AAPM Newsletter September/October 2010 Vol. 35 No. 5

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. 5

SEPTEMBER/OCTOBER 2010

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

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would like to thank everyone who attended the annual meeting this year and made it a success. The scientific, educational and professional programs were filled with relevant material for each of us. If you didn’t attend the meeting, I hope you take advantage of the virtual library, including SAMs. This year, CAMPEP approved a request by AAPM to accredit new virtual library SAM’s which will allow us to streamline the production of these important modules.

The meeting was highlighted by a trip on July 17th to Philabundance, a local food bank, where a group of AAPM members and guests packed meal boxes for senior citizens. We packed 920 boxes Saturday morning, each one containing approximately one week’s worth of food for a senior. Thank you to everyone who participated.

This year we focused the President’s symposium on Why We Do What We Do. Ultimately, the result of the Medical Physicist’s work, regardless of whether we do research, provide education or deliver clinical service, is the very best possible patient care. We were fortunate to have professor Jim Donnelly, a head and neck cancer survivor, tell us first hand about his experiences as the patient, being subjected to the daunting technology Included in this issue: and complex process used for diagnostic evaluation and ultimately Chair of the Board p. 4 for curative treatment. Most of us President-Elect p. 6 Jim Donnelly speaking during found Jim’s words very moving and Executive Director p. 9 President’s Symposium truly an exclamation point as to our Editor p. 11 primary focus as medical physicists. He received a standing Administrative Council p. 12 ovation after his heartfelt presentation, which will be available Professional Council p. 14 in the virtual library.

Leg. & Reg. Affairs p. 17 Website Editor p. 21 What we do begins with the AAPM Mission (2009): to advance ACR Accreditation p. 22 the science, education and professional practice of Health Policy/Econ Issues p. 23 medical physics. And the accompanying goals: New Professionals SC p. 26 1. Promote the highest quality medical physics services for Minority Recruitment SC p. 27 patients.

ITART Report p. 28 2. Encourage research and development to advance the Research Seed Award p. 30 discipline.

Coolidge Award Intro p. 32 3. Disseminate scientific and technical information in the Coolidge Award Acceptance p. 34 discipline.

Persons in the News p. 39 4. Foster the education and professional development of medical physicists.

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continued - AAPM President’s Column 5. Support the medical physics education of physicians and other medical professionals.

6. Promote standards for the practice of medical physics.

7. Govern and manage the Association in an effective, efficient, and fiscally responsible manner We spent a significant portion of the Board of Directors meeting reviewing draft objectives and associated strategies for AAPM to carry out our Mission. The Strategic Planning Ad Hoc Committee submitted a report with 34 draft objectives and 142 associated strategies to carry out. The Board broke into working groups and provided a prioritization of the objectives that they will direct the Strategic Planning Committee and various Councils and Committees to take action on.

We also held a special symposium on patient safety on Sunday afternoon. The symposium started out with Walt Bogdanich, the New York Times reporter who wrote the series of stories earlier this year that attracted national attention to safety in the medical use of radiation and a particular focus on the responsibilities of medical physicists in imaging and therapy procedures. This entire experience of reading about our field in the national press, having AAPM members appear before Congress, FDA, NRC, on national broadcasts, etc., has helped to put our profession in perspective.

It also demonstrates how our specialty is little understood by most people, yet how important what we do is to the quality and safety of patient procedures that utilize radiation. From our Mission and Goals, our efforts in this case toward quality and patient safety have been developed.

Since 1977, AAPM has published over 150 reports that describe quality and safety measures for technology and procedures in medical imaging, radiation therapy and informatics including: performance and quality assurance, radiation dose, exposure and safety, technique, guidance and standards, radiation safety, mechanical safety, imaging doses, exposure control, therapy doses, disaster preparedness, codes of practice, communication standards, specific technical issues for patients, quality assurance and quality review, educational guidance at graduate and post graduate levels. We have provided annual education on error reduction and prevention since 2005, as well as numerous publications in our journal Medical Physics on these topics.

To continue to improve quality and safety, AAPM joins other groups in strong support of the following initiatives that we have stated through many communications. These activities also involve the charges of numerous AAPM committees: 1. Individuals involved in the delivery of medical radiation for imaging and therapy must demonstrate competence through nationally recognized and consistent qualifications that guarantee that proper education, clinical experience and certification have been achieved. – Both houses of Congress have the 2010 Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE) Act under consideration. The standards proposed in CARE demonstrate why the 2012/2014 certification initiative is so important; so that the education and evaluation processes are in place to ensure that individuals can meet the requirements to satisfy the definition of AAPM QMP for clinical practice.

2. Accreditation is a mechanism by which a practice is reviewed and evaluated to ensure quality and safety: that qualified people in appropriate staffing numbers perform medical radiation procedures following national consensus best, safe practices. Practice accreditation should be required for imaging and therapy and may need the incentive of being tied to reimbursement.

3. Uniform, consistent, quantitative, accessible national event reporting and notification is critical. Such a system will: • have a single centralized, modality independent repository for events and potential events • be easy to use, universal, anonymous and non-punitive • have uniformly defined nomenclature, event definitions, minimum reporting details, consistently used by all participants • have comprehensive analysis processes established that will be evaluated for critical patterns and timely dissemination

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continued - AAPM President’s Column 4. Improvements by manufacturers and FDA are necessary.

• Evaluation and test data should be uniformly reported in the 510(k) process and in user documentation.

• There should be increased communication/interface/display standardization as well as increased robust safety checks built in to radiation delivery systems.

• The FDA 510(k) process should consider the review of additional safety and testing data and should leverage objective external expert reviews.

I would also like to report continued positive steps toward the 2014 CAMPEP accredited residency requirements for ABR examination. There are now 44 accredited residency programs with a number more in the pipeline. Of specific note, there were three programs accredited this year that demonstrate a commitment to provide accredited training in models that are different than a conventional academic residency. These are the Vanderbilt Doctor of Medical Physics program, the Upstate New York Medical Physics diagnostic imaging residency and the Northwest Medical Physics therapy residency program. With continued efforts likes these as well as growth in conventional programs we will meet our 2014 goals.

Finally, as always I encourage you to get involved with any of the activities within the AAPM you feel strongly about. There is much to be done and much need for volunteer expertise. Financial involvement is also critical. Please support the dues increase when it comes time to vote.

2010 John R. Cameron Young Investigator Competition Results 1st Place

2nd Place

3rd Place

Adam Melancon MD Anderson Cancer Center

Jeffrey Schlosser Stanford University

David Busch University of Pennsylvania

Range Adaptive Proton Therapy for Prostate Cancer

Real-Time Soft-Tissue Imaging Concurrent with External Beam Radiation Therapy Delivery

Blood Flow and Volume Changes During Simulated Mammography

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

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he excitement and growth of our field was apparent again at our 52nd Annual Meeting of the AAPM held in Philadelphia this past July. For the fourth time, the AAPM Board of Directors hosted a “Town Hall Meeting” at the annual meeting. The town hall format allows for informal discussion between the members and the Board, with issues being raised by the members in attendance. Thirty-four board members were present at the meeting with approximately 75 AAPM members in attendance, ranging from new members to retired members. As Chair of the Board, I was given the privilege to moderate this session. A few of the discussions are noted in this newsletter article.

The Town Hall meeting began with a student member thanking the Board for their efforts in supporting students and paving the future for the profession.

Next an active discussion ensued around the AAPM election process including a suggestion for having a presidential level debate between the two candidates – perhaps online or at the annual meeting. Currently, when the election ballot is posted, a forem is set up on the AAPM’s Board Bulletin System (i.e. the BBS, which is accessible from the AAPM website) on which all members can ask questions to the candidate. This year there were no comments or questions posted during the three-week election period. Thus, it appears that this topic is still under discussion as to its need. Another attendee voiced a request for the actual number of votes for each candidate be made known. Most in the subsequent discussion noted that such information was not necessary and that it potentially could kept some from agreeing to run for office or a board member position.

A concern was raised that this Town Hall Meeting is scheduled during scientific session time.

EXCOM acknowledged this concern and noted that they are looking at combining the Town Hall meeting and Annual Business meeting for next year.

Another member asked how is AAPM addressing new advances in physics and technology, such as in IMRT, and the corresponding QC needed. The Board response illustrated the collaborative relationship between the AAPM Councils. For example, Science Council may have a task group develop a document on the QC of some specific new technology, and then work with Professional Council to create practice guidelines. More discussion followed regarding the Abt study and needed practice accreditation.

Once the attendees’ questions subsided, I asked the Board members if they had any questions for the attendees. One BOD member asked the audience if any of them did not vote in the recent AAPM election, and if so, why not. One noted that he felt removed from the AAPM activities. Many of the Board members then gave suggestions for becoming more involved in the AAPM, including joining committees/subcommittees/task groups, having established AAPM members mentor new members, attending chapter meetings, attending AAPM summer schools, and reading the Committee Classifieds, which are posted on the AAPM website. The discussion led to potentially developing a FAQ on how to become involved.

Overall, the Town Hall meeting was deemed a success and it will continue to grow at next year’s AAPM meeting.

Improving Patient Care through e-Communication in Imaging This past August, I attended as a representative of AAPM EXCOM, the American Board of Radiology Foundation 2010 National summit Meeting on “Improving Patient Care through e-Communications in Imaging”. [http://www.abrfoundation.org/summit.html] This meeting was held in collaboration

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continued - AAPM Chair of the Board’s Column with the NIBIB and the ABR. The meeting included lectures and break out groups with the focus of how to use information technology to help in health care. Attendees included physicians, medical physicists, providers, payers, and consumers. A concerning note was that the USA overspends on health care but under-spends on Health IT (information technology). A collaborative national effort is needed to increase knowledge, communication, and the sharing of patient data, as well as a collaborative multi-departmental approach in one’s own institution. A clear message was that with the advances in IT, health care is moving from a “provider-centric” world to a “patientcentric” world. The AAPM through its leadership and members, will be working with the other organizations to achieve these important goals.

Medical Physics is First AIP Publishing Partner Journal Migrated to Scitation C³ AAPM publication to benefit from platform’s greatly enhanced functionality

MELVILLE, NY (July 8, 2010) — Medical Physics, a journal from the American Association of Physicists in Medicine (AAPM), went live today on Scitation C³, the next-generation hosting platform of the American Institute of Physics (AIP) (www.aip.org). This move is the first in a projected plan by AIP to migrate all its publishing partner journals to Scitation C³ by year’s end. AIP made significant upgrades to the platform this year, particularly by incorporating MarkLogic Server and a Polopoly web content management system, which provide users with an XML-enabled functionality that significantly reduces discovery and reading time.

“This exciting initiative significantly adds value to AIP’s strategic partnership with AAPM,” said Robert Harington, Publisher, AIP Partnerships. “The migration of Medical Physics onto AIP’s Scitation C³ platform will enable us to provide AAPM’s diverse constituency of authors, readers and members with leading-edge functionality and innovative features to deliver a creative and flexible user experience.”

The new Medical Physics homepage includes a “Just Published” RSS feed and “Editor’s Picks” articles, while abstracts include links for “Related Content” and access to article objects (figures, tables, multimedia, etc.). Members and subscribers who log in encounter added tools for article objects, including the ability to export figures to PowerPoint.

Mobile phone users are automatically redirected to the streamlined mobile version of the site.

“We’re very pleased that the migration of Medical Physics has given the journal a fresh new look and brought Scitation C³’s innovative features and tools to our members and subscribers,” said Penny Slattery, AAPM’s Journal Manager.

“AIP has long proven to be an excellent partner on numerous projects. They designed the new Medical Physics pages to our specifications and showing a great awareness for how we need to present our content to subscribers.”

