AAPM Newsletter January/February 2011 Vol. 36 No. 1

Newsletter

AME RIC AN AS S O C I ATI O N O F P H Y S I C I S TS I N M E D I CI N E We advance the science, education and professional practice of medical physics

AAPM Column VOLUME President’s 36 NO. 1

JANUARY/FEBRUARY 2011

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

The past year had a significant impact on Medical Physics ……

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vents over the last year had great impact on our association and the profession of medical physics, which can be summarized in three words: New York Times. Mike Herman, as President, did an outstanding job by leading the AAPM charge, crafting several directed responses, taking the leading role in communicating the AAPM’s position and the medical physicists’ responsibilities in testifying before Congress on February 10. Three major events were sponsored by the AAPM as a result of his tremendous work and leadership: The “AAPM CT Dose Summit: Scan Parameter Optimization” meeting held April 29-30, in Atlanta; the “Safety in Radiation Therapy – A Call to Action” meeting held June 24-25 in Miami; and the Foundation for the National Institutes of Health (FNIH) “Diagnostic Imaging Database Roundtable” and “Radiation Therapy Database Roundtable” held in the morning and afternoon of October 19, in Bethesda. These meetings, all rooted in the key issue of patient safety, brought together the prominent stakeholders, including technologists, physicians, physicists, government regulators, industry representatives, payers, and professional associations to improve the delivery of patient care and implement procedures in which catastrophic errors can be eliminated. There will be certainly more news as these initiatives continue, and the AAPM will certainly be proactive in the coming year. And recognition also goes to the AAPM headquarters Included in this issue: staff, who responded brilliantly to the challenges of planning p. 3 and implementing these meetings at the last minute. Thanks Chair of the Board President-Elect p. 4 to Angela and her team who make the headquarters.

Executive Director p. 5 A whole-hearted thanks to Maryellen Giger, for her many p. 9 years of leadership and continuing service on the Executive Editor Treasurer p. 10 Committee, first as Treasurer for 4 years, and then through Education Council p. 12 the Presidential chain of command of our Association. She Professional Council

p. 15 has given mightily for the AAPM, is a stalwart defender of p. 17 all medical physicists, and has a specific interest in the non- Leg. & Reg. Affairs clinical side of the profession, where medical physicists play Website Editor p. 20 important roles and have key positions in academic research, ACR Accreditation p. 21 government, and industry. Her directives in establishing Health Policy/Econ Issues p. 23 a Technology Assessment Institute is now well underway, AAPM History Interviews p. 27 with an active committee under the Science Council chaired Image Gently Update p. 28

by Bill Hendee. A plan was presented to the AAPM Board Image Wisely Initiative p. 30 of Directors at the RSNA meeting for the establishment of New Professionals SC Report p. 31 The Institute for Assessment of Medical Devices (IAMD), a p. 32 partnership of the Morgridge Institute for Research (MIR) a UNYAPM Chapter Report ORVC 2010 Fall Sym. Report p. 33 non-profit organization established for technology assessment Person in the News p. 34 across a wide area of disciplines, including medical imaging Obituary p. 35 and radiation therapy, and the AAPM. The IAMD mission

AAPM Newsletter

January/February 2011

continued - AAPM President’s Column statement is “… to develop procedures for technology assessment of medical device, and to provide unbiased and useful assessments of medical devices.” This is an exciting and relevant area for medical physicist interaction, and the MIR-AAPM partnership will foster many opportunities for strengthening the future in both the clinical and non-clinical aspects of our profession. Certainly in light of the significant attention on the 2012/2014 issues for clinical practice, it is easy to lose sight of the fact that without support in non-clinical areas, the Medical Physics profession loses innovative thought, becomes academically diminished, and ultimately is less prepared for the future.

Speaking of 2012/2014, the clock officially started on October 1, 2010, as September 30 was the last day to apply for the American Board of Radiology certification examination without having attended a CAMPEP-accredited graduate program or residency in Medical Physics. In two years, the requirement will shift to requiring a CAMPEP-accredited residency in Radiation Therapy or Diagnostic Imaging. Efforts by the AAPM over the past year have resulted in a significant increase in the number of accredited Radiation Therapy residencies, which should have a sufficient number of slots to meet anticipated workforce demand by 2014. For diagnostic imaging residencies, however, there could be a problem in attracting enough institutions or clinical practice groups to meet the need. This was recently discussed during a conference call of EXCOM, the Education Council, and the Education and Training of Medical Physicists committee. In addition to encouraging Medical Physics graduate programs to put forth an effort in assisting in the possible establishment of Diagnostic Imaging Medical Physics residencies, Mike Herman and I, in conjunction with the RSNA Board, have crafted a letter directed to the leaders of Radiology, indicating the need for these residencies, particularly in light of the upcoming requirements for accreditation for advanced imaging devices and the requirement for the qualified medical physicist (QMP) to oversee the technical quality control aspects entailed in the process. Of course, medical physicists in academic institutions and large practice groups must also step up in participating in the establishment of residency programs, because it is in our collective interests to ensure that there are a sufficient number of future QMP’s available to meet the high level of qualifications and standards demanded for clinical medical physics practice. The AAPM has committed resources in 2011 to continue the 2012/2014 directives begun over 4 years ago; it is our (7000+ members) collective responsibility to assist in the effort to meet these challenges.

A new year, with continuing and new challenges…..

This is my first AAPM newsletter column as President; it is indeed a great honor to be serving you for the coming year. I will do my best to represent the AAPM in all areas important to our membership and our profession, including scientific, educational, professional, and administrative functions, and to ensure that the Association is fully available to our constituencies in medicine, government, industry and the public. I plan on supporting the initiatives of my predecessors and the Board of Directors, and look forward to hearing from you and providing suggestions and comments as to what your views and opinions are on the multitude of issues that are relevant to our jobs and professions. Together we can make this year a successful and productive one for medical physics and the AAPM. Implementation of the Strategic Plan is well under way, with Mike continuing his quest begun last year to see the plan evolve, with direct involvement of the Board of Directors. (See his article in this issue). Gary Ezzell, as President-Elect, is also very involved in the process. This is an extremely important and key effort of the coming year that will guide the future direction of the AAPM, and ensure that our vision, mission, and goals are consistent with our actions.

One of the immediate functions of the incoming president is to work with the nominating committee, this year comprised of Jerry White, Don Frey, and Dan Low to assist in the identification of nominees for President-Elect, Secretary, and at-large board members for election in 2011 to serve in 2012 for a three year term. I am very open to suggestions and thoughts from the membership for potential candidates in each of these positions.

I wish all of you a very prosperous, peaceful, productive, and happy new year.

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AAPM Chair of the Board’s Column Michael G. Herman, Mayo Clinic

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too would like to begin with a big thank you to Maryellen Giger who completed her term on the AAPM executive committee on December 31. Her influence, openness and commitment to medical physics made AAPM and our profession better. I would also like to thank those Board members rotating off and welcome those with whom we will work in 2011.

Strategic planning for AAPM began in earnest at a retreat held in April, 2010. The members of the Adhoc committee generated a list of 34 objectives with 136 associated strategies that were reviewed and prioritized by the AAPM Board this summer. The SP committee refined the top 16 items into a draft strategic plan. At RSNA the Board reviewed the SP recommendation and adopted the draft strategic plan with strategies associated with and assigned to existing AAPM committees. We set direction to finalize the strategic plan and continue the process under Board direction.

The activities that will occur prior to the next strategic planning meeting in March include editing the draft plan to improve clarity and combine similar items; integrating the results of a strengths, weaknesses, opportunities and threats analysis; refinement of the implementation plan and recommendation for a process for ongoing strategic planning.

Earlier this year, our board of directors formed an adhoc committee to recommend a plan to formally integrate the vision, strength, innovation and spark of the American College of Medical Physics into the AAPM. The adhoc committee submitted a report that outlined the specifics to bring the core functions of the ACMP into the AAPM. For many reasons, the time has come for us to reunify and utilize our national and individual resources in support of Medical Physics and those we serve in the most optimum fashion. The ACMP has had a positive and balancing impact on issues relevant to medical physics over the past nearly three decades. During that same time, however, the profession of medical physics has matured and grown. As this has gone on, medical physicists in all organizations have cooperated for the most important and meaningful causes – those efforts that ultimately provide the best scientists, educators and practicing medical physicists in medicine. The ACMP and the AAPM have also both matured in such a way that a single unified association will be stronger and can better focus on the priorities and issues of importance to medical physicists and those we serve.

