AAPM Newsletter November/December 2010 Vol. 35 No. 6

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. 6

NOVEMBER/DECEMBER 2010

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

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n active year it has been for AAPM and I thank you for the opportunity and honor to serve as your president this year. We started out the year in high gear after strong public attention was focused on excessive doses in radiologic imaging followed directly by the New York Times articles highlighting heart breaking errors in radiation therapy. We have been engaged with Congress, federal agencies, other organizations and the press ever since.

We testified to the House Subcommittee on Health along with other societies on ways we could reduce and prevent medical radiation errors, which included: • Ensure national recognition of radiation therapy treatment team qualifications - 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. – support and pass the CARE bill. (This has become stagnant for a number of reasons).

• Improve and require practice accreditation - 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.

Included in this issue: • Provide a uniform, consistent, quantitative, and accessible national event reporting and notification system. Such a Chair of the Board p. 4 system will be a single centralized, modality independent President-Elect p. 6 repository for events and potential events that is easy to Executive Director p. 8 use, universal, anonymous and non-punitive. It will be Editor p. 9 based on a clearly defined nomenclature and provide a Education Council p. 11 mechanism for comprehensive analysis and information Professional Council p. 13 dissemination.

Leg. & Reg. Affairs p. 17 • Improve the FDA review process. Safety test data should ACR Accreditation p. 20 be uniformly reported in the 510(k) process and the results Health Policy/Econ Issues p. 21 of such testing made available to users in a transparent Working Group Report p. 23 manner. Robust safety checks should be well documented and demonstrated. Manufacturers should provide increased Med Phys Residency News p. 24 New Professionals SC p. 26 communication/display standardization.

ABR Physics Trustees Report p. 29 We have made similar statements to NRC, FDA and others on Travel Grant Report p. 30 multiple occasions.

Chapter Report p. 33 AAPM organized and hosted a CT Dose summit and followed it Image Wisely™ Report p. 35 through by developing and posting the first of its kind, specific US Science and Engineering CT scan quality protocols for use by the medical physics Festival Report p. 37 community in implementing consistent and safe imaging. We

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continued - AAPM President’s Column sponsored a Safety in Radiation Therapy Meeting to bring together the broad community in radiation oncology to present and discuss safety concerns within the practice of radiation oncology and to set direction for making improvements. A white paper from this meeting will be published soon. We wrote numerous position statements and responses related to our position or actions being taken regarding safety in the use of medical radiation. Working together with FDA, NCI and the Foundation for the NIH, we organized stakeholders roundtables on dose registries and medical event reporting databases for diagnostic imaging and outcomes registries and medical event reporting for radiation therapy. The meetings included government agencies, national associations, state regulators and manufacturers, all to help develop consensus and direction for the development of these essential tools. Dose and outcomes registries are necessary to recognize patterns of care in the larger cohort of patients at the national level and provide benchmarks for comparative effectiveness and practice quality. Medical event reporting is also essential at the national level as noted above, to learn from mistakes and prevent near misses from becoming catastrophic events. This will require all the stakeholders cooperating for an extended period of time. We formed an AAPM/ACR/ASTRO Patient Safety Task Force, which has met and continues to help guide and coordinate activities on patient safety in radiation oncology. We are continuously evaluating how AAPM can most effectively contribute to each of these efforts and take positive action either cooperatively or directly. We have commented on NRC rulemaking and policy proposals on medical events, safety culture and training and experience for example. We have spoken at FDA and White House listening sessions on technology assessment, comparative effectiveness and science.

We convened a Strategic Planning Adhoc Committee earlier in the year to develop a proposed list of objectives and strategies to carry out the new AAPM Mission and Goals approved by the Board of Directors in late 2009. This committee developed a list of 34 objectives with 136 specific strategies that were reviewed and prioritized by the AAPM Board of Directors this summer. Based on the Board review and prioritization a specific strategic plan is being proposed to the Board for review and approval at the RSNA meeting. The strategies include specific and achievable actions, associated with committees and councils of the AAPM. One of the actions taken at the Summer Board meeting created an Adhoc Committee on the Assumption of the Core Functions of the ACMP by the AAPM. This committee is finalizing a proposal to the AAPM BOD and the ACMP Board of Chancellors that will bring these functions into AAPM to create a single unified force for medical physics. It includes essential components such as maintaining the JACMP, the Marvin MD Williams award and maintaining a Spring medical physics meeting. The time has come for this re-unification.

The Technology Assessment Institute has become a permanent committee under Science Council, building structure to provide a broad array of capabilities toward comparative assessment and technology quality reviews (See Tony’s and Maryellen’s articles for more).

At our recent Fall AAPM meetings, EXCOM approved a request by the Administrative Council to continue work on a national database for qualified medical physicists. This is being done under the auspices of the Conference of Radiation Control Program Directors (CRCPD), with the understanding that state regulators (who comprise the membership of CRCPD) will use the new database as a primary mechanism to recognize that individuals meet the qualified medical physicist as defined by AAPM (PP-1). The national database will effectively be a secure, third party, list of board certified medical physicists. This work remains part of our national Qualified Medical Physicist and licensure efforts.

We have continued to develop strengths in practice guidance and accreditation, as Professional Council increases the visibility and scope of the Clinical Practice Committee and the Subcommittee on Practice Guidance. Working with the always prolific scientific and technical output of Science Council, this group is working toward developing medical physics practice guidance. We are also working to enhance cooperative work with accrediting organizations, including ACR/ASTRO and the IAC, each of whom benefits from the input of qualified medical physicists.

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continued - AAPM President’s Column We continue to make progress on the 2012/2014 deadlines through cooperative work with other organizations and continuing to support and guide accreditation for clinical medical physics education programs. Education Council continues to coordinate much of this work along with EXCOM. We still have work to do and if you are providing education, please work toward accreditation.

Our $50 dues increase request failed to pass a full membership vote by a close margin. This still indicates that we can tighten our belts and cut services and activities to maintain a better financial performance. This will have to be revisited if we wish to continue to be the premier medical physics organization in the world. While we accomplish much through huge volunteer effort, resources are needed to provide infrastructure and support and maintain this work.

One of the critical aspects of the Association that our dues support is our headquarters. This group of professionals provides unparalleled support for each of our officers, councils and committees.

Without the commitment and capability of the headquarters staff, AAPM could not achieve its goals.

I have had the privilege to represent AAPM in a number of capacities this year including the 20th Anniversary meeting of the Korean Society of Medical Physics and the second meeting of the Sino-American Network for Therapeutic Radiology and Oncology. It is fulfilling to see these organizations developing cooperative educational and professional activities. In Seoul we observed their efforts to tackle national licensure (not dissimilar to our own) and their successes in creating a robust board certification process.

I would like to personally thank each one of you who stepped up to the plate this year and took on more volunteer work on behalf of the AAPM and those whom we serve. Without the effort of each of you, AAPM would not be pre-eminent, nationally and internationally recognized or successful.

Your scientific, educational and professional efforts continuously improve patient care in diagnosis and treatment.

The American Association of Physicists in Medicine cordially invites you to attend the AAPM Tuesday Evening Reception at RSNA during the 2010 AAPM / RSNA Meeting Tuesday, November 30, 2010 6:00 pm - 8:00 pm Waldorf Room, Chicago Hilton Chicago, Illinois light hors d’oeuvres AAPM gratefully acknowledges the following co-sponsors for their contributions to this reception: Landauer, Inc.

Radiological Imaging Technology, Inc.

RTI Electronics, Inc.

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

AAPM, the Field of Medical Physics, Investments, Chocolates, and Thank Yous

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his is my last newsletter, being written now as your Chairman of the Board. On December 31, 2010, I will complete my tenure on the AAPM Executive Committee – first four years as your Treasurer, followed

by President-Elect, President, and then Chairman of the Board. I have been a member of the AAPM since 1980, and the AAPM has been a constant companion in my career as a medical physicist. I am proud and humbled to have served you all.

Many changes have occurred in the AAPM over the past decade and the association has kept with its vision of being a premier organization in medical physics, which is a broadly-based scientific and professional discipline encompassing physics principles and applications in biology and medicine.

The mission of the AAPM is to advance the science, education and professional practice of medical physics. How a medical physicist contributes to the mission can follow many paths involving innovative research, strong educational programs, and effective clinical care. How an association contributes comes from its strategic planning. Over the years, the interaction between EXCOM and the chairs of the Education Council, Professional Council, and Science Council has increased with growing synergy between the various council activities. I have learned much and my ad hoc committees were motivated by my visits to the various council retreats.

With regards to education, a major AAPM activity has been the hosting of the 2012/2014 summits at which AAPM leaders met with leaders from related organizations (such as CAMPEP, ABR, etc.) in order to reach a consensus on the didactic education and clinical training necessary to become a qualified clinical medical physicist. Through these discussions it became apparent that medical physics graduate programs are responsible for didactic education, research, and some clinical exposure, and that medical physics residency programs were responsible for clinical training.

The Figure below shows the various potential educational components and careers of a medical physicist. It is important to note that there are multiple careers in medical physics, and studies of our members, our profession, and our workforce should carefully include all.

Graduate Training and Career Pathways P in Medical Physics PhD (MS) in CAMPEP Medical Physics

Post Doc MedPhys

PhD (MS) in non--CAMPEP Medical Physics or PhD (MS) in other Physics [or equiv valent with at least minor i i Ph in Phys]]

CAMPEP medical physics residency Postt D P Doc MedPhys

CAMPEP combined Programs for MS/Residency [PMDM] or P fD /R id ProfDoc/Residency [DMP]

Post Grad CAMPEP courses* CAMPEP medical physics residency

Board Exams Research/ teaching career in academia or industry * Post Grad CAMPEP courses would be approved or taken in either a CA AMPEP Grad Program or CAMPEP Residency that have such post grad course CAMP PEP approval.