About Scitation AIP’s Scitation publishing platform hosts 2,000,000 articles from 200 scholarly publications for 28 learned society publishers in physics, chemistry, geosciences, engineering, acoustics, and other sciences. Scitation’s evolving nextgeneration platform, C³, represents today’s best-of-breed technology, with an XML foundation and flexible framework for multi-channel distribution of content and services, that enables both publishers and end users to manipulate and deliver content as never before and creates the tools and environment for content producers to position themselves for future publishing opportunities.

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President-Elect’s Column J. Anthony Seibert, UC Davis Medical Center

Cool as a Cucumber …… in Philadelphia

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or me, the 10 days spent at the annual meeting and summer school were quite cool, even though it was climatologically hot (no, very hot!). My week started on Friday midday, with a 10 hour EXCOM meeting, dealing with the business of the Association from all constituencies. Cool, as in very cool individuals running the show, including Mike Herman, the President, Maryellen Giger, the Chairman of the Board, John Gibbons, the Secretary, Janelle Malloy, the treasurer, and the glue and institutional knowledge that keeps it all together, Angela Keyser, the Executive Director. I am so lucky and privileged to be riding the coattails of so many dedicated and accomplished individuals, and as President-Elect, I hope to provide some coattails of my own in the coming years for future leaders of the AAPM…..

On Saturday morning (early!!) I participated in the Philabundance project to feed the hungry, with 20+ members of the AAPM volunteering to assist in the effort to sort, assemble and box canned goods, fresh food, and vegetables for distribution to those needing a helping hand and to have a source of food for a healthy meal and to simply make ends meet. When assembled, all volunteers were given a choice to work on the assembly line to box canned goods, boxed cereals, etc., or to work in the “cold room” to sort vegetables; the latter was described as having a coat available if needed for the lower temperatures. Well, for me sensing the 90 degree+ heat in the warehouse, I immediately volunteered for sorting the vegetables, ready and willing to work in an “air conditioned” environment, and scoffing at the thought of a jacket. Indrin Chetty and Angela Keyser apparently thought similarly, and we became the AAPM “cool team.” Upon entering the work area, the cool environment energized us, despite the presence of 5 gigantic tubs of cucumbers waiting to be sorted (and little did we know at the time there were more in the other room!). Given instructions on how to sort the cucumbers, we all began our tasks with gusto: good whole cucumbers, transfer over to a huge box; cucumbers not meeting standards, eventually send to the dumpster……but after a short while, my hands, wet with cucumber “sweat”, became extremely cold along with the rest of my body, and now I was wishing for one of those assembly-line jobs in the warmth of the open warehouse. I had to ask for a jacket (as did Indrin), which made things more tolerable. Angela, the stalwart, continued to work, sans jacket – keeping us going and pushing us to sort more and more cucumbers. After finishing the large tubs and taking a break, we came back to many more cucumbers to sort. These cucumbers was not as cold, and eventually through a lot of teamwork, we finished our tasks of tons of cucumber sorting with a great sense of accomplishment and gratification that we are able to help those in need, who really need our help. Other members of the AAPM and their family members on the assembly line were also incredibly productive, and all received a Philabundance Tshirt as a parting remembrance Philabundance T-Shirt given to all participants. Indrin Chetty and Tony Seibert working at Phildabudance.

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continued - AAPM President-Elect’s Column shown in the picture. Helping the community in which we have our annual meeting has become a tradition. I look forward to our next community volunteer service project at the Annual AAPM meeting in Vancouver 2011, and cordially invite you to participate – you’ll be glad you did!

Constant meetings during the first half of the Annual Meeting week meant very little personal time for me to attend scientific sessions or review posters or go to educational courses….. but the one truly fantastic session in which I was present and totally awed by was Mike Herman’s Presidential Symposium, “Diagnosis and Treatment, the Patient’s Perspective” where Mike skillfully put together the doctor’s point of view, from Radiation Oncologist, Dr. Robert Foote, with the patient’s perspective, Professor Jim Donnelly, a survivor of head and neck cancer. Due to unforeseen delays and airplane mechanical problems, Dr. Foote, who was scheduled to arrive in Philadelphia the night before, was stuck in Detroit, Michigan. No problem, until the first early morning flight for Philadelphia was also cancelled! Realizing that Dr. Foote would not be available to be at his 10:30 AM talk, Mike calmly asked Jim Donnelly to begin the session in the reverse intended order – and wow, what a captivating and riveting story presented to a large audience! A great speech and impromptu discussion of Dr. Donnelly’s trials and tribulations from the patient’s perspective of radiation therapy treatment sessions, what was important and comforting (as well as the not so comfortable aspects…) with the audience totally engaged…….. As his wonderful presentation ended, the audience stepped up to ask many pertinent questions, and a nice give and take discussion and recitals of the importance of the patient perspective was underway.

In the meantime, a plane was en route to Philadelphia, which landed at about 10:45 AM, with transportation waiting at the airport. After negotiating the morning traffic, Dr. Foote arrived just at the time the discussion (and Jim Donnelly’s dancing) was winding down. With very little delay and a lot of composure, Dr. Foote addressed the audience with a clinical overview of the patient’s situation, choices that had to be made, and the steps taken to provide the treatment planning, prognosis, continuing care, and follow-up. Amazing that it all happened the way it did, given the circumstances, and despite the steep odds of pulling it as a resounding success, Mike was “cool as a cucumber” through it all. Congratulations Mike! And congratulations to Dr. Foote and Professor Donnelly and to the audience who listened and participated.

I was honored to attend and represent the AAPM at the inaugural Society of Euro-American Medical Physicists (SEAMP) gathering on Tuesday evening of the annual meeting, and was very impressed at the festivities and esteemed medical physicists present at the event. Best wishes to Victor Gurvich, President of SEAMP and colleagues for the development of the Society. We at the AAPM look forward to future collegial and cooperative interactions, as we do with other medical physics organizations world-wide.

At the Board of Directors meeting on Thursday, an important step in the development and honing of the strategic plan for the AAPM was taken by Maryellen Giger, Chairman of the Board, and Mike Herman to have the board members take part in an active discussion in order to rank the importance of the stated objectives and goals that were the outcome of the efforts by Jerry White and Bill Hendee, the authors of the report. We all look forward to the direction of the board and the results of their deliberation to set the course for the AAPM in an effective and purposeful way through the framework of the strategic plan.

Early morning Friday, day 8 in Philadelphia, began with a change of venue to the beautiful University of Pennsylvania campus across town, and to the summer school of “LOVE” -- Learning Onsite Very Effectively …. with a program designed to help medical physicists become better teachers to physicians, graduate students, and technologists. Bill Hendee, the scientific director of the school (how does he do so much good stuff???) put together an outstanding program with top-notch educators and presenters to share their experiences with the attendees. Topics included how

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continued - AAPM President-Elect’s Column to become effective teachers, how to learn problem solving techniques, how to become a more effective speaker, how to learn through problem solving, collaboration, and assessment, how to create an active learning environment, how to engage students in the learning process, and how teachers should serve as “learning facilitators” among many, many other “how-to’s”. Just an amazing summer school! Thanks Bill, thanks George Starkschall, Education Council Chair, thanks William Parker, Chair of the Summer School subcommittee, thanks local arrangements committee, and thanks Karen McFarland and all headquarters staff who did an excellent job with logistics and keeping everything together!

My stay in Philadelphia ended midday Sunday, with a trip back to cooler California and to even eating some cucumbers on the way home….. Certainly this “cool as a cucumber” annual meeting was very love-ly and will be one to remember.

Memories of the 2010 Annual Meeting......

additional photos from the meeting can be found at: http://www.flickr.com/photos/96369280@ N00/sets/72157624483839939/

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AAPM Executive Director’s Column Angela R. Keyser, College Park, MD AAPM Annual Meeting in Philadelphia The Annual Meeting is always both an exciting and exhausting time for the HQ team! It is the one time during the year when many of us get to meet with you, our members and customers, face-to-face. I am proud of the AAPM HQ Team and the wonderful job they did supporting the many AAPM volunteers who planned the 52nd Annual Meeting in Philadelphia. We hold a “debriefing” meeting on Thursday afternoon before we depart the meeting city to share what worked, what didn’t, our lessons learned and areas for improvement. I’m always excited by the energy in the room and the true desire of the team to improve upon the recent experience.

I am pleased to report that the 2010 meeting drew the largest attendance in AAPM history, with a total of 4,080 registrants. There were 2,619 scientific registrants, which was up almost 12% from 2009.

While it may be hard to imagine, plans for the 2011 Annual Meeting are already gearing up.

AAPM will meet in conjunction with COMP in the beautiful city of Vancouver, BC. The meeting will be held July 31 – August 4, 2011.

Deadlines Approaching September 9 is the deadline for voting members to cast their vote on the proposed By-Laws amendments and dues changes. Do not delay in voting!

October 15 is the deadline for nominations for the William D. Coolidge Award, Edith H. Quimby Lifetime Achievement Award and AAPM Fellows as well as applications for the AAPM-IPEM Medical Physics Travel Grant. (http://www.aapm.org/org/callfornominations.asp) Attention Junior and Student Members Junior Members must provide an annual attestation from a Full Member that they are currently eligible for Junior Membership. Junior Membership is open to individuals who possess an earned graduate degree in the Physical or Biological Sciences, Computer Sciences, Mathematical Sciences, or Engineering and who are currently a Post-Doctoral Student, Fellow or Resident in a program not accredited by CAMPEP on a full- or part-time basis, and who are engaged in professional, research, or academic activity related to applications of physics in medicine and biology.

All Junior Members were sent an email in mid-August with instructions on the process.

In order to remain a Student member after the first year of membership, students are asked to request that their Program Director go online and attest that the individual is enrolled in a degree program in the Physical or Biological Sciences, Computer Sciences, Mathematical Sciences, or Engineering (which may include a work-study program) at an accredited college or university, has an interest in applications of physics in medicine and biology and is not otherwise employed in the applications of physics in medicine and biology.

We recommend that you have your attestation in by October 1st to ensure that your renewal will go smoothly. If you have any questions, please contact HQ at 301-209-3350.

2011 AAPM Dues Renewals Dues renewal notices for the 2011 year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an official member.

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Editor’s Column

Mahadevappa Mahesh, Johns Hopkins University

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he annual meeting in Philadelphia was quite enduring amidst the heat wave. Now that the summer holidays are coming to an end, hopefully the heat wave will subside. I enjoyed the opportunity of talking with many of you during the annual meeting.

Regarding our efforts to increase the readership of this newsletter, as mentioned in the website editor’s column, the visit to the newsletter webpage increased by nearly 50% when the second notification was sent to those members who had not visited earlier. This is encouraging and therefore I have requested AAPM staff to send a second reminder about the availability of the newsletter to those who may have missed the first announcement. Increasing readership is key in our efforts to increase the revenue from the advertisement. Secondly, the newsletter contains articles from the leadership conveying AAPM activities and involvement in areas that impact our profession. Hence, I invite all those who regularly visit the newsletter webpage to encourage those colleagues of yours who may skip reading the newsletter on a regular basis.

continued - AAPM Executive Director’s Column New Reports Available Report of AAPM Task Group #159 – Recommended ethics curriculum for medical physics graduate and residency programs (http://www.aapm.org/pubs/reports/default.asp#tg159) Report of AAPM Task Group #101 -- Stereotactic body radiation therapy (http://www.aapm.org/ pubs/reports/default.asp#tg101) US Physics Team Each year, AAPM joins with the American Association of Physics Teachers (AAPT), the American Institute of Physics (AIP) and other societies to sponsor a team to represent the United States at the International Physics Olympiad Competition. This year the US team brought home 1 gold medal, 2 silver medals, and 2 bronze medals from the 41st International Physics Olympiad, held July 17 to 25 in Zagreb, Croatia.

