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. 6
NOVEMBER/DECEMBER 2011
AAPM President’s Column J. Anthony Seibert, UC Davis Medical Center
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his is my last Newsletter article as your President. It has been a demanding yet very satisfying year. I am honored and thankful for the support and trust of the membership, and very grateful for those in EXCOM, the Board of Directors, the Council Chairs and headquarters staff for giving me assistance and advice throughout the year. Mike Herman has been very gracious and supportive in assisting me with presidential responsibilities. His leadership as Chair of the Board of Directors was the main force in the development of the strategic plan, and his continuing efforts on initiating patient safety and event reporting mechanisms have been fantastic. I am extremely enthused about Gary Ezzell taking over as President, which will bring back a bit more of the “process” needed to effectively run a meeting and to provide the insight and experience of his previous service on EXCOM as Secretary. His interests in forging a workable strategic plan through the Strategic Planning committee as well as reinvigorating the focus on medical physics residencies are well placed; as incoming Chair of the Board, I am looking forward to working with him on these and many other initiatives in the coming year. John Hazle, as incoming President-Elect, brings a wealth of administrative experience and leadership to EXCOM, having served on the AAPM Finance Committee and past president of CAMPEP as two pertinent examples—his vision and clear thinking will undoubtedly keep the initiatives of the AAPM progressing in a positive way. John Gibbons is completing the 3 year term as Secretary – I would like to take Included in this issue: this opportunity to thank him for diligent service, being the voice of reason, keeping EXCOM honest in our deliberations Chair of the Board p. 3 throughout the year, and often taking the role of the devil’s President-Elect p. 4 advocate to help us make our decisions. Beth Schueler steps Executive Director p. 5 into the Secretary position in 2012, and I have the utmost Editor p. 9 confidence that she will continue in the tradition of excellence Science Council p. 10 that John has provided over his tenure. Janelle Molloy, as Education Council p. 11 Treasurer, has implemented some needed changes to the Professional Council p. 13 budgeting process to make it more transparent and objective. Leg. & Reg. Affairs p. 15 In the coming year, her initiatives will continue to be refined. ACR Accreditation p. 18 The fall meeting of the AAPM was recently held from October WPSC Report p. 19 17-20 at the headquarters in College Park. This meeting NPSC Report p. 21 represents the time to advise incoming board members of their p. 23 responsibilities to the members in terms of leadership, fiduciary Health Policy/Econ Issues responsibilities, decision-making processes, and setting future AAPM Spring Clinical Meeting p. 25 p. 26 directions for the association. Congratulations to our newly CT Dose Summit Report indoctrinated board members – we, the membership, very Coolidge Award Introduction p. 27 much appreciate your commitment, and rely on your vision and Coolidge Award Acceptance p. 29 judgment to guide the Association. It is also a time to prepare ORVC Report p. 31 the budget for the coming year, which is the responsibility of
AAPM Newsletter
November/December 2011
continued - AAPM President’s Column the Budget Subcommittee (BSC). This latter effort, headed by Janelle Molloy, was performed in concert with the members of the BSC and the Council Chairs, for the deliberation of budget requests by the Science, Education, Professional, and Administrative Councils. A change is being adopted in the budgeting process to align funding of programs and initiatives by the Councils with respect to the strategic plan. As demonstrated by this initial trial effort at the October meeting and based on feedback from the Council Chairs, there are adjustments that are necessary to make this a more efficient process. An implicit underlying principle in the original development of the strategic plan is to ensure that the projects and initiatives that we do well (e.g., supporting and maintaining the Medical Physics journal) continue. One of the outcomes of the meeting is a directive to the Strategic Planning Committee of the Board to consider these issues and determine the proper course of action in modifying/updating the strategic plan by explicitly including a broader description of AAPM activities and programs. After all, one of the (implicit) strategies is to keep the plan up to date, pertinent, and useful. An improved ability to decide how limited funding can best be allocated to the many worthwhile requests is the desired outcome, with a secondary benefit of identifying those desirable projects that don’t receive funding. The latter is important for future considerations of realigning the strategic plan and for justification of membership dues adjustments in the coming years to ensure the availability of programs that make a positive difference to our members. At the beginning of September, I traveled to Dublin, Ireland to participate in the AAPM/EFOMP Workshop on Optimization and Justification in Radiology and Radiotherapy, at Trinity College. Thanks to Herb Mower for organizing the AAPM side of the event and making the extra effort to coordinate the program with our European counterparts, in particular Wil Van Der Putten. I was also a faculty participant in a round-table entitled, “Future of Medical Physics” during the main meeting of the conference, representing the AAPM vision of our profession. There is much to gain by maintaining an international presence in the medical physics field by exchanging knowledge and ideas, and to be aware of trends and processes that can have a positive (or negative) impact on what we do as medical physicists. My last AAPM local chapter visit this year was to the Ohio River Valley Chapter at their annual fall meeting on October 7-8, in Louisville, Kentucky at the Brown, an elegant and historical destination hotel in downtown Louisville. Michael Gossman, President, and Minsong Cao, President-Elect of the chapter, were outstanding hosts and put together an interesting scientific program of presentations and posters, all of which were superb. Congratulations! David Pickens delivered the James G. Kereiakes keynote address: “CT imaging for diagnosis and therapy treatment planning: How can we ensure that the studies are performed without excessive patient exposure?” – a timely and thorough presentation of radiation dose issues in imaging. Vendor participation at the Chapter meeting was very high, which gave the attendees a chance to interact with a variety of local representatives. All in all, this was a very worthwhile event, and I was very happy to participate. Thanks again to the members of the ORVC! This has been quite a memorable year for me, with many indelible and unforgettable highlights of representing the AAPM at locales near and far, and in particular the Vancouver annual meeting. The wonderful camaraderie and support by my fellow medical physicists and AAPM headquarters staff is sincerely appreciated. I hope to see many of you at the annual Radiological Society of North America meeting in Chicago, November 27- December 2 (the Board meeting is scheduled on Wednesday November 30). As always, please write to me if you have any questions, concerns, or suggestions regarding our AAPM.
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AAPM Newsletter
November/December 2011
AAPM Chair of the Board’s Column Michael G. Herman, Mayo Clinic
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nd so it goes, my time on the AAPM Executive Committee is coming to an end. It has been a privilege and an honor to serve among the leaders and members of this organization. I am continually humbled by the effort that many medical physicists dedicate to their practice, their students, their labs and this profession we have weaved so fully into our lives. Together we do make a difference in the safety, quality and efficacy of patient care. We are leaders in techniques, science and technology for imaging and therapy and we set examples for the development of the profession of medical physics worldwide. The experience of participating in the leadership is a reward that comes from the collaborations, partnerships, successes and challenges that our profession offers. We have seen a time where the technology and procedures we are responsible for have become ever more powerful and complex. Although we carry out millions of procedures safely each year, the combination of humans and technology presents conditions that allow some errors to occur that sometimes injure a patient or other person. While these events are few, they demonstrate our continuing need for vigilance and improvement. We continue to work within our ranks and in cooperation with other societies, industry, regulatory and accreditation bodies and with state and federal agencies to improve the patient care process. We believe that qualified individuals in adequate staffing numbers, following best practices will make a difference. The AAPM Board of Directors adopted a new mission statement – to advance the science, education and professional practice of medical physics. We developed the AAPM strategic plan, a living set of objectives and strategies to achieve the AAPM mission. This plan is monitored by a standing strategic planning committee of the AAPM board. We see our profession maturing with the joining of ideals of the American College of Medical Physics and the AAPM. We are now approaching the day when qualified medical physicists in clinical practice will follow a well defined educational pathway that culminates in an accredited clinical residency and board certification. I hope you will consider participating in additional activities beyond your daily clinical, academic or professional responsibilities. In particular, consider engaging in activities that support the vision, mission and goals of the AAPM. I would like to thank each of you for providing me the opportunity to serve our organization and for working with me over the years.
The American Association of Physicists in Medicine cordially invites you to attend the AAPM Tuesday Evening Reception at RSNA during the 2011 AAPM / RSNA Meeting Tuesday, November 29, 2011 • 6:00 pm - 8:00 pm Waldorf Room, Chicago Hilton • Chicago, Illinois light hors d’oeuvres
AAPM gratefully acknowledges the following co-sponsors for their contributions to this reception:
RTI Electronics, Inc.