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continued - AAPM Chair of the Board’s Column During the past years, the AAPM has invested much effort and resources into making sure that those medical physicists who participate in clinical practice have sufficient education and training, and that this need is recognized by the appropriate government bodies. Firstly, the licensure initiative was supported by your AAPM Board of Directors, and as it continues, enhanced support for a registry of certified/qualified medical physicists has been added. I am sure discussions will continue on these two related but different routes; until certification and regulatory mechanisms are in place to help ensure quality patient care.

Another active initiative of the AAPM concerns technology assessment. The Technology Assessment Initiative (TAI) had been suggested by Science Council [chaired by John Boone], began as an ad hoc committee [chaired by Bill Hendee], and is now becoming a permanent committee under Science Council. The TAI aims to develop mechanisms with which to evaluate emerging medical physics technologies in the pre-FDA-market and post-market stages with respect to safety and efficacy. Collaboration with universities, government agencies, and other associations is now under discussion in order to make the TAI a reality.

Strong scientific research is a major reason that the field of medical physics is doing so well. Various ground-breaking innovations can be attributed to AAPM members, including establishment and advances in IMRT, image-guided therapy, digital angiography, tomographic imaging, molecular imaging, computer-aided diagnosis, and many many others. Thus, it is crucial that the AAPM continues to enhance its support of medical physics research. Continued support is needed for the various focused scientific meetings and forums that the AAPM hosts for AAPM members, which bring together experts to discuss pertinent topics as well as serve to disseminate state-ofthe-art information to all. Additional resources should be allocated in the future to promote the education of tomorrow’s medical physics innovators, to organize collaborative grant submissions, to continue publishing via Medical Physics, and to fund promising pilot research. AAPM will remain the premier association of medical physics only if advancements are made in BOTH the scientific and professional aspects of the discipline. Strong scientific discoveries and developments from basic science to translational to clinical research are critical to the continued improvement in the clinical care of patients. These are the investments that need to be made.

The Night Out and Mingling I want to stress the importance of having multiple opportunities to mingle at our Annual Meeting.

As I “grew up” at the AAPM meetings, many of my interactions with my fellow AAPM members, including many of the “greats of the time”, occurred during the social events – the coffee breaks, the ice breakers, the award ceremony gathering, and the night out. Now with my students, introductions are made generation to generation. It is important that AAPM retains these opportunities. I wonder how many innovative ideas occurred during these mingling discussions.

Chocolates and Thank You I would like to thank the many EXCOM members (past and present), AAPM members, and Headquarter staff with whom I have worked throughout my seven years on EXCOM – too many to name here and risk leaving someone out. You all know who you are! I also want to thank my family for supporting me and tolerating the many days and weeks that I spent away from home.

Finally, I will miss the very late night EXCOM meetings and the constant supply of chocolate to which EXCOM has grown accustomed. Angela Keyser and Lisa Giove were essential in keeping EXCOM organized and on course. The dedication of EXCOM, the Council chairs, the AAPM staff, and the AAPM volunteer members has been enlightening and inspiring. The number of donated hours by the many AAPM volunteers is what makes the AAPM, the AAPM. Get involved. Thank you.

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

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his is my final newsletter column as President-Elect – for me, in retrospect, seemingly an instant in time (of course until I had to think about what to write for the bimonthly newsletter column!......) What an amazing unfolding of events from the beginning of the year that have put medical physics issues on the national “prime-time” stage, ultimately with respect to the care of the patient. Mike Herman has done an outstanding job as president of our Association, responding in a very appropriate and timely way to Congress and to other stakeholders with regards to radiation in medicine and event reporting. His efforts have been very effective in contributing to the many directives and activities of the AAPM that have been initiated as a result of national media attention and publicity that have continued throughout the year. One recent example is the October 19 meeting of the Foundation for the National Institutes of Health, who together with the AAPM under Mike’s direction, invited representatives and stakeholders from several professional societies including physicians, technologists, and physicists; manufacturers (under the umbrella of MITA – The Medical Imaging and Therapy Technology Alliance); payers (CMS); accreditation groups (ACR and Joint Commission); and regulators (Center for Devices and Radiological Health –FDA and the Council on Radiation Control Program Directors – CRCPD). Lynne Fairobent was present to provide organizational support from the AAPM. Mike moderated both roundtable discussions for imaging in the morning session, and therapy in the afternoon. Efforts in developing a National Dose Registry and a National Event Reporting database for diagnostic imaging applications were discussed. While there is already a significant effort underway in the development of a National Dose Registry by the ACR, more attention and development of an Event Reporting Database is clearly needed. In the afternoon, the focus shifted to Radiation Therapy concerns with respect to an Outcomes Database for therapy procedures, in addition to a National Event Reporting database. The overall goals of the roundtable discussions were to determine potential collaboration and to develop consensus amongst the stakeholders regarding data access and consistent reporting mechanisms. There are many opportunities for the AAPM to take a leading role in many of the initiatives, to establish the medical physicist as a key component of these efforts, and to work with all stakeholders, including the users, the manufacturers, the payers, the accreditation organizations, and the regulators. A framework for further interaction has been agreed upon with those present at the roundtable discussions.

Attending on behalf of the AAPM were Bob Pizzutiello and me for the diagnostic imaging roundtable, and Gary Ezzell and Eric Ford for the radiation therapy roundtable. I plan to continue these efforts as a presidential agenda item in the coming year in concert with Mike as Chairman of the Board.

On the following day, October 20, I presented the AAPM position on several medical issues of concern to bring to the attention to the Commissioners of the Nuclear Regulatory Commission.

These included (1) reiteration of the need for Medical Event Reporting in a national system that is modality independent, easy to use, universal, anonymous, and non-punitive; (2) discussion of the limitations of the current, non-publicly available Nuclear Materials Event Database, NMED; (3) urging final resolution of the Ritenour Petition filed November 2006, requesting revision of the grandfather provision of part 35 to recognize individual diplomats previously named prior to October 2005, which affects over 2,000 Authorized Medical Physicists; and (4) support for the development of a continuous supply medical radioisotopes, which is essential to avoid delays in nuclear medical imaging procedures and potential of delivering suboptimal patient care. The

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continued - AAPM President-Elect’s Column commissioners and staff of the NRC were open to ours and others’ suggestions regarding many of the medically directed issues that affect us all.

In late September, Angela Keyser, Mike Herman, and I were invited to the annual meeting with the Radiological Society of North America (RSNA) Board of Directors, to discuss common issues and goals for the future of our respective organizations. The RSNA and AAPM ties, in terms of joint programming at the RSNA meeting, have existed since 1972, and we continue to work closely together. Recently, our organizations have expanded interactions beyond the annual meeting. Of current and great interest is the paradigm shift of educating diagnostic radiology residents with respect to American Board of Radiology initiated “Exam of the Future” that is beginning with this year’s class. Education modules, jointly produced by the AAPM and RSNA, are available on the RSNA website, http://www.rsna.org/Education/physics.cfm, with free access to members of the AAPM and RSNA. These modules are intended to provide educational opportunities to residents during their clinical rotations, with the medical physicist as an integral part of the education process. A question yet to be answered is how the physicist can most effectively make use of this content in terms of interactions with the residents and teaching with a more clinical emphasis. I urge all members, particularly those with teaching obligations to radiology residents, to log onto website and review the suite of available modules and become acquainted with the material. I think you will find it very useful, and with accumulated experience, details on how to best use the material will undoubtedly be discussed at upcoming AAPM meetings.

Another issue brought up with the RSNA leadership is the critical need for medical physics imaging residencies. There is already a substantial commitment to funding two resident positions per year by the RSNA, with the recognition and realization of the need for developing accredited imaging residency programs. We were fortunate to have this message re-broadcast by providing details to Dr. Reed Dunnick, a member of the RSNA Board of Directors, who was subsequently attending the annual meeting of the Society of Chairmen of Academic Radiology Departments (SCARD).

Hopefully, with the word getting out regarding medical physics residency programs in imaging, there will be programs being planned and sufficient slots to fill the anticipated needs for 2014 and beyond.

Regarding the need for more residencies in imaging physics, I direct your attention to the excellent newsletter article by Bob Pizzutiello (page 24) on a private-practice medical physics imaging residency program recently accredited by CAMPEP. Congratulations to Bob and his group for achieving this milestone and showing that residencies can be successfully established beyond academic centers with a business model and sustainable plan for success.

Finally, just before the fall AAPM meetings in College Park, I took the opportunity to meet the Delaware River Valley and RAMPS chapters of the AAPM, and wish to thank them for a great turnout, interesting discussions, and their hospitality. As always, I really appreciate the hard work and volunteer efforts of the membership, and look forward a productive year as President of the AAPM. I promise to work diligently to the cause of our profession, and represent you to the best of my abilities.

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AAPM Executive Director’s Column Angela R. Keyser, College Park, MD AAPM events during RSNA 2010 The most up-to-date schedule for AAPM meetings during the RSNA meeting is available online at: http://www.aapm.org/meetings/rsna2010/ schedule.asp. Make plans to join your colleagues on Tuesday, November 30th from 6:00 PM – 8:00 PM for the AAPM Reception during RSNA at the Chicago Hilton. Thanks to Landauer, Radiological Imaging Technology and RTI Electronics for their financial contributions to offset the costs for this event.

2011 Meeting Dates AAPM is partnering with the Canadian Organization of Medical Physics (COMP) to host AAPM’s 53rd Annual Meeting which will be held July 31 – August 4, 2011 at the Vancouver Convention Center in Vancouver, British Columbia. I would like to remind you at this time that all AAPM members residing outside of Canada must have a passport to get into the country. The Call for Abstracts will be available online in early January 2011. Registration and housing information will be posted in March.

The 2010 Summer School will immediately follow the Annual Meeting, running from August 4-9, 2011 at nearby Simon Fraser University. The topic is Uncertainties in External Beam Radiotherapy with Rock Mackie and Jatinder Palta serving as Program Directors.

Your Online Member Profile This is a reminder to keep your AAPM Membership Profile information up to date by going to http://www.aapm.org/memb/profile/ and making any changes necessary. Please, upload your picture if you have not already done so.

Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy: http://www.aapm.org/org/policies/details. asp?id=287&type=PP FYI The full report of AAPM TG 121 - Off-label use of medical products in radiation therapy is available online at: http://www.aapm.org/pubs/reports/RPT_121.pdf A new AAPM Career Services (Placement Bulletin) will be launched early in 2011 with enhanced features for job seekers and those looking to hire. Stay tuned for more details in the coming weeks.

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

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Editor’s Column

Mahadevappa Mahesh, Johns Hopkins University

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elcome to the final issue of the 2010 AAPM Newsletter. Earlier this year we began to publish the Newsletter in an electronic format only, there by transforming the Newsletter into a revenue source for AAPM. I would like to thank all of the Corporate Affiliates who continue to support the Newsletter by advertizing in it. As per our readers’ requests, we have changed the Newsletter format from three-column text to singlecolumn text hoping to enhance the electronic only format. In addition, we are now able to accurately track the number of members reading each issue of the Newsletter. In order to increase readership, we now send a second email reminder notice to the AAPM membership about the availability of the latest edition.

In general, 2010 has been very exciting to our field of medical physics and in fact several events have taken place that have highlighted the role medical physicists and their respective visibility further in the clinical arena. This Newsletter issue contains several articles about the medical physics profession from the leadership level to someone who just started as a career as medical physicist (page 26).

Finally, I would like to wish all of you happy holidays and an early wish for a happy newyear. I look forward to meeting many of you at the RSNA meeting later in November-December.

Next year we will continue to refine how we present our articles hoping that more of the AAPM membership will access the Newsletter. As always, I look forward to receiving any comments/ suggestion related to the Newsletter. continued - AAPM Executive Director’s Column charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities, Minority Serving Institutions or non-Minority Serving Institutions to gain such experience and apply to graduate programs in medical physics. For more information, go to: http://www.aapm.org/education/MUSE/ 2011 Dues Renewal 2011 dues renewal notices were distributed in October. You may pay your dues online or easily print out an invoice and mail in your payment. Eighteen AAPM Chapters have elected to have HQ collect chapter dues. Make sure to check to see if your chapter is participating. If it is, we hope that you will appreciate the convenience of paying your national and chapter dues at one time!

Headquarters News I firmly believe that part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high performing association management professionals. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2010. I want to publicly Lisa Rose Sullivan Penny Slattery Michael Woodward Farhana Khan Peggy Compton Noel Crisman-Fillhart

Yan-Hong Xing Tammy Conquest Corbi Foster Jackie Ogburn Kathleen Dwyer

17 years of service 14 years of service 14 years of service 12 years of service 6 years of service 5 years of service

4 years of service 3 years of service 3 years of service 3 years of service 1 year of service

thank them and acknowledge their efforts.

The AAPM Headquarters office will be closed Thursday, November 25th – Friday, November 26th, Friday, December 24th and Friday, December 31st. I wish you and your loved ones a happy and healthy holiday season.

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AAPM Newsletter

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Education Council Report George Starkschall, Houston, TX

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or the past few years, the 800-pound gorilla in the medical physics room has been the 2012/2014 deadline. For those few AAPM members who may not have heard of the deadline, it means that any individual seeking to sign up for Part 1 of the ABR certification examination in any branch of radiological physics in 2012 or later must be enrolled in a CAMPEPaccredited educational program (graduate program or residency), and any individual seeking to sign up for Part 1 of the examination in 2014 or later must be enrolled in a CAMPEP-accredited residency. Whether or not the establishment of this deadline is a good idea is no longer a debatable issue; it is the law of the land, and one of the challenges that has faced our community, the AAPM, and Education Council has been to ensure that a sufficient number of accredited residency programs are available to meet both the manpower needs of the healthcare community as well as to provide clinical educational opportunities for individuals completing accredited graduate educational programs.

In order to meet this challenge, the Medical Physics Residency Training and Promotion Subcommittee (MPRTP) was constituted several years ago. First chaired by John Bayouth and now chaired by Eric Klein, this subcommittee has been charged with developing plans to promote the development of residency training programs in medical physics. Over the past several years the subcommittee has held workshops to assist developing programs in preparing their self-study documentation, the preparation of such documentation being perhaps the most formidable challenge to a new program’s accreditation process.

Although initially, encouragement of residency program development was targeted at medical physics practices based in academic institutions, it was recognized that academic institutions alone would not be able to supply the community with a sufficient number of qualified clinical training opportunities. Moreover, private medical physics practices, and especially some of the larger practices, already had existing programs for training entry-level medical physicists that, with a small amount of effort, could be turned into accredited residency training programs.

Recently, the AAPM provided a grant to one such private practice, Upstate Medical Physics, led

by Bob Pizzutiello, to assist the practice in achieving CAMPEP accreditation for their training program. A stipulation of the grant was that they share their experience with other practices, enabling and encouraging other practices to follow their suit. They have now completed their application for accreditation and have made available to the community a copy of their selfstudy document and their business plan for their residency program. This past year, a residency program at another private medical physics practice, Northwest Medical Physics Center, led by Larry Sweeney, completed their self-study and has achieved CAMPEP accreditation. Last year, a residency program at a smaller practice, the Kansas City Cancer Center, led by Brian Wichman, achieved CAMPEP accreditation by affiliating their program with Mayo Clinic to provide trainees with clinical opportunities not available at a smaller practice.

It is not uncommon for medical physics practices to train entry-level physicists internally; the leap from an internal training program to a formal CAMPEP-accredited residency program is a feasible one. Not only would such a program provide its trainee with a path to ABR certification, but the process of accreditation provides the training program with a set of standards and a system of validation. Medical physicists who are key participants in private medical physics practices are strongly encouraged to consider formalizing their internal training programs and seek CAMPEP accreditation. For guidance and assistance in taking the first steps toward accreditation, please contact Eric Klein.

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AAPM Newsletter continued - Education Council Report Although the educational pathway towards a clinical career in medical physics is moving toward that of CAMPEP-accredited graduate program followed by CAMPEP-accredited residency program, the medical physics community has long been aware of alternative pathways toward clinical competence, recognizing the immense contributions made to our profession by individuals entering medical physics from other branches of science and engineering. To ensure that such individuals have the appropriate didactic background in medical physics to be able to enter CAMPEP-accredited residency programs for their clinical training, a Working Group, chaired by Richard Maughan, has been constituted to define the minimal didactic requirements for entry into a residency program.

Whereas the recently-published Report 197, Academic Program Recommendations for Graduate Degrees in Medical Physics, identifies the “shoulds” of an academic program, the report that Richard’s Working Group is producing will identify the “shalls” of an academic program.

Recently, many applications to ABR Part 1 were rejected because of inadequate evidence of completion of medical physics and biology didactic course requirements. Once adopted, the document being developed by the Working Group will provide residency programs with an explicit list of didactic requirements for candidate entry, placing initial responsibility for determining candidate qualifications on the residency program to which the candidate has applied.

Candidates in CAMPEP-accredited residency programs will thus have met the ABR requirements for didactic medical physics instruction.

November/December 2010

2010 See what’s new in the

AAPM Virtual Library 52nd AAPM Annual Meeting 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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November/December 2010

Professional Council Report Per H. Halvorsen, Newton, MA

An eventful year everal developments this year can have a significant impact on our profession – but only if we follow through on our own initiatives and seize the opportunities afforded us by external events.

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• • • •

To name a few: • Mainstream media coverage of errors in x-ray based imaging and therapy procedures, focusing a spotlight on the lack of standards whether in the realm of training, delineation of duties (scope of practice), clinical procedures, or quality assurance.

• New momentum for federal legislation mandating minimum training for clinical staff, and possibly legislation mandating accreditation for all therapy and imaging services.

Growth of clinical residency programs in anticipation of the 2014 ABR requirement.

Interest in rigorous technology assessment programs.

Strategic planning process within the AAPM leadership.

Possible alignment of the ACMP and AAPM.

We have an opportunity to strengthen the profession, both in terms of our own standards and in terms of the profession’s stature, and many of your colleagues are volunteering their time to ensure that we follow through on these initiatives.

Patient safety and clinical practice standards AAPM President Mike Herman has coordinated our collaboration with the ACR and ASTRO on development of a series of White Papers related to patient safety in radiotherapy. Hopefully these will be available to the membership shortly. At the same time, we are strengthening the AAPM’s support for the ACR/ASTRO Technical Standards and Practice Guidelines while we also work to lay the foundation for having the AAPM develop Medical Physics Practice Guidelines. The Practice Guidelines Subcommittee, chaired by Maria Chan and Joann Prisciandaro, will lead this effort and will seek greater cross-Council involvement through the Therapy and Imaging Physics Committees within Science Council and the Government and Regulatory Affairs Committee within the Administrative Council. Already today, the ACR program is only one of three CMS-approved accrediting entities, the IAC and The Joint Commission being the other two. Every accrediting entity will need a set of practice guidelines as a framework for accrediting clinics. In the long term, it would be better for our profession to have one consistent set of such practice guidelines, and the AAPM would be the natural source of such guidelines. Until then, we will offer support to each accrediting entity to ensure that medical physics is appropriately reflected in their practice guidelines.

Clinical residency programs With the ABR’s 2014 requirement moving ever closer, the pace of applications to CAMPEP for accreditation of residency programs is increasing. While most applicants to date have been academic institutions, one recent applicant was a private-practice imaging physics group. See the article by Bob Pizzutiello elsewhere in this Newsletter for a summary of their experience.

Medical physics workforce study The Center for Healthcare Workforce Studies at SUNY has completed the workforce study that the AAPM contracted for. Their report was recently submitted to the Medical Physics Workforce Subcommittee under the Professional Services Committee, and the Committee is reviewing the report now. Once the review is complete, this information should be available to the members.

It will be very helpful to have a clear understanding of the internal and external factors in our workforce trends, and we hope that this study will achieve this objective. A related project, the “Diagnostic Abt” study being chaired by Ed Nickoloff under the oversight of the Professional

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November/December 2010

continued - Professional Council Report Economics Committee, was deferred in 2010 due to budget constraints. We hope that this project will receive sufficient funding in 2011 to begin its work.

