AAPM Newsletter March/April 2011 Vol. 36 No. 2

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. 2

MARCH/APRIL 2011

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

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afety in imaging and therapy is back in the news, with the most recent New York Times articles authored by Walt Bogdanich reporting and describing stereotactic radiosurgery errors resulting in complications of patient outcomes, and in some instances, death. These are certainly regrettable incidents that we, as medical physicists, must acknowledge, study, analyze. We need to improve processes so as to decrease the probability of adverse medical events and to strive for zero errors. There have been many asking, “Where is the AAPM response to this specific article?”

Be assured that the Executive Committee is acutely aware of the situation, and the AAPM continues to communicate consistent positions on many issues: patient safety, national and international event reporting, outcomes analysis, defined education requirements and training for clinical Medical Physicists, and need for passage of the CARE bill, among the many initiatives detailed by Mike Herman during the Congressional hearings of last year. The AAPM is also working with the many stakeholders, including the manufacturers, federal and state regulators, and accreditation agencies, among others to address patient safety issues, in addition to sponsoring the establishment of the Institute for Assessment of Medical Devices, in conjunction with the Morgridge Institute for Research. There is certainly much to do, but, as the article in this newsletter issue, “Patient Safety in Radiation Medicine -- AAPM initiatives” (primarily authored by Gary Ezzell) points out, there has been a significant effort underway within the AAPM to ensure that patient safety is of utmost concern. Sustaining these efforts will be challenging but they are crucial elements of the strategic plan and vision of our association.

At the end of January I took the opportunity to attend the Southern California chapter of the AAPM winter meeting, on “Patient Safety and New Methodologies in Radiation Therapy along with an Overview of New State and Federal Regulations.”

Highlights of the program included talks on treatment errors and radiation accidents, their causes and possible mitigation, quality management in radiation therapy, overview of the major AAPM initiatives (by Gary Ezzell), and new approaches to educate medical physicists, residents and dosimetrists.

There was also an overview of a new law recently passed in California (Senate Bill 1237) that will likely have future ramifications regarding required reporting of CT doses in diagnostic reports, overexposures, and mis-administered doses in both CT and therapy settings in many other states.

Regarding the new California law, more will be described in a future newsletter article describing the potential impact on medical physics and AAPM involvement in this endeavor.

Please write me with questions, comments, and suggestions ….. I really appreciate your feedback, and thanks for taking the time to read the newsletter!

Included in this issue: Chair of the Board p. 2 President-Elect p. 3 Executive Director p. 7 Editor p. 9 Education Council p. 11 Professional Council p. 13 Leg. & Reg. Affairs p. 17 Professional Liability Prog. p. 19 ACR Accreditation p. 21 ABMP Exam p. 22 New Professionals SC Report p. 23 Person in the News p. 26 Obituary p. 27

AAPM Newsletter

March/April 2011

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

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ur primary focus in this newsletter is the article that Gary, Tony and I wrote about patient safety. There is and will continue to be a lot of work going on to improve patient safety in the short and long term.

I also wanted to briefly comment on the AAPM Strategic Plan, which I mentioned previously is still under construction. A meeting of the 2011 Strategic Planning Committee will be held later this month to bring the plan into near final focus for presentation to the AAPM Board. To improve and inform the completion of the strategic plan, we are performing a Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis. The analysis will include input from each board member and members of the strategic planning committee (2010 and 2011). As an AAPM member, you might have suggestions for any of the categories of the SWOT and I encourage you to submit those suggestions directly to any Board member or to me for inclusion in our analysis. Please make yourself heard.

Online Learning Service

The NEW AAPM Career Services online job site is up and running!

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Join the hundreds of other AAPM members who are using the Online Continuing Education Program for their continuing education, research, and information needs.

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If you are not currently enrolled in the AAPM Online Education Program, you can enroll and pay the $65 fee online (must be logged in to www.aapm.org first).

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The following ABR approved SAMs are now available and accessible to individuals registered in the AAPM OnLine Continuing Education program:

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Particle Therapy: Issues and Considerations Imaging: MRI II:ACR MRI Accreditation Program Update Imaging: Radionuclide Imaging II: PET/CT: Technology Updates, Quality Assurance and Applications Therapy: Dose Calculation Algorithms in 3D-CRT and IMRT Therapy: HDR and LDR Brachytherapy: Everything You Need to Know 2010 ACMP Clinical Implementation of ARC Therapy Imaging for Radiation Therapy (ACR Guidelines/ AAPM TG 142) Brachytherapy

For more information visit the Online Learning Center at http://www.aapm.org/education/ce/info.asp.

org or call 301-209-3187

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AAPM Newsletter

March/April 2011

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

Patient Safety in Radiation Medicine – AAPM initiatives Gary Ezzell, President-Elect

Tony Seibert, President

Mike Herman, Chairman of the Board

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rticles in the New York Times beginning in 2010 focused attention on episodes in which patients were injured by errors in the application of radiation during their medical care. The attention has been new, but medical physicists’ concern for safety and quality is not. AAPM has a number of initiatives relevant to these issues, many that began well before 2010. We three current links in the presidential chain thought it timely to describe the most pertinent activities and indicate who within AAPM has responsibility for them. Public attention will come and go, but effecting change requires organization and persistence. AAPM has the structure and our members have the will to make patient care safer.

Different groups within the AAPM structure manage these many efforts. AAPM is composed of four councils: Administrative [AC], chaired by Melissa Martin; Science [SC], chaired by John Boone; Education [EC], chaired by George Starkschall; and Professional [PC], chaired by Per Halvorsen. Those initials appear below to indicate where the various groups have their homes.

Some of these initiatives fall completely within AAPM, and others are cooperative efforts involving sister societies, regulators, and manufacturers. Although many overlap, they can be organized into four main categories: • Qualified individuals working in accredited practices • Minimum standards for general practice and for advanced techniques • Event reporting • Improving product usability and safety Qualified individuals working in accredited practices A necessary condition for medical care to be delivered safely is that all the team members be appropriately qualified. State requirements for professional qualifications of different types of radiation workers vary greatly. AAPM has for years worked for formal recognition of board certification as the definition of a Qualified Medical Physicist (QMP), who has a defined, minimum role in medical imaging and radiation therapy. These efforts have multiple fronts. We have joined other organizations in lobbying for the CARE(1) bill, which would require that minimum standards be established for personnel who perform, plan, evaluate, or verify dose for medical imaging examinations or radiation therapy procedures. Passage of the CARE bill would still leave the setting of the standards to individual states, so AAPM has been preparing draft documents in order to be ready. Specifically, Dave Keys, Jeff Masten, Jerry White, Herb Mower, Ken Vanek and our government and regulatory affairs staff under the Government and Regulatory Affairs Committee [AC], have been involved in the development of specific text and support of the CARE bill for the past nearly 10 years.

We have related, ongoing efforts to provide state radiation regulators with model regulations defining the role of the Qualified Medical Physicist in imaging and radiation therapy. These will be beneficial in states that can not or choose not to pursue licensure of medical physicists. AAPM has close ties with the Council of Radiation Control Program Directors (CRPCD) via liaisons Aaron Kyle Jones, Ralph Lieto, Doug Pfeiffer and Herb Mower, with Debbie Gillie being a liaison from CRCPD. AAPM has contracted with CRCPD to create a database of board-certified physicists (populated and updated directly from the certification bodies) that state regulators, employers and others can access; once created, that database will be maintained by CRCPD. It should be available in 2011. In addition, efforts continue to establish licensure of medical physicists, concentrating

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continued - President-Elect’s Column in 2011 in two states: MA and PA. The efforts related to state regulations are coordinated by the Government and Regulatory Affairs Committee [AC] chaired by Herb Mower with primary staff support from Lynne Fairobent. The licensure effort is run by the Joint Medical Physics Licensure Subcommittee [AC], chaired by Bob Pizzutiello with primary staff support from Amanda Potter.