The gold medal winner is Daniel Li, a senior at Thomas Jefferson High School for Science and Technology, Alexandria, VA. The silver medal winners are Eric Spieglan, a sophomore at Naperville North High School, Naperville, IL and Anand Oza, a senior at Montgomery Blair High School in Silver Spring, MD. The bronze medal winners are Jenny Lu, a senior at Pomperaug High School in Southbury, CT and David Field, a senior at the Phillips Andover Academy in Andover, MA. For a full report, go to: http://www.aapt.org/physicsteam/2010/

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Administrative Council Column Melissa Martin, MS, Gardena, CA

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he Administrative Council of the AAPM met for the first time on Saturday evening, July 17, 2010, at the Annual Meeting in Philadelphia. The Administrative Council was formed on the recommendation of an Ad Hoc Committee to group all of the major financial committees under one council in order for them to communicate and interact with one another better. The Board of Directors will have final approval as usual for the budget. It is my privilege to serve as the Chair of this new Council along with Bruce Curran as Vice Chair. We look forward to working with the Chairs of the committees constituting the Administrative Council. These committees and chairs are: Matt Podgorsak - Meeting Coordination Committee, Sam Armato - Journal Business Management Committee, Mark Bruels - Investment Advisory Committee, Janelle Molloy - Treasurer (Finance Committee), Allan deGuzman - Membership Committee, Doug Pfeiffer - Government and Regulatory Affairs Committee, Don Frey - Awards and Honors Committee, Larry Rothenberg - History Committee, Marty Weinhous - Electronic Media Coordination Committee, Paul DeLuca - Development Committee, Raymond Wu - International Affairs Committee, Eric Hendee - Regional Organization Committee, Per Halverson - Professional Council, and Staff Liaison - Angela Keyser. We were privileged to have several members of the Executive Committee at our Saturday evening meeting to provide their input and insight as to the goals and paths that the AAPM will be focusing on in the future.

A new Task Group #208 on Advertising Revenue and Policy was formed at this initial meeting to look at all of the sources of advertising revenue streams that fund the activities of the AAPM and develop consistent policies and pricing strategies for consistency within our many publications and meetings. These include the Medical Physics Journal, the Newsletter, banner ads for the placement service and other electronic notices, as well as exhibits at the national meetings and chapter meetings. Optimizing these sources of income will help develop a more consistent revenue stream to the organization.

At the Thursday Board of Directors meeting, one of the projects with high priority from the Strategic Planning Session was to task the Administrative Council with the development of a coordinated and consistent revenue stream to the organization. This will be done in conjunction with the Finance Committee and the AAPM staff. Work on this project will be initiated this fall along with the Budget Subcommittee meeting and meetings of the Council Chairs and EXCOM. Raymond Wu and Don Frey reported on several International Meetings and Schools that will be requesting AAPM endorsement, sponsorship, and/or Financial Support. Following the submission of all of these activities, a total amount of funding available to these schools and meetings will be decided at the Budget meeting and divided up according to priorities decided by the respective committees and council.

Robin Miller and Tom Potts, as Chairs of the Placement Service Task Group, along with Marty Weinhous, EMCC Chair, are actively working on a redevelopment of the current Placement Service. There is a proposal that has been developed and approved by the committee and council to proceed with this project with the AIP and Boxwood Technologies. This project should bring our outdated Placement Service into a more modern mode and make us more competitive for job placement listings. A service to incorporate listings for consulting services as well as residency listings will be incorporated into this new service. The goal of this project is to have the new service in place by early 2011.

Sudarshan Chamakuri, Media Relations Subcommittee Chair, is looking for ideas to make this subcommittee more active. Any members interested in participating on this project are invited

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continued - Administrative Council Column to contact Sudarshan to volunteer their time and ideas. With the many interactions with the media that our AAPM members have had in the past few months, we definitely need more training on how to interact appropriately with the public and the media.

2010 See what’s new in the

Doug Pfeiffer and Bob Pizzutiello are actively working on government activities. Bob Pizzutiello reported on the Joint Licensure Committee’s activities and accomplishments as well as the obstacles encountered along the way. At least two other states are very actively considering licensure of medical physicists at this time. The passage of the CARE Bill, which is closer than ever before, will be another significant and positive step at defining the qualifications of personnel providing medical physics services in addition to those states actively pursuing licensure.

52nd AAPM Annual Meeting

Paul DeLuca and other members of the Development Committee are actively developing ways to encourage AAPM members to donate to provide funding to support the development and training of future medical physicists. Currently only about 15% of the membership participates in this activity. Methods to make this easier and more beneficial to the membership are being explored on a continual basis.

Larry Rothenberg is looking for more members interested in the history of the AAPM. Opportunity exists at this time for new volunteers and ideas in addition to the continuation of the video interviews of notable members each year. These interviews are available for viewing on line in the video library.

As you can see, the Administrative Council is active and developing. We have been tasked with some significant responsibilities and will work toward accomplishing these in a timely and successful manner. We will be meeting again at the RSNA on Monday morning and actively working through conference calls until then.

AAPM Virtual Library Philadelphia, PA July 18-22

Physicists of Note Interviews

Presented by the AAPM History Committee Philadelphia, PA

AAPM Summer School Teaching Medical Physics: Innovations in Learning July 22-25 University of Pennsylvania Philadelphia, PA

Safety in Radiation Therapy A Call to Action June 24 – 25 Miami, FL

CT Dose Summit Scan Parameter Optimization April 29-30 Atlanta, GA

AAPM Training Session Brachytherapy

Presented at the CRCPD Annual Meeting April 18 Newport, RI

Presentations posted in the Virtual Library include: • Streaming audio of the speakers • Slides of the presentations In addition to the online presentations, DVD ROMs are also available.

Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs. http://www.aapm.org/meetings/virtual_library/

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AAPM Newsletter

September/October 2010

Professional Council Report Michael D. Mills, Louisville, KY

T

his month we have an array of items that impact our profession. First up is the CARE Bill, now introduced in the U.S. Senate. The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and radiation therapy bill (S. 3737) was introduced in the U.S. Senate by Sen. Mike Enzi, R-Wyo. And Sen. Tom Harkin, D-Iowa. Sen. Richard Burr, R-N.C. and Sen. Al Franken, D-Minn., are cosponsoring the CARE bill with Sens. Enzi and Harkin.

The CARE bill has been referred to the Senate Health, Education, Labor and Pensions Committee. In September 2009, the House CARE bill (H.R. 3652 was introduced by Rep. John Barrow, D-Ga., and now has 117 bipartisan cosponsors.

This year, supporters are more optimistic than ever before. The national attention to radiation safety combined with the largest ever support in the House support this optimism. If you receive word that a note to your Senator or House Representative would be especially timely, please do not neglect the opportunity.

The Clinical Practice Committee has been an active group with several significant projects ongoing. The Subcommittee on Practice Guidelines has provided an ongoing valuable service in offering review from a clinical/professional perspective of soon to be published AAPM Reports. SPG, headed by Maria Chan and Joann Prisciandaro, is also planning to fulfill their charge of drafting Medical Physics Practice Guidelines (MPPGs), pending direction from ExCom. MPPGs, an initiative and vision from Michael Herman and the Professional Council, will signify a major change in our association – to that of a practice guidance setting organization and as such is being approached enthusiastically yet cautiously by Professional Council. More information on this topic will be discussed in the months to come.

TG-194 – Simulation training for Medical Physicists and Impact on Procedure Outcome, chaired by Mike Schell, is moving forward with trial topics and an aggressive agenda. The Subcommittee on Vendor Relations and Product Usability (SPRVU) headed by Sugata Tripathi is working towards an advanced Product Problem Reporting Database and is in discussions over form, content, and reporting. This effort will produce a critical tool not currently provided by FDA to allow more complete tracking and trending of equipment issues.

A new Subcommittee which is being chaired by Dan Pavord will focus on the drafting of Competency Guidelines for clinical medical physicists, in an effort to formalize and standardize documentation in this important, if often overlooked area. For both the group practice as well as the solo practitioner, this is an essential component of peer review and demonstration of maintenance of qualifications.

The Diagnostic Work and Workforce Study Subcommittee, under Chairman Ed Nickoloff, has the following focus: There are two primary goals: (1) Create a guide based on a good statistical survey that would allow diagnostic facilities to assess that proper physics staffing based upon the type and number of imaging equipment (2) Provide a CPT type of assessment of the cost of medical physics support for each type of modality in term cost per patient study. The second goal could become important in assessing the cost for patient imaging studies by government agencies and insurance companies. The survey they developed is comprehensive while as simple as possible to measure the information we need. There will be a small trial survey this fall to test the instrument before national distribution. The final result will be a benchmark measurement of work for the diagnostic physicist, similar to the information provided by the Abt study in radiation oncology.

This summer, the Economics Committee is called upon to review the Hospital Outpatient Prospective Payment System rule for 2011, the 2011 Medicare Physician Fee Schedule, and interact with our physician colleagues to determine the appropriate positions for the AAPM to take. Also, ECON is working on an update for the Reimbursement Roadshow for 2011. This comprehensive lecture on the place of medical physicists in national economic health care policy is available for presentation to AAPM Chapter Meetings, provided speaker travel costs are provided. Please see Wendy Fuss Smith’s column for more details on the activities of the Economics Committee.

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AAPM Newsletter

September/October 2010

continued - Professional Council Report Please see Melissa Martin’s and Lynne Fairobent’s columns this month for updates respecting Government Relations (GRAC). As most of you are aware, GRAC has made an appropriate move to the Administrative Council and its activities will no longer be discussed in this column. Even so, we have a continuing interest in GRAC activities as they continue to affect the regulatory environment of our professional practice.

The New York Center for Health Workforce Studies of the University at Albany (State University of New York) has released two preliminary documents for review by the Workforce Subcommittee. The purpose is to address the current complexity of medical physics with respect to our training programs and pathway to board certification, and to develop a model for supply and demand for medical physicists for the foreseeable future. Ned Sternick serves as Chairman of Medical Physicist Workforce Subcommittee. At the 2010 Annual Meeting, results from the Workforce Study were presented that provide perspective on the difficulties medical physicists face in maintaining an expanding professional presence. The existing number of residency programs, especially diagnostic residency programs, is unacceptably too low to maintain the profession. The final report is expected toward the end of September.

Recommended ethics curriculum for medical physics graduate and residency programs: Report of Task Group 159 has been published in Medical Physics (Med. Phys. 37(8), August 2010). Christopher Serago and his Task Group are applauded for their comprehensive and detailed effort. Inclusion of this in the overall curriculum for training of medical physicists will only strengthen our profession.

Please note two important announcements from the American Board of Radiology concerning certification of medical physicists. The first clarifies Eligibility Requirements for the Part I Examination in Radiologic Physics: http://theabr.org/forms/ic_rp_statement.pdf, and the second addresses a relaxation in the employment requirement as a condition for taking Part I, http://theabr.org/news/extension.html.

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AAPM Newsletter

September/October 2010

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AAPM Newsletter

September/October 2010

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

NRC Issues Proposed Rule – Part 37 (75 FR 33901) Physical Protection of Byproduct Material; Proposed Rule (http://edocket.access.gpo.gov/2010/pdf/2010-13319.pdf)

O

n June 15th, NRC issued a proposed rule 10 CFR Part 37, Physical Protection of Byproduct Material; Proposed Rule in the Federal Register. If you have a blood irradiator or gamma knife, then you are currently under an NRC or Agreement State Order related to increased controls and need to review both the proposed rule and proposed guidance documents carefully to assess the differences between the order and proposed rule. It is equally important for AAPM members that do not currently have a blood irradiator or gamma to review the proposed rule and provide comment too.