The ACMP board of chancellors voted on November 28, 2010 to cease operations of the College at the end of December 2011. The AAPM Board voted to accept and enact the adhoc committee proposal at the board meeting on December 1, 2010. Among other actions, the proposal outlines continuation of the ACMP annual meeting as an AAPM standing spring clinical meeting, the continuation of the Marvin M.D. Williams Award as an AAPM award and the publication of the Journal of Applied Clinical Medical Physics as an AAPM journal. These and other activities will occur over the rest of 2011.

Mark your calendar to attend . . .

More details of the draft strategic plan as well as the full ACMP Assumption Adhoc Committee report are available in the November 2010 Board of Directors packet under the President’s agenda at http://www.aapm.org/org/organization. asp

http://www.aapm.org/ meetings/2011CTS/

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2011 AAPM CT Dose Summit Interdisciplinary Program on Scan Parameter Optimization for Imaging Physicians, Technologists and Physicists October 7 - 8, 2011 Denver, CO

Registration Opens May 11

AAPM Newsletter

January/February 2011

President-Elect’s Column Gary A. Ezzell, Mayo Clinic Scottsdale

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APM does a number of things right. One of them is giving newly elected officers six months before their terms start to scramble up the learning curve. It is a long curve: there is a lot going on. I’ve been able to attend meetings of our four councils: Science, Education, Professional, and Administrative, as well of the Board, Executive Committee, Finance Committee, and a few others. It is rather dizzying, actually, and impressive; we have so many talented and dedicated people who are working on behalf of .... well, who, actually?

That is a non-trivial question, and one that deserves some thought. Who would benefit from all the initiatives currently underway? Are they worth the energy? Are they worth the financial support?

Consider AAPM’s ongoing efforts to promote board certification as the appropriate credential for accrediting clinical physicists. Who benefits from that? Patients, presumably, as well as physicists who want their commitment to quality and safety to be supported. To that end, AAPM volunteers and staff are currently working with the Council of Radiation Control Program Directors (CRCPD) to develop a national database of board-certified physicists. AAPM volunteers are also working with ACR and other practice accreditation bodies to ensure that imaging and therapy practices follow appropriate standards. Practice accreditation is becoming a requirement for reimbursement in ever more fields.

Who benefits if AAPM physicists play an important role in setting the standards? Conversely, who loses if we do not?

Residencies are becoming a requirement for board certification, and we need more of them. AAPM physicists are working with educational institutions and private practices to create imaging and therapy residencies. Not only is achieving certification becoming more rigorous, so is maintaining it. This is the way of the world as a field matures, and many AAPM 2011 physicists are developing educational material to Summer School help the rest of us. Who benefits when someone Uncertainties in External accepts an invitation to speak and takes the time Beam Radiation Therapy to create a Self Assessment Module?

So, back to the beginning. Who are all these dedicated people working on behalf of? Patients, for sure, or nothing else matters. Those of us currently working and trying to do our jobs well. And another group: those people yet to enter the field. Medicine and medical physics are dynamic; either we adapt or we become irrelevant. I am encouraged as an incoming officer to see so many of us picking up a piece of the work and making our profession better. We medical physicists are doing good work together within the framework of our AAPM. We are also doing progressively more with other groups, such as RSNA, ASTRO, ACR, and CRCPD. There is an African proverb: To go fast, go alone. To go far, go with others. We have come far, and the road continues. It will be an honor to come along.

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August 4-9, 2011

immediately following the AAPM Annual Meeting Simon Fraser University, Burnaby, BC http://www.aapm.org/ meetings/2011SS/ Registration Opens March 30 Program Directors: Jatinder R. Palta, PhD, University of Florida T. Rock Mackie, PhD, University of Wisconsin

AAPM Newsletter

January/February 2011

AAPM Executive Director’s Column Angela R. Keyser, College Park, MD Summer Fellowship Programs Please consider participation as a mentor in AAPM’s Summer Undergraduate Fellowship Program (SUFP) or Minority Undergraduate Summer Experience Program (MUSE).

The SUFP 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. Both student and mentor applications are due by February 1. For details, go to: http://www.aapm.org/ education/SUFP/ .

The MUSE program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institutions (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For details, go to: http://www.aapm.org/education/MUSE/.

The deadline for applications is February 8.

Funding Opportunities AAPM is pleased to announce the following 2011 Funding Opportunities: Two $25,000 Research Seed Funding Grants will be awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. It is expected that funding will begin on July 1, and that subsequent research results will be submitted for presentation at future AAPM meetings. Deadline: February 21.

AAPM/RSNA Fellowship is offered for the training of a doctoral candidate in the field of Medical Physics. Deadline: March 15. $35,000 in matching support for (1) two-year grant to be made to institutions in matching support of a full-time Clinical Residency in Imaging Medical Physics. Deadline: April 15.

RSNA is sponsoring (2) two-year grants to be made to institutions in matching support of fulltime Clinical Residencies in Diagnostic Medical Physics. Deadline: April 15.

Program details and Information regarding each grant or fellowship available online at: http:// www.aapm.org/education/GrantsFellowships.asp.

2011 Meeting Dates AAPM is joining with COMP for a Joint meeting July 31 – August 4 in Vancouver, British Columbia. The online abstract submission process opens on January 5, with the deadline for submission on March 7. Registration and housing information will be posted by March 16. More information is available online at: http://www.aapm.org/meetings/2011AM/.

New in 2011: • Special Ultrasound Symposium (Monday – Wednesday, August 1 - 3), including Education, Imaging, and Therapy aspects of medical ultrasound.

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AAPM Newsletter

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continued - AAPM Executive Director’s Column • 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.

• The John S. Laughlin - Science Council Research Symposium: “Science and Engineering for Patient Safety in Therapy and Diagnostic Medical Physics”.

• The John R. Cameron - John R. Cunningham Young Investigators Symposium held jointly by the AAPM and COMP. • A new Short Oral format in addition to regular scientific talks.

• “Best in Physics” interactive theatre highlighting leading research in Imaging and Therapy.

The 2011 AAPM Summer School, Uncertainties in External Beam Radiotherapy, will immediately follow the Annual Meeting, from August 4-9 at Simon Fraser University in Burnaby, British Columbia. Program Directors Jatinder Palta and Rock Mackie have put together a “must attend” program. For details, go to: http://www.aapm.org/meetings/2011SS/.

Scholarships in the form of a full waiver of tuition fees for the entire AAPM 2011 Summer School are being offered for applicants who are early in their careers in medical physics. In addition to the tuition scholarships, two $500 grants to assist with other expenses related to the AAPM Summer School (i.e., housing, travel) are being sponsored by Capintec in memory of Dr. Arata Suzuki, Ph.D. The deadline for applications is February 25.

2011 Dues Payments 2010 renewal notices were sent several times since October, 2010, with payments due by March 1. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on “Pay Your 2011 Dues Online.”

Remember, you can pay Chapter dues with your AAPM dues for any Chapter of which you are already a member!

The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301-209-3396.

Staff News I am pleased to announce that Jackie Ogburn has been promoted to the position of Education Manager. In her new role, Jackie will work with the volunteers to oversee the Online Learning and Virtual Library programs, provide support to CAMPEP and manage AAPM grants and funding opportunities.

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continued - AAPM Executive Director’s Column AAPM HQ Team…at your service!

Along with the continued growth in the AAPM Annual Meeting and Summer School, AAPM is now sponsoring specialty or topical meetings throughout the year. As we see the availability of the volunteer hour shrinking, many non-technical, program-related tasks previously handled by volunteers have migrated to the HQ team.

While all the members of the AAPM HQ team play an important role Meetings & Programs Dept (L - R); Kathleen Dwyer, Corbi Foster, Karen MacFarland, Nancy Vazquez, Jackie Ogburn, Lisa Rose Sullivan and Laurie Hayden in the meetings and programs processes, the major responsibilities are handled by the Meetings and Programs Department.

Lisa Rose Sullivan joined the staff in November 1993 as Projects Coordinator. She was one of the original five Maryland staff members hired when the AAPM HQ offices relocated from NY to College Park, Maryland. Lisa was promoted to Exhibits and Scientific Program Manager in 1998 and then to Director, Meetings and Programs in 2005. Lisa oversees the meetings and programs operations and the provision of services to ACMP and CAMPEP. Nancy Vazquez joined the HQ team as the 6th staff person back in 1996, serving as the Receptionist. She was promoted to Programs Manager in 1998 and took on the responsibility of managing the registration processes for the various AAPM-managed meetings. In 2007, the production of the AAPM newsletter was brought in house, with Nancy working directly with Editor Mahesh to produce the bi-monthly publication. Nancy is also the staff liaison to the Awards and Honors Committee and plans the yearly Awards and Honors Ceremony and Reception.

