AAPM Newsletter July/August 2012 Vol. 37 No. 4

Newsletter

AME RIC AN AS S O C I ATI O N O F P H Y S I C I S TS I N M E D I CI N E We advance the science, education and professional practice of medical physics

AAPM Column VOLUME President’s 37 NO. 4

JULY/AUGUST 2012

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

S

ummertime – the season for the annual gathering of medical physicists. Just for fun I pulled out the Medical Physics issue for July/August, 1979, my first AAPM meeting. It was in Atlanta, ran from Monday through midday Thursday with committee meetings on Sunday, and featured 134 orals and posters and 11 morning refresher courses. The President's Symposium was on "Nuclear Medicine in the CT era."

This year we return to the South, to Charlotte. The meeting structure is similar (don't fix it if it ain't broke). Mostly the meeting has grown. The educational courses are not only in the morning, and there are 37. There are 9 parallel tracks, 587 oral presentations, and 978 posters to choose from. We still end on Thursday afternoon, but we start a day earlier. So much for a lazy summer.

And so much for looking back. What has been consistent for all these years is that the meeting itself is all about looking forward.

This year's President's Symposium, organized by Harald Paganetti and Thomas Bortfeld, is on "The Future of Physics Research in Cancer Therapy and Imaging." As a clinically oriented therapy physicist, I have spent most of my professional life implementing new technologies, so I am used to looking at the near horizon.

But each of those improvements started off on the far horizon, and as an organization we need to be aware of how we need to evolve if we are to continue to contribute.

This symposium will help us look ahead in some important directions.

The program as a whole looks to be outstanding. The scientific, professional, and educational program directors have organized a superb set of symposia, educational courses, and scientific sessions. Fifteen SAMS sessions are available to those of us in the MOC process. As in 1979, we have a Night Out. Back then it was a BBQ at Stone Mountain. In 2012 it is NASCAR, with dinner and a band: good music, good eating, and good friends. Don't fix it if it ain't broke.

And come to the Annual Business Meeting and Town Hall to tell the officers and Board what is broke and needs fixin'.

And to say "thanks" to the volunteers and staff who put this meeting together.

Included in this issue: Chair of the Board President-Elect Executive Director Editor Treasurer Ad Hoc Committee of the Board Report Professional Council Education Council CAMPEP News ACR Accreditation Health Policy/Econ Issues Leg. & Reg. Affairs AAPM Work Group Report WPSC Report NPSC Report Science and Engineering Festival Report Chapter Report Travel Grant Report ISEP Report SUFP Report

p. 2 p. 4 p. 5 p. 7 p. 8 p. 11 p. 14 p. 15 p. 17 p. 18 p. 20 p. 22 p. 24 p. 25 p. 27 p. 28 p. 29 p. 31 p. 34 p. 35

AAPM Newsletter

July/August 2012

AAPM Chair of the Board’s Column J. Anthony Seibert, UC Davis Medical Center

AAPM Goodwill Ambassador Visit to China

T

he World Congress on Medical Physics and Biomedical Engineering was held from May 26-31, 2012 in Beijing, China, with the AAPM and the Medical Physics journal represented at the meeting in the exhibits area, through the tremendous efforts of the Beijing office of the American Institute of Physics (AIP), the publisher of our journal. This event was widely attended by an international audience of medical physicists and biomedical engineers, and provided an excellent venue for showcasing the Medical Physics journal and discussing the opportunities/advantages of becoming AAPM international corresponding members, with access to AAPM services and products. Xingtao Ai, the chief representative of the AIP Beijing office, deserves special gratitude for all of her tremendous efforts and time spent to make this happen. On behalf of the AAPM, I would like to thank Xingtao (and the AIP) for going beyond the call of duty to make this a very successful endeavor.

World Congress of Medical Physics and Biomedical Engineering, Beijing, China, May 2012. Dr. Hendee is conversing with Xingtao Ai on the left.

