AAPM Newsletter July/August 2011 Vol. 36 No. 4

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. 4

JULY/AUGUST 2011

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

The International Scene ….. ver the past three months I have traveled to the International Congress of Medical Physics meeting in Porto Alegre, Brazil (April), to the Spanish Medical Physics Society meeting in Seville, Spain (May), and most recently to the AAPM-sponsored International Scientific Exchange Program summer school at the University of Patras, in Patras, Greece (June). I have been warmly welcomed at each venue, and have similarly delivered greetings on behalf of the AAPM. There are many individuals (many not named below) that I would like to acknowledge who have put forth great effort and time to ensure the success of these interactions, including Cari Borrás, Paulo Costa, Fridtjof Nüsslin and Bill Hendee for the ICMP meeting in Brazil, Cari Borrás, Jose “Pepe” Herandez-Armas, and Bill Hendee for the SEFM-AAPM joint workshop in Spain, and George Kagadis, George Nikiforidis, Mahadevappa Mahesh, and Bill Hendee for the ISEP summer school. (Bill does get around, doesn’t he?)

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These are extremely valuable exchanges of information and ideas from which we all can learn and benefit. At each of these meetings I had the opportunity to present several scientific and/or educational talks on diagnostic imaging physics, and discussed many of the issues important to our colleagues in each of these countries. I have found (perhaps not surprisingly) that situations regarding clinical medical physics education and Included in this issue: training requirements are similar to our own, and a desire to ensure reciprocity for clinical certification status around the Chair of the Board p. 3 world is gaining traction. Our association benefits greatly from President-Elect p. 4 international relationships that allow the bidirectional sharing of Executive Director p. 5 ideas. This occurs chiefly through the Medical Physics journal, Editor p. 9 which provides a forum for the continued development of scientific Education Council p. 10 ideas and technological advances that improve and maintain our p. 11 relevance as a profession and for those who we serve, ultimately Science Council p. 13 the patient. I feel it is very important that we, as a professional Professional Council p. 14 society, undertake an effort to attract more medical physicists Leg. & Reg. Affairs from beyond North America to become members of the AAPM in Website Editor p. 19 order to continue our growth and extend participation to those in ACR Accreditation p. 21 other countries with common goals and shared aspirations in all MDCB Announcement p. 23 areas of medical physics.

Chapter News p. 24 WPSC Report p. 26 Continuing on the international theme, the annual meeting in ACMP Final Meeting Report p. 27 Vancouver (yes, this is an international conference for us in the ABR Press Release p. 28 States) in conjunction with the Canadian Organization of Medical p. 29 Physics promises to be an outstanding success, with record- ACMP Awards breaking numbers of registrants who will enjoy an unprecedented ICMP Report p. 33 program of excellent scientific, educational, and professional IHE-RO Report p. 35 learning opportunities. Access to commercial exhibitors throughout Obituary p. 39 the week will also be available, a perfect time to interact with your vendors and equipment manufacturers for insight into product

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continued - President's Column enhancements and future directions. I also urge you to schedule time to come to the Annual Business Meeting beginning at 6:15 PM (a short 15 minutes) followed immediately by the Town Hall Meeting through 7:30 PM on Wednesday, August 3 in Ballroom C of the Vancouver Convention Center. Here, you will get a brief report of the state of the AAPM, and will have a chance to speak up, discuss your concerns, likes, and dislikes about the AAPM and its operations, and ask questions to the Board of Directors, the Executive Committee, and the Executive Director, all of whom will be present at the Town Hall Meeting. It is at this venue that you will have the full attention of the AAPM leadership and directors in expressing your comments and thoughts.

Diagnostic Imaging Medical Physics Residencies One concern that many of us have (AAPM and RSNA leadership, medical physics educators, and graduate students in medical physics programs) is the lack of current accredited Diagnostic Imaging (Dx) Medical Physics residencies, which are now producing an average of 7 graduates per year. As 2014 is fast approaching, there are currently not enough slots to meet the anticipated demand for future Dx qualified medical physicists (QMPs) in subsequent years, who beginning in 2014, must have completed a two-year residency accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP) to sit for the American Board of Radiology examination. While a more complete workforce study is needed to determine the future number of Dx QMPs needed (a range from 10 up to 30 per year have been estimated), clearly additional residency programs and positions are needed immediately. In particular, with the large push to accredit advanced imaging technologies, accreditation bodies are recognizing the value of the Dx QMP for critical image quality and dose assessments for reducing the risk and enhancing the safety of the patient, which will likely increase the future demand.

The AAPM and the RSNA are committing support for the establishment of accredited residencies, including financial grants to initiate the required CAMPEP self-study, and monetary assistance in building the elements of a residency program. A letter signed by me, Mike Herman, and Sarah Donaldson, Chair of the RSNA Board of Directors to “The Leaders in Radiology� will be published in the August 2011 RSNA newsletter urging the consideration of establishing several diagnostic imaging medical physics residencies. We as medical physicists also have a responsibility to contribute to this effort by interacting with our department chair / leaders and providing faculty leadership and support roles in the development of these residencies.

Presidential ad hoc committees to be established Related to the discussion above regarding the potential number of residency slots needed for Diagnostic Imaging (Dx) QMPs, there appears to be several practice groups who are not following the Scope of Practice for Medical Physics by having non-qualified personnel doing Dx QMP work in an unsupervised or inappropriately supervised fashion. In part this is due to the lack of guidelines and definitions regarding which diagnostic imaging physics tasks should directly be performed by a Dx QMP, and which tasks (measurements, evaluations, official reports) can be performed by a non-qualified person under direct supervision by a QMP, and general supervision (when appropriate).

Based upon the above, the ad hoc committee to determine Dx QMP supervisory roles is charged with defining a list of procedures and tasks performed by the Dx QMP, including levels of supervision (direct or general) required for a non-qualified assistant. It is expected that this guidance will supplement the Scope of Practice for the Dx QMP under the auspices of the Professional Council, and consistency in this guidance should help to better define the manpower needs and expected demands beyond 2014.

A second ad hoc committee chiefly comprised of AAPM liaisons to the accrediting bodies (American College of Radiology, Intersocietal Accreditation Commission, and The Joint Commission) has a charge to develop a dialog regarding a common base for medical physicist qualifications for all accreditations, and to lobby these organizations for the required participation of a Dx QMP in order for a practice to obtain accreditation.

As always, I am open to your comments, criticisms and suggestions. I look forward to seeing you all in Vancouver at the annual meeting. In the meantime, enjoy the summer!

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

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s we head into our 53rd annual meeting in Vancouver, with what is promises to be a very well attended and highly interactive meetings, we can reflect on why we strive to be the best medical physicists we can.

We will gather to learn cutting edge science, to review practice guidance and refresh our memories on standard and advanced techniques. We will present and participate, discuss and debate, build alliances and friendships.

The commonality is medical physics. We all wish to be a productive and significant part of a team and a profession that makes a positive difference in the lives of other people. We do not do this for fortune or fame, but because it improves humankind. Thank you all for actively participating in our profession and making it what it is.

We have seen an amazing and continuing maturation of the field and profession of medical physics in education, practice and science, all focused on developing better technology and techniques to deliver the best patient care. We have entered a new era of accountability and responsibility for safe and accurate patient care. Our credentials are recognized by regulatory and legislative bodies, the news media and the public. The need for the expertise of the medical physicist has never been greater, in the clinic, in the lab and in the process of technology development and quality control.

Each of our successes and every change in our field or the medical environment that encompasses our profession create new and significant challenges that we must meet.

We have defined our priorities through an updated strategic plan (under Board vote as this letter is written) to guide our association toward the futures. We can only continue to meet challenges, obtain success and deliver the goods for improving patient’s lives, if we all remain involved and committed. We each are expected to perform our clinical, research, development, educational, regulatory roles to the best of our ability. In addition, Special Ultrasound Symposium – Advances in we must each become and remain Therapeutic and Diagnostic Ultrasound involved in the improvement of August 1 – 3, 2011 the profession of medical physics.

Agree to be a mentor, lead or write Diagnostic symposia include: on a task group, chair or sit on • Contrast & Interventional Agents (US and optical), and a committee, teach and educate Small Animal in your clinic, at the local college • Advanced Systems, Components, Signal/Image Processing or high school, write grants and & Display manuscripts and collaborate with • Photoacoustic Imaging others to maximize potential.

• Breast, Other Applications, Guidance of Interventions • Quantitative Imaging & Measures Work toward solving the problems • US Image Guidance in Radiation Therapy that limit our success or add risk to Therapy symposia include: patients. Share the results freely.

We are all in this together and for the long run. Make your energy and effort count.

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Clinical Systems & Applications Image Guidance & Assessment Advanced Technology and Implementation Novel Technologies & Therapeutic Strategies

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

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am writing this while on a flight from Phoenix to Detroit, heading to a homecoming of a sort: the Great Lakes Chapter meeting. My first experience of the AAPM Board was as the chapter representative from this chapter, back in 1996-9. Back then I spent most of the three year term trying to understand what the Board did; there was no orientation other than what your predecessor might tell you. It was not all that engaging or satisfying an experience, as I recall. We got a notebook full of reports about two weeks before the meeting and then at the meeting itself another notebook full of reports and action items from committees that had just met.

We dealt with stuff we were just seeing for the first time. It was not a process that promoted or even allowed much thoughtful action. Lots of rubber stamping and off the cuff debate, not much forethought or high level thinking.

We do much better now, thanks to many Board members, officers, and headquarters staff who redesigned the Board processes over the past several years. People thought seriously about the appropriate role of the Board and how to make it work. Material now goes out frequently and electronically, fewer routine issues are brought to the Board, and those that are handled by electronic vote or consent agenda. The Board has more time now to think about where medical physics should be going and how to best position our association. The Board has created a strategic plan that will be formally adopted at the Vancouver meeting. Much time and effort went into its creation. Now we have to use it.

The challenge is not only to use this plan to set priorities over the next few years, but to institutionalize the process so that it doesn’t die. We need to implement the plan through the Councils, review progress on the individual elements, and update the plan periodically. We have many initiatives; some will get done quickly, others will take time, and new issues will arise.

Keeping up with all that needs a small group’s concentration. To that end, the Board is considering setting up a permanent committee of the Board to oversee strategic planning. It will work with the officers and council chairs, who oversee AAPM’s activities, to make sure we stay on track and to decide what issues need to come to the full Board for attention. Membership will include six chosen from the general Board and four from the officer chain*.

This idea balances two competing needs within our AAPM culture. One is this desire use our elected leaders’ abilities to think deeply and long term.

That needs a small group filter. It is hard to have a thoughtful discussion about more than one topic with 40+ Board members around the table. Another is to respect and maintain the highly participatory nature of the AAPM membership. We are a much more bottom-up society than ASTRO or RSNA, and people like the idea of direct representation in our governance. So the idea is to use a small group within the Board to oversee strategic planning and help set the agenda for the whole Board.

2011 Practical Medical Physics Track Highlights: • • • • •

Will this work? I’ll be curious to get the Great Lakes reaction. Tell your representative (and me) what you think. Gary Ezzell; ezzell.gary@mayo.edu

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*Board members serve for three years.

The proposal is to have two in their second year, two in their third, and two who have just rotated off. The officer chain will include the Presidentelect, President, Chairman of the Board, and the immediate past Chairman.

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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

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AAPM Executive Director’s Column Angela R. Keyser, College Park, MD Remember to Vote!

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lections for the 2011 President-Elect, Secretary and Board Members-AtLarge will close on July 13. Make sure to cast your ballot.

