AAPM Newsletter September/October 2011 Vol. 36 No. 5

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. 5

SEPTEMBER/OCTOBER 2011

AAPM President ’s Column J. Anthony Seibert, UC Davis Medical Center A focus on the Annual Meeting fantastic annual meeting in Vancouver.... and I thank everyone who attended that helped make it a great success from both the AAPM and COMP! Not only the weather, but the Convention Center, the bay, the scenery, the scientic, professional, educational offerings and the overall organization were simply outstanding. For those not able to attend, and for those who attended but were unable to make many of the sessions, several were recorded and will soon be available through the AAPM Online Learning Center and Virtual Library from the annual meeting. I know I will take advantage of this great service, since I missed many events because of EXCOM meetings and other commitments that precluded my attendance ….. I highly recommend this valuable resource to you as well. Check it out on the AAPM website. Try it, you ’ll like it!

A

Community Project

To kick things off in Vancouver (after a long EXCOM meeting on Friday and Saturday morning), I was very happy to participate in the annual AAPM community service project – a tradition that has been ongoing for several years, since our 50th anniversary meeting in Houston. About 15 of us were put to work at the Vancouver Food Bank, sorting and boxing Included in this issue: all kinds of canned goods, p. 4 boxes of pasta, juices, Chair of the Board President-Elect p.

5 and a variety of household p. 6 goods. We worked steadily Executive Director Service Project Participants (L - R): through the afternoon, with Editor p. 9 Gary Ezzell, Corbi Foster, Chae-Seon Hong, Mike Herman, Karen Brown, Julie two major teams, one doing Science Council p. 10 Rainwater, John Gibbons, Tony Seibert, the sorting, and the other Education Council p.

11 Indrin Chetty, Mary Fox doing the boxing. After all Professional Council p. 13 was said and done (a little more than 2 hours ’ worth of time) Leg. & Reg. Affairs p. 16 the team was gifted with the knowledge that we were able to ACR Accreditation p. 19 help about 800 families, each with one week of support, in the 2010 ISEP Report p. 21 greater Vancouver area as a result of our efforts. Thanks go p. 23 to Corbi Foster from headquarters who made the contacts 2011 ISEP Report Health Policy/Econ Issues p.

24 and established the means for this event. For next year, I Publication News p.

27 encourage all members to consider assisting in the community p. 29 service project (look for announcements when you sign up for Travel Grant Report p. 33 the annual meeting registration for 2012). This is an extremely Physics Today Online worthwhile event that makes us all proud of our profession, Persons in the News p. 34 our Association, and the knowledge that we can truly make a Letter to the Editor p. 35 difference to those in the local area who are less fortunate. I

AAPM Newsletter

September/October 2011

continued - AAPM President ’s Column still revel in the feeling that this brings, knowing that we collectively have an impact … …. And with more participation, even bigger achievements can be accomplished in future endeavors.

President ’s symposium On Monday morning the President ’s Symposium, entitled The Future of Medical Physics Research: Challenges and Opportunities, featured ve AAPM speakers who gave various perspectives on this extremely important part of our profession. Medical Physics is experiencing profound changes as we move into the second decade of the 21st century. In particular, the impending requirements for professional certication, sub-specialization requiring longer in-depth training, and increased emphasis on the monetary benets of a clinical career have placed medical physics research in jeopardy, which could have a stiing effect on the innovation and creativity that have been the hallmarks of progress and improvements in patient care There was a full house for the President's Symposium! over the last 50 years. With this reality confronting the profession, and realizing that there is a need for a balance of professional competence, educational activity, and scientic research creativity in medical physics requires a serious open discussion and analysis to determine the way forward to review and, as necessary, reconstruct the medical physics career pathways for the future. I would personally like to thank the organizer of this timely topic, Bill Hendee, who had the insight to outline the goals, put together top leaders in our profession (with a bit of arm-twisting), and inspire them to deliver exceptional talks. I am also indebted to John Boone, Rebecca Fahrig, David Rogers, George Starkschall, and Per Halvorsen for their contributions and responses to the lively discussion that followed the presentations. The bottom line is that robust clinical, educational, professional, and scientic research pathways are needed to keep the Medical Physics profession strong, relevant, and with a purpose to innovation and patient safety in both the clinical and research areas. See more information about the symposium in the Science Council chair report (page 10) in this Newsletter.

Awards and Honors The chance to recognize and honor all of those who have served our Speaker John Boone and profession is a great thrill, particularly when you get to personally congratulate President Tony Seibert at the each and every one! I had a grand time on the podium. podium with the unbelievable opportunity to meet and greet the established and future leaders of our eld. While not naming anyone in this column except the highest honorees, kudos to all the medical physicists who participated in the young investigators competition, the Jack Fowler Junior Investigator Award, Award for Innovation in Medical Physics Education, scholarships, fellowships, research grants, and the travel grant awards. It ’s quite an achievement to be named the winners of the Farrington Daniels and Sylvia Sorkin Greeneld Awards for the best papers in Medical Physics journal. Being named a Fellow recognizes the signicant and continual contributions and service to the profession and to the AAPM. Gary Becker Two individuals were selected for Honorary Membership, for their long-term dedicated support to the medical physicist community and to the AAPM. It was a real pleasure to introduce Gary Becker M.D., Executive Director of the American Board of Radiology and past-president of the RSNA, who has always been a supporter of medical physics throughout his career, particularly in his leadership roles. Sal Tro, the former Executive Director of the AAPM, guided the Association and its headquarters move through a difcult transition from New York to College Park and re-established the direction of the headquarters operations. The Edith H. Quimby lifetime achievement awards were presented to Joel Gray and Marty Weinhous for their outstanding contributions to our profession. And the last and most signicant was the presentation of the highest honor given to a medical

2

Sal Tro

AAPM Newsletter

September/October 2011

continued - AAPM President’s Column physicist, the William D. Coolidge award, this year presented to Rick “Blue Jay” Morin for an amazing career of truly great achievements and service in our profession, with much more to come. My hat is off to you, my good friend, for well-deserved recognition.

Congratulations to you and to all who were honored at a magnificent ceremony!! ….. oh, and thanks Nancy Vazquez for the script and making things go smoothly – the support was great, and you made me appear better Joel Gray than I really am….

Marty Weinhous

Business Meeting and Town Hall meeting A requirement of the bylaws of the AAPM is to have a business meeting prepared by the President and approved by the Executive Committee. This year, EXCOM’s desire was to keep the business meeting focused on an overview report by the President, followed by the treasurer’s report of the Association’s financial situation, and business issues handled by the Secretary – concise and short. The bulk of the time was spent on the membership interacting with the Board of Directors at the Town Hall meeting. For future reference (Charlotte 2012!!! put in on your calendar), this is your opportunity to interact with the directors, ask pointed questions, make comments, and enter into a discourse on any matter that concerns you and the AAPM. Mike Herman led the discussion this year, with a wide range of issues including the strategic plan, support for licensure, fitting research into the medical physics curriculum, the impending issues Rick Morin surrounding residencies and the fate of the master’s level physicist, among other items. With this type of discourse, the board gains a better sense of what is important to the membership regarding the future of the AAPM in terms of planning, direction, and actions. See you at next year’s Town Hall meeting for your ideas and points of discussion!

Ad Hoc on Diagnostic QMP Scope and Supervision requirements The first Ad Hoc committee commissioned by me as President has a charge to describe and delineate the responsibilities of the Diagnostic Qualified Medical Physicist (Dx QMP) supervisory roles, by determining the procedures and tasks that can be performed by an unqualified assistant (e.g., a medical physicist in training or support personnel) under various levels of supervision by the QMP – personal or direct or general – for specific tasks otherwise performed by the Dx QMP. The committee first met at the annual meeting. Members include me, Tony Seibert (chair), Jessica Clement, Per Halvorsen, John Hazle, Mike Herman, Melissa Martin, Doug Pfeiffer, Bob Pizzutiello, Beth Schueler, and Jeff Shepard. Lynne Fairobent provides support from headquarters. Our goal is to have a document ready for review by the middle of October. Initial guidance of the group will be provided by a directive published by the State of Texas and the licensure requirements that describe the supervisory roles of the physicist and the assistant. This ad hoc committee is open to comments and suggestions by the general membership, by forwarding emails to any of the members mentioned above.

Final thoughts Wow! An unbelievably great annual meeting, supported by the best staff and headquarters personnel that anyone could imagine……fantastic volunteer efforts by the meeting organizers for the educational, scientific, and professional components, and planning by the Meeting Coordination Committee. Many thanks go to the vendors and commercial exhibitors for their participation. Seeing the meeting from the top of the heap gives a different perspective to all that goes into this massive effort….. certainly something that should never be taken for granted. I am very honored and humbled to have been able to experience this event as President of the AAPM. My sincere appreciation goes to everyone who had a role, and to those who took the time to attend.

3 3

33

AAPM Newsletter

September/October 2011

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

I

would like to add my thanks to everyone who attended and made the annual meeting in Vancouver a great success. I would like to focus the rest of my column on the recently approved and posted AAPM Strategic Plan. The strategic plan was developed after the Board of Directors revised and approved a new AAPM mission statement with associated high level goals (RSNA 2009). The mission statement and goals are more or less permanent with the previous mission statement dating to 1997. The strategic plan however has a time frame of 3-5 years and it guides the prioritization of initiatives and assignment of resources in the context of the current scientic, professional and educational environment and our own perceived strengths and weaknesses.

The current strategic plan was produced by an ad hoc committee that included membership from across the AAPM. The committee began work in early 2010 and generated a list of 34 objectives and 136 strategies to achieve the goals of the AAPM mission. Working with the full AAPM Board, the ad hoc committee developed a more specic list of the highest priority and most time-pressing objectives (22) and associated strategies (50). It is important to recognize that the strategic plan represents an assessment at a given point in time under a given set of circumstances. It indicates what our priority activities are in the near future. In any case, part of our plan is to continue to do what we already do well. The committee, again working with the Board of Directors and council chairs then dened specic deliverables associated with each strategy and each strategy was assigned to an appropriate AAPM council or committee for implementation. It is also important to note that the strategy/deliverable assignments were made to existing AAPM entities, so we take full advantage of our already effective committee structure.

