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 37 NO. 1
JANUARY/FEBRUARY 2012
AAPM President’s Column Gary A. Ezzell, Mayo Clinic Scottsdale
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his is my 35th year as a medical physicist. Like many of my generation, I came into this field sideways, after entering graduate school expecting to do something else. As this generation is experiencing, finding my first job was difficult. Ultimately it turned on a stroke of good fortune as much as my own efforts. Life, as we know, is so often that way. We prepare for what we think will happen, and then we live with what does, and do the best we can. So, 35 years after learning that physicists work in medicine, I find myself writing this article as AAPM President. This is an honor that also owes much to fortune; one that I will do my best to uphold. There are many good examples to follow, the most recent being Tony Seibert, who has completed his term as President and now is our Chairman of the Board. He and Mike Herman, our outgoing Chairman, represented our profession well as intense public attention was focused on errors in diagnostic and therapeutic uses of radiation. Mike was also instrumental in initiating AAPM’s strategic planning efforts and in creating structures that will keep our Board involved in strategic thinking over the long term. The cycle continues. John Gibbons has completed his term as Secretary, and he carried out his duties with commendable efficiency and initiative, as well as keeping our Executive Committee’s deliberations on target. Beth Schueler now joins EXCOM as Secretary, and John Hazle as President-Elect. They too will Included in this issue: be good stewards of our Association, of that I am sure. Stewardship of our profession is a responsibility that all of us share. None of us works alone. In my daily work I make use of concepts, techniques, and protocols developed by predecessors and contemporaries. As a therapy physicist, I make use of TG-51, published in 1999. The AAPM website lists 68 published task group reports since 1999. There are 70 active task groups and 234 active committees; you can see the list with the charge and status of each task group at http://www.aapm.org/org/structure/report_stats. asp . 14.5% of our membership work at least one national group, and that does not include those who serve chapters. Our Association is remarkable for its degree of participation in the advancement of medical physics. This Association, and the work we do through it, is important. AAPM is our primary organizational tool for working together and learning from each other through meetings, reports, and publications. It is the primary venue for medical physicists to provide and obtain the continuing education we all need to
Chair of the Board Treasurer Executive Director Editor Science Council Professional Council Education Council Website Editor ACR Accreditation Leg. & Reg. Affairs Health Policy/Econ Issues RSNA/AAPM Physics Educational Modules Diagnostic Physics Survey AAPM/SEFM Agreement NJMPS Chapter Report Person in the News
p. 3 p. 4 p. 7 p. 9 p. 10 p. 11 p. 14 p. 15 p. 17 p. 18 p. 20 p. 23 p. 24 p. 25 p. 26 p. 27
AAPM Newsletter
January/February 2012
continued - AAPM President’s Column stay current, and that many of us need to maintain our certification. Our primary job as officers and Board members is to be good stewards, to keep AAPM healthy and to prepare, as best we can, for the future. That preparation includes following through on the strategic plan that was adopted this past summer. The Board's Strategic Planning Committee will meet in March in conjunction with the Spring Clinical Meeting in Dallas. The plan helped to inform the priorities realized in the budget for 2012 that the Board adopted at its RSNA meeting, but funding for some important priorities had to be cut back. These included the creation of Medical Physics Practice Guidelines, which will provide regulators and accrediting bodies with appropriate and realistic references, and efforts to promote additional residencies, especially in imaging. We are doing what we can, but more could be done. The Board has the fiduciary duty is to provide for AAPM's financial and programmatic health. And so at the RSNA meeting our Board voted unanimously to bring a proposal for a dues increase to the membership for a vote in 2012. We understand that this will need to be explained and justified, and we will do that in future communications. People will want to know how we have controlled costs and created other sources of revenue. My point here is that we have a large Board of Directors, representative of and responsible to the membership and fully committed to being good stewards of our resources and our future. The Board is convinced that a dues increase in justified and necessary. Ultimately, the decision will be made by the membership. AAPM is a member-driven organization, and that is our fundamental strength. Here’s hoping for a smooth and productive 2012. Whatever happens, “keep calm and keep on.”
AAPM 2012 SUMMER SCHOOL
Medical Imaging using Ionizing Radiation: Quality Control, Dose Measurements and Optimization Strategies June 24-29, 2012 • University of California, San Diego Program Directors: Dianna Cody, PhD, U.T.M.D Anderson Cancer Center Cynthia McCollough, PhD, Mayo Clinic
Mark your Calendars - Registration Opens March 21 Medical imaging using ionizing radiation is coming under intense scrutiny from public, professional, and regulatory groups sharing a common goal to ensure patient safety by minimizing risk. In medical physics, traditional approaches to minimizing risk are to provide relevant, up to date education on the safe uses of the various technology, best methods to test image quality and dose performance, and changes in technology or regulatory/ accreditation requirements that require a different approach. This multidisciplinary summer school faculty is coming together to ask, and answer, critical questions in each of these areas for practicing medical physicists, whether in diagnostic, nuclear medicine, or therapy.
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AAPM Newsletter
January/February 2012
AAPM Chair of the Board’s Column J. Anthony Seibert, UC Davis Medical Center
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t the RSNA event in Chicago, the AAPM Board meeting was conducted flawlessly by my colleague and friend Mike Herman. I have been very fortunate as President-Elect and President to ride in his wake of great leadership, and was privileged to present him with the traditional gavel, a memento expressing thanks and gratitude for his dedicated, selfless, and outstanding service to the AAPM. We, as an association, are benefitting greatly from his efforts over the past three years, and will continue to enjoy his leadership and foresight as a one-year member (as past chairman) of the Strategic Planning Committee (SPC) for 2012. As incoming Chairman of the Board, I will assume the position of Chair of the SPC as well, and look forward to having Mike’s presence to maintain the continuity and momentum that he has so ably provided. In addition, President Gary Ezzell and President-Elect John Hazle will be assisting in the operation and direction of the SPC. More will be described in the next several newsletters. Each board member agrees to serve a three year term, and every year one-third of the board is refreshed with new members. I would like to take this opportunity to thank those board members completing their three-year term for their leadership and service to the AAPM, including Ed Barnes, John Bayouth, Ivan Brezovich, Janice Campbell, George Daskalov, Jim Goodwin, Joe Hellman, Dharanipahty Rangaraj, Steve Rudin, Beth Schueler, and Russell Tarver. And a hearty welcome to the new members of the Board of Directors; in addition to the new officers, John Hazle, President-Elect, and Beth Schueler, Secretary, other new board members include Kyle Antes, Gene Cardarelli, Stephanie Franz, Saiful Huq, Miriam Lambert, Michael Mills, Mark Oldham, Joann Prisciandaro, Chester Ramsey, Susan Richardson, and Michael Schell. Dr. Dan Low, as incoming Science Council Chair, will also have a non-voting seat on the Board of Directors. Congratulations to all, and to a great 2012! A major issue discussed at the last board meeting was regarding membership dues. I was really struck by Per Halvorsen’s November/December newsletter article describing all of the value-add education content, medical physics support, and activities among many other things that the AAPM membership includes, much of which are often taken for granted -- and then started thinking about all that I too have taken for granted, such as my thumb and its use in many tasks such as writing (until I fractured it in a skiing incident), and lower torso for walking (until I fractured my acetabulum and pelvis in a biking accident). These examples remind me that there are many benefits that I take for granted but depend on so much in my day to day existence. We should all realize that the AAPM provides tremendous benefits to us individually as well as for the profession of medical physics. It is also evident from the strategic planning process that while there is much we are doing well, there is also a lot we could be and should be doing that currently cannot be accomplished without more funding. Please reflect upon the significant value that the AAPM represents when considering the need for supplementing the budget with a dues adjustment – I do know that the members of the Board of Directors have thoughtfully discussed these issues, and are moving forward with recommendations. Finally, I had the opportunity to personally recognize Science Council members who have completed their terms at the December 12-13 council meeting in New York. Over the last six years, Therapy Physics Committee chair and Science Council vice chair Ellen Yorke, Imaging Physics Committee chair and Science Council vice chair Jeff Shepard, and Science Council chair John Boone have provided tremendous leadership and volunteered countless hours to ensuring that the science, research and innovation in medical physics remain a vital part of the vision, mission and goals of the AAPM. In sincere appreciation, thanks again for all of your efforts! Tony Seibert gives 3 members of Science Council plaques in appreciation of their service to Science Council: Jeff Shepard, John Boone and Ellen Yorke.