2011 Summer School If you have delayed in making your decision….you can still register for the 2011 AAPM Summer School, Uncertainties in External Beam Radiotherapy, at the discounted registration rates. Don’t delay! The Summer School will immediately follow the Annual Meeting, from August 4-9 at Simon Fraser University in Burnaby, British Columbia. For details, go to: http://www.aapm.org/meetings/2011SS/ Annual Meeting reminders Mark your calendar now! September 1, 2011 is the last day to complete the online evaluation system and receive CAMPEP credits for the sessions attended and reviewed from the Vancouver meeting.

Use the online Meeting Planner to generate your personal meeting schedule by compiling sessions, talks and committee meetings you plan to attend into a single chronological document. You must be logged in to the abstract system to use the Meeting Planner. Then, compile your schedule, download the .vcs file to import to your PDA, or print it out as a reference. If the time of your meeting, session or talk changes, the planner automatically updates your personal schedule. A specially formatted mobile program now available for iPhone, BlackBerry, etc.

Selected speakers have been asked to provide handouts for their presentations. The speakers will either provide the handout for posting on the website pre-meeting or at show site, to be posted following the meeting. Please check the Handout site for the progress on submissions.

Selected presentations given during the meeting will be available via DVD Rom following the meeting.

You may order at the Conference Recordings desk in Vancouver. Presentations will include audio of the speakers synchronized with their slide presentation and animations. Details are available online.

Selected presentations given at the Annual Meeting will also be captured for posting following the meeting in the AAPM Virtual Library. The posted presentations will include streaming audio of the speakers and slides of the presentations.

Visit the Vendors! Make sure to block out time in your Annual Meeting schedule to visit the Exhibit Hall. An online Buyers Guide is available. A list of companies exhibiting is posted online. Hours: • Sunday, July 31 – 1:00 – 6:00 PM • Monday, August 1 – 9:30 AM – 6:00 PM • Tuesday, August 2 – 9:30 AM – 6:00 PM • Wednesday, August 3 – 9:30 AM – 2:00 PM Make plans to attend the 2011 Annual Business and Town Hall Meeting on Wednesday, August 3 from 6:15 PM - 7:30 PM in Ballroom C, Vancouver Convention Centre. Members of the AAPM Board of Directors want to hear directly from the membership. What should AAPM be working on? How can the organization better serve you? Here's your chance to be heard. AAPM's President and Treasurer will report on the status of the organization. There will also be a discussion of proposed amendments to AAPM's By-Laws. The proposed amendments will then be voted on via an online vote in the fall.

The Vancouver Vacation Guide is now available in the iTunes App Store! Spectacular natural beauty, urban excitement and a cosmopolitan vibrancy all help to land Vancouver at the top of "best cities to visit" lists. Perfect for meeting attendees, this guide to Vancouver is loaded with ideas for exploring the best of the city, whether you've got just a day or two to see the top highlights or a bit longer to delve into some of the locals' favorites. The guide is FREE and available in 20 languages.

Click here to check it out.

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continued - Executive Director's Column Other local area information: 10 Vancouver 'MUST SEE' Attractions Vancouver with Kids 25 FREE Things to do in Vancouver, including the Grouse Grind!

New Publications The 2010 Professional Survey is available online. You can download a PDF from the web or have the document emailed to you. If you have any problems, please contact HQ. The Workforce Study and Professional Survey Validation reports are available online as well.

The two studies were conducted by the Center for Health Workforce Studies at the School of Public Health at the State University of New York – Albany (SUNY). The first study was a comprehensive study of the medical physics workforce to better understand current supply and demand for the profession. The second study was initiated to validate the accuracy of the data collected by the AIP for the annual AAPM Professional Survey.

The report of Report of AAPM TG 135: Quality assurance for robotic radiosurgery is now available online.

2011 Summer Undergraduate Programs This year 49 undergraduates competed for five AAPM Summer Fellow positions (SUFP). The program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. For more information on the program, go to: http://www.aapm.org/education/SUFP/default.asp This year 6 undergraduate students competed for two AAPM MUSE (Minority Undergraduate Summer Experience) Summer Fellow positions. The MUSE program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institutions (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For more information on the program, go to: http://www.aapm.org/education/ MUSE/ SUFP Fellows Mentors Ronald Alexander Tess Armstrong Zephyr McCormick Mara Rosenberg Victoria Yu

Yi Le Sonja Dieterich Lori A. Young James A. Tanyi Lei Xing

Students participating in the program SUFP and MUSE are placed into summer positions that are consistent with their interest and are selected for the program on a competitive basis. Each Summer Fellow receives a $4,000 stipend from AAPM.

Funding Award Winners Announced The 2011 AAPM/RSNA Fellowship for Graduate Study in Medical Physics is awarded to Scott Haile Robertson, Duke University.

The 2011 Research Seed Grants are awarded to Yahya Alivov, University of California Irvine and Hao H. Zhang, University of Maryland School of Medicine.

MUSE Fellows Mentors Anisley Valenciaga MichaelMcNitt-Gray The 2011 AAPM Clinical Residency is awarded to Kenneth Verlage Cynthia McCollough Duke University Medical Center, Ehsan Samei, Program Director.

The 2011 RSNA Clinical Residencies are awarded to UT MD Anderson, Charles E. Willis, Program Director and Upstate Medical Physics, Robert J. Pizzutiello, Jr., Program Director.

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continued - Executive Director's Column Congratulations to the recipients. The programs are supported by the AAPM Education and Research Fund. More information about the various funding programs and the great work supported is available in the 2010 Annual Report. Please consider making a donation to the AAPM Education and Research Fund.

CT Dose Summit 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. Program Directors Cynthia McCollough and Diana Cody have put together an outstanding faculty with the goal to provide practical information for users that will help them operate their CT scanners wisely, improving the quality and usefulness of CT images while reducing the radiation dose to patients.

Registration for the 2011 event will open on May 11. Do not delay in registering as 2010 event sold out in record time. For more information, go to: http://aapm.org/meetings/2011CTS/.

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

Staff News Rachel Smiroldo joined the HQ team in early June as the Exhibits and Meetings Assistant. Rachel is a 2011 graduate of McDaniel College with a B.A. in Sociology and served as our meeting summer intern in 2010. Many of you may have met her during the 2010 Annual Meeting in Philadelphia. We are thrilled to have her as an official member of AAPM Headquarters' Staff Anniversaries the team!

Nancy Vazquez 15 years of service Staff Recognition Jennifer Hudson 10 years of service Part of the success of AAPM HQ operations is Zailu Gao 10 years of service our ability to attract and retain an excellent Cecilia Hunter 8 years of service team of high-performing professionals. The Karen MacFarland 8 years of service following AAPM team members celebrated an Lynne Fairobent 7 years of service AAPM anniversary in the first half of 2011. I Lisa Giove 6 years of service want to publicly thank them and acknowledge Laurie Hayden 4 years of service their efforts.

Onasis Budisantoso 3 years of service Amanda Potter 3 years of service AAPM HQ Team…at your service!

Viv Dennis 1 year of service AAPM’s interactions within the science and science policy communities continue to increase. The organization has a great HQ team hard at work alongside numerous AAPM volunteers to represent AAPM and the medical physics profession.

Lynne Fairobent joined the AAPM team in 2004 as Manager, Legislative and Regulatory Affairs. She works with AAPM volunteers to interact with Congress, federal agencies and other policy makers. Lynne also coordinates efforts with other sister organizations.

She is also serves as a liaison to the Professional Council.

Amanda Potter came onboard with AAPM in 2008. As the State Legislative and Regulatory Affairs Specialist, Amanda gathers and disseminates information on the activities of the state legislatures and state agencies on issues related to the medical physics profession. She is also working with volunteers to develop and implement a grassroots program for AAPM.

L: Amanda Potter; R: Lynne Fairobent

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Diagnostic Imaging Educational Courses The program will include 32 Educational Courses in Diagnostic Imaging Physics and Technology. The courses will include: image reconstruction, radiation dose, breast imaging, radionuclide imaging, MRI, radiography, radiation safety and risk, multimodality imaging, medical informatics, and teaching physics to radiology residents. Six hours of breast imaging CE will be available in the breast imaging, radionuclide imaging, and MRI courses. Also new this year is our improved dawn-to-dusk program. Less parallel education content means you can earn more CE credits and attend more sessions that interest you.

Imaging SAMs: • SAM Session 1: Breast tomosynthesis - Principles of breast tomosynthesis acquisition and reconstruction and the role of the medical physicist in clinical implementation of breast tomosynthesis • SAM Session 2: Estimating patient dose at CT and estimating patient dose resulting from fluoroscopically-guided interventions • SAM Session 3: Physics of MRI safety and clinical MRI safety • SAM Session 4:Yttrium-90 microsphere therapy planning and dose calculation; Absorbed dose estimation for radiopharmaceuticals

For complete program information, go to http://www.aapm.org/meetings/2011SS/ Why attend?

1. Radiotherapy is under scrutiny for mistreatments. What are you doing to better expend your quality management resources so that it doesn’t happen at your facility? The SS is a cost-effective choice.

2. What has the IAEA on IMRT said about how dose prescriptions should be reported? If you don’t know, you should attend the Summer School.

3. Rank the following in terms of likely impact to patient outcome (correct answers at bottom of the page): • dose calculation accuracy • calibration accuracy • setup uncertainty • uncertainty in contouring the gross tumor volume If you hesitated in your answer, you should attend the Summer School.

4. What is failure mode and effects assessment? If you do not know, you should come to the Summer School and find out.

Course Directors: Rock Mackie, PhD University of Wisconsin and Jatinder Palta, PhD University of Florida Health Science Center REGISTER NOW - Save $$ and register prior the meeting. Registration fee is significantly higher on-site Registration includes all meals, hard cover proceedings with CD ROM, Ice Breaker on Thursday evening, Night In on Sunday evening. Reminder: Check the expiration date on your travel documents.

Correct ranking for question 3: (1) uncertainty in contouring the gross tumor volume; (2) setup uncertainty; (3) dose calculation accuracy; (4) calibration accuracy

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Editor's Column Mahadevappa Mahesh, Baltimore, MD

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elcome to the 4th issue of the Newsletter. By the time you are reading this issue, most of you may be preparing for the trip to attend this year’s Joint AAPM/COMP meeting in Vancouver, Canada. Don’t forget to take your passport or other travel documents to avoid any delay at the borders. This issue contains a wealth of information about our association’s activities and forthcoming plans. In addition to the usual columns from the leadership, this issue also includes columns from the three councils, reports from the Upstate New York chapter, the American College of Medical Physics (ACMP) and also from the International Congress of Medical Physics (ICMP).

This issue also contains an obituary for Dr. Charles Lescrenier. I want to share my thoughts on Dr. Charles Lescrenier, known to many of us as 'Les'.

Many of you have known Les for his contributions to medical physics (for more details read the obituary column on page 39) but I want to personally recall his support and encouragement I received all of these years. I personally benefited from his generosity through receiving my 1st year graduate school scholarship from him and his continued encouragement and support throughout my graduate school. His passing is a great loss for the medical physics community and want to express my personal thanks and best wishes to Peggy Lescrenier and her family during these hard times.

Finally, I wish all of you a very happy summer and look forward to seeing many of you at the annual 4/21/11 2:41 PM Page 1 meeting. Once again, for those who are planning to attend the annual meeting, don’t forget to take your passport or other travel documents to avoid any delay at the borders.

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http://www.aapm.org/careers The American Association of Physicists in Medicine (AAPM) is a partner in the AIP Career Network, a collection of online job sites for scientists, engineers, and computing professionals. Other partners include Physics Today, the American Association of Physicists in Medicine (AAPM), American Association of Physics Teachers (AAPT), American Physical Society (APS), AVS Science and Technology, and the Society of Physics Students (SPS) and Sigma Pi Sigma.