With approval of the strategic plan this June, a standing committee of the Board of Directors was created to monitor and help manage the strategic plan process. The Strategic Planning Committee of the Board is comprised of six sitting BOD members plus the President-Elect, President, Chairman of the Board, Immediate Past Chairman of the Board and the Executive director (Ex-ofcio). The primary functions of this committee are 1) to oversee the implementation and progress of the plan, reporting to the full board; 2) participate in the budget prioritization process and 3) guide (at ~5 year intervals) a comprehensive review and revision of the strategic plan. The full charge and membership of this committee is posted under the committee structure.

The committee drafted an implementation template and review schedule to be used by each assigned group so that plans and progress could be readily assessed following a consistent process. This information was shared with council chairs and the full BOD in Vancouver and we hope to see the rst rounds of template use and feedback in the 2012 calendar year.

The full strategic plan is posted on the AAPM website under the mission statement at: http:// www.aapm.org/org/TheAAPMStrategicPlan-2011_Full_Version_nal.pdf

4

AAPM Newsletter

September/October 2011

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

P

oliticians should be more like physicists. At its Vancouver meeting, the AAPM Board of Directors demonstrated how representative democracy is supposed to work. At issue was a question about which people differ: how much money should AAPM budget annually for working on licensure and how long should we continue before formally reassessing the commitment.

The entire process worked well, in my opinion, beginning some months before the Board meeting. The Executive Committee, prompted by our Treasurer, Janelle Molloy, asked the Licensure Subcommittee for a summary report and a motion to be brought to the Board in order to clarify the long term commitment. That committee, chaired by Bob Pizzutiello, brought that report and draft motion up through its parent committee, and the Administrative Council, chaired by Melissa Martin, debated and edited the motion that eventually came to the Board.

The motion was clearly written; the Board debated the question closely and respectfully for about an hour; the vote was taken and the matter concluded.

The motion, which passed by a 3:1 margin, was: “The AAPM Professional Policy 2-D supports licensure of Qualied Medical Physicists (QMP). Recognizing this, the AAPM Board of Directors reafrms the goal of advancing licensure of QMPs in the United States. In support of furthering AAPM ’s Strategic Plan (approved by the AAPM BOD June 27, 2011) Goal 6, Objective 1, Strategies 3 and 5, licensure shall be considered a major strategic objective and shall be funded in accordance with Goal 7, Objective 3, Strategy 2. AAPM efforts supporting licensure shall be funded for 3 years at a level not to exceed $200,000 per year. ” The best results come from multiple brains working together, and AAPM volunteers - committees, Council, and Board - showed how it should be done. What is more, the Board concluded its business almost two hours early, allowing us to enjoy our nal afternoon in a beautiful city.

The Vancouver meeting was superb, both the locale and the offerings. If you enjoyed it, please take a moment to reect on what it takes to put such a meeting together, and perhaps even to thank an individual responsible for a piece you found most valuable. Some of them are listed here: http://www.aapm.org/meetings/2011AM/ProgramDirs.asp

REGISTRATION IS STILL OPEN....

WITH LIMITED SEATS AVAILABLE! http://www.aapm.org/meetings/2011CTS/

Program Summary:

Rapid developments in CT scanner technology over the last 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 specic 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.

5 5

55

AAPM Newsletter

September/October 2011

AAPM Executive Director ’s Column Angela R. Keyser, College Park, MD AAPM Annual Meeting in Vancouver I expect that most attendees of the recent Joint AAPM/COMP meeting would agree that Vancouver is a wonderful meeting destination. I heard over and over again ….. ”we should meet here every year! ” Once again, registration numbers exceeded previous years ’ totals with roughly 4,400 attendees, including more than 2,700 scientic registrants. The success and continued growth in the meeting is due in large part to the countless volunteers who devote their time to planning an outstanding program. Thank you for all that you do for AAPM and the medical physics profession. I also want to acknowledge the hardworking team of professionals at HQ who take such great pride in doing their very best for the organization and each other. Thank you for giving 110%!

Make sure to mark your calendars for the 2012 AAPM Annual Meeting to be held July 29 – August 2, 2012 in Charlotte, NC. Meeting News September 23 in the last day to register for the 2011 CT Dose Summit: Interdisciplinary Program on Scan Parameter Optimization for Imaging Physicians, Technologists and Physicists, to be held 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.

Make sure to register for the RSNA meeting by November 4 to receive the complimentary registration provided to all AAPM members. The AAPM Reception will be held on Tuesday, November 29 from 6:00 PM – 8:00 PM. Mark your calendars for the 2012 AAPM Spring Clinical Meeting to be held March 17-20, 2012 in Dallas, TX. As part of an agreement between AAPM and ACMP, AAPM is folding the ACMP Annual Meeting into a new program managed by AAPM. Program information is expected shortly!

New Report Available Report of AAPM Task Group #144 -- Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies.

2012 Awards Deadlines Approaching October 15 is the deadline for nominations for the William D. Coolidge Award, Marvin M.D. Williams Award, Edith H. Quimby Lifetime Achievement Award and AAPM Fellows as well as applications for the AAPM-IPEM Medical Physics Travel Grant.

AAPM Forms new chapter At the recent AAPM Board meeting, a proposal to form the Arizona Chapter of the AAPM was approved. This brings the total of AAPM chapters to 21. If you are not involved with your local chapter, please consider attending an upcoming meeting. Chapter information can be found online at: http://www.aapm.org/org/chapters/ US Physics Team Each year, AAPM joins with the American Association of Physics Teachers (AAPT), the American Institute of Physics (AIP) and other societies to sponsor a team to represent the United States at the International Physics Olympiad Competition (IPhO). This year the team received 2 gold medals and 3 silver medals at the IPhO held in Bangkok, Thailand in July. For more information about the accomplishments of the US Team and all the teams attending the Olympiad, please go to: http://aapt.org/physicsteam/2011/ .

6

AAPM Newsletter

September/October 2011

continued - AAPM Executive Director ’s Column Attention Resident, Junior and Student Members Junior Members must provide an annual attestation from a Full Member that they are currently eligible for Junior Membership. Junior Membership is open to individuals who possess an earned graduate degree in the Physical or Biological Sciences, Computer Sciences, Mathematical Sciences, or Engineering and who are currently a Post-Doctoral Student, Fellow or Resident in a program not accredited by CAMPEP on a full- or part-time basis, and who are engaged in professional, research, or academic activity related to applications of physics in medicine and biology. All Junior Members were sent an email in mid-August with instructions on the process.

Residents must also obtain an annual attestation, however a Resident shall provide an annual attestation from the program director of a CAMPEP Accredited Residency Program that they are currently eligible for Resident Membership on that basis. Resident Membership is open to individuals who are enrolled in a residency program in Medical Physics that is accredited by the Commission on Accreditation of Medical Physics Educational Programs, Inc. or its successors (CAMPEP).

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

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

2012 AAPM Dues Renewals Dues renewal notices for the 2012 year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an ofcial member.

AAPM HQ Team …at your service!

In this issue, I would like to prole two members of the team who play a signicant role in serving the AAPM membership.

Cecilia Hunter joined the AAPM HQ team in June 2003, as Director, Finance and Administration.

She has put her extensive background of non-prot association management to work guiding AAPM ’s nancial and administrative functions, ensuring that the leadership is kept fully informed of the nancial position of the organization. Cecilia oversees the accounting and scientic journal activities and serves as the staff liaison to the Science Council. She also serves as AAPM ’s contact with outside professional service providers, including auditors and bank afliations.

Penny Slattery, AAPM Journal Manager, will soon celebrate her 15th AAPM anniversary. She began her AAPM career in 1996 when AAPM transitioned the administrative support of the Medical Physics journal to HQ. She coordinates the processing of manuscripts for the journal and serves as liaison to the publisher, the American Institute of Physics. Penny was instrumental in moving the manuscript submission process online and to the overall success of the journal.

L - R: Penny Slattery & Cecilia Hunter

7 7

77

AAPM Newsletter

September/October 2011

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

— — — —

Monthly mechanical and imaging QA procedures Light/radiation eld coincidence & crosshair alignment, jaw positioning, scaling – MV & kV imaging Star shot analysis for annual mechanical procedures Collimator rotation isocenter, gantry rotation isocenter, couch rotation isocenter Automatic CATPHAN analysis for monthly CBCT QA tests Geometric distortion, spatial resolution, HU constancy, contrast, noise Stereotactic QA Automatically analyze EPID images of Winston-Lutz ball marker

1281-25, 08/10

—

Monthly MV and kV imaging tests Spatial resolution, contrast-to-noise, overall noise

8

AAPM Newsletter

September/October 2011

Editor's Column

Mahadevappa Mahesh, Baltimore, MD

W

elcome to the 5th issue of this year. This issue contains post Joint AAPM-COMP meeting reports from many of our regular contributors and provides a snap shot of what was at the meeting, how the meeting went and also provides information of what major decisions were taken at the annual AAPM Board of Directors' meeting. The Annual Meeting across the border (Vancouver, BC, Canada) was a huge success not only in terms of scientic and educational content but also due to pleasant weather conditions and the geographical location.

I would like to draw your attention to the ‘Letter to the Editor ’ on page 35. I feel this article will be especially of interest to those who perform/ provide CT Accreditation services as the signee of the letter have expressed their grave concerns about the proposed CT phantom and its practical limitation due to excessive weight.

Finally, this issue is coming out few days late and I can blame it by saying, “Oh! no, the earth was shaking (yes, we too on the East coast experienced the earth quake for the rst time), and the sky was falling (excessive rain and power outages from IRENE), but I won ’t. It is just that all of these factors plus an extended time period to receive most of the post-meeting reports contributed to the delay and hopefully this delay will prompt you all to read the Newsletter to keep abreast of our society ’s activities.

T H E

W A T E R

P H A N T O M

C O M P A N Y

S I N C E

1 9 2 2

MP3 Water Phantoms

Music to your ears MP3-P Particle Therapy

Which one strikes a chord with you?

MP3 Large Field Dosimetry MP3-T TomoTherapy ®

MP3-M Standard LINACS

TomoTherapy ® is a registered trademark of TomoTherapy Inc.

+1 516-827-3181 www.ptwny.com/mp3

9 9

MP3-XS Stereotaxy / IORT

99

Knowing what responsibility means

AAPM Newsletter

September/October 2011

Science Council Report John Boone, Sacramento, CA

T

he enormous success of the annual meeting of the AAPM in Vancouver this summer has illustrated the importance of venue. Despite the higher cost of Vancouver and the additional issues of passport control (which affect some members more than others), the attendance was up signicantly over recent meetings. I congratulate the organizers of the meeting, including Mitch Goodsitt, Indrin Chetty, and Jeff Siewerdsen for complementing this beautiful venue with a well thought-out scientic program, and once again the AAPM staff did a fantastic job at making the complicated arrangements of a large meeting work seamlessly. It would appear that even physicists appreciate esthetics, given the unanimous positive sentiment that I heard throughout the week in Vancouver. However, much speculation remains as to the composition of the large yellow pile across the bay ….