The purpose is to amend NRC regulations to establish security requirements for the use and transport of category 1 and category 2 quantities of radioactive material, which the NRC considers to be risk-significant and therefore to warrant additional protection. Category 1 and category 2 thresholds are based on those established in the International Atomic Energy Agency (IAEA) Code of Conduct on the Safety and Security of Radioactive Sources, which NRC endorses. The objective of this proposed rule is to provide reasonable assurance of preventing the theft or diversion of category 1 and category 2 quantities of radioactive material. The proposed regulations would also include security requirements for the transportation of irradiated reactor fuel that weighs 100 grams or less in net weight of irradiated fuel. The proposed rule would affect any licensee that is authorized to possess category 1 or category 2 quantities of radioactive material, any licensee that transports these materials using ground transportation, and any licensee that transports small quantities of irradiated reactor fuel.

This rulemaking will codify the requirements in effect via specific orders issued to licensees with category 1 and category 2 sources. Category 1 quantities of radioactive material have been called radioactive material in quantities of concern (RAMQC). Category 1 and category 2 quantities of radioactive material have been called risk-significant radioactive material and refer specifically to 16 radioactive materials (14 single radionuclides Category 1 Threshold Category 2 Threshold and 2 combinations).

These materials are: americium-241; americium-241/beryllium; californium-252; curium-244; cobalt-60; cesium-137; gadolinium-153; iridium-192; plutonium-238; plutonium-239/beryllium; promethium-147; radium-226; selenium-75; strontium-90 (yttrium-90); thulium-170; and ytterbium-169. Irradiated fuel and mixed oxide fuel are not included even though they may contain cat-

Radioactive Material Americium-241 Americium-241/Beryllium Californium-252 Curium-244 Cu u Cobalt-60 Cesium-137 Gaolinium-153 Iridium-192 Plutonium-238 Plutonium-239/Beryllium

Terabequerals (TBq) 60 60 20 50 30 100 1,000 80 60 60

Promethium-147 Radium-226 Selenium-75 Strontium 90 (Yttrium-90) Strontium-90 (Yttrium 90) Thulium-170 Ytterbium-169

40,000 40 200 1 000 1,000 20,000 300

17 17

17 17

Curies (CI) 1,620 1,620 540 1,350 ,350 810 2,700 27,000 2,160 1,620 1,620 1,080,00 0 1,080 5,400 27 000 27,000 540,000 8,100

Terabequerals (TBq) 0.6 0.6 0.2 0.5 0.3 1 10.0 0.8 0.6 0.6 400 0.4 2.0 10 0 10.0 200 3.0

Curie s (CI) 16.2 16.2 5.40 13.5 3.5 8.10 27.0 270 21.6 16.2 16.2 10,80 0 10.8 54.0 270 5,400 81.0

AAPM Newsletter

September/October 2010

continued - Legislative and Regulatory Affairs egory 1 or category 2 quantities of radioactive material; these materials are covered by other regulations. The thresholds for category 1 and category 2 quantities of radioactive material are provided in the following table. Terabecquerels is the official value to be used for determining whether a radioactive material is a category 1 or category 2 quantity. Because many licensees use curies in their activities instead of becquerels, the table provides the curie value at three figures for practical usefulness.

NRC is asking for specific comments in the following areas: • Fingerprinting of reviewing official • Background investigation elements • Protection of information • LLEA notification at temporary jobsites • Disabling vehicle exemption • License/address verification for transfer • NRC-approved monitoring plan for railroad classification yard This proposed rule and associated guidance were discussed at the Organization of Agreement States (OAS) meeting in August. In their comment letter dated July 8, 2010, OAS stated: “In general, OAS continues to believe that the regulations should reflect the Orders, and any expansion should be based on evidence where the Orders were ineffective. We believe the Orders are adequate and implementation issues have been addressed through the use of frequently asked questions posted on the NRC Increased Controls and Security Tool Box.” The complete OAS letter can be found at: http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900 006480b1d852.

The proposed rule and additional information can be found at www.regulations.gov at NRC 20080120. Comments are due to NRC October 15, 2010. In addition to the proposed rule, NRC has posted the following documents at www.regulations.gov NRC 2010-0194: Draft Implementation Guidance, Draft Regulatory Analysis and EA and FONSI for review and comment.

If you have any questions, please contact Lynne Fairobent, AAPM’s Manager of Legislative and Regulatory Affairs at lynne@aapm.org.

NRC Commissioners Direct Staff to Rework Reproposed Rule: Medical Use of Byproduct Material – Amendments/Medical Event Definitions (RIN 3150-AI26) In the last issue of the newsletter I discussed that NRC staff had released their recommendations to repropose a rule to amend 10 CFR Part 35 related to reporting and notification of medical events and to clarify requirements for permanent implant brachytherapy. Since the article was published, the NRC Commissioners disapproved the staff’s recommendation to publish the reproposed amendments to Part 35 in the Federal Register. The Commissioners stated that: • The staff should work closely with the Advisory Committee on the Medical Uses of Isotopes and the broader medical and stakeholder community to develop event definitions that will protect the interests of patients, allow physicians the flexibility to take actions that they deem medically necessary, while continuing to enable the agency to detect failures in process, procedure, and training as well as any misapplication of byproduct materials by authorized users.

• The staff should hold a series of stakeholder workshops to discuss issues associated with the medical event definition. Areas for discussion should include, but not limited to, methods for defining medical events which continue to ensure the safe use of radioactive materials while providing flexibility to account for medically necessary adjustments and the terms and thresholds for reporting medical events to the NRC and patients.

Given the recent Commission vote, the current regulation will remain effective until the staff completes the additional outreach to stakeholders. Some interesting quotes from the Commissioners’ voting records follow.

Chairman Jazcko stated: “The staff should also work with stakeholders to address the apparent misunderstanding of medical events and the impact that the reporting of these events has on the

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AAPM Newsletter

September/October 2010

continued - Legislative and Regulatory Affairs patients. Unless this issue is addressed, there will always be a reluctance to have medical events reported regardless of the definition. Specifically, the staff should consider approaches for the agency and licensees to take to better educate patients and medical professionals about the role medical events play in NRC requirements.”

Commissioner Svinicki stated: “Of particular note, in my mind, were concerns that the proposed changes might interfere with the clinical judgments of medical practitioners to such an extent that the delivery of a beneficial treatment modality - “real-time” brachytherapy prostate implantation - would be impeded, or abandoned entirely, in favor of inferior or more invasive treatment modalities.”

Commissioner Magwood stated: “recommend that the staff work closely with the ACMUI and the broader medical community to develop an approach that will protect the interests of patients, allow physicians the flexibility to take actions that they deem medically necessary, and enable the agency to detect failures in process, procedure, and training as well as any misapplication of byproduct materials by users. This work should include a reconsideration of the term “medical event” and how it is used by the agency.”

Commissioner Ostendorff stated: “I believe that the policies outlined in the Commission’s 2000 Policy Statement on the Medical Use of Byproduct Material should guide the Commission’s actions here. That Policy Statement states that the “NRC will not intrude into medical judgments affecting patients, except as necessary to provide for the radiation safety of workers and the general public.” The Policy Statement further states that the “NRC will, when justified by the risk to patients, regulate the radiation safety of patients primarily to assure the use of radionuclides is in accordance with the physician’s directions.” In my view, the proposed changes to Part 35 are inconsistent with these policy directives.”

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AAPM Newsletter

September/October 2010

continued - Legislative and Regulatory Affairs Commissioner Apostolakis stated: “Staff should work with ACMUI and the medical community to develop a workable definition that addresses the NRC regulatory needs and that is reflective of the practice of permanent implant brachytherapy.”

The full Commission decision can be found at: http://www.nrc.gov/reading-rm/doc-collections/ commission/srm/2010/2010-0062srm.pdf and the individual votes and discussion of each of the NRC Commissioners can be found at: http://www.nrc.gov/reading-rm/doc-collections/commission/cvr/2010/2010-0062vtr.pdf.

If you have any questions, please contact Lynne Fairobent, AAPM’s Manager of Legislative and Regulatory Affairs at lynne@aapm.org.

Development of U.S. Nuclear Regulatory Commission Safety Culture Policy Statement: Public Meeting (75FR52046) (http://edocket.access.gpo.gov/2010/pdf/2010-20966.pdf ) The NRC plans to hold a public meeting on September 28, 2010, in its Las Vegas, Nevada hearing facility to solicit comments on the revision of its draft safety culture policy statement, including the revised definition and traits. The revision has been developed as a result of the NRC staff’s evaluation of the public comments submitted in response to the draft policy statement (74 FR 57525, November 6, 2009; Adams accession number: ML093030375), the results of the NRC’s February 2010 workshop (February workshop) on safety culture, and additional comments that stakeholders and other interested parties have provided to the staff at the various outreach activities that have occurred since February. The draft policy statement focuses on the unique aspects of nuclear safety and security and highlights the Commission’s expectations that the policy applies to individuals and organizations performing or overseeing NRC-regulated activities. Go to the following link for information related to NRC’s Safety Culture Policy Statement: http://www. nrc.gov/about-nrc/regulatory/enforcement/safety-culture.html.

NRC Issues Regulatory Guide 8.35 Revision 1: Planned Special Exposures (75FR52999) (http://edocket.access.gpo.gov/2010/pdf/2010-21517.pdf) Regulatory Guide 8.35 provides guidance on the conditions and prerequisites for permitting planned special exposure(s) (PSE(s)), as allowed by Title 10 of the Code of Federal Regulations (10 CFR) Part 20, “Standards for Protection against Radiation” (Ref. 1), the associated specific monitoring and reporting requirements, and examples of acceptable means of satisfying these requirements. This was issued with a temporary identification as Draft Regulatory Guide, DG–8032.

The full text of Regulatory Guide 8.35 Revision 1 can be found at: http://www.nrc.gov/readingrm/doc-collections/reg-guides/occupational-health/rg/.

NRC Notice of issuance and availability of Draft Regulatory Guide, DG–8035, ‘‘Administrative Practices in Radiation Surveys and Monitoring. ’’ (75FR52996) (http://edocket.access.gpo.gov/2010/pdf/2010-21522.pdf) On August 30, 2010, NRC announced the availability of Draft Regulatory Guide DG-8035. DG– 8035 is proposed Revision 1 of Regulatory Guide 8.2, dated August 1973. This guide provides general guidance that the staff of the NRC considers acceptable for the administrative practices associated with surveys and monitoring of ionizing radiation in licensed institutions, intended primarily for administrative and management personnel in organizations that are involved in, or are planning to initiate, activities involving the handling of radioactive materials or radiation.

The administrative requirements for radiation monitoring are mainly specified in Title 10 of the Code of Federal Regulations, part 20, ‘‘Standards for Protection against Radiation’’ (10 CFR part 20), and are applicable to all NRC-licensed activities. This part requires surveys in order to evaluate the significance of radiation levels that may be present. In addition, it requires radiation monitoring in order to obtain measurements for the evaluation of potential exposures and doses.

Comments are due October 29, 2010. A link to DG-8035 can be found at: http://www.aapm.org/ government_affairs/default.asp.

20

AAPM Newsletter

September/October 2010

AAPM Website Editor Report Christopher Marshall, NYU Medical Center

W

e assume that all members log in to the website (or do not log out after each session so as to be logged in automatically). Login allows us to provide personalized messages, personalized shortcuts under “MY AAPM” and to give access to restricted content on the site.