Unfors Instruments, Inc. 3 3
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VIDAR Systems Corporation
AAPM Newsletter
November/December 2011
President-Elect’s Column Gary A. Ezzell, Mayo Clinic Scottsdale
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eing President-Elect involves some travel. So far I have spoken at seven chapter meetings, choosing to focus on major AAPM initiatives that are underway. I have also tried to highlight some opportunities and challenges that we have yet to confront. These visits are not only for me to talk; each is also a chance to hear people’s concerns. One topic that has repeatedly arisen in various forms relates to consequences of requiring residencies for ABR certification. People have spoken about the difficulties that MS-prepared graduates have in finding residencies, about the difficulty in recruiting postdocs, and about the fundamental problem of how to create enough residencies. This is a real and significant “growing pain” for our profession. For humans, growing pains are natural events that pass with time. For our profession, the analogy in not perfect: this is a problem that we need to actively work to solve. The primary challenge is to take the money that has been available for on-the-job training and direct it into residencies. People who run clinics understand hiring young talent and training them, and they understand hiring physicians for whom residencies are a well-established and funded prerequisite. In order for medical physics to transition from an OJT norm to a residency norm, we need to create structures that make it reasonably easy for clinics that plan to hire a new graduate to do it by funding a residency. Not all will do that, and not all need to because the number of residencies is in fact growing, especially in therapy. But we will not likely meet the full demand unless we can create more hub-and-spoke residency structures, in which a regional center can provide much of the administrative infrastructure and some specialized training opportunities, while other nearby facilities house and fund most of the residents’ activities. The problem is mostly one of incentives. People need incentives to spend the time and energy to create these relationships and agreements, which may also require transcending competitive barriers. It is not easy to persuade people to invest in the future. The incentive will build as we all start to internalize that medical physics residency is as permanent and needed as physician residency, and that the availability of qualified, board-certified physicists in the nottoo-distant future depends on our creating these structures and agreements soon. AAPM has a role to play in this. On the local level, we can work through our chapters to create hub-and-spoke structures. On the national level, we can collect and distribute information from groups that have created successful residency models. AAPM has already helped to support the creation of an imaging residency based in a consulting group and can provide details. I think we need to do more, but “we” is a personal pronoun. We will make this happen by real people stepping up and leading with their creative energies. AAPM is our means of organizing collective efforts. In our ever more connected and constrained world, successfully adapting will more and more require that we work together. Ours already is a highly collaborative and participatory structure. We have the means; we now need the focus.
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AAPM Career Services
AAPM’s all-new online Career Services site now has a mobile version available! Search for career, training, and residency positions between appointments, while waiting for an airplane… basically from anywhere you have a wireless signal. Scan this QR code with your iPhone or Android smartphone to take a peek at the exciting medical physics employment opportunities available right now!
AAPM Newsletter
November/December 2011
AAPM Executive Director’s Column Angela R. Keyser, College Park, MD AAPM events during RSNA 2011 ake plans to join your colleagues on Tuesday, November 29th from 6:00 PM – 8:00 PM for the AAPM Reception in the Waldorf Room of the Chicago Hilton. Thanks to RTI Electronics, Unfors Instruments, Inc. and VIDAR Systems Corporation for their financial contributions to offset the costs for this event.
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Visit AAPM at Booth 200 Lakeside Center - Hall D for information on association programs and membership, latest postings in Career Services, demonstration of the AAPM Virtual Library, the current list of AAPM publications, and to pick up complimentary copies Medical Physics. The most up-to-date schedule for AAPM meetings during the RSNA meeting is available online at: http://www.aapm.org/meetings/rsna2011/ . 2012 Meeting Dates NEW! AAPM will be hosting a Spring Clinical Meeting, March 17 - 20, 2012 in Dallas, Texas. Previously known as the ACMP Annual Meeting, the Spring Clinical Meeting program organizers are hard at work to put together a robust meeting program. The 2012 Summer School, Medical Imaging Using Ionizing Radiation: Optimization of Dose and Image Quality, will be held June 24 – 29 at the University of California, San Diego. The 54th AAPM Annual Meeting will be held July 29 – August 2 in Charlotte, North Carolina. Be on the lookout for emails from HQ as meeting details are posted! Your Online Member Profile This is a reminder to keep your AAPM Membership Profile information up to date by going to http:// www.aapm.org/memb/profile/ and making any changes necessary. Please, upload your picture if you have not already done so. Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy - http://www.aapm.org/org/policies/details. asp?id=287&type=PP) 2012 Dues Renewal 2012 dues renewal notices were distributed in October. You may pay your dues online or easily print out an invoice and mail in your payment. Eighteen AAPM Chapters have elected to have HQ collect AAPM HQ Staff Anniversaries: chapter dues. Make sure to check to see if your Lisa Rose Sullivan 18 years of service chapter is participating. If it is, we hope that Penny Slattery 15 years of service you will appreciate the convenience of paying your national and chapter dues at one time! Michael Woodward 15 years of service Headquarters News I firmly believe that part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high performing association management professionals. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2011. I want to publicly thank them and acknowledge their efforts.
Farhana Khan
13 years of service
Peggy Compton
7 years of service
Noel Crisman-Fillhart
6 years of service
Yan-Hong Xing
5 years of service
Tammy Conquest
4 years of service
Corbi Foster
4 years of service
Jackie Ogburn
4 years of service
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AAPM Newsletter
2012 AAPM Annual Meeting July 29 – August 2, 2012 Charlotte Convention Center Charlotte, NC
November/December 2011
2011 See what’s new in the
AAPM Virtual Library 2011 Joint AAPM/COMP Meeting Vancouver, BC July 31-August 4 Physicists of Note Interviews
December 2011: 2012 Annual Meeting website activated. View the site for the most up to-date meeting and abstract submission information. http://www.aapm.org/meetings/2012AM/ January 18: Website activated to receive electronic abstract submissions.
March 1: Deadline for receipt of 300 word abstracts and supporting data. This deadline recognizes other conference schedules. There will be NO EXTENSIONS OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review. March 21: Meeting Housing and Registration available on-line.
Presented by the AAPM History Committee Vancouver, BC
AAPM Summer School Uncertainties in External Beam Radiotherapy August 4 - 9 Simon Fraser University
Safety in Radiation Therapy A Call to Action June 24 – 25 Miami, FL
ACMP 28th Annual Meeting April 30 – May 3 Chattanoogan, TN
By April 16: Authors notified of presentation disposition.
AAPM Corporate Affiliate - Vendor Presentations
By May 11: Annual Meeting Scientific Program available on-line. June 14: Deadline to receive Discounted Registration Fees. New this year… • Expanded SAMS offerings • John S. Laughlin - Science Council Research Symposium topic: "Imaging of Therapy Response" • New session formats, including debates and panel discussions • Charlotte, the Queen City, is both a charming, walkable town and a cosmopolitan, financial epicenter with unique cultural offerings and entertainment. With its diverse restaurants plus the Levine cultural campus with four new museums just 1 block from the convention center, Charlotte will surprise you!
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Xoft, Inc as presented during the 2011 Joint AAPM/COMP Annual Meeting
Presentations posted in the Virtual Library include: • Streaming audio of the speakers • Slides of the presentations In addition to the online presentations, CD ROMs are also available. To view details, including a list of CD ROM presentations, please visit: http://www.associationarchives. com/SITES/aapm Join the hundreds of other AAPM members who are using the AAPM Virtual Library for their continuing education, research, and information needs. http://www.aapm.org/education/VL/
AAPM Newsletter
November/December 2011
continued - AAPM Executive Director’s Column The AAPM Headquarters office will be closed Thursday, November 24 – Friday, November 25, Monday, December 26th and Monday, January 2nd. I wish you and your loved ones a happy and healthy holiday season. AAPM HQ Team…at your service! Lisa Giove joined the AAPM team in 2005 as the Receptionist. Her hard work and dedication were quickly evident, and she now serves as Senior Executive Assistant and the Executive Director’s right-hand! Lisa supports the Executive Committee and Board on governancerelated projects, maintains the AAPM Policy Manual, handles elections, and manages the headquarters office at various AAPM association meetings. She is also the HQ liaison to AAPM chapters.
L - R: Lisa Giove, Viv Dennis and Noel Crisman-Fillhart
Noel Crisman-Fillhart started her career with AAPM in 2005 as part of the Accounting team. In 2008, Noel transitioned to a new role within the office and is now the Administrative Assistant. In this capacity Noel coordinates the AAPM E-News process and assists with numerous office service functions. Viv Dennis celebrated her oneyear AAPM anniversary early in 2011. As the Customer Service Representative, Viv answers the main phone line, handles general inquiries, and assists with setting up conference calls. She also assists with the Medical Physics journal.
