting to work on that ‘extra’ duty when you find yourself at an inevitable slow period at your primary job. My recommendation is to avoid this temptation unless you’ve fully cleared this with your immediate supervisor. While it might not seem to be an issue if things are slow, it could reflect on you unfavorably as colleagues in the clinic might resent the fact that you are working on ‘some other project’ on company time. The use of your primary employer’s equipment is also heavily frowned upon unless explicitly approved. Does ‘you break it, you buy it’ sound familiar?

While at the consulting site you will be entrusted with protected information. Treat this information the same as information from your primary site. You may also learn information of a business nature, e.g., patient load, equipment specifications and performance, etc. This is considered proprietary information. You might be tempted to share this information with your primary employer, but it would be inappropriate to do so unless given permission.

As a consultant, you might think that your responsibilities are only those delineated in the ‘scope’ of your duties. Not true. As a professional, your responsibility is to the patient first. When made aware of clinical issues that need to be addressed, whether it’s your job or not you must ensure that this information is communicated to the right people. If the issue isn’t addressed, or is of a continuing nature, you must elevate the level of communication; from therapist to physicist, from physicist to physician, from physician to administrator, or whatever the appropriate pathway might be. By failing to do so, you are tacitly participating in the issue you have identified as unacceptable.

When writing your contract, be sure to specify the scope of expected work, payment terms, due dates, responsibilities, and liabilities. Many employers will require you to carry professional liability insurance. Occasionally you will be required to carry general contractor insurance as well.

Make certain that you carry the necessary insurance if required. One item often overlooked in contracts is the employer’s responsibility with regards to machine and equipment uptime. Be clear in your contract about duty performance when equipment is malfunctioning. Detail whether payment is still due, work is postponed, or whether the work will be completed at a later time at additional cost. There are many ways for this to be written so be clear and unambiguous with your intent.

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continued - New Professionals Subcommittee Report Conflicts of interest can and do occur. The most likely scenario is when contracting to an employer that is in direct competition with your primary employer. In this situation, your best course of action is to be steadfast in your ability to keep the performance of each job separate from the other. Personally, I try to avoid these situations and keep my contracts geographically separate from my primary employer.

Many consulting jobs are available because the site doesn’t need a fulltime physicist, can’t find one, or needs to backfill the existing physics staff. In a market society the rules of transactions say charge as much as the buyer is willing to pay (much like airline tickets). In the short term this may seem great. However, by charging a reasonable rate that doesn’t stretch the employer’s patience and at the same time provides reasonable compensation for time and effort, both parties are happier and it’s a more productive arrangement. Don’t put yourself into the position of using additional contract work to maintain a lifestyle. It’s better to think of it as maintaining your retirement lifestyle. Don’t get me wrong, spend and enjoy some of it, but don’t get hooked on it as it could end at any time.

In summary, contracting is a great way to supplement your income, provide a service for an employer, and potentially broaden your clinical skill set. Be aware of the complications that come with it: business expenses, tax implications, professional liability, increased work load, and decreased home life. Your CPA should be high on your contact list. And finally, seasoned fulltime consultants are great resources for information.

Persons in the News New NCRP Members Elected

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he National Council on Radiation Protection and Measurements (NCRP), Bethesda, MD, has elected 10 new members to its Council, and reelected 11 other members. The election was held at the 46th NCRP Annual Business Meeting on March 9, which was held in conjunction with the 2010 NCRP Annual Meeting on the topic of Communication of Radiation Benefits and Risks in Decision Making.

NCRP was chartered by Congress in 1964 under Public Law 88-376 to serve as a nonprofit organization that represents a national resource on topics related to radiation protection and radiation quantities, units and measurements. NCRP’s mission is to formulate and widely disseminate information, guidance and recommendations on radiation protection and measurements which represent the consensus of leading scientific thinking. The Council’s mission also encompasses the responsibility to facilitate and stimulate cooperation among organizations concerned with the scientific and related aspects of radiation protection and measurements.