I strongly believe that this makes the site more useful to members. A long-standing issue is how to make the site more useful to non-members, which I have commented upon in previous reports. We recently added a new feature that is a small step in that direction. Non-members (or members who have not logged in) now see a general welcoming message, where you would normally see your personalized greeting. This new message provides a shortcut so that potential employers can get immediate access to the career services pages and a short statement about the AAPM extracted from the testimony that Mike Herman provided to Congress, with emphasis on our concern for safety issues. Check this out by selecting “Logout” from the top of the web page so that you emulate a non-member. Our next step is to provide a customized home page for non-members, which will be a subset of the page that members see – this will simplify navigation and allow us to focus non-members on non-member content. The bottom line is - if our website suddenly looks different then make sure you are logged in!

I spent my time at the Annual Meeting attending committee meetings as a member, consultant or guest wherever possible, and had many useful chats with individuals as we coincided in the corridors. While web-based tools allow committees to conduct business efficiently in virtual space these days, it’s hard to beat real space for serendipity.

We have learned more about how we can use tracking data since I first reported on that topic.

In particular we have learned that sending a second email reminder about the Newsletter to those who did not access it the first time boosts readership by about 50%. We also found that sending similar reminders to those who did not yet vote helped boost the total vote significantly.

I assume that members are busy, that it is easy to miss things the first or second time around, and that reminders are helpful, although I also recognize that excess emails are an annoyance.

Rest assured that the tracking system is only used to generate the automatic email reminder – we don’t keep score.

Sixteen committees were using the wiki tools for various projects at last count, some of which are intended to provide information to members. This creates a new issue. Traditionally committees produced content that was completed, approved by parent committee or council and then published in some form. However a wiki is dynamic in that it can be continuously updated, and there is no moment when it can be said to be completed and thus reviewed and released. Alternatives are to accept that reality and the associated risk that inaccurate or inappropriate content might then be made available, or to “freeze” the wiki content, review and release it and perhaps release periodic updates. No decision has been made but comments on the issue would be appreciated.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www. aapm.org/pubs/newsletter/WebsiteEditor/3505.asp

2011 Awards and Honors Call for Nominations and Applications Deadline is October 15, 2010

http://www.aapm.org/org/callfornominations.asp 21 21

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AAPM Newsletter

September/October 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 launched its newest accreditation program, the Breast MRI Accreditation Program, in May 2010. The following questions are actual ones received by the ACR regarding this new program. To see more FAQs on this topic, please visit the ACR website.

Q. May we apply for Breast MRI accreditation as a module under the general MRI Accreditation Program?

A. No, the Breast MRI Accreditation Program is a stand-alone program and not a module under the general MRI Accreditation Program. You must apply for accreditation in breast MRI separately.

Q. We are applying for several modules in the MRI Accreditation Program’s online application process and want to apply for Breast MRI at the same time. Is Breast MRI Accreditation available through the online application? (We are combining this with a CT application so we can get 10% multi-modality discount.)

A. No. Application to the Breast MRI Accreditation Program is not available online at this time.

Because it is a new program, the Breast MRI Accreditation application process is manual. (However, eventually it will be part of the online accreditation process.) You may download the application documents from our website, complete them on paper and return them to us for processing. ACR staff will verify your application status to ensure you receive the 10% multi-modality discount.

Q. Why is a separate accreditation program needed specifically for Breast MRI? A. A growing number of facilities performing breast MRI do so on dedicated magnets. They are not able to apply for the general ACR MRI Accreditation Program since they would not be able to submit the required exams for review. In addition, there are unique quality components to a breast MRI exam that are critical to a high quality exam and diagnosis. These are evaluated by the new Breast MRI Accreditation Program.

Q. What facilities should apply for Breast MRI Accreditation? Outpatient? Hospitals?

A. ACR encourages any facility performing breast MRI to apply for Breast MRI Accreditation. However, it is critical to note that effective January 1, 2012, all providers that bill for CT, PET, nuclear medicine and MRI (including breast MRI), under part B of the Medicare Physician Fee Schedule must be accredited in order to receive technical component reimbursement from Medicare. Facilities should apply no later than July 1, 2011 in order to be accredited by the deadline of January 1, 2012. Unlike the provisional status for mammography under MQSA, CMS will not reimburse for breast MRI if a site is not fully accredited.

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CONGRATULATIONS!!

Congratulations to the four winners of the 2010 Visit the Vendors Program that took place during the Annual Meeting in Philadelphia. Each winner will receive free registration to the 2010 AAPM Annual Meeting to be held in Vancouver, BC Canada. Congratulations to: Libby Brateman

Bruce Thomadson

Wayne Butler

Qingyun Zhang

AAPM Newsletter

September/October 2010

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

2011 Proposed Rule Provides Payment Increases to Radiation Oncology and Decreases to Radiology

T

he Centers for Medicare and Medicaid Services (CMS) recently released the 2011 Medicare Physician Fee Schedule (MPFS) proposed rule. The MPFS specifies payment rates to physicians and other providers, including freestanding centers. The most widespread specialty impacts of proposed 2011 relative value unit (RVU) changes are generally related to two factors. First, CMS is implementing the second year of the 4-year transition to new practice expense RVUs using the American Medical Association (AMA) Physician Practice Information Survey data. The second factor is the proposed 2011 rescaling of RVUs based on a revised Medicare Economic Index (MEI).

Specialties with a high proportion of costs attributable to practice expense, such as radiation oncology, are estimated to experience an increase in aggregate payments due to MEI rebasing and revising.

The MEI is a measure of practice cost inflation to estimate annual changes in physicians’ operating costs and earning levels. The MEI is used in the annual update calculation to determine the conversion factor. CMS proposes to rebase and revise the MEI for 2011 to reflect physician’s expenses in 2006. This proposal increases payments to radiation oncology by 4 percent and radiation therapy centers by 8 percent in 2011. It has zero impact to radiology payments.

CMS continues to implement a “bottom-up” practice expense methodology that utilizes the AMA Physician Practice Information Survey data. The AMA data is being phased-in over a 4-year period and has a redistributive effect on Medicare payments, which favors primary care specialties.

Effective January 1st, the Affordable Care Act mandates a 75 percent equipment utilization rate assumption to expensive diagnostic imaging equipment priced over $1 million. This provision will reduce future payments for diagnostic computed tomography (CT) and magnetic resonance imaging (MRI) procedures. In addition, CMS proposes to expand the list of services subject to the 75 percent utilization rate to expensive computed tomography angiography (CTA) and magnetic resonance angiography (MRA) procedures.

In 2006, CMS implemented the multiple procedure payment reduction (MPPR) to the technical component (TC) of certain diagnostic imaging procedures performed on contiguous areas of the body in a single session. Effective July 1, 2010, the Affordable Care Act increased the MPPR of the technical component of imaging services in a single session on contiguous body parts within families of codes from 25 to 50 percent. For 2011, CMS proposes to apply the MPPR regardless of family, that is, the policy would apply to multiple imaging services furnished within the same family of codes or across families and not limited to contiguous body areas. This proposal has a significant negative impact to diagnostic CT, CTA, MRI, MRA and ultrasound payments, whereby the first procedure with the highest payment receives 100% Medicare reimbursement; and only 50% reimbursement for the second and subsequent procedures provided in a single imaging session.

Further, the Affordable Care Act amends the in-office ancillary services exception to the selfreferral law as applied to MRI, CT and positron emission tomography (PET) to require a physician to disclose to a patient in writing at the time of the referral that there are other suppliers of these imaging services. CMS proposes to require that the referring physician provide the patient with a list of ten alternative suppliers within a 25-mile radius of the physician’s office who provide the same imaging services.

Lastly, based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 27.4 percent reduction to the current 2010 conversion factor of $36.87. Without legislative action, CMS estimates a 2011 conversion factor of $26.66. AAPM anticipates that Congress will

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AAPM Newsletter

September/October 2010

continued - Health Policy/Economic Issues avert the payment decrease slated for January 1, 2011, however, if Congress does not pass legislation the 2011 conversion factor would reduce all payments by an additional 27.4 percent to the impacts shown below.

Specialty

Radiation Oncology

Radiation Therapy Centers Radiology Total

Impact Work & Malpractice RVU Changes

Impact Practice Expense RVU & MPPR Changes

Impact MEI Rebasing

2011 Combined Impact

0%

-2%

+4%

0%

-3%

+8%

+5%

0% 0%

-6% 0%

0% 0%

-6% 0%

(Does not include -27.4% CF reduction)

+2%

AAPM will submit comments to CMS by the August 24th deadline. To read a complete summary of the proposed rule and to review impact tables go to: http://aapm.org/government_affairs/CMS/2011HealthPolicyUpdate.asp 2011 Policies & Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) published the 2011 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The proposed rule includes a 2.1% increase to Medicare payment rates for most services paid under the HOPPS in 2011.

The majority of radiation oncology procedure codes would realize increases in hospital outpatient facility payments, however, high dose rate (HDR) brachytherapy (APC 313), proton beam therapy (APCs 664 and 667) and stereotactic radiosurgery treatment delivery (APCs 65, 67 and 127) have payment reductions slated for 2011. Medical physics codes 77336 & 77370 in APC 304 receive a 2.4% increase in 2011 payments (see table on page 22).

SUMMARY OF 2011 PROPOSED RADIATION ONCOLOGY HOPPS PAYMENTS The Affordable Care Act imposes a 0.25% reduction to the 2011 hospital outpatient increase factor, requires Medicare to adjust HOPPS payments to eleven dedicated cancer hospitals and waives beneficiary cost-sharing for most Medicare-covered preventive services.

Other key CMS proposals include: • Continue to pay separately for each of the brachytherapy sources on a prospective basis, with payment rates to be determined using the 2009 claims-based median cost per source for each brachytherapy device. • Continue packaging of radiation oncology imaging guidance services for 2011.

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AAPM Newsletter

September/October 2010

continued - Health Policy/Economic Issues APC

Description

CPT Codes

2010 Payment

65 66 67 127 299 300

Level I SRS Level II SRS Level III SRS Level IV SRS Hyperthermia & Radiation Treatment Level I Radiation Therapy

301

Level II Radiation Therapy

303

Treatment Device Construction Level I Therapeutic Radiation Treatment Prep

G0251 G0340 G0173, G0339 77371 77470, 77600-77620 77401-77409 (77406), 77789 77411-77416, 77422,77423, 77750 77332-77334, 77338 77280, 77299 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399

304

305

Level II Therapeutic Radiation Treatment Prep

310

Level III Therapeutic Radiation Treatment Prep

312

Radioelement Applications

313

Brachytherapy

412 651

IMRT Treatment Delivery Complex Interstitial Radiation Source Application Level I Proton Beam Therapy Level II Proton Beam Therapy LDR Prostate Brachytherapy Composite

664 667 8001

$960.26 $2,481.99 $3,563.04 $7,326.30 $379.65

2011 Proposed Payment $940.86 $2,516.19 $3,414.14 $7220.61 $390.09

Percentage Change 2010 to 2011 -2.0% 1.4% -4.2% -1.4% 2.7%

$92.55

$98.43

6.4%

$154.86

$162.07

4.7%

$190.15

$198.12

4.2%

$102.68

$105.14

2.4%

$265.67

$278.27

4.7%

$925.07

$926.05

0.1%

$301.55

$348.00

15.4%

$775.65

$710.40

-8.4%

$420.19 $891.31

$440.04 $978.41

4.7% 9.8%

77520, 77522

$940.00

$902.21

-4.0%

77523, 77525

$1,229.66

$1,180.23

-4.0%

55875 + 77778

$3,104.99

$3,201.82

3.1%

77285, 77315, 77327, 32553, 55876, 77301, 77761, 77763, 77777, 77785, 77787, 77418, 77778

77290, 77321, 77328 49411, 77295, C9728 77762, 77776, 77799 77786, 0182T 0073T

• CMS is not proposing any new composite APCs for 2011, but continues composite APC payments for low dose rate prostate brachytherapy and multiple imaging procedures, including computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography and ultrasound.