Karen MacFarland, AAPM’s Meetings Manager joined the team in 2003. Karen handles the meeting negotiations and logistics for many of the association meetings that are scheduled throughout the year, including the Annual Meeting and the Summer School.

Corbi Foster joined AAPM in 2007 as Meetings and Programs Manager, serving as the staff lead on ACMP activities. Along with Karen, Corbi shares the responsibility for overseeing the specialty and topical meetings held throughout the year.

Laurie Hayden joined the team 2007 as the Customer Service Representative. Later that same year, she was promoted to the newly created position of Programs Assistant, providing assistance with the meeting program development and abstract submission processes for various meetings.

When Laurie was promoted in 2007, Jackie Ogburn was hired to fill our Customer Service Representative position. In 2008, Jackie was promoted to the newly created position of Education Assistant. She has just recently been promoted to the position of Education Manager, overseeing the Online Learning and Virtual Library programs, AAPM grants and funding opportunities and providing staff support to CAMPEP. Kathleen Dwyer is the newest addition to the Meetings Team, joining AAPM in October, 2009, as the Exhibits and Meetings Assistant. Kathleen assists with exhibits and meeting registration for AAPM meetings.

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AAPM Newsletter

January/February 2011

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AAPM Newsletter

January/February 2011

Editor’s Column

Mahadevappa Mahesh, Johns Hopkins University

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appy New Year and welcome to the first issue of 2011. As expressed by others in this issue, I too feel that medical physics and medical physicists are in the lime light from last year because of the various media articles and public meetings both by regulators and legislatures.

This makes it even more important for all of us to be aware of the many other activities of the association. What better place to read all of this than this newsletter and hence I welcome all regular readers and new readers to avail this opportunity. In addition to regular columns, in this issue we have a number of interesting articles including one on ‘Why be a member of the AAPM?” I would also like to draw your attention to two articles, namely ‘Image Gently Update’ and ‘Image Wisely Initiative’. Image gently has become a social media success story for the imaging community highlighting the importance of radiation dose reduction in pediatric imaging. In this issue, ‘Image Gently Update’ highlights the need for reducing the radiation dose during fluoroscopy (“Pause and Pulse”). On the other hand, ‘Image Wisely’ is a multi-society collaborative initiative aimed at optimizing radiation dose and image quality during imaging in adult patients.

It gives me great pleasure to serve as the editor for the newsletter, which provides me a 30,000 feet view of what is happening in the medical physics profession and in the AAPM. I will continue to fine-tune the newsletter with any comments and/or suggestions received by you all.

Once again, I welcome all of you to the first edition of 2011 and wish all of you a very happy new year. continued - Executive Director’s Column On November 4, the Meetings Team participated in a service project organized by the Professional Convention Management Association (PCMA).

Known as the “Service In Sync Day”, meeting professionals from around the Washington, DC area joined to assemble care packages for U.S. Armed Forces currently deployed overseas.

80 volunteers participated in the half day event, and 5,750 care packages were assembled. In addition, $2,935.00 was raised for the USO. This event gives our meetings team the opportunity to “give back” while fostering our “AAPM team” can-do spirit!

Coming next issue….group profile of the AAPM Information Services team.

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Treasurer’s Column

Janelle A. Molloy, University of Kentucky Financial Position and Estimates for 2010

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stimates for 2010 indicate that we will complete the year with a relatively balanced budget for operations and a positive gain on reserves. As reported to the Board of Directors in early December, income is expected to total $7.5 million. Registration and exhibit income from the Annual Meeting, and advertising and subscription income from the Journal, were higher than anticipated.

Expenses are estimated at $7.64 million, compared with a budget of $7.58 million. Current estimates of total expenses include extraordinary unbudgeted legal expenses. Operations are expected to break even or realize a surplus depending on how the remaining Council and Committee budgets are spent.

At present, our investment portfolio is showing a gain and, if the market continues to advance, our reserves at the conclusion of the year will exceed $8,000,000.

2011 Budget The Finance Committee met via Webex on November 4th to review and approve a draft budget for presentation to the Board. A great deal of work by the Councils and Committees, as well as the Budget Subcommittee, went into the development of this budget. Chairs were asked to maintain a level of spending in 2011 equal to their 2010 budgets. Many tough decisions had to be made with respect to financial support for well-deserved projects. The Council Chairs met via teleconference and then worked diligently to propose budgets within the guidelines.

Revenue in 2011 is expected to be $7.7 million and total expenses are budgeted at $8.1 million, with a deficit of $361,376. Our financial modeling tool projected that the Association could budget a deficit slightly over $200,000 and still break even at year’s end. However, we are estimating that additional legal expenses may be incurred in 2011 and the Board approved the additional deficit for the year to be taken from reserves if necessary.

A copy of the detailed budget appears in this Newsletter, along with several illustrations.

Please do not hesitate to contact me with any questions you may have.

I can be reached at jmo222@email. uky.edu

Net Income – 2005 through 2011 Budget

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continued - AAPM Treasurer’s Column

Comparison of 2011 Draft and 2010 Approved Budget Differences Based on Direct Revenues and Expenses

Income by Major Source – Approved 2011 Budget

Expenses by Major Category Approved 2011 Budget

Total = $7,701,404

Total = $8,062,780

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January/February 2011

Education Council Report George Starkschall, Houston, TX

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he AAPM Education Council is comprised of several committees. Over the next several months, I would like to introduce you to these various committees by inviting the chairs to write article for the Newsletter about the activities of their individual committees. I have invited Don Frey, Chair of the International Educational Activities Committee, to write the first such article. The following is a guest article co-authored by Don Frey and Perry Sprawls: The International Educational Activities Committee

by G. Donald Frey and Perry Sprawls I have always been impressed with the AAPM’s commitment to education, not only of its members, but to all groups that need medical physics education. The AAPM Education Council not only has committees that deal with the education of medical physicists (Education and Training of Medical Physicists and Continuing Professional Development), but also even more committees that deal with the education of non-members (Public Education, Medical Physics Education of Physicians, Medical Physics Education of Allied Health Professionals, and International Educational Activities).

The International Educational Activities Committee (IEAC) is the newest member of the council.

It was created and joined the council in 2005. The IEAC confirms the AAPM’s commitment to international education. Previously all of the AAPM’s international efforts were through the International Affairs Committee. This committee was formed in 2005 to increase international education activities and to provide better coordination of international and national education programs.

International Scientific Exchange Programs (ISEP) The ISEP is the oldest and most central activity of the IEAC. The ISEP programs combine medical physics education with team building and mentoring. Typically two courses, one in oncology and one in diagnostic physics, are conducted each year. The objective of each one-week course is to provide local participants with an introduction and overview of current topics in clinical medical physics. The development of an ISEP often takes years. AAPM coordinators work with the medical physicists in the host country to develop and strengthen the local medical physics organization.

The local organization must be able to work with local ministries of health and regulatory agencies to develop and fund the course. During the one-week course both AAPM members and local medical physicists present the lectures. The ISEP process has helped develop effective medical physics organizations in many countries.

International Atomic Energy Agency (IAEA) Cooperative Activities The AAPM works closely with the IAEA on international education. Here the AAPM frequently provides speakers for IAEA courses. This is a wonderful way to leverage the AAPM investment since additional funds from the IAEA and other major organizations like the European Federation of Organisations for Medical Physics (EFOMP) provide much of the funding. The AAPM also works with the IAEA on the Interregional Project, which is developing a description of the scope of practice for clinical medical physicists, minimum educational requirements, recommendations for accreditation and certification and suggestions for staffing levels and public education.

International Organization for Medical Physics (IOMP) The AAPM works with the IOMP in several educational activities. Also, through the IOMP the AAPM has a relationship with the World Health Organization and the International Labor Organization.

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continued - Education Council Report AAPM Developing Country Education Associate (DCEA) Program Many physicists in developing countries cannot join the AAPM. In recent years the AAPM has created the DCEA program so those physicists can have accesses to our publications, and on line educational materials.

Endorsement and Sponsorship of International Programs AAPM members are known throughout the world for their expertise on scientific topics and their educational skills. Many regional organizations feel that their meetings would benefit from some association with the AAPM. The AAPM, through the IEAC, endorses or co-sponsors many meetings throughout the world. We also sometimes send speakers to carefully selected meetings that have a significant regional or worldwide audience.

Visiting Consultants Program The most recent innovation is a program through which AAPM sends a highly-experienced medical physicist to a developing country to work directly with the medical physicists there.