The newly elected members of Council included one AAPM member, Louis Wagner. AAPM Members of Council who were reelected to another six-year term on Council are: William Kennedy and Stephen Seltzer.

There are 100 elected members of the Council, who are recognized as leaders in many scientific fields of relevance to radiation protection and measurements in medicine, homeland security, environmental protection, nuclear technology, and public and occupational radiation exposures.

Additional information about NCRP is available online at http://NCRPonline.org.

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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

May/June 2010

Radiation Quality Control Oversight: A Repeat of History? 1 Raymond L. Tanner, Ph.D.

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n 1973 it came to the attention of the American Association of Physicists in Medicine (AAPM) that the Division of Cancer Prevention and Control of the National Cancer Institute (NCI), part of the National Institutes of Health, was concerned about maintaining high standards of care in the nation’s radiation oncology facilities and reducing the risk of cancer from mammography. The recent proliferation of clinical trials and project “Outreach” programs in a rapidly expanding number of community and other hospitals offering these services lay in the background of their concern at that time.3 The AAPM sought and received an NCI contract to establish an expert oversight committee to support, coordinate and standardize the efforts of regional Centers for Radiological Physics (CRP’s), to be separately funded by the NCI. Six CRP’s, subsequently funded in 1974, were to assure the delivery of uniform, quality care all across America at academic, government, major medical and community hospitals. Initial protocols included therapy for Hodgkin’s Disease, head and neck Ca, breast Ca, and physics support for the Breast Cancer Detection Demonstration Project.

The AAPM Coordination Contract assured a high national level of care in radiation oncology by maintaining a data bank of site visits (including over 1,600 therapy machines) from all CRP’s.

It hosted annual CRP dosimeter intercomparison meetings; hosted joint annual meetings of the Coordinating Committee and the CRP Directors; and developed and disseminated educational materials pertaining to the practice of medical physics and implementation of AAPM Task Group reports specifying physics protocols for electron and X-ray therapy.

Each of the six regional CRP’s made regular site visits to participating radiation therapy centers in their area of the country. These visits were made to assure correctness and uniformity of procedures by making measurements of: delivered doses, timer accuracy, light/X-ray beam congruence, collimator operation, linac gantry operation, accuracy of optical distance indicators and centering devices, field size indicator accuracy, etc. Also selected patient charts and treatment plans were examined for errors (this preceded significant use of computerized treatment planning).

Following the visits the therapy centers were promptly provided an evaluation report describing the extent of compliance with standards and any problems discovered.

Mailed thermoluminescent dosimeters sent from the CRP’s were utilized to permit more frequent checks on delivered doses both for therapy and mammography (the dosimeters were quite small and could be placed on the skin of the patient). Activities of the CRP’s for mammography involved development of a breast phantom, evaluation of mammography equipment and measurement of doses delivered therein. Many center’s radiation doses from mammography were lowered as a result of image evaluation and dissemination of information about the optimum technique factors.

An important role of the CRP’s was to act as a resource for the technological transfer of “state of the art” radiological physics procedures to clinics and hospitals across the U.S. The national Radiological Physics Center in Houston (established in 1968) cooperated with the regional CRP’s and shared some measurement techniques with them.

The AAPM Coordination Contract and the six CRP contracts operated for nearly twelve years under NCI auspices until funds were withdrawn in early 1986 by virtue of the Graham-Rudman-Hollings Act. There was no question of the viability of the CRP’s or AAPM’s contracts. The six original regional centers (and their directors) were: MD Anderson - Robert Shalek, Ph.D.; Memorial/

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continued - Radiation Quality Control Oversight: A Repeat of History?