We also should see our long term efforts to standardize and improve the training of medical physicists as relating to patient safety. The ABR requirement for medical physics residencies is both an advance and a challenge. The Medical Physics Residency Training and Promotion Subcommittee [EC], chaired by John Bayouth, is providing assistance to groups forming residencies. Recognizing the potential shortfall in diagnostic imaging residencies, AAPM leadership is partnering with RSNA to promote the creation of imaging physics residencies.

Having qualified individuals is not enough; they must work together productively and safely.

AAPM, ACR, and ASTRO have all come out in support of practice accreditation being a condition for procedure reimbursement. Practice accreditation is perhaps the best method for ensuring that qualified individuals are staffed in appropriate numbers and perform procedures based on national consensus guidelines. This is already in place or in progress for certain imaging modalities because of the MQSA(2) and MIPPA(3) laws, although these follow different models. MQSA is much more prescriptive in defining explicit personnel qualification and quality techniques than MIPPA, which delegates setting the accreditation standards to approved accrediting bodies. AAPM has or is developing relationships with those accrediting bodies in order to ensure that the imaging standards include appropriate assessment of image quality and patient dose by QMPs. On the therapy side, ASTRO and ACR partner in a joint radiation oncology accreditation program. AAPM physicists are active within both organizations in developing the accreditation standards. There is an opportunity to formally cooperate with ASTRO and ACR in practice accreditation, currently under discussion with ASTRO and AAPM leadership.

Minimum standards for general practice and for advanced techniques We have a cart and horse problem with respect to practice accreditation. We would be in a stronger position to recommend specific guidance to accrediting bodies if we had already developed consensus practice guidelines. Our AAPM task group reports do not distinguish between recommendations and minimum practice standards. To that end, Professional Council is developing a proposal for creating a formal structure within AAPM for creating Medical Physics Practice Guidelines. The Practice Guidelines Subcommittee [PC], chaired by Maria Chan, which is part of the Clinical Practice Committee [PC], chaired by Dan Pavord, will coordinate this work, but it will involve representation from all parts of the Association. We are also working with ACR to more immediately provide guidance on technical standards for practice and accreditation of imaging and therapy practices. This specifically involves AAPM formally partnering with ACR on guidelines that relate to the practice of medical physics.

Regarding specific and immediate guidance for advanced procedures, medical physicists have participated in an ASTRO initiated creation of a set of “white papers” for clinical practice. The first of these is entitled Safety Considerations for IMRT and has been critically reviewed and endorsed

by AAPM. In addition, the Credentialing and Competency Guidelines Subcommittee [PC], chaired by Dan Pavord, is charged with developing guidelines for the initial credentialing of a physicist performing specific procedures and for the ongoing verification of competency. A report recommending the creation of a Medical Physics Practice Accreditation body is in development. The idea is to supplement the general competency tested by the ABR process with more specific guidance relevant to particular advanced procedures.

Similarly, our field needs to develop consensus guidelines on minimum staffing requirements.

ASTRO has recently invited AAPM to participate in a revision of the 1991 “Blue Book” on staffing in radiation oncology. A steering committee is being formed and will meet in person in early May. Staffing issues fall within the Professional Services Committee [PC], chaired by Michael Mills.

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continued - President-Elect’s Column On the imaging side, the Diagnostic Work and Workforce Study Subcommittee [PC], chaired by Ed Nickoloff, is charged with estimating the workforce required to provide diagnostic physics imaging services in the US. Similar to the three Abt studies for radiation therapy medical physicist work effort, this will provide critical baseline data to inform adequate staffing models.

AAPM is a founding member of both the Image Gently campaign for lowest dose pediatric imaging and the Image Wisely Campaign, recently launched for the same purpose in adult populations.

AAPM members Russ Ritenour and Keith Strauss have been integral in the Image Gently program and Bill Hendee represents AAPM on the Image Wisely front.

There is an underlying commonality in these developments that range from training individuals to accrediting practices. We are setting standards and holding ourselves accountable to them. This is a measure of the maturation of our profession. A comparable measure is the degree to which we are partnering with other organizations, and this is evident in the last two major topics.

Event reporting We all recognize that one of the best ways to improve safety is to learn from the experiences of others, and we also recognize that our field has done a particularly poor job of collecting and disseminating useful information in a timely way. Mike Herman from AAPM worked with the Foundation for the National Institutes of Health (FNIH) which sponsored a roundtable in October, 2010, on a number of related issues: event reporting in radiation therapy and in diagnostic imaging, outcomes database in radiation therapy and patient dose database in diagnostic imaging.

Representatives from most of the main stakeholders were present, including AAPM, ACR, ASTRO, ASRT, FDA, Medical Imaging and Technology Alliance (MITA, a manufacturer’s group), CRCPD, and NCI. There was broad agreement on the importance of creating such tools, and also that it would be a challenge to coordinate and fund these large national efforts with multiple organizations involved. CRCPD has begun working on an event reporting process, and ACR is piloting a CT dose index registry. The FNIH workshop identified some volunteers to continue the work. Anthony Seibert of AAPM volunteered to continue the discussion on the radiation imaging dose registry.

Robert Pizzutiello of AAPM and Jennifer Elee of CRCPD volunteered to lead the event reporting group for diagnostic imaging. On the therapy side, the event reporting effort will be lead by Jennifer Elee and Eric Ford, who chairs AAPM’s Work Group on Prevention of Errors in Radiation Oncology [SC]. The outcomes registry work will be lead by Eric Ford and Jatinder Palta, representing both AAPM and ASTRO. Independent of any FNIH-organized efforts, the Work Group on Prevention of Errors is developing a taxonomy structure to support medical event reporting to be completed early in 2011.

Furthermore, a proposal for a voluntary national event reporting project was drafted in August, 2010, by Eric Ford, Jim Galvin, and Dick Fraass. It comprehensively discusses the issues involved and recommends potential solutions. It could well be the basis for further definite action, possibly by creating a pilot study involving a few institutions. The next steps will be collaborative, tapping resources from major organizations and coordinating a common program plan for each major initiative. The impact at the national level requires continuous, patient and cooperate work.

Putting together a robust and viable event reporting mechanism will be a major undertaking requiring sincere and sustained cooperation from physicists, physicians, regulators, manufacturers and perhaps ultimately legislators.

Improving product usability and safety AAPM is exploring the creation of Institute for the Assessment of Medical Devices (IAMD), to be a partnership with the Morgridge Institute for Research (MIR), based in Madison, WI. Its mission is to develop procedures for technology assessment of medical devices and to provide unbiased and useful assessments of medical devices, with the purpose of being a resource that improves the rational assessment of devices being brought to market. This effort is the continuation of the work of a presidential ad hoc committee formed by Maryellen Giger and is led by Bill Hendee and Rock Mackie. The intention is that the Institute will be self supporting financially via the corporate

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continued - President-Elect’s Column sector and federal grants. While MIR and AAPM would be the founding members, the plan is that IAMD membership would expand nationally to include other associations, research institutions, hospitals and ultimately medical device companies concerned with effective biomedical innovation and high standards of patient safety.

AAPM is also exploring different avenues with vendors to improve the safety of the products we use and that are used in the care of our patients. The Medical Imaging and Technology Alliance (MITA) and Advanced Medical Technology Association (Advamed) are trade associations that have met with AAPM, RSNA, ASTRO, and ACR at different venues. Discussions include product standardization, safety improvement, more robust validation testing, product compliance and documentation.