Summary The AAPM engages in a wide range of international educational efforts. Our major thrust is to improve the professional lives of medical physicists in developing countries. We also work closely, especially through the IAC, with international organizations to promote the interests of medical physicists and to coordinate our efforts. The AAPM can be proud of these efforts. While the membership as a whole benefits from international coordination most of our efforts are altruistic and designed primarily to improve the professional lives of our colleagues in the developing world.

It’s almost AAPM Career Services time!

In just a few short weeks, our all-new AAPM Career Services online job board will launch. This exciting member benefit will put an array of useful recruitment tools at your fingertips, no matter which side of the hiring equation you’re currently on: Job Seekers will easily search relevant medical physics job openings, establish automatic email job alerts, and quickly post resumes and other application documents.

Hiring Employers will securely post medical physics jobs as well as navigate a scientific resume database featuring thousands of targeted and current documents.

Get ready to simplify your recruitment process with our expert help. Keep watch for another message with more information and a direct link to the revamped AAPM Career Services once we’re live in January!

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AAPM Newsletter

January/February 2011

Professional Council Report Michael D. Mills, Louisville, KY

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here are a couple of leadership changes in the Professional Council as of the first of the year. With the impending AAPM-ACMP merger, David Hintenlang, Chair of ACMP becomes the new Vice-Chair of the Professional Council. I will move to Chair the Clinical Practice Committee, assisted by Jessica Clements as Vice-Chair. The purpose of this move is to ensure continuity during the AAPM ACMP merger and to ensure ACMP’s core functions in the professional practice arena are properly integrated and provide continuing support to the community.

The New York Center for Health Workforce Studies of the University at Albany (State University of New York) has released their final Workforce Report and Survey Validation Report for review by the Workforce Subcommittee and the Clinical Practice Committee. The purpose is to address the current complexity of medical physics with respect to our training programs and pathway to board certification, and to develop a model for supply and demand for medical physicists for the foreseeable future. Ned Sternick served as Chairman of Medical Physicist Workforce Subcommittee. The Professional Council is making recommendations as to how the AAPM should follow-up on this report so the medical physics profession may develop and implement strategic plans for the future.

The Diagnostic Work and Workforce Study Subcommittee, under Chairman Ed Nickoloff, has created a comprehensive survey that would allow diagnostic facilities to assess the proper physics staffing based upon the type and number of imaging equipment. In addition, the survey provides a CPT based assessment of the cost of medical physics support for each type of modality in term cost per patient study. This effort could become an important database to assess the costs for patient imaging studies by government agencies and insurance companies. A small trial survey to test the instrument has been completed. Now that proof of concept has been accomplished, a larger AAPM in-house survey is planned and analysis tools are being developed. The hope is to do as much as the developmental work as possible in house, thus limiting the costs if and when the survey is ultimately conducted by an outside consulting group.

The Economics Committee is completing an update for the Reimbursement Road show for 2011.

This comprehensive lecture on the place of medical physicists in national economic health care policy is available for presentation to AAPM Chapter Meetings, provided speaker travel costs are provided. Please see Wendy Fuss Smith’s column for more details on the activities of the Economics Committee and for the announced CMS changes in reimbursement for 2011.

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

Since I am rotating off as Vice-Chairman of the Professional Council, this will be my last newsletter column, at least for a while. I would like to thank Michael Herman and Per Halverson for their support and confidence in me over the past five years. It has been an honor to serve the AAPM in this capacity.

15 15

AAPM Newsletter

January/February 2011

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AAPM Newsletter

January/February 2011

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

CARE Act Update – by Herbert Mower and Lynne Fairobent

T

he Alliance for Quality Medical Imaging & Radiation Therapy (AQMIRT) met in conjunction with the RSNA meeting in Chicago. Attending for ACMP was Herbert Mower and for AAPM Jerry White and Lynne Fairobent.

There was an update on the status of the current versions of the CARE bills - H.R. 3652 and S. 3737. It was noted that it is a popular bill and seems to be non-controversial. In the House, there is no opposition to the bill. If a ‘noncontroversial’ bill is brought to the floor before the end of the year, it will probably be amended to this and move forward. There will probably be an ‘Omnibus’ bill introduced at the end of the year that will have many medical items in it. There is a good possibility that the CARE bill will be included here. This ‘Omnibus’ bill will probably be passed right before Christmas as a ‘present’ to the citizens of the US. One issue impacting the passing of the bill is that the Congressional Budget Office has not scored the bill.

Although there are some differences between the two versions of the bill, Rep. Barrow has indicated his willingness to accommodate the Senate’s version. For ACMP and AAPM, we prefer the Senate’s version.

As of December 16th, there has not been action on moving this bill forward. If this remains the case, as Congress is soon to go out of session for the rest of 2010, then we will need to have a bill introduced in the 112th Congress. As you know, there be a leadership change in the House and we will need to align with the Republicans. The CARE bill and medically related QA and ‘culture of safety’ issues are still a very ‘hot’ issue in Congress. Thus we would expect an early introduction of the bill. We already have targeted a couple of key possibilities as sponsors in both the House and Senate.

The Alliance also briefly discussed issues around event reporting and dose reporting. The question was raised as to whether or not the Alliance as a consortium should become involved with these issues. Amongst some of the questions were the following: · Does this lead to the government becoming involved with ‘regulating’ medicine? · What are the implications relative to malpractice? · Will dose reporting solve all problems” · What is the line between ‘outside the norm’ and a malpractice event?

It was felt that these issues might be of importance to the Alliance members but that we should not tie them into the CARE bill or delay promoting the CARE bill for inclusion of these concerns.

Licensure Update: For 2011 the Joint Medical Physics Licensure Subcommittee (LMPSC) decided to pursue licensure in two states – Pennsylvania (PA) and Massachusetts (MA) with our outside lobbyist - Bevan, Mosca, Giuditta and Zarillo (Bevan). This decision was reached in part based on budgetary considerations. The State Committees in Michigan and Ohio will continue to be active, and will work with AAPM staff to educate and assist the licensure effort gain member support in those states. In addition, we will continue to work with the Conference of Radiation Control Program Directors and individual states to purse regulatory changes requiring that Qualified Medical Physicists perform clinical medical physics.

17

AAPM Newsletter

January/February 2011

T

his year’s joint program will be held in the new West expansion of the Vancouver Convention Centre. This breathtaking venue is in the heart of downtown, with the Gastown District, Stanley Park, and the natural splendor of sea and mountains as only British Columbia can offer.

The education program and professional program will offer a significant opportunity to gain practical knowledge on emerging technical and professional issues. The scientific program will feature the latest research in the physics of medical imaging and radiation therapy, including a major focus on the increasing integration on advanced imaging technologies in the guidance of medical therapeutics.

There will be several major changes to the 2011 Program: •

• • • •

• •

Special Ultrasound Symposium (Monday – Wednesday, August 1 - 3), including Education, Imaging, and Therapy aspects of medical ultrasound. Diagnostic topics include: Breast, Other Applications, Guidance of Interventions; Advanced Systems, Components, Signal/Image Processing & Display; Quantitative Imaging & Measures; Contrast and Interventional Agents (US and optical), and Small Animal Imaging; Photoacoustic Imaging. Therapy symposia are: Clinical Systems and Applications; Novel Technologies & Therapeutic Strategies; Treatment Planning, Modeling, & Control; Image Guidance and Assessment.

The abstract submission procedure has been revised and will include a one page summary of basic instructions necessary to submit the abstract.

There will be a tiered-down approach for selecting categories with major categories and tiered sub-categories.

The Moderated Poster Category has been removed and will be replaced with a “Short Oral Presentation” featuring brief oral presentations (5 minutes + 1 minute Q/A) in a moderated session.

Investigators associated with the top five scoring abstracts in each of the tracks, Therapy, Imaging and Joint Imaging/Therapy, will be required to develop 8’ posters in addition to their oral presentations. These posters will be displayed in a specially designated “Best in Physics” theater.

The Young Investigators Symposium will be held jointly by the AAPM and COMP and will be entitled: “The John R. Cameron and John R. Cunningham Young Investigators Symposium”.

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.

2011 Dates to Remember www.aapm.org/meetings/2011AM/

January 5

Web site activated to receive electronic abstract submissions.

March 7

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.

March 18

Meeting Housing and Registration available on-line.

By April 19

Authors notified of presentation disposition.

By May 12

Annual Meeting Scientific Program available on-line.

June 8

Deadline to receive Discounted Registration Fees.