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AAPM Newsletter
November/December 2011
JOB POSTING BY THE NATIONAL COUNCIL ON RADIATION PROTECTION AND MEASUREMENTS (NCRP) FOR PRESIDENT NCRP 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-3095 Attn.: Dr. Jerrold Bushberg, NCRP Senior Vice President (bushberg@NCRPonline.org) Description: President of the National Council on Radiation Protection and Measurements (NCRP). NCRP is seeking candidates for the position of President to replace the retiring current President, Dr. Thomas S. Tenforde. It is expected that the selected candidate will be named in 2012 and will serve as an advisor to NCRP until formal election as President occurs at the Annual Business Meeting. The President of NCRP serves as the leader, chief spokesman, and public representative of the organization. Candidates for this position must have well documented expertise in areas of radiation protection and measurements relevant to meeting the Congressionally mandated objectives of NCRP, and demonstrate a strong record of success in obtaining funding for research projects from federal and private sector sources. A record of successful interactions with representatives of federal agencies and Congressional representatives is highly desired. Prospective candidates must have a doctorate in either the physical sciences or life sciences. Demonstrated experience in scientific and financial management for a period of at least 10 years is essential. The successful candidate is expected to reside in the greater Washington, DC area. Compensation and other terms of employment will be negotiated with the successful candidate. NCRP is an equal opportunity employer that offers an excellent benefits package. Interested candidates should submit a letter of interest and a CV, including a complete description of prior job titles and experience and a list of publications. This information should be submitted to: Dr. Jerrold Bushberg, NCRP Senior Vice President, 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814-3095 (fax: 301-907-8768; e-mail: bushberg@NCRPonline.org). The closing date for this announcement is January 1, 2012.
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AAPM Newsletter
November/December 2011
Editor's Column
Mahadevappa Mahesh, Baltimore, MD
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elcome to the final issue of the 2011 AAPM Newsletter. This was the first full year that the Newsletter was published in electronic format only and I would like to thank all of the Corporate Affiliates who have continued to support the Newsletter. In addition to sending email notifications regarding the availability of the current issue, a second email reminder was also sent to the membership a few weeks after it was posted. Although sending the second notification has slightly increased the viewership, I hope to see even more readership next year. Since this is the last issue of this year, I’d like to thank Ms. Nancy Vazquez, for all of her work on the Newsletter and Ms. Farhana Khan for facilitating the posting the Newsletter on the AAPM website in a timely fashion. I would like to express my sincere thanks to Angela Keyser and the headquarters’ staff, the Newsletter Editorial Board and the Executive Committee for their help and advice. Special thanks to our regular contributors for submitting their articles on time. Finally, I would also like to thank my wife and kids for their cooperation in this task. As this issue arrives to you, we are entering the holiday season and I wish you and your family a very happy holiday season. As always, I look forward to receiving any comments/suggestions related to the Newsletter.
ABR/ACR/RSNA/AAPM/ASTRO/ARS Online Modules on Ethics and Professionalism These education modules were developed by the American Board of Radiology Foundation (ABRF) with educational grants from the Academy of Radiology Research (ARR), the American Association of Physicists in Medicine (AAPM), the American Board of Radiology (ABR), the American College of Radiology (ACR), the American Radium Society (ARS), the American Society for Radiation Oncology (ASTRO), and the Radiological Society of North America (RSNA). They are designed to educate physicists and physicians about the attributes and nuances of ethics and professionalism that are essential to the practice of medical physics, radiology and radiation oncology. Each module is self-guided and includes self-testing features to help the reader assess his or her comprehension and application of the principles and practices described in the module. Each module has been developed by an expert team of individuals and has been peer reviewed for content, quality and clarity. These modules provide a basic understanding of ethics and professionalism issues, including the following topics: • • • • •
Attributes of Professions and Professionalism Physician/Patient/Colleague Relationships Personal Behavior and Employee Relationships Conflicts of Interest Ethics of Research
• • • • •
Human Subjects Research Research with Animals Relationships with Vendors Publication Ethics Ethics of Education
The ABR/ACR/RSNA/AAPM/ASTRO/ARS Online Modules on Ethics and Professionalism are available to AAPM members as part of the benefits of membership. The AAPM has applied to the Commission on Accreditation of Medical Physics Education Program, Inc. (CAMPEP) for 15 MPCEC credits. This activity has been qualified by the ABR for SAM credit in fulfillment of MOC requirements. Please note that credits for these modules will not be automatically transferred to the ABR through the CME gateway. If you are seeking MPCEC and/or SAM credit, you should attest to completion of the module(s) through your ABR Personal Database (PDB). Please print your module(s) completion certificate for your records and for audit purposes. Click here to access modules
Click here to learn more about the modules
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AAPM Newsletter
November/December 2011
Science Council Report John Boone, Sacramento, CA
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o those of you with young children, dinosaurs are no doubt a part of your life. My kids are in college now but back when they were quite young we watched a lot of Land Before Time. We went to museums with the bones of Tyrannosaurus Rex and Brachiosaurus towering above us. Dinosaurs are cool. During my kid’s teen years, we watched Jurassic Park and its sequels about 1000 times. I have always loved dinosaurs, but - sadly, I have become one. I have been vice chair or chair of Science Council for 12 years – two 3 year terms in each position. In a world that is measured in what happened before or after 9/11/2001 – I was vice chair of Science Council before that horrible day. And a dozen years later, this is my last newsletter column. When I was vice chair, my good friend Jatinder Palta was chair. He was the therapy guy, and I was the diagnostic one. It was clear that the entire organization of Science Council was askew, and we completely reorganized the structure of the council, which required changes in the rules and the bylaws in order to achieve symmetry in the structure of Science Council between the therapy and diagnostic programs. This took years. Long ago, the machinations of Science Council were all about approving new task groups and approving the reports of old task groups – largely perfunctory and somewhat boring. But we changed that too, and now Science Council deals with the necessary (and important) administration of committees and task groups in a more efficient manner (conference calls). We have separated the Science Council meeting from the annual meeting and RSNA, and we now have a 2.5 day Science Council retreat at an academic venue (to reduce cost) where we spend most of our time together for strategic planning and blue sky sessions. This change has kept us focused on the future of science in medical physics, acting in a proactive – not reactive, manner. But one of the charges of Science Council is to be responsive to the inquiries of the press and other outside entities, and we have certainly done that in the past few years where radiation dose issues and radiation accidents have been featured in the New York Times and many other news agencies. The press releases and other statements developed by Science Council in some cases required document drafts being circulated at 3 am to keep ahead of the news cycle, vetting statements with Council members and EXCOM in real-time across three time zones. Somewhere along the way the Council chairs were made non-voting members of the AAPM Board of Directors, and that change has led to the tighter integration of all of the Councils into the AAPM leadership structure. It has also led to the recognition by most observers of the important role that all of the Councils play in the activities of the society. EXCOM and the AAPM staff lead the organization day-to-day, for sure, and the participation of the Board of Directors provides a broad foundation of leadership for AAPM activities. The function of the Councils, and for some reason I think this is especially true of Science Council, however, generally occurs below the day-to-day radar of the Board and EXCOM. If EXCOM is comprised of generals, and the elected board members are colonels, the council chairs and vice chairs are lieutenants, closer to the heat of battle - little real authority, certainly expendable, but we ultimately function as minions which help to facilitate the many activities of the AAPM. I thank the members of Science Council during my terms – certainly some of the best scientists that I have had the honor of knowing and working with, and some of the most creative and productive medical physicists that our profession has known. I have learned so much from your collective wisdom. I thank the Professional and Education Council Chairs – sometimes we were placed in the position of advocacies, as we competed for declining resources, but I hold each of you in the highest regards and know that you will continue to help lead the society with passion, intellect and perspective. If Education Council is the heart of the AAPM, Professional Council the pocketbook, and the Administration Council it’s brain, then I see Science Council as the soul of our society. Without Science, the AAPM is just another trade organization representing industries like housewares, real estate, or steel manufacturers. While continuing education is essential and professional stature is vitally important in any field, it is our scientific heritage that transcends mere self-interest and makes the AAPM an organization which provides benefit to society beyond our membership. In my opinion we need to continue to foster our scientific heritage and expand the scientific activities of the AAPM. I am confident that with the outstanding scientists on Science Council and with incoming chair Dan Low’s leadership, Science in the AAPM will be under excellent stewardship in the years to come. Godspeed.