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Education Council Report George Starkschall, Houston, TX

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n my career, I have often been asked what does a medical physicist do.

To address that question, I generally use the following 25-words-or-less definition of a medical physicist: “Ensures that radiation delivered to a patient in a medical procedure is done so in a safe manner.”

Over the past year and a half, a series of articles in the New York Times has identified situations where patient safety had been compromised. Recently (May 16, 2011), in an interview on NPR’s Fresh Air, Walt Bogdanich, the author of this series of articles, said of medical physicists, “it’s their job to … figure out how to most safely deliver this radiation in a precise manner.”

The word is now out to the public that our job is patient safety.

In our upcoming AAPM Meeting in Vancouver, the Education Council Symposium will address how we can teach patient safety. Organized by John Bayouth, the Symposium will include speakers Mike Herman, Peter Dunscombe, Derek Brown, and Sasa Mutic, and include the following topics: “Establishing a culture of safety through education,” “Inclusion of patient safety into didactics and clinical training of medical physicists,” and “Training individuals to use voluntary reporting systems.” The Symposium will be held on Sunday, July 31, from 11 am to 12:30 pm in Ballroom A of the Convention Centre, and I hope you will be able to attend. Special thanks goes to John for organizing this Symposium.

AAPM New Member Symposium

Tuesday, August 2 • 4:30pm - 6:00pm Room 224,Vancouver Convention Centre Welcome: J. Anthony Seibert, PhD Professional Etiquette: George Sherouse, PhD Panel Discussion: Rocky Barra, Michael Mills, PhD John Swanson, PhD, Eric Klein, PhD Calling all AAPM New Members (who have joined since 2008) Grab a beer and meet the committee chairs from 4 AAPM Councils: Science, Education, Professional and Administrative.

New AAPM members registered for the 2011 Joint AAPM/COMP Meeting -- RSVP now so we know you are coming!

Please be aware of several other activities that address education at the Meeting. Later on Sunday, July 31, we will have a General Poster Discussion session from 3 pm to 6 pm in the Exhibit Hall that will include posters on educational methods. On Tuesday afternoon from 2 pm to 3:50 pm, a Practical Medical Physics session entitled “Clinically Focused Physics Education” will be conducted by Perry Sprawls and held in Room 301 at the Convention Centre. Finally, the annual Innovations in Medical Physics Education session will be held Wednesday from 4:30 pm to 6 pm in Ballroom C.

In addition, all new members who RSVP will receive a drink ticket, good for one complimentary beer served at the New Member Symposium.

In addition, I want to call your attention to the Annual Meeting of the Society of Directors of Academic Medical Physics Programs (SDAMPP), which will be held on Saturday, July 30, from 8 am to 11 am in Room 110 of the Convention Centre.

The topic of the meeting is Medical Physics Education in a Post-2014 World: Apocalypse or Transformation?

In addition to several presentations, there will also be discussion on this topic.

RSVP: http://www.aapm.org/meetings/2011AM/ NewMemberSymposium.asp Deadline to RSVP (tickets will be included with your badge onsite) is July 13.

Opportunities exist at the AAPM meeting to improve your knowledge in medical physics education, and I shall be looking forward to seeing you in Vancouver at the end of July.

All new AAPM members who RSVP will receive a raffle ticket (enter to win a complimentary registration for the 2012 Annual Meeting in Charlotte!)

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Science Council Report John Boone, Sacramento, CA

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cience Council has been active in supporting a number of AAPM sponsored activities over the past year. In this newsletter, I will highlight a few activities on the diagnostic side of the house, and in the next newsletter, Science Council activities in radiation oncology physics will be discussed.

Spawned during discussions with leaders from the Image Gently campaign at the April 2010 AAPM CT Dose conference in Atlanta, Task Group 204 was charged to develop size dependent dose estimates for computed tomography (CT) examinations. The TG-204 Report was released in May 2011, and provides guidance on how medical physicists can use the CTDIvol reported by a CT scanner, combined with an estimate of the patient’s body size, to better estimate tissue dose (in mGy) in the scanned region of the patient. The report was endorsed by the International Commission on Radiological Units and Measurement (ICRU) and by the Image Gently campaign, which is dedicated to reducing dose in pediatric CT. Because of the utility of this report beyond the medical physics community, it is available on the AAPM website with no password restrictions.

A few years ago, AAPM Report 111 (chaired by Bob Dixon) was completed which described a fundamentally new approach to CT dosimetry. At the time, it was recognized that a corresponding CT dosimetry phantom would need to be developed. AAPM Task Group 200, chaired by Donovan Bakalyar, was formed last year to address this issue. An open and collaborative effort towards phantom design has emerged, resulting in the design and fabrication of a number of identical prototype phantoms for evaluation by members of the TG and others. The phantom is machined from high density polyethylene to reduce cost, and is 30 cm in diameter and 60 cm in length. The phantom has three sections, each 20 cm in length – each section weighs about 13.4 kg (~30 pounds). The length of Data from TG-204

the phantom is needed to insure that scatter photons from the periphery contribute to the dose measurement (as they do in a patient), and this overcomes one of the central problems with the traditional CTDI-100 measurement, as it only integrates scatter over a length of 10 cm in a 15 cm long phantom. Phantom fabrication is complete, and these phantoms will be put to the test at several sites around the U.S. and in Europe in the coming months. This exercise in CT phantom development was performed in collaboration with the ICRU, and national laboratories including the National Instituted for Standards and Technology (NIST) in the U.S. and PTB in Germany have participated in phantom development or evaluation as well. Recommendations of the task group are expected by early 2012.

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continued - Science Council Report AAPM Task Group 195, led by Ioannis Sechopoulos, is making excellent progress in establishing standard conditions for benchmarking Monte Carlo computations relevant to diagnostic radiology. In effect, the aim of this task group is to develop standard phantoms, beam spectra, and measurement criteria for the validation of Monte Carlo simulation tools – all in the virtual environment. Mathematical phantoms are being developed for Monte Carlo analysis and validation in projection radiography, mammography, and computed tomography.

There has been significant concern over the radiation levels of x-ray backscatter scanners at airports in the United States and around the world.

Recognizing that medical physicists are in an excellent position to make x-ray dose measurements from these devices and share the data with the flying public, Science Council approved the formation of Task Group 217, chaired by Chris Cagnon in Spring 2011. Members of the TG have now visited the main manufacturer of these systems (Rapidscan) twice, and with full cooperation (and no financial support) from the manufacturer, made extensive measurements of the x-ray beam quality and radiation dose output of the backscatter scanner systems. A report will be completed by the fall of 2011, and this will potentially be accompanied by a news conference in order to share this dose information with the lay public, in a manner which is understandable to most.

Currently there are about 75 active task group activities under Science Council in both the diagnostic and therapy physics, and this report was intended to highlight just a few of these activities.

Backscatter Image of an Participation on Task Groups is generally open to any interested AAPM 1800 cc ion chamber member, and becoming involved in a task group by showing up at the TG meetings or calling in to conference calls is one of the best ways to develop national collaborations and become involved in the workings of the AAPM. Task Groups are listed on the AAPM web site under each council, and I strongly encourage any AAPM member to check these out and see if any of these activities are of interest. Then, talk to the chair of the task group in regards to potential participation.

Items of Note: • Meeting begins: Sunday, July 31 at 9:30 am • Meeting ends: Thursday, August 4 at 2:50 pm • An Exciting Sunday Schedule Kicks Off the Week 1:30 – 3:00 pm Short Oral Sessions 3:00 – 6:00 pm Refreshments, Technical Exhibits, and Poster Discussion 3:30 – 4:00 pm NEW! Best-in-Physics (BiP) Poster Discussion 4:00 – 6:00 pm John R. Cameron - John R. Cunningham Young Investigators Symposium • New in 2011 – Short Oral Sessions The Moderated Poster Sessions have been replaced by an expanded program of Short Oral Sessions in 2011.These give an improved forum and opportunity for authors to show their work in a fast-paced, moderated oral session.

Short Oral Sessions are on Sunday (1:30 – 3:00 pm) and Monday (4:30 – 6:00 pm).

• New in 2011 – Special Ultrasound Track for Imaging and Therapy An entire track dedicated to research and education in imaging, image-guidance, and therapeutic applications of ultrasound will debut in 2011.The track gets underway on Sunday with Short Orals, continues Monday and Tuesday with emphasis on ultrasound imaging, and concludes with a full day schedule on Wednesday focusing on image guidance and therapeutic ultrasound.

• An Emphasis on Patient Safety Throughout the meeting are sessions and symposia dedicated to the science and engineering of improving patient safety in medical physics – including issues in both medical imaging and therapy. See the program for dedicated scientific symposia, education courses, and the John S. Laughlin – Science Council Research Symposium dedicated to this important, timely topic.

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Professional Council Report Per Halvorsen, Newton, MA

Joint AAPM-COMP meeting in Vancouver – focus on Boards and accreditation he program for the joint AAPM-COMP meeting provides an impressive breadth of timely topics. The Professional Track has a significant focus on the ABR examination process and on accreditation of imaging and radiation oncology clinics, with practical advice by subject matter experts.

Look for the Professional Symposium sessions in your meeting planner, and bring your questions for the experts!

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New Members Symposium in Vancouver – a new format The New Professionals Subcommittee has assumed responsibility for arranging the New Member Symposium at the Annual Meeting, and they have adopted a new format this year.

Look for Jessica Clements’ column in this newsletter for more details.

Women’s Professional Subcommittee hosts a panel session in Vancouver The Women’s Professional Subcommittee will host a panel discussion on successful career strategies for women in medical physics. The session is scheduled for Tuesday August 2nd at 10:30. Should you be unable to attend the session and wish to follow the discussion, contact Jean Moran (chair of the Subcommittee).

Medical physics workforce study, salary survey validation, and 2010 Professional Survey reports The Professional Services Committee notes the publication on the AAPM website of two reports by The Center for Healthcare Workforce Studies at SUNY – a workforce study including an executive summary as well as supply and demand models, and a validation of the AAPM’s methodology and findings in our annual Professional Information Survey. Also, the 2010 Professional Information Survey was published in May and is available to members on the AAPM website.

Updates to the Qualified Medical Physicist and Scope of Practice policy statements The Professional Council is currently working on draft revisions to the Scope of Practice and Qualified Medical Physicist (QMP) policy statements, and will coordinate its efforts with the recently announced Ad-Hoc committee on defining the Diagnostic QMP practice model. These documents can have broad impact on the practice of clinical medical physics. Should you have any specific suggestions or concerns (e.g., specific language in the current versions which are of concern to you, or specific aspects you feel have not been adequately addressed), please send a brief note to Lynne Fairobent at lynne@aapm.org or me.

Leibel Memorial Symposium: Advanced IMRT Planning and Delivery and Future Directions August 1, 2011 - 2:00 - 3:50 PM

Dr. Steven Leibel, MD was an inspiring leader in radiation oncology. The Leibel Memorial symposium honors his memory and his collegial relationships with medical physicists at Memorial-Sloan Kettering Cancer Center, Stanford University, and the American Board of Radiology. Dr. Leibel was a major innovative force in development and application of Intensity-Modulated Radiation Therapy (IMRT), and his vision and energy were instrumental in national and international adoption of this ground-breaking technology in radiation therapy. In this memorial symposium, three distinguished medical physicists will examine the current state of IMRT and provide their vision for its future, including considerations of biologically-adaptive IMRT, tumor modeling integrated into IMRT, and advanced technical IMRT features.