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AAPM Newsletter
January/February 2012
Treasurer’s Report Janelle A. Molloy Lexington, KY
2011 Estimates s of mid-December 2011 we anticipate that income and expenses from operations will be break-even, with the exception of legal expenses allocated to defending an ongoing lawsuit. The 2011 budget as approved by the Board of Directors was once again developed using a statistical model to project revenue and expenses based on our historical spending trends. The past two years have proven a fairly close relationship between the model and our ending balances.
A
Figure 1 below presents a graphical view of AAPM's net income from operations for the period 2007 through the approved 2012 budget. An independent audit of the 2011 year's finances is scheduled for early April. Volatility in the financial markets is expected to reduce the value of our investments, perhaps as much as a half million dollars. We are hopeful at this writing that markets improve before the end of the year. 2012 Budget We would like to once again thank the volunteers who serve on councils, committees, task groups, and working groups for working together to prepare budgets that meet the criteria for presenting the Board with a budget balanced to the statistical model. The Budget Subcommittee had a relatively easy task due to the hard work and negotiation carried out by these Chairs. Below and on the following pages you will find a full copy of the approved Budget, together with graphs illustrating the sources and uses of revenue. Income is expected to total $8.2 million, with expenses totaling $8.46 million. Also on page 5 is a table showing a comparison of the 2011 and 2012 budgets which highlights the variances between the two. Based on the statistical model, the 2012 budget projects a slightly lower net loss than we budgeted in 2011. As you will have read in articles by both officers and council chairs, there is considerable concern that it is becoming increasingly necessary to curtail or detail a number of very worthwhile activities, due to a lack of funds. We have in place a very comprehensive strategic plan that is designed to move the AAPM forward by addressing the many concerns and issues affecting our profession. Patient safety, development of educational opportunities to support new entrants into our field, and professional training to maintain and support certification are just a few that
Income by Major Source – Approved 2012 Budget
Net Income – 2007 through 2012 Budget
$2,474,626 , 30.24%
$1,000,000 $800,000
$802,726
$375,250 , 4.59%
$1,470,118 , 17.96%
$595,600 , 7.28% Dues
$600,000
Committee Projects Education
$400,000
Publications
$158,599
$200,000
Other
$0 ($35,993)
($200,000)
($302,043)
($400,000) 2007
2008
2009
2010
($241,785)($280,890) 2011 est.
2012 Budget
4
$3,268,126 , 39.93%
Total = $8,183,720
AAPM Newsletter continued - Treasurer’s Report Column require funding above and beyond our available income. The Board of Directors is addressing these concerns by requesting membership support for a dues increase in 2013 that will move us forward in implementing many of the objectives and goals in our Plan and provide long-term stability with a small annual increase in succeeding years. Additional details will be presented in the coming months and a vote will take place following the 2012 Summer Meeting.
January/February 2012
Expenses by Major Category Approved 2012 Budget $1,332,631 , 16%
$164,147 , 2%
$721,071 , 8% $240,937 , 3% $1,976,693 , 23% Member Services Governance Committee Projects Education Publications
$1,508,884 , 18%
Administration Other $2,520,247 , 30% Total = $8,464,610
Please do not hesitate to contact me with any questions you may have
Comparison of 2012 Draft and 2011 Approved Budget Differences Based on Direct Revenues and Expenses
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January/February 2012
continued - Treasurer’s Report Column A
B
Revenue
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73
C
2012 First Draft Budget
1 2
Draft to FINCOM Nov 8, 2011 Dues (Net of Journal) Renewal Notices Applications and Reinstatements
Subtotal
1,445,118 9,000 16,000 $1,470,118
Overhead 5,000
$5,000
Membership Services
Member Inquiries/Services Membership Directory AAPM Web Site
Subtotal
Organizational
Board of Directors Executive Committee Executive Committee - Contingency Elections & Society Votes
25,500 65,900 40,919 Subtotal
Councils and Committees
Administrative Council Education Council Professional Council Science Council Committees Reporting to the Board Liaisons with other Organizations
62,652
62,652 5,000
$62,652
$67,652
196,809 3,405 453,205 $653,419
196,809 3,405 453,205 $653,419
(196,809) (3,405) (453,205) ($653,419)
27,580 71,845
53,080 137,745 40,919 9,193 $240,937
(53,080) (137,745) (40,919) (9,193) ($240,937)
$371,144
714,965 398,036 276,720 406,058 179,414 1,500 $1,976,693
(374,565) (227,336) (218,220) (380,058) (179,414) (1,500) ($1,381,093)
439,585 23,494 69,462 179,443 $711,984
1,919,338 263,154 158,312 179,443 $2,520,247
947,677 32,957 (153,312) (79,443) $747,879
128,028
987,604 (22,000) 1,000 (862) $965,742
9,193 $108,618
233,923 55,161 34,050 18,046 29,964
Subtotal
Subtotal
2,442,126 30,000 1,500 1,000 $2,474,626
1,326,494 52,000 500 500 $1,379,494
1,362 $129,390
1,454,522 52,000 500 1,862 $1,508,884
72,000
33,028
105,028
(105,028)
27,200 122,000 35,000 $256,200
1,043,403
1,070,603 122,000 35,000 $1,332,631
(1,070,103) (122,000) (35,000) ($1,332,131)
500
Subtotal
$500
3,000 16,400 300 152,000 80,850 120,000 1,200
$1,808,263
100 24,000 1,500
Subtotal
1,000 $374,750
10,950 81,650 1,000 $119,200
TOTAL FROM OPERATIONS
$8,183,720
$5,306,025
$1,076,431
4,767
AAPM Education & Research Fund
Grand Total
153,400
158,600
$8,337,120
$5,464,625
3,000 11,633 200 128,000 43,938
35,412
4,767 100 24,000 36,912
4,768 $44,947
10,950 81,650 5,768 $164,147
1,200 (10,950) (81,650) (4,768) $90,603
$3,158,585
$8,464,610
($280,890)
158,600
(211,000) (69,890) (5,200)
$8,623,210
($286,090)
Model
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1,382,466 4,000 16,000 $1,402,466
$1,479,753 239,660 88,850
Other Income & Expense
Computers in Physics, Royalties AAPM Mailing Lists Membership Certificates Investment Earnings & Fees CAMPEP ACMP Web Hosting Contributions and Donations Dues and other payments Miscellaneous
Total
2,867,015 296,111 5,000 100,000 $3,268,126
Administrative
Professional Services Headquarters Travel General Operations Credit Card Processing AIP Services
481,042 342,875 242,670 388,012 149,450 1,500 $1,605,549
Net
$595,600
Publications
Medical Physics Journal JACMP Books Reports
F
Subtotal
Education & Professional Development Annual Meeting Summer School RSNA Other Meetings
$132,319
340,400 170,700 58,500 26,000
E
Expenses Direct
Membership Dues
D
$3,158,585
11/16/2011, 11:07 AM
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January/February 2012
AAPM Executive Director’s Column Angela R. Keyser, College Park, MD 2012 Meeting Dates NEW! Registration is now open for the Spring Clinical Meeting, March 17 – 20 at the Westin Galleria in Dallas, Texas. Previously known as the ACMP Annual Meeting, the Spring Clinical 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 meeting is designed to provide easy access for clinical physicists 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. We anticipate offering as many as 16 SAMs sessions; the exact number of SAMs will be announced after ABR approval. Register by February 8 to receive discount registration fees! Also, Young Investigator abstracts are due by January 10. 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! Summer Fellowship Programs Please consider participation as a mentor in AAPM’s Summer Undergraduate Fellowship Program (SUFP) or Minority Undergraduate Summer Experience Program (MUSE). The SUFP is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a stipend from the AAPM. Both student and mentor applications are due by February 1. For details, go to: http://www.aapm.org/ education/SUFP/ . The MUSE program is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institution (university, clinical facility, laboratory, etc). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. For details, go to: http://www.aapm.org/ education/MUSE/ . The deadline for applications is February 2. Funding Opportunities AAPM is pleased to announce the following 2012 Funding Opportunities: The AAPM 2012 Research Seed Funding Initiative provides start-up funds for researchoriented medical physicists and is are intended to provide funds to develop exciting investigatorinitiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. Two $25,000, one-year awards will be made in 2012. The awards. It is expected that funding will begin on July1 of the year in which the award is made, and that subsequent research results will be submitted for presentation at future AAPM meetings. Application Deadline: February 29. AAPM Fellowship for Graduate Study in Medical Physics is awarded for the first two years of graduate study leading to a doctoral degree in Medical Physics from a program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP).