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AAPM Newsletter
November/December 2011
Education Council Report George Starkschall, Houston, TX
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his month’s report is another in the series of reports to describe to you the activities of the committees that make up the AAPM Education Council. We have already had reports from the International Educational Activities Committee and the Medical Physics Education of Physicians Committee. This month I asked Ed Barnes, Chair of the Continuing Professional Development Committee, to describe to you the activities of his committee. Continuing Professional Development Committee - J. Ed Barnes, PhD The mission of the Continuing Professional Development Committee is to organize and develop activities that will contribute to the professional development of the Association’s members. The committee is organized into 5 subcommittees and we will review the activities of each of these subcommittees. The Summer School Subcommittee is chaired by Will Parker. The role of this subcommittee is to organize the content of the annual summer school, select a site for holding the summer school and work with AAPM staff to execute the plan for holding the event. This is a big job and requires people on the subcommittee that have experience with putting these arrangements together. One job of this subcommittee is to select the topic for each school along with the Program Director to organize the program. This year’s school was on “Uncertainties in Radiotherapy” and was directed by Rock Mackie and Jatinder Palta. Next year’s summer school will be on “Medical Imaging Using Ionizing Radiation: Optimization of Dose and Image Quality” and will be held at the University of California, San Diego. The Program Director for next year’s school is Dianna Cody and Cynthia McCollough. Putting on a weeklong school each year requires attention to many details. Leading this effort for the AAPM staff is Karen McFarland. She and other members of the staff do an excellent job of making sure everything goes smoothly. We couldn’t do it without them. We have several members of this committee that have considerable experience organizing the summer school and in particular two individuals, Sherry Connors and Robin Miller serve as consultants to this subcommittee and contribute their knowledge to setting up this important educational opportunity. The RSNA Education Coordination Subcommittee is chaired by Jerry Allison and its job is to organize all of the medical physics educational offerings at the annual RSNA meeting, which they do very efficiently. They organize the content and speakers for several Physics Track Refresher Courses. Individuals taking responsibility for this work are Debra Brinkman, Gina Tourassi and Jerry Allison. The AAPM/RSNA Physics Tutorial for Residents program is put together by Richard Massoth and the AAPM/RSNA Tutorial on Equipment Selection program is organized by Jerry Thomas. In the RSNA Daily Bulletin there are physics Question and Answer sets which are prepared by Sharon White. The RSNA Physics Case of the Day is put together by Chuck Willis. Beth Schuler serves on the RSNA Exhibits Committee as a Liaison to help determine if an exhibit is primarily education or science. Another major effort is to organize the AAPM/RSNA Basic Physics Lecture for the Radiologic Technologist which is ably performed by Doug Pfeiffer. So you can see that many individuals are contributing large amounts of their time to bring all of the physics educational content to the RSNA meeting and we thank them for their efforts. The Online Learning Services Subcommittee is currently chaired by Jeff Limmer. He will be stepping down as chair next year and Charles Bloch will be heading up this effort. This subcommittee’s job is to bring online educational opportunities to the membership by doing the necessary work to convert the material captured on video from the annual meeting and other educational meetings into modules with CAMPEP credit and online SAMs. This is a considerable effort to develop quizzes for the material and get them approved for credit. Association members
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AAPM Newsletter
November/December 2011
continued - Education Council Report can access these educational modules by subscribing to the online educational services when you renew your annual dues. This is a very large subcommittee which is necessary to develop all of the quizzes required. Thanks to everyone involved to make this possible. Jeff Limmer has done a great job building a foundation for an electronic learning resource center that will eventually serve as a resource for the practicing and student/resident medical physicist. Many of our Association members are involved in the Maintenance of Certification program by the ABR and are required to participate in a number of self assessment modules (SAMs). Originally a task group was formed to help to get SAMs approved at the annual meeting. That group has been converted into the Maintenance of Certification Subcommittee and is chaired by Michael Yester and vice chaired by Jeff Garrett. This subcommittee’s focus is to coordinate the approval process and management of SAM’s offered at the annual meeting. They also liaison with the Online Leaning Services Subcommittee to transition the modules online. The requirements for approval of SAMs are intricate and require considerable coordination. Jackie Ogburn leads the AAPM staff support for this activity and does a great job. A new subcommittee is being formed to provide a focused effort on defining the ongoing continuing professional development needs of the Association membership. This effort is being chaired by Brent Murphy. There are several activities on the Association that require a good understanding of what the needs for professional development are so we can bring you the programs and educational opportunities that are most needed. Brent will be putting together the membership of the subcommittee to reflect the varied interests in the Association. This subcommittee will be asking for your input to compile these needs and will then share the results with all the committees and councils that organize educational activities. So you can see the activities of the Continuing Professional Development Committee are extensive. We would like to thank all the Association members serving on the committee itself and these subcommittees and especially to the AAPM staff that support these activities and make all of this happen. We all benefit professionally from these efforts.
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AAPM Newsletter
November/December 2011
Professional Council Report Per Halvorsen, Newton, MA
Budget pressures ust as many of us are actively engaged in the annual budget cycle in our work places, the AAPM is finalizing its 2012 budget proposal this month and the Councils are working with the Budget Subcommittee to prioritize the Association’s activities in order to meet the overall budget constraints. The Board of Directors has the ultimate fiduciary responsibility, of course, and the Board will consider the budget proposal at its meeting in Chicago during the RSNA conference.
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Until then, your colleagues who volunteer on the four Councils are struggling to find an appropriate balance between long-established ongoing priorities and important new initiatives – while constrained to a total budget figure that has not changed in years and represents an effective reduction year-to-year given inflation and increased infrastructure costs. As most of you know, we have debated membership dues increases – and the membership has twice voted to reject ANY increase in the past few years. I have heard some colleagues express that the AAPM is “not spending its money on anything of practical value to me.” That’s an easy charge to level, but I will posit that this is wrong. Do you reference Task Group reports when deciding how to structure your physics program? Have you sent chambers to an ADCL for calibration? Are you a graduate of a CAMPEP-accredited graduate or residency program? Do you have a professional liability insurance policy through the AAPM? Have you found a job or hired a new colleague through the Placement Service? Have you used the Professional Survey to help negotiate a salary with an employer? Do you use the AAPM directory to locate colleagues? Have you attended a Summer School? Have you read the Code of Ethics or sought advice on how to resolve a professional ethics dilemma? I could go on, of course, but it should be clear that we all benefit from the many AAPM programs that exist today. Let’s also remember that we work in diverse practice environments, and the AAPM attempts to serve all these diverse needs on a rather small budget. Though I am a full-time clinical radiation oncology physicist, it is obvious to me that our profession cannot remain strong unless we support medical physicists in research, education, applied science, industry, clinical practice, and yes, public policy and enforcement. This is a broad spectrum of needs, and with such a limited budget we simply cannot fund everything that comes up in conversations starting with “The AAPM should do [fill in your favorite subject]”. Two important points to remember in this context: 1. The volunteers in the AAPM are making a sincere effort to utilize our Association’s resources most effectively – the Council leaders regularly meet and discuss priorities with a collegial spirit. This is not “the battle of the Councils” – it’s “how do we best serve the needs of the profession with the resources available.” 2. Despite everyone’s best intentions, we simply cannot continue with a zero-growth budget and expect that the Association can fund worthy new initiatives without reducing or eliminating support for other worthy, established programs. A zero-growth budget year after year leads to stagnation. If we cannot identify significant new sources of revenue, a dues increase may be the only way to inject additional resources to support the profession’s needs.
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AAPM Newsletter
November/December 2011
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AAPM Newsletter
November/December 2011
Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD
CRCPD Announces the Availability of a Registry to Verify Qualified Medical Physicists s many of you are aware, the AAPM has contracted with the Conference of Radiation Control Program Directors (CRCPD) to establish a registry of Qualified Medical Physicists. CRCPD is a nonprofit organization of state and federal radiation regulators who inspects medical facilities to assure that radiation is being used safely and securely. CRCPD promotes consistency in state regulations and the registry will allow state regulators’ to verify the qualification of medical physicist working in their state.