The outreach to the Chinese medical physics community continued after the Congress, with a contingent headed by Bill Hendee, Editor of the Medical Physics journal, and included Charlie Ma and me, with Xingtao as our facilitator. Early in 2011, Bill envisioned the opportunities of a “Goodwill Ambassador Tour” to universities, hospitals, and cancer centers in China, and with a lot of volunteer time and effort, he organized a plan to meet and greet students, faculty, staff, and administrators in several cities throughout the country. Our mission was to discover the state of the practice of medical physics in China, to share ideas, provide a glimpse of medical physics as practiced in North America to our Chinese counterparts, and to introduce the opportunities of membership in the AAPM with access to the Medical Physics journal. Beginning in Beijing, we visited Peking University and Tsinghua University, followed by a high-speed train trip to Tianjin for interactions at Tianjin University and a tour of Tianjin Union Medical Center. Next stop was Shanghai, where we were hosted by Fudan University, with a tour of the Fudan University Shanghai Cancer Center.

From there, a bus trip took us to Hangzhou for a visit to the Department of Radiation Oncology and Radiology at Zhejiang University Second Affiliated Hospital, and the Zhejiang Cancer Hospital.

An evening airplane ride transported us to Wuhan with next morning presentations at Huazhong University of Science and Technology, at one of the few medical physics graduate programs in China. Wuhan Cancer Center was visited in the afternoon, and then travel via air to Guangzhou for meetings at Sun Yat-Set University Cancer Center the following day. Transportation by train to the final destination, Hong Kong, included visits to Queen Mary Hospital, Queen Elizabeth Hospital, and meetings with the members of the Hong Kong association of medical physics. At each location,

2

AAPM Newsletter

July/August 2012

continued - AAPM President’s Column we presented talks on “Advances in Medical Imaging and the role of the Diagnostic Physicist,” “A Medical Physicists Role in Radiation Therapy of Cancer,” and “Writing and reviewing papers for Medical Physics and other scientific journals,” by Seibert, Ma, and Hendee, respectively. A specific theme was describing the Medical Physics journal and its state-of-the-art publications in scientific investigation, review articles, Vision 20/20 papers, editorials, and medical physics task group documents. The opportunities to submit creative works for publication in Medical Physics, and to consider becoming reviewers of the journal were also discussed. We were treated royally at each location, and had great interactions with graduate students, medical physicists in-training, practicing medical physicists, radiation oncologists, physicians, faculty researchers, administrators, and several university presidents.

We were graciously welcomed at all of the sites we visited, and had enthusiastic responses by attendees with insightful, interactive discussions.

During the visits, we noticed a common theme: state of the art equipment, excellent facilities, rapidly expanding radiation oncology programs, lots and lots of patients, AND a severe shortage of medical physicists and medical physics services. We witnessed radiation oncology clinics treating 150 to 200 patients per day with only one or two clinical medical physicists, with radiation oncologists performing much of the treatment planning and medical physicist duties. Only a small number of therapy medical physicists are trained each year in graduate programs, and there are no residency training programs that are formalized. The presence of diagnostic imaging medical physicists to support clinical operations is practically nonexistent, and almost total reliance on imaging equipment manufacturers to set up examination protocols and perform quality assurance of radiology imaging equipment is the norm. There currently is no official recognition of the medical physics profession by the Chinese health ministry, and a seeming lack of appreciation regarding the importance of medical physicists to provide safe and effective care of the patient as part of the clinical team. Certainly there is a large gap to be filled over the coming years. Communications with our hosts have opened potential venues of collaboration in the areas of education, research, clinical, and professional activities, with efforts to increase opportunities for students to enter the field of medical physics, and to enhance the status of the profession. We are very encouraged about the positive impact of our trip, and look forward to future and continued mutually beneficial interactions between the AAPM and our medical physics colleagues in China.