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January/February 2012
continued - AAPM Executive Director’s Column Additional information on CAMPEP accredited programs can be found at http://www.campep. org. Application Deadline: April 17. $33,500 in matching support to be made to institutions in matching support of a full-time Clinical Residency in Imaging Medical Physics. Application Deadline: April 20. Program details and Information regarding each grant or fellowship available online at: http:// www.aapm.org/education/GrantsFellowships.asp . 2012 Dues Payments 2012 renewal notices were sent several times since October, with payments due by March 1. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on "Pay Your 2012 Dues Online." Remember, you can pay Chapter dues with your AAPM dues for any Chapter of which you are already a member! The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Peggy Compton at 301-209-3396. Staff News I am pleased to announce that Jennifer Hudson has been promoted to the position of Membership Services Manager. This promotion acknowledges the increasing level of support Jennifer provides to the Membership Committee and her involvement in the membership and renewal processes. Jen began her career with AAPM in April 2001 as the Receptionist and was promoted to Membership Services Coordinator in 2004. The AAPM Headquarters office will be closed Monday, December 26th and Monday, January 2nd. I wish you and your loved ones a happy and healthy holiday season.
AAPM Position Statement on Radiation Risks from Medical Imaging Procedures December 13, 2011
The American Association of Physicists in Medicine (AAPM) acknowledges that medical imaging procedures should be appropriate and conducted at the lowest radiation dose consistent with acquisition of the desired information. Discussion of risks related to radiation dose from medical imaging procedures should be accompanied by acknowledgement of the benefits of the procedures. Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be nonexistent. Predictions of hypothetical cancer incidence and deaths in patient populations exposed to such low doses are highly speculative and should be discouraged. These predictions are harmful because they lead to sensationalistic articles in the public media that cause some patients and parents to refuse medical imaging procedures, placing them at substantial risk by not receiving the clinical benefits of the prescribed procedures. AAPM members continually strive to improve medical imaging by lowering radiation levels and maximizing benefits of imaging procedures involving ionizing radiation.
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AAPM Newsletter
January/February 2012
Editor's Column
Mahadevappa Mahesh, Baltimore, MD
H
appy New Year and welcome to the first issue of 2012. As we head into the new-year, this issue contains our regular columns by regular contributors and few new contributors (due to change of leadership). I welcome our new contributors and look forward to hearing their thoughts under their columns. In addition to regular columns, this issue contains articles about RSNA/AAPM Physics Educational modules, Diagnostic Physics Survey, agreement between AAPM and Spanish Society of Medical Physics and Chapter news. Finally, I would like to congratulate our AAPM member Dr. Habib Zaidi for receiving the 2010 Kuwait Prize in Applied Sciences for his contributions to Biomedical Technology. It gives me great pleasure to serve as the editor for the newsletter, which provides me a 30,000 foot view of what is happening in the medical physics profession and in the AAPM. I will continue to fine-tune the newsletter with any comments and/or suggestions received by you all. Once again, I welcome all of you to the first edition of 2012 and wish all of you a very happy new year.
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Knowing what responsibility means
AAPM Newsletter
January/February 2012
Science Council Report Daniel Low, Los Angeles, CA
G
reetings from the Science Council. As of January 1, I became the chair of the Science Council and I am excited to be working with such an esteemed group of physicists. First, I would like to thank John Boone for his years of service as the previous chair. John did an excellent job and I will try my best to fill his shoes. I was Science Council meets at Memorial Sloan-Kettering Cancer impressed by his emphasis on developing new Center, New York on December 12-13, 2011; back row, L-R: programs and agendas for the AAPM rather Bill Hendee, Norbert Pelc, Dave Rogers, Ellen Yorke, Saiful Huq, Mackie, Rebecca Fahrig, Jeff Siewerdsen, Jeff Shepard, than make the Science Council a rubber-stamp Rock Donald Peck, Joe Deasy, Jean St. Germain; Front row seated, authority over the Imaging and Therapy Physics L-R: Tony Seibert, Dan Low, John Boone, Maryellen Giger Committees. John emphasized the importance of the Science Council to develop and support initiatives that moved the AAPM forward in science and quality assurance. I will maintain that emphasis during the time I am chair. The current issues I believe we need to address include: 1. Securing the role of science in the AAPM through its operations, such as task and working groups, through its meetings, and finally through its initiatives. One of the important initial issues is the role of science in the AAPM strategic plan. The strategic plan needs to be updated to include more explicit support for science within the AAPM. 2. Fostering the next generation of medical physics research scientists. In the past, the AAPM has sponsored grantsmanship workshops and they have been very successful (I attended one that was held after the AAPM meeting in Montreal and I found it extremely useful in generating and writing grants). The need for such workshops extends beyond grantsmanship. Physicists will not be successful in securing grant funding until they have a publication track record and many of them lack suitable mentors. I feel that the AAPM can play a role in training junior faculty members in some of the practical skills they will need to succeed as scientists. 3. Broadening the definition of medical physics in an era of image-guided invasive procedures and the explosion of biomedical engineering and biophysics. The definition of Medical Physics should be broadened to include other image-guided therapies, including ablative therapies conducted by surgeons. The need for safe, quantitative localization and dosimetry equivalents (e.g. thermometry) justifies the need for qualified technical experts for the planning and verification of these modalities and the training and clinical practice of medical physics makes it a natural and appropriate extension of our field. 4. Safety: There are many initiatives within the AAPM dealing with patient safety and the future of quality assurance in radiation therapy and diagnostic radiology. There is a critical need to modernize quality assurance procedures to manage the current and future treatment planning and delivery complexity. The Science Council has responsibility for subcommittees, working groups and task groups actively engaged in moving radiation therapy safety forward. We will continue to support and promote these safety improvement efforts to allow Radiation Therapy to improve its already excellent safety record. I also want to extend a special thanks to Donald Peck and Saiful Huq, the chairs of the imaging physics and therapy physics committees, respectively. I look forward to working with them on the scientific challenges facing our field.