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The registry provides the solicitor with one stop to look up a physicist who has passed one of five participating boards. Prior to the registry, state and federal regulators depended on copies of board certification; now with a few entries the same regulator can independently validate the credential of the medical physicist for all five boards. The five participating boards are The American Board of Radiology, The American Board of Medical Physics, The Canadian College of Physicists in Medicine, The American Board of Science in Nuclear Medicine and The American Board of Health Physics. Currently no law or regulation in place that compels an employer to hire an individual who is listed on the registry. The QMP registry is a tool that can be used by regulatory agencies and employers to independently verify that the individual has successfully passed a recognized examination in their specialty. It will prevent fraudulent activities with counterfeit certifications similar to what happened in some states several years ago. In addition, in institutionalizes the definition of a Qualified Medical Physicists making it easier to develop regulations and licensure. It’s limitation is that all information comes from the board who certifies the individuals and only if the board certification is revoked will the individual’s name be removed from the registry. As part of the agreement with the CRCPD, the information contained in the registry is received directly from the certifying board and is not manipulated by the CRCPD. If you check your listing and the information is not correct, you should contact the board, not CRCPD to correct the information. You can access the registry by: www.crcpd.org. Status of Strontium/Rubidium Generators At the recent meeting of the Nuclear Regulatory Commission’s (NRC) Advisory Committee on Medical Use of Isotopes, Orhan Suleiman of the U.S. Food and Drug Administration (FDA) reviewed the recent history of events and provided a brief update to the ongoing investigation. Earlier this year, the Department of Homeland Security’s Customs Border Protection identified two patients at two different border entry points who had unexpected and detectable quantities of Srontium-82 and Strontium-85. Once they learned that these patients had had rubidium-82 cardiac imaging scans 2 and 4 months earlier in two different states, their findings were reported to the FDA. Rubidum-82 is a positron emitter used in PET imaging, and has a 75 second half-life. It is actually produced with a generator, not a cyclotron. The parent nuclide is Strontium-82, (T ½ = 25 days), but as part of the production of Sr-82, Sr-85 (T ½ = 67 days) is also present. The two nuclides were identified by their respective gamma emission spectra. Sr-82 is detected from its rubidium-82 daughter (511 annihilation photons and a 776 keV gamma) with which it is in secular equilibrium, while the Sr-85 has a 514 keV gamma. Drug quality standards allow permissible levels of the two strontium nuclides as breakthrough contaminants. After whole body counting at Oak Ridge National Laboratories it was verified that they had exceeded these limits at the time of injection by 40 and 125 times respectively for the Sr-82 and 7 times for the Sr-85. Consequently, the two index patients received radiation absorbed doses of 21 mSv (2.1 rem) and 49 mSv (4.9 rem) effective dose, E, for the two patients. They therefore exceeded the manufacturer’s prescribed label dose of 0.12 rem by 18 and 38 times, respectively. FDA did comment that although there was value in using effective dose for comparing doses from different sources, for medical applications knowledge of the underlying organ doses was essential, and
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continued - Legislative and Regulatory Affairs using effective dose alone inappropriate. Organ doses were not released, since they are still undergoing review. FDA, at this time, continues to rely on the manufacturer’s dose estimates, based on the Oak Ridge whole body counts. To minimize confusion it is important to use the same set of organ dose tables and methodology. There are several organ dose models and tables that can be used. Ironically, using the current manufacturer’s dose estimates the patients should have receives 4.8 mSv each, but using the manufacturer’s own patient insert organ dose table, they each should have received 1.2 mSv. Depending on which table you use you get two very different answers. Unfortunately, high levels of uncertainty are typical in estimating doses from radiolabeled drugs. As a result of these initial investigations FDA issued a Drug Safety Communication on July 15th alerting patients to potential breakthrough contamination if they had a cardiac nuclear medicine scan (http:// www.fda.gov/Drugs/DrugSafety/ucm263112.htm). After FDA met with the manufacturer and shared their mutual safety concerns, the manufacturer, Bracco Diagnostics, Inc., voluntarily recalled the product until the safety issues could be resolved. (http://www.fda.gov/Drugs/DrugSafety/ ucm265278.htm). FDA’s main objectives are to determine the extent of the problem, i.e. are more patients contaminated or is this an isolated incident; and if more patients are contaminated, were any of the radiation absorbed doses higher than the first two index patients. FDA along with the manufacturer is actively investigating the root cause of the problem. In addition to the manufacturer, the two agreement states, Nevada and Florida, are also actively conducting their own investigations. As more information on the status of these generators becomes available, updates will be posted on the Government Affairs page of the AAPM website. ACMUI approves Permanent Implant Brachytherapy Final Report On October 18, 2011, the Advisory Committee on the Medical Uses of Isotopes (ACMUI) unanimously approved the attached Permanent Implant Brachytherapy Final Report. The ACMUI report provides recommendations to NRC staff for consideration in revising the criteria for determining medical events for macroscopic permanent implant brachytherapy procedures. The report can also be found on the ACMUI public website under “Related Information”: http://www.nrc.gov/about-nrc/regulatory/ advisory/acmui.html. The NRC staff will consider these recommendations in the revision to 10 CFR Part 35 currently underway. AAPM Members provide testimony before MA Joint Committee on Public Health on Licensure (MA House Bill - H. 3515) The MA Joint Committee on Public Health held a hearing on October 25, 2011 to discuss House Bill H. 3515, An Act Relative to the Practice of Medical Physics. Testifying were: Per Halvorsen, Martin Fraser and Fred Fahey. After the oral statements were presented, the co-chairs of the committee then proceeded to ask LOTS of questions, all of them relevant and intelligent (e.g., what exactly is a medical physicist, what's our role on the clinical team, scope of practice differentiation from physicians and technicians, "why now - why wasn't this important years ago", can we cite specific cases of patients in Massachusetts being harmed as a direct result of poor medical physics support and how would licensure prevent that, etc). This resulted in a very educational and beneficial discussion between the committee members and us. The one area where Chairman Sanchez seemed skeptical about the bill was on the subject of cost, and how this fits into the bigger picture of health-care reform and cost reduction. We explained the revenueneutral approach, of course, but his contention was that the cost ultimately transfers through to the cost of the patient care. We focused on the fact that medical management of mistakes (recurrent disease, treatment complications) is much more expensive than the cost of getting it right the first time. Overall, our lobbyists, Murray Bevan and Gabrielle Figueroa as well as Martin Nastasia, Director, Government Law & Strategies from Brown Rudnick in Boston (a co-associated firm with Bevan, Mosca, Guiditta and Zarillo) who accompanied our group to give support from the local perspective, felt that the hearing went very well and that the questions from the committee members were a positive sign that they're taking a serious interest in the bill. Other medical physicists present were Herbert Mower and Lindsay Lavoie. Amanda Potter, AAPM staff was also in attendance. Copies of the MA H. 3515 and the testimony are available at: http://www.aapm.org/government_ affairs/default.asp.
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AAPM Newsletter
November/December 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. Is Breast MRI Accreditation available through the ACR’s online application? A. Yes, the online system became available October 10, 2011. It is available at http://www.acr. org/accreditation/Breast-MRI.aspx. Q. We are applying for CT and MRI accreditation and want to apply for Breast MRI at the same time so we can get the 10% multi-modality discount. How do we do this? A. Apply online. The system will automatically calculate your fee to include the discount. Q. Who can supervise the technologist’s 6 months clinical MRI scanning experience? A. The supervision may be performed by a radiologist or technologist who is already qualified in breast MRI. The supervisor should be present to observe and correct, as needed, the performance of the individual being supervised who is performing the examination. Q. All of our MRI technologists perform breast MRI. We do not have sufficient volumes of breast imaging patients for all of our technologists to maintain the ACR-required continuing experience of 50 breast MRI examinations every 24 months. What can we do? A. The continuing experience requirements were set by the members of the ACR’s Committee on Breast MRI Accreditation. They realize that there are low-workload facilities providing important services to their communities and have offered alternative ways to document that staff has adequate experience. For technologists, if 2 persons participate in performing a breast MRI exam, both may count the exam towards their continuing experience. Q. May we submit a case from a patient with implants? A. Yes, as long as the exam is bilateral and the implants are in place with the native breast tissue. Cases from patients who have implants for mastectomy reconstruction should not be submitted. Cases from patients reconstructed with TRAM, latissimus or other autologous tissue flaps (with or without implants) should not be submitted.