The 2011 President ’s Symposium featured a number of speakers discussing the topic of THE FUTURE OF MEDICAL PHYSICS RESEARCH. At president Tony Seibert ’s request, Bill Hendee organized the symposium with contributions from three AAPM Council Chairs (John Boone, George Starkschall, and Per Halverson) and perspectives from mid-career researcher Rebecca Fahrig and more seasoned researcher David Rogers. The topic of how research in our eld can be sustained in the changing environment of Medical Physics is important and timely – the 2014 American Board of Radiology requirements essentially mandate that all medical physicists coming into the eld who plan to practice clinically (and hence be ABR board certied) go through a residency program, which will add approximately two years to the training path. These requirements have caused and will continue to cause stress in medical physics trainees because of the limited number of residency programs, especially in diagnostic imaging, where there are only a handful of residency programs in North America. The historical pathway of doing a research post-doc (funded by the NIH or other research organization) while picking up clinical skills on the side has essentially been voided by the revised ABR requirements.

The perceived shortage of entry avenues into the eld of medical physics has already led to the realization by many that young scientists-in-training will need to be exceptionally well prepared to compete successfully for these residency slots. This is a situation that has existed for decades among physician residency programs in diagnostic radiology and radiation oncology, and typically physicians competing for these programs are in the top 5% of their medical school class. Competition will likely improve the quality of scientists entering medical physics residency programs as well.

Furthermore, these residency programs have and will continue to provide better training in the fundamentals of clinical medical physics than less rigorous historical approaches. Therefore, there will likely be some very positive outcomes of the new ABR requirement that will raise the bar for training the new generation of clinical medical physicists – and it is hard to argue in good conscience against that.

How will these changes affect the future of researchers in the eld of medical physics? Unlike the four years of practical physician training (for the M.D. degree) that is required prior to residency and fellowship in radiology and radiation oncology, the four to six years of Ph.D. training that is one path into a medical physics residency is research training – a Ph.D. in science is of course fundamentally a research training program. After emerging from a couple years of clinical training, many of these individuals will reconnect with their research training (or even better, will never disconnect) and be prepared to enter a career which involves both clinical service and research productivity.

Therefore, I remain condent that the FUTURE OF MEDICAL PHYSICS RESEARCH remains strong.

Indeed, it is my observation that while not all scientists have the passion and creativity required to be a committed and successful researcher, people with these attributes will quietly sneak into our residency programs and become the future leaders in the research discovery and engineering developments that continuously renew the practice of medical physics. It can also be observed that much of the research in medical physics is not done, and does not need to be done, in a clinical environment by clinically certied medical physicists. There is ample room in our discipline for researchers who do not want to be distracted by the demands of clinical duties, and it is likely that larger academic medical physics groups will promote and support clinical-only, research-only, and clinical researchers.

10

AAPM Newsletter

September/October 2011

Education Council Report George Starkschall, Houston, TX

I

1

n a recent Newsletter, I described to you an AAPM report , Report 197-S, that identied a pathway by which individuals educated in disciplines other than medical physics could receive didactic education in medical physics to prepare them for residency in medical physics. The report identied six courses that constitute appropriate medical physics remediation, and there appears to be general acceptance of the report.

However, an unresolved question remains as to how an individual can take these remediation courses and be qualied for a CAMPEP-accredited residency program.

One possibility is that the individual be accepted into the residency program and make up the course deciencies while in the residency program. This can work if the residency program is afliated with a CAMPEP-accredited graduate program. The resident can take up to two courses in the graduate program without extending the length of the program. Alternatively, if more remediation is required, it may be necessary to extend the residency program to enable the candidate to take the additional courses and still obtain sufcient clinical time. If the residency program is not afliated with an accredited graduate program, CAMPEP has provided a mechanism for review of these didactic courses.

Another alternative is for the individual to take the remediation courses while involved in a postdoctoral program. This alternative could work if the postdoctoral appointment is an institution that has a CAMPEP-accredited graduate program. Moreover, this option would require cooperation from the individual ’s research mentor to enable the individual to take time from research to study didactic courses.

Yet another alternative would be a certicate program. A certicate program is a one-year program in which a student can take the core medical physics courses specied in AAPM Report 197S. No degree would be required, since the student already has an advanced degree; all they need is acknowledgment that the specied courses have been taken and passed. Several institutions already have established certicate programs, and more are likely. CAMPEP has indicated that courses satisfying the 197S requirements in a certicate program housed in a CAMPEP-accredited graduate program are automatically approved for remediation.

A more difcult issue that needs to be resolved is the fact that there are still rather few CAMPEPaccredited graduate programs that could offer remediation courses to a potential medical physics applicant. Consequently, the candidate must be in residence at an institution that hosts an accredited graduate program. There is no provision at this time for distance learning.

One proposal that has been suggested to alleviate this issue is that of providing online medical physics courses, but the acceptability of such coursework is still a controversial issue.

Some mechanism would be needed to ensure the quality of the educational experience. Two key issues would need to be resolved. First, it would be necessary to provide an appropriate level of studentstudent and student-faculty interaction. Without that interaction, a student could just read a text, but reading a textbook alone does not provide adequate didactic education. The second issue is how to evaluate a student ’s achievement in an online course and ensure that the correct student is indeed the one being examined. Validating the quality of online medical physics education is an issue that is yet to be resolved and providing adequate didactic education for individuals transitioning into a career in medical physics from another discipline in physics is yet another challenge we face as we move forward towards 2014.

1

http://www.aapm.org/pubs/reports/RPT_197S.pdf

11 11

11 11

AAPM Newsletter

September/October 2011

PHYSICISTS AND DOSIMETRISTS

NEW NEW NEW VIRTUAL BOARD REVIEW COURSE NO TRAVEL EXPENSES * STAY HOME * WATCH IT OVER & OVER

SAVE TIME STUDYING FOR YOUR BOARDS!

Certification Radiotherapy Review Courses Dosimetry Boards

(ABR) Written Physics I & II Therapy (ABR) Oral Physics Therapy No-Nonsense Instruction Study-Buddy Option Available

SYMPOSIA:

Estimated Time Savings In Excess of 100 Hours

Target & Critical Structure Delineation Practical Radiation Oncology Nursing Education

2 Day Classroom Instruction Still available

REGISTER NOW! CALL US TODAY

WWW.ARCPHYSICS.NET 866-537-2200 12

AAPM Newsletter

September/October 2011

Professional Council Report Per Halvorsen, Newton, MA

Recap: Joint AAPM-COMP meeting in Vancouver any thanks for the Meetings Coordination Committee and everyone who worked so hard to prepare for the Annual Meeting in Vancouver!

The venue was fantastic, the meeting program comprehensive and interesting, and of course the opportunity to interact with colleagues was wonderful. Hopefully you found the Professional Track program to be relevant to your practice, and interesting.

M

CMS publishes 2012 proposed reimbursement rules The Centers for Medicare and Medicaid Services (CMS) has published its proposed rules for the Medicare Physician Fee Schedule (physicians and outpatient centers) and the Hospital Outpatient Prospective Payment System (hospital-based centers). The overall effect, if the proposed rules go into effect, is payment reductions of 4% for radiation oncology services in freestanding centers, 1% for radiation oncology services in hospital centers, and expansion of the Multiple Procedure Payment Reduction in imaging, whereby additional advanced imaging procedures are reimbursed at 50% of the nominal rate when more than one such imaging procedure is performed in one session. For a detailed explanation, see the article by our consultant Wendy Smith Fuss elsewhere in this issue.

New permanent committee to address medical physics workforce issues At its meeting in Vancouver, the AAPM Board of Directors approved the formation of a new committee within the Professional Council. The Workforce Assessment Committee will continue the AAPM ’s efforts to better understand the many factors affecting the workforce trends in our profession.

Recognizing the importance of this issue to our profession, the new committee will coordinate the Association ’s various initiatives related to workforce, such as workforce studies, professional surveys, and the development and validation of predictive supply & demand models. The committee will initially be chaired by Michael Mills, and will begin its work on January 1st, 2012.

AAPM Board approves the formation of AAPM Medical Physics Practice Guidelines At its meeting in Vancouver, the AAPM Board of Directors granted nal approval of the Professional Council ’s proposal to develop Medical Physics Practice Guidelines. This proposal, which was developed over the past year with broad input from all Councils and many AAPM members, denes a formal framework for developing Practice Guidelines which can be referenced by clinical physicists, accreditation bodies, regulators, and hospital administrators when determining the minimum acceptable level of medical physics practice to support a clinical service. The Practice Guidelines Subcommittee of the Clinical Practice Committee will act as the clearinghouse for the development of these Guidelines, overseeing multiple Task Groups developing specic Guidelines. The process is designed to result in guidance documents which reect the medical physics community ’s broad consensus whenever possible, following a similar philosophy as the ACR currently employs with its Technical Standards and Practice Guidelines. All AAPM Councils and all AAPM members will be invited to comment on draft documents during an Open Comment period before each Guideline is nalized and presented for Professional Council approval. The entire proposal, as approved by the Board in Vancouver, is shown below. If you have any questions or suggestions, please contact Lynne Fairobent at AAPM headquarters who will coordinate all responses and distribute to the leaders of the Council and committee.

APPROVED PROPOSAL: 1.

Introduction

The American Association of Physicists in Medicine (AAPM) has long advocated a consistent level of medical physics practice, and has published many guidelines and position statements toward that goal, such as Science Council Task Group reports related to calibration and quality assurance, Education Council and Professional Council Task Group reports related to education, training, and peer review, and Board-approved Position

13 13

13 13

AAPM Newsletter

September/October 2011

continued - Professional Council Report

Statements related to the Scope of Practice, physicist qualifications, and other aspects of medical physics practice.

Despite these concerted and enduring efforts, the profession does not have a clear and concise statement of the acceptable practice guidelines for routine clinical medical physics. As accreditation of clinical practices becomes more common, Medical Physics Practice Guidelines (MPPGs) will be crucial to ensuring a consistent benchmark for accreditation programs.