As this is the newsletter prior to the annual meeting, I look forward to seeing many of you in Charlotte and encourage that you plan to participate in the Town Hall meeting on Wednesday afternoon, August 1, 2012, from 6:15-7:30 PM in Ballroom B of the Charlotte Convention Center, where issues of importance can be discussed with the board of directors and leadership of the AAPM. This is your chance to be heard and to express your opinions on the directions and goals of our association.

Please contact me with any comments, questions, suggestions, or advice, at jaseibert@ucdavis. edu.

3 3

33

AAPM Newsletter

July/August 2012

AAPM President-Elect's Column John D. Hazle, UT MD Anderson Cancer Center

T

he ad hoc committee on editor compensation had its one planned meeting at AAPM headquarters on June 13th. The committee includes Nesrin Dogan, Jeff Garrett, Janelle Molloy, Mark Oldham and myself. Sam Armato and Bill Hendee presented on behalf of Medical Physics, Larry Berkley and George Starkschall represented the Journal of Applied Clinical Medical Physics (JACMP), Chris Marshall and Bruce Curran represented the web service, and Mahadevappa Mahesh and Bruce Curran represented the Newsletter. The meeting was extremely valuable in calibrating the committee on the scope of activities and effort devoted to each of these activities. While substantially different in purpose and scope, all four of these publications provide valuable services to our membership.

Medical Physics is not only the association’s primary scientific publication, but also a substantial source of revenue. The journal has continued to grow under Bill’s editorial leadership in almost all aspects and his service, once again, to AAPM cannot be overstated. He will be stepping down as editor at the end of 2013. A search committee, chaired by Colin Orton, was recently formed and will be executing the search process with the goal of having the next editor identified by summer of 2013, allowing for substantial overlap with Bill. It has also been suggested that the journal has outgrown the model of a single compensated editor. Bill justified to the committee a full-time equivalent position to the ad hoc committee with a recommendation that this effort be shared by an Editor-in-chief and two Deputy Editors (one in therapy and one in imaging).

With JACMP rolling under the AAPM umbrella earlier this year, we now have a second journal to support our members' needs. JACMP has also grown substantially over the last few years and is now publishing outstanding clinical research related articles at a rapid pace. As it’s title implies, JACMP is focused more on the science of clinical medical physics. While the line between the two journals is soft, it is clear that Bill and George have worked together well to try and get the best manuscripts published in the most appropriate journal. George has also asked to be relieved of his Editor duties at JACMP and we will be quickly working to form a search committee and have a new editor in place for that publication this year.

The Newsletter continues to be a valuable periodic publication under the guidance of Mahesh and the AAPM will continue to make sure that this publication is adequately resourced.

Finally, Chris Marshall has asked to be replaced as the web site editor. This position continues to grow with the ever increasing reliance on the internet for communication. It was proposed that we consider renaming this the web presence editor and include social media as part of the scope of this position. The committee was in agreement that this made sense to coordinate the AAPM presence on the web. The new editor will be asked to develop a strategy, working with all appropriate existing committees, and implement this strategy over the next few years to keep AAPM up to date on our web presence.

Finally, I want to once again voice my strong support for the dues increase that will be voted on just after the summer meeting. While we are continually looking to improve efficiency in how we run the organization, the cost of doing business continues to increase. There are so many new initiatives that are planned to keep our members at the forefront of professional practice and science, that this increase will be critical in us being able to accomplish all the important things we want to get done in the years ahead. Please think about what AAPM does for you and your future. I think if you do, the modest increase in dues can easily be justified as an investment in our future and in support of a stronger profession.

I look forward to seeing many of you at the annual meeting in Charlotte!!!

4

AAPM Newsletter

July/August 2012

AAPM Executive Director’s Column Angela R. Keyser, College Park, MD Remember to Vote! lections for the 2012 President-Elect, Treasurer and Board Members-AtLarge will close on July 11th. Make sure to cast your online ballot.