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AAPM Newsletter

January/February 2011

Innovations in Medical Physics Education: The Education Council of the AAPM will be sponsoring the Innovations in Medical Physics Education symposium to honor and publicize innovations in Medical Physics Education. AAPM members are invited to submit a one page description of innovative medical physics educational activities for radiology residents, radiation oncology residents, medical physicists, technologists or others. The projects can be scientific research, novel teaching strategies – team teaching or adult learning efforts, novel educational materials – lectures, websites, or other innovations.

The top six submissions will be invited to present their projects at the symposium during the 2011 AAPM annual meeting in Vancouver, BC. Each speaker will be allocated 15 minutes.

The top project will be presented a plaque. Additional honorable mention plaques may be awarded.

Unfortunately no travel support is available. The deadline for submissions is March 7, 2011. Selected submissions will be notified by April 19, 2011.

Joint Imaging-Therapy Track: The 2011 Therapy Track will include the following general topics: engineering for science in patient safety, targeted radionuclide therapies, functional imaging including PET and MRI for treatment planning and response, nanotechnology applications in radiation oncology, and normal tissue imaging of dose response.

Therapy Track:

The 2011 Therapy Track will include the following general topics: biological modeling and QUANTEC, advanced IMRT/IGRT planning and future directions, on-line and off-line adaptive radiotherapy, verification of complex radiation treatments, and multiscale modeling of tumor growth and response to therapy.

Imaging Track:

Scientific symposia will include: 3D breast models for x ray imaging, multiple source x ray imaging, x ray phase contrast and phase contrast CT imaging, Quantitative CT imaging and analysis, computing patient specific radiation doses in fluoroscopy, radiography and mammography, computing patient specific radiation doses in CT, and a debate on the benefits and risks of CT.

Educational Course Therapy Track:

The Therapy Physics series will feature approx. 30 lectures. The program will feature courses on standard therapy physics practices including linac calibration and QA as well as special clinical procedures including volumetric modulated arc therapy (VMAT), quality management systems, and planning, QA, and IGRT strategies for head and neck, abdomen and pelvis radiotherapy.

Educational Course Imaging Track:

There will be approximately 30 Educational courses and four SAM sessions in Diagnostic Imaging Physics and Technology. They will cover all imaging modalities, image reconstruction, radiation safety and risk management issues, accreditation, and recent developments in medical imaging physics education. Also, this year will feature special joint sessions with the Imaging Science track related to radiation dose and risk.

Professional Track:

A number of sessions will be provided to keep our members abreast of the latest professionally related developments. Topics we are planning to include: news on ABR 2014 requirements, a session on preparing for diagnostic ACR accreditation, a presentation by the women’s professional subcommittee on career strategies, a session on voluntary and regulatory standards, tips on how to prepare for ABR exams, an economics and entrepreneurship session, a session devoted to new members, and a look at medical physics in Africa.

John S. Laughlin Science Council Research Symposium:

Topic: Science and Engineering for Patient Safety in Therapy and Diagnostic Medical Physics

19

AAPM Newsletter

January/February 2011

Website Editor Report Christopher Marshall, New York, NY

A

s I look forward to 2011 we should take satisfaction in the work done on the website in 2010 by our excellent staff team, but it often feels we are running up the proverbial down escallator.

Moreover, this escallator is accelerating as we add more content and expand our reach, and thus have more to maintain. Members may not realize that the same staff team is also juggling workload on several other websites. The miracle is that we are holding our own but only because staff stretch the day to get the job done.

Interaction about a recent posting started at 5.45 am and ended at 10.59 pm based on my email record.

The Board took a major step at the RSNA meeting and approved the Strategic Plan. While work remains to be done, it is already clear that there will be challenges for the website. One is to improve the ability to find things on the site. One avenue that is already being explored is to make a further significant upgrade to our search engine to allow it to search even more content. Another and potentially complementary approach is to categorize content with key words, as is routinely done in the journal publishing world, to allow search to become more targeted. I plan to experiment with this approach by tagging all the Reports with key words for search purposes, and I plan to appoint a TG or SC to assist me in this process. If you have any interest in this area, please let me know.

I previously reported on the use of wiki tools for various committee projects and noted that since a wiki can be continuously updated there is no single moment when the content can be reviewed by a council and released to the membership, as we do for reports. A very practical tool has now been developed by staff that will allow wiki content to be copied and “frozen” for release to the membership, leaving the committee free to develop more content for eventual release by using their own copy. We need some experience to see if this approach will meet all needs, but it is a start.

The EMCC continues to review our experiments with social networking, and has authorized an official Facebook presence for the AAPM, which should be launched in the New Year. One comment made at the last EMCC meeting and worth repeating is that we may need to allow members a choice in how they communicate with the AAPM – while some of us remember the birth of email, our younger members may already regard it is as obsolete. Another issue is whether we can successfully exploit the popular social networks, or should we be investing in networks designed to serve technical and scientific communities such as AIP’s UNIPHY to http://www.aipuniphy. org/ I hope that you find the Website useful, visit it often, and send me your feedback at http:// www.aapm.org/pubs/newsletter/WebsiteEditor/3601.asp

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AAPM Newsletter

January/February 2011

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. Are there weekly/monthly QC tests for breast MRI? Who should perform these tests?

A. Yes, there are periodic QC tests that must be performed by the MRI technologist. All required QC tests and their frequencies are outlined in the Breast MRI Accreditation Program Requirements and the 2004 ACR Magnetic Resonance Imaging (MRI) Quality Control Manual. The medical physicist/MR scientist should identify the MRI technologist responsible for performing the tests and may choose to increase the frequency of testing based on the facility and MRI usage. If any QC parameter being monitored falls outside of the control limits, corrective action must be taken.

A medical physicist/MR scientist should be available to assist in prescribing corrective actions for unresolved problems.

Q. We have the standard large ACR Phantom that sits in the head coil. Should the technologist conduct the weekly QC of the breast MRI unit using the large ACR phantom in the head coil?

A. The ACR leaves the choice of the QC phantom and the resultant action criteria to the facility.

This decision must be made by the qualified medical physicist/MR scientist in cooperation with the system vendor. Although many of the procedures and action criteria outlined in the 2004 ACR Magnetic Resonance Imaging (MRI) Quality Control Manual were written specifically for the ACR MRI Accreditation Phantom, the ACR understands that the use of this phantom may not be possible for all QC in breast imaging. Some facilities use the ACR Small MRI Phantom for this purpose.

Q. Do you have a list of vendors who offer a MRI phantom that would fit in a unit only designed for breast?

A. The ACR’s “small” MRI phantom does fit in most breast coils. Information about the phantom is located on our website at the links below: http://www.acr.org/accreditation/mri/mri_qc_forms/phantom_order_form.aspx http://www.acr.org/accreditation/mri/mri_qc_forms/ SiteScaningInstructionsSmallPhantom.aspx http://www.acr.org/accreditation/mri/mri_qc_forms/ PhantomTestGuidanceSmallPhantom.aspx Q. Our site cannot print hardcopies of MRI images. (Although laser printers are available in mammography, they are not hooked up to the MRI scanners.) Is it required that the MRI department perform QC testing on those printers?

A. No, if your facility does not have laser printer capability for Breast MRI, there is no need to perform QC for a laser printer. Just indicate that you do not use a laser printer when you complete the application forms.

21

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January/February 2011

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

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

T

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

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

The MEI is a measure of practice cost inflation to estimate annual changes in physicians’ operating costs and earning levels. The MEI is used in the annual update calculation to determine the conversion factor. CMS will rebase and revise the MEI for 2011 to reflect physician’s expenses in 2006. This policy increases payments to radiation oncology by 4 percent and radiation therapy centers by 8 percent in 2011. It has negative 1% impact to radiology payments.

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

Another factor contributing to the impacts (on a specialty-specific rather than widespread level) are changes to RVUs for potentially misvalued codes. CMS notes that some specialties, such as radiation oncology, that commonly furnish potentially misvalued codes that have been examined by the AMA RUC and newly valued for 2011, experience decreases in aggregate payment as a result of these changes (e.g. CPT 77427).

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

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

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

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AAPM Newsletter

January/February 2011

continued - Health Policy/Economic Issues Lastly, based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 25 percent reduction to the current 2010 conversion factor. Without legislative action, CMS estimates a 2011 conversion factor of $25.52. AAPM anticipates that Congress will avert the payment decrease slated for January 1, 2011, however, if Congress does not pass legislation the 2011 conversion factor would reduce all payments by an additional 25 percent to the “combined” impacts shown below.