A complete summary of the proposed rule and impact tables is on the AAPM website at: http://aapm.org/ government_affairs/ CMS/2011Health PolicyUpdate.asp The final rule will be published by November 1st, with an effective date of January 1, 2011.

APC reassignments for 2011 are highlighted in bold

IGRT Hospital Coding Alert Hospital outpatient departments are strongly encouraged to continue to report charges for all image guidance (e.g., 76000, 76001, 76950, 76965, 77011, 77014, 77417, 77421) and image processing services (e.g., 76376, 76377) regardless of whether the service is paid separately or packaged, using correct CPT codes. Medical Physicists should check with their department or hospital billing staff to ensure that they are aware of the need to report these charges. The goal is to continue to capture the costs of the packaged image guidance services utilized in radiation therapy procedures in the hospital data used to develop future APC payment rates.

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AAPM Newsletter

September/October 2010

New Professionals Subcommittee Report

Indra J. Das, Vice Chair, Professor and Director of Medical Physics & Midwest Proton radiotherapy Institute, Indiana University School of Medicine, Indianapolis

T

he title of professor (assistant, associate and full) in an academic setting sets one apart with their peers and provides automatic recognition in high class and society. This recognition comes with a price of hard work toiling multiple years during graduate school getting an advanced degree (PhD or DSc), followed by several years of post doctoral fellowship. During this time one gets used to a sleep deprived state, depression with poor data, unexplained and poor theory of research, rejection of a research paper or euphoria of publication of a paper in a scientific journal. This seasoning usually creates an environment of achievement and provides a mission to never lose sight of success.

Being in Medical physics one needs to realize that it is the patient that comes first. Hence what you do needs to be linked with clinical care. In an academic center life sits on a 3 legged chair (clinical, research and teaching). If it is a balanced chair you will never fall. However, life is not that simple and the 3 legs are always uneven and hence tipping and falling is a common situation. In modern days the qualification of the majority of medical physicists is a PhD degree that provides better recognition of stature and sets them apart from nurses and technologists that comprise the majority of the staff in a medical center or a hospital.

Academic life is not for every one. Think twice about the possibility that often your days never end.

You cannot keep your spouse happy with promises of dinner time, often being late for kid’s games and possibly postponing a long awaited vacation. Success is measured with yard sticks of your performance on each leg of the chair. However, your hard work provides opportunity for promotion to the next rank and ecstasy of happiness when your name is shown on a paper.

To achieve success, you must set your goals. A goal could be anything clinical, research or teaching such as: devising a better method for patient treatment, commissioning a machine, writing papers, getting a grant, writing a book chapter, teaching a course etc. Once you set a goal, you must work for it and look every week at what you have achieved. The shadow of your past days should be a good reflection of how well you have kept your pace.

Your hard work and creativity will always be rewarded by your institution, society, country and often internationally. With the internet age, people know you internationally in your field when they read your papers, reports and books. Such satisfaction could provide you a sense of accomplishment and a measure of success. It also provides you with possibility of collaboration with near or distant colleagues. Academic collaboration provides an additional level of satisfaction that promotes your academic endeavors.

Collaborations should be sought and friendships should be bridged to facilitate publication and involvement in task groups and grants. I would strongly advise getting involved as early as possible in your career by attending meetings, getting to know senior members, volunteering to work as referee of a manuscript and trying to participate as a guest or member of a task group or organizing a local meeting. These small chores add to your portfolio and let you meet other people who are working on such projects.

Make yourself visible in the clinical arena. Participate in departmental activities, meetings, seminars and chart rounds. Help start a journal club, help dosimetrists and therapists, support clinical care and most importantly interacts with intra- and inter-departmental physicians. These interactions provide opportunities for clinical problems to be solved; a seedling for an idea that leads to a project, then publication and possibly a grant application. Your success provides an opportunity to mentor new students and colleagues that are pivotal to expanding your ideas.

In summary, an academic life if balanced properly with opportunities for clinical care, research and teaching provides a channel for life-long learning, sharing knowledge, providing meaningful satisfaction and joy of achievement that every human should devour.

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AAPM Newsletter

September/October 2010

Minority Recruitment Subcommittee Report Paul Guèye, Chair

T

here are many physics demonstration kits available on the market for various fields (optics, mechanics, astrophysics …) but none in medical physics. If available, such tool could have enormous potential for publicizing and recruiting. Such a tool was pre-developed by the Minority Recruitment SubCommittee of the AAPM between the fall 2009 and spring 2010. The concept uses on a low power (few mW) laser that is passed through a plastic based human phantom containing various objects acting as internal organs and cancer tumors.

The laser is used to demonstrate imaging practices (i.e., viewing of internal anatomical features via X-rays, MRI …) and cancer therapy (such as skin cancer treatment, optical coherence tomography and other particle therapy beams). An anthropomorphic phantom is used to actually visualize the internal anatomy and the Geant4 Monte Carlo simulation toolkit for viewing the radiation beams during actual in clinical practice examples.

Figure 1: Medical physics laser based demonstration kit Last, the audience uses nerve guns and protecconcept. tive gears to mimic the accuracy of particle beams and moving targets. This tool was used in 2010 at various institutions: an elementary school (Robert E. Lee Elementary, Hampton, VA), an undergraduate school (Strayer University, Newport News, VA), a middle school summer program (Young Doctors Program of Hampton University, Hampton, VA) and was presented at the 2010 APS March meeting held in Portland, OR.

Figure 2: Demonstration at an elementary school (2nd graders). The far left picture shows the use of focusing (ex: pristine Bragg peak) and defocusing (ex: spreadout Bragg Peak) of laser light. The far right simulate a particle beam using nerve guns: one student mimic the beam momentum and direction, while the other student is a static or moving (respiratory gated) tumor.

In addition, we have participated in the 2010 MIT Cambridge Science Festival on April 24th. The intent in 2011 is to complete a detail description of the possibilities of such demonstration kit, train local students and faculty in using the kit and perform three demonstrations (spring, summer [during the AAPM annual meeting] and fall). For the summer, the goal is to follow the annual meting and interact with local students, faculty, and radiation oncology departments to perform annual demonstrations to raise the awareness within local communities with a sustainable involvement. This is an analogous of the Science Ambassador K-12 outreach program of the National Society of Black Physicists (www. nsbp.org).

Figure 3: Demonstrations at an undergraduate institution (far left) and a middle school summer program (far right). The far left picture shows the effect of diffraction in a medium (water) filled with different materials (oil, solid objects … for internal x-ray/CT/MRI imaging). In the far right, the anthropomorphic phantom can be seen lying on the table. The periodic table is shown by a 2nd grader to explain atomic and molecular structures.

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AAPM Newsletter

September/October 2010

Imaging for Treatment Assessment in Radiation Therapy (ITART) 2010 Robert Jeraj

I

n June 2010, the Imaging for Treatment Assessment in Radiation Therapy (ITART) 2010 meeting was held in Washington D.C. focusing on a simple question - how can imaging be explored in innovative ways to improve efficacy of radiation therapy? The meeting was co-sponsored by American Association of Physicists in Medicine (AAPM), American Society for Therapeutic Radiation Oncology (ASTRO), European Society for Therapeutic Radiology and Oncology (ESTRO), Radiological Society of North America (RSNA) and National Cancer Institute (NCI). The lion’s share of organizational efforts was provided by the wonderful staff at AAPM HQ. The strong scientific program with world-renowned invited speakers and high-quality proffered submissions attracted about 150 participants from four different continents and 13 different countries (20% outside US). About half of the participants were medical physicists, but a healthy mix of radiation oncologists (35%), radiologists, nuclear medicine physicians and biologists ensured very lively discussions. Sometimes complimentary views and opinions of a physicist, radiation oncologist and nuclear medicine physician could be heard at the same time. This strong inter-disciplinary flavor, combined with plenty of time reserved for questions, comments and brainstorming discussions provided a unique atmosphere, typically lacking from large meetings, where the academic spirit of scientific questioning, reasoning and arguing was at its best.

It was a kind of a meeting that everyone who has at least some academic and research drive could not resist but to enjoy immensely.

The meeting was divided into four different sections, each occupying half a day, each featuring three world-renowned invited speakers and a number of proffered oral and poster presentations. While radiation therapy was definitely in the main focus, many of the topics were of general interest to researchers involved in any therapeutic imaging application. The four sections were: (1) Imaging for target definition, (2) Imaging for treatment assessment, (3) Quantitative imaging and (4) Industry and regulations. While the highlights of the meeting are just too many to mention, it is worth it to single out a couple of them. The central focus of the imaging for target definition session was the question how to explore different molecular imaging modalities to better define tumor volumes for conventional radiotherapy, as well as how to explore tumor heterogeneity to define biological targets for biologically conformal radiotherapy, or dose painting. The main issues discussed were microscopic vs. macroscopic picture of biology with its visualization gap, importance of cancer stem cells in defining radioresistance, inadequacy of simple PET thresholding techniques for target definition and need for more advanced segmentation techniques, need for concurrent investigation of multiple biological phenotypes and their changes through the course of therapy, and need for more clinical trials that will uncover what the main phenotypes or combinations Poster viewing area at ITART that one would need to target are. The imaging for treatment assessment session focused on the question how to most effectively use anatomical, functional and molecular imaging to better understand treatment response dynamics and potentially validate imaging biomarkers as surrogate endpoints of clinical outcome. The main issues

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AAPM Newsletter

September/October 2010

continued - Imaging for Treatment Assessment in Radiation Therapy (ITART) 2010 discussed were relation and complimentarity between anatomical and functional/molecular Dade Moeller Gaithersburg MD response, lack of reliable imaging biomarkers Radiation Safety Las Vegas NV for normal tissue response assessment, and Academy need for direct clinical validation of imaging endpoints, rather than indirect validation with “gold standards” which are really only “surrogates of surrogates.” The quantitative imaging session offered a variety of perspectives Are you a Medical Physicist, RSO, assistant RSO, or on the need, problems and initiatives to Authorized User responsible for radioactive materials and leverage currently predominantly qualitative radiation-producing machines in your hospital? imaging to the adequate quantitative level.

To help keep you current with new techniques and The main issues discussed were the positive procedures, Dade Moeller Radiation Safety Academy offers this spiral of increased awareness for the need course for those managing or working with radioactive material of image quantification, trade-off between and radiation sources in a medical environment. clinical feasibility and practical utility of image For 5 days, you will receive practical information on a quantification, need for physical phantoms variety of topics including discussions of real-world experiences: and appropriate site credentialing, problems with quantitative imaging in a multi-center Regulatory inspections/audits Medical licensing setting, and strong need for close collaboration Instruments Fluoroscopy safety and team work of different stakeholders that Safety program management PET/CT programs Emergency response Brachytherapy sometimes have little in common to bring DOT shipping/receiving Nuclear medicine quantitative imaging into the clinical practice.

The last session on industry and regulations This course is approved by CAMPEP for 40.25 MPCEC did not have a proffered session, but the for qualified Medical Physicists. invited speakers offered plenty of food for thought, sometimes forgotten in an academic Visit: www.moellerinc.com/academy for a detailed course agenda. setting. The main issues discussed were close similarity between academic and industry Register online or call 800-871-7930

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needs and goals in the field of quantitative imaging, differences and increasing similarity between FDA regulations on drug and technology approval and strong concern about currently inadequate status of quantitative imaging requiring more academic research, luckily being supported by an increased number of funding opportunities not to be missed.