Sloan Kettering - John Laughlin, Ph.D.; University of Wisconsin - John Cameron, Ph.D.; University Of Washington - Peter Wootton, Ph.D.; Univ. of Colorado - William Hendee, Ph.D.; and Univiversity of Pittsburgh - Prakash Shrivastiva, Ph.D. Halfway through the program the University of Colorado center’s grant was assigned to San Francisco - Mary Louise Meurk, M.S. Near the end of the program the Memorial/Sloan Kettering center’s grant was shifted to Yale University - Robert Schulz, Ph.D. The Coordination Program of AAPM was staffed by a full time director, Lloyd Bates, Ph.D., and supported by a Coordination Committee of five senior physicists. Most of the committee members also served the AAPM in major capacities as chairs of the Scientific Council, its Therapy Committee, the Professional Council, and/or holders of national offices in the AAPM. Its membership rotated over the 12 years the contract was held.

The recent spate of newspaper articles on the dangers of radiation oncology (therapy) combined with the myriad of complexities involved with highly sophisticated equipment, trained (but not always certified or licensed) health care professionals on the team (physician, medical physicist, dosimetrist, nurse and radiation therapist), and the complex computer treatment planning and delivery programs have caused this author to collect and recall some of the history of the CRP’s and the AAPM Coordinating Committee and restate its positive impact on quality care between 1974 and 1986. More importantly, it would seem that termination of those nation-wide standardizing activities was premature and unfortunate.

Reestablishment of a national network of regional radiation oncology quality assurance oversight centers under the auspices of the AAPM in concert with ASTRO and ACR seems to be demanded in the present situation and for the foreseeable future.4 Such an effort would, of necessity, involve activities very similar to those formerly carried out by the CRP’s, though considerably more involved due to the highly evolved state of radiation treatment design and delivery. Selecting the AAPM as the primary oversight agency for a nation-wide radiation oncology quality assurance activity is a logical choice since oncology equipment selection and maintenance, treatment planning, dose delivery and measurement are the stock-in-trade of medical physicists. The ACR’s excellent Mammography and other Accreditation Programs and its Practice Guidelines involve significant medical physics activity as they reach an ever growing number of facilities.

The Radiological Physics Center at M.D. Anderson in Houston continues to play a critical role in maintaining uniformity of dosimetry and treatment Q.A., but it’s role is restricted (due to its NCI funding) to institutions that participate in NCI sponsored clinical trials. There is need therefore for a national program whose mission will include evaluation of all personnel, equipment and activities within every radiation oncology center in the country.

Given the current push in biomedical research for “translational science” (http://www.cancer. gov/trwg/TRWG-definition-and-TR-continuum), whose purpose is to move scientific advances from the “bench to the bed-side”, it seems that CRP-like activities are required again to standardize and assure timely implementation in clinical practice of the highest quality of rapidly developing technologies in radiation oncology with a strong emphasis on patient safety and accuracy of dose delivery.

1 “Centers for Radiological Physics”, Shalek, Robert and Masterson-McGary, Mary Ellen, Medical Physics, Vol. 25, No. 7, July, 1998, Part 2.

2 Professor Emeritus of Radiology, University of Tennessee, Health Science Center; President of the American Association of Physicists in Medicine, 1973-1974; Chairman of the Commission on Physics of the American College of Radiology, 19821988; First Chairman of the ACR Physics Committee on Mammography, 1987-1990. rltanner@uthsc.edu.

3 The author is greatly indebted to the following for much of the information in this article – any errors are the author’s, however: Bob Cacak, Larry DeWerd, Lisa Giove (AAPM Staff), Will Hanson, Bill Hendee, Geoffrey Ibbott, Win Malone (Contract Officer for the CRP’s), Mary Ellen Masterson-McGary, Mary Louise Meurk, Bhudatt Paliwal, Larry Rothenberg, Jean St.Germain, Robert Schulz, Bob Shalek, Prakash Shristava, and Marilyn Stovall.