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AAPM Newsletter
November/December 2011
Women's Professional Subcommittee Report Laura Cerviño, La Jolla, CA Andrea Molineu, Houston, TX
Women's Professional Subcommittee (WPSC) activities at AAPM/COMP 2011
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he WPSC had two main activities during the AAPM/COMP 2011 annual meeting in Vancouver. The first one was a Professional Symposium organized by Andrea Molineu and Jean Moran. It was held on Tuesday August 2nd and the topic was "Successful Career Strategies in Medical Physics.” The second event was a luncheon organized by Nicole Ranger with assistance from Jessica Clements and Laura Cerviño. Both events were well received. The feedback from the audience was that the speakers at the WSPC Professional Symposium were “funny and charming” and “great mentor(s) for us all.” Winnie Zue, Mary Fox, Maryellen Giger, and Sonja Dieterich all gave insightful and riveting talks about professional issues facing women medical physicists today. The speakers shared pointers for becoming involved in AAPM, ideas for harmonizing life with work and outside activities and responsibilities, and tips for climbing both metaphorical and physical mountains. Note that all of these things can and do apply to both men and women. One of the things that I (Andrea) have already implemented in my professional life is Maryellen Giger’s suggestion to use a light-switch technique to help separate home and work. This technique encourages the individual to set a metaphorical “switch” to either home or work and to stop worrying and thinking about one when the “switch” is set to the other. I admit to having reservations about this in the beginning, but have found that being specific and directed in this way has helped me become more productive and to better enjoy both my home life and my work life. The talks were followed by a panel discussion between the attendees, the presenters, and the moderators. The panel discussion enabled attendees of all experience levels to receive advice from some of the women leaders of our field. The audience was inspired by each of the speakers and everyone learned from the discussion. The Professional Symposium was followed by a networking luncheon for women medical physicists. Luncheon tickets were made available through an open registration process that filled up in less than 2 days. There were about 140 attendants, which included a balanced combination of senior and junior medical physicists, distributed in tables of about 10 women each. The luncheon program started with a welcome address from Nicole Ranger, Co-chair of the WPSC , Dr. Anthony Seibert, AAPM President, Dr. Mary Martel, former AAPM President, and Dr. Jean Moran, Cochair of the WPSC. A break-out session followed with table introduction and discussions. The questions discussed were:
1. What are your professional goals for the coming year and where would you like to be professionally in five years? 2. What challenges do you face as a woman medical physicist and how do you compensate or cope? 3. How can the WPSC serve you and what do you think our priorities should be? Each table had a senior medical physicist as a facilitator for the discussion and a designated scribe to record points of discussion and recommendations.
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continued - Women's Professional Subcommittee Report Common concerns amongst the attendants were the balance between family and work, opportunities for women to be visible within the AAPM, mentoring of young women, and means for family attendance to the annual meeting. We received a tremendous amount of feedback, much of it positive, on the event and have also received suggestions to improve the event for next year. We thank Karen MacFarland and other AAPM HQ staff for their contributions in making this event a success. (L - R): Andrea Molineu, Jessica Clements, Jean Moran, Anthony Seibert, Nicole Ranger, and Laura Cerviño.
The WPSC would also like to thank the facilitators of the discussions.
This event was completely funded by sponsorship. Our sponsors were Varian (Platinum level); Landaurer, RaySearch, Siemens Medical, West Physics Consulting (Gold level); MD Anderson Dosimetry Lab, VisionRT, Pacific Medical Physics, RTI Electronics (Silver level); and Diagnostic Technology Consultants, IsoAid, Unfors (Bronze level). Finally, thank you to those of you who participated and shared your goals, insights, and strategies for success during the discussions.
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AAPM Newsletter
November/December 2011
New Professionals Subcommittee Report Jessica Clements, Chair Dallas, TX
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he New Professionals Subcommittee was responsible for organizing the AAPM New Member Symposium, held on Tuesday, August 2, at the Vancouver Convention Centre. This symposium was open to all meeting attendees; however, those that have become members (full, associate, etc.) in the past three years were specifically invited. For 2011, 1745 new members were invited, and approximately 150 registered to attend. The programming was redesigned this year to provide useful information for physicists at all levels of their careers, especially new professionals. All invited attendees that registered in advance received a raffle ticket, as well as a drink ticket. The symposium began with a welcome from AAPM President Tony Seibert. George Sherouse followed with a talk about professional etiquette. The professional identity for medical physics was discussed with a strong emphasis that clinical medical physicists are medical specialists. The clinical training required of medical specialists was described as well as how a medical specialist should act in the clinic. Advice was also given about interacting with peers, how to handle a disagreement, and also some practical tips for negotiating salary. Finally, additional resources within AAPM were shared. Next, there was a panel discussion about the current job market. A wide range of physics professionals were represented on the panel, including: Per Halvorsen, Eric Klein, Rocky Barra, and Michael Mills. This panel represented academia, private practice, recruiting, and workforce expertise. Questions were accepted from members of the audience and focused on applying for jobs, what to Dade Moeller Gaithersburg MD expect when working with a recruiter, the Radiation Safety Las Vegas NV future of the DMP and MS degrees, and how to successfully obtain a residency position. Academy The raffle followed the panel and Corey Clift, a medical physics resident at Montefiore Medical Center in Bronx, NY, was presented with a complimentary registration to the 2012 AAPM meeting in Charlotte, NC. The session attendees then left the meeting room and were able to redeem their drink tickets and meet with leadership from each of the four AAPM councils. Attendees were encouraged to learn more about and get involved with the various AAPM councils.
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November/December 2011
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AAPM Newsletter
November/December 2011
Health Policy/Economic Issues Lena Lamel, M.S. Vice-Chair, Professional Economics Committee
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e are all aware of the importance of accurately using the radiation oncology codes to describe physics work effort. By doing so, we are thereby justifying and protecting staffing levels, besides generating revenue for our departments. We also align our work to what is in the best interest of the patient. Coding usage undergoes constant change as it is reinterpreted and redefined. From our vantage point, the work effort we provide is also changing. As our profession changes, so does our work. How acuity of care and increasing procedure complexity affects what we do is a challenge to capture effectively. There is also a constant drive to increase efficiency and reduce staffing levels. Adding to this scenario, there are two different methodologies that the Centers for Medicare and Medicaid Services (CMS) uses to determine costs in radiation oncology. All freestanding radiation oncology centers fall under the payment rates of the Medicare Physician Fee Schedule (MPFS). These rates are determined through a ‘bottom-up” approach to calculate direct costs. Under this approach, CMS determines the direct practice expense by adding the costs of resources (i.e., clinical staff, equipment and supplies) typically required to provide each service. This data is drawn from extensive surveys of actual physician practices. This data is refined and assigned to each CPT code in the CMS practice expense database. The result is a Practice Expense Relative Value Unit (RVU). The actual payment to the center will be a ‘global’ payment, based on this RVU as well as RVU’s calculated for the physician work and malpractice expenses. How can you affect the determination of this value? First of all, be familiar of the Abt III survey, located on the AAPM website under the heading of “Unnumbered Reports”. Think about the real work effort it takes to perform tasks that can be attributed to a CPT code. Be ready to provide accurate numbers to your radiation oncologist on the work effort and equipment necessary to do the job. Be ready to justify the work you are doing based on Task Group reports, white papers, etc. If you are aware of your radiation oncologist receiving such a survey, make sure that your input is used to determine survey responses. Only you are in a position to understand what you do—not other technical staff. Part 2 in a future newsletter will cover outpatient departments. New and Revised Radiation Oncology Codes for 2012 Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant
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ffective January 1, 2012, there will be new CPT® codes available for providers performing intraoperative radiation delivery treatments and management. The list below includes the new codes and their descriptors. The payment rates for both the Medicare Physician Fee Schedule (MPFS) and the Hospital Outpatient Prospective Payment System (HOPPS) will be released when the Medicare final rules are published on or about November 1st. The 3 new radiation oncology codes effective January 1, 2012: 77424 Intraoperative radiation treatment delivery, x-ray, single treatment session 77425 Intraoperative radiation treatment delivery, electrons, single treatment session 77469 Intraoperative radiation treatment management In addition, there has been a code descriptor revision to the special treatment procedure code below: 77470 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral, endocavitary or intraoperative cone endocavitary irradiation) CPT 77470 assumes that the procedure is performed 1 or more times during the course of therapy, in addition to daily or weekly patient management.