Impact Work & Malpractice RVU Changes

Impact Practice Expense RVU & MPPR Changes

Impact MEI Rebasing

Radiation Oncology

-2%

-3%

+4%

-1%

Radiation Therapy Centers Radiology

0%

-5%

+8%

+3%

-2%

-7%

-1%

-10%

Total

0%

0%

0%

0%

Specialty

2011 Combined Impact (Does not include -25% CF reduction)

To read a complete summary of the final rule and to review impact tables go to: http://aapm.org/government_affairs/CMS/2011HealthPolicyUpdate.asp 2011 Policies & Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) published the 2011 Hospital Outpatient Prospective Payment System (HOPPS) final rule. The final rule includes a 2.5% increase to Medicare payment rates for most services paid under the HOPPS in 2011.

The majority of radiation oncology procedure codes realize increases in 2011 hospital outpatient facility payments, however, high dose rate (HDR) brachytherapy (APC 313) and stereotactic radiosurgery treatment delivery (APCs 67) have payment reductions slated for 2011. Medical physics codes 77336 & 77370 in APC 304 receive a 1.8% increase in 2011 payments (see table on next page).

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

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AAPM Newsletter

January/February 2011

continued - Health Policy/Economic Issues SUMMARY OF 2011 RADIATION ONCOLOGY HOPPS PAYMENTS APC

Description

CPT Codes

2010 Payment

65 66 67 127 299

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

G0251 G0340 G0173, G0339 77371 77470, 77600-77620 77401-77409 (77406), 77789 77411-77416, 77422,77423, 77750 77332-77334

300 301

Level II Radiation Therapy

303

Treatment Device Construction Level I Therapeutic Radiation Treatment Prep

304

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

2011 Proposed Payment $977.12 $2,504.67 $3,408.69 $7661.15 $388.58

Percentage Change 2010 to 2011 1.8% 0.9% -4.3% 4.6% 2.4%

$92.55

$97.82

5.7%

$154.86

$160.54

3.7%

$190.15

$199.71

5.0%

77280, 77299 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77315, 77321, 77327, 77328 32553, 49411, 55876, 77295, 77301, 77338 C9728 77761, 77762, 77763, 77776, 77777, 77799 77785, 77786, 77787, 0182T 77418, 0073T

$102.68

$104.48

1.8%

$265.67

$271.61

2.2%

$925.07

$926.74

0.2%

$301.55

$354.95

17.7%

$775.65

$700.10

-9.7%

$420.19

$438.22

4.3%

305

Level II Therapeutic Radiation Treatment Prep

310

Level III Therapeutic Radiation Treatment Prep

312

Radioelement Applications

313

Brachytherapy

412

IMRT Treatment Delivery

651

Complex Interstitial Radiation Source Application

77778

$891.31

$1,129.46

26.7%

664

Level I Proton Beam Therapy Level II Proton Beam Therapy

77520, 77522

$940.00

$1,031.71

9.8%

77523, 77525

$1,229.66

$1,349.61

9.8%

LDR Prostate Brachytherapy Composite

55875 + 77778

$3,104.99

$3,229.24

4.0%

667 8001

APC reassignments for 2011 are highlighted in bold

25

AAPM Newsletter

January/February 2011

continued - Health Policy/Economic Issues The Affordable Care Act waives beneficiary cost-sharing for most Medicare-covered preventive services.

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

• Continue packaging of radiation oncology imaging guidance services for 2011.

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

A complete summary of the final rule and impact tables is on the AAPM website at: http:// aapm.org/government_affairs/CMS/2011HealthPolicyUpdate.asp All policies and payments are effective date January 1, 2011.

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AAPM History Interviews William R. Hendee, Rochester, MN

Video-Recorded Interviews with Prominent Physicists

I

n 1990 Bob Gorson initiated an oral history project for the American Association of Physicists in Medicine (AAPM) by conducting video interviews with prominent medical physicists and other individuals important to medical physics. The project has continued with other interviewers so that to date approximately 150 individuals have been interviewed, a few more than once. The interviews vary from 50 minutes to 4 hours, and the subjects covered include professional research and experience, early education and family history, and the history of medical physics and the AAPM. The interviews have been preserved in the Niels Bohr Library & Archives of the American Institute of Physics. The interviews are fascinating to watch and provide excellent insight into the history of the profession. The list of interviewees can be seen by opening http://aip.org/history/ icos and typing “American Association of Physicists in Medicine History Committee” in the author category. Most of the interviews are listed in one of two categories: AAPM interviews with physicists in medicine [videorecordings], 1990-2004, and AAPM History Committee physicists of note interviews, 2005-2009. The same web site also lists video interviews of 25 early radiation workers. These can be accessed by typing “Vignettes of Early Radiation Workers” in the title category. The interviewees are also available on the AAPM History and Heritage website (http:// www.aapm.org/org/history/interviews.asp).

Interviews on DVDs can be borrowed on 30-day loan from the Niels Bohr Library & Archives. To borrow DVDs, users: 1. complete and submit an Application for Access form (http://aip.org/history/ nbl/accessform.html).

Submitting an Application for Access is a one-time process; once the application is on file, an individual may borrow DVDs and use anything in the Library & Archives.

2. identify the interviews of interest and request them by email (nbl@aip.org), phone (301 209-3177), or regular mail (Niels Bohr Library & Archives, American Institute of Physics, One Physics Ellipse, College Park, MD 20740-3843). The DVDs are sent

by FedEx, and there is a $5 shipping fee.

Individuals who are in the area can avoid the fee by picking up the DVDs at the Niels Bohr Library & Archives.

The AAPM is indebted to Bob Gorson for starting this oral history project and to those who have continued it.

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27

AAPM Newsletter

January/February 2011

Image GentlyTM Campaign Update Image Gently™ Campaign Focuses on Need to “Pause and Pulse” in Pediatric Fluoroscopy

C

ontinuing its mission of increasing awareness of the opportunities to lower radiation dose in pediatric imaging, the Alliance for Radiation Safety in Pediatric Imaging (the Alliance) is launching the Image Gently™ campaign’s fourth phase — “Pause and Pulse” — with a focus on diagnostic fluoroscopic procedures.

Since its inception three years ago, the Alliance has grown into an international coalition of 57 member medical societies. In previous campaign phases, Image Gently™ reached out to radiologists, referring physicians, medical physicists, radiologic technologists, and parents, to spotlight benefits and potential risk related to medical imaging in computed tomography (CT) (January 2007) and interventional radiology (August 2009), and to promote medical literacy among parents (January 2008).

“There is no doubt that medical imaging saves lives, but children are particularly susceptible to the potential adverse effects of radiation, so fluoroscopic procedures should be used wisely with dose optimization in accordance with the ALARA principle — As Low as Reasonably Achievable,” says Marta Hernanz-Schulman, MD, FAAP, FACR, professor of radiology and pediatrics at Vanderbilt University Medical Center and chair of the fluoroscopy campaign.

The availability of endoscopy and CT has reduced the number of fluoroscopic procedures, but fluoroscopy sometimes provides the only non-invasive method of making a diagnosis or monitoring treatment. The international push to lower radiation dose has spurred tremendous innovation in fluoroscopic equipment. The latest equipment, Hernanz-Schulman notes, often achieves “significant reductions in dose while maintaining, and sometimes significantly improving, image quality.”

“Pulsing the X-ray is one of the greatest dose-savings measures in fluoroscopy and is especially important to children with smaller bodies and greater vulnerability to radiation,” HernanzSchulman says. “But even before this, radiologists need to pause and make sure the study is indicated for the clinical problem. As with any test, there should be clear reasons to request the study. In some situations ultrasound or occasionally magnetic resonance imaging (MRI) could provide similar information without exposing a child to radiation.”

Radiologists can utilize numerous techniques to significantly decrease the amount of radiation children are exposed to while still allowing diagnostic-quality images. These include: • • • • •

having a clear initial understanding of the patient’s problems and goals of the study limiting fluoroscopic time in general and limiting use of magnification mode in particular careful collimation to the area of interest and appropriate shielding matching tube output (kVp and mAs) to the size of the child utilizing pulsed digital fluoroscopic equipment with adjustable frame speeds as well as last image hold and capture capability

To ensure that a qualified, experienced and credentialed medical team is performing the fluoroscopic examination with fluoroscopic equipment suitable to children, referring physicians and parents are encouraged to ask: 1) 2) 3) 4)

if the facility is accredited by the ACR if the technologists are certified how frequently the facility performs the requested fluoroscopic study in children if a board-certified radiologist with pediatric experience or a pediatric radiologist will be performing and interpreting the study

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AAPM Newsletter

January/February 2011

continued - Image GentlyTM Campaign Update Ishtiaq Hussain Bercha, MSc, lead medical physicist on the fluoroscopy phase of Image Gently™ and a medical physicist at The Children’s Hospital, Aurora, Colorado, notes, “The medical physicist, having a background in physical sciences as applied to medicine, is uniquely positioned to help optimize the whole procedure, including radiation safety. The bottom line is that the physicist should work very closely with all of the professionals involved.” He also notes the need to recognize potential radiation exposure to the fluoroscopist and assisting personnel when the medical team is trying to immobilize and position the child during a procedure.