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Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

H.R. 2104 Introduced June 6, 2011 – CARE Act

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epresentative Ed Whitfield (R-KY) introduced the Consistency, Accuracy, Responsibility, and Excellence (CARE) in Medical Imaging and Radiation Therapy Act of 2011 in the House of Representatives (H.R. 2104). The CARE Act takes an important step in ensuring upmost safety for patients receiving potentially life-saving radiation therapy procedures by setting minimum certification and educational standards for non-physician technical personnel performing medical imaging and administering radiation therapy to patients.

The CARE bill, which as of June 22nd already has 33 cosponsors in addition to its chief sponsor, Rep. Whitfield, would set federal minimum education and certification standards in the Medicare program for the technical personnel providing, planning and delivering all medical imaging examinations and radiation therapy treatments. Following the introduction of the bill, it was immediately referred to the House Energy and Commerce Committee and House Committee on Ways and Means for review. Although this bill has been introduced in past Congressional sessions there are positive signs for the CARE bill in 2011. The full text of H.R. 2401 can be found at: http:// www.gpo.gov/fdsys/pkg/BILLS-112hr2104ih/pdf/BILLS-112hr2104ih.pdf.

Recently there have been a number of inquiries regarding the effect of the CARE bill on those who perform treatment planning tasks. There is concern that if the CARE bill passes, only certified medical dosimetrists could perform treatment planning. This is false. The bill does not directly address scope of practice issues. Although it is likely that, under regulations promulgated subsequent to the CARE bill passage non-certified or non-licensed medical dosimetrists will not be able to perform treatment planning, it is incorrect to imply that only certified medical dosimetrists will be able to perform treatment planning. Qualified medical physicists who are licensed to practice therapy medical physics and medical physicists who are board certified in therapy medical physics will also be able, under the CARE Act and its subsequent regulations (as envisioned by the Alliance) to perform treatment planning. Physicians are not restricted in their activity by the CARE bill. The intent of the CARE Bill is to establish minimum certification and educational standards for non-physician technical personnel performing medical imaging and planning or administering radiation therapy to patients.

The CARE bill does not limit the performance of procedures. Section 3 of HR 2104 states: `(2) QUALIFICATIONS- Individuals qualified to perform or plan the technical component of medical imaging examinations or radiation therapy procedures shall-`(A) possess current certification in the medical imaging or radiation therapy modality or service they plan or perform from a certification organization designated by the Secretary pursuant to subsection (c); or `(B) possess current State licensure or certification, where-`(i) such services and modalities are within the scope of practice as defined by the State for such profession; and `(ii) the requirements for licensure, certification, or registration meet or exceed the standards established by the Secretary pursuant to this section.

Further in Section 3: `(3) MINIMUM STANDARDS- Minimum standards established under this subsection shall reflect the unique or specialized nature of the technical services provided, and shall represent expert consensus from those practicing in each of the covered imaging modalities and radiation therapy procedures as to what constitutes excellence in practice and be appropriate to the particular scope of care involved.

Thus, the CARE bill does not limit scope of practice. Note, however, that states would retain the right to limit scope of practice. For example, CARE sets minimum standards for the performance of magnetic resonance imaging (MRI) but it does not limit the performance of MRI to only magnetic resonance imaging technologists (since radiographers can perform MRI in the majority of states). Consequently, it will be very important for the AAPM to work with each state as they determine how to implement the CARE Act.

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continued - Legislative and Regulatory Affairs It is the goal of the AAPM and ACMP to maintain the role of defining the Scope of Practice for Medical Physicists. The AAPM Professional Policy 17 (PP-17) Scope of Practice of Medical Physics (http:// www.aapm.org/org/policies/details.asp?id=225&type=PP#rd) states as part of the scope of practice for Therapeutic Radiological Physics: “Development and/or evaluation, with the medical practioners, of the dosimetric component of patients’ treatment plans”.

We are also actively working on the drafting of the implementing standards for consideration by the Secretary of Health and Human Services once H.R. 2104 is enacted.

Your support of the CARE Bill is vital to its success. We encourage you to contact your representative and ask them to join the 33 cosponsors of HR 2104 (Note: there were 33 co-sponsors as of June 22, 2011 - to see if your representative is a co-sponsor go to: http://thomas.loc.gov/cgi-bin/ bdquery/D?d112:1:./temp/~bdIF5E:@@@P|/home/LegislativeData.php|).

The CARE Act is an important step in ensuring upmost safety for patients receiving potentially lifesaving radiation therapy procedures by setting minimum certification and educational standards for non-physician technical personnel performing medical imaging and planning and administering radiation therapy to patients.

You are also encouraged to directly contact Lynne Fairobent at lynne@aapm.org with any questions concerning the CARE bill and help us to prevent the dissemination of erroneous information concerning this important legislation.

Licensure Update: 1. AAPM Receives letters of Support for Medical Physics Licensure from the American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO) - As part of AAPM’s effort to ensure that the practice of clinical medical physics is performed by appropriately trained and credentialed individuals, AAPM had discussions with both the ACR and ASTRO. These discussions resulted in letters of support from both organizations. ACR stated: “the American College of Radiology is pleased to support medical physics licensure in order to improve the quality of radiation oncology and medical imaging care in the United States.” ASTRO stated: “ASTRO fully supports your position that anyone practicing clinical medical physics should be appropriately credentialed and ultimately licensed to practice.” We are very pleased with the support of both organizations on this important initiative for AAPM. 2. Pennsylvania House Bill 1559 on Licensing Medical Physicists Introduced - In mid-May, the medical physics licensure bill was introduced in the Pennsylvania (PA) General Assembly as House Bill 1559. The next step for HB 1559 is to be scheduled for public hearing, which is an opportunity for any member of the public to speak for or against the bill. One or more of the members of the Pennsylvania State Committee will be speaking in favor of HB 1559 at the hearing. Concurrently, the PA Sunrise Evaluation will continue its review process. As you may recall, the Sunrise Evaluation was instituted in PA by former Governor Ed Rendell (D) to assist the Commonwealth in determining the need and feasibility for instituting a new professional licensure law and the process is continuing through the current administration under Governor Tom Corbett (R). While it is not necessary for the medical physics licensure Sunrise Evaluation to have a positive report to move forward in the legislative process, a positive report will be critical to secure Republican co-sponsors. The PA Republicans are not likely to support a concept that the current administration does not support. Grassroots efforts to educate the legislative body on the profession and to encourage bill sponsorship are ongoing.

NRC Part 35 Workshop – NY York – Herb Mower, GRAC Chair and Lynne Fairobent The NRC held its first of two public workshops June 20 and 21 in NYC. The second public workshop will be in Houston, Texas in August (link: http://www.blsmeetings.net/ NRCMedicalRulemakingWorkshop/).

Herbert Mower represented AAPM on the panel to discuss specific points related to Medical Event [ME] reporting requirements for permanent implant brachytherapy and included: • Should the regulations have a specific section for prostate implant brachytherapy rather than

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AAPM Newsletter

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continued - Legislative and Regulatory Affairs combined with all other permanent implant brachytherapy? AAPM response: NO. It should apply to any permanent implant brachytherapy.

• Should the criterion for defining an ME for permanent implant brachytherapy be activity-based only? AAPM response: YES. Written directive should be at the time of the implant, prior to the patient being discharged from the facility. Relates to ‘real time’ planning in the operating room (OR). Pre-plan is a ‘guidance’ for ordering and not for anything else.

• Should the criterion for defining an ME for permanent implant brachytherapy be dose-based only? AAPM response: NO. Not dose based but activity-based.

• Should the criteria for defining an ME for permanent implant brachytherapy be a combination activity- and dose-based criterion? AAPM response: NO. Not dose based but activity based.

• Should the NRC require training on how to identify MEs? AAPM response: NO. Training, in general, is part of the licensee’s ALARA training program.

• Many professional organizations have recommended standards for when a dose to the treatment site for permanent prostate implants is assessed. The NRC staff is considering adding a time requirement to the regulations for this purpose. What is the appropriate time frame? AAPM response: NO. Do NOT add a time frame to the regulations. This can vary from same day to one month depending on patient availability for any individual licensee.

All of the presentations by the panelists can be accessed at: http://www.blsmeetings.net/ NRCMedicalRulemakingWorkshop/presentations.cfm.

Overall the discussions were quite friendly. One point of general agreement amongst the professionals on the panel was that the definition of a ME for prostate brachytherapy should be activity-based and not dose based for several reasons. Although the NRC kept moving the actual time and date, it was also finally agreed upon that the written directive would not be considered finalized until the procedure was completed, usually correlating with discharge of the patient from the OR. Relative to the MEs, it was noted that many events so reported are of very little medical consequence though they become both a ‘legal’ issue as well as having psychological implications for the patient and his family. One of the stakeholders noted that the designation of medical event is being used for a definition of ‘good medical practice,’ such a determination being outside the scope of the NRC. The two major points still unresolved at the end of the day were the length of time after the procedure by which the follow-up CT exam should be performed and if the definition for a ME for prostate brachytherapy should be the same or different from the definition for other permanent implant procedures. Relative to the time interval within which the follow-up CT exam should be performed, there was a strong feeling to have this as a maximum of 60 days. However, there was an equally strong feeling that, not meeting this deadline should not constitute a medical event.

There was no strong sentiment one-way or the other relative to having a separate ME definition for prostate brachytherapy relative to other types of permanent implant brachytherapy.

The NRC recapped day one with the following points: • Amongst states, fairly uniform regulations • NRC staff will pursue for the new rule, using source strength for prostate implants, not dose • The ± 20% window, though not universally accepted as the bet ‘window’ for determining compliance relative to a medical event, it seems like the best option at present.

• A Medical Event should be defined such that it is a clinically significant event.

• Rules need to be flexible enough to allow physicians to do what they need to do • Authorized Users need to sign an attestation that the seed distribution in an implant is acceptable. [ed. note: the NRC is looking for further discussion on this point in Houston] • There was discussion, with no agreement, on when to do post procedure CTs. • There was discussion, with no agreement, on when a procedure is considered ‘completed.’

The second day (June 21st) dealt with: • Preceptor Attestation Requirements and Extending Grandfathering to Certain Certified Individuals [also known as the Ritenour Petition]

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continued - Legislative and Regulatory Affairs • Naming Associate / Assistant Radiation Safety Officers on NRC Medical Licenses • Additional Molybdenum Breakthrough Testing and Reporting Requirements, and • Additional Items Under Consideration for Rulemaking Ralph Lieto represented AAPM on the panel to discuss point one above. The day’s discussions were lead by Neelam Bhalla of the NRC staff.

Relative to ‘attestation,’ attestation in the current regulations is required for both the certification pathway and the alternate pathway. Prior to 2005, attestation was not required for the certification pathway. For an individual to be authorized, there are three pathways: certification, alternate pathway and grandfathering [i.e., listed on a NRC or agreement state license on the date of conversion to the revised Part 35]. NRC with due input from the various professional societies and the ACMUI, is strongly considering removal of the attestation requirement for any board certified individual, regardless of the date of certification. Robert Dansereau [OAS], Pat Zanzonico [ACMUI] and Ralph Lieto [AAPM] all supported this position.

NRC staff raised the question that, if attestation goes away, how does the NRC know the area of expertise of the individual. The answer, of course, is clearly stated on the certificate of certification from the board. The NRC also questioned the graduate and residency training programs. We pointed out that our programs are certified and periodically recertified by CAMPEP. In addition we noted that the program directors of the various physics programs have their own society where they meet and review the various aspects of their programs.

Dr. Malmud, Chair of the ACMUI, stated that the NRC should accept the actions of the boards. If the board says that someone is trained, they are! He also noted that the word ‘competency’ should be removed from the attestation requirement clause. He commented that the NRC does need more clarification on who qualifies as an Authorized Medical Physicist as this term did not exist in the early NRC [pre 2005] documents.