2. Vision The AAPM will lead the development of MPPGs in collaboration with other professional societies. The MPPGs will be freely available to the general public. Accrediting organizations, regulatory agencies and legislators will be encouraged to reference these MPPGs when defining their respective requirements.

3. Scope MPPGs are intended to provide the medical community with a clear description of the minimum level of medical physics support that the AAPM would consider to be prudent in all clinical practice settings. Support includes but is not limited to staffing, equipment, machine access, and training. These MPPGs are not designed to replace extensive Task Group reports or review articles, but rather to describe the recommended minimum level of medical physics support for specific clinical services.

4. Process The following describes the procedure for the development of a MPPG: a.

b.

The Practice Guidelines Subcommittee (“Subcommittee�) of the Clinical Practice Committee in the Professional Council will be charged with the development and timely updates of MPPGs. The Subcommittee membership will be expanded to include one standing member each from the Therapy Physics Committee and Imaging Physics Committee of Science Council, and the Government and Regulatory Affairs Committee of Administrative Council. The leadership structure of the Subcommittee will be revised to include a Chair, a Vice Chair for Imaging Physics Guidelines, and a Vice Chair for Therapy Physics Guidelines.

AAPM Color Horizontal Ad 6.75 x 4.75 due 6/15/11 submitted 6/30/11

Unparalleled Accuracy & System Choice Measure Dose, Rate, kV, Time, HVL, Filtration, mA, Scatter / Leakage and more.

Radiography, Fluoroscopy, Mammography, CT, Dental Gold Standard Ion Chamber Sensors

NEW

ACCU-GOLD THE NEXT GENERATION

Vast Software Capabilities of Rapidose Extensive Sensor Selection of Accu-Pro

ACCU-PRO

RAPIDOSE RAPID MEASUREMENTS

with a super small footprint solid state sensor

GOLD STANDARD SENSOR SELECTION for all your measurement needs

Solid State Sensors Radcal

426 West Duarte Road Monrovia CA 91016 USA

Vast Customizable Software Functionality

The Gold Standard in Radiation Measurement

14

T: (626) 357-7921 F: (626) 357-8863 sales@radcal.com

www.radcal.com

AAPM Newsletter continued - Professional Council Report

September/October 2011

c. Other professional societies [e.g., the American College of Radiology (ACR), the American Society for

Radiation Oncology (ASTRO), the Canadian Organization of Medical Physicists (COMP), the American

College of Radiation Oncology (ACRO), the Society of Nuclear Medicine (SNM)] will

be invited to collaborate with the Subcommittee in development of such MPPGs and alignment

with existing guidelines documents, with liaison or membership arrangements as deemed appropriate

and commensurate with their society’s support for the MPPGs. d. The Subcommittee will be charged with developing a list of appropriate subject areas in need of

MPPGs, including a prioritization for their development. The Clinical Practice Committee will review

the list, the prioritization and provide suggested revisions. Once the Clinical Practice Committee

has approved the list, it will be forwarded to the Professional Council for review and approval. e. The Subcommittee will also develop a common framework for all MPPGs, describing required sections

and core terminology of a MPP. The Subcommittee will coordinate the development of the draft

MPPGs, assembling a Task Group for each project composed of a representative group of subject-

matter experts. The Subcommittee will ensure that each MPPG Task Group includes at least

one member of any active relevant AAPM Council’s Task Group. MPPG Task Groups should be

constituted within 60 days of the Professional Council’s approval of the formation of such MPPG Task Groups. f. Each MPPG Task Group will present draft MPPG documents to the Subcommittee for initial review and

suggestions within 6 months of being constituted. g. When the Subcommittee deems a draft MPPG document ready for broader review, the

draft MPPG document will be made available to the membership, to collaborating

societies, and to all AAPM Councils for a 30-day open comment period. After this 30-day review

process, the MPPG Task Group will evaluate all such comments for possible incorporation into

the MPPG before updating the draft. If the revision contains significant changes in content, it may

warrant another 30-day open comment process. E-mail alerts will be distributed to the AAPM

membership three times for each open comment period: one week before the start of the open

comment period, on the first day of the open comment period, and one week prior to the close

of the open comment period. h. When the Subcommittee votes to approve a MPPG document (via a majority vote), the document will

be submitted to the Clinical Practice Committee for approval, with a vote scheduled to occur within 30

days of submission. A majority vote of the Clinical Practice Committee is necessary for approval. i. Upon, approval by the Clinical Practice Committee, the final draft MPPG will be submitted to the

Professional Council for review and approval. Professional Council has 30 days to review. A majority

vote of the Professional Council is necessary for approval. j. Upon Professional Council approval, each MPPG will be published on the AAPM website, with a title in

the format “AAPM Medical Physics Practice Guideline X.y: Topic” where X is an integer and y is

a lower-case alphabetic suffix to provide a unique version number, and “Topic” is a descriptive label

for the scope of the Guideline. For example, “AAPM Medical Physics Practice Guideline 1.a: Image-

Guided Radiation Therapy”. When deemed appropriate, the MPPG may be submitted to a peer-

reviewed journal such as the Journal of Applied Clinical Medical Physics (JACMP) for publication. k. The Subcommittee will set a sunset date of 5 years from the date of publication. One year before

the sunset date, the Subcommittee will re-convene a Task Group with the charge of re-assessing

the Guideline and considering a possible revision. Any revisions will follow the same

process for development, review and publication as described in steps f through j. If a revision is not

warranted, the Task Group must recommend a new sunset date or removal of the MPPG. l. The Subcommittee will review the recommendation to sunset or revise an MPPG and make a

recommendation to the Clinical Practice Committee. Final approval to sunset or revise will be the

purview of the Professional Council. m. Other societies (e.g., ACR, ASTRO, COMP, ACRO, SNM) will be invited to co-sign any new or revised

MPPG when they have collaborated in its development. Such co-signatory status must be approved

in writing by the leadership of the relevant society for each MPPG prior to Professional Council’s vote. n. All societies and, in particular, practice accreditation organizations, will be encouraged to reference the

published MPPG.

15 15

15 15

AAPM Newsletter

September/October 2011

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

Report of Activities at the Conference of Radiation Control Program Directors Meeting May 16-19, 2011 - Herb Mower, Liaison and Lynne Fairobent, Staff

T

he CRCPD 43rd Annual Meeting was held in Austin, Texas. Once again, immediately prior to the meeting, there was an AAPM Training Session. This year the session was devoted to computed tomography and included ‘hands-on’ activities for the enrolled state inspectors.

Approximately 85 state inspectors participated in the training. Melissa Martin and Lynne Fairobent coordinated this activity. Next year we will be presenting a similarly structured program relative to radiation oncology. AAPM members participating in this year's training were: Douglas Pfeiffer, Keith Strauss, Thomas Payne, A. Kyle Jones, Melissa Martin, Tom Ruckdeschell, and Mike Tkacik.

Once again the medical physics community was well represented at the meeting with the following also taking part as speakers and/or authors: Gary Ezzell, Lynne Fairobent, Benedick Fraass, Joel Gray, Ileana Iftimia, Melissa Martin, Herb Mower, Thomas Payne and Keith Strauss.

The Gerald S. Parker Award was presented to Debbie Gilley of the Florida Department of Health, Bureau of Radiation Control. Debbie is well known to many of us in the AAPM and ACMP as she has participated in several of our meetings and is a member of GRAC. We have also worked with Debbie on various CRCPD committees and working groups. We all join in congratulating Debbie on this deserving award.

This year Tom Payne presented the John C. Villforth Lecture, giving an excellent review of “CT Scanning and Patient Dose – Past, Present, and Future.” The presentation was entertaining and an excellent review of the life of CT scanners.

Debbie Gilley receiving Gerald S. Parker Award

Robert Lewis of the NRC noted that the NRC is currently considering potential revisions to Part 20.

The theme for this year’s meeting was: “Synergy of Strategic alliances in Radiation Protection.”

Presentations ranged from industrial concerns, inter-agency cooperative efforts, medical events and the Japan power reactors following this year’s earthquake and tsunami. The NRC commented on the

16

AAPM Newsletter

September/October 2011

continued - Legislative and Regulatory Affairs importance of maintaining good communication between various groups especially since some, as the NRC itself, have a very high staff turnover rate.

Of particular interest to board certified medical physicists, the CRCPD on-line registry of board certified physicists is expected to go on-line this July.

Members of the CRCPD mentioned several times their appreciation of the close relationship with the AAPM and their hopes that this would continue into the future. Over the years the medical physics community has participated in the pre-meeting training sessions, served as consultants on the various working groups, SRS task groups and committees and presented several papers at CRCPD meetings. This is indeed a worthwhile effort of the AAPM and one that we need to support in future years.

NRC Issues Final Draft Safety Policy Statement – Lynne Fairobent The Nuclear Regulatory Commission has issued its final safety culture policy statement that sets forth expectations that, individuals and organizations involved in NRC-regulated activities establish and maintain a positive safety culture proportionate to the safety and security significance of their activities. The statement reinforces the NRC’s emphasis on a “safety-first” focus but is not a regulation and, as such, does not impose requirements.

“The development of the Safety Culture Policy Statement is a testament to the strength of a shared commitment to safety,” said Chairman Gregory B. Jaczko. “The Policy Statement was developed with the input of a broad spectrum of stakeholders, ranging from our licensees to public interest groups. By proactively engaging the public and our stakeholders at an early stage, we have been able to take a substantial step forward in promoting and maintaining safety and security at our nation’s nuclear power and fuel cycle facilities, and in the security and usage of nuclear materials.”

Safety culture refers to an organization’s collective commitment, by leaders and individuals, to emphasize safety as an overriding priority to competing goals and other considerations to ensure protection of people and the environment. NRC believes that the policy statement complements agency regulations and guidance.

The Commission expects the regulated community to take the necessary steps for promoting a positive safety culture by fostering the nine traits as they apply to their specific activities. A trait, in this case, is a pattern of thinking, feeling, and behaving that emphasizes nuclear safety. The traits are: 1. Leadership Safety Values and Actions – Leaders demonstrate a commitment to safety in their decisions and behaviors; 2. Problem Identification and Resolution – Issues potentially impacting safety are promptly identified, fully evaluated, and promptly addressed and corrected commensurate with their significance; 3. Personal Accountability – All individuals take personal responsibility for safety; 4. Work Processes – The process of planning and controlling work activities is implemented so that safety is maintained; 5. Continuous Learning – Opportunities to learn about ways to ensure safety are sought out and implemented; 6. Environment for Raising Concerns – A safety-conscious work environment is maintained where personnel feel free to raise safety concerns without fear of retaliation, intimidation, harassment, or discrimination; 7. Effective Safety Communication – Communications maintain a focus on safety; 8. Respectful Work Environment – Trust and respect permeate the organization; and 9. Questioning Attitude - Individuals avoid complacency and continuously challenge existing conditions and activities in order to identify discrepancies that might result in error or inappropriate action.