4 April 7, 2010 letter from Michael Herman, Ph.D., President of the AAPM to Rep. Frank Pallone, Jr., U. S. House of Representatives, Chair, Sub-Committee on Health. http://www.aapm.org/publicgeneral/AAPMAddlCommentsPallone.pdf.

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International Scientific Exchange Program Report Prof Dogan Bor (Host Co-Director) Mahadevappa Mahesh (AAPM Co-Director)

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n “International Workshop on Current Topics in Diagnostic Medical Physics” was held at the Ankara University, Ankara, Turkey from October 17-20, 2009. This workshop was sponsored by the American Association of Physicists in Medicine (AAPM) under the International Scientific Exchange Program (ISEP). The Institute of Nuclear Science – Ankara University, Ankara, Turkey, locally hosted the workshop and the Turkish Scientific and Technological Research Council cosponsored the workshop by partially funding the expenses of select attendees (graduate students). Each year AAPM-ISEP organizes such workshops/courses in the developing countries in the area of radiation therapy physics and medical diagnostic physics with the goal of enhancing interactions between the AAPM and the practicing medical physicists in the developing countries.

The AAPM-ISEP provides travelling funds to the participating AAPM faculty while the local hosts supports the boarding and lodging expenses of the AAPM faculty.

The establishment of official medical physics training programs in Turkey have started a decade ago, but the number of the members of the national medical physics society is growing rapidly and has already reached 300, and two third of them are working in radiation therapy. The attendance comprised of medical physicists, physicians and students. There were more than 100 participants at the workshop and almost half of them came from outside of Ankara. There were 25 medical physicists with masters (MS) and doctorate (PhD) levels and more than 50 graduate students.

The AAPM faculty included Donald Frey, PhD from Medical University of South Carolina, Mahadevappa Mahesh, MS, PhD from Johns Hopkins University School of Medicine, Richard Morin, PhD from Mayo Clinic, Adel A. Mustafa, Ph.D from the New York Medical College, Stephen Thomas, PhD from the University of Cincinnati and Habib Zaidi PhD from Geneva University Hospital, Geneva, Switzerland.

The co-directors for the workshop were Mahadevappa Mahesh, MS, PhD representing AAPM-ISEP and Prof Photograph showing AAPM faculty: Don Frey, Steve Thomas, Mahadevappa Mahesh, Adel Dogan Bor, PhD from Mustafa, Richard Morin and Dogan Bor (Host and Co-director) with workshop attendees.

Ankara University. Dr. Dogan Bor was the local organizer and host to AAPM faculty.

Dr Donald Frey – AAPM faculty demonstrating mammography QC at the practical sessions.

The official program included more than 24 hours of classroom lectures on various diagnostic medical physics topics such as computed tomography, radiography (CR and DR), radiation dosimetry, interventional fluoroscopy, mammography, nuclear medicine topics (gamma camera, SPECT-CT and PET-CT), mammography accreditation and other topics.

In addition to didactic lectures, one afternoon was dedicat-

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continued - ISEP Report ed to practical sessions in the imaging and dosimetry laboratories of the Institute of Nuclear Science at the Ankara University, Ankara. Participants were divided into multiple groups to work with conventional X-ray, fluoroscopy, mammography systems and in the nuclear medicine laboratories. The AAPM faculty demonstrated some of the quality control procedures and patient dosimetry techniques. The graduate students and local faculty members ably aided them. Although the time for each modality was short, participants were quite active and enthuDr. Stephen Thomas – AAPM faculty explaining QC siastic and asked many relevant questions to lectur- tests at the practical sessions. ers. The attendees hailed the workshop as success and according to them “the success was mainly due to the excellent knowledge of the faculty and their ability to share their experiences. Even after the long travel hours and jet lag, they exhibit no sign of exhaustion during the whole course.”