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AAPM Newsletter
January/February 2012
Professional Council Report Per Halvorsen, Newton, MA
Revised professional policies Two important Professional Policies have recently been revised, and were approved by the Board of Directors at its meeting in November. Look for the updates to be posted on the website shortly. The revised policies are: PP-1 “Definition of a Qualified Medical Physicist” and PP-17 “Scope of Practice of Clinical Medical Physics”. CMS publishes final 2012 reimbursement rules The Centers for Medicare and Medicaid Services (CMS) has published its final rules for the Medicare Physician Fee Schedule (physicians and outpatient centers) and the Hospital Outpatient Prospective Payment System (hospitalbased centers). During the public comment period after publication of the proposed rules, the AAPM provided detailed written comments, objecting to the proposed reductions in reimbursement which were more significant than for all other medical specialties. The final rules include moderate increases in the Relative Value Units for most procedures, and a smaller impact of the Multiple Procedure Payment Reduction for imaging, whereby CMS reimburses less than 100% when multiple imaging studies are performed in a single session. Note that code 77338, the treatment device code for MLC-based IMRT delivery, will see a significant reduction for hospital-based centers in 2012. The bundling of image-guidance codes will continue in 2012 for hospital-based radiation therapy programs. For a detailed explanation, see the article by our consultant Wendy Smith Fuss on page 20 in this issue. ACR collaborative standards and guidelines Many of you may be aware that the AAPM became a collaborating society with the ACR in 2011, which means that we will collaborate on the development of ACR Technical Standards and Practice Guidelines. Many of the upcoming revisions will be published as joint ACR-AAPM Technical Standards and Practice Guidelines. In 2011, we have collaborated on four revisions to imaging documents: ACR-AAPM Technical Standard for Diagnostic Medical Physics Performance Monitoring of Computed Tomography (CT) Equipment, ACR-AAPM-SIIM Practice Guideline for Digital Radiography, ACR-AAPMSIIM Technical Standard for Electronic Practice of Medical Imaging, and ACR-AAPM-SIIM Practice Guideline for Determinants of Image Quality in Digital Mammography. For 2012, four Technical Standards and Practice Guidelines in imaging and nuclear medicine are due for revision, and we will begin work on these shortly. Update on AAPM Medical Physics Practice Guidelines As described in an earlier column, the AAPM Board of Directors approved the development of Medical Physics Practice Guidelines (MPPG) during its Vancouver meeting. The Subcommittee on Practice Guidelines convened a workshop in early November to begin the development process, and has identified the first two MPPG topics: Linac-based imaging, and CT protocol management and review. Four additional topics were identified for initiation in 2012. The group is currently refining the charge for each MPPG Task Group and identifying members for these Task Groups. Online modules on ethics and professionalism As you may know, the ABR Foundation recently completed development of a comprehensive set of educational modules related to professional ethics and professionalism. The modules were developed with support from the AAPM and many other professional societies. See the following link for more information: http://www.aapm.org/education/onlinemodules.asp Leadership changes within the Professional Council As the end of the year draws close, I’d like to thank all colleagues who volunteer their time and expertise for the benefit of our profession, whether as volunteers within the AAPM (nationally and in chapters) or with other scientific and professional societies. Within the Professional Council, we’ll have some changes in committee leadership. Michael Mills rotates off as Chair of the Professional Services Committee and begins 2012 as Chair of the new Workforce Assessment Committee. Jessica Clements becomes Chair of the Professional Services Committee joined by Russell Tarver as Vice Chair. In the Clinical Practice Committee, Dan Pavord becomes Chair with Martin Fraser serving as Vice Chair.
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January/February 2012
2012 AAPM Annual Meeting July 29 - August 2, 2012 Charlotte, NC
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! The education program and professional program will offer a significant opportunity to gain practical knowledge on emerging technical and professional issues. The scientific program will feature the latest research in the physics of medical imaging and radiation therapy, including a major focus on the increasing integration on advanced imaging technologies in the guidance of medical therapeutics. New this year… • Expanded SAMS offerings. • New session formats, including debates and panel discussions. • Increased dawn-to-dusk content in scientific and educational tracks. • Expanded scientific content in imaging (all modalities), image-guided therapy (radiation therapy and minimally invasive interventions), and therapy physics (including novel arc therapies, proton therapy, and targeted radionuclides). Joint Imaging-Therapy Track The 2012 Joint Imaging-Therapy Track will feature exciting topics highlighting the collaborative efforts between imaging and therapy medical physics. This track will include the following topics: a lively debate on the future of adaptive radiation therapy, risks and realities of radiation in imaging, treatment assessment using MR, advances in image guided therapy, and advances in molecular imaging. Therapy Track The 2012 Therapy Track will showcase the current hot topics in therapy but all show potential future directions of medical physics research and innovation. Symposia will include the following general topics: recent advances in outcome modeling, proton therapy, biophysical modeling, new concepts in treatment planning, image-guided and adaptive radiotherapy, imaging for treatment assessment and others. Imaging Track The 2012 Imaging Track will explore several excellent topics that explore near and far term future directions of medical physics research and innovation. Scientific symposia will include the following general topics: State of the Art In Quantitative Imaging (involving CT, PET and MRI); Assessment of Image Quality in CT – present and future; Computer-Aided Diagnosis: Performance Evaluation, User Training and QA issues; Approaches for significant dose reduction in Fluoroscopy, Recent Advances in Molecular Imaging and others. Educational Course Therapy Track The Therapy Physics CE series will feature a total of 31 hours of educational lectures. This year our goal is to increase interactivity and quality of the education programs: most educational courses will use audio response systems (ARS) for audience feedback. The emphasis of the program will be on safe and effective use of new technologies addressing the current issues in clinical practice. The program is designed to address the broad educational needs of our membership and will include topics in SRS, SBRT, IGRT, IMRT, VMAT, QA and safety, brachytherapy, electron and proton therapies as well as radiobiology. The program will feature five SAM sessions and several new courses including "unsettled issues in the radiobiology of hypofractionation and PET-guided treatment planning," "electron therapy: past, present and future," and "the emerging role of image guidance for breast radiotherapy." The 4D IMRT and the role of image guidance,
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AAPM Newsletter
January/February 2012
2012 AAPM Annual Meeting July 29 - August 2, 2012 Charlotte, NC
review of radiobiological principles, the use and QA of biologically related models for treatment planning, inclusion of imaging dose in radiation therapy planning, initiating an IGRT program, safety issues in radiation therapy physics, radiation related second cancers, and the dosimetry of HDR; present status and future direction are few examples of the courses that the therapy educational program will feature this year. Educational Course Imaging Track There will be 36 hours of imaging education offered at AAPM 2012, including 8 hours of SAMS. The scheduling of the imaging education sessions has been rearranged to minimize the number of overlapping lectures, with educational content available both morning and afternoon on Monday - Thursday. An emphasis will be placed on practical content to support the needs of the clinical diagnostic medical physicist. CE credits will be available in CT, MR, Nuclear Medicine, and Mammography to meet accreditation requirements. Sessions will cover newer clinical technology such as tomosynthesis, and last year's popular session on medical radiation risk will be repeated with the latest information. Professional Track The Professional Track continues to grow in depth and breadth to keep our members abreast of the latest professionally-related developments. Topics this year cover both clinical and research aspects of our profession. To be included in the track are: news on ABR 2014 requirements, a session on preparing for therapy ACR accreditation, PQI, Practice Guidelines, Ethics, Publishing, Journal Article Review, Economics of Light Ion Teletherapy and two symposia on international medical physics. John S. Laughlin Science Council Research Symposium Topic: Imaging for Therapy Assessment – Understanding response to therapy is a cornerstone in optimizing patient therapy to achieve optimal clinical outcome. Determining response during the course of therapy provides means for treatment adaptation. In addition, searching for new therapies is growing more complex with the availability of patient-specific genetic information and extensive incorporation of various biomarkers. Furthermore, with novel molecular targeted therapies the response to therapy may not be observed at the same magnitude or speed on radiographic images as it used to be. A clear need exists to develop and qualify more sensitive and specific quantitative imaging techniques as surrogate biomarkers for ever-growing numbers of clinical trials and routine clinical practice. 