Additional information about the policy statement, including relevant background documents, meeting notices and presentations made at public meetings, as well as other outreach activities,

17 17

17 17

AAPM Newsletter

September/October 2011

continued - Legislative and Regulatory Affairs is located on the NRC’s public website at: http://www.nrc.gov/about-nrc/regulatory/enforcement/safety-culture.html.

This website will also have tools that support the policy statement, including a brochure and case studies, in the near future.

Congratulations to the new Class of ACR Physic Fellows: The following medical physicists were honored by the American College of Radiology as part of the 2011 Class of Fellows:

Donovan M. Bakalyar Peter D. Esser Martin W. Fraser James M. Galvin

18

Ralph P. Lieto Donald J. Peck Jerry Soen George Starkschall

AAPM Newsletter

September/October 2011

ACR Accreditation

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

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

Q. May we submit cases with “stacked ” or “interleaved ” sequences for accreditation?

A. The ACR ’s Committee on Breast MRI Accreditation prefers that each sequence be presented separately and not as “stacked ” or “interleaved ” sequences. (Contact your MRI manufacturer representative for assistance). If your manufacturer informs you that it is impossible for your equipment to present the sequences separately, we will accept them. However, reviews may be delayed due to the difculty of reviewing these cases.

Q. My unreviewed accreditation cases were returned to me because the “disc would not open within 2 minutes. ” What can I do to provide discs that will open under 2 minutes?

A. The ACR requires that discs submitted for accreditation open to show the patient images within 2 minutes in order to prevent any delay of your accreditation reviews. (ACR reviewers have reported that they have spent up to 10 minutes waiting for discs to open before they can review some cases; this signicantly impacts the number of cases they can review.) The most common reason causing the delayed opening is that facilities burn the entire exam on the disc rather than only the requested sequences. ACR staff checks each disc submitted for accreditation on a modern, powerful PC to ensure that images open within 2 minutes before sending them to the reviewers to score.

In order to minimize the time it takes to open a disc, we recommend the following: •

Only submit the 4 requested sequences (1. T2-weighted/bright uid, 2. Pre-contrast T1, 3. Early phase (rst) post-contrast T1, and 4. Delayed phase (last) post-contrast T1) along with the scout/localizer. If you are unsure how to provide only the requested sequences, please contact your equipment manufacturer or your PACS vendor if you are burning the discs via PACS. (ACR staff cannot assist you with this since this process is different for every manufacturer; we also do not want to provide wrong information that may apply to one manufacturer and not another.)

•

Open and check each disc on a different computer to make sure it opens to display images within 2 minutes and the embedded viewer displays all required exam identication and labeling information (or they are easily accessed through the DICOM header).

Q. Must the images provided for Breast MRI Accreditation be in a DICOM format?

A. Yes, the images must be in a DICOM format without compression. Other formats (JPEG, BITMAP, etc.) are not acceptable. ACR reviewers look at the DICOM information to aid them in determining if the cases submitted meet the accreditation program ’s requirements.

Q. With our system, the only way we can burn a disc with the images in a DICOM format is from the equipment ’s workstation. However, our equipment manufacturer informs us that they cannot embed a viewer from the workstation. We can embed a viewer on the

19 19

19 19

AAPM Newsletter

September/October 2011

continued - ACR Accreditation disc if we burn it via our PACS. However, our PACS vendor informs us that we cannot burn images in a DICOM format; it only burns images in a JPEG format. What should we do?

A. Under these special circumstances, you must submit the cases in a DICOM format, even if you cannot embed a viewer on your disc. The ACR reviewers will evaluate the cases with a separate viewer. Please include a note with the submitted cases that you were unable to embed a viewer on the disc so that the disc is handled appropriately.

2011 Joint Young Investigators Symposium The John R. Cameron - John R. Cunningham Young Investigators Symposium a competition for new investigators within a special symposium in honor of Dr. John Cameron and Dr. John Cunningham Congratulations goes to......

1st place: Melissa Hill of the Sunnybrook Research Institute for her abstract: Dual-Energy Contrast-Enhanced Breast Tomosynthesis: Signal Response to Tissue Contrast Uptake Kinetics 2nd place: Matthew Webster of the University of California – San Diego for his abstract: Dynamic Modulated Brachytherapy (DMBT): Concept, Design, and Application 3rd place: Irina Vergalasova of Duke University for her abstract: A Novel Technique for Markerless Self-Sorted 4D-CBCT

Complimentary Registration Winners!

This year during the 2011 AAPM/COMP Annual Meeting there were two opportunities for attendees to enter to win "complimentary registration" for the 2012 AAPM Annual Meeting to be held in Charlotte, NC next summer.

Congratulations goes to......

New Member Symposium Winner: Corey G. Clift of Monteore Medical Center Visit the Vendor Winners: Martha Moore of Midwest Radiation Physicists Jessica Clements of Texas Health Presbyterian Hospital Dallas Ingrid Marshall of Medical University of South Carolina

20

AAPM Newsletter

September/October 2011

Report on the 2010 AAPM International Scientic Exchange Program (ISEP) Adel Mustafa, New York Medical College Director, ISEP 2010 Jordan Advances in Diagnostic and Therapeutic Physics Amman, Jordan • October 7 – 10, 2010

T

he AAPM/ISEP meeting on Diagnostic and Therapeutic Physics was held in Amman, Jordan during October 7th-10th, 2010. The venue was the Landmark Hotel in Amman City Center.

The program was sponsored by the AAPM - ISEP. Local sponsorship was provided by Jordan ’s King Hussein Cancer Center (KHCC) and Jordan Association of Physicists in Medicine (JAPM).

The objectives of this course were to present current state of the art in diagnostic and therapy physics: technology, medical applications and future trends. The target audience is medical and health physicists, radiologists, radiation oncologists, academics interested in the applications of physics in medicine, radiologic technologists, radiation therapists, students and allied healthcare professionals. Another major objective of this activity was to raise the professional prole of medical physics in Jordan and the region by increasing the visibility of their national medical physics organizations.

There were over 130 attendees from countries in the region, namely Iraq, Palestine, Lebanon, Saudi Arabia, United Arab Emirates, and the host country Jordan. Iraq ’s representation was the highest after that of Jordan.

Dr. Mahmoud Sarhan, President and CEO of King Hussein Cancer Center was honorary Chair of the local arrangements committee, while Dr. Shada Ramahi, the Chief Physicist at KHCC was the local chair and program director. The AAPM faculty included Drs. Robert Gould (UCSF), Moyed Miften (U. Colorado, Denver), Muthana Al-Ghazi (U. California, Irvine), Bruce Thomadsen (U. Wisconsin, Madison), Arthur Boyer (Texas A&M School of Medicine), Issam Al-Naqa (McGill University, Canada) and me, Adel Mustafa (NYMC).

The program schedule was made in collaboration with the participating faculty. Dr. Muthana AlGhazi was instrumental in helping me with directing the therapy section and with recruiting the therapy faculty. Dr. Shada Ramahi was the corner stone in making an outstanding implementation of the program scientic and organizational aspects. The program consisted of 32 presentations given over four days, almost equally divided between diagnostic and therapy physics. The daily program started at 8 AM and ended around 5 PM with time for breaks and discussions. Details of the program, including lecture topics, speakers and members of the organizing committee are attached with this report. Each of the attendees was given a CD containing PDF les of the presentations in addition to other useful material suggested by several speakers.

The opening ceremony was chaired by Dr. Mahmoud Sarhan, a nationally renounced medical oncologist, President and CEO of KHCC. The AAPM introductory remarks were presented by the author of this report and a photo opportunity followed. The AAPM attendance certicates were distributed at the end of the program.

Coffee and lunch breaks were opportunities for attendees to interact with faculty informally.

Arrangements were made for AAPM faculty to visit KHCC. An impressive regional cancer center with the latest cancer care technology certied by the International JCAHO. The social program was impressive and was very much appreciated by the participating faculty who felt the generosity of our Jordanian hosts.

Towards the end of the meeting and for weeks following that I received many positive remarks from the local organizers and participants. The participants asked if this could be repeated every other year! Special thanks to the AAPM and the speakers who carried the AAPM torch to such far lands.

21

21

21 21

TM

$OSIMETRY 3ERVICES $IVISION

22

©

JOTUBEPTF

©

JOTUBEPTF

©

JOTUBEPTF

JOTUBEPTF

JOTUBEPTF

©

September/October 2011

©

AAPM Newsletter

AAPM Newsletter

September/October 2011

Report on the 2011 AAPM International Scientific Exchange Program (ISEP) George Kagadis (Host Co-Director) Eugene Lief (AAPM Faculty)

Diagnostic Physics Course Patras, Greece • June 17-20, 2011

T

he AAPM-ISEP workshop in Diagnostic Physics was held on June 17-21, 2011 at Patras University in Patras (Greece). The course organizers were Prof.

George Nikiforidis and Prof. George Kagadis from the Univeristy of Patras, Greece (local organizers) and Prof. Mahadevappa Mahesh (AAPM-ISEP). The main topics included Medical Imaging and its Quality Metrics, Digital Imaging, Imaging Modalities, Patient Dose and its Reduction, Radiation Safety, Image Display and Perception, Nuclear Medicine, Shielding Calculation, Quality Control, and Medical Physics Certification. Nearly 21 hours of academic material were delivered at Patras Photograph 1:AAPM faculty: Mahadevappa Mahesh, House of Sciences Center – new and beautiful building Habib Zaidi, William Hendee, Tony Seibert, Eugene with interesting scientific exhibits. There was also a visit Lief and Don Frey (Left to Right on Bottom Row) to the Patras University Hospital where the attendees with local hosts and co-directors George Kagadis were shown the classic and modern clinical equipment. and George Nikiforidis (First and Sixth from Left More than 90 participants registered for the course (Photo on Bottom Row respectively) with some of the 1). Their experience range was very broad; from students workshop attendees. to senior physicists. They represented 10 countries of Europe, Asia, and America. The course faculty were Distinguished Professor William Hendee from Medical College of Wisconsin, Professors Donald Frey from Medical University of South Carolina, Anthony Seibert from the University of California Davis, Mahadevappa Mahesh from Johns Hopkins University School of Medicine, Drs. Habib Zaidi from Geneva University Hospital and Eugene Lief from White Plain Hospital – Marsden Medical Physics.