As always, the radiologic technologist has a key role. “Reducing dose is a team effort. Acquiring an optimal pediatric fluoroscopic exam with minimal radiation dose to the patient must be a coordinated effort between the radiologist, physicist and the radiologic technologist,” says Greg Morrison, MA, RT(R), CNMT, CAE, chief operating officer of the American Society of Radiologic Technologists (ASRT) and a member of the Alliance’s steering committee.

“We really need to image our kids with care,” Hernanz-Schulman notes.

“During the fluoroscopy, the Image Gently™ Pause and Pulse Campaign reminds medical professionals to pause to properly plan and prepare for study; to activate dose saving features of equipment; to take no exposures unless necessary; to depress last image hold instead; and to pulse at the lowest possible frame rate.”

Pause

&Pulse

More information is available at www.imagegently.org.

Fluoroscopic procedures help us save kids’ lives.

But... when we image patients, radiation matters. Children are more sensitive to radiation. What we do now lasts their lifetimes.

• Image our kids with care.

• Stop and child-size the technique.

• Use lowest pulse rate possible.

• Consider ultrasound or MRI when applicable.

For more information about pediatric radiation safety, visit www.imagegently.org.

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AAPM Newsletter

January/February 2011

Image WiselyTM Initiative

William Hendee, Rochester, MN AAPM Representative to the Image Wisely Initiative

O

ver the past three decades, imaging examinations have replaced several more invasive medical procedures, thereby benefiting patients and revolutionizing medicine.

This evolution has substantially increased the exposure of the public to radiation, causing concern that the immediate benefits of medical imaging could be accompanied by future adverse consequences for patients. This possibility has encouraged medical physicists and their radiology and technologist colleagues to ensure that patients receive only necessary imaging procedures, and that the lowest radiation dose is used consistent with acquiring the information needed for diagnosis or image-guided therapy.

At the recent meeting of the Radiological Society of North America (RSNA), the Image Wisely Initiative was launched as a collaborative effort of the American College of Radiology (ACR), RSNA, American Society of Radiologic Technologists (ASRT) and American Association of Physicists in Medicine (AAPM). The Image Wisely Initiative encourages image providers to: (a) Optimize imaging examinations to use only the radiation necessary to produce diagnostic quality images; (b) Convey the principles of the Image Wisely Initiative to the imaging team in order to ensure that the facility optimizes its use of radiation when imaging patients; (c) Communicate optimal patient imaging strategies to referring physicians, and be available for consultation; (d) Routinely review imaging protocols to ensure the use of the least amount of radiation necessary to acquire a diagnostic quality image for each exam.

Image Wisely urges physicians, physicists and technologists to demonstrate to patients that they “image wisely� by: (a) Taking the Image Wisely pledge; (b) Getting their facility accredited by the ACR or equivalent accrediting organization; and (c) Participating in a Dose Index Registry.

More information about these objectives, and a site to sign the pledge, are available at http:// imagewisely.org/ Also available at the Image Wisely website is information for imaging professionals, including medical physicists, in the form of downloadable PDF and HTML files. The medical physicist information, initially focusing on computed tomography, has been prepared by several medical physicists and consists of the following topics: (a) Appropriateness Criteria With Accountability for Radiation Dose (Drs. Karellas and Hussain); (b) The CTDI Paradigm: A Practical Explanation for Medical Physicists (Drs. Dixon and Boone); (c) CT Protocol Design and Optimization (Drs. McNitt-Gray and Kofler); (d) How to Understand and Communicate Radiation Risk (Drs. Peck and Samei); (e) Image Reconstruction Techniques (Drs. Yu and Leng); (f) Statement on Multiple CT Exams (Drs. Zink and Morin); (g) The Pregnant Patient: Alternatives to CT and Dose-Saving Modifications to CT Technique (Drs. Coakley, Cody and Mahesh); (h) Physicist Considerations for PET/CT and SPECT/CT (Drs. Matthews and Bonta; and (i) Diagnostic Reference Levels (Dr. McCollough). Readers are encouraged to use this information to improve CT procedures and protocols used in their institutions.

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AAPM Newsletter

January/February 2011

New Professionals Subcommittee Report Jessica Clements, Dallas, TX

Why be a member of the AAPM?

A

s a new professional, you may find yourself “shopping” for a professional organization and wondering why you should join. The purpose of this article is to highlight some of the benefits of being an AAPM member.

First, it is best to understand the membership types available. Student membership is available for medical physics graduate students and undergraduate students in science, engineering, or a related field. The resident category is available to residents of CAMPEP accredited programs. Junior memberships are available to post-doctoral students, residents of non-CAMPEP accredited programs, or fellows of a medical physics training program. Full membership is available to those working in the field of medical physics. For more information about these various levels of membership, fees, eligibility requirements, and the application process, please go here: http://www.aapm.org/memb/ newmembinstructions.asp. Benefits vary somewhat by the membership level held. From this point forward, the benefits described are for those with a full membership.

Standard inclusions with a full membership are: • Print subscriptions to the Medical Physics Journal and Physics Today.

• Access to online publications of the Medical Physics Journal, AAPM Newsletter, Salary Survey, Member Directory, Career Services (Blue Book), and Task Group Reports.

• Benefits including the option to purchase professional liability insurance, reduced meeting registration rates, voting, and a reduced rate on AIP publications.

Beyond these standard inclusions, I find that perhaps one of the most valuable benefits of being a full member of the AAPM is the ability to volunteer with the organization. Much of the work of the AAPM is conducted by volunteer committees. In general, you must be a full member to join a committee or subcommittee as a voting member. Participation in AAPM committees gives you the opportunity to apply your skills in various areas of interest to serve the medical physics community. Please watch for a future article from this subcommittee which will address how to get involved.

There is also great value in the on-line learning center and virtual library. As a new professional, you may find it difficult to attend national meetings or special sessions due to limited travel funds or a busy work schedule. The virtual library is a resource that gives you access to streaming video and/or audio of presentations at your leisure. These presentations keep you current with a wide range of topics. For a very reasonable annual fee of $65, you can add access to the on-line learning center to your membership and complete quizzes for continuing education credit. SelfAssessment Modules (SAM) are also available in the on-line learning center.

One last highlight that all new professionals should know about is funding available for new professionals. The first is a summer school tuition scholarship. This competitive scholarship offers a full waiver of tuition fees for the entire summer school. There are also additional grants available through Capintec to assist with other expenses such as travel and housing. Eligibility and application requirements for this program can be found on the AAPM website and should be available for the 2011 summer school at the beginning of the year. There is also a Research Seed Funding Initiative which offers a $25,000 award for one year. Information and applications become available in November and are due in February of the following year with the award beginning in July. Information about this program can be found here: http://aapm.org/ education/ResearchSeed/.

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AAPM Newsletter

January/February 2011

UNYAPM Chapter Report

Iris Z. Wang, President-Elect Zhou.Wang@RoswellPark.org

UNYAPM Chapter Honors Joel Gray at its Fall Meeting

T

he Upstate New York Association of Physicists in Medicine held its semi-annual meeting at the Bone and Joint Center, SUNY Upstate Medical University, East Syracuse, on October 6th. Attendees of the meeting included UNYAPM chapter members all across the upstate New York region and representatives from the sponsoring vendors. The highlight of the meeting was the annual presentation of the Lifetime Achievement Award in Medical Physics and this year’s recipient was Joel E. Gray, Ph.D. As part of the award ceremony, Dr. Gray presented a core lecture entitled “Radiation Dose Reduction and Image Quality in Diagnostic Imaging – Easily and Inexpensively”.

Through examples of different clinical scenarios, the key message delivered by Dr. Gray was “Doses and image quality can be optimized easily and inexpensively, often at little or no cost to the radiology department. Such reductions in dose are truly appreciated by radiologists and radiology staff today, especially with the sensitivity of public to radiation doses in medicine.”