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AAPM Newsletter
Yes We Do
November/December 2011
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AAPM Newsletter
November/December 2011
AAPM Spring Clinical Meeting David Hintenlang Chair, Spring Clinical Meeting Subcommittee
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his spring the AAPM will present the inaugural Spring Clinical Meeting. This meeting has been created in response to AAPM members’ desires for additional opportunities to meet continuing education requirements and for a meeting that focuses on clinical topics of current interest. The new Spring Clinical Meeting is designed to provide easy access for clinical physicists in a compact format for up-to-date clinical education. Dallas, TX has been selected as the location and provides participants with flexible travel schedules from locations throughout the US. The program permits participants to meet continuing educational requirements for their clinical specialties, including SAMS on a wide variety of topics, and accommodates attendees who may be limited to participating only on the weekend, or only during weekdays. The full meeting program runs from Saturday, March 17 through Tuesday, March 20 and encompasses a series of topics of current clinical interest. The program is in the final stages of development and we believe that this is a great opportunity to get updates, and share and compare ideas with colleagues. We hope that you will be able to attend and contribute to the success of the Spring Clinical Meeting and help to make this a continuing opportunity for the medical physics community’s education.
SAVE THE DATE! AAPM Spring Clinical Meeting • March 17 – 20, 2012 Westin Galleria Dallas • Dallas, Texas Registration and Housing open on December 7th Website (including draft program) is now available: http://www.aapm.org/meetings/2012SCM/ 25 25
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November/December 2011
Report of the 2011 AAPM CT Dose Summit Cynthia McCollough, Program Director Mayo Clinic
2011 AAPM CT Dose Summit: An interdisciplinary program on scan parameter optimization for imaging physicians, technologists and physicists Another successful meeting on this important topic
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apid 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. To address the needs of the imaging community to optimize image quality while managing patient dose, the AAPM sponsored a highly successful CT Dose Summit in April of 2010; registration for the meeting was sold out in under a week! This year, we selected a larger venue, added new speakers and content, and held break out sessions for physicians, technologists and physicists. Response to the program was again outstanding. The over 220 participants came from a total of 9 countries, and included approximately 130 physicists, 20 imaging physicians, 24 technologists, 12 health physicists, as well as regulators, administrators and manufacturer representatives. A key theme of the meeting was the need for close interaction between physicists, physicians and technologists, an in depth understanding of the features of the CT system being used, and the need to systematically design and review CT protocols, tailoring them to specific diagnostic tasks and to each patient being scanned. Directed by Cynthia McCollough, PhD from the Mayo Clinic in Rochester, MN and Dianna Cody, PhD of the University of Texas, MD Anderson Cancer Center, the program included an in depth analysis of the trade-offs between various scan parameters on modern CT systems, discussing in particular automatic exposure control systems and adjustment of tube potential according to the patient size and exam indication. A key component of the program that is unique to the AAPM summit were presentations from several radiologists describing the benefits, key elements, and best dose reduction strategies of CT exams of the head and body for a wide range of clinical indications. New topics discussed this year included the ACR Dose Index Registry, diagnostic reference levels and dose notification levels, and the controversy surrounding the use of bismuth shielding to reduce dose to specific anterior organs (e.g. lens of the eye and breast). The meeting was held at the Westin hotel in downtown Denver, which provided not only large, comfortable, modern hotel rooms, but also exceptional food for our breaks, breakfasts and lunches. Many thanks to AAPM meeting planner Karen MacFarland for arranging such a pleasant venue! Registration costs for the meeting were exceptionally low compared to meeting of similar scope and quality, and this year we offered a trainee registration rate to help make the meeting affordable for students, residents and fellows. The exceptional value for meeting attendees was made possible through generous contributions from the Medical Imaging Technical Alliance (MITA), which represents manufacturers of medical imaging devices and software, the American College of Radiology and the Radiological Society of North America. The meeting was also endorsed by the American Board of Radiology Foundation, and CAMPEP and ASRT continuing education credits were offered. Unfortunately, CME credits were not available to participating physicians this year, but we hope to offer these in the future. For those who were unable to join us this year, we hope that you’ll consider attending future meetings. In the mean time, PDFs of the slide presentations are available for AAPM members on the AAPM website to assist physicists in working with radiologists and technologists to optimize image quality while managing radiation dose in CT imaging. http://www.aapm.org/meetings/2011CTS/ProgramInfo.asp
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AAPM Newsletter
November/December 2011
AAPM Coolidge Award 2011
INTRODUCTION OF RICHARD MORIN by Tony Seibert t is my honor and privilege to recognize and introduce Richard L. Morin, Ph.D., the 2011 William D. Coolidge award winner, the highest recognition for a medical physicist. Dr. Morin began his illustrious medical physics career at the University of Florida, receiving a Masters of Science Degree in 1973, for a thesis entitled, “Radioisotope Distribution and Radiation Dosimetry in 169Yb-DTPA Cisternography,” followed by a brief stay at the University of Wisconsin, where he pursued Positron Emission Tomography studies in 1974-75. He then attended the University of Oklahoma and received a Ph.D. degree in Radiological Physics in 1980 with a dissertation entitled “The Use of Monte Carlo Simulation and Pattern Recognition in Computed Tomography for the Removal of Foreign Object Artifact." His work on Monte Carlo analysis led to the editorship and publication of a book “Monte Carlo Simulation in the Radiological Sciences,” in recognition of the early seminal work in the field that he and others were pursuing at the time.
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As a freshly minted medical physicist, his career path took him to the University of Minnesota from 1981-1986, as an Assistant Professor of Radiology, the growing years of his career. He received tenure as an Associate Professor in 1986, and then took a position at the Mayo Clinic, Rochester as Associate Professor in 1987. He subsequently relocated to Mayo Clinic, Jacksonville in 1990, and received a promotion to Professor of Radiological Physics in 1993. In 2000, Dr. Morin was named the Brooks-Hollern Professor in the Mayo Medical School, and continues in this position today. Rick earned fellowship status in the AAPM in 1998. Throughout his illustrious career, Dr. Morin has worked diligently on developing a clinical and research presence in medical physics at his institution, locally through the AAPM chapter and Florida State Radiological Society, as well as nationally and internationally in many scientific and professional organizations. He received ABR certification in Diagnostic Radiological Physics and Medical Nuclear Physics in 1984, has been primary and co-author on more than 85 peer-reviewed publications. He has been the thesis advisor to 12 students, mentoring to many more, established a model program to teach Radiology residents, and has been a source of knowledge for radiologic technologists and medical physicists in training. Leading a team of radiologists, technologists, informaticists and administrators, Rick pioneered the implementation of Picture Archiving and Communications Systems (PACS) and Automated Radiology System at Mayo Jacksonville, an auspicious undertaking at the time, a true trailblazer and innovator. Dr. Morin’s contributions to our profession of medical physics are simply outstanding. He served in many positions in the AAPM, culminating with his service as President in 1993, and leading the move of the Association’s headquarters from New York to College Park, Maryland during his tenure. His well-thought-out decisions are manifested in the wonderful headquarters and staff from which current members are reaping the benefits every day. For the American College of Radiology, Rick served as a member of the Commission on Medical Physics from 1996 to 2005, and was Chair from 2000 to 2005, serving on the Board of Chancellors during that same time. He was an inaugural editor of the Journal of the American College of Radiology at its inception, became a fellow of the ACR in 1994, and currently is the Chair of the National Dose Index Registry committee. In conjunction with his service on the ACR, Dr. Morin also served on the Florida Radiological Society (FRS), was president in 2008-2009, and received the FRS Gold Medal in 2002. For the Radiological Society of North America, a long list of dedicated service and achievement culminated in his appointment as Third Vice-President of the society in 1998. And it does not end. Dr. Morin has contributed significantly to the success of the American Board of Radiology, initially as an item writer for the Part 2 Diagnostic Radiological Physics written exam in the early 1990’s. Moving through the ranks, Rick was appointed as a Trustee of the ABR in 2005, and now he serves as the Secretary-Treasurer and Assistant Executive Director. He received the ABR Lifetime Service Award in 2010 as a result of his tremendous efforts and contributions. Recognition for his life-
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November/December 2011
continued - AAPM Coolidge Award 2011 long dedicated and meaningful support of diagnostic radiology and radiological physics resulted in the awarding of the American Roentgen Ray Society Gold Medal in 2011. In the related field of Imaging Informatics, Dr. Morin led the Society for Imaging Informatics in Medicine as its chair in 2006-2007, and became a fellow of the society in 2008. Rick was the founding Chairman of the Board of Trustees of the American Board of Imaging Informatics in 2008, and he currently serves as an as an active member. Rick continues to contribute to the profession, and his plate of professional activities and contributions is as full as ever – certainly an exceptional level of service and commitment. And the amazing thing is that Rick actually has a personal life and loving family. He is the consummate gentleman and loving husband to his wife, Carol, and father to his son, Charles. He has demonstrated the ability to be at more than one place at a time (not sure how he violates the laws of physics!) and truly enjoys life with his family and friends. I consider myself very lucky to be among his close friends. In recognition of outstanding contributions to the advancement of Medical Physics, please join me in congratulating the 2011 William D. Coolidge award winner…….