The Veteran’s Administration, with experience in credentialing hundreds of AUs, AMPs and RSOs has found no benefit to the ‘attestation’ requirement and sees no value in keeping it.

Discussion then shifted to associate and/or assistant RSOs on licenses. The NRC is looking for guidance on this issue. Part 35 does NOT state only one RSO. It is contained in a ‘policy’ statement found in a “Statement of Consideration.” The NRC is looking for input on: • • • •

Should there be provisions for assistant / associate RSOs? If yes, what should be the qualifications?

Should there be a limit on the number of associate / assistant RSOs? What should they be called?

It was noted that, with the shortage of clinical RSOs, it would be beneficial to have such personnel.

Following input on thoughts relative too assistant / associate RSOs, we moved into a discussion concerning Mo-99 breakthrough testing. Currently the regulations only require testing on the first elate. Prior to 2002, each elate was to be tested. The feeling by the stakeholders present was that each eluate should be tested. However it was strongly felt that the reporting should be to the FDA and not the NRC as this was considered a product failure. The manufacturer of the radiopharmaceutical, being a licensed entity, would have the responsibility of reporting to both the NRC and FDA. The day concluded with a brief review of other ‘updated’ items in the pike for Part 35 with few significant items other than those covered previously in the workshop.

Individuals interested in attending the Houston workshop on August 11th and 12th can register at: (link: http://www.blsmeetings.net/NRCMedicalRulemakingWorkshop/). A summary of the NY workshop will be posted on the NRC website prior to the Houston workshop.

AAPM will also be participating in the panels in Houston.

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Website Editor's Report Christopher Marshall, New York, NY

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ne of the challenges for the website is to improve the signal/noise ratio for topical alerts. For this reason we took a cautious step into the fourth dimension earlier this year by adding motion to signal the release of each Newsletter and the latest monthly virtual library webcast. Only one of these flashing alerts is active at a time and only for a limited period. Is this effective or does it just annoy you? Let me know – it’s your website! We also rotate between the Image Gently and Image Wisely icons to emphasise the importance of these two interrelated campaigns and to save precious space on the home page.

The AAPM Working Group on Standardization of CT Nomenclature and Protocols released their Guidelines for Use of the NEMA XR 25 CT Dose-Check Standard recently and almost simultaneously the Board approved relaxing the restriction on access to the Brain Perfusion CT Protocol, which heretofore had been limited to AAPM members.

All content that may be accessed from the CT Protocol button is now open to everyone.

I have commented in the past on expanding our internet communication reach beyond our own membership, and on the long-standing desire of many to have a “public” website. Because the “public”, as defined as the non-member community, is in reality made up of multiple different subsets – journalists, patients, other professionals, students etc., we need different information properly packaged for each subset to do this properly. That translates into a major development and sustained content update effort that could not be achieved without professional support, and we simply cannot afford that at this time. However, we are able to take incremental steps. One is the introduction of a “Message of the Month” (MOM) to those who access the website without logging in – i.e. non-members. Members need to log out to see this feature, which takes the place of the personalized messages that our members see when logged in. The intent of MOM is to highlight one item of general but immediate interest for about a month. To date we have featured the appointment of Michael Mills to the Medicare Coverage Committee, the AAPM press release on patient protection in mammography, and the passing of Nobel Laureate and founding member of the AAPM, Roz Yalow. If you have something that could be featured, please let me know - this is a work-in-progress. We also plan for a simpler “stripped down” version of the home page for non-members that will provide a simpler overview of our programs.

Social networks are an alternate pathway to reach beyond the AAPM membership, and it requires minimal development effort on our part. The AAPM LinkedIn group should soon reach the 1000 member number. A significant number of AAPM members have joined as have a significant number of related professionals from several countries. It thus provides a forum for individuals to share information within a broad peer community. We feed some content from the website but a site of this type should ideally become self-sustaining. Some of the most useful discussions to date were initiated by new or potential entrants to our field and I thank those members who have responded to such postings.

We now have landing pages for each major menu topic on the home page with the addition of a page that lists all the opportunities for commercial advertising through the AAPM. We currently support advertising on paper through our Journal or online through the Online Journal, Newsletter, Meeting Program, Website and Careers Services. We recently initiated a more detailed tracking mechanism for online advertising so we can track hits by location and potentially market a wider choice of advertising packages for vendors and get a better handle on which locations draw most traffic.

I hope that you find the Website useful, visit it often, and send me your feedback at http:// www.aapm.org/pubs/newsletter/WebsiteEditor/3604.asp

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ACR Accreditation

Priscilla F. Butler, Senior Director ACR Breast Imaging Accreditation Programs

ACR Accreditation: Frequently Asked Questions for Medical Physicists Does your facility need help on applying for accreditation? In each issue of this newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR’s accreditation web site portal (www.acr.org; click “Accreditation”) for more FAQs, accreditation applications and QC forms.

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

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

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

A. ACR encourages any facility performing breast MRI to apply for Breast MRI Accreditation.

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

Q. My out-patient facility is already accredited by the ACR in MRI. Are we also required to be accredited in Breast MRI in order to be reimbursed by CMS for breast MRI exams?

A. Yes. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) requires accreditation for CT, MR, Nuclear Medicine and PET. Breast MRI is included since it is an MRI examination. In addition, the CMS final rule on MIPPA implementation states: “We did not propose any substantive standards that suppliers furnishing the TC of advanced imaging would have to meet. We have chosen to utilize clinical guidelines that are already accepted by the experienced accreditation organizations already performing accreditation.”

The above statement means that CMS has accepted and approved both the ACR’s MRI Accreditation Program and the Breast MRI Accreditation Program requirements. Consequently, if you choose to accredit with the ACR, your facility is required to accredit in the two separate programs (if you perform both general MRI and MRI of the breast).

Reimbursement works as follows: Once you are accredited with the ACR in either MRI, Breast MRI or both, the ACR will submit a modality code (along with other required information) to CMS. In this case, the code will be one for “MRI;” it is not specific for breast MRI. However, you should keep in mind that the ACR is required by CMS to conduct on-site Validation Surveys. One of the functions of the ACR surveyor is to determine that all equipment at the facility is accredited in all

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continued - ACR Accreditation the modalities and submodalities performed with the unit. If the surveyor discovers that breast MRI is performed with a unit accredited in general MRI, but the unit is not accredited in breast MRI, the ACR may revoke the facility’s MRI accreditation. If accreditation is revoked, you will not be reimbursed by CMS. Q. What is primary source verification?

A. Every site needs to have a formal procedure to verify the credentials of their employees. Most licensing and certifying bodies provide the ability to verify an individual’s credentials on line. For example: • To verify a physician’s medical license they would check the physician licensing board in their state. Example: http://www.mbp.state.md.us/bpqapp/ • For physicians and medical physicists, certifications can be verified at the American Board of Medical Specialties website at: https://www.certificationmatters.org/is-your-doctorboard-certified/search-now.aspx • For technologists, they can use their specific certifying agency. Example: https://www. arrt.org/ • The procedure does not need to be submitted to ACR. However, if ACR or CMS does a site visit they will expect to see the written (or electronic version) or the procedure.

Medical Dosimetrist Certification Board Announcement Felicia Lembesis, CAE MDCB Executive Director

MCDB Announces New Standards for Medical Dosimetry Certification

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he Medical Dosimetrist Certification Board (MDCB) is announcing new standards for certification in medical dosimetry designed to elevate the dosimetry profession. Recognizing the integral role medical dosimetrists play in the treatment of oncology patients, MDCB's new standards for the certification exam will raise educational requirements, increasing the quality of healthcare provided to patients.

The changes to eligibility requirements for the medical dosimetry exam will be phased in during the next several years. While clinical experience and completion of MDCB-approved credits was heavily emphasized in certification standards, formal dosimetry education was not required for Route 2 and Route 3 candidates.

After evaluating the eligibility criteria, MDCB established the following new standards and timelines, balancing clinical experience with a greater emphasis on education: • In 2013, Bachelor's Degree or registration with a recognized radiological technology credentialing organization for Route 2 candidates • In 2015, Bachelor of Science for Route 1 and Route 2 candidates • In 2017 there will be one standard for all applicants. Candidates will be required to have a Bachelor of Science degree and have graduated from a formal dosimetry program accredited by the Joint Review Committee on education in Radiologic Technology (JRCERT).

The changes in standards coincide with the MDCB's support of the Consistency, Accuracy, Responsibility and Excellence (CARE) in Medical Imaging and Radiation Therapy Act of 2011. If approved, the CARE Act will set minimum standards for technical personnel using medical imaging and radiation therapy to create more accurate diagnosis, planning and treatment of patients.

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AAPM Newsletter

July/August 2011

Chapter News

Dinko Plenkovich, Jamestown, NY

UNYAPM Chapter News

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n May 5, 2011, the Upstate New York Association of Physicists in Medicine held a successful Spring Meeting in Rochester General Hospital, in Rochester, NY. The business meeting was followed by a lunch and visits to the vendors’ exhibits. The UNYAPM President, Iris Wang, Ph.D. opened the meeting and introduced the speakers. Jim Ernsberger of Sun Nuclear Corporation reached the entire audience with his talk entitled “Novel Cylindrical 3D Scanner – A fresh new approach – Less subjectivity.” In addition to this vendor talk, the meeting included seven proffered and one invited presentation. Five presentations were from Roswell Park Cancer Institute (RPCI), two from Toshiba Stroke Research Center (TSRC) of University at Buffalo, and one from Center for X-Ray Optics, Physics Department, University at Albany and Department of Radiation Oncology of Albany Medical Center.

Six graduate students competed in the Annual Young Investigator Symposium.

1. Sandesh Gupta from TSRC presented “Study of high-resolution (HR) and high-light (HL) phosphors in the micro-angiographic fluoroscope (MAF) using generalized linear systems analyses.” [Fig. 2] 2. Daniel Bailey from RPCI analyzed an “Estimation of confidence intervals for pass Fig 2. UNYAPM President Iris Wang, Ph.D. asks Sandesh Gupta a question after his presentation rates of low-density 2D IMRT QA planes.” [Fig. 3] 3. Ashish Panse from TSRC talked about “Adaptive temporal filtering based on the motion of an object of interest for image guided procedures using the high resolution microangiographic fluoroscope (MAF).”

4. Jason Spaans from RPCI introduced “A novel hybrid radiotherapy technique combining a VMAT arc with beam angle optimized IMRT fields.”

5. Hassan Abbas from University at Albany presented “Dose calculation with MCNP5 in the buildup region for 6 MV photon beams.”

6. Juan Carlos Paz Lozada from RPCI talked about “Evaluation of the accuracy in the algorithm used for optical patient alignment.”

The UNYAPM officers appointed a Panel of Judges tasked to rate each speaker individually on his topic and Fig 3.

Daniel Bailey presentation. Hassan Abbas won the delivers his talk on Young Investigator Award for his Monte “Estimation of confidence Carlo simulation presentation.

Our intervals for pass rates of heartfelt congratulations go to soon-to- low-density 2D IMRT QA be Dr. Abbas and his mentors/coauthors planes” Jahangir Satti, Ph.D. from Albany Medical Center and Carolyn MacDonald, Ph.D. from the Physics Fig 4. UNYAPM President Iris Department of University at Albany. It is commendable that all Wang, Ph.D. presents the Young three of them came from Albany to attend UNYAPM Spring Meeting Investigator Award to Hassan in Rochester, NY. [Fig. 4] Abbas

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AAPM Newsletter

July/August 2011

continued - Chapter News The remainder of the meeting consisted of two presentations from Roswell Park Cancer Institute.