E

AAPM Annual Meeting Make plans to attend the 2012 Annual Business and Town Hall Meeting on Wednesday, August 1 from 6:15 PM - 7:30 PM in Ballroom B, Charlotte Convention Center. Members of the AAPM Board of Directors want to hear directly from the membership. What should AAPM be working on? How can the organization better serve you? Here's your chance to be heard. AAPM's President and Treasurer will report on the status of the organization. There will also be a discussion of the proposed dues increase and amendments to AAPM's By-Laws, with an online vote to follow in the fall.

AAPM Members may use the online Meeting Planner to generate your personal meeting schedule by compiling sessions, and talks you plan to attend into a single chronological document. Then, compile your schedule, download the .vcs file to import to your PDA, or print it out as a reference. If the time of your meeting, session or talk changes, the planner automatically updates your personal schedule. A mobile app will soon be available for Android, iPhone, BlackBerry, etc. through Google Play and iTunes. In addition to the new app, get live show updates all week long about the AAPM Annual Meeting by following #2012AAPM on Twitter.

Selected speakers have been asked to provide handouts for their presentations to be posted on the website. Please check the Handout site for the progress on submissions.

A number of meeting presentations will be available via DVD Rom following the meeting. You may order at the Conference Recordings desk in Charlotte. Presentations will include audio of the speakers synchronized with their slide presentation and animations. Details are available online.

A selection of presentations will also be captured for posting following the meeting in the AAPM Virtual Library. The posted presentations will include streaming audio of the speakers and their slide presentations.

Important: August 29th is the last day to complete the online evaluation system and receive CAMPEP credits for the sessions attended and reviewed from the 2012 Annual Meeting.

Visit the Vendors! Make sure to block out time in your Annual Meeting schedule to visit the Exhibit Hall. An online Buyers Guide is available, with information about the exhibiting companies.

Exhibit hours are: • Sunday, July 29 – 1:00 – 6:00 PM • Monday, July 30 – 9:30 AM – 6:00 PM • Tuesday, July 31 – 9:30 AM – 6:00 PM • Wednesday, August 1 – 9:30 AM – 2:00 PM Charlotte’s got a lot is now available in the iTunes App Store! The app identifies your location and maps nearby Visit Charlotte restaurants, hotels, attractions and more. The app is FREE. Click here for more information.

New Publications The 2011 Professional Survey is available online. You can download a PDF from the web or have the document emailed to you. If you have any problems, please contact HQ. The Short Report of the AAPM and ESTRO: Dose calculation for photon-emitting brachytherapy sources with average energy higher than 50 keV is now available online.

5 5

55

AAPM Newsletter

July/August 2012

CALL FOR EDITOR OF MEDICAL PHYSICS All submission materials should be sent to editorsearch@mail.aapm.org

The term of the current Editor of the journal Medical Physics, William Hendee, Ph.D., will end effective December 31, 2013. A search committee established by the Executive Committee of the AAPM is now seeking applications from qualified individuals to become Editor. The primary responsibility of the Editor is to ensure the scientific integrity, quality, and international stature of Medical Physics. The Editor manages the manuscript review process and represents the Journal in national and international forums. The Editor selects members of the Editorial Board, which has authority over the policies and procedures of the Journal. The Editor is appointed by, and reports to, the Board of Directors of the AAPM. The Editor is Chair of the Medical Physics Editorial Board and a voting member of the Medical Physics Journal Business Management Committee. The Editor also maintains a working relationship with the American Institute of Physics with respect to journal production issues.

Editorial staff support services at AAPM Headquarters will be provided to the Editor, who retains authority over the manuscript review and publication process. Staff ensure the timely distribution and tracking of manuscripts through these processes, the generation of correspondence and statistical data, and the maintenance of archival records under the instruction of the Editor and with support and local oversight of the AAPM Executive Director. A model of editorial responsibilities distributed across the Editor and two Deputy Editors is under discussion. The new Editor will participate in discussion of the final model including Deputy Editor selection.