The faculty had a difficult task of giving talks interesting to a broad spectrum of Diagnostic Physicists attending the course. Nevertheless, the course reached its goal. The lectures were well-attended and were highly interactive. The attendees asked many questions and continued to communicate with the faculty and with each other in their free time. Many participants were interested in CAMPEP credits which were offered to them. The University of Patras has well-established traditions in Medical Physics. Several University Rectors were Medical Physicists, including Professor G. Panayiotakis who is Rector now. One of the organizers of this course Professor Nikiforidis has served as a Dean of the School of Medicine. Several world-famous physicists had been working here. The world-famous graduate program here awards 12-15 MS degrees and 6-8 PhD diplomas in Medical Physics annually.

Unfortunately, during the course one of the world legends in Medical Physics, Professor Emeritus Basil Proimos, died in a car accident at his home town on the island of Crete. This sad news along with Professor Proimos short biography and achievements were announced to the participants to the participants by Professor Nikiforidis.

Photograph 2: AAPM President Tony Seibert, William Hendee, Mahadevappa Mahesh with the local hosts and co-directors of the workshop Dr George Kagadis and Prof George Nikiforidis after presenting special recognition plaques.

Overall, the course was a success. The material was comprehensive and relevant to the needs of practicing medical physicists. Communication between the participants and faculty was very efficient. The social program included an opening reception and a gala dinner. Transportation between the hotel and the Science Center was perfectly arranged. All that was possible because of tireless efforts of local organizers: Professor George Nikiforidis and Professor George Kagadis from Patras University. Their work was appreciated by the AAPM and was acknowledged by special plaques provided to the local organizers by the AAPM (Photo 2).

23

23

23 23

AAPM Newsletter

September/October 2011

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

2012 Proposed Rule Provides RVU Decreases to Majority of Radiation Oncology Codes and Expands Radiology MPPR Policy The Centers for Medicare and Medicaid Services (CMS) recently released the 2012 Medicare Physician Fee Schedule (MPFS) proposed rule. The MPFS species payment rates to physicians and other providers, including freestanding cancer centers. Changes in payment for hospitalbased outpatient facilities are described in a second article below.

The most widespread specialty impact of the relative value unit (RVU) changes to the majority of radiation oncology procedure codes is related to the current "bottom-up" practice expense methodology that utilizes the AMA Physician Practice Information Survey (PPIS) data. CMS is implementing the third year of the 4-year transition to new practice expense RVUs using the AMA PPIS data, which reduces RVUs for the majority of radiation oncology codes. This CMS policy has a negative 4 percent payment reduction to total radiation oncology payments and 5 percent payment reduction to radiation therapy centers. The policy has a redistributive effect on Medicare payments, which favors primary care specialties.

In the 2012 proposed rule, CMS is signicantly expanding the potentially misvalued code initiative.

CMS proposes to consolidate the existing formal ve-year review of work and practice expense with an annual review of potentially misvalued codes. This year, CMS is focusing on the highest volume and dollar codes billed by physicians to determine whether these codes are overvalued and if evaluation and management codes are undervalued. CMS has selected the highest expenditure procedural codes for radiation oncology for review and possible re-valuation in 2012/2013. These include: • 77014 CT guidance for placement of radiation therapy elds • 77301 IMRT planning • 77421 Stereoscopic X-ray guidance In 2006, CMS implemented the multiple procedure payment reduction (MPPR) to the technical component (TC) of certain diagnostic imaging procedures. Effective January 1, 2012, CMS proposes to expand the MPPR policy to the professional component (physician image interpretation) of advanced diagnostic imaging services. This proposal has a signicant negative impact to diagnostic CT, CTA, MRI, MRA and ultrasound payments, whereby the rst procedure with the highest payment receives 100% Medicare reimbursement; and only 50% reimbursement for the second and subsequent procedures provided in a single imaging session. This CMS proposal primarily reduces payments to the specialties of radiology and interventional radiology. CMS estimates that this policy would reduce payments for these diagnostic imaging services by about $200 million, which would be redistributed to other services paid under the MPFS. Lastly, based on the currently awed sustainable growth rate (SGR) calculation, CMS estimates a 29.5 percent reduction to the current 2011 conversion factor of $33.98. Without legislative action, CMS estimates a 2012 conversion factor of $23.96. AAPM anticipates that Congress will avert the payment decrease slated for January 1, 2012, however, if Congress does not pass legislation the 2012 conversion factor would reduce all payments by an additional 29.5 percent to the impacts shown on the next page.

AAPM will submit comments to CMS by the August 30th deadline. To read a complete summary of the proposed rule and to review impact tables go to:

24

AAPM Newsletter

September/October 2011

continued - Health Policy/Economic Issues Specialty

Radiation Oncology Radiation Therapy Centers Radiology Total

Impact Work & Malpractice RVU Changes 0%

Impact Practice Expense RVU & MPPR Changes -4.0%

2012 Combined Impact

0%

-5.0%

-5.0%

-1.0% 0%

-2.0% 0%

-4.0% 0%

(Does not include -29.5% CF reduction)

-4.0%

(budget neutrality)

http://aapm.org/government_affairs/CMS/2012HealthPolicyUpdate.asp The nal rule will be published by November 1st, with an effective date of January 1, 2012.

2012 Policies & Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) recently released the 2012 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The projected increase in payment rates for hospital outpatient services, other than those of 11 designated cancer hospitals, is 1.1 percent for 2012.

Many of the radiation oncology procedure codes have slight payment reductions proposed for 2012, with non-prostate LDR brachytherapy APC 651 realizing a 23.3% decrease. Medical physics codes 77336 & 77370 in APC 304 receive a 0.7% decrease in 2012 payments (see table on the next page).

As can be seen, 77338 (MLC IMRT treatment device) will receive a 72.3% payment decrease due to its reassignment to APC 305.

New 2012 CMS proposals include: •

Apply a payment adjustment to 11 designated cancer hospitals, which results in an aggregate 9% increase to the 11 cancer hospitals and a 0.6% reduction to payment rates to all noncancer hospitals to ensure budget neutrality.

•

Establish an independent advisory review process through the existing APC Advisory Panel to review stakeholder requests for assignment of supervision levels other than direct supervision for outpatient hospital therapeutic services.

Maintain existing key policy proposals in 2012 to: •

Continue to pay separately for each of the brachytherapy sources on a prospective basis, with payment rates to be determined using the 2010 claims-based median cost per source for each brachytherapy device.

•

Continue packaging of radiation oncology imaging guidance services.

•

Continue composite APC payments for low dose rate prostate brachytherapy and multiple imaging procedures, including computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography and ultrasound.

A complete summary of the proposed rule and impact tables is on the AAPM website at: http://aapm.org/government_affairs/CMS/2012HealthPolicyUpdate.asp AAPM will submit comments to CMS by the August 30th deadline.

The nal rule will be published by November 1st, with an effective date of January 1, 2012.

25 25

25 25

AAPM Newsletter

September/October 2011

continued - Health Policy/Economic Issues SUMMARY OF 2012 PROPOSED RADIATION ONCOLOGY HOPPS PAYMENTS APC

Description

CPT Codes

2011 Payment

65 66 67 127 299

Level I SRS Level II SRS Level III SRS Level IV SRS

G0251 G0340 G0173, G0339 77371

Hyperthermi a& Radiation Treatment

77470,

Level I Radiation Therapy Level II Radiation Therapy

300 301

303 304

305

310

312

Treatment Device Construction Level I Therapeutic Radiation Treatment Prep Level II Therapeutic Radiation Treatment Prep Level III Therapeutic Radiation Treatment Prep Radioelement Applications

313

Brachytherapy

412

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

651

664 667 8001

$977.12 $2504.67 $3408.69 $7661.15 $388.58

2012 Proposed Payment $864.37 $2446.76 $3250.79 $7367.50 $389.40

Percentage Change 2011- 2012 -11.5% -2.3% -4.6% -3.8% 0.2%

77401-77407, 77789

$97.82

$94.61

-3.3%

77408, 77409, 77411-77416, 77422,77423, 77750 77332-77334

$160.54

$164.39

2.4%

$199.71

$193.75

-3.0%

77280, 77299 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77315, 77321, 77327, 77328, 77338 32553, 49411, 55876, 77295, 77301, C9728

$104.48

$103.76

-0.7%

$271.61

$256.92

-5.4%

$926.74

$919.54

-0.8%

77761, 77762, 77763, 77776, 77777, 77799 77785, 77786, 77787, 0182T 77418, 0073T

$354.95

$326.37

-8.1%

$700.10

$684.89

-2.2%

$438.22

$447.22

2.1%

77778

$1129.46

$866.08

-23.3%

77520, 77522

$1031.71

$992.37

-3.8%

77523, 77525

$1349.61

$1298.16

-3.8%

55875 + 77778

$3229.24

$3247.18

0.6%

77600-77620

26

AAPM Newsletter

September/October 2011

Publication Notice: Joint Commission: Sentinel Event Alert, Issue 47, August 24, 2011 J. Daniel Bourland Winston-Salem, NC

Radiation risks of diagnostic imaging

O

f interest to the medical physics community is the recent Joint Commission (JC) Sentinel Event Alert, Radiation risks of diagnostic imaging[1]. This important notice from an important organization is well-written, includes input from medical physicists, references appropriate radiological literature, and reviews and cautions the medical community about ionizing radiation dose from diagnostic medical imaging procedures. The Alert's cautions and actions include the five categories of: Right test, Right dose, Effective processes, Safe technology, and Safety culture. The Alert’s recommendations are specific to diagnostic imaging, excluding fluoroscopy and therapeutic radiation, however, in general, the five categories are relevant to all radiological procedures. Medical physicists should review the Alert with their administrators and clinical and technical directors because of the highest priorities for patient safety, the JC’s importance and visibility for credentialing of healthcare organizations, and the widespread use and diagnostic benefits of radiological imaging procedures that impact a large number of patients nationwide.