2012 Dates to Remember January 18 Web site activated to receive electronic abstract submissions. March 1 Deadline for receipt of 300 word abstracts and supporting data. This deadline recognizes other conference schedules that have conflicted in the past and has been extended accordingly. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review. March 21 Meeting Housing and Registration available on-line. By April 16 Authors notified of presentation disposition. By May 11 Annual Meeting Scientific Program available on-line. June 14 Deadline to receive Discounted Registration Fees. http://www.aapm.org/meetings/2012AM/
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AAPM Newsletter
January/February 2012
Education Council Report George Starkschall, Houston, TX
I
n an attempt to streamline the process for candidates who wish to apply for medical physics residency programs, a common application process (CAP) has been implemented by the Education and Training of Medical Physicists Committee, under the direction of John Bayouth. A great deal of this process has resulted from the efforts of John Antolak, and for this effort we owe John a great debt of gratitude. The two Johns have provided the following update on the status of the CAP: By: John A. Antolak, PhD, Chair, Workgroup on Coordination of Medical Physics Residency Programs & John E. Bayouth, Chair, Education and Training of Medical Physicists Committee The CAP has been open to applicants since November 16. Many applicants have completed their registrations and have been busy getting their information into the forms, getting reference letters, and so on. We had a few hiccups as the system got off the ground (a few more than we expected), but we are making good progress. The program registration piece and application pieces are being tested right now. This week we expect to open up the system to programs to enter their program information, including open positions. Applicants will see some new pages for selecting programs and submitting applications. Our primary focus has been making sure that applicants can get their information safely into the system and I think we are now succeeding. Applicants should be reviewing the ads in the AAPM placement service, and deciding on programs they want to apply to. Once the system is open for applications, it should be very easy to submit the application, since no additional data entry will be needed beyond selecting the desired programs. We have been getting several messages from concerned applicants and program directors, wondering when programs can be selected and applications submitted. We would like to assure you that we have a vested interest in getting this program operational and are working hard to get this done. One of us (JB) is only accepting applications via the CAP, and the other (JA) is strongly encouraging applicants to apply via the CAP. Failure to get the CAP up and running would directly affect our programs, and we do not want that to happen. To partially ease the stress that applicants are feeling right now, both of us are planning to extend our previously stated deadline by a few days. The new deadlines will be included in the CAP program, and the current job advertisements will be updated soon. I would also encourage other program directors that are planning to use the CAP to consider a similar extension if their deadline was Dec 15.
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!
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AAPM Newsletter
January/February 2012
Website Editor
Christopher Marshall, New York, NY
"Don’t sweat the details!” is an admonition best ignored by the website team. Small details can make a big difference to the perception of the website and its ease of use – or that is the impression I get from the comments I receive. For example, the “MY AAPM” submenu opens by default if you are logged in as a member. While several members have commented positively on the value of the MY AAPM feature, other members have noted that its long submenu list pushes other menus off the screen, impeding navigation. We therefore modified the behavior of this submenu earlier this year. It still opens by default on login, but it now closes and remains closed once any other content is selected. It can now also be closed manually if it is open. It’s a small detail but not trivial to implement if one needs the coding “just right." A different example is the newly launched “Educator’s Resource Guide” developed under the sponsorship of Ed Council, through the efforts of Perry Sprawls working with The Medical Physics Education of Physicians Committee of Education Council, chaired by Mark Rzeszotarski. Their content was developed to address the needs of members who were teaching diagnostic radiology to residents, but it became clear to us during the formatting and publication process that a general portal to educational resources would have potentially greater value. The scope of this section was therefore broadened to bring other resources together with room left for development of a wider array of educational resources in the future (see http://www.aapm.org/education/ERG/). Yet another example is the development and implementation of the CAP resident match program http://www.aapm. org/CAP/ under the sponsorship of Ed Council’s Workgroup for Coordination of Medical Physics Residency Programs where Onasis Budisantoso and Farhana Khan from staff are working very hard with John Antolak and John E. Bayouth on many details as I write. As we close on this year we are planning to bring various resources related to the ACMP under the AAPM website umbrella in 2012. These should be either in place or in the process of implementation when this Newsletter is released. JACMP will of course become an AAPM publication so the icon will be featured on the AAPM home page alongside the other AAPM publication icons. The ACMP website content will be frozen, but will remain accessible for the immediate future. Items of historical significance will be preserved “in perpetuity” through the History and Heritage section of the website http://www.aapm.org/org/history/ under the supervision of the History Committee, which has an expanded membership to help deal with that issue. We also plan to make further updates to the version of the website seen by non-members. (You only see this content if you log out of the website.) Early in the 2012 we expect to remove some of the hot buttons that are only useful to members and to add links to free content in the Medical Physics journal to help promote readership. We may also feed these links to our LinkedIn group, which now has a membership of over 1.5K. I end the year as I began it – grateful that we have a dedicated IS group that is willing to “sweat the details” and pleased to wish you all a “Happy New Year.” I hope that you find the Website useful, visit it often, and send me your feedback at http:// www.aapm.org/pubs/newsletter/WebsiteEditor/3701.asp
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AAPM Newsletter
January/February 2012
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AAPM Newsletter
January/February 2012
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. Q. How many facilities are currently accredited by the ACR in Breast MRI? What is the pass rate? A. As of December 2011 the ACR Breast MRI Accreditation Program has accredited 752 units at 685 facilities. The pass rate upon initial attempt is approximately 80%. The vast majority of units that do not pass take corrective action and successfully accredit upon their second attempt. Q. We are applying for Breast MRI Accreditation. Should we send a pathology report with the cancer case? A. No, do not submit a pathology report with the cancer case. However, the cancer case you submit must be biopsy-proven. The biopsy may have been conducted either before or after the MRI. Finally, the cancer must show enhancement on the MRI. Q. Should the lines be left on the scout/localizer that is submitted for Breast MRI Accreditation review? A. If possible, you should remove the lines from the scout/localizer images before submitting them to the ACR. (However, you may submit them with the lines if you cannot remove them.)