Placement Service being redesigned Though the Placement Service Subcommittee is now within the Administrative Council, I’m excited to hear that the redesign of the “Blue Book” service is finally underway. As most of you know, this important service could use a modern interface and modern features (such as attaching resumes), and a thorough plan for the new design was presented in past years but was deferred due to budget constraints. Look for more information from chairperson Robin Miller in the months ahead.

New Professionals Subcommittee The New Professionals Subcommittee within the Professional Services Committee has been actively working on a resource guide for new members, and will soon post this as a Wiki tool for all members to benefit from. We have also invited them to design and moderate the New Member Symposium at next year’s Annual Meeting – they have a much better sense of what matters most to new members than the “old folks” on the Council, and I look forward to an engaging symposium next summer!

ACMP and AAPM At the ACMP’s Board meeting in May, the College voted to explore the possibility of an alignment with the AAPM. At the AAPM’s Board meeting in July, the Association voted to assume the core elements of the ACMP subject to the approval of a joint agreement by both organizations. This represents an opportunity to forge a close alignment of the two organizations’ common goals for the profession – whatever the final outcome of the current discussions. AAPM President Mike Herman formed an Ad-Hoc Committee to develop a set of recommendations for how we could accomplish these goals, and the Ad-Hoc aims to have the recommendations ready for the Boards by November.

Dade Moeller Gaithersburg MD Radiation Safety Las Vegas NV Academy

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Medical licensing Fluoroscopy safety PET/CT programs Brachytherapy Nuclear medicine

Regulatory inspections/audits Instruments Safety program management Emergency response DOT shipping/receiving

This course is approved by CAMPEP for 40.25 MPCEC for qualified Medical Physicists.

Visit: www.moellerinc.com/academy for a detailed course agenda.

Register online or call 800-871-7930

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Money matters As you know, the Association has limited resources and cannot support all projects simultaneously. Last November, the Board approved the 2010 budget with significant reductions in funding for many Council and Committee level activities, prompted by the membership’s rejection last year of a proposed dues increase. Another dues increase proposal was rejected this summer. As a result, without alternate sources of revenue, the Association will have no choice but to stop funding many programs and could be unable to fund important new initiatives. We must, as an Association, make some difficult choices about funding priorities. The four Councils have collaborated closely in trying to find a balance that supports our Mission – by balancing the funding for scientific, educational, and clinical programs. I encourage you to look carefully at each Council’s projects and voice your opinion on whether we have prioritized correctly – we are all volunteers, and welcome your constructive criticism and suggestions for how we can do a better job with the resources available to us. If we are to continue without any dues increase in the foreseeable future, further cuts in projects and existing programs will surely be necessary.

AAPM Newsletter

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November/December 2010

AAPM Newsletter

November/December 2010

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

NRC Grants Extension to Public Comment Period for the Proposed Rule – Part 37 (75 FR 33901) Physical Protection of Byproduct Material; Proposed Rule (http://edocket.access.gpo.gov/2010/pdf/2010-13319.pdf)and Proposed Guidance Document to January 18, 2011

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ast month I provided information regarding this proposed rule. In response to a request by the AAPM and many others organizations and individuals, the NRC granted an extension to the public comment period until January 18, 2011.

The proposed rule and additional information can be found at www.regulations.gov at NRC 2008-0120. 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 at: http://www.regulations.gov/search/Regs/home.html#d ocumentDetail?R=0900006480b02554, Draft Regulatory Analysis and EA and FONSI at: http://www.regulations.gov/search/Regs/home.html#documentDetail?R=09000064 80b02554) for review and comment.

AAPM’s President-elect Briefs the NRC Commissioners on Three Issues October 20, 2010 President-elect, Tony Seibert was one of the stakeholders briefing the NRC Commissioners on October 20, 2010 during the Commission’s meeting on Medical Issues. Dr. Seibert briefed the Commission on the following three issues: • The need for a national event reporting database • Finalization of the issues raised in the Petition for Rulemaking filed by AAPM in September 2006 on training and experience • The need for a reliable US supply of medical isotopes Dr. Seibert stated that: • Event reporting in a national system is essential.

• Event reporting must be modality independent, easy to use, universal, anonymous, and nonpunitive.

• Event reporting must be able to collect potential and actual event data completely and efficiently.

• Data on medical errors is essential to conduct a trend analysis, make assessments, inform the community, and make improvements.

• Urged the NRC to resolve the 2006 Petition for Rulemaking (PRM-35-20) issues on training and experience.

• That is it critical that a reliable US supply for medical isotopes be developed.

Complete information from the briefing can be found at: http://www.nrc.gov/reading-rm/ doc-collections/commission/slides/2010/20101020/ AAPM files comments on the U.S. Nuclear Regulatory Commission’s Proposed Draft Safety Culture Policy Statement In response to a request for comments by the NRC on its revised draft safety culture policy statement, AAPM filed comments on October 19, 2010. In summary AAPM stated: 1. It is the responsibility of the licensees and certificate holders for developing and maintaining a strong safety program.

2. It is critical that a common language of safety culture traits and behaviors exist between NRC and each category of licensee.

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continued - Legislative and Regulatory Affairs 3. AAPM concurs with the revised definition.

4. AAPM concurs with excluding the term “security” from the definition including security in the definition denigrates other equally important processes that protect the patient, the public, and the environment.

5. Safety culture is not an appropriate subject for rulemaking.

6. NRC needs to acknowledge for medical institutions that patient safety is first and foremost and that the use of radioactive materials in the practice of medicine is to enhance diagnosis or treatment of disease while ensuring that the patient receives the best medical care.

7. Although it is laudable to try and have a single definition that can apply to all categories of licensees, it is equally important to note that implementation of the traits and behaviors as they apply to the specific licensee categories may differ.

8. NRC must define:

a. The characteristics that, in the agency’s view, define a positive safety culture, and

b. The metrics for assessing a licensee’s program against those characteristics.

c. Without specific definition, the interpretation of a positive safety culture remains

subjective.

9. AAPM believes the next critical step is to develop specific actionable characteristics and behaviors specific to each license category. This next level or “third tier,” once developed will provide more meaning in the individual licensee category and relate the general characteristics to specific behaviors and indications of a strong safety culture in that particular field.

10. NRC must work closely with the Agreement States to prioritize this effort relative to other regulatory issues.

11. NRC should conduct workshops, in coordination with the Agreement States, specific to each category of licensee to clarify NRC’s approach to safety culture and ensure that its expectations are clearly understood.

12. NRC should refrain from including safety culture issues in inspection reports and assessments until such time that the final policy has been issued, relevant coordination with the regulated community and Agreement States has occurred, and implementing guidance is issued to ensure that NRC’s expectations are clear.

13. NRC’s safety culture scheme should be clarified that if medical licensees can demonstrate the extent to which current requirements and practice meet the “intent of the NRC safety culture policy”, they should not have to use methods and terminology developed by NRC staff who might have limited understanding of methods and requirements currently used by healthcare organizations.

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.

OECD Nuclear Energy Agency (NEA) Releases its report titled: “The Supply of Medical Radioisotopes: An Economic Study of the Molybdenum-99m Supply Chain” on October 15, 2010 “The Supply of Medical Radioisotopes: An Economic Study of the Molybdenum-99 Supply Chain” is the first of a series of reports being prepared in support of the NEA High-level Group on the Security of Supply of Medical Radioisotopes (HLG-MR). The study offers a unique analysis of the economic structure and present state of the Mo-99/Tc-99m supply chain (from reactors to patients), and presents options to governments and other important decision makers for creating

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continued - Legislative and Regulatory Affairs a sustainable economic structure. A goal of the report is to enhance understanding amongst stakeholders of the costs of supplying Mo-99 and ultimately contribute to a better functioning market.

Findings from the report: • The current economics of the supply chain of the most widely used medical radioisotope are not adequate for supporting new investment.

• The study finds that the market’s historical foundations have created an economically unsustainable supply chain.

• To have an economically sustainable supply chain, remuneration for reactor irradiation services and processing services needs to be based on the full costs of production.

• According to the study, the impact on the final cost of medical diagnostic procedures from a possible price increase would be small.

• To create an economically sustainable supply chain, the report provides a number of options for decision makers to consider. A key requirement is for governments to define and to clearly communicate their role in financially supporting the industry. Once this is defined, the full cost of Mo-99 production must be identified and funded. Actors in the supply chain must also recognize the value of having reserve capacity and be willing to pay for this capacity to ensure reliable supply. To overcome the long-standing, longer-term problem of insufficient capital investment, changes must occur.

The full report can be found at: http://www.nea.fr/med-radio/.

November 5 Deadline for AAPM members to register (free) for the RSNA meeting

AAPM Meetings The schedule of AAPM meetings to take place during the 2010 RSNA meeting is posted at http://www.aapm.org/meetings/rsna2010/schedule. asp; all AAPM committee meetings will take place in the Hilton Chicago unless otherwise noted.

If you are a Council, Committee, Subcommittee, Task Group or Working Group Chair who wishes to add/move a meeting, please contact Karen MacFarland at karen@aapm.org

RSNA Program Physics and Basic Science Meeting Program can be found at: http://rsna2010.rsna.org/search/search.cfm?action=add

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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. Why is there a requirement that facilities accredited in breast MRI have MRI biopsy capabilities or an off-site arrangement for such?

A. The ACR Committee on Breast MRI Accreditation wants to ensure that women who have a suspicious finding under breast MRI are able to get a biopsy based on the results of the examination that discovers the finding. There are two key underlying reasons for this: • Cost - there have been frequent reports of patients who needed a biopsy as a result of a diagnostic breast MRI at one center and could not have the biopsy performed at that center.

They were then forced to pay out of pocket for a repeat breast MRI at another center that could perform their biopsy before that center would schedule a biopsy. This is because these centers are uncomfortable with the quality of exams performed at some facilities and do not feel that they can perform a biopsy safely without repeating the scan.

• Patient safety - a facility which does not have arrangements to schedule a biopsy could lead to patients foregoing needed biopsy because of inconvenience or cost, or because that facility might fail to recommend a biopsy based on their lack of equipment.