A transition period between Editors is planned to ensure continuity of editorial operations. The AAPM will provide the Editor and, potentially, the Deputy Editors, with honoraria and expense budgets.

Candidates for Editor should:

(1) Be highly distinguished members of the medical physics community through research, publications, professional society involvement, and other activities.

(2) Be committed to maintaining Medical Physics as the premier journal for the publication of scientific and clinical papers in keeping with the Journal’s masthead as The International Journal of Medical Physics Research and Practice.

(3) Have strong organizational and administrative skills and the ability to work collegially with Deputy Editors, Editorial Board, and AAPM staff in an environment of distributed support and responsibility.

(4) Have a working knowledge of the process of managing the operation of a scientific journal and have prior service on one or more editorial boards or equivalent.

(5) Possess a strategic vision of the position of the Journal within the arena of scientific publications and an operational plan for continued improvement of the Journal.

(6) Be aware of the changing publishing environment associated with electronic publication technology and challenges such as open-access publication.

(7) Work in an environment that accommodates the Editor’s workload.

(8) Be prepared to serve as Editor for 6 years, subject to reappointment after a three-year term.

(9) Reside in North America.

Individuals who are interested in applying for the Editor position should send an e-mail to editorsearch@ mail.aapm.org at the earliest opportunity indicating their intent to submit a detailed application by August 15, 2012. The detailed application should be submitted electronically to editorsearch@mail.aapm.org in the form of a letter addressing the previous items plus any other relevant considerations along with a curriculum vitae.

The anticipated timetable for the selection and transition processes is as follows: (A) The search committee will compile a short list of the most qualified candidates by August 15, 2012.

(B) Selected candidates will give a presentation to the search committee during September 2012.

(C) Selected candidates will be asked to address their financial needs, to discuss their candidates for the Deputy Editor positions, and to demonstrate that they have the time available and the institutional commitment (if relevant) to assume the Editor’s responsibilities.

(D) The new Editor will be appointed by the Board on or before January 1, 2013, at which time the transition process between Editors will be initiated.

(E) Transition arrangements occurring during 2013 will be the responsibility of the current and new Editor with the support of the Editorial Board, the Journal Business Management Committee, and AAPM staff.

(F) The new Editor will assume full responsibility on January 1, 2014.

6

AAPM Newsletter

July/August 2012

Editor's Column

Mahadevappa Mahesh, Baltimore, MD

B

y the time you are reading this Newsletter, most of you may be preparing to travel to the AAPM annual meeting in Charlotte, NC. This issue contains a wealth of information about our association’s activities and forthcoming plans. I also would like to draw your attention to the article from the treasurer and the chair of the ad-hoc committee of the board on dues strategy report highlighting the need for a membership dues increase. This issue also contains reports from the education and professional councils, a local chapter report, AAPM-IPEM travel grant and AAPM-ISEP workshop reports along with other articles.

Finally, as outlined in the President-Elect’s column, a search committee has been formed to search for a new editor for the Medical Physics Journal (details are on page 6). Overall, I wish all of you a happy summer and look forward to seeing many of you all at the annual meeting.

continued - AAPM Executive Director’s Column The Executive Summary and Full Report of TG-125: Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems are now available online.

Funding Award Winners Announced The 2012 AAPM Fellowship for Graduate Study in Medical Physics is awarded to David Fried, UT Health Science Center.

The 2012 Research Seed Grants are awarded to Magdalena Bazlova, Ph.D., Stanford University and Huanjun Ding, Ph.D., University of California, Irvine.

Congratulations to the recipients.

These programs are supported by the AAPM Education and Research Fund. More information about the various funding programs and the great work supported is available in the 2011 Annual Report. Please consider making a donation to the AAPM Education and Research Fund.