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AAPM Newsletter
January/February 2012
Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD
AAPM and ACR Collaborative Process on Practice Guidelines and Technical Standards AAPM is officially collaborating with the American College of Radiology (ACR) on one Practice Guideline and three Technical Standards. The four documents are: • ACR–AAPM Technical Standard For Diagnostic Medical Physics Performance Monitoring Of Computed Tomography (CT) Equipment • ACR–AAPM–SIIM Practice Guideline For Determinants Of Image Quality In Digital Mammography • ACR–AAPM–SIIM Practice Guideline For Digital Radiography • ACR–AAPM–SIIM Technical Standard For Electronic Practice Of Medical Imaging In November, these documents were distributed to all AAPM members for comment. The AAPM members of the Collaborative Committees for each document reviewed the comments received and official AAPM comments were submitted to ACR. Comment resolution is underway and final drafts will be prepared. In late January AAPM will be given the opportunity to review the final draft documents for approval and concurrence. During the ACR’s annual meeting these documents will be presented to the ACR Council for approval. Once approved, the ACR will publish the final documents. AAPM will notify its members when the final documents are available. Thanks to all the members who submitted comments on these documents. If you have any questions, please contact me at lynne@aapm.org. DOE/NNSA Molybdenum-99 (Mo-990 Topical Meeting) The United States Department of Energy, National Nuclear Security Administration’s Global Threat Reduction Initiative held a meeting to discuss issues related to a stable supply of molybdenum-99 (Mo-99). Over four days, more than 100 participants, from 20 countries attended the meeting. The meeting included government and key private sector stakeholders involved in Mo-99 production and use along with the International Atomic Energy Agency (IAEA), Organization for Economic Cooperation and Development-Nuclear Energy Agency (OECD-NEA). Technetium-99m (Tc-99m) obtained from molybdenum-99 (Mo-99) is the most commonly used medical radioisotope in the world. Annually, it is used in approximately 80% of all nuclear medicine diagnostic procedures performed globally. Currently, between 85-95% of the Mo-99 used by the medical community is produced via the use of highly enriched uranium (HEU) targets. Presentations highlighted existing producers’ commitments to convert current production from HEU targets to low enriched uranium (LEU) targets, new entrants’ technical development of nonHEU production methods, and work being performed at the U.S. National Laboratories to support the non-HEU based production of Mo-99. There are no scientific barriers to the conversion of HEU facilities to implement production of Mo99 from LEU. The most significant risks to achieve a non-HEU-based full cost recovery industry that were indentified include: 1. Potential loss of government support to transition to a full cost recovery, non-HEU-based industry. 2. Reliability of ageing reactors and the availability of HEU targets until new production can be implemented. 3. Continuation or use of subsidies for long-term, large-scale production undermines both new entrants and the conversion of current producers to LEU targets. 4. The re-imbursement rate process for all markets requires further study, as it is related to the ability of the industry to move to a full cost recovery, non-HEU-based industry.
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AAPM Newsletter
January/February 2012
continued - Legislative and Regulatory Affairs 5. A global agreement of the appropriate actions that government, industry and the medical community can take to support the difficult transition period from subsidized HEU-based industry to a full cost recovery, non-HEU-based industry. 6. Concern that transitioning to a full cost recovery, non-HEU-based industry could have unintended negative impacts to the medical community, including supply reliability and adverse impacts to patients and medical practitioners if alternative isotopes are used. Given the probability of another Mo-99 supply crisis occurring, the transition to a non-HEU-based Mo-99 production regime should continue to be actively pursued; industry and governments should not become complacent in their commitment to the establishment of a reliable non-HEUbased supply chain, especially during times of supply stability. The attendees recognized that this is a global issue and that all stakeholders need to continue to actively and consistently pursue goals to ensure that the Mo-99 supply chain is on a solid foundation for long-term reliability of supply through full-cost recovery and transition to non-HEU-based production.
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AAPM Newsletter
January/February 2012
Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant
2012 Final Rule Provides RVU Increases to Majority of Radiation Oncology Codes and Expands Radiology MPPR Policy he Centers for Medicare and Medicaid Services (CMS) recently released the 2012 Medicare Physician Fee Schedule (MPFS) final rule. The MPFS specifies payment rates to physicians and other providers, including freestanding cancer centers. Changes in payment for hospital-based outpatient facilities are described in a second article below.
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AAPM provided written comments to the CMS regarding the proposed rule noting that many radiation oncology codes would realize significant reductions greater than 10 percent in 2012. AAPM advised CMS that Radiation Oncology and Radiation Therapy Centers have the largest negative impacts to both 2012 and 2013 total payments compared to all 57 physician specialties. AAPM added that continued reductions to RVUs and MPFS payments will have a deleterious effect on freestanding cancer centers and impact the provision of cancer care, and that Medicare beneficiaries deserve access to quality cancer treatment provided in freestanding and communitybased cancer centers. James Goodwin, Chair of the Professional Economics Committee, reports that almost all radiation therapy procedure codes have increased RVUs from the proposed rule values (except CPT codes 77418, 77421, 77435), however, many procedures will yield payment decreases in 2012 compared to 2011 payments. 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 expands the MPPR policy to the professional component (physician image interpretation) of advanced diagnostic imaging services. This policy has a significant negative impact to diagnostic CT, CTA, MRI, MRA and ultrasound payments. For 2012, CMS finalized the proposal, with modifications, to expand the MPPR to the professional component of advanced imaging services, whereby the first procedure with the highest payment receives 100% Medicare reimbursement; and only 75% reimbursement for the second and subsequent procedures provided in a single imaging session. CMS had originally proposed a 50% payment reduction for the 2nd and subsequent advanced diagnostic imaging procedures but modified the final policy to a 25% reduction based on public comments from AAPM, the American College of Radiology and other stakeholders. Lastly, based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 27.4 percent reduction to all physician payments. However, AAPM anticipates that Congress will avert the payment decrease slated for January 1, 2012. It is likely that Congress will pass legislation for a 1 or 2 year temporary fix that will keep payment at 2011 levels or increase them slightly by 1.0 to 2.0 percent., In the unlikely event that Congress does not pass legislation, the revised 2012 conversion factor would reduce all payments by an additional 27.4 percent to the impacts shown below. Specialty
Impact Work & Malpractice RVU Changes
Impact Practice Expense RVU
2012 Combined Impact
Radiation Oncology Radiation Therapy Centers
0%
-6.0%
-6.0%
0%
-6.0%
-6.0%
Radiology Total Averaged Across All Specialties (budget neutrality)
-1.0%
-2.0%
-3.0%
0%
0%
0%
20
(Does not include -27.4% CF reduction)
AAPM Newsletter
January/February 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) final rule. The projected increase in payment rates for hospital outpatient services is 1.9 percent for 2012. The majority of radiation oncology procedure codes have slight to moderate payment increases for 2012. Medical physics codes 77336 & 77370 in APC 304 receive a 2.7% increase in 2012 payments. Some stereotactic radiation oncology procedures will realize payment decreases from -1.0 to -7.6 percent in 2012 (see APCs 65-67 and 127). In addition, procedures in APC 305 will decrease 2.9 percent in 2012. CPT code 77778 in APC 651 has a significant reduction of 26.1 percent. Please note that APC 651 does not describe LDR prostate brachytherapy (see APC 8001) but other complex interstitial brachytherapy procedures, including treatment for hepatic cancer (see table on page 24.)