Could there be a better conclusion, proving that currently we have more questions than answers and that we are really just at the beginning of an exciting trip that merges imaging and radiotherapy research together? When the participants were asked for their feedback on whether the ITART meeting should be repeated, and in what form, the answer was absolutely yes, in the same form, and as often as possible. While this means more work for the organizing committee, the excitement, the need, the promises and the future call for another ITART meeting in two years. If you missed ITART 2010, you might want to reserve some time on your 2012 calendar already today. We might even have some answers by then…

Attention AAPM Committee Chairs: The 2011 Committee Appointment process is well underway. Please review your current and 2011 committee rosters.

If you would like to make any new appointments to your committee, we strongly encourage you to utilize AAPM’s Committee Classifieds: http://www.aapm.org/aapm_advertising/ committee_classifieds/

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AAPM Newsletter

September/October 2010

2010 Research Seed Funding Initiative Award

Paul Keall and Sabee Molloi, Co-chairs, Joint Working Group for Research Seed Funding Initiative

N

anoparticles, hypoxia imaging, MRI-linacs, real-time 3D image guidance, GPU programming, low dose CBCT and time of flight PET were some of the topics to be investigated by the twenty 2010 Research Seed Funding applicants. They are all being explored by 20 outstanding junior scientists in medical physics who applied for the AAPM Research Seed Funding Initiative awards.

The titles of all 20 applications are given in Table 1.

Table 1. Title of 2010 applications.

Imaging of the unstable plaque using a gold nanoparticle contrast agent and a CT system with photon counting detectors

High Quality and Low Dose 4D CBCT for IGRT

Tissue Oxygenation Metric to Determine the Efficacy of Oxygen-Assisted Radiotherapy Quantifying Design Characteristics of an In-Line Linac-MRI Apparatus for Image Guided Radiotherapy Monte Carlo Simulations of Compact Plasma Proton Accelerators for Pediatric Brain Tumor Radiotherapy A Study on the Use of Micromegas Technology for Proton Therapy Dosimetry NanoXact Gold Nanoparticles 50 nm Diameter Real-Time Image Registration for 3D Ultrasound Guided Partial Breast Irradiation Early Outcome Prediction for Cervical Cancer during Radiation Therapy Development of a GPU-based low dose conebeam CT reconstruction system for image guided radiotherapy Developing of In-House Wireless Automatic Continuous Inter and Intra-Fraction Patient Movement Monitoring Device Using Computerized Imaging System for External Beam Radiation Treatment

Figure 1. 2010 AAPM Research Seed Funding Initiative Award winner Guillem Pratx.

Single-projection based volumetric image reconstruction and 3D tumor tracking for lung cancer radiotherapy Image-guided radiation therapy for functional bone marrow sparing in patients with pelvic malignancies Ultrasound-Image Guided Radiation Treatment with Amplitude-Based Gating System GPU-based Fast Beam Orientation and Aperture Optimization for External Beam Partial Breast Irradiation X-Ray Luminescence Computed Tomography A novel technique for measurement of linear energy transfer in proton therapy beams Impact of Time-of-Flight and Respiratory Motion on PET/CT Tumor Detection and Characterization Feasibility Study of a patient-specific scatter correction approach for digital breast tomosynthesis

High Quality and Low Dose 4D CBCT for IGRT

Congratulations to the winner, Guillem Pratx (Figure 1) from Stanford University for his application X-Ray Luminescence Computed Tomography.

X-ray luminescence computed tomography is a molecular imaging modality based on the excitation and optical detection of X-ray-excitable material; in this case phosphor nanoparticles are used. The nanoparticles can be manufactured to emit near-infrared light when excited with X-rays. Tomographic images are generated by irradiating the subject using a sequence of programmed X-ray beams, while sensitive photo-detectors measure the light diffusing out of the subject. Dr. Pratx will receive $25 000 to further develop his research idea that is expected to lead to AAPM presentations, publications and a larger grant application to help Dr. Pratx develop into an independent scientist. Dr. Pratx received his BS degree in engineering from Ecole Centrale in Paris, France and his MS and PhD degrees in electrical engineering from Stanford University where he is now a post-doctoral fellow working with Professor Lei Xing.

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AAPM Newsletter

September/October 2010

continued -2010 Research Seed Funding Initiative Award This year the reviewers used the revised NIH application scoring from 1 to 9 for the areas Significance, Investigator, Innovation, Approach and Environment and gave a score for the Overall Impact. Potential conflicts between reviewers and applicants were identified. Three reviewers without conflicts were assigned to each proposal based on the expertise area of each reviewer.

Scores were compiled, after which the top applications were discussed in a conference call. Final voting and compilation of the scores was performed after the call.

Thank you to the members of the Joint Working Group for carefully reviewing the applications, and also to Jackie Ogburn at AAPM headquarters whose efforts greatly assisted the review process.

We look forward to receiving more interesting proposals, and supporting selected applicants in their quest to advance our scientific understanding in medical physics.

There are ongoing efforts to increase the number of awards through internal AAPM funding and external funding. Hopefully we can support more of the outstanding projects and scientists who have applied for seed funds. Past winners are listed in Table 2. Look out for announcements in late 2010 for the 2011 awards.

Also, all the best to Dr. Harald Paganetti who will be taking over the co-chair role from Paul Keall in 2011.

Year

Name

2005

Andrei Pugachev, Ph.D.

Institution Memorial SloanKettering Cancer Center

2006

Tom C. Hu, PhD

Medical College of Georgia

2007

Marco Carlone, Ph.D.

University of Alberta

2008

Zejian Liu

Johns Hopkins School of Medicine

2008

Amit Sawant

Stanford University

2009

Dan Ruan

Stanford University

2009

Kang-Hyun Ahn

Stanford University

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Title FDG uptake as an indicator of tumor microenvironment Monitoring Myocardial Ischemic-Reperfusion Induced Calcium Homeostasis Alteration

by MRI in Small Murine Model Study of RF interference for real time image guided adaptive radiotherapy Noninvasive imaging of radiation-induced lung inflammation via peripheral benzodiazepine receptor based nuclear imaging 4D Adaptive Radiotherapy Using InIn Room MRI for Treating Moving and Deforming Targets Developing a Hybrid IGRT System with Adaptive Measurements Accurate and ALARA Development of multiparametric molecular imager by integrating Overhauser-enhanced MRI with prepolarized MRI

AAPM Newsletter

September/October 2010

AAPM Coolidge Award 2010

INTRODUCTION OF DAVID W.O. ROGERS by Ervin B. Podgorsak Mr. President, officers of the AAPM, members of the Awards and Honors Committee, distinguished guests, ladies and gentlemen, colleagues and friends:

I

t is a real pleasure and great honor for me to stand in front of you here tonight to introduce Professor David Rogers, the 2010 recipient of the AAPM Coolidge Award. The Coolidge Award, the highest honor presented once a year by the AAPM, requires the recipient to have had an eminent and longstanding career in medical physics and to have demonstrated both leadership and excellence with significant impact: (1) on the scientific practice of medical physics, (2) on the professional development of the careers of other medical physicists, and (3) on national and international medical physics organizations, with specific emphasis on service to the AAPM. Professor Rogers is a superb Canadian medical physicist with a stellar world-wide reputation as a great scientist, gifted teacher, and exceptional role model. He clearly fulfilled the requirements for the Coolidge Award while working at the National Research Council in Ottawa from 1973 to 2003 (the last 20 years as Group Leader of the Ionizing Standards Group) and since 2003 as Canada Research Chair in Medical Physics and Professor of Physics at Carleton University in Ottawa, Ontario. Time does not permit me to describe in detail all Dave’s accomplishments; however, I will briefly present you with highlights touching upon the three areas of relevance for the Coolidge Award.

Dr. Rogers has had a significant impact on the practice of medical physics in two areas: (1) in development of EGS4/PRESTA/EGSnrc/BEAMnrc series of Monte Carlo codes for simulating radiation transport in dosimeters and patients and (2) in radiation dosimetry both with primary standards and in clinical dosimetry protocols. His work on clinical Monte Carlo codes is truly legendary and, of the many research papers that he wrote with his collaborators in this area, the 1995 paper, with close to 600 citations, became the most cited research paper published to date in the journal »Medical Physics«, while four papers were honored with Farrington Daniels Awards and one with a Sylvia Fedoruk Award. A summary of Dave’s remarkable scientific productivity reads as follows: 138 refereed publications; 25 chapters in books or proceedings; 2 edited books; and 176 invited presentations.

Dr. Rogers has had a significant positive influence on the professional development of a large number of students and colleagues, be it as a classroom teacher, workshop leader, course organizer, senior colleague, or thesis supervisor. During his NRC years as Group Leader, he invited and supported 17 postdoctoral fellows or research associates to work with him and his colleagues on various research projects in radiation dosimetry. Today, the list of these visiting scientists reads like a who’s who in contemporary radiation dosimetry.

Since 1986 Dave has organized and been a major lecturer at 28 EGS or BEAM courses and provided external beam dosimetry expertize at several AAPM summer schools. With Joanna Cygler he was co-director of the successful 2009 AAPM summer school on clinical dosimetry and he edited the book associated with the summer school, a badly needed up-to-date textbook on clinical radiation dosimetry.

During his professional career Dr. Rogers has played leadership roles both in the Canadian Organization of Medical Physicists (COMP) and the AAPM as well as in many other national and international organizations.

In the COMP, Rogers served most notably on its Executive Committee, as chair of the COMP, as founding chair of the Awards and Honors Committee and as founding chair of its Gold Medal Committee. He was a member of the Atomic Energy Control Board’s Advisory Committee on

32

AAPM Newsletter

September/October 2010

continued - AAPM Coolidge Award 2010 Radiation Protection from 1995 to 2000 and managed to divert an effort by the AECB to regulate clinical radiotherapy in Canada. The AECB was the precursor of the current Canadian Nuclear Safety Commission (CNSC), the Canadian equivalent of the US NRC. Dr. Rogers has played a role in a variety of international organizations. For example, for 15 years he was Canada’s representative on the “Comité Consultatif des Rayonnements Ionisants” of the “Bureau International des Poids et Mesures” (BIPM) in Paris which is basically the group coordinating the work of primary standards labs around the world. He has served as a consultant to the International Atomic Energy Agency (IAEA) concerning Monte Carlo related databases and has taught at a school in Trieste sponsored by the IAEA. He has also been on the international advisory boards for the World Congresses on Medical Physics for the past 20 years and on similar committees for the International Conferences on the use of computers in radiation therapy (ICCR).

Dave’s service to the AAPM is truly outstanding and broad, ranging from membership on numerous task groups through 3 terms on the Radiotherapy Committee to one term on the Board of Directors.

He also maintains a long-standing relationship with the journal Medical Physics, having served on its Editorial Board as Associate Editor since 1987 and as Deputy Editor for Radiotherapy since 2005. In addition, he served on the journal Business Management Committee for 6 years. He also served on the AAPM publications and research committees and as co-director of the 2009 summer school.

From this short summary of Dave’s stellar accomplishments, hard work, and significant contributions to medical physics, it is evident that he is an exceptional scientist in general and a superb medical physicist in particular, well worthy of the AAPM’s highest honor, the Coolidge Award. But, he is also a good man in general: a good husband, a great father, a role model to his students, and, just like in his approach to science, very practical and sensible in his approach to life. He had the good sense to propose marriage to Dr. Joanna Cygler, a very gifted medical physicist, and he had the good fortune that she accepted his proposal. In Joanna, Dave got his most ardent supporter and advisor in matters related to medical physics.