AAPM and MITA have agreed to co-host a product usability workshop later in 2011. This will bring together manufacturers and users for detailed discussion of optimizing the safe use of medical imaging technology. AAPM has also made direct recommendations to FDA about improvements in the manufacturing process that can be monitored and offered suggestions to improve the 510(k) process by utilizing external, expert, objective technical/safety reviews.

Summary The drive to improve patient safety did not start with the New York Times articles, but they did create a new momentum. Over the last year AAPM has participated in meetings, briefings, hearings and listening sessions with multiple government agencies and Congress. AAPM is not alone in these efforts and the cooperation between AAPM and other organizations is strong and productive. For example, the special meeting in June, 2010, on Safety in Radiation Therapy - A Call to Action, organized jointly

by AAPM and ASTRO, resulted in a joint publication in Medical Physics and Practical Radiation Oncology.

It has twenty recommendations, many of which are addressed by the initiatives reported here. AAPM also spearheaded the CT Dose Summit, which has produced an effort to develop and publish specific CT and imaging procedure protocol guidelines.

The challenge will be to sustain the effort, because we are working to change ingrained aspects of our collective medical culture, and that will not be simple or quick. It can be done, however, if we have the vision and strength to carry it through. ___________________________ 1) CARE: Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy 2) MQSA: Standards Act

Mammography

Quality

3) MIPPA: Medicare Improvements for Patients and Providers Act

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AAPM Executive Director’s Column Angela R. Keyser, College Park, MD New Report he report of TG 138 and GEC-ESTRO: A dosimetric uncertainty analysis for photon-emitting brachytherapy sources is available online at: http:// www.aapm.org/pubs/reports/RPT_138.pdf

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History and Heritage Thank you to all who answered our plea for copies of old membership directories. The AAPM History and Heritage site now includes membership directories dating back to 1969. Historical Salary Surveys, now known as the Professional Information Survey, are also available 1979.

Reminder - Funding Opportunities Deadlines are approaching!

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.

Upcoming Meetings AAPM is a co-sponsor of the 28th Annual Meeting of the American College of Medical Physics to be held April 30 – May 3 in Chattanooga, TN. AAPM Members can register for the meeting at member rates! The Preliminary Meeting Program is now available. Remember to register before March 16 to receive discounted registration. The deadline to make hotel reservations is April 7.

The Joint AAPM/COMP meeting will be held July 31 – August 4 in Vancouver, British Columbia.

The deadline for receipt of abstracts is March 7. Registration and housing information will be posted by March 16. More information is available online at: http://www.aapm.org/ meetings/2011AM/ .

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. Make sure to register by June 1 to receive discounted registration fees. For details, go to: http://www.aapm.org/meetings/2011SS/ .

AAPM is hosting the 2011 CT Dose Summit: Interdisciplinary Program on Scan Parameter Optimization for Imaging Physicians, Technologists and Physicists, October 7-8 in Denver, CO. The 2010 event sold out in record time, so stay tuned to email communications announcing further details on the program. Information can be found at: http://www.aapm. org/meetings/2011CTS/ Staff News I am pleased to announce that Melissa Liverpool joined the AAPM in January as part of the Accounting team. Melissa is well known to the HQ team as she worked for AIP in the payroll department for 4 years.

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AAPM wishes to acknowledge and thank the following individuals for their 2010 contributions: Education and Research Fund: Charles M. Able Hassaan Alkhatib Lowell L. Anderson John A. Antolak David M. Applebaum Samuel G. Armato Michael J. Bailey John P. Balog Morris I. Bank Jonathan K. Bareng Alan H. Baydush Clyon Wayne Bell Ishtiaq H. Bercha Frank P. Bolin J. Daniel Bourland Arthur L. Boyer Suresh M. Brahmavar Megan M. Bright Harry S. Bushe Raymond R. Capestrain James E. Carey Paule M. Charland Jean Jacques Chavaudra Laurence P. Clarke Kevin W. Corrigan Phillip E. Cubbage Edmund P. Cytacki Maximian Felix D’Souza Jerome G. Dare Lawrence T. Dauer Allan F. deGuzman Paul M. DeLuca Jun Deng Colleen M. Desrosiers John F. Dicello James L. Durgin Kenneth E. Ekstrand Ravimeher L. Errabolu Lynne Fairobent Jennifer Hann Fisher Everardo M. Flores Doracy P. Fontenla D. Jay Freedman G. Donald Frey William R. Geisler Bruce J. Gerbi Steven J. Goetsch David Lee Goff David Lloyd Goff Bennett S. Greenspan Suzanne A. Gronemeyer Madhup Gupta Per H. Halvorsen Homayoun Hamidian Russell J. Hamilton Carnell J. Hampton Oliver D. Hanson Herman R. Haymond John D. Hazle Christopher M. Hearn Joseph P. Hellman Frank William Hensley William H. Hinson Donald E. Holmes

Cecilia A. Hunter Gulkan Isin Edward F. Jackson Mary Ellen Jafari Chandra Prakash Joshi Alexander Kapulsky Alireza Kassaee William Tyler Kearns Angela R. Keyser Latha Kota Roger O. Ladle Lena S. Lamel Bhujanga R. Lankipalli Renee X. Larouche Edwin M. Leidholdt Lisa C. Lemen Jin Sheng Li Lifeng Lin Liyong Lin Dale W. Litzenberg Jeffrey M. Long Gary Luxton Jingfei Ma Thomas R. Mackie Gig S. Mageras Eugene Mah Mahadevappa Mahesh C.J. Maletskos William Malloy Lesley Ann Malone S. R. Manoharan Christopher H. Marshall Mary K. Martel Rafael Martin James E. McDonough Mahta M. McKee Sharon K. McMillan Michael F. McNitt-Gray Matthew A. Meineke Albert V. Mesa Brian M. Methe Ira D. Miller George Mitev Raj K. Mitra Raj Kumar Mitra Mary E. Moore Monzon Jose Morales Michael T. Munley V. Natarajan David M. Nelson Sachio Ogawa Olabode Thomas Ogunleye Arthur J. Olch Norris J. Parks Shashi A. Perera Paula L. Petti Douglas E. Pfeiffer Bhaskaran K. Pillai Robert J. Pizzutiello Jerimy C. Polf Nicole T. Ranger Ailsa J. Ratcliffe Chester S. Reft Peter J. Riley Mark J. Rivard Dante E. Roa Daniel G. Robertson

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Gene E. Robertson Lawrence N. Rothenberg Scott Sample Glen H. Sandberg Vikren Sarkar Alan Schoenfeld L. John Schreiner Alexander W. Scott Shakil Bin Shafique Jungwook Shin Thomas B. Shope Deborah J. Shumaker Douglas J. Simpkin Larry D. Simpson Eric Daniel Slessinger Palmer G. Steward Kazumichi Suzuki John B. Sweet Russell B. Tarver Michael Tassotto David D. Taylor Philip M. Tchou James A. Terry Peter J. Thirunelli Michael Dean Thomas Stephen R. Thomas Earl A. Trestrail de Riet Van Rohena Rafaela Varela Vaidehi Venkatakrishnan John T. Washington Gerald A. White Thomas White, Jr. John D. Willins Robert John Wilson Charles Wissuchek John F. Wochos Margaret A. Wolf John W. Wong Ching-Chong Jack Yang Fang-Fang Yin Ellen D. Yorke Cedric X. Yu Ning J. Yue James A. Zagzebski Pengpeng Zhang Qinghui Zhang Timothy C. Zhu

Ed Fund Members Memorial Thomas A. White, Jr.