Q. Currently, we perform our breast biopsies on the MRI unit located within the hospital’s breast care center. Here we have code team response and surgical support should the biopsy prompt a severe bleed. Our routine breast MR exams are performed on a different unit due to the availability of specialized pulse sequences. The same organization owns both units and the same physicians and technologists involved with the diagnostic procedures perform the biopsies. Is it possible to obtain accreditation for both units…one for biopsy and one for diagnostic?

A. No. The ACR does not accredit breast MRI units specifically for breast biopsies. If you perform all breast imaging on one MRI unit and perform all breast biopsies on a different unit, the MRI unit that is used to perform breast biopsies is NOT required to undergo breast MRI accreditation. You only need to apply for accreditation of the unit used for diagnostic imaging.

Q. We perform our diagnostic breast MRI studies on a 3T unit but perform our interventional procedures on a 1.5T unit. Do we have to accredit both scanners?

A. No. If you perform all breast imaging on one MRI unit and perform all breast biopsies on a different unit, the MRI unit that is used to perform breast biopsies is NOT required to undergo breast MRI accreditation. You only need to apply for accreditation of the unit used for diagnostic imaging.

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

Accreditation of Advanced Diagnostic Imaging Section 135(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), designates organizations to accredit suppliers, including but not limited to physicians, nonphysician practitioners and Independent Diagnostic Testing Facilities, that furnish the technical component (TC) of advanced diagnostic imaging services. The provision is a condition of Medicare payment for the technical component (TC), or acquisition of the image, and covers the equipment, the technologists, and the supervising physician. The law includes a provision requiring providers of advanced diagnostic imaging services (ADIS) to meet comprehensive accreditation standards.

ADIS are defined as MRI, CT, and nuclear medicine/PET and specifically exclude x-ray, ultrasound, and fluoroscopy.

Since MIPPA deals only with the Medicare Physician Fee Schedule, it does not relate to hospital services. Therefore, it is important to note that hospitals are not required to meet the comprehensive accreditation requirements by 2012.

In addition, MIPPA only applies to providers of diagnostic imaging services and does not apply to CT scans performed for radiation oncology treatment planning purposes.

For additional information and FAQs, you may access the ACR website at: http://www.acr.org/accreditation.aspx Tips on Setting Charges for HDR Brachytherapy Sources in a Hospital Outpatient Department Medicare payments for brachytherapy sources provided in a hospital outpatient department are based on claims data, therefore, it is important to capture the costs of brachytherapy sources used to develop future outpatient payment rates.

High dose rate (HDR) Iridium-192 (HCPCS code C1717) is the source used in the HDR brachytherapy procedures (CPT codes 77785-77787). In order to cover the costs for this source it is important that hospitals carefully set their charges for Iridium-192 code C1717.

The worksheet below will assist hospitals in setting charges for HDR Iridium-192 sources. This is estimated on your utilization and costs for a quarter. It calculates a charge that will result in reimbursement of the direct costs for the source.

These charges are calculated per treatment, when billing a single treatment the number of units should be one.

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

Example: Hospital A estimates 100 HDR fractions per quarter. The quarterly service and source cost is $12,500. The hospital-specific cost-to-charge ratio (CCR) is 0.325. The estimated charge per treatment fraction is $384.62

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/

$12,500/100= $125/0.325 = $384.62

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continued - Health Policy/Economic Issues

1. Average number of patient treated with HDR per quarter 2. Estimated number of treatment fractions per patient 3. Estimated number of treatment fractions per quarter (Line 1 multiplied by Line 2) 4. Estimated quarterly service and source costs. If you have a service agreement, enter the quarterly cost of the service agreement and any other service related costs. If you do not have a service agreement, enter your estimate of the quarterly preventive maintenance and source costs 5. Calculate the average cost per treatment fraction (Divide Line 4 by Line 3) 6. Enter your hospitals cost to charge ratio 7. Estimate the charge needed to recover direct costs of the source (Divide Line 5 by Line 6)

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AAPM Newsletter

November/December 2010

Report from the Working Group on Standardization of CT Nomenclature and Protocols Cynthia McCollough, Rochester, MN and Dianna Cody, Houston, TX AAPM Posts CT Protocols on its Website

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he equipment settings and scan instructions that fully describe a CT examination are collectively referred to as the exam protocol. CT protocols specify how data collection and reconstruction, patient positioning and contrast administration are to be performed, the effect of which can be dramatic on the final exam quality or dose. A number of the settings are interrelated, where changing one parameter can require adapting several other parameters if image quality and/or dose are to be maintained at a specified level. Thus, the quality and dose of a CT exam are largely predetermined by the protocol used. In CT, there is however no single protocol that is “the correct protocol”; acceptable image quality and dose can be achieved using many different combinations of scan parameters.

Recently, CT patient overdoses and injuries caused by the use of inappropriate scan protocols have been reported in the media. Other reports have raised concerns about potential variability in doses and image quality among different practices and scanner models from protocols intended to accomplish similar diagnostic tasks.

In response to these concerns, the AAPM has agreed to post on its website reasonable scan protocols for frequently performed CT examinations. These protocols will summarize the basic requirements of the exams and provide several model-specific examples of scan and reconstruction parameters. The protocols will represent a sampling of currently available scanner models. They are not intended to provide comprehensive information for all available scanner models. The provided protocols are considered by the Working Group to be reasonable and appropriate to the specified diagnostic task. The settings provided are representative of typical clinical values and they may not always match default protocols.

The work is the charge of the Working Group on Standardization of CT Nomenclature and Protocols (http://www.aapm.org/org/structure/default.asp?committee_code=WGCTNP), whose membership includes academic and consulting medical physicists who specialize in CT imaging, representatives of each of the major CT scanner manufacturers, and liaisons to the American College of Radiology, American Society of Radiologic Technologists, and the Food and Drug Administration. Because efforts on nomenclature standardization are just beginning, published protocols will use the manufacturer-specific parameter names (eg. Scout, Topogram, Surview, Scanogram, etc. versus CT radiograph).

Access to the protocols is restricted to AAPM members; a qualified medical physicist is a necessary member of a practice’s CT protocol development and review team, and can best facilitate the comparison of a site’s existing protocols with those provided by the Working Group.

The first posted protocols are for adult CT brain perfusion studies. Others will follow as they are developed by the Working Group. The protocols may be accessed at http://www.aapm.org/ pubs/CTProtocols/. It is our hope that these resources will help AAPM members as they work to ensure the safe and effective use of CT imaging.

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Medical Physics Residency News Robert Pizzutiello, Victor, NY

Private Practice Group Residency receives CAMPEP Approval

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edical physics residency programs are essential to our profession, both in the near and long-term. By now, everyone should be aware of the imminent changes to the entry requirements for the American Board of Radiology examinations and medical physics. In summary: • Beginning in 2012, in order to take the ABR Part 1 examination in Radiologic Physics, candidates must be enrolled in or have graduated from a CAMPEP accredited education program (e.g., MS, PhD, or residency). • Beginning in 2014, in order to take the ABR Part 1 examination in Radiologic Physics, candidates must be enrolled in or have completed a CAMPEP accredited residency program.

Early in 2009, this issue was raised at the AAPM Professional Council (PC) retreat. It became evident that the need for additional residency program positions would be particularly critical in Imaging. PC theorized that the paucity of imaging physics programs applying for residency might be attributed in part to the fact that medical physics practice groups provide a large portion of the imaging physics services in the US. These private practice groups may not have viewed themselves as viable candidates for a residency program, which we traditionally associate with hospitals and Universities.

For nearly 30 years, I have been the president of Upstate Medical Physics, a growing imaging physics group serving well over 100 facilities in the Northeast. In the last 5 years, our medical physics practice group successfully trained two fine medical physicists, culminating in ABR certification. With lots of encouragement from many folks in AAPM leadership (including Mike Herman, Tony Siebert, Maryellen Giger, Per Halvorsen, Melissa Martin and Doug Pfeifer), the path became clear. I decided to start down the road to converting our on-the-job training (OJT) program into a formal residency, and apply to CAMPEP for accreditation.

After a little research, I learned that CAMPEP would entertain an application for a residency from a medical physics practice group. Realizing that such an application would be breaking new ground, AAPM agreed to provide some modest financial support so that we could rapidly create a template for other private practices to use, and convert existing OJT programs into residency programs suitable for accreditation. I quickly reached out to my dear friend and colleague, Joel Gray, for help preparing the CAMPEP Self-study application and refining our OJT program into a real residency. Joel was able to contribute his past experience with medical physics residencies and numerous connections with the national and international medical physics community. We worked together closely by phone and e-mail, addressing each of the items in the CAMPEP SelfStudy. Joel attended the CAMPEP-sponsored review session on our behalf. I produced a Business Plan and Joel surfaced a draft copy of the IAEA document on training of imaging physicists, which we used as a resource. Within about three months we had a draft self-study for a three-year residency program that would work well in our practice environment.

The CAMPEP self-study asks each program to consider its strengths and weaknesses - always a useful exercise. As a busy medical physics practice group, one clear advantage was that our residents would be exposed to a wide diversity of imaging practice environments, equipment, and regulatory requirements. Since there were no radiologists here in our practice, interaction with our physician colleagues seemed like an area for improvement. Eventually, we came upon a creative solution that has become perhaps the Hallmark of our residency program.

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continued - Medical Physics Residency News Each month, we have both a Physics Journal Club, presented by a resident, and a Clinical Journal Club presented by a radiologist. Together with our associate residency program director, Dustin Gress, we choose an article from one of the clinical journals (Radiographics, Radiology, etc.). We hired 2 experienced radiologists to serve as consultants to our group, presenting alternate months to ease scheduling. (Yes, this costs us some money, but the radiologists provide significant value to the residents and all the members of our group.) The radiologist starts with a half hour clinical introduction to the clinical subject specifically geared to our residents, followed by presentation and discussion of the article. All participants in the Journal clubs and other educational activities of the program receive CAMPEP credits. Our part-time educational coordinator, Mary Jo Bonin, RT, handles the process to obtain CAMPEP credits, and generally keeps our program organized and on track. We currently have a total of three excellent residents in our program, one in each year of our three-year program.