In addition to Dr. Gray’s talk, the scientific program featured seven other presentations given by students, faculty and clinical Joel Gray giving the keynote lecture at the physicists from various universities and cancer centers. From UNYAPM fall meeting. the University of Rochester (UR), Dr. Michael Schell presented an interesting talk about stereotactic radiosurgery with an emphasis on the safety of treatment delivery and How to Stay Out of the New York Times. Also representing UR, Dr. Walter O’Dell presented their research on development of a realistic simulated lung nodule dataset for quantitative evaluation and comparison of CAD algorithms. Roswell Park Cancer Institute (RPCI) was well represented by four talks describing their research and experiences related to clinical treatment planning and patient specific IMRT QA. Among them, Dr. Iris Wang’s vital presentation pointed out the potential dosimetric variations in treatment planning caused by image artifact from Joel Gray receives the UNYAPM Chapter’s Lifetime Achievement Award. From left to right: immediate extended field-of-view of a wide bore CT simulator. past president Walter O’Dell, award recipient Joel Also from RPCI, Dr. Mohammad Bakhtiari and Gray, president of UNYAPM Michael Schell, and Mr. Daniel Bailey discussed a couple of topics president-elect Iris Wang regarding using EPID for QA: a new approach to use EPID for VMAT quality assurance (M.B.) and the off-axis dosimetric response of the EPID by comparing Varian PortalDosimetry and Sun Nuclear EPIDose (D.B.). Dr. Dinko Plenkovich from WCA Hospital, an affiliation of RPCI, described an interesting artifact occurring in a bilateral breast treatment plan. Representing Vassar Brothers Medical Center, chief medical physicist Mr. Daniel Pavord presented very detailed information of their clinical experiences using Intrabeam system from Zeiss for intraoperative radiation treatment of breast cancer.

At the business meeting prior to the scientific session, it was decided to hold the next semi-annual UNYAPM meeting at Rochester NY in April 2011. As always, non-members are also welcome to attend. Details can be obtained from the chapter secretary, Dr. Ciprian Ionita (cnionita@buffalo. edu) and the chapter web site (www.UNYAPM.org).

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AAPM Newsletter

January/February 2011

2010 ORVC Fall Educational Symposium Michael S. Gossman, O RVC President ‐ Ashland, KY

T

he Ohio River Valley Chapter of the AAPM held its fall meeting on the Campus of Indiana University – Bloomington during the weekend of September10 - 11, 2010. The meeting was dedicated and renamed The Jian Z. Wang Honorary Symposium to honor the life of our former President who died earlier this year. We were thankful to have had the opportunity to provide a Service Award plaque for President Jian Wang to his surviving wife, Sherry Li, as well as to have created and released a college donation fund for their son, Roy Wang.

The meeting was highlighted by a Night Out event at the ProCure Training Center on Friday, including hands-on tours and educational sessions over the entirety of the proton treatment training site. This was accompanied by acoustical smooth jazz

Figure 2. Left – ProCure simulation training session during tour Friday; Right – IU Cyclotron Beam Control during tour Saturday

Figure 1. Rebecca Richardson, Roy Wang, Sherry Li, and Michael Gossman during awards

provided by the Indiana University School of Music. Following the symposium, the meeting was also highlighted by lengthy tours of the Cyclotron Facility and the Midwest Proton Radiotherapy Institute. Attending the meeting were 110 people including 22 exhibitors, again setting new records for the Chapter.

Speakers chosen to present research at the symposium included Douglas Frye of Methodist Hospital of Indiana, Wen Hsi of ProCure Treatment Centers, Jay Reiff of Drexel U niversity, Indra Das of Indiana University, Niek Schreuder of ProCure Treatment Center, and Chee-Wai Cheng of Indiana University.

Speakers invited specifically due to their expertise and the current interest of the Chapter included Nina Mayr, MD of Ohio State University, Michael Stabin of Vanderbilt University, and Mahadevappa Mahesh of Johns Hopkins University. A complete version of the Symposium Program is available on our Chapter website. We were pleased to have organized a program which included medical physics topics of interest in radiation oncology, nuclear medicine, diagnostic radiology, health physics, radiobiology, and radiation safety.

The Symposium concluded with our Chapter Business Meeting. With the recent revisions to our By-Laws voted to be active, we are now permitted as a Chapter to influence legislation towards licensure in support of the Association’s interest. We are actively gearing towards communicating with state regulatory authorities in pursuit of the licensure topic in Indiana, Ohio and Kentucky.

It is expected that we will invite or join the Great Lakes Chapter for Indiana communications and the Penn-Ohio Chapter for Ohio communications on these matters soon, since these two states have divided Chapter lines.

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AAPM Newsletter

January/February 2011

Person in the News Carlos E. de Almeida Ph.D.

T

he Arts, Letter and Science Academy of Langeudoc-France has created in 1992 the Henri Becquerel Award.

Since then, several scientists have been granted, among them, Profs.

Jean Dutreix, Andre Dutreix, Andre Allisy, Jean-Claude Rosenwald, Albert Kellerer, Daniel Blanc, Jean Chavaudra and Bernard Pierquin.

This year, Carlos E. de Almeida Ph.D., Full Professor in Medical Physics of the State University of Rio de Janeiro has been one honored in recognition for his outstanding achievements in Medical Physics and to promote the Medical Physics in Latin America. The award was presented by Prof. Jean Chavaudra.

continued - 2010 ORVC Fall Educational Symposium I am thankful for the tremendous efforts of my colleagues, Rebecca Richardson (ORVC Secretary/Treasurer) of Louisville Radiation Oncology Center, Matthew Meineke (ORVC PastPresident) of Hardin Memorial Hospital, and Howard Elson (ORVC Chapter Board Representative) of the University of Cincinnati, for their efforts and dedication to the success of the Chapter. We individually acknowledge the efforts Suzan Klein of Indiana University for tireless organizational assistance.

Finally, I would like to thank the following corporate sponsors for their generous contributions to the Chapter and attendance at the symposium: Platinum Sponsors: Varian Medical Systems, ProCure Treatment Centers; Gold Sponsors: MPRI, Bloomington Hospital, IU Cyclotron Operations; Silver Sponsors: Best Medical/ CNMC Company, BrachySciences, Tomotherapy, IBA Dosimetry, Modus Medical, LAP of America, Oncology Tech, PTW New York Corp, BrainLab, Sun Nuclear, Theragenics Corporation, Multidata Systems, ISOAID, Elekta, LACO, Siemens Healthcare, Philips, Core Oncology, Landauer, Calypso Medical Technologies, and NELCO Worldwide

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Figure 3. Michael Gossman and Matthew Meineke with Sherry Li during the corporate exhibition

AAPM Newsletter

January/February 2011

You won’t want to miss the ACMP Annual Meeting in Chattanooga, Tennessee at The Chattanoogan, where cosmopolitan style and upscale amenities mingle with uncommon comfort and the unique delivery of premium conference services. This year the meeting is co-sponsored by the AAPM and AAPM members can register at ACMP member rates!

• • • •

Chattanooga is accessible, affordable and hospitable.......the perfect destination for the ACMP meeting.

There are direct flights from many major cities, and once you land, the Chattanoogan is just a 15-minute drive from the airport.

The hotel room rate is only $139++ and there’s free wireless available throughout the hotel.

This year included with your meeting registration: luncheon buffet in the hotel restaurant Saturday, Sunday and Monday, continuous refreshment station Saturday through Monday to include beverages all day and morning/afternoon break each day.

The ACMP Meeting Program Committee always plans an excellent program, to include topics of interest to all medical physicists and associates. Topics this year to include: • Accreditation for Facilities and & Imaging modalities • Clinical Implementation of SBRT • Mammography Workshop • Computed Tomography Workshop • ABR Exam Review • Image Guidance – Application and QC • Residency and Medical Physics Workforce Issues • MRI and PET Accreditation • Radionuclide Imaging and Source Availability

For more information on the meeting, go to www.acmp.org.

For information on Chattanooga, go to www.DiscoverScenicCity.com For information on The Chattanoogan Hotel, go to www.thechattanooganhotel.com

Obituary

Britton Chance, Sc.D.

http://www.archives.upenn.edu/ people/1900s/chance_britton.html

D

r. Britton Chance died on Tuesday at the age of 97. He was Eldridge Reeves Johnson University Professor Emeritus of Biochemistry and Biophysics, as well as of Physical Chemistry and Radiological Physics at the School of Medicine of the University of Pennsylvania. Dr. Chance was an active researcher until his death. While he made numerous advances in a variety of research fields, he is probably best known for his work in biomedical and diagnostic optics. He was elected to the National Academy of Sciences in 1952 and received the National Medal of Science in 1974. In addition to his many scientific accomplishments, Dr. Chance won a gold medal in sailing at the 1952 Summer Olympics in Helsinki.

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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: March/April • Submission Deadline: February 9, 2011 • Posted On-Line: week of March 1, 2011