John R. Cameron Memorial Fund: Harry S. Bushe Frank P. Bolin Michael J. Bailey Morris I. Bank Jean Jacques Chavaudra Edmund P. Cytacki Jayne M. Knoche David A. Lightfoot Lawrence N. Rothenberg Bruce R. Thomadsen Thomas White, Jr.

Hy Glasser Memorial Fund Jerome G. Dare Lawrence N. Rothenberg Thomas White, Jr.

John Hale Memorial Fund Joanna E. Cygler David A. Lightfoot Thomas White, Jr.

Doug Jones Memorial Fund Thomas White, Jr.

Jack S. Krohmer Memorial Fund Jerome G. Dare David Lloyd Goff David Lee Goff Edwin M. Leidholdt David A. Lightfoot Thomas White, Jr.

John S. Laughlin Memorial Fund Jerome G. Dare John F. Dicello Jennifer Hann Fisher Edwin M. Leidholdt David A. Lightfoot Gig S. Mageras Radhe Mohan Eduard A. Mullokandov Lawrence N. Rothenberg Larry D. Simpson Thomas White, Jr. Qinghui Zhang

Robert Loevinger Memorial Fund Jerome G. Dare Lawrence N. Rothenberg Thomas White, Jr.

Edward Webster Memorial Fund Jerome G. Dare Thomas White, Jr.

AAPM Newsletter

March/April 2011

Editor's Column Mahadevappa Mahesh, Baltimore, MD

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elcome to the second issue of the 2011 AAPM Newsletter. Even though, Punxsutawney Phil predicted an early spring, I see no sprouts of greenery yet. Any way, the main focus of this newsletter is about the patient safety initiatives. In fact, all three columns in this issue from the President, President-Elect and the Chairman of the Board focus on the various initiatives that the AAPM is currently undertaking or plan to undertake to address patient safety. This is followed by a few other articles that also directly or indirectly address this important issue (including recent release of NCRP report number 168-Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures).

For those who are planning to take the board exam, I would like to draw your attention to the new professional subcommittee report article on page 25 discussing the strategies to prepare for the oral board exam. I welcome all readers to send me any suggestions or comments on any of the articles or about the Newsletter itself.

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Knowing what responsibility means

AAPM Newsletter

March/April 2011

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

AAPM has an Information Services team of seven professionals who are hard at work in support of AAPM’s growing electronic presence.

Although their valuable work is often behind the scenes, the IS team plays a vital role in all HQ service areas.

Michael Woodward joined the staff in October 1996 as Internet Services Manager.

As AAPM’s first webmaster, Michael worked closely with the newly formed Electronic Media Coordinating Committee (EMCC) to develop AAPM’s web presence. With Information Services Team (L-R): Tammy Conquest, Yan-Hong Xing, Jennifer Hudson, Zailu Gao, Farhana Khan, Michael Woodward and Onasis Budisantoso the reorganization of the IS department in 1998, Michael was promoted to Director, Information Services. Michael continues to play a critical role in AAPM’s HQ operations, leading the IS efforts and overseeing the Membership Department.

Farhana Khan started with AAPM in May, 1998, as a temporary staff person and was later hired full-time to gear up for AAPM’s management of the Chicago 2000 World Congress. After the World Congress, Farhana was named as AAPM’s Webmistress. Farhana works closely with Website Editor Chris Marshall to maintain and enhance AAPM’s web presence. She is also responsible for AAPM email services and a number of other sites hosted by AAPM. She is our resident “graphic designer” and works closely with the staff to create logos for meetings and other programs.

Zailu Gao joined the IS team in March, 2001 as an Applications Developer and was promoted to Senior Applications Developer at the end of 2003. Zailu is responsible for the e-commerce areas of the AAPM website including Online Dues Payments and meeting registration. Zailu is also a key player in the abstract submission process.

Jennifer Hudson began her career with AAPM in April, 2001 as the Receptionist and was promoted to Membership Services Coordinator in 2004. In 2006, the membership process was moved to the IS team in recognition that the AAPM database and website are an integral part of the membership process. Jennifer serves as the first point of contact for membership questions and works closely with the Membership Committee in the review and processing of membership applications and requests.

Yan-Hong Xing, AAPM’s Database Administrator, joined the team in October of 2006. She handles all technical matters related to the Associations’ databases as well as fulfillment of mailing list orders.

Tammy Conquest came on board in November of 2007 as an Applications Developer. Tammy is responsible for design and implementation of new and existing database programs. Tammy has worked closely with CAMPEP in the development and maintenance of the CEC database. She is also the go-to person on committee wikis.

Onasis Budisantoso, joined the IS team in May of 2008 as an Applications Developer. He has been instrumental in developing the “AAPM events that pertain to you…” functionality on the web site. He has also written several programs that assist with HQ administrative functions like an automated timekeeping system and committee scheduling program. Coming next issue….group profile of the AAPM Accounting team.

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Education Council Report George Starkschall, Houston, TX

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lthough many physicists enter medical physics through graduate programs in medical physics, our profession has had a long tradition of providing entry for individuals with degrees in disciplines other than medical physics, for example, nuclear physics, condensed matter physics, or biomedical engineering. In fact, for many years, the majority of medical physicists entered our profession via pathways other than the route of formal educational programs in medical physics. In recent years, the rules of the game have been changed. Most medical physicists are well aware of the fact that if one wishes to take the American Board of Radiology (ABR) certification examination in one of the branches of medical physics in 2014 or later, one must have completed a clinical residency accredited by the Commission on Accreditation of Medical Physics Educational Programs (CAMPEP).

In addition to fulfilling a clinical training requirement, candidates for ABR certification also need to fulfill a didactic educational requirement. The ABR website1 explicitly identifies the need for a candidate to have completed two biology courses and three graduate medical physics courses. The CAMPEP guidelines for accreditation2 indicate that entering residents will have either graduated from a CAMPEP-accredited medical physics educational program, or will be provided with additional didactic education in the course of their residency, which may result in an extension of the length of the residency program.

Most CAMPEP-accredited residencies are the required minimum 24 months duration, without provisions for candidates to receive the additional didactic education. So where does that leave the alternative pathway?

Must an individual with a PhD in nuclear physics who in interested in a career transition into medical physics enroll in a master’s degree program in medical physics, and follow it with a two-year residency in order to be eligible for ABR certification?

In order to address this issue, the Education and Training of Medical Physicists Committee of the Education Council formed a Working Group, with Richard Maughan as Chair, to identify the minimum didactic requirements for an individual seeking a career in medical physics. The goal of this report is to provide unambiguous guidance to those wishing to enter a CAMPEP-accredited residency through an alternative pathway. This report was recently accepted by the Education Council and is now posted on the AAPM website3.

In summary, the report indicates that the following courses are required: 4. Radiobiology 5. Anatomy and Physiology 6. Radiation Therapy Physics

1. Radiological Physics and Dosimetry 2. Radiation Protection and Radiation Safety 3. Fundamentals of Imaging in Medicine

These six courses should constitute about 18 credit hours of study.

It should be noted that the report does not specify how these hours are to be attained. Although many individuals may elect to study this material within the context of a formal lecture course, the report also allows for such educational mechanisms as one-on-one tutorials or distance learning; the acceptability of a specific mechanism for attaining these didactic competencies is up to CAMPEP. The report also indicates that these courses could be made up during a clinical residency, but an extension of the residency time would likely be required, which is consistent with the CAMPEP guidelines.

In summary, the AAPM recognizes the continued need to provide alternative pathways for individuals interested in a career in medical physics, and now has provided a mechanism by which individuals can meet didactic and clinical requirements.