Reaction to our residency program has been overwhelmingly positive from our staff, clients, and the residents themselves. We were most grateful to receive a generous educational grant from Landauer, Inc. and Global Physics Solutions, Inc. In medicine, it is common for residency programs to be supported by manufacturers that provide equipment or service to the physician specialists. I hope that other corporate sponsors of AAPM will see the mutual benefit of supporting medical physics residency programs, and partner with us to meet the training needs for the next generation of medical physicists.

In July 2010, Upstate Medical Physics (UMP) became the first non-hospital based group to receive CAMPEP approval of a Diagnostic Imaging Physics Residency Program. A model program is now available for private practice imaging physics groups to create residency programs and apply for CAMPEP accreditation. UMP Diagnostic residency materials, including the Self Study and Business Plan, are available through AAPM. Contact Jackie Ogburn [jackie@aapm.org].

In closing, I have to admit that conceiving the residency program in our practice and preparing the CAMPEP self-study document required a lot of work; and without Joel Gray’s help it would’ve taken a long time. The good news is that this trail has now been successfully blazed for others to follow. All of the material regarding our residency program application, including a financial model, is now available for others to use as a resource or template to develop other residency programs. Joel is also available to serve as a consultant to other practices as well.

Most importantly, creating a residency program has elevated the quality of our practice on a daily basis in ways that I only vaguely anticipated. The energy and recent academic preparation that the new residents bring to our group has been a great addition to our practice. We are all better medical physicists as a result of the residency, and our clients and the patient’s are already seeing the benefits. More residency programs are urgently needed – particularly in Imaging. I hope that you will seriously consider adding residency to your medical physics practice. If you like to talk about this privately, you know that “I am in the book.” ___________________________________________ This article is also published simultaneously in other publications including ACR News

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New Professionals Subcommittee Report Sherry A Leeper, Lowell, MA

What to Expect at Your First Job as a Clinical Medical Physicist

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efore you begin the search for your first job as a clinical medical physicist, you should prepare yourself for relocation. Flexibility with geographical location is more important than ever these days, and by limiting your job search to a small region you will probably find yourself jobless and frustrated for a longer period of time. Also, applying to both jobs and residencies will increase your chances of finding a position more quickly. Unless money is extremely important, accepting a position that will provide the best opportunity for professional growth and development will undoubtedly benefit your career in the long run, especially if you have a dedicated mentor at that facility.

Once you have landed that coveted first medical physics position, prepare yourself for an environment that may be a bit different than what you were used to in graduate school. You must learn not only the technology at your new center, including machines, QA devices and software, but also how your clinic functions in the day-to-day treatment of patients. It will take time to become familiar with all the processes of your particular clinic because each clinic has their own way of doing things. To facilitate adaptation into your new environment, you should spend adequate time with each team in the department, including doctors, therapists, sim therapists, dosimetrists and fellow physicists to get a clear understanding of how your role fits into the clinic.

There is a good chance you will be one of the youngest and most inexperienced people in your new work environment. It takes real finesse to learn from your more experienced peers while also being responsible for pointing out their errors, and if not done with tact could be hazardous to your work environment’s health. A good approach is to first ask why someone did something the way they did, and facilitate a learning opportunity for one or both parties, instead of jumping to the conclusion that someone is wrong. Mutual respect should be maintained among your peers, as well as recognition of each person’s strengths and experience.

For the first six months you should expect, and even insist, on having your work double checked.

You are no longer in the classroom and making mistakes can result in injury, miscalibration of equipment or mistreatment of a patient. If your boss doesn’t trust you with their equipment for a while, or if they scrutinize your QA procedures or treatment plans try not to be offended, rather be grateful they are helping to prevent errors that can have potentially serious consequences.

Practice QA procedures on your own, read manuals, call vendors, and ask colleagues, mentors or former classmates to get useful tips and tricks. Remember that any problem with a device can usually be solved by turning it off and turning it back on again.

Understand your limitations. If you are uncomfortable with a task, ask for help or for a second check. Being given too much responsibility too soon can be dangerous without the proper training and experience.

Your actual day-to-day responsibilities as a physicist will vary from clinic to clinic based on the dynamics and technology available at your facility. The pure breadth of these responsibilities, however, is governed by the type of facility in which you work. Physicists in smaller facilities, such as community hospitals and small private clinics, will have a broader range of clinical duties that are shared amongst just a few physicists, whereas physicists at large facilities may have a more limited number of tasks that each individual is responsible for. As a new professional, it is

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continued - New Professionals Subcommittee Report important to obtain a clear understanding of your individual role from the beginning, as well as the tasks you will be responsible for.

As a clinical medical physicist, you are a medical professional that has the technical knowledge and training that others in the department do not have. Expect to be consulted for simulation, treatment setups and planning, and most other technical issues in your department. You should also expect that not all consultations will be solicited, and that your expertise may be necessary even when not explicitly asked for.

A new professional’s first job is an exciting time. It is a crucial moment for not only the development of technical skills, but also for professional growth. Be curious, be confident, and always remember that graduation is just the beginning of your education.

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AAPM Newsletter

November/December 2010

2011 Annual Meeting First Announcement

AAPM Annual Meeting/joint with COMP Canadian Organization of Medical Physicists July 31 – August 4, 2011 Vancouver Convention Centre • Vancouver, BC Reminder: Your VISA/PASSPORT will be required to enter Vancouver. Make sure it has not expired, or that it will not expire while at the meeting.

New this year…

•

Special Ultrasound Symposium (Monday – Wednesday, August 1-3), including Education, Imaging, and Therapy aspects of medical ultrasound.

•

A “dawn-to-dusk” program (8:00 am – 6:00 pm) of Educational, Professional and Scientific Programs will allow attendees more sessions in areas of particular interest with less parallel track overlap.

•

A beautiful venue at the Vancouver Convention Centre near the heart of downtown, the Gastown District, Stanley Park, and minutes away from the natural splendor of sea and mountains as only British Columbia can offer.

December 2010

•

January 5 March 7 at 5 PM Eastern

• • •

March 16

By April 19

By May 12 June 8

• • • •

2011 Annual Meeting website activated. View the site for the most up-to-date meeting and abstract submission information. http://www.aapm.org/meetings/2011AM/ Web site activated to receive electronic abstract submissions.

Deadline for receipt of 300 word abstracts and supporting data.

This deadline recognizes other conference schedules that have conflicted in the past and has been extended accordingly. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review.

Meeting Housing and Registration available on-line.

Authors notified of presentation disposition.

Annual Meeting Scientific Program available on-line.

Deadline to receive Discounted Registration Fees.

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AAPM Newsletter

November/December 2010

ABR Physics Trustees Report

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

The Death of A Question

I

n the March/April 2009 issue of the newsletter we wrote about the “Life of an ABR Physics Question.” In this article we address the unfortunate death of such a question. .....Question B3479-3 was the perfect question. When it was first used on Part 2 of the Diagnostic Physics exam in 2008 70% percent of the candidates got it correct. Even better it discriminated very well! Only 45% of the candidates in the lowest quartile got it correct but 85% of the candidates in the highest quartile got it correct. B3479-3 had every prospect of a long and useful life. Unfortunately B3479-3 had been copied down by a candidate and appeared on the notorious website “ physicsrecallsRus.com.” When B3479-3 was used again in 2010 85% of the candidates got it correct and it no longer discriminated between the best and the worst candidates. B3479-3 was dead. It was removed from the question pool and sent to the great big bucket in the sky.

People often fail to see the importance of ABR questions not only for the ABR itself but also for the candidates taking the test, for the medical physics profession and for the general public that relies on the ABR to only certify candidates with the appropriate level of knowledge. In order to certify physicists effectively, the ABR has to provide tests that are at the appropriate level and that discriminate properly. Thus the ABR needs a pool of reliable questions. Each exam is developed using a mix of previously used questions that meet a standard and new questions. If a question is too easy or too hard or does not discriminate properly it cannot be used. New questions are given a preliminary evaluation but it is only after a question is used that one really knows its value. It would be almost impossible to make an exam that only used new questions. The exam would have to be too long and it would be difficult to insure continuity and reliability from year to year.

The questions in the pool are developed by the significant efforts of volunteer physicists and physicians. They are reviewed by professional editors and analyzed by professional statisticians.

There is a significant intellectual effort and financial cost that goes into the development of each question. This cost is the major the largest single contribution to the cost of the certifying exam. When questions are removed from the pool the financial costs of replacing the question are significant and that cost is born by the exam takers. Even more costly, in a sense, is the intellectual effort necessary to replace the question. There are only so many talented question writers and every question they write is of great value.

Because of these considerations the ABR makes an effort to protect the questions. This is not to deny students a useful study tool, nor to make money for the ABR but rather to assure the students that the exam is valid. The questions are copyrighted and when people apply for the exam and at several additional places they agree to honor that copyright. Efforts are made to prevent any commercial use or posting to websites.

It is surprising that a number of people who would be upset if a student used copyrighted material or plagiarized material in a scientific paper don’t seem especially worried about the issue when it comes to ABR copyrighted material. Perhaps this is because they fail to understand the nature of the material and its value both to the ABR but also to the candidates, the profession and to the public. As the questions are shared they lose value. We would hope that individuals would respect the process and the statements that they signed. Failure to do so is clearly a violation of the federal copyright law and the AAPM Code of Ethics. We hope that a better understanding of the reasons that the material is copyrighted will lead to more sensitivity and respect for the process in the medical physics community.

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2009 AAPM-IPEM Travel Grant Report Lili Chen Department of Radiation Oncology Fox Chase Cancer Center

I

t is a great pleasure to report my UK visit between June 21 and July 5, 2010 as the recipient of the 2009 AAPM-IPEM Medical Physics Travel Grant.