One reference possibly out of context in the Alert is the application of "ALARA guidelines as required by the Nuclear Regulatory Commission." ALARA guidelines, including those by the NRC[2], are relevant to radiation protection for occupational radiation dose, not to patients receiving dose from medical imaging - these two scenarios should not be confused, though both involve risk-benefit analyses. Medical physicists should review this important difference with administrators who may interpret the NRC ALARA statement in the Alert as a regulation for patient doses received during medical imaging. Of course, ALARA is a very desirable radiation protection philosophy for the individuals who perform medical imaging. And, the Alert is careful to state that too low radiation dose (too few quanta) can lead to reduced benefits in patient care such as poor image quality or repeated imaging studies.

This JC Alert provides the opportunity for the medical physicist to share his unique radiological expertise with administrators, technical and clinical directors, and other colleagues, for the benefit of safe and effective patient care. A thorough review of its action points is recommended.

References: 1. The Joint Commission. Sentinel Event Alert, Issue 47, 2011. http://www.jointcommission.org/sea_issue_47 and http://www.jointcommission.org/assets/1/18/SEA_471.PDF 2. US Nuclear Regulatory Commission: 10 CFR 20.1003. http://www.nrc.gov/reading-rm/basic-ref/glossary/ alara.html

From the Editor: Following the JC alert, American College of Radiology issued a statement confirming the utility of the alert however, highlighted certain inaccuracies issued in the JC alert.

The complete ACR statement on JC’s sentinel event can be found at: http://www.acr.org/ HomePageCategories/News/ACRNewsCenter/ACR-Statement-on-TJC-Sentinel-Alert. aspx

27 27

27 27

AAPM Newsletter

September/October 2011

Yes We Do

TG142

RIT software performs or trends Every Imaging and Dosimetry Test recommended in TG142

Analyze images from your EPID, Film, and Array!

radimage.com

#ALLç çççsççç%MAILçSALES RADIMAGE COM

28

© Radiological Imaging Technology, Inc., August, 2011

AAPM Newsletter

September/October 2011

2010 AAPM-IPEM Travel Grant Report Lu Wang Fox Chase Cancer Center

A

s the recipient of the AAPM-IPEM Travel Award in 2010, I had the honor of visiting several cancer centers and hospitals in the United Kingdom in June 2011. By visiting these prestigious cancer centers and hospitals, I learned about the clinical, research, and educational activities and programs in medical physics in the UK. These visits were very informative, educational, and productive. Throughout my trip, I was warmly welcomed by my UK colleagues at the hospitals and centers.

Christie Hospital in Manchester My trip began with a visit to Christie Hospital. I ew to Manchester on Memorial Day to meet Ranald Mackay and other physicists on June 1. Ronald had arranged for Gareth Webster, the physicist responsible for their stereotactic body radiotherapy program, to be my host during the visit to Christie. Gareth warmly greeted and introduced me to their stereotactic body radiotherapy (SBRT) program. He also gave me a tour of the treatment area. Later, I met with Julia Handley and we discussed volumetric modulated arc therapy (VMAT) and whether it can be used for SBRT. From chatting with Gareth and Julia, I learned that, although their SBRT program is in its early stages, they are diligently working on establishing class solutions for different sites and planning approaches used for the SBRT program. I was quite impressed by their efforts. We discussed extensively the clinical issues of the SBRT approach, such as how to dene an internal target volume by taking target motion into consideration, how much beam margin is appropriate, and the benet of using non-coplanar beams versus coplanar beam arrangement. I also met with two other physicists, Adam Aitkenhead and Chris Boylan, who were highly involved in the early stages of Monte Carlo dose calculation and clinical implementation at Christie. We discussed the efciency of various usercodes and Monte Carlo beam commissioning. Ranald Mackay later took time from his busy schedule to meet with me to discuss our respective research experience in stereotactic radiotherapy.

Later in the afternoon, I gave a talk to their physicists on the clinical implementation of SBRT and the approaches used at Fox Chase Cancer Center. My presentation was well received as indicated by the active discussion following the presentation.

Clatterbridge Centre for Oncology on Merseyside My next stop was to Liverpool to visit Clatterbridge Center for Oncology on Merseyside, where Alan Nahum was my host. I have known Alan and have been familiar with his research work for several years. I recently became very interested in his proposal to customize patient dose and fractionation scheme based on patient normal tissue complication probability (NTCP). In fact, one of the reasons of visiting Clatterbridge Centre for Oncology was to discuss with him the recent developments on radiobiological modelling and to get his advice on applying this research to lung SBRT. It was a great pleasure to meet with him and his research team and to visit the department. He introduced me to his recent research work and to the new software, BioSuite, written by his post doc, Julien Uzan. We discussed the applicability of BioSuite for SBRT dose/ fraction customization analysis and research. We then talked about possible collaboration on the verication of the TCP and NTCP models using our clinical data for SBRT lung cancer patients.

It was a worthwhile visit and I enjoyed the conversation and discussion with him on the above topics.

Subsequently, I met with physicist Alison Scott, who is involved in SBRT implementation, and we exchanged our respective approaches in SBRT treatment planning and treatment delivery verication, as well as clinical research on the use of advanced imaging technology for patient relocalization. I also met with Philip Mayles, the chief physicist at the center, and discussed the recent development in stereotactic radiosurgery and radiotherapy. It was very nice of him to have droved me to the port of Liverpool in order to catch the last ferry.

29 29

29 29

AAPM Newsletter

September/October 2011

continued - AAPM-IPEM Travel Grant Report At noon, I delivered my seminar on SBRT and related research. After the seminar, I met with Julien Uzan and he showed me all the functionalities of BioSuite, a software he developed for TCP and NTCP analysis for dose customization. Another highlight of my visit to Clatterbridge Center for Oncology was to attend Alan Nahum and his group ’s research meeting, which consisted of two Ph.D. students and two post-docs. At the meeting, two Ph.D. students and two postdocs each introduced their research project and gave an update on their work. Alan offered suggestions and advice while I joined the discussion on the use of Monte Carlo dose calculation method for treatment planning verication. It was rewarding to learn about their projects and to see that such a structured and cohesive medical physicist training program can be established between hospitals and universities in the UK. St. James's Institute for Oncology After spending a Saturday in Manchester touring the city and saying my goodbyes, I left for Leeds and visited the St. James's Institute for Oncology on the following Monday, where I was hosted

by Viv Cosgrove, the chief radiotherapy physicist at the center (thanks to David Thwaites for this introduction).

Viv warmly greeted me at the department and introduced to me the hospital and clinical programs.

St. James's Institute for Oncology is housed in a new and spacious facility. I was quite impressed by the fact that each vault pair has a full-sized room attached, so that plan preparation and physician review can be carried out without distraction of the staff in the control areas for the linacs.

The department is equipped with the latest technology and advanced research tools, such as a video camera-based surface rendering system (AlignRT) and cone-beam CT system (CBCT), featuring 4-dimensional (4D) imaging acquisition capability. I enjoyed my discussion with Jonathan Sykes on the application of 4D CBCT for SBRT imaging guidance, as well as possible improvements in future developments. St. James's Institute for Oncology is also one of the rst centers in the United Kingdom to implement the SBRT program. They are treating the largest number of SBRT patients in the UK. It was satisfying to learn that we have much in common in terms of our approach to SBRT and we share similar experiences and concerns about the issues encountered during SBRT treatment, such as target relocalization accuracy, motion management, most desired imaging guidance technique for lung cancer patients, etc. I truly enjoyed visiting their center L - R: Vive, Lu and Jonathan and conversing with my UK colleagues at St. James's Institute for Oncology.

Royal Marsden Hospital in Sutton My next stop was Sutton, to visit the Royal Marsden Hospital and Institute of Cancer Research.

Mike Partridge was the host during my visit to Royal Marsden Hospital. He was very considerate in arranging my visit to coincide with their monthly meeting for lung cancer treatment and research. This was one of the highlights of my visit to Royal Marsden Hospital and it offered me a wonderful opportunity to get a taste of their routine/daily research activities and allowed me to learn their advanced research and treatment paradigm in lung cancer radiotherapy. During the meeting, Gavin Poludniowski, a post doc, presented innovative research work on the use of transmitted uence from a patient ’s daily VMAT treatment delivery for an axial imaging construction and, thus, for daily target localization verication. The physicians, radiation oncology residents, physicists and research associates who are involved in lung cancer patient treatment were all actively engaged in the presentation and discussion. This research idea was very interesting and the discussion very stimulating. From the meeting, I learned that they have been using active

30

AAPM Newsletter

September/October 2011

continued - AAPM-IPEM Travel Grant Report breathing control (ABC) for target motion control, an approach that we have been interested in for some time. I continued the discussion with their physicians and residents on the use of ABC and its applicability and clinical benet for different stages of lung cancer patients. Later on in the day, Fiona McDonald, a radiation oncologist, showed me the entire ABC process while they were treating a lung cancer patient. The discussion and direct experience on the use of ABC were both very helpful toward my goal of implementing the technique in the future.

During my visit to the hospital, I could not help but notice their unique and dynamic research environment. Throughout the day, I enjoyed meeting with various physicists and learning about their research projects funded by the Institute of Cancer Research, which also helps to support a very active post-doctorial program. For example, Mike Partridge and his team are active in functional imaging research and James Bedford is working on the latest clinical innovation – optimized arc therapy. Their enthusiasm toward their research was nothing short of superb and impressive.

My seminar on the SBRT approach and associated research was scheduled at noon and it was a surprise to see the audience lling the conference room so quickly. After my presentation, there were questions and active discussions on the use of 4DCT versus the helical CT images for target denition. It was a rewarding experience to have delivered my seminar in such a dynamic environment.

Later in the day, I had the honor and pleasure to meet and talk with Steve Webb and Jim Warrington. We mainly exchanged information on the treatment technology used at each of our institutions.

These exchanges of theories and practices were both informative and rewarding.

I was excited to have such a wonderful learning experience in RMH in Sutton.

Royal Marsden Hospital in London Later in that week, I visited Royal Marsden hospital in London, where I was hosted by Ms. Carole Meehan, a principle physicist in RMH in London. She gave me a tour of the treatment

area and introduced me to the department ’s new L - R: Mike, Lu, Steve, Jim commissioning processes for the Exactrac gating module and a Cyberknife machine. I met with their physicists briey in the treatment planning area and learned that they have fully implemented IMRT and VMAT for routine clinical usage.

In the afternoon, I gave a presentation to their physics staff and we discussed some clinical issues in the SBRT approaches. It was a very didactic visit to the RMH in London.