Dave Rogers is clearly one of the greatest Canadian medical physicists and I am not referring only to his height. He is also well-known for his contributions to scientific and professional meetings on medical physics. He always has a strong opinion on matters at hand, and subscribes to the maxim that everybody is entitled to his opinion, making for a lively and stimulating discussion.

Before I transfer the podium to Dave, I would like to express, on behalf of all Canadian medical physicists, our sincere appreciation for the opennes and welcoming attitude the AAPM is extending to Canadian medical physicists. This openness is expressed not only by encouraging us to make a contribution to the AAPM but also through holding occasional AAPM meetings in Canada and through honoring Canadian medical physicists, as is the case with the 2010 Coolidge Award.

Sincere thanks to American colleagues and congratulations to Professor Dave Rogers.

The podium is warmed up and yours, Dave.

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AAPM Newsletter

September/October 2010

2010 William D. Coolidge Award Acceptance Speech David W. O. Rogers

July 19, 2010 AAPM Awards Ceremony, Philadelphia, PA

F

irst I want to thank my long-time friend and colleague, Ervin Podgorsak for his introduction and for the work that he and many others did to nominate me for this award. I will always be grateful for that.

Second let me say how pleased I am to receive this honour from my friends and colleagues of the AAPM. This is especially true because of the great esteem that I feel for the many giants of the field that have been honored with this same award. Although I am a tall man, I don’t feel I measure up to the likes of John Laughlin, Larry Lanzl, John Cameron and many of the others who have won this award.

I also cannot help but acknowledge with gratitude your typically American generosity for having honored a non-US physicist for the second year in a row.

I am also deeply honored to join the company of 3 other Canadians who have received this award, people whom I have greatly admired and from whom I have learned so much: Harold Johns, Jack Cunningham and, of course, Ervin Podgorsak.

Similarly, as someone who has worked most of his career in a standards lab, I am deeply honored to follow in the footsteps of two other recipients, my now departed standards labs friends, Bob Loevinger and Herb Attix.

So in short, thank you very much for this award which means a great deal to me because of all these very positive associations.

When one is honored in this way, it makes you vitally aware of how much you owe to the many different people in your life. In particular I must give a huge amount of credit to my lovely wife, Joanna Cygler, who, as many of you know, is a superb clinical physicist. As I sit in my ivory tower, Joanna has helped me to understand what clinical physics is really about. But more importantly she has been my beloved partner in this adventure called living and I don’t know what I would do without her love and support.

As many of you know, our family is a blended family and one of the things I am most proud of in my life is that our four children are good friends and fine young people of whom I am very proud. Three of the four are with us this evening. Our eldest daughter Brenda is a statistician who presented us with our first grandchild, Brianna, on Valentines day this year. Our daughter Karine is currently working on her masters in social work and working weekends in an alcohol harm-reduction program. Our son Adam already has his MSW and works in the Canadian prison system after honing his skills working in the Texas system. Our younger son Mark cannot be here tonight as he is working at an outdoors camp and is just back from a 2 week canoe trip in the wilderness north of Lake Superior. Mark starts university in maths and physics this fall (as he says, “not because I like it but because it is easy!’’). So there is still a remote chance of continuing the tradition whereby the children of Canadian Coolidge awardees are involved with medical physics.

While I am introducing the family, I would like to thank my best friends Pat and Clive Doucet who have joined us here for a few days to get a break from Clive’s campaign to become the next mayor of the City of Ottawa. After 12 years on City Council, Clive is running as an inner city councillor who wants to strengthen local communities, and while he is up against the development lobby, win or lose Clive will continue to make Ottawa a better place to live.

But aside from one’s good friends and family, there are many other people who contribute to ones success and I have been especially blest.

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Figure1: Ted Litherland

AAPM Newsletter

September/October 2010

continued - 2010 William D. Coolidge Award Acceptance Speech My career in research started under the supervision of Ted Litherland (fig 1), one of the world’s great nuclear physicists in the 50s and 60s who later became a leading developer of accelerator mass spectrometry. He taught me the joy of doing science.

As with most other Canadian medical physicists, my career has been strongly influenced by Harold Johns (fig 2) who badgered NRC into putting me in charge of the dosimetry program because, when Harold was the president of the Canadian Association of Physicists in the late 1970s, I had dared to publicly confront him about the exploitation of young physicists. It tells you a lot about Harold Johns that by opposing him I had earned his respect, not his anger.

Something I only recently learned is that part of Harold’s success can be traced back to Tommy Douglas who was recently voted in a national poll to be the “greatest Canadian of all time.” He was a socialist Christian clergyman who went into politics and was responsible for the creation in the early sixties of the Canadian universal health care system. But more importantly in this context, in 1949 Harold Johns walked into Douglas’ office (who was Fig 2: Harold E. Johns then the minister of health for the province) and asked for the enormous sum of $100,000 to develop a Co-60 unit for radiotherapy - and Harold walked out of the office with the money secured on a handshake. The rest is history. Johns went on to be a driving force for Co-60 radiotherapy and the entire field of medical physics. So I am very pleased to have even an indirect link to our greatest Canadian. I hope that someday Americans will vote to recognize the person who finally establishes universal health care here as your greatest citizen as well (there was a round of applause).

Often good luck plays a real role in life, and it was my good luck that in the early 80s, John Scrimger was having a problem knowing whether one of his graduate students was brilliant or off-the-rails. The student was using Monte Carlo along with some novel analytic techniques to calculate dose in a patient. Scrimger’s solution was to have a one day symposium and he invited me to come along so I could meet Rock Mackie (fig 3) and hear about what Rock was doing. This was a great piece of good luck as it led me to make friends with a remarkable young scientist with whom I have had the pleasure of collaborating in various ways ever since. It was through Rock that I met and became good friends with Paul Reckwerdt. It has been a wonderful experience to watch the pair of them first build the treatment planning system now called Pinnacle and then to watch Tomotherapy grow from a far-out idea to a large commercial enterprise.

Figure 3: Rock Mackie and Paul Reckwerdt

In 1984 the entire section I was part of at the National Research Council was laid off in a civil-service-wide reduction implemented by the then new Conservative government.

There was a large protest created by the medical physics departments across Canada and Rock Mackie helped by getting headlines in the papers out west. Similarly, while being interviewed on Canada’s premier national radio science program about the effects the layoffs would have on cancer patients, Jack Cunningham (fig 4), after giving a properly Figure 4: Jack and Sheila Cunningham at our scientific explanation of the effects, was asked, point blank, home, Christmas 1998 “Do you mean Dr Cunningham that more cancer patients will die as a result of these layoffs?” Jack saved our bacon by exaggerating somewhat and stating: “Yes Jay, that is what I mean.” So although Jack couldn’t make it to this meeting I want to thank him for that interview since it is one of the reasons I am here today.

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continued - 2010 William D. Coolidge Award Acceptance Speech One of the other strokes of good fortune in my life was becoming friends with and collaborating with Ralph Nelson (fig 5) at the Stanford Linear Accelerator Center. Ralph had developed this really neat Monte Carlo simulation code called EGS3 and I joined the team trying to make it work better for low-energy applications (i.e. anything under 100 MeV). Ralph released EGS as freeware/ shareware before these terms became well known. We sent out over 1000 copies of the EGS4 system on 12� reels of mag tape before the internet made distribution easier. I still remember using e-mail to ship the EGS4 system back and forth most nights during 1985 as we prepared to release EGS4. This caused our IT people to repeatedly rap my knuckles for going over the 300 line limit on e-mails! We all owe Ralph Nelson a huge debt of thanks for his work on the EGS system and his drive to make it open software which has ensured that it is constantly improved by the user community.

Figure 5: Ralph Nelson, retired from SLAC, bluegrass band member

Figure 6: NRC Colleagues, Alex Bielajew, Ernesto Mainegra-Hing, Iwan Kawrakow, Michel Proulx and Blake Walters

I must also thank the wonderful people with whom I have so closely collaborated over the years at NRC as we developed and maintained the EGS and BEAM systems of Monte Carlo codes (fig 6). Alex Bielajew made major contributions to the EGS4/PRESTA code system; Iwan Kawrakow is the creative genius who has made the EGSnrc system what it is today and also developed the much faster VMC codes (along with Matthias Fippel who worked with Iwan for 3 months at NRC); Blake Walters who knows more about the BEAM code than anyone else and whose BEAM song is world

famous; and Ernesto Mainegra-Hing and Michel Proulx who have provided software/physics and systems support respectively.

One of the things I am most proud of in my career is the young physicists whom I have brought to North America and who have gone on to make significant contributions to medical physics (fig 7). This list includes Charlie Ma whom I brought from England (and indirectly his wife Lili Chen), Jan Seuntjens from Belgium, Malcolm McEwen from the UK, Ernesto MainegraHing from Cuba, Ken Shortt, a Canadian returning from Switzerland and Iwan Kawrakow came to NRC from Germany to work as a PDF with

Figure 7: Colleagues brought to North American medical physics: Ernesto Mainegra-Hing, Iwan Kawrakow, Ken Shortt, Jan Seuntjens, Charlie Ma, Claus Yang, George Ding along with Joanna and Dave, Houston 2009

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continued - 2010 William D. Coolidge Award Acceptance Speech Alex Bielajew, but whom I managed to hire on staff. It gives me great pleasure to see the contributions that each of them continues to make. This picture also shows George Ding and Claus Yang whom I supervised and who have gone on to strong careers as medical physicists.

Another one of the great joys in my life has been my interaction with students from Carleton University. Their accomplishments leave me with a sense of fatherly pride (fig 8). There have been too many to go through them all but many of them are presenting papers here at this meeting. Similarly I am very proud of the many PDFs who have worked with me and who have gone on to be heads of departments, academic researchers and certified medical physicists throughout Canada, the US and the rest of the world.

While talking about students and post-docs, I want to finish with a note of caution about the future of our field. While I fully realize that Figure 8: Some of the many students who have studied with Dave patient care is the bottom line of all clinical medical physics, I believe that the reason medical physicists are seen as essential to the radiotherapy and diagnostic processes is because we were the ones doing the cutting edge research that created whole new concepts in medicine such as Co-60 units, linacs, CT and PET Scanners, MRIs, IMRT and much much more. These advances are why many of us make the big bucks today and I firmly believe that we are on the road to no-where unless research is further emphasized and given a high priority by all medical physicists. I know many jobs are seen as purely clinical, but if all we do is clinical service, we risk being equated to technologists.

I recently performed a review in Canada of a joint college/university program for medical radiation technologists. The entry requirements were higher than for an honours degree in Physics at this first tier university because there were so many applicants to this technologist’s program which virtually guarantees a job after their BSc. These students are learning lots of physics and math as well as clinical skills: e.g., they had 12 Pinnacle treatment planning systems available in their labs. So what are we doing as clinical medical physicists to distinguish ourselves from these radiation technologists? We have to be doing research: it is research that sets us apart. Without a research component to every clinical physics position, we will soon find ourselves being replaced by radiation technologists making half the salary but doing a perfectly adequate clinical job with their strong physics background.

So as a start, I would like to see CAMPEP graduate programs and residency programs include a compulsory research component. The current Report 197 defines the curriculum required for a graduate program and has a section on Clinical Research in the topical outline, but the section in the text is empty. What kind of message is that sending? Research must be ingrained in every medical physicist at the graduate level. Research is the reason that we have been important in medicine. Of course not everyone can be producing revolutionary ideas, but everyone can contribute to the improvement of our craft, thereby improving patient care and continuing the traditions of our field.

I will now get down off my soapbox.

Once again, I want to thank my friends and colleagues for their friendship and support throughout the years. I thank you all very much for the honour you have bestowed upon me tonight. It is greatly appreciated.

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Persons in the News

F

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