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AAPM Newsletter
November/December 2011
2011 William D. Coolidge Award Acceptance Speech Richard L. Morin
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hanks, very much, Tony. I am quite sure everyone now knows far more about me and my career than they ever wished to know. Board of Directors, Awards and Honors Committee, Members, Ladies and Gentleman, I am very honored to receive the highest award of the American Association of Physicists in Medicine, the most prestigious Medical Physics organization. I wish to thank the Florida Chapter of the AAPM for my nomination and their support. This truly is a special event for me and my family and friends. In thinking of my remarks regarding this evening, I was struck by several things. First of all my family, who impressed upon me that my remarks tonight should be brief, very brief. I certainly don’t want to let my family down on this wonderful occasion.
It is indeed a great honor to be included in the ranks of those who have received this award. I am humbled to be mentioned among those who pioneered and have led Medical Physics. As I mentioned, I was struck by the events which bring one to this situation. This great honor is not mine alone. I wish first of all to thank my colleagues, students, and residents for the support and inspiration which has sustained my work and my career. I have learned a great deal and have been enriched by these experiences. Most of all, I wish to thank Dr. John Palms, my Physics professor at Emory University. I would not be a Medical Physicist had it not been for him and Physics 257. I also wish to thank Dr. David Raeside, my dissertation advisor at the University of Oklahoma. He taught me science, the joy of discovery and innovation, and the intricacies of academics and life in general. I am forever grateful to both of them. To the teachers, mentors and particularly young faculty present tonight, never forget the profound influence you can have upon your students and their lives. As I implied earlier, no one gets to this podium alone. I thank the Radiology Departments of the University of Minnesota and Mayo Clinic for their support and encouragement. I have been blessed during my career to be a valued member of the Radiology Team. These teams consist of Medical Physicists, Radiologists, Radiation Oncologists, Technologists, and Paramedical Staff. I think this is an important reflection in our profession today and in the foreseeable future. A team approach is necessary to most properly serve our patients. The current team approach to Image Gently and Image Wisely are truly examples. I hope you all have pledged to both. You certainly don’t want to “Image Roughly” or “Image Dumbly.” The movement to teams or groups or committees to routinely review CT protocols with respect to image quality and radiation dose is another example of the benefit to our patients when we exercise the wealth of diversity and talent among our practices. While this is just the beginning, I am very optimistic that we shall allay the concerns and sometimes public fears and continue to provide crucial decisions for the diagnosis and treatment of our patients. This team concept is even apparent in all professional societies. Several years ago when one of our newest Honorary Members, Sal Trofi joined us, he was adamant about bringing his young and talented assistant, Angela with him. The rest is history. Those here know that the AAPM staff is the best! In closing, I am very happy that I have my family here with me tonight to share this wonderful moment. My sister and mother were unable to attend due to medical reasons. It’s too bad my mom cannot visit with you my colleagues (she still is not sure what I do for a living). Not here tonight is my dad, Charles Morin. He passed away a few years ago. He not only worked with mom to raise me (a sometimes challenging task), he taught me about life and how difficult it is to become wise. He was a wise man. The older I get, the wiser he becomes. I am happy to have my son, Charles and his girlfriend, Nicole, with us tonight. Fortunately, he is in IT and does understand a bit about what I do for a living!
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AAPM Newsletter
November/December 2011
continued - 2011 William D. Coolidge Award Acceptance Speech I mentioned earlier that you don’t get to this podium alone. Well, my Award is shared tonight with my spouse of many years, Carol. It is her wish that the exact number of years be divulged only on a need to know basis. Apparently, you don’t need to know! She steadfastly supported me through the indecisions of my college years, the alternating excitement and drudgery of graduate school and the long hours of research and teaching typical of a young academic with clinical duties. Her unwavering support has been crucial to my professional life. But that is not the main thing. She is without question the most wonderful person I have ever known. Thanks, Carol. I love you! I thank the American Association of Physicists in Medicine for this wonderful honor and memorable experience of a lifetime. Thank you very much.
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AAPM Newsletter
November/December 2011
Report of 2011 ORVC Spring Educational Symposium Michael S. Gossman: ORVC President Ashland, KY
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he management and organization for the Fall Symposium of the Ohio River Valley Chapter of the AAPM was conducted by ORVC President Michael S. Gossman, President-Elect Minsong Cao, Secretary/Treasurer Rebecca F. Richardson, and Chapter Board Representative Indra J. Das. The event was held at the prestigious and historical Brown Hotel in downtown Louisville, KY during the weekend of October 7-8, 2011. This was co-hosted in collaboration with Michael D. Mills from the James Graham Brown Cancer Center of the University of Louisville. The meeting was highlighted by a Friday Night Out “Meet & Greet” event, sponsored by Accuray, Inc. This social venue included a poster session on 22 different topics of interest in medical physics as well as one Elite Sponsor Presentation. The Symposium educational sessions followed on Saturday. The James G. Kereiakes Keynote Lecture entitled “CT imaging for diagnosis and therapy treatment planning: How can we ensure that the studies are performed without excessive R. Pickens (James G. Kereiakes patient exposure?” was delivered by David R. Pickens of David Keynote Lecturer) receiving a plaque from Vanderbilt University Medical Center. Other sessions were AAPM ORVC Officers - President Michael S. delivered by the following invited speakers: Michael D. Mills, Gossman and President-Elect Minsong Cao Indra J. Das, Nathan C. Davis, James R. Gray MD, J. Anthony Seibert, Moataz N. El-Ghamry MD, Chee-Wai Cheng and Ibrahim B. Syed. Talks included the following according to title: 1. “Recent technology developments for the CyberKnife and TomoTherapy Systems” 2. “Medical physics workforce issues in the USA“ 3. “Impact of ICRU-83 in IMRT“ 4. “BolusECT case study” 5. “Stereotactic body radiotherapy for prostate cancer “ 6. “CT imaging for diagnosis and therapy treatment planning: How can we ensure that the studies are performed without excessive patient exposure?” 7. “Airport whole body scanners: fact and fiction“ 8. “Uveal melanoma: A brachytherapy perspective“ 9. “A quality management program (QMP) for craniospinal irradiation (CSI) with proton therapy (PT): a failure mode and effects analysis (FMEA) approach“ 10. “Medical physics as a profession – tips for young physicists“ The Chapter again, successfully exceeded its recorded marks in all areas at the Night Out with 85 participants, as well as for the Symposium with 106 participants and total of 45 contracted exhibitors (28 exhibits & 17 advertisements). The Symposium concluded with our Chapter Business Meeting. Finally, I would like to thank these sponsors for their generous contributions and attendance at the symposium. Platinum Sponsors: Accuray, Varian Medical Systems, Philips, .decimal, WFR Aquaplast/Q-Fix Systems Gold Sponsors: CNMC Company (C/O Best Medical Intl.), Brainlab, ScandiDos, Onconcepts, Nucletron, LAP, K&S Associates, RTI, Sun Nuclear, Orfit, Vision RT, Standard Imaging, BrachySciences, NELCO, Radiation Business Solutions, Landauer, iba Dosimetry, Velocity, Architection, Isoaid, Multidata Silver Sponsors: The Phantom Laboratory, Bard, Alpha Cradle Bronze Sponsors: Xoft (C/O iCAD), Modus Medical, Calypso, Siemens, Oncology Tech, CIRS, PXi Precision X-ray, D3 Oncology Solutions, Mick Radio-Nuclear Instruments, Cancer Carepoint, Vidar Systems, Acceletronics, LinaTech, CIVCO, Canberra
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American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846
Editor
Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115
Editorial Board Priscilla Butler, MS, Eileen Cirino, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390
PRINT SCHEDULE • The AAPM Newsletter is produced bimonthly. • Next issue: January/February • Submission Deadline: December 8, 2011 • Posted On-Line: week of January 2, 2012