On this trip I visited five medical physics and radiation therapy centers: the Institute of Cancer Research/Royal Marsden NIH Trust; St. Mary Hospital; Oxford University/Churchill Hospital; the Clatterbridge Centre for Oncology; and, Castle Hill Hospital. I had the opportunity to meet many old friends and colleagues. I visited their facilities, observed their routine clinical practice, and discussed research that we were interested in and/or involved with. I prepared five different talks based on the research work with which I was involved at Fox Chase Cancer Center: 1. MRI-Based Treatment Planning for Radiotherapy: Dosimetric Verification for Prostate IMRT. 2. Clinical Implementation of MRI Simulation for Advanced Radiation Therapy 3. Image Guided Radiation Therapy for Prostate IMRT: Daily Rectal Dose Variations during the Treatment Course 4. MR Guided Focused Ultrasound for Treatment of Painful Bone Metastases 5. MR Guided Focused Ultrasound for the Treatment of Prostate Cancer: A Feasibility Study on Increasing Intratumoral Uptake of Docetaxel in Vivo The first stop on my trip was the Joint Physics Department, Institute of Cancer Research (ICR) and Royal Marsden NHS Trust (RMT). About seventeen years ago I completed my Ph.D. in medical physics and biophysics under the supervision of Professors Gail ter Haar and Kit Hill. I moved to Canada in 1994 to work for the University of Toronto and subsequently to the USA in 1997 to work for Stanford University School of Medicine. I have been with Fox Chase Cancer Center (FCCC) since 2001. The AAPM-IPEM Medical Physics Travel Grant offered me an excellent opportunity to visit the Marsden again after all of these years. Professor Hill retired right after my graduation.

Professor ter Haar is well known for her accomplishments in high-intensity focused ultrasound (HIFU) and is still actively researching in this area. Professor ter Haar hosted me at the ICR. I met Dr. Ian Rivens and other members of her research group at the Sutton site. I joined their weekly research meeting in the morning and one of her Ph.D students, Anna Tokarczyk, presented her study on histological evaluation of HIFU induced vascular bioeffects in the presence or absence of contrast agents. She demonstrated that the blood vessel (from a rabbit ear model) permeability is increased in the group with ultrasound contrast agents (UCAS) compared with those without UCAS. Her research gave me some insights that will help me with my DOD grant on enhancement of drug delivery using a mouse model. In the afternoon I gave a talk on “MR Guided Focused Ultrasound for Treatment of Painful Bone Metastases.� The audiences included the medical physicists, Ph.D students, research scientists and clinicians from the Radiology Department. The talk generated many interesting discussions on the details of palliative patient care with HIFU. We also discussed many issues regarding the use of HIFU for tumor ablation and enhancement of drug delivery in the treatment target for chemotherapy and gene therapy.

Later that week, I visited the Department of Interventional Magnetic Resonance Imaging, St. Mary Hospital, London. St. Mary Hospital is well known internationally for its leadership in clinical trials using MRgHIFU. Professor Gedroyc, leader of the MRgHIFU clinical trials and the head of the Department, was my host. He enthusiastically explained their clinical applications, including treatment of uterine fibroids, bone metastases, and liver tumors, etc. He was expecting in the near future an endorectal transducer probe from a commercial vendor (InSightec) to conduct a

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continued - 2009 AAPM-IPEM Travel Grant Report clinical trial on prostate cancer. We also discussed some strategies regarding organ motion and ultrasonic beam shielding of the rib cage for liver cancer treatment.

The third stop on my trip was Oxford University and Churchill Hospital, Oxford. Dr. Feng Wu organized my visit and hosted a tour to the HIFU facility in the morning, where a clinical trial is being conducted on HIFU surgery for renal cancers. Dr. Wu is an expert on thermal ablation using HIFU and the creator of the Haifu ultrasound surgery system that has been clinically implemented in more than 50 treatment centers in China and Europe. I met Dr. Constantin Coussios at the Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford in the afternoon and visited his Biomedical Ultrasonics and Biotherapy Laboratory (BUBL). I presented our clinical experience with the InSightec MR guided HIFU system for bone palliation and our research results of pulsed HIFU drug delivery for chemotherapy and gene therapy to his lab staff and students. I also had an opportunity to discuss future research and clinical directions in diagnostic and therapeutic ultrasound with Drs. Wu and Coussios.

In Clatterbridge, I was hosted by Professor Alan Nahum, who showed me the Radiation Oncology Department in the Clatterbridge Centre for Oncology (CCO). I also met Dr. Philip Mayles, the head of the Physics Department at CCO, who was the clinical chief at the Sutton Branch when I was with RMT and ICR. He left the Marsden in 1994 and established a very proficient and motivated physics group at CCO. The radiotherapy facility is one of the largest regional centers and hosts the only proton treatment facility in the UK. About 70 patients were treated annually at this facility. In the morning, Drs. Nahum and Baker of the University of Liverpool organized discussion sessions with their research students who worked on Monte Carlo simulations, dosimetry verifications and radiobiological modeling for radiotherapy treatment planning. A light lunch at a nearby country club concluded with the hot topics of the morning session. In the afternoon, I gave a seminar on the Fox Chase Cancer Center Experience with Prostate Radiotherapy. The focus was image guidance for target delineation and treatment localization. It is interesting to note the difference in the health care systems between the UK and the USA and its impact on treatment decisions and techniques used; a much smaller fraction of patients are being treated with intensity-modulated radiation therapy (IMRT) now in the UK than in the USA. Drs. Helen and Philip Mayles were very kind to prepare a delicious buffet dinner in their lovely country residence to welcome all of us and celebrate our reunion.

The drive to Castle Hill Hospital, Hull, which was my final stop, was very enjoyable. The weather had been nice from the moment I arrived in the UK--sunny and warm. The scenery along the motorway in northern England was unforgettable! Professor Andy Beavis’ driving directions were very accurate and I found a perfect parking spot right in front of the magnificent cancer treatment center. Cancer services were transferred from the Princess Royal Hospital and Hull Royal Infirmary to the Queen’s Centre for Oncology and Hematology about two years ago. Professor Beavis and I first met at Stanford Medical Center more than 10 years ago. We had common research interests in MRI based treatment planning for 3D conformal radiotherapy and IMRT. I gave a seminar to his physics staff on image guidance for prostate IMRT. The radiotherapy program has expanded significantly since my last visited in 2001. There are 6 modern linear accelerators in the new center treating more than 2000 patients a year. I was also impressed by their integrated clinical psychology program that is easily accessible to cancer patients and their family members. The picturesque view of the infusion room clearly reflected the vision for the new oncology unit to create a patient-centered environment and to offer a holistic approach to patient care that promotes well-being in a healing environment. Professor Dr. Beavis also demonstrated his development of a radiotherapy teaching tool – a linac and treatment simulator that can be used for radiation therapy training. It was a very fruitful visit.

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continued - 2009 AAPM-IPEM Travel Grant Report By the end of my visit, the long weekend served as a mini-vacation for me, so I could spend some time visiting physics colleagues and old friends in other cities and institutions. Many times while driving to my destinations, I passed scenic areas in northern England and southern Scotland, where I had amazing memories of the good old days. The weather changed dramatically every 100 miles or so, and within a day I experienced drizzle, thunderstorms and hail! Snow patches were still clearly seen on mountain tops through the morning mist! The last part of the journey along the East Coast was very pleasant. The highway snaked through small villages and green fields along the beautiful coastal line. By the time I arrived in Oxford on Sunday evening, it was near dusk. With the ancient church and the old country pubs as a backdrop, the fading colors of the sunset into the darkening sky were mesmerizing.

I was very delighted to be able to make this trip, during which I was given the opportunity to meet numerous established scientists and experienced physicists, and improve my research and clinical knowledge. The hospitality shown to me at each visit was unforgettable. I appreciate the precious time and energy my hosts and their colleagues spent showing their centers, discussing their practices and sharing their research and clinical experiences with me. I would also like to thank the AAPM-IPEM for providing this wonderful opportunity and Fox Chase Cancer Center for supporting my travel. Finally, I would like to mention that I could not have had such a pleasant trip without the GPS while not driving on the right side!

AAPM Career Services site coming soon!

AAPM Members – This January, we will proudly launch our all-new AAPM Career Services online job board. This feature-rich site will allow Job Seekers to search relevant medical physics job openings, setup job alerts, and post their resumes. Hiring Employers will be able to post medical physics jobs as well as search a scientific resume database featuring thousands of targeted and current documents.

We’ll send you another message with more information and a direct link once we’re live…stay tuned!

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New England Chapter Report Martin Fraser, Cambridge, MA

Successful Fall Meeting Held by the New England Chapter

T

he NEAAPM hosted the 4th and final meeting of the year on October 4th at a charming old New England setting. The historic Publick House in Sturbridge, MA was the venue but the lovely seasonal location was not the main draw.

Chapter Scientific Program Director (and President Elect) Fred Fahey assembled a terrific program which drew 63 attendees to this half day event.

The program started off at Noon with a hearty lunch (Yankee Pot Roast, fixins, and homemade Apple Pie for dessert!) and then moved promptly to several timely talks provided by eminent speakers.

Eric Klein (Washington University, St. Louis) started things off with an overview of the AAPM TG -142 report with a focus on patient safety aspects. Eric, (TG 142 chair) explained the reasoning behind some standards and changes from TG-40. These insights were gratefully received by the large audience.

Following Eric, a change of pace and an in depth look at Brachy Therapy dose calculation error analysis and propagation was provided by Mark Rivard (Tufts Medical School). Mark, chair of the AAPM Brachytherapy Subcommittee and member of various related committees in the U.S. and Europe, was fresh from his trip to Vancouver to deliver a keynote address at CARO (Canadian ASTRO). Hs talk was both highly -technical and clinically relevant and extensive discussion ensued.

After a break (for coffee and Apple Pie!), President Georges el Fakhri conducted the annual chapter business meeting.

Immediately following, we enjoyed a presentation by AAPM Secretary John Gibbons (Mary Bird Perkins CC, Baton Rouge, LA) on the AAPM structure and its organized efforts related to the recent flurry of public interest in radiologic safety in medicine. This was a valuable update and an excellent primer on AAPM process for the many younger members in the audience.