1) http://www.theabr.org/ic/ic_rp/ic_rp_req.html

2) “Guidelines for Accreditation of Residency Education Programs in Medical Physics,” Commission on Accreditation of Medical Physics Education Programs, Inc., May 2009, http://www.campep.org/ resguidelines.pdf 3) http://www.aapm.org/pubs/reports/RPT_197S.pdf

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AAPM Newsletter

TG-142 QA Made Easy Streamline the integration of TG-142 procedures into your workflow by consolidating a multitude of QA tests into a single application.

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March/April 2011

AAPM Newsletter

March/April 2011

Professional Council Report Per Halvorsen, Newton, MA

ACMP and AAPM: A shared goal – and now a common structure

A

s most of you know, the ACMP and AAPM Boards voted last November to combine into one organization by the end of 2011. An Ad-Hoc committee comprised equally of ACMP and AAPM members presented the organizations with detailed suggestions for how to accomplish this “merger.” We are now in the implementation phase, charting the detailed changes and associated timelines to ensure that we accomplish a smooth transition to a unified organization by the end of this calendar year.

Toward that end, the Professional Council will meet in Chattanooga just prior to the ACMP Annual Meeting at the end of April, where we will hold a joint session with ACMP leadership to finalize the details of the changes within the Professional Council. We have already seen some welcome changes, with David Hintenlang (ACMP Vice Chairman) joining the Professional Council as Vice Chair, and the chairs of the Imaging and Therapy Standards Committees from the ACMP being invited to join the AAPM’s Practice Guidelines Subcommittee. The Council leadership and At-Large positions are now equally balanced with members from Imaging and Therapy disciplines. The ACMPAAPM “merger” is an opportunity to critically assess the Professional Council’s role and how well the current structure supports this role, and will bring a fresh perspective to the Council’s work. As such, 2011 promises to be an exciting year.

Medical physics workforce study and Salary Survey validation project The Center for Healthcare Workforce Studies at SUNY has completed the workforce study that the AAPM contracted for, as well as the validation of the AAPM’s salary survey methodology and findings.

Their reports have been reviewed by the Professional Services Committee, and should be Gravity-based ready for Council review and approval shortly, ABR exam prep? followed by distribution to all members. It will be very helpful to have a clear understanding of the internal and external factors in our workforce trends, and to have independent validation of our salary surveys. Look for announcements in the coming months when the reports are ready for downloading.

There’s a better way!

Professional Mentorship Program The New Professionals Subcommittee under the Professional Services Committee is developing documentation and support for a Professional Mentorship Program within the AAPM. This program would pair relatively new graduates with experienced professionals from the same AAPM region. The purpose is to give new professionals additional resources to prepare for ABR Board Examinations, answer general questions about the profession, and help the new professional to network and find his/her place within the organization.

REVIEW: Hundreds of oral exam style questions, each with detailed explanations to save you time.

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AAPM Newsletter

March/April 2011

Therapy Program Scientific Symposia

Proffered Abstract Submissions

•

Safety and quality in SRS/SBRT

•

Patient Simulation Imaging for Planning (JOINT)

•

Predicting and Exploiting the Effects of Radiation Quality in Ion Therapy The Present and Future of Online Adaptive Radiotherapy: on line vs. off line vs. adaptive on-line

•

Treatment Planning

•

Treatment Delivery and Verification

•

Patient Safety and Quality Assurance (QA) Procedures

•

Outcome Modeling

•

Basic Radiobiology

•

Informatics

•

Small Animal Studies

•

Radiation Protection and Shielding

•

Targeted Radionuclide Therapies

• • • • •

Advanced IMRT planning and delivery and future directions Outcomes modeling including QUANTEC How should we verify complex radiation therapy treatments?

Mathematical Oncology: multi-scale modeling of tumor growth, microenvironment and response to therapy

Imaging Program Proffered Abstract Submissions

Scientific Symposia • • • • • • •

Patient Dose in CT: Calculating Patient Specific Doses in CT (JOINT WITH EDUCATION) Radiation Risks in Diagnostic Radiology Patient Dose in Fluoroscopy: Estimating Patient Specific Radiation Dose From Fluoroscopy (JOINT WITH EDUCATION) X-ray Phase Contrast and Phase Contrast CT Imaging 3D Breast Models Quantitative CT Imaging and Analysis: Limitations of the CT Scanner as a Measurement Instrument Multiple Source X-ray Imaging

• • •

• • • • • • • • • • • • •

CAD Computed Tomography Dosimetry, Radiation Protection, and Quality Control (Imaging) Fluoroscopy Image Registration, Fusion, Segmentation, and Visualization Image Science Magnetic Resonance Imaging Mammography Multi-Modality Imaging Non-conventional Imaging Nuclear Medicine Optical and other Novel imaging Radiography Small Animal Imaging Ultrasound Vascular, Endovascular, and Cardiac Imaging

Joint Imaging/Therapy Program Scientific Symposia • • • • • • •

Proffered Abstract Submissions

Engineering for science in patient safety Targeted radionuclide therapies Nanotechnology applications in radiation oncology Normal tissue imaging of dose response Preclinical and clinical hypoxia imaging: current and emerging methods and technology Molecular and functional imaging for treatment planning 4D-MRI for Radiation Therapy of Moving Tumors

• •

• • • • • • • •

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Proffered Abstract Submissions John S. Laughlin / Science Council Research Symposium: Science and Engineering for Patient Safety in Therapy and Diagnostic Medical Physics Computed Tomography Fluoroscopy Image Registration, Fusion, Segmentation, and Visualization Magnetic Resonance Imaging Outcome Modeling Patient Simulation Imaging for Planning Treatment Delivery - Immobilization and Localization Targeted Radionuclide Therapies

AAPM Newsletter

March/April 2011

Special Ultrasound Symposium Diagnostic symposia include:

Therapy symposia include:

•

•

Clinical Systems and Applications

•

Novel Technologies & Therapeutic Strategies

•

Treatment Planning, Modeling, & Control

•

Image Guidance and Assessment

• •

Therapeutic Ultrasound advances Image Guidance and Assessment of Ultrasound Therapies

• •

Bubble Based Ultrasound Therapies Drug Delivery, Activation and Enhancement Ultrasound Therapy Program and HIFU/ HITU Standards Biological & Physiological Effects of Therapeutic Ultrasound Clinical Ultrasound Therapy

• •

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

Proffered Abstract Submissions •

Advanced Systems and Components, Evaluations and Safety

• •

Signal/Image Processing & Display Algorithms Quantitative Imaging & Measures

•

Contrast and Interventional Agents (US & Photoacoustic) Small Animal Imaging Breast and Other Applications Guidance of Interventions Photoacoustic Imaging

• • • •

• • •

Practical Medical Physics Program • • • • • • • •

Joint AAPM - CCPM educational session Writing/ reviewing papers for Medical Physics Going paperless in a radiation oncology clinic Clinically focused physics education Practical contouring: prostate and H&N anatomies Overview of accreditation programs for radiation oncology: ACR and ACRO Practical tips for VMAT implementation Practical concerns with airport whole-body scanners

• •

Review of radiation detectors for diagnostic radiology applications The new ACR CT accreditation program: phantom submission process

Professional Program • •

Professional Council Symposium - Preparing for Radiation Oncology ACR/ASTRO accreditation ABR 2014: Trained for Competence

• • •

Preparing for Diagnostic ACR accreditation Women’s Professional SC Panel: Successful Career Strategies in Medical Physics The Role of Voluntary versus Mandatory Regulatory Standards

•

Meet the Experts – Young Member Symposium

• • •

Medical Physics in Africa Preparing for ABR Board Exams Economic Focus: Practical Aspects

•

Role of Medical Physics in Federal and State Government More than 50 hours of educational courses in medical imaging and radiation therapy physics will be offered. This will include SAMS courses for diagnostic, medical nuclear, and radiation therapy physicists. www.aapm.org/meetings/2011AM/

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AAPM Newsletter

March/April 2011

PHYSICISTS AND DOSIMETRISTS

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AAPM Newsletter

March/April 2011

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

S99: “American Medical Introduced in the Senate

Isotopes

Production

Act

of

2011”

S

enator Bingaman introduced the American Medical Isotopes Production Act of 2011 on January 25, 2011. The purpose of this legislation is “To promote the production of molybdenum-99 in the United States for medical isotope production, and to condition and phase out the export of highly enriched uranium for the production of medical isotopes.”