Reassignment of CPT 77338 (MLC IMRT treatment device) from APC 310 to APC 305 yields a 71.5% payment decrease to 2012 payment. Other new 2012 policies include: § Apply a payment adjustment to 11 designated cancer hospitals. These cancer hospitals will receive an estimated 11.3 percent increase in 2012 payments. In response to AAPM and other stakeholder comments, CMS modified their policy and will provide the 2012 payment adjustment to cancer hospitals in the form of an aggregate payment at cost report settlement, thereby avoiding higher copayments for Medicare beneficiaries. The modified policy reduced the budget neutrality conversion factor of 0.2 percent compared to 0.7 percent in the proposed rule. § 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. CMS will maintain the following policies in 2012 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. § Package radiation oncology imaging guidance services. § Continue composite APC payments for low dose rate prostate brachytherapy (APC 8001) and multiple imaging procedures, including computed tomography, computed tomography angiography, magnetic resonance imaging, magnetic resonance angiography and ultrasound (APCs 8004-8008).
See what’s available in the 2011 Joint AAPM/COMP Meeting Vancouver, BC, Canada
AAPM Virtual Library Safety in Radiation Therapy - A Call to Action Miami, FL - 2010
2011 AAPM Summer School - Uncertainties in External Beam Radiotherapy Simon Fraser University, BC, Canada
AAPM CT Dose Summit: Scan Paramater Optimization - Atlanta, GA - 2010 Physicists of Note Interviews - Philadelphia, PA - 2010
2011 Physicists of Note Interviews Vancouver, BC, Canada
AAPM 2010 Training at CRCPD - Brachytherapy Presented at the CRCPD Annual Meeting Newport, RI 2010
ACMP 28th Annual Meeting Chattanooga, TN - 2011
52nd Annual Meeting - Philadelphia, PA - 2010
In addition to the online presentations, DVD/CD ROMs are available
AAPM Summer School - Teaching Medical Physics: Innovations in Learning University of Pennsylvania, PA - 2010
http://www.aapm.org/education/VL/
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AAPM Newsletter
January/February 2012
SUMMARY OF 2012 RADIATION ONCOLOGY HOPPS PAYMENTS APC
Description
CPT Codes
2011 Payment
2012 Payment
65 66 67 127
Level I SRS Level II SRS Level III SRS Level IV SRS Hyperthermia & Radiation Treatment Level I Radiation Therapy
G0251 G0340 G0173, G0339 77371
$977.12 $2504.67 $3408.69 $7661.15
$902.53 $2520.30 $3373.60 $7459.88
Percentage Change 2011- 2012 -7.6% 0.6% -1.0% -2.6%
77470, 77600-77620
$388.58
$394.79
1.6%
77401-77407, 77789
$97.82
$99.79
2.0%
77408, 77409, 77411-77416, 77422,77423, 77750
$160.54
$169.08
5.3%
77332-77334
$199.71
$200.06
0.2%
299 300 301
Level II Radiation Therapy
303
Treatment Device Construction
304
Level I Therapeutic Radiation Treatment Prep
77280, 77299 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399
$104.48
$107.33
2.7%
Level II Therapeutic Radiation Treatment Prep Level III Therapeutic Radiation Treatment Prep
77285, 77290, 77315, 77321, 77327, 77328, 77338
$271.61
$263.83
-2.9%
32553, 49411, 55876, 77295, 77301, C9728
$926.74
$954.54
3.0%
305
310 312
Radioelement Applications
77761, 77762, 77763, 77776, 77777, 77799
$354.95
$378.39
6.6%
313
Brachytherapy
77785, 77786, 77787, 0182T
$700.10
$697.97
-0.3%
77418, 0073T
$438.22
$458.27
4.6%
77778 (NOTE: This is not prostate brachytherapy)
$1129.46
$835.11
-26.1%
77520, 77522
$1031.71
$1183.98
14.8%
412
651
664 667 8001
IMRT Treatment Delivery Complex Interstitial Radiation Source Application Level I Proton Beam Therapy
Level II Proton 77523, 77525 $1349.61 $1548.82 14.8% Beam Therapy LDR Prostate Brachytherapy 55875 + 77778 $3229.24 $3339.98 3.4% Composite APC reassignments for 2012 are highlighted in bold
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AAPM Newsletter
January/February 2012
RSNA/AAPM Physics Educational Modules William Hendee, Rochester , MN
RSNA-AAPM Physics Web Modules hen a couple of straggler Phase II physics web modules are completed and mounted on the RSNA website, the number of modules will number 47. Each module takes +/- an hour to complete, including the post test. The modules are intended primarily for the physics education of radiology residents, but they are also excellent teaching tools for graduate students in medical physics. The modules can be accessed from the AAPM website by going to www.aapm.org, clicking on Education, and scrolling down and clicking on RSNA/AAPM Online Physics Modules.
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The modules have been in production over the past few years and are updated every two years. This effort has been overseen by a committee composed of Ehsan Samei, Mary Moore, Mark Rzeszotarski, Mahadevappa Mahesh, Phil Heintz, Mitch Goodsitt, and two physicians: George Bisset and Robert Dixon. Bill Hendee has chaired the oversight committee since its inception. Starting on January 1st, 2012, Bill Hendee retired from the chairmanship of the oversight committee and it passed to a physicist-physician duo. The physicist is Eric Gingold of Thomas Jefferson University, and the physician is Robert Dixon of the University of North Carolina. The co-chairs are committed to the ongoing success of the online physics modules, and we can expect to see additional improvements in the modules in the future. ABRF Web Modules on Ethics and Professionalism In November the American Board of Radiology Foundation (ABRF) released ten web-based modules on ethics and professionalism focused primarily on the professions of medical physics, radiation oncology and radiology. Sponsors of the modules, in addition to the ABRF, are the AAPM, Radiological Society of North America (RSNA), American College of Radiology (ACR), American Society of Radiation Oncology (ASTRO), American Board of Radiology (ABR), American Radium Society (ARS), and the Academy of Radiology Research (ARR). Development of the modules was led by a 3-member team composed of Jennifer Bosma PhD from the ABRF, Linda Bresolin PhD from the RSNA, and Bill Hendee PhD from the AAPM. The modules are available for CE and SAMS credits that are applicable to the Maintenance of Certification process for physicists, oncologists and radiologists. They also are intended for residents in radiology and radiation oncology, and for graduate students and residents in medical physics. They may be accessed by going to www.aapm.org, clicking on Education, and scrolling down and clicking on Online Ethics & Professionalism Training Modules.