7. I, Dinko Plenkovich, Ph.D., believe that the attention on details is the key to avoiding mistakes in radiation medicine. In my talk, I presented several sources of errors, as well as improvements, we have made in our clinic to avoid mistakes. They include checking in Eclipse treatment plan report that the User Origin has been set, that the beam isocenter has been placed at the User Origin or another desired location, contouring carina and projecting it on DRRs of lung/chest patients, making the patient shifts on the first day only, and having a picture of a BOLUS truck in the charts of patients who have to be treated with bolus. [Fig. 5] 8. The highlight of the UNYAPM Spring Meeting was the invited talk by Harish Malhotra, Ph.D. He shared his experience in the clinical implementation Fig 5. A visual of Stereotactic Body Radiation Therapy at RPCI. reminder to radiation He went into detail about the clinical rationale therapists to put behind this very promising modality, covered all bolus on the patient aspects of its implementation in a clinic and the necessity of having a rigorous quality assurance procedures. He also reviewed some of the patients who got sub-optimal treatments from the literature and suggested simple methods which could be easily implemented in a clinic to prevent their occurrence. The effort put into preparing the excellent one-hour talk “SBRT: A paradigm shift from conventional radiotherapy” is greatly appreciated. [Fig. 6] I am thankful for the tremendous work of Debra Koch from Rochester General Hospital. She reserved the rooms for our meeting, ordered Fig 6. Harish Malhotra, our lunch, and made all other local arrangements. My thanks go also Ph.D. gives an invited talk “SBRT: A paradigm to my colleagues Iris Wang, Ph.D. (UNYAPM President) and Ciprian shift from conventional Ionita, Ph.D. (UNYAPM Secretary/Treasurer) for their dedication to radiotherapy” the success of the Spring Meeting and the growth of our AAPM chapter.

Finally, I would like to thank the following sponsors for their generous contributions and attendance at the meeting: Upstate Linac Services, Sun Nuclear, Resonant Medical Inc., Vision RT., Elekta, BrainLAB AG, CIVCO Medical Solution, LACO Inc, PTW, BARD, Accuray Inc. RAD Technology Medical Systems, IBA Dosimetry , and ScandiDos. We would like to invite you to our future meetings: • The Fall 2011 UNYAPM meeting will be held on Tuesday, October 18, 2011 at Roswell Park Cancer Institute in Buffalo, NY. The meeting will feature the Annual UNYAPM Lifetime Achievement Award presentation. Please submit scientific / professional abstracts to UNYAPM President Iris Wang, Ph.D. at Zhou.Wang@RoswellPark.org • The Spring 2012 UNYAPM meeting has been planned to take place on Wednesday, May 2, 2012 at Bone & Joint Center in East Syracuse, NY. The facility has two screens and two projectors.

The presenters may choose to make one PowerPoint file for the left projector, and another for the right one. Please send abstracts to dinko@post.harvard.edu We encourage submissions and participation from all parts of New York State, as well as from other states and Canadian provinces.

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AAPM Newsletter

July/August 2011

Women’s Professional Development Subcommittee (WPSC) Jean Moran, Ann Arbor , MI Nicole Ranger, Durham, NC

Women’s Professional Development Subcommittee (WPSC) at AAPM/COMP 2011

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n 2010, the WPSC was formed to serve and support the professional development of women at different stages in their careers. One of the avenues of providing this support is through programming at the annual meeting. At AAPM 2010, Professor Jane Ammons of the Georgia Institute of Technology spoke on “Negotiation for Women” which included a lecture and an audience interactive discussion section that was very well-received. The session was part of the Professional Track Symposium on Negotiation Tactics for Medical Physicists.

This year we are delighted to have two events. On Tuesday, August 2 from 10 am to noon, there will be a Professional Symposium on "Successful Career Strategies in Medical Physics" hosted by the WPSC. Our panelists are Sonja Dieterich of Stanford University, Mary Fox of Minneapolis Radiation Oncology, Winnie Zhu of the Childrens Hospital of Philadelphia, and Maryellen Giger of the University of Chicago, past president of the AAPM. The panelists have experience in different practice settings and are at different career stages. The presentation topics range from the must-knows of mentorship, starting in the early stages of your career, career transitions, and balancing your personal and professional life.

Following the presentations will be a discussion session which will be moderated by Andrea Molineu and Jean Moran. This event is open to all attendees. Please come and bring your questions!

Our second event at AAPM, immediately following the panel, is a networking luncheon for women medical physicists that is made possible through the generous support of commercial sponsors. The sponsors for this event will be announced at the luncheon. Nicole Ranger is leading the coordination of the event with assistance from Laura Cervino and Jessica Clements. The event will begin with comments about the future of our field and the important role of our female members, by Anthony Siebert, President of AAPM and followed by comments about opportunities for women by Mary Martel and a summary of upcoming WPSC initiatives by Jean Moran. Senior women will facilitate discussions at each luncheon table, allowing women to discuss professional challenges and share strategies for success with each other. It will also be an opportunity for members to provide feedback to the WPSC about the type of programming that you would like to see for future events.

To expand our reach and improve access we expect to kick-off a webinar series beginning in Fall 2011 so watch for more details coming soon.

Therapy Program

Therapy Program

Scientific Symposia

Proffered Abstract Submissions • • • • • • • • • •

• •

Patient Simulation Imaging for Planning (JOINT) Treatment Planning Treatment Delivery and Verification (JOINT) Patient Safety and Quality Assurance (QA) Procedures Outcome Modeling including imaging for therapy assessment (JOINT) Basic Radiobiology Informatics Small Animal Studies Radiation Protection and Shielding Targeted Radionuclide Therapies (JOINT)

• • • • •

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Safety and quality in SRS/SBRT 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 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

AAPM Newsletter

July/August 2011

American College of Medical Physics – Final Annual Meeting Rene Smith, Wyomissing , PA

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t the ACMP Board of Chancellors meeting in Chicago on November 28, 2010, the Board agreed to cease ACMP operations on December 31, 2011.

Key functions of the ACMP will be assumed by the AAPM. Therefore the 2011 ACMP meeting was the final annual meeting organized by the ACMP. It took place in Chattanooga, TN, from April 30 Figure 1: Photo of awardee with the ACMP meeting organizers. to June 1, at The Chattanoogan Hotel. The meeting offered a series of technical, professional and clinical sessions on important topics to practicing medical physicists in a variety of different fields. All the sessions were conducted in a friendly atmosphere where more than 150 scientific attendees had time to interact among themselves as well as with the presenters. There was plenty of time to speak and interchange ideas with the exhibitors in the exhibitor’s hall.

Benjamin (Ben) R. Archer, Ph.D. received the 2011 Marvin M. D. Williams Award, the highest award presented by the ACMP. Dr. Stewart (Stu) Bushong accepted the award for Dr. Archer who was unable to attend, but was able to view the ceremony via Skype. We were able to see a video presentation which Ben had prepared for the occasion. Stephen Balter, Ph.D., J. Ed. Barnes, Ph.D., Mahadeveppa Mahesh, Ph.D., Ellen David Yorke, Ph.D. and Robert D. Zamenhoff, Ph.D. are the 2011 Fellow REGISTRATION IS NOW OPEN!!

Recipients. More details can be found in the Rapid developments in CT scanner technology over the last article titled ‘ACMP awards’.

decade have yielded new clinical capabilities and substantial improvements in patient care. The greater complexity of today’s CT scanners, however, creates considerable challenges for CT users, who must master a wide range of equipment features and clinical applications.

This summit will demonstrate how scan acquisition and image reconstruction parameters should be selected and managed to improve image quality and reduce radiation dose. Faculty members will explain the essential criteria for specific diagnostic tasks, and participants will have an opportunity to practice the selection of optimum scan protocols. The goal of the summit is to provide practical information for users that will help them operate their CT scanners wisely, improving the quality and usefulness of CT images while reducing the radiation dose to patients.

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Melissa C. Martin, M.S., the Chair of the Board of Chancellors, David E. Hintenlang, Ph.D. the Vice-Chair of the Board of Chancellors (who was responsible for assembling a series of excellent speakers) and Christopher F. Serago, Ph.D., the Immediate Past Chair of the Board of Chancellors deserve our special thanks and recognition for all the work they have done in the last few ACMP Annual Meetings. Many other individuals who have contributed to the success of the ACMP Annual Meetings deserve our appreciation for all their work, some are here with us and others are no longer with us, but we are still benefitting from their wisdom and their commitment to the ACMP. It is impossible to name all them, but this is a time to thank every one of them.

AAPM Newsletter

July/August 2011

Contact: Donna Breckenridge

May 20, 2011 Phone: 520‐790‐2900 FOR IMMEDIATE RELEASE E‐mail: dbreckenridge@theabr.org

Radiologic physics changes name to medical physics

In concordance with the prevalent and accepted terminology used in the field of medical physics, the American Board of Radiology (ABR) is making a nomenclature change from the previous "radiologic physics" to the updated terminology "medical physics." This represents an adjustment in nomenclature only, with no change in any of the processes and requirements previously in place for certification of medical physicists by the ABR. The Nuclear Regulatory Commission (NRC) and the American Board of Medical Specialties (ABMS) have approved the name change.

The specific changes are as follows:

• Therapeutic Medical Physics replaces Therapeutic Radiologic Physics.

• Diagnostic Medical Physics replaces Diagnostic Radiologic Physics.

• Nuclear Medical Physics replaces Medical Nuclear Physics.

The previous nomenclature will remain in effect on the older certificates, with the change to medical physics commencing with those certificates issued in 2011. The name will be updated on the ABR website in the near future.

### Established in 1934, the mission of the American Board of Radiology (ABR) is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, and understanding essential to the practice of diagnostic radiology, radiation oncology, and radiologic physics.

The ABR is one of 24 Member Boards of the American Board of Medical Specialties. For more information, go to http://www.theabr.org.

Therapy Physics Educational Courses The Therapy Physics Educational Courses will feature courses on therapy physics practices including TG-51 calibration, QA/Safety, and site-specific treatment strategies (pelvis and head/neck) as well as special clinical procedures including Stereotactic Body Radiotherapy (SBRT), motion management, and non-ionizing imaging, data flow and management, Monte Carlo for planning, dosimetry of small fields, proton therapy, and radiobiology for radiotherapy among others. Our goal this year was to create an overall learning opportunity directed toward junior physicists, students, and physics residents while the SAM sessions go into depth on a novel/advanced topic and therefore should be suitable for more experience physicists as well.

Therapy SAMs: • SAM Session 1: Breathing-Induced Motion Management in Radiation Therapy • SAM Session 2: Imaging Acquisition, Processing and Display for Guiding and Adapting Radiotherapy • SAM Session 3: Quality Management Systems in Radiotherapy • SAM Session 4: SBRT

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AAPM Newsletter

July/August 2011

ACMP Awards

Congratulations to Our Honored ACMP Members The ACMP honored several of its members at the 28th Annual Meeting Awards Banquet on May 2nd in Chattanooga. The Honorees included: 2011 ACMP Marvin M. D. Williams Award Benjamin R. Archer, Ph.D. Dr. Benjamin R. Archer has served our profession as a leader in education, research, and professional development. His impressive list of achievements includes AAPM, ACMP, and ACR fellowships, and many committee and leadership positions in these organizations. He recently received the AAPM Edith Quimby Award for Achievement in Medical Physics. Dr. Archer was Co-Chair of the 2000 World Congress Scientific Program. He served as Editorial Board member for the AAPM Newsletter for many years. Dr. Archer has served as a Board Member of the AAPM, ACMP, and the ABMP, and assisted the latter as an oral examiner. In 2000, he was elected as a Council Member of the National Council on Radiation Protection and Measurements, reelected for a second term in 2006, and served on the NCRP Finance Committee.