S99 is virtually identical to a measure that passed the House by a 400–17 vote last year, the bill (S-99) would codify and authorize funds for an interagency effort already under way to help establish a US supply of 99Mo that would be produced without the use of highly enriched uranium (HEU).

The introduction of S-99 restarts a legislative push that stalled last year due to opposition from a single lawmaker, Senator Christopher Bond (R-MO). Bond, who retired in December, used a Senate procedure known as a hold to prevent the measure from coming to a vote. The measure aims to establish a reliable source of 99Mo in the US and to prevent a recurrence of a shortage like the one that occurred last year, when two of the five research reactors that account for nearly all the world’s supply of the radioisotope were shut down for the better part of 2010.

At a 1 February hearing before the Senate Committee on Energy and Natural Resources—Parrish Staples, director of the office of European and African threat reduction, at the Department of Energy’s National Nuclear Security Administration (NNSA) —welcomed the bill’s provisions to phase out use of HEU in 99Mo production. The American Medical Isotopes Production Act would prohibit US exports of HEU in seven years, a deadline that could be extended by as much as six years if the administration determines that there is insufficient 99Mo produced without HEU. NNSA is offering financial and technical assistance for 99Mo producers to convert their HEU-based production processes to low-enriched uranium. Last year, with NNSA’s help, the South African Nuclear Energy Corp (Necsa) became the first of the major producers to ship a commercial quantity of the isotope that was made without HEU. The Senate bill would authorize $143 million over three years for the development of HEU-free domestic production sources. NNSA has cooperative agreements in place with four US industry teams, each of which is developing a different novel approach to manufacturing 99Mo. The costshared grants allow for up to $25 million in federal funds for each of the teams: GE Hitachi Nuclear Energy, Babcock & Wilcox, NorthStar Nuclear Medicine and Morgridge Institute for Research.

There will be a session on these cooperative agreements at the upcoming meeting of the American College of Medical Physics.

Image Gently launched the latest campaign – Pause and Pulse – Safety in Fluoroscopic Imaging!

On February 14th, Image Gently launched the Pause and Pulse – Safety in Fluoroscopic imaging!

We know that children are more sensitive than adults to radiation and cumulative exposure to their growing, smaller bodies could, over time, have adverse effects. To help ensure that imaging providers account for these factors, the AAPM is an active participant and collaborator in the Alliance for Radiation Safety in Pediatric Imaging.

We invite you to the visit the Image gently Website (www.imagegently.org) to review new educational content for this new campaign phase.

Alliance member organizations urge that when performing imaging exams on children, radiologists should:

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AAPM Newsletter

March/April 2011

continued - Legislative and Regulatory Affairs 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 kids with care: Pause and child-size the technique use the lowest Pulse rate possible.

Consider ultrasound or MRI when possible.

The Image Gently Web site (www.imagegently.org) contains the latest research and educational materials to help imaging providers determine the appropriate radiation techniques to use in the imaging of children and helpful protocols for you to follow at your facility.

Click the image to the left to visit the Image Gently Web site today and pledge to do your part to “child-size” the radiation dose used in children’s imaging. Your active participation is appreciated.

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AAPM Newsletter

March/April 2011

New AAPM Professional Liability Program Underwriter

William A. Roventine, Chairman, AAPM Insurance Subcommittee

S

ince the inception of our professional liability insurance program, this coverage has been underwritten by the Chicago Insurance Company (CIC). Initially and for most of those years, CIC has been a responsive and cooperative partner as carrier for this program. However, over the past few years we and Marsh have been dissatisfied with the apparent unwillingness of CIC to sufficiently improve the program offering and clarify policy language. For these reasons, we are pleased to announce that after careful research and extensive negotiations over the past year, the AAPM Insurance Subcommittee has approved conversion, effective 4-1-11, to Liberty Insurance Underwriters (Liberty) as the new underwriter for our professional liability program.

Liberty, a member of the Liberty Mutual Group, is rated A (Excellent) by A.M. Best Company and is licensed in all 50 states plus the District of Columbia for Professional Liability and all Property/ Casualty coverage. The Liberty policy is designed to provide the same broad coverage and affordable premium to which you have become accustomed. As part of this transition, we have worked with Liberty to provide the following coverage enhancements at no additional cost: • Shielding Design coverage, subject to the policy’s Limit of Liability, is now built into the policy form at no additional cost; • Individuals now have 180 days, in the event of Death or Disability, to request Dade Moeller Gaithersburg MD an unlimited coverage tail (Extended Radiation Safety Reporting Period Option) at no additional Las Vegas NV Academy cost; • The Property Damage to Property of Others coverage sublimit has been increased to $100,000.

Medical Radiation Safety Officer Training Course

The program will continue to be administered

by Marsh U.S. Consumer, the industry leader with over sixty years experience in designing and administering Professional Liability coverage.

Effective 4‑1‑11, all new and renewal policies with a renewal date of 4‑1‑11 or later will be underwritten by Liberty, in all states except New York state which will come on line upon approval of that state’s filing. New policies or renewals with an effective date prior to 4‑1‑11, will be underwritten by CIC and converted to Liberty upon the next renewal.

We look forward to a smooth conversion transition and a productive new relationship with Marsh and Liberty.

Are you a Medical Physicist, RSO, assistant RSO, or Authorized User responsible for radioactive materials and radiation-producing machines in your hospital?

To help keep you current with new techniques and procedures, Dade Moeller Radiation Safety Academy offers this course for those managing or working with radioactive material and radiation sources in a medical environment.

For 5 days, you will receive practical information on a variety of topics including discussions of real-world experiences: Medical licensing Fluoroscopy safety PET/CT programs Brachytherapy Nuclear medicine

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

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

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

Register online or call 800-871-7930

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Dosimetry Services Division

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instadose

™

instadose

™

instadose

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March/April 2011

instadose

instadose

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AAPM Newsletter

AAPM Newsletter

March/April 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. What quality control (QC) data do we need to submit for accreditation?

A. As part of accreditation, you must submit a copy of your most recent medical physicist/MR scientist equipment survey for each unit used for breast MRI. The ACR also requires that routine QC be performed by the technologist on all MRI units used for breast imaging. See the Breast MRI Program Requirements for details.

Q. We already submitted our medical physicist’s MRI Equipment Evaluation results for this unit to the ACR when we accredited in the general MRI accreditation program.

Does the medical physicist have to repeat the survey on the same unit for breast MRI Accreditation?

A. No, your medical physicist/MR scientist does not need to repeat the MRI Equipment Evaluation survey specifically for breast MRI as long as the breast coils were checked during the survey.

However, you must submit the MRI Equipment Evaluation survey Breast MRI Accreditation, even if it was submitted previously for general MRI accreditation. The ACR will check to ensure that the unit has been surveyed within the past year.