Churchill Hospital in Oxford The following week I visited the Churchill Hospital in Oxford. This was an informal visit that was not initially planned. Thanks to Ivan Rosenberg, my mentor when I was a graduate student in Medical Physics at Rush University, I was introduced to Elizabeth Macaulay, who is the chief physicist at Churchill Hospital. She warmly welcomed me for my short visit.

Elizabeth explained their clinical programs and practices. I was impressed by the comprehensive programs, including SBRT and HDR, the physicists provided to the hospital and the effectiveness of the programs. It was also good to learn that we use similar approaches for the SBRT practice and we share very similar experiences. After the introduction, Elizabeth gave me a tour of the physics and treatment areas. The newly constructed and spacious building was a pleasure to tour.

31 31

31 31

AAPM Newsletter

September/October 2011

continued - AAPM-IPEM Travel Grant Report Acknowledgements I would like to thank the AAPM and the Institute of Physics and Engineering in Medicine for the travel grant, which offered me a great opportunity to see and communicate directly with our colleagues in the UK to learn how they conduct clinical research and radiotherapy practices. Each center that I visited was unique, allowing me to learn different aspects of the radiotherapy practice and clinical research. I was impressed by the fact that, in general, our UK colleagues seemed to have more manpower to invest in the implementation of new treatment paradigms. Their diligence and rigorous attitude toward the new implementation was impressing. It was encouraging to see that the practice of radiotherapy is evolving in a similar manner as in the United States, as more advanced imaging guidance technology and arc therapy delivery capabilities are becoming available. It was a wonderful learning and educational experience for me throughout this trip.

I would also like to thank my generous hosts who have made this trip a very informative and wonderful experience. These hosts are: Ranald Mackay and Gareth Webster at Christie Hospital (Christie NHS Foundation Trust or Manchester Cancer Research Center), Alan Nahum and Philip Mayles at Clatterbridge Centre for Oncology on Merseyside, Vive Cosgrove and Jonathan Sykes at St James's Institute for Oncology, Steve Webb and Mike Partridge at the Royal Marsden Hospital in Sutton, and Carole Meehan at the Royal Marsden Hospital in London, and nally Elizabeth Macaulay at Oxford. I truly appreciate their generosity and hospitality in hosting me.

I look forward to any possible opportunity for future collaboration with my colleagues in the UK, especially in imaging guided hypofractionated radiotherapy and biological modeling.

Experimenting with your hiring process?

Finding the right medical physics job or hire shouldn’t be left to chance. The American Association of Physicists in Medicine (AAPM) Career Services site is your ideal recruitment resource, targeting thousands of expert researchers and qualified top-level managers in medical physics, radiation oncology, medical ultrasound, nuclear medicine, clinical medical physics, radiation health, and other related fields worldwide. Whether you’re looking to hire or be hired, AAPM provides real results by matching relevant jobs with this hardto-reach audience each month.

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.

32

AAPM Newsletter

September/October 2011

Physics Today Online Charles Day College Park, MD

A short tour of Physics Today Online hysics Today magazine was founded in 1948 to serve as a unifying force within the physics community at a time of increasing specialization. It continues to do so by informing readers of the latest research in physics, by explaining how physics impacts the wider world and vice versa, and by serving as a forum for the exchange of ideas.

P

Physics Today Online (PTOL) has the same goal —which, I hope, should be evident when you visit the magazine's website (http://physicstoday.org).

The rst thing that catches your eye is likely to be the display of rotating images. The images link to a selection of news stories and feature articles from the current print issue. Although most of Physics Today's print content lies behind a rewall, AAPM members can access the entire print archive for free —right back to the rst issue —by registering on the website.

Below the rotating images you'll nd highlights from departments that make up the Daily Edition. The Dayside is my blog. The topics I cover range all over —and sometimes beyond —the world of physical science. Points of View offers opinion, commentary, and reminiscence. Singularities has news from and about the physics community. Science and the Media takes a critical look at how major newspapers and other outlets cover physics and other sciences.

Those four Daily Edition departments made their debuts last year. Three others have been up and running since 2004. Politics and Policy brings readers up to date about developments in politics and funding of science. News Picks, which you can nd on the top right of the homepage, provides brief summaries of news stories from elsewhere.

Physics Update describes newly published Dade Moeller Gaithersburg MD research.

The Daily Edition also includes three communitysubmitted sections: Obituaries, We Hear That for news from AAPM and AIP's other members societies and an Events Calendar.

Continuing the tour of the PTOL homepage, you'll nd, below the Highlights from the Daily Edition, a window on Physics Today's Facebook page. The four-to-ve daily posts offer short snippets of interest to people whose enthusiasm for the physical sciences is professional, recreational, or both.

In producing PTOL, my colleagues and I strive to meet Physics Today's founding goal in ways that both complement the print magazine and take advantage of the internet's speed, multimedia nature, and interactivity. Besides the website and Facebook page, we also have email alerts and RSS feeds. It's a work in progress. If you have any comments, questions or suggestions, please send me an email at cday@aip.org.

Submissions to Points of View are especially welcome. It's your website too!

Radiation Safety Academy

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

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

For 5 days, you will receive practical information on a variety of topics including discussions of real-world experiences: ! ! ! ! !

Medical licensing Fluoroscopy safety PET/CT programs Brachytherapy Nuclear medicine

! ! ! ! !

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

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

Charles Day is Physics Today's online editor.

Before he joined the magazine's editorial staff in 1997 he was an x-ray astronomer at NASA's Goddard Space Flight Center in Greenbelt, Maryland.

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

Register online or call 800-871-7930

33

33

Las Vegas NV

33 33

AAPM Newsletter

September/October 2011

Persons in the News Frey to be ABR Associate Executive Director for Medical Physics

T

he American Board of Radiology (ABR) appointed G. Donald Frey, Ph.D., its associate executive director for medical physics effective January 2012. Dr. Frey, a professor of radiology for the Medical University of South Carolina in Charleston, has served as an ABR examiner since 1996 and is currently a member of the American Association of Physicists in Medicine (AAPM) Medical Physics Exam Committee and the Physics Maintenance of Certication Committee.

He is a fellow of the American Association of Physicists in Medicine (AAPM), has twice served as president of the Southeastern Chapter of AAPM (SE-AAPM), and is a past president and chairman of the Board of Directors of AAPM. He served as chairman of the AAPM Education Council, has served twice as director of the AAPM summer school, and was director of the European summer school.

SCCT Fellow Award

M

ahadevappa Mahesh became a Fellow of Society of Cardiovascular Computed Tomography.

Mahadevappa Mahesh was recognized as the Fellow of the Society of Cardiovascular Computed Tomography (SCCT) during their annual meeting in July 2011. SCCT stated that “Mahadevappa Mahesh has made an outstanding contribution in cardiovascular disease through cardiovascular computed tomography research, and patient care and is designated a Fellow of the Society of Cardiovascular Computed Tomography ”. Dr Mahesh is actively involved in a number of SCCT activities including radiation committee, basic sciences working group, board certication exam, annual scientic program planning committee and others.

Dr. Mahesh is an Associate Professor of Radiology and Cardiology at Johns Hopkins University School of Medicine and is the Chief Physicist at the Johns Hopkins Hospital. Dr. Mahesh is also a Fellow of the AAPM, ACR and ACMP.

2012 Awards and Honors Call for Nominations and Applications for: William D. Coolidge Award, Marvin M. D. Williams Award, Edith H. Quimby Lifetime Achievement Award, Fellow and AAPM-IPEM Medical Physics Travel Grant

Deadline is October 15, 2011 http://www.aapm.org/org/callfornominations.asp

34

AAPM Newsletter

September/October 2011

Letter to the Editor Dear Editor: As practicing clinical medical physicists, located both within hospitals and working as consultants, we wish to express our concerns over the proposed CT phantom, which consists of three sections, each weighing approximately 30 pounds.

While the concept of this proposed phantom is commendable, and we understand that there is a need in some situations to make dose measurements in such a phantom, it appears that practical realities have been overlooked.

It must be realized that the vast majority of CT scanners in this country are supported by consulting medical physicists. Even those who are located within hospitals are typically spread across several campuses. This reality necessitates frequent moving of phantom. At present, consultant physicists are already obligated to carry both imaging and dose assessment phantoms. Even though the proposed phantom breaks down into three pieces and nominally includes dose and image quality modules, it is not trivial to transport 100 pounds of phantom. Loading, unloading, and transporting these phantoms into facilities will become a major challenge. If other survey work is needed, such as R/F testing, the amount of equipment required may well not even t into a standard sedan.

Weight limits are important. Many medical physics consultant companies may be negatively impacted by requiring the employees to lift and maneuver 100 pounds. Many medical physicists of smaller stature including some female physicists or those with medical conditions may not be able to accomplish this at all. Such a heavy lifting requirement can seriously impact the insurance status of employers, as the risk of injury is greatly increased.

We do not see that there is a need to perform these types of dosimetry measurements in phantom in the eld at all. This is purely an historic holdover that does not add to our ability to quantify the output of a CT scanner. If the manufacturers use this phantom, characterizing and quantifying their system, and provide physicists with those values and the associated air values, the physicists in the eld can easily and condently verify performance of the scanner, using these air measurements for dosimetry estimates. As was stated by Dr. Boone at the ACMP meeting in Chattanooga, it is possible to adequately characterize the beam in air, as we do with all other diagnostic systems.

CT beams are very well understood, and well modeled in Monte Carlo calculations. Such calculations, which are in many ways more dependable than phantom measurements, require air kerma input, not phantom values.

We strongly wish to encourage the careful consideration of the full consequences and practical realities of promoting this phantom design for regular clinical use. Measurements of air kerma and, if necessary, doses in the existing phantoms can be used to qualify that the unit is operating within the manufacture ’s designed outputs. Let the more detailed measurements be made where they belong, with the manufacturers and research institutions. Allow the rest of us to make reasonable measurements in a reasonable manner, using the more appropriate evaluations tools.

Signed, Steven Amzler, Benjamin Archer, James Astarita, Libby Brateman, Dean Broga, Kenneth Coleman, Richard DiPietro, Tyler Fisher, Steven Jones, Melissa Martin, Katie Mavinkurve, Nikolaos Perdikaris, Douglas Pfeiffer, Stephen Steuterman, Kevin Strining

35 35

35 35

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-ofcio) 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: November/December

•

Submission Deadline: October 12, 2011

•

Posted On-Line: week of Nov 1, 2011