As Treasurer of the ABMP, Dr. Archer was one of the three members who helped to negotiate a settlement with the ABR that effectively ended the dispute that was a cause of dissension between our professional organizations. The medical physics community and the AAPM have demonstrably benefited from the resulting unified board certification. For the last six years Dr. Archer has served as the Executive Director of the ABMP, which currently has nearly 600 Medical Physics diplomates.

Recently, Dr. Archer’s contributions to NCRP and ACMP have been especially significant. He served as Co-Chair of the joint AAPM Task Group 13 and NCRP Science Committee 9, which produced a seminal document on radiation shielding in medical imaging that was subsequently published as NCRP Report 147. His research efforts produced the “Archer Method” of x-ray transmission data that became a fundamental part of the final NCRP Report.

Additionally, with Lou Wagner, Ph.D., he has been in the forefront of the effort to reduce radiation injuries from fluoroscopic radiation. Together they have given numerous lectures and published four editions of a monograph that has reached many thousands of physicians, radiographers, and administrators.

During his forty years at Baylor College of Medicine he has instructed more than 300 resident radiologists and 1,000 radiologic technologists at the Houston Community College. Many years ago he proposed an award, “Honorary Medical Physicist”, for those resident radiology residents who scored in the ninetieth percentile on the ABR physics examination. He has presented a plaque to those successful residents during special ceremonies at Baylor.

Dr. Archer has had a distinguished career— his contributions to clinical medical physics; his level of participation in our professional societies; and the number of students that he has influenced are typical of his level of efforts and professionalism. Dr. Archer is most deserving of the ACMP Marvin M.D. Williams Award as recognition by his peers of his accomplishments.

(Stewart C. Bushong, Sc.D. and Joel E. Gray, Ph.D.) 2011 ACMP Fellows Stephen Balter, Ph.D. Dr. Balter received his Bachelor’s degree in Physics from the Polytechnic Dr. Balter received,his Doctoral degree in Physics from the Polytechnic Institute of Brooklyn. He has served as the chief physicist at St. Vincent Hospital (Worcester, MA), for 22 years as the Senior Medical Physicist at Phillips Medical Systems, and at other hospitals in the New York City area. In 2004 he joined Columbia-Presbyterian Medical Center as a medical physicist. Dr. Balter has

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July/August 2011

continued - ACMP Awards been active professionally in the National Council on Radiation Protection and Measurement (NCRP), National Electrical Manufacturers’ Association, and the Society for Interventional Radiology (SIR) and in International Electrotechnical Commission and the International Atomic Energy Agency. Dr. Balter is a Fellow of the ACR, AAPM, and SIR, and received the Lifetime Achievement Award from the AAPM Upstate New York Chapter in 2004. He has published over 80 scientific papers and 35 books, chapters, and editorials.

J. Ed Barnes, Ph.D. Dr. Barnes received Doctoral degrees in Radiation Biophysics from the University of Kansas. His experience includes the Lovelace Foundation Inhalation Toxicology Research Institute (Albuquerque, NM), University of New Mexico School of Medicine where he participated in the Radiation Therapy Pion Research Project at the Los Alamos Meson Physics Facility, and GE Healthcare. Dr. Barnes founded Rocky Mountain Medical Physics (Denver, CO) and in 1990 founded Medical Technology Management Institute (MTMI). He has served the medical physics community for over 20 years by providing continuing education courses through MTMI, starting before continuing education was required to maintain certification. Dr. Barnes is a diplomate of the ABR and a Fellow of the ACR. He is presently Executive Director of MTMI, which has presented approximately 280 educational events in 2010 for medical physicists and other medical professionals.

Mahadevappa Mahesh, Ph.D. Dr. Mahesh received his Doctoral degree in Medical Physics-Biophysics from the Medical College of Wisconsin, Milwaukee, WI. He has been with the Department of Radiology at Johns Hopkins University, Baltimore, MD since 1994 and is currently the Associate Professor of Radiology and Cardiology and Chief Physicist for the Johns Hopkins Hospital. Dr. Mahesh has published over 60 scientific papers, book chapters, and monographs. He serves as associate editor for the Journal of the American College of Radiology, contributing editor for Radiographics and editor of AAPM Newsletter. Dr. Mahesh is a Fellow of both the AAPM and ACR. Ellen Davis Yorke, Ph.D. Dr. Yorke received her Doctoral degree from the University of Maryland. She has held faculty positions at the University of Maryland, George Washington University, and the University of Pennsylvania and hospital positions at George Washington, University of Pennsylvania, and Memorial Hospital for Cancer and Allied Diseases. Dr. Yorke has published over 125 refereed papers and over 110 other publications. She is a member of the American Physical Society, the American Association for the Advancement of Science, AAPM, SNM, ASTRO and ACMP. Robert Zamenhof, Ph.D. Dr. Zamenhof received his Doctoral degree in nuclear engineering and applied radiation physics from the Massachusetts Institute of Technology. He has been a staff member of the Tufts School of Medicine and New England Medical Center, and Harvard Medical School. He is the Professor of Radiation Oncology at Tufts University School of Medicine and serves as the Interim Director of Medical Physics at the Midwest Proton Radiotherapy Institute. Dr. Zamenhof has been active in ACMP, AAPM, ACR, and with the ABR. He has published over 100 scientific papers and presented numerous papers and education courses. Dr. Zamenhof is a Fellow of AAPM and is Past President of the International Society for Neutron Capture Therapy.

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July/August 2011

continued - ACMP Awards Recognition of ACMP Outgoing Officers Outgoing Chairman Award: Christopher F. Serago was recognized for his significant contribution and service as Chairman of our Association in 2010.

Outgoing Secretary Award: John Pacyniak was recognized for his significant contribution and service as Secretary of our Association in 2009 and 2010.

Graduate Student Award Christopher Jason Tien, BSE, MSE Christopher Tien was selected to receive the ACMP 2010 Graduate Student Award and a $1,000 grant for attendance at the ACMP annual meeting. Mr. Tien is a doctoral candidate at the University of Florida. His dissertation is entitled “Optimal dose reduction in computed tomography methodologies predicted from real-time dosimetry”. David E. Hintenlang, Ph.D. is his research adviser.

JACMP Best Paper Awards 2010 The following authors were recognized for their excellence in scientific writing: The RIT Award of Excellence for the Best Medical Imaging Article in 2010 was awarded to: Luciant Wolfsberger, Matthew Wagar, Paige Nitsch, Mandar Bhagwat, Piotr Zygmanski, For the article entitled: “Angular dose dependence of Matrixx TM and its calibration,” 11(1) 241-251.

The Unfors Award of Excellence for the Best Radiation Measurements Article in 2010 was awarded to: Thomas Frederick Boltz, William Pavlicek, Robert Paden, Markus Renno, Angela Jensen, Metin Akay, For the article entitled: ” An anthropomorphic beating heart phantom for cardiac x-ray CT imaging evaluation,” 11(1) 191-199.

The Sun Nuclear Award of Excellence for an Outstanding Radiation Oncology Article in 2010 was awarded to: Ahmed Abdel Rahman Eldib, Mohamed I. ELGohary, Jiajin Fan, Lihui Jin, Jinsheng Li, Charlie Ma, Nader A. Elsherbini, For the article entitled: ” Dosimetric characteristics of an electron multileaf collimator for modulated electron radiation therapy,” 11(2) 5-22.

The Elekta Award of Excellence for an Outstanding Radiation Oncology Article in 2010 was awarded to: Vladimir Feygelman, Geoffrey G Zhang, Craig W Stevens, For the article entitled: ”Initial dosimetric evaluation of SmartArc - a novel VMAT treatment planning module implemented in a multi-vendor delivery chain,” 11(1) 99-116.

The Varian – Editor in Chief Award of Excellence for an Outstanding General Medical Physics Article in 2010 was awarded to: Salahuddin Ahmad, Daniel Johnson, Jessica R. Hiatt, D. Timothy Still, Eli E. Furhang, David Marsden, Frank Kearly, Damian A. Bernard, Randall W. Holt, For the article entitled: “Comparison of tumor and normal tissue dose for accelerated partial breast irradiation using an electronic brachytherapy eBx source and an Iridium-192 source,” 11(4) 155-161.

Young Investigator Awards Each year the ACMP provides awards for outstanding scientific paper presentations at the meeting.

This year the Young Investigator Awards were presented to: The first place award went to: Scott Lacey for an outstanding scientific paper presentation entitled: “Assessment of Margins for Set-Up Errors in Head-And-Neck IMRT” The second place award went to: Christopher Tien for an outstanding scientific paper presentation entitled: “Plastic Scintillation Dosimetry for Measurement of Age-Related Macular Degeneration Radiosurgery Device” The third place award went to: Hao Li for an outstanding scientific paper presentation entitled: “Dual-Energy Dual Cone-Beam CT for Image Guided Radiotherapy”

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AAPM Newsletter

July/August 2011

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AAPM Newsletter

July/August 2011

International Congress of Medical Physics Report E. Ishmael Parsai, Toledo, OH William Hendee, Rochester, MN Yacov Pipman, Forest Hills, NY

HIGHLIGHTS OF THE 18TH INTERNATIONAL CONGRESS OF MEDICAL PHYSICS Porto Alegre, Brazil, April 15-18, 2011

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he 18th International Congress on Medical Physics: Science and Technology for Health for All (ICMP) was held in Porto Alegre, Brazil during April 17-20, 2011. The congress was well attended primarily by medical physicists and biomedical engineers, and was sponsored by the International Organization for Medical Physics (IOMP), the Latin American Association of Medical Physics (ALFIM) and the Brazilian Association of Medical Physics (ABFM). The participants came from around the world but mostly from Latin American, North and South American countries. The congress included 6 Plenary sessions with 34 keynote speakers, and 6 round table moderators invited from Argentina, Australia, Belgium, Brazil, Canada, Denmark, France, Germany, Malaysia, Sweden, Switzerland, the United Arab Emirates, the United Kingdom, and the United States, and from three international organizations: the International Atomic Energy Agency, the Pan American Health Organization and the World Health Organization.

The host institution was the Physics School of the Pontifical Catholic University of Rio Grande do Sul (PUCRS) located in downtown Porto Alegre. This beautifully designed and modern convention center located within the campus of PUCRS offered both participants and exhibitors convenience of easy access to all conference proceedings and exhibition halls.

Two other events were ongoing with selected overlapping sessions: the XVI Brazilian Congress of Medical Physics (XVI CBFM) and the fifth Instrumentation and Medical Imaging Symposium (V-SIIM), both traditional Brazilian events with medical physicists, physicians and biomedical engineers. The invited speakers for the Educational & Professional Sessions were from USA (5), UK (1), Mexico (1), Argentina (1), and Germany (1).

In the mission statement of the ICMP it is noted that “the mission of the ICMP 2011 is to consolidate the efforts of medical physicists and scientists working in hospitals, clinics, research and education institutions and companies from different countries for solving health care problems related with radiation therapy, diagnostics, imaging, radiation detection, medical and technological information and radiation protection.� The congress organizers felt that they made significant progress towards achieving the stated objectives during this international scientific meeting.

A two days CAMPEP accredited pre-conference course on various topics related to Medical Physics was offered. Research papers and key notes on many topics were presented in this congress including: Brachytherapy, External Beam Radiotherapy, Lasers, Biomagnetism and Non-Ionizing Technologies, Magnetic Resonance Imaging and Spectroscopy, Ultrasound, Medical Physics Education, Nanotechnology for Biomedical Applications, Nuclear Medicine Imaging and Therapy, Optical and Molecular Imaging, Physiological and Biomedical Modeling, Radiation Biology and Radiation Protection, and radiation dosimetry. Speakers from many countries participated in this pre-conference course

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continued - International Congress Of Medical Physics Report including 13 from USA, 2 from Canada, 1 from Portugal, 6 from Brazil, and 1 speaker from Germany.