Immediately after the AAPM-ISEP workshop, the 12th National Medical Physics Congress of Turkey was held at Hilton Hotel in Ankara (October 21-23, 2009) with the collaboration of Ankara University and Turkish Medical Physics Society. The majority of the participants of AAPM-ISEP workshop had the chance to join and benefit from this congress. One of the AAPM faculty members, Dr. Habib Zaidi attended the congress and gave remarkable lectures. There were more than 360 participants in this meeting and 20 technical company support the congress with a technical exhibition.

According to Dr. Dogan Bor, “one of the immediate output of the AAPM-ISEP workshop is that there are now more physicists willing to work in diagnostic imaging and applying to our post graduate program.” Dr. Bor and his colleagues expressed thanks to AAPM for organizing the workshop at their institute.

Special AAPM Seminar on Patient Safety AAPM Annual Meeting, Sunday, July 18th 2:00 PM - 4:00 PM The AAPM meeting organizers are presenting a special symposium to respond to the recent public interest in patient safety in radiology and radiation therapy. The goal of the symposium is to explore the issue of patient safety from the perspective of the general public, the AAPM, other national and international organizations. The speakers are Walt Bogdanich, the author of the recent New York Times articles on patient safety, Mike Herman, the president of the AAPM, Ola Holmberg of the IAEA, and Bill Hendee, a cofounder of the National Patient Safety Foundation.

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News from the Working Group on the Prevention of Errors

Peter Dunscombe, Chair of Work Group on Prevention of Errors in Radiation Oncology

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he recent articles in the New York Times have renewed our focus on the risks of radiotherapy and how to mitigate them. The AAPM’s Working Group on the Prevention of Errors continues to play its part in contributing to the discussion and guiding the community towards safer practices.

Of note are the following initiatives:

1. There is now a link from the AAPM’s home page to several documents related to patient safety and error management (http://www.aapm.org/links/mrir.asp). If you haven’t already done so you should take a look.

2. Mike Herman and Jim Galvin requested the Working Group to provide an update on current initiatives and future plans in the area of safety in radiotherapy. This the Working Group did with the document including a proposal for a Traveling Workshop on techniques of error management such as FMEA and Root Cause Analysis.

3. Several members of the WG are looking into the language and structure of error reporting/ learning systems. As a result of the NY Times articles there is renewed interest in a national incident database. Additionally, several of us are actively developing their own local databases. Whether or not the proposed national database comes to fruition we need to speak the same language if we are to share experiences between different treatment facilities. Once the subgroup has distilled its thoughts a proposal for language and structure will be forwarded through the WGPE to the wider community.

Upcoming educational activities of note include: 1. The AAPM-ASTRO meeting “Safety in Radiation Therapy – a Call to Action” in Miami in June (http://www.aapm.org/meetings/2010SRT).

2. At the AAPM’s Annual Meeting in Philadelphia there will be a session in the Continuing Education track entitled “Error Management and Patient Safety in Radiation Therapy.” This session, which will be held from 10am – 12pm on Wednesday, 21st July, will include such topics as FMEA and Fault Tree Analysis.

3. For those of you going to ESTRO this year in Barcelona there is a Pre-meeting Workshop on “Safety in Radiation Oncology” (http://www.estro-events.org/Pages/estro29patientsafety.aspx).

If you have any views on current WGPE initiatives or possible future directions please let us know.

Also, if you have any additional links regarding errors or error prevention in radiation oncology which you think other members should know about, send them to me for evaluation. The WG will be meeting in Philadelphia just prior to the Annual Meeting and we would be happy to discuss your comments then as well.

Announcement

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he International Conference on Radiation Protection in Medicine, will be held from 1st to 3rd of September 2010 in Varna ‑ the “Sea capital” of Bulgaria. The motto of the Conference is “Where we are and where we are going in radiation protection in medicine?” AAPM is a co‑sponsor of the conference.

The deadline for abstract submission is April 30th, 2010, with possible extension. Details and updates can be found on the conference website www.rpm2010.org

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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: July/August • Submission Deadline: June 10, 2010 • Posted On-Line: week of July 1, 2010