Staff Recognition Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high-performing professionals. The following AAPM team members celebrated an AAPM anniversary in the first half of 2012. I want to publicly thank them and acknowledge their efforts.

STAFF REGOGNITION Nancy Vazquez Jennifer Hudson Zailu Gao Cecilia Hunter Karen MacFarland Lynne Fairobent Lisa Giove Laurie Allen Onasis Budisantoso Amanda Potter Viv Dennis Melissa Liverpool Rachel Smiroldo

7 7

77

15 years of service 11 years of service 11 years of service 9 years of service 9 years of service 8 years of service 7 years of service 5 years of service 4 years of service 4 years of service 2 year of service 1 year of service 1 year of service

AAPM Newsletter

July/August 2012

AAPM Treasurer’s Column Janelle A. Molloy, University of Kentucky An appeal for your vote

A

t their December meeting in 2011, the Board of Directors (BRD) voted to approve a one-time $100 dues increase for the 2013 dues year, followed by an automatic annual cost of living increase of 3%.

This requires approval by the general membership and you were asked to send comments to the Secretary for inclusion in the discussion at the Annual Business Meeting this summer in Charlotte. In a corresponding article by the Chairman of the Ad Hoc Committee of the Board on Dues Strategy, Dharani Rangaraj, the Chair of this Committee responds to the comments we have received.

My article is intended to provide the membership with a brief synopsis of the financial rationale for such an increase. As you know, the current economic climate, both in general and for medical physicists, is tentative. There are fewer jobs and many of us are working with reduced staffs. Pay raises are scarce and small. And even those who are not directly impacted by the precarious economic environment are justifiably concerned and cautious. Given these circumstances, the AAPM membership deserves ample justification before approving such a significant dues increase.

Budget Development Beginning this year, the budgeting process will be guided directly by priorities set in our association’s strategic plan. This is accomplished via the Strategic Planning Committee (SPC) of the BRD. The SPC will meet each year in early spring and provide strategic guidance on the expenditure of the AAPM’s resources. Chairs are being asked to develop programs that are consistent with the major goals and objectives of the Strategic Plan. We encourage each and every member to review the Plan, which can be found at: http://www.aapm.org/org/TheAAPMStrategicPlan-2011_Full_Version_final.pdf Current financial status AAPM once again operated at a deficit in 2011. Likewise, another significant loss on reserves was experienced due to declines in the market $1,000,000 value of investments. In total, the deficit was approximately $802,726 $800,000 $222,000. The graph on the left shows the downward trend $600,000 over the past several years.

$400,000 Our major sources of revenue are dues, the Annual Meeting, $158,599 $200,000 and proceeds from Medical Physics advertising and $0 subscriptions.

In addition ($35,993) to the Placement Service, ($200,000) AAPM provides management ($222,000) ($302,043) ($280,890) assistance for both CAMPEP ($400,000) and SDAMPP for which we 2012 2011 2009 2010 2007 2008 receive fees.

These latter activities, along with all of our advertising income, are taxable at regular corporate income tax rates. In 2011, our tax liability for these activities rose to $278,000. Because we are a 501c3 not-for-profit corporation, IRS

Net Income – 2007 through 2012

8

AAPM Newsletter

July/August 2012

continued - AAPM Treasurer's Column guidelines regulate the percentage of income that can be earned outside of activities related to our mission. Our auditors have indicated that the percentage of taxable income should not exceed 15%. AAPM’s taxable income in 2011 was over 18% of the total. Therefore, it is important that we focus on generating additional income related to our mission, dues being the primary example.

The full 2011 Audited Financial Statements are available to all members at: http://www.aapm.org/AAPMUtilities/download.asp?file=finance%2FFinancialRepo rt2011.pdf&submit2=go Almost 40% of all income is derived from the Annual Meeting and other professional development and educational activities, including Summer School and specialty meetings such as the CT Dose and ITART meetings. Many of you who attend the meeting each year raise concerns about the cost of the registration