At the Conference there was also the Second Workshop of the Health Technology Task Group (HTTG) of the International Union for Physical and Engineering Sciences in Medicine (IUPESM), moderated by Barry Allen, IUPESM President and Cari Borrás, the HTTG Co-Chair.

In addition to the pre-congress courses, all the oral sessions of the ICMP and the HHTG were CAMPEP-Accredited.

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 New Member Symposium/ Meet the Experts Medical Physics in Africa Preparing for ABR Board Exams Economic Focus: Practical Aspects Role of Medical Physics in Federal and State Government

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AAPM Newsletter

July/August 2011

IHE-RO: From System Incompatibility to Clinical Solutions

Charles Able1, Colin Field2, Nick Linton3, Walter Bosch4 1 Wake Forest University School of Medicine, Winston Salem, NC, USA, 2 Cross Cancer Institute, Edmonton, Alberta, Canada, 3 Elekta Impac Software, Kanata, Ontario, Canada, 4 Washington University School of Medicine, St. Louis, MO, USA.

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he Radiation Oncology domain of Integrating the Healthcare Enterprise (IHE-RO) is an ASTRO sponsored initiative by healthcare organizations, professionals and industry to improve the way computer systems in healthcare share information. This article is part of our effort to educate all stakeholders, such as Medical Physicists, about the process and tangible results of the IHE-RO. Introduction The goal of Integrating the Healthcare Enterprise (IHE) is to enable the sharing and exchange of all information relevant to a patient’s care between all healthcare systems thereby eliminating “interoperability” challenges. Each domain of the IHE (i.e. radiation oncology, radiology, cardiology, laboratory, etc.) has a Planning Committee (PC) and a Technical Committee (TC). Membership on the PC and TC is available to all IHE members. The only requirement for membership in IHE is an organizational commitment to the stated goal, there is no monetary cost to join the IHE. Membership applications are available at http://www.ihe.net/governance/index. cfm#membership .

ASTRO sponsors the Radiation Oncology domain of IHE (IHE-RO). Medical Physicists, Radiation Oncologists and representatives from Radiotherapy Medical Equipment vendors form the PC.

The PC for the Radiation Oncology domain or any domain: • Recruits vendors of relevant information systems and users with clinical and operational experience Dade Moeller Gaithersburg MD • Prioritizes & coordinates domain activities Radiation Safety • Identifies, gathers, reviews and Las Vegas NV Academy prioritizes integration and information inter-operability problems (http:// en.wikipedia.org/wiki/Use_cases) • Selects inter-operability problems based on technical feasibility and effort Are you a Medical Physicist, RSO, assistant RSO, or evaluation for consideration by the TC Authorized User responsible for radioactive materials and • Approves inter-operability problems radiation-producing machines in your hospital? selected by the TC for the development To help keep you current with new techniques and of solutions procedures, Dade Moeller Radiation Safety Academy offers this • Develops educational materials for the course for those managing or working with radioactive material domain and clinical solutions

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and radiation sources in a medical environment.

The TC includes computer scientists and representatives of the standards working groups as well as Medical Physicists, Radiation Oncologists, and representatives from Radiotherapy Medical Equipment vendors.

The TC for the Radiation Oncology domain or any domain: • Recruits vendors of relevant information systems and users with technical experience • Assesses the feasibility and estimated effort of inter-operabillity problems selected by the PC

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

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AAPM Newsletter

July/August 2011

continued -IHE-RO: From System Incompatibility to Clinical Solutions • Builds consensus on the appropriate standards-based solutions to a selected inter-operability problem • Develops Integration Profiles (clinical solutions) to document the technical aspects to resolve the inter-operbility problem in detail • Maintains the Technical Framework for the domain. The Technical Framework documents all Integration Profiles, which describes the solution to the inter-operability problem. The solution is described in terms of Actors, a system or part of a system that creates, manages or acts upon data; and Transactions, a specific interaction between Actors to exchange information using current established standards.

Inter-operability problems and Clinical Solutions One of the principal tasks of the PC is to solicit, define and prioritize inter-operability issues as defined clinical incombatility problems (Use Cases). A Use Case is a description of how end-users will accomplish a goal by performing a task or a series of tasks using systems (or software), and includes the responses of the systems (or software) to user actions. Inter-operability problems will be solicted from the radiotherapy community, and “champions” will be selected to present each issue (Use Case). Past, current and future Use Cases are summarized on the IHE wiki at http://wiki.ihe.net/index.php?title=Radiation_Oncology#Use_Case_Selection. All Use Cases are prioritized, and the TC evaluates the feasibility and effort required to satisfy a Use Case. Annually, the top 3 Use Cases which are deemed feasible to solve are identified by the TC and approved by the PC. The Use Case is then developed into a clinical solultion (Integration Profile) description.

An integration profile provides an implementation guide for equipment vendors, and an effective shorthand for healthcare providers to specify integration requirements when purchasing systems.

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July/August 2011

continued -IHE-RO: From System Incompatibility to Clinical Solutions The Integration Profile (clinical solution) describes the clinical information and workflow scenario and also documents how to use established standards (e.g. HL7, DICOM) to accomplish it. A group of systems that implement the same Integration Profile address the Use Case scenario in a mutually compatible way. Public comments are solicted as the final step in the development of an integration profile. A brief summary of completed IHE-RO integration profiles are available at http://wiki.ihe.net/index.php?title=Profiles#IHE_Radiation_Oncology_Profiles Connectathons are annual events hosted by the TC where equipment vendors bring products and test their inter-operability with other vendors against the defined IHE Profiles (clinical solutions).

These connectathons require a significant effort by the vendors and the IHE-RO. The efforts of those participating in the connectathon (vendors and committee members) provides the final link to the successful implementation of IHE Integration Profiles. Public Demonstrations are public events which demonstrate IHE Profiles by vendors who have passed the connectathon tests.

Public demonstrations have been held periodically at the ASTRO annual meeting.

Summary The IHE-RO takes on inter-operability problems between healthcare systems in radiation oncology and works to resolve them in a systematic way using established industry standards.

The PC solicits inter-operability problems from clinical radiotherapy professionals and transforms them into Use Cases. The TC takes the Use Cases that have been approved and develops an implementation roadmap for vendors that is called an Integration Profile. Once the vendors have implemented the Integration Profile they come together at a Connectathon and demonstate that the inter-operability problem has been resolved.

The IHE-RO is committed to tackling practical clinical concerns. An example currently under consideration is the Structure Template, Creation, Export, and Import Use Case. The use of anatomical structures is pervasive in image based radiotherapy treatment planning and delivery.

While the DICOM standard provides a means to represent structure sets associated with image series, inconsistent identification of anatomic structures limits the ability to automate treatment planning and plan evaluation for individual patients. Lack of standardized structure names also makes difficult the comparison of plans among patients, e.g., in registries and clinical trials.

Ongoing development of a standardized structure nomenclature by the ATC, RTOG, and other collaborators is an important first step toward consistent and predictable structure identification.

To facilitate the practical implementation of such a nomenclature for clinical workflows and clinical trials data analysis, the IHE-RO is working to define a template for communicating structure identifiers across platforms and systems. The use of structure templates for national clinical trials would help improve the consistency of structure delineation for patients on these trials and would increase the efficiency of quality assurance review and analysis of the data submitted. Therefore, this Use Case is one of several practical problems currently being addressed by IHE-RO. If you are aware of an interoperability issue in the Radiation Oncology domain, please prepare a one page summary of the problem and go to http://astro.org/Research/ ResearchHighlights/IHERO/documents/ IHEROsub.pdf to submit the issue to IHE-RO. Please contact the IHE-RO secretariat or any of the committee co-chairs to submitt a Use Case or if you’d like additional information.

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2011 History Symposium Historical Aspects of Brachytherapy Wednesday, August 3, 2011, 4:30 PM Lawrence Rothenberg, Moderator Speakers: Dr. Basil S. Hilaris, author of "BRACHYTHERAPY the first 100 years" and Jean M. St.Germain, Vice-Chair Medical Physics, MSKCC

AAPM Newsletter

Imaging Program Scientific Symposia

Imaging Program Proffered Abstract Submissions • • • • • • • • • • • • • • • •

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

July/August 2011

• • • • • • •

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

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AAPM Newsletter

July/August 2011

Obituary

Charles Lescrenier, DS.c.

by Colin Orton

W

e are saddened to report that one of our most distinguished and successful colleagues, Charles Lescrenier, passed away Saturday, May 7, at Badger Prairie Health Center, Verona, WI. Charles (or Les as many of us affectionately knew him), earned his B.A. degree from Texas A & M University in 1960. Initially he worked as a hospital radiological physicist, primarily at the M.D. Anderson Hospital and the Medical College of Wisconsin where, among other things, he helped in the development of compensating filters for radiotherapy and practical applications of the NSD concept (both in collaboration with Dr. Frank Ellis), and laser positioning devices for therapy and imaging. It was the latter that led him to form Gammex in 1969 to design, manufacture and market lasers and other technological innovations for radiology.

This kicked off an amazingly productive entrepreneurial career. He founded or acquired several organizations, mostly related to healthcare. In 1987 Gammex acquired Radiation Measurement, Inc. (RMI) founded by John Cameron as a spin-off from the University of Joint Imaging/Therapy Program Wisconsin, Madison, one of the leading manufacturers Scientific Symposia of equipment used by medical physicists.

• Engineering for science in patient safety For his many contributions to medicine, Charles • Targeted radionuclide therapies received numerous acclamations and awards. He • Nanotechnology applications in radiation was elected a Fellow of the AAPM and the ACR, and oncology an Honorary Member of the ACMP. He was awarded • Normal tissue imaging of dose response an honorary Doctor of Humane Letters by Lakeland • Preclinical and clinical hypoxia imaging: current College in 1990, received the Governor’s New Product and emerging methods and technology and Entrepreneur of the Year Awards and, on two • Molecular and functional imaging for treatment occasions, the Export Achievement Award, from the planning State of Wisconsin. But many of us remember him • 4D-MRI for Radiation Therapy of Moving best for his generous support of medical physics.

Tumors For example, he founded the Wisconsin Innovarium which supported many medical physics projects, Joint Imaging/Therapy Program supported the foundation of the IOMP Libraries Proffered Abstract Submissions for Developing Countries program, established and supported the ASRT Educational Foundation, • John S. Laughlin / Science Council Research provided scholarships to support students and Symposium: Science and Engineering for the Jack Fowler Professorship in the University of Patient Safety in Therapy and Diagnostic Wisconsin Medical Physics Department, funded the Medical Physics AAPM Travel Awards and the Coolidge Award gold • Computed Tomography medals and, of course, funded the AAPM Gammex • Fluoroscopy • Image Registration, Fusion, Segmentation, and Fun Run since its inception.

Visualization Throughout his life, Dr. Lescrenier was not only a • Magnetic Resonance Imaging great supporter of medical physics but also of the • Outcome Modeling including imaging for community in which he lived and worked where therapy assessment he supported and established numerous funds and • Patient Simulation Imaging for Planning grants for both education and recreation. He will be • Treatment Delivery - Immobilization and sorely missed by all who were privileged to know Localization and love him especially his wife Peggy, children • Targeted Radionuclide Therapies Karen, Jon, and Peter, and his 3 grandaughters.

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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: September/October • Submission Deadline: August 17, 2011 • Posted On-Line: week of Sept. 5, 2011