Q. We submitted our medical physicist’s MRI Equipment Evaluation results along with his completed Evaluation of Site’s Technologist QC Program form to the ACR. However, we received a notice from the ACR that the information was incomplete since he did not Mark your calendar to attend . . . evaluate the MRI technologist’s “Artifact Analysis” test. Our medical physicist uses the Evaluation of Site’s Technologist QC Program 2011 AAPM CT Dose Summit form in the 2004 ACR Magnetic Resonance Interdisciplinary Program on Scan Imaging (MRI) Quality Control Manual. Is this Parameter Optimization the correct form?

A. Yes, this is the correct form but there is an error in it. Although the Artifact Evaluation test is clearly outlined in the technologists section of the 2004 ACR Magnetic Resonance Imaging (MRI) Quality Control Manual, the Artifact Analysis test evaluation is missing from the Evaluation of Site’s Technologist QC Program form in the medical physicist’s section.

This has been corrected in the Evaluation of Site’s Technologist QC Program form on the ACR website.

Your medical physicist should use this form. We apologize for the confusion and will correct this in future editions of the manual.

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for Imaging Physicians, Technologists and Physicists October 7 - 8, 2011 Denver, CO http://www.aapm.org/ meetings/2011CTS/

Registration Opens May 11

AAPM Newsletter

March/April 2011

ABMP Exam

Dean W. Broga, Chair, American Board of Medical Physics

J

uly 9, 2010, the NRC recognized the American Board of Medical Physics certification in Medical Health Physics as RSO eligible. The NRC web site now lists the ABMP as an approved board under Training for Radiation Safety Officer. New MHP candidate forms for endorsement by a Certifying Physician and Medical Physicist have been developed and are available at the ABMP website (www.abmpexam.com). Candidates must indicate that they are requesting certification with RSO eligibility at the time of application. Both the Certifying Physician and Medical Physicist must document training and experience in alignment with the present requirements in 10 CFR Sections 35.50(a) on the new forms. Exams for 2011 will be offered at two locations: the ISMRM Meeting in Montreal and the AAPM Meeting in Vancouver.

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AAPM Newsletter

March/April 2011

New Professionals Subcommittee Report Minsong Cao, Indianapolis, IN Jeffrey S. Wyler, New Braunfels, TX

Preparation Strategies for the ABR Radiologic Physics Oral Board Exam

P

assing the ABR Oral exam can be achieved through a well organized plan of study. You should try to allocate at least 6-8 months to prepare for your Oral exam. It might not be a bad idea to start to make a plan of study right after the celebration of passing your written exam. Try to become familiar with the exam format and requirements. A short study guide is provided on the ABR website. Make sure that you understand the requirements of the five exam categories listed in the study guide and allocate appropriate time for each category according to your background and knowledge. Organizing the requisite study references are key parts for taking each portion of your boards; for Parts I and II organization is a large part of the preparation process. The Oral preparation portion is a much smaller portion of the study process; do not delay this preliminary portion of your study activities. Once you have a clear plan for studying each exam category, you should try to commit a certain number of hours a week to study and don’t allow yourself to become sidetracked, as study time can exceed 200 total hours. Do not expect that you can complete all your study during working hours. The study is very intensive and you have to dedicate and sacrifice a significant amount of your spare time.

There are numerous references and resources that can be used to prepare for the exam. You should try to use the resources in the most efficient way. The AAPM Virtual Library has hundreds of educational presentations which cover nearly every aspect of medical physics. Listening to a 30-minute talk from a well known expert in the field can help you save hours of self-study on some dry topics. The AAPM provides a two-day review course during its annual conference.

Additionally, several board preparation classes are available that offer numerous class dates.

Attending a review course can help you obtain a clear picture of the key elements in the exam and improve the efficiency of your self-study. Many textbooks in radiation therapy are now available in Google Books. You can use the powerful search function in Google Books to find the relevant information in these textbooks when you have a particular question. Also, do not forget your colleagues and classmates. Sometimes a phone call or email can save you many hours in searching online or textbooks. Journal review articles can provide a good summary of the minimum body of knowledge required by the exam for many topics. A good example is the review article of linear accelerator design published by C. J. Karzmark in Medical Physics Journal [1].

AAPM Task Group and NCRP reports are also great resources for studying special procedures and topics, e.g., shielding, HDR and LDR brachytherapy.

In addition to the didactic study material, use the resources that you have on-hand in the clinic.

Perform key tasks around the clinic, with the dual purpose of reviewing how to accomplish each item along with the “why” each item is accomplished in the specified manner. Some examples are: machine calibrations, monthly and annual QA, review of CT/diagnostic annual reports, review of State requirements, TPS QA, brachytherapy QA, understanding of 2nd check calculations, TPS algorithms, shielding review for XRT and brachytherapy, shielding surveys, machine commissioning and acceptable documents, RAM requirements, hot lab set-up, radiation safety badging and typical worker exposure, special procedure QA (IMRT, SRS, VMAT), and the principles of operation for all

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March/April 2011

continued - New Professionals Subcommittee Report support devices used clinically (daily output devices, film analysis specifics, array devices). It is very helpful to answer a question based upon recent first-hand experience.

If you work in a small clinic, you may not be exposed to all the special procedures or modalities that will be questioned in the exam. You should try your best to study these topics through the various resources discussed above, such as web-based video presentations. After you gain a basic knowledge of the topic, try to contact your peers in local areas who perform this special procedure/modality and arrange for a site visit. The fundamentals for all modalities used clinically are fair questions, regardless of what you work with on a routine basis. Obtaining forms and internal procedure documents from other clinics can also facilitate your learning of the procedure.

The benefit of observing a procedure is absolutely worth the driving time and gasoline expense.

Basic instruction for the exam process will be given immediately prior to the start of your boards.

Some key information is provided prior to the day of your boards, such as the strict cell phone policy. The exam will take place in a hotel near the Louisville airport. You should try to arrive at least a half day before the exam day so that you can get familiar with the exam location. For those from the west coast with an early morning exam appointment, it may be a good idea to plan for a day or more to overcome jet lag. The entire exam takes about 3 hours including a halfhour orientation. During orientation, you will be given a list of names and room numbers of five examiners. You will need to meet each examiner in his/her hotel room. Yes, this will probably be the only chance during your whole life to talk about physics in a hotel room. So do not panic and just relax! A computer will be provided in the hotel room for display of exam questions.

Pens and paper will also be provided for sketching or writing formulas. Each examiner will ask you a total of 5 questions in 5 different exam categories within 30 minutes. So you have only 5-6 minutes to answer each question. It is critical that you can organize your thoughts quickly and express your answers in a clear and concise way. This kind of skill can be practiced through mock exams with your colleagues. You can set up regular meetings with your senior physicists for simple mock questions on different topics. There is a magnitude of difference between knowing a subject from studying and being able to talk for 5-6 minutes about both broad and specific related components. This kind of practice will prepare you well for the real exam.

Your goal is to successfully complete the process, but what is the roll of the examiner? The ABR does not have an official statement on this currently, but consideration is being given to develop one. An unofficial answer was given by an ABR trustee, who was not quoting ABR official policy, as: • Arrive at the exams with a clear understanding of the standard against which candidates are being judged. The standard is minimal competence in the subject areas being covered. The examiner must know what he or she believes constitutes minimal competence in, for example, treatment machine QA. This is addressed in the training provided to examiners.

• Give the candidate every possible opportunity to demonstrate his or her proficiency in the subject areas covered.

• Judge whether or not the candidate can function safely when working independently in the clinic.

• Avoid any behaviors that are irrelevant to the exam or that could bias or mislead the candidate. Examiners are trained to refrain from positive or negative reinforcement, or questions about the candidate’s background or training. They also avoid comments about such things as the weather or the candidate’s appearance, that don’t contribute to and could detract from the exam.