The ultimate speaker was TPC chair Ellen Yorke (MSKCC, NY) who delivered a talk on TG -100, an excellent bookend to the opening talk .

Ellen, chair of the AAPM Therapy Physics Committee and author of TG100, gave an excellent overview of this complex, voluminous report (2 reports, in fact, as she informed us). Dovetailing with TG142 and future plans of the group were most illuminating.

17 vendor booths enhanced this fine and well attended meeting, and they were thanked for their continued support.

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AAPM Newsletter

November/December 2010

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AAPM Newsletter

November/December 2010

Image Wisely™ Focuses on Dose Reduction in Adults Matthew Robb

A

t the RSNA Scientific Assembly and Annual Meeting, Nov. 28–Dec. 3, the ACR/RSNA Joint Task Force on Adult Radiation Protection will launch Image Wisely™, a high-visibility campaign that seeks to deepen understanding of adult radiation protection among radiologists, referring practitioners, medical physicists, and radiologic technologists. While the educational component is sweeping in scope, perhaps even more noteworthy is the Image Wisely call to action.

“Radiation awareness has increased exponentially in the last few years, but now Image Wisely is asking stakeholders to actually commit — by pledging their support and utilizing the radiation safety resources available on its new website,” says James A. Brink, MD, FACR, Chairman of Diagnostic Radiology, Yale University School of Medicine. Brink co-chairs the Image Wisely Joint Task Force with E. Stephen Amis Jr., MD, FACR, Chair of Radiology, Albert Einstein College of Medicine.

Image Wisely is a collaborative effort of four charter members: the American College of Radiology (ACR), the Radiological Society of North America (RSNA), the American Association of Physicists in Medicine (AAPM), and the American Society of Radiologic Technologists (ASRT). Image Wisely follows on the remarkable success of Image Gently™, which since its January 2007 start continues to focus attention on safe imaging of pediatric patients.

“Image Wisely seeks to raise awareness of opportunities to eliminate unnecessary imaging examinations and to lower radiation in necessary imaging examinations to only that needed to acquire appropriate medical images,” Brink notes. “Initially, the campaign will focus on computed tomography (CT), but will broaden to include nuclear medicine procedures, fluoroscopy, and radiography,” says medical physicist William R. Hendee, PhD, FACR, distinguished professor of radiology at the Medical College of Wisconsin.

Through education and networking, the Joint Task Force anticipates the campaign will significantly expand participation among affiliated health care organizations, educational institutions, government agencies, and vendors. The campaign logo, a wise owl, is expected to give Image Wisely instant brand recognition.

Imaging stakeholders will have at their fingertips an exceptional array of electronic and print resources, including a new, state-of-the-art website linked to www.RadiologyInfo.org for patient information. This highly successful website, cosponsored by the ACR and the RSNA, will give patients and the general public an interactive resource guide outlining the benefits of medical imaging vis-à-vis the risks of exposure to ionizing radiation. In addition, the Image Wisely website will provide links to vendor microsites that outline dose-reduction techniques on specific equipment. Combined, these user-friendly resources — described as “the best of the best” by Amis — will foster greater insight among imaging professionals, patients, and the public at large, while underscoring the reality that radiation dose in adult imaging requires further study and is impacted by numerous factors.

In its calls to action, Image Wisely will ask stakeholders (individuals and groups) to demonstrate their involvement by electronically signing formal online pledge cards “that demonstrate their commitment to the campaign’s overarching principles,” Amis says.

Amis also encourages facilities to enroll in ACR accreditation programs and participate in national dose index registries. Brink notes that the ACR has “a vigorous radiation protection process as part of its CT accreditation program,” and says ACR Appropriateness Criteria™ enhance quality of care by providing evidence-based guidelines so that referring practitioners and other professionals can make the most appropriate imaging decision for a specific clinical condition.

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continued - Image Wisely™ Focuses on Dose Reduction in Adults Image Wisely reminds all that the radiation received from medical imaging scans could, over time, have adverse effects, but these advanced technologies also save lives, reduce the need for surgery, and speed recovery. “CT, nuclear medicine procedures, angiography, and interventional imaging methods give us powerful tools, but do deliver fairly high doses of radiation. We as medical physicists need to ensure the protocols we use are optimized according to the as low as reasonably achievable (ALARA) concept, without compromising quality,” says Hendee.

Greg Morrison, Chief Operating Officer, American Society of Radiologic Technologists, sees the nation’s 300,000 registered technologists as central to dose reduction. “As the final imaging professional that can make a difference before exposure, it is the technologist’s responsibility to take an active role and ensure that dose is reduced through every means possible,” says Morrison.

A special interest session at the RSNA Annual Meeting will provide additional details about the Image Wisely campaign.

Editors Note: This article is being published in the member news magazines of the Image Wisely charter member organizations.

Mountain Man Dave to Lead Another Memorable Adventure Post-AAPM/COMP Annual Meeting* in Vancouver August 7 - 14, 2011 Naiset Huts - Mount Assiniboine Park in the Canadian Rockies Deadline for reservations for the Naiset Huts: December 27, 2010 Contact Dave Jette for more information: dave@jettes.org

There is nothing more spectacular than the Canadian Rockies. Mountain Man Dave gives you 2 options to travel to the Naiset Huts in Mount Assiniboine Park: • Option 1: two-day high route in (from Sunshine, just west of Banff townsite), and going out along a lower route through Wonder Pass, staying at Bryant Creek cabin.

• Option 2: Take the helicopter in, at a reasonable cost of $168 each way. Not only exciting, but also saves a great amount of time and energy.

Naiset Huts: There are five reservable cabins, each sleeping 5-8 persons (33 people total). There is a cooking building with

propane stoves and lighting and with sinks and running water – a great place to play games in the evening! There are various lakes on this high plateau (7000’), and a number of very nice 5-6-hour hikes. Everyone is expected to prepare their own breakfasts and lunches; day hikes start around 10:00 AM. Dinner to be eaten together. Forty pounds of gear/person is allowed on the helicopter, so we will be able to bring in plenty of delicious food.

Helicopter: Runs only 3 times/week, and next summer we’ll be flying in on August 7th (a Sunday) or on August 10th (for those taking the summer school) and flying back out on August 12th (a Friday) or on August 14th, with a cabin cost of ~ $35/ person/night (or less, depending on how full we pack the cabins). Those who are backpacking in will start from Sunshine a day earlier (with lighter packs since we’ll be carrying their food on the helicopter) and take either one or two days to hike out via Wonder Pass and Bryant Creek.

Please be sure to register with M.M. Dave by December 27th, since the Naiset Hut bookings absolutely must be made at the crack of dawn on January 2nd. Also, there will be the opportunity to continue on with Dave for up to two additional weeks of camping and day hiking in the Canadian Rockies. *This post-meeting adventure led by Dave Jette is not affiliated with or sponsored by AAPM.

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2010 US Science and Engineering Festival Report Hugo de las Heras, Silver Spring, MD and Muhammad A Yousuf, Baltimore, MD

AAPM’s booth at the US Science and Engineering Festival - October 23-24, 2010

T

he committee for public education hosted a booth at the first edition of this festival, which gathered over 500,0001 visitors on October 2324 at the National Mall in Washington, D.C. The booth was designed to enhance the participation of our youth in the areas of science, technology, engineering and math (STEM).

AAPM took this opportunity to introduce the work of medical physicists in saving the lives of cancer patients. Since the actual equipment used in medical physics was difficult to transport to the venue, and the nature of the subject was serious, novel methods were employed to attract and retain students at the booth while volunteers conveyed the actual message across.

The following two interactive attractions (and accompanying informative posters on the walls) were displayed for the enjoyment and active learning and were viewed by the numerous children and adults who visited the booth.

1. How can robots and advanced sensors handle problems in medicine?

The first attraction on the booth was of ‘Botball’ robots pre-designed and programmed to show simple, sensor based behaviors. These robots were used to explain how sensors and actuators work and how similar concepts and methods (infra red and light sensors, robotic couches, Cyberknife, etc) are employed in the field of medical physics. Students were given a chance to learn the basics of these technologies in a playful manner. This exhibit also conveyed the message that life long learning and team work are essential to becoming a successful Children enjoying the robotics activity professional in any field of STEM, including medical physics.

2. Create your own piece of “Computed Tomographic Art” On the other part of the table, Dr. Hugo de las Heras and the team of volunteers invited and helped visitors to play with a computer program that allows the visitor to draw an arbitrary object and generate its sinogram. Sinograms are indeed beautiful representations of reality seen from an unusual perspective.

Visitors, in particular 5 to 15-year old children, found it fun to Sinogram resulting from the scan of a 2x2 checker board using 512 views along a 180 degree rotation of a simulated x-ray source.

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AAPM Newsletter

November/December 2010

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AAPM Newsletter

November/December 2010

continued - 2010 US Science and Engineering Festival Report get a different representation of their own creations, and several of them opened their eyes wide with a “wow” after the sinogram appeared on the screen. More than 50 kids and adults got their creations sent to their e-mail accounts.

AAPM is thankful to all the volunteers, to Mr. Steve Goodgame of the KISS Institute of Practical Robotics (Norman, Oklahoma) for providing the robots and for his untiring help in responding to questions raised by children and parents who visited the booth, to Oleg Tischenko (Helmholtz Zentrum München, Germany) for his support developing the program, and to Hugo’s colleagues at FDA for the material provided. _______________________________ 1 Conservative estimate of the organization

Volunteers (left to right) Muhammad (Ali) Yousuf, Steve Goodgame (KISS Institute), and Hugo de las Heras. Not pictured- Viji Raju, David Djajaputra, Jim Deye, Desiree Jangha, Mary Fox.

RTI

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American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846

Editor

Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115

Editorial Board Priscilla Butler, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390

PRINT SCHEDULE • The AAPM Newsletter is produced bimonthly.

• Next issue: January/February • Submission Deadline: Dec. 8, 2010 • Posted On-Line: week of Jan. 3, 2011