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AAPM Newsletter
January/February 2012
Important Diagnostic Physics Survey Edward Nickoloff, New York, NY
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he Diagnostic Work and Workforce Subcommittee (DWWSS) of the Professional Council is in the process of conducting an very important survey. It is trying to gather data about the physics efforts required to do initial acceptance testing and routine annual QC support of various imaging modalities, such as; radiography fluoroscopy, ultrasound, mammography, CT, MRI and nuclear medicine imaging equipment. The goals of this survey are to update the AAPM Report No. 33 on manpower which is about 20 years old and to determine the financial cost of this physics support. The survey divides the data into hospital based and consultant based physics services. Physics efforts for teaching, research, administrative functions and other endeavors are evaluated separately. The Diagnostic Workforce survey was sent to selected members. Please check your email (from mdmill03) for this survey. It must be accessed from your unique email link. IT IS IMPORTANT TO OBTAIN AS MANY DIAGNOSTIC PHYISCS SURVEY RESPONSES AS POSSIBLE SO THAT VALID STATISTICS CAN BE ADDRESSED.
The first annual AAPM Spring Clinical Meeting will include practical information designed to help medical physicists integrate emerging technologies into the clinical environment, keep abreast of regulatory and accreditation related issues, and provide a forum for the exchange of ideas in support of practice quality improvement. Registration & Housing now open! Important Dates to Remember: • January 20 – Scientific Program Available • February 8 – Deadline for discounted Registration fees • February 22 – last day to make hotel reservations at the group rate • February 24 – Online Registration closes Application will be made to the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) for approval of the program in order to provide medical physics continuing education credits (MPCEC) to qualified medical physicists attending this Meeting. AAPM will apply to the ABR for Self-Assessment Modules (SAMs) which allow for interactive learning and self-assessment of knowledge gained during these sessions. We anticipate offering as many as 16 SAMs sessions - exact number to be disclosed after ABR approval. For more information www.aapm.org/meetings/2012SCM/
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AAPM Newsletter
January/February 2012
AAPM/SEFM Agreement Juan M. Pérez, Madrid, Spain Radiofísico Hospitalario
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uring the course of the 2010 RSNA in Chicago, members of the Board of the Spanish Society of Medical Physics (SEFM) met with the Executive Committee of the AAPM and the Chair of the WGNIMP to assess the status of the cooperation agreement between the AAPM and the SEFM, signed in 2009. The goal of such agreement is to establish collaboration between both societies, including exchange programs for Medical Physics trainees. As a result of this agreement, I was the first exchange Spanish Medical Physicist travelling from Spain to the United States. I spent two months in the Radiation Oncology Department in the University of Colorado Hospital, from mid August to mid October. Over this time I had the opportunity to observe different aspects about the department’s organization, as well as the role of medical physicists in the Radiation Oncology Department. Also, I could acquire some experience in treatment planning and patient specific quality assurance in Volumetric Modulated Arc Therapy (VMAT) and Helicoidal Intensity Modulated Radiation Therapy. In addition, I learnt the practical differences between the TG-51 and TRS-398 dosimetry protocols, as well as their application to a special case of a Tomotherapy treatment machine. In addition, I could exchange views about other issues that we have experience in my department: IMRT, SBRT, LINAC commissioning and permanent prostate seeds implants. It’s a very enriching experience to know the procedures of a different group of professionals using Dade Moeller Gaithersburg MD other equipment in order to implement Radiation Safety Las Vegas NV similar treatment techniques. I hope I have Academy contributed at least a small part to what they have given me. I would like to thank the AAPM and the SEFM boards for the opportunity to enjoy this stay in the US, as well as the medical physicists of the University of Colorado Hospital for always answering my questions with a smile in their face and being so kind, and to the Administrative staff for helping me to arrange my stay, show me beautiful Colorado and being so kind too and being concerned about me. All of them have made my stay very nice. I would also like to thank my co-workers for taking extra workload during this two months and allow me to enjoy this stay. I hope they will benefit from what I’ve learned.
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. Visit: www.moellerinc.com/academy for a detailed course agenda.
Register online or call 800-871-7930
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AAPM Newsletter
January/February 2012
NJMPS Chapter Report Maria Chan, Chapter Representative Basking Ridge , NJ
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he New Jersey Medical Physics Society (NJMPS), NJ AAPM local chapter, held its winter meeting at the Kenilworth Inn, Kenilworth, NJ on December 7th, 2011. Attendees of the meeting included NJMPS chapter members in the NJ/NY region and representative from the sponsoring vendor (Sun Nuclear Corp.). The president of NJMPS, Gilad Cohen, first announced the president-elect candidate being Dr. Venkat Narra, Associate Professor at Cancer Institute of New Jersey, Robert Wood Johnson Medical School. The scientific program featured 2 presentations by an invited speaker and one local speaker. From Canis Lupus LLC and University of Wisconsin, Dr. Benjamin Nelms presented an interesting talk on “The Evolution of Dose QA Metrics for Highly Conformal Plans”. Another speaker, Dr. Jingdong Li, presented his research along with Dr. Maria Chan from the Memorial Sloan-Kettering Cancer Center at Basking Ridge on “Quantification of the impact of system errors: HN IMRT case studies.” One important role of the clinical medical physicist is to ensure that the highly conformal 3D doses, which are customed per patient, are accurately planned and delivered. One common method, used for both system commissioning and also per patient dose QA, is to deliver beams or plans to dosimetry phantoms and compare the TPS dose predictions to the measurements. Recent research has focused on the effectiveness of various mechanisms of dose comparisons, i.e. the "metrics" used to quantify the fitness and accuracy of both the TPS and the delivery system. Both presentations detailed this research and related publications/ presentations, covered the assessment of conventional/ accepted metrics and introduced new methods with superior sensitivity and specificity in Dose QA analysis. At the business meeting prior to the scientific session, it was decided to hold the next NJMPS chapter meeting at the same place (Kenilworth Inn) in April 2012. As always, non-members, including NJ/ NY State regulators, are also welcome to attend. Details can be obtained from the chapter secretary, Scott Murphy (smurphy@prapa.com) and the chapter web site (chapter.aapm.org/njmps).
The chapter officers/members/speakers in the pictures from L-R are: Venkat Narra (president-elect), Gilad Cohen (president), Jingdong Li (speaker), Ning Yue (past president), John Napoli (Treasurer), Maria Chan (Representative), Miao Zhang, Sou-Tung Chiu-Tsao, and Benjamin Nelms (speaker).
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AAPM Newsletter
January/February 2012
Person in the News Habib Zaidi Honored with 2010 Kuwait Prize in Applied Sciences for Outstanding Contributions to Biomedical Technology
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r. Habib Zaidi is the recipient of the prestigious 2010 Kuwait Prize in Applied Sciences given by the Kuwait Foundation for the Advancement of Sciences (KFAS) for “Outstanding Contributions to Biomedical Technology”. The prize consisting of 100’000 US$ cash sum, KFAS gold medal and certificate of recognition, was awarded by his Highness the Emir of Kuwait at a ceremony held in Kuwait City on December, 21st 2011. Habib is a senior physicist and head of the PET Instrumentation & Neuroimaging Laboratory at Geneva University Hospital and faculty member at the medical school of Geneva University. Dr. Zaidi has authored over 300 publications, including ~130 peer-reviewed journal articles, conference proceedings and book chapters and is the editor of three textbooks on Therapeutic Applications of Monte Carlo Calculations in Nuclear Medicine, Quantitative Analysis in Nuclear Medicine Imaging and Multimodality Molecular Imaging of Small Animals. He is also the recipient of 2004 Tetalman Memorial Award from the Society of Nuclear Medicine and 2003 Young Investigator Medical Imaging Science Award from IEEE Nuclear Medical Imaging.
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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: March/April • Submission Deadline: February 9, 2012 • Posted On-Line: week of March 1, 2012