• Conduct the exam in a manner that avoids unnecessary stress for the candidate. We recognize that travelling to Louisville and facing senior and well-known members of the profession in this one-on-one format is intimidating for many candidates, and we employ various techniques to minimize this.

The examinee’s roll is to pass. The relationship during the Oral Board is very dynamic when you

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March/April 2011

continued - New Professionals Subcommittee Report mix in the different knowledge levels and skills sets of both the examinee and the examiner. With this in mind, a comfort level for preparedness should be addressed. If you were to bin the relative levels of preparedness, you could use: not prepared enough, prepared just enough, and no question as to competency and ability. These are relative levels, depending on who you ask the “prepared just enough” level could equal the “not prepared enough” level. In fact, if you follow any professional discussions, you could find that “no question as to competency and ability” could be widely debated. In the end, it is your own personal level of preparedness and comfort with the requirements set forth that you will use to determine when you preparations are complete.

1) Karzmark, C. J. Advance in linear accelerator design for radiotherapy, Med. Phys. 11(2), p105-128. 1984

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!

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/meetings/2011AM/

NCRP Releases Report No. 168, Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures

NCRP Report No. 168, Radiation Dose Management for Fluoroscopically-Guided Interventional Medical Procedures, provides recommendations and supporting information on radiation dose management for patients and medical staff during the use of fluoroscopic systems for guiding diagnostic and therapeutic medical procedures.

This Report is focused on the use of fluoroscopic systems as a tool for guiding diagnostic and therapeutic procedures because higher radiation doses (compared to conventional radiography and fluoroscopy) are received regularly from some types of FGI procedures and occasionally from many other types of FGI procedures. Other medical applications of fluoroscopy (e.g., examination of the gastrointestinal system, guiding open surgical procedures) are outside the scope of this Report. Computed-tomography-guided interventional (CTGI) procedures are not discussed in detail due to continuing changes in the technology driven by the evolution of multi-slice computed tomography (CT) detectors. However, the principles presented in this Report are generally applicable to these domains. Most of the recommendations contained in this Report should be applied in all settings where fluoroscopic guidance is used.

The Report is available from the NCRP website, http://NCRPpublications.org, in softcopy format (PDF).

Hardcopies will be available in March 2011. For additional information contact David A. Schauer, ScD, CHP at schauer@NCRPonline.org, 301.657.2652 (x20) or 301.907.8768 (fax).

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AAPM Newsletter

March/April 2011

Person in the News

AAPM member, Madan Rehani to be awarded Honorary Membership of the Society of Pediatric Radiology at a function in May 2011 in London, UK.Medical Physics

W

orking at the IAEA he has established networks on “Radiation protection of children” and implemented projects in over 50 developing countries to strengthen protection of children.

Formerly, Professor & Head of Medical Physics at All India Institute of Medical Sciences, New Delhi, India. Currently, Secretary-General, IOMP and Secretary, Radiation Protection in Medicine Committee of ICRP.

Awards: Harold Johns Medal by the IOMP, 2009; Dr. K.M. Rai Oration by Indian Radiological & Imaging Association, 2001 and Homi Bhabha Memorial Oration by Society of Nuclear Medicine India, 1999.

Chaired Task Groups that resulted in Annals of ICRP 87 and 102 on Computed Tomography.

Published papers in Lancet, Br Medical Journal besides cardiology, radiology, nuclear medicine, medical physics and dosimetry journals. Edited 5 books.

At IAEA, he manages website http://rpop.iaea.org. Current important projects being handled by him are radiation induced cataract among interventionalists and Smart Card/SmartRadTrack project.

AAMD 36th Annual Meeting June 12-16, 2011 St. Louis, Missouri Registration is now open for the AAMD 36th Annual Meeting, June 12 – 16, 2011 in St. Louis, Missouri. This year the pre-conference workshops on Saturday, June 11 will include an 8-hour CMD Exam Review Course and two Contouring Workshops with hands-on practice for contouring of the breast, brain and thorax. The educational sessions, Sunday, June 12 through Thursday, June 16, will offer attendees at least 30 MDCB approved credits, including a panel discussion on Electronic Medical Records.

AAPM members are eligible for the AAMD member discount registration rates by referencing the AAPM code: AAPM 2011 For complete AAMD Annual Meeting details and to register, visit the AAMD website at http://www.medicaldosimetry.org/meetings/annual.cfm

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AAPM Newsletter

March/April 2011

Obituary

Leonard Stanton, MS

In Memoriam: Leonard Stanton, MS, DABR, CHP, FACR, FAAPM 1917-2010 by David A. Lightfoot

L

en Stanton, Professor Emeritus of Radiation Oncology and Nuclear Medicine (Radiological Physics) Hahnemann University School of Medicine, died on Tuesday, December 28, 2010 at the age of 93. He was a charter member of the AAPM and served as secretary from 1965-1971 and was one of the 16 directors constituting the initial Board of Directors named in the AAPM Articles of Incorporation filed in the District of Columbia, on November 10, 1965: He received the Gold Medal from the RSNA in 1985 and the Coolidge Award from the AAPM in 1996.

His death at 93 was not unexpected since he had been in failing health for a few months. Up until then, he maintained his interest in the world and the field of science. He is survived by his wife Emma and his two sons Fred and Bob and will be greatly missed.

His text “Basic Medical Radiation Physics” was published in 1969 and was developed from a course of lectures given by him in Philadelphia over the preceding 16 years to radiologists and physicians. Many of his associates at work undoubtedly have fond memories of Len with a can of soda in one hand, an outline in the other and his feet propped up on the desk leaf late on a Tuesday afternoon as he cleared his mind from the concerns of the day to prepare for his evening lecture. His lectures were peppered with humorous analogies to help his audience remember the essentials he described. He worked with Paul Goodwin in developing Len and Emma, 3/2009 the didactic slide tape sets for radiation physics released by the RSNA in 1977 containing lectures by well known medical physicists selected for their extensive scientific and teaching experience.

Leonard Stanton was born on August 21, 1917, in Philadelphia, Pennsylvania. He received the A.B. degree in physics from Temple University in 1938, after having served as teaching assistant in physics during 1937 and 1938. In 1939, Mr. Stanton took part in an instruction course in industrial instrumentation at the Brown Instrument Company, and later in the same year joined the Fischer and Porter Company, taking charge of the theoretical department. In 1940 he was employed by the United States Weather Bureau, leaving the following year to accept a research position on a confidential project with the National Bureau of Standards.

Mr. Stanton joined the research department of the Brown Instrument Company in 1942, and became engaged in war work directly related to contracts essential to the synthetic-rubber program. He held two patents relating to electrical testing apparatus. He received an MS degree from the University of Pennsylvania in 1952.

Len’s area of expertise in medical physics was largely spurred by his sister’s death from breast cancer. He was resolved to do all he could to spare other women from the pain and suffering she had experienced. Some of his early work was related to radiation measuring devices and circuits, perhaps a carryover from his testing apparatus patent work. However, he had been mentored in medical physics by James Weatherwax who was a pioneer in the development and use of phantoms. Thus, Len turned his attention to improving early detection of breast cancer through better imaging. His work in developing a suitable phantom for evaluation of mammographic images is perhaps his most widely known work. It undoubtedly had a strong influence on the current ACR phantom and will serve as a lasting legacy to his efforts. His resolve to help women has been realized by the success of mammography and the advances in early detection and treatment that have resulted from mammography.

1967

1987

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

PRINT SCHEDULE • The AAPM Newsletter is produced bimonthly.

• Next issue: May/June • Submission Deadline: April 6, 2011 • Posted On-Line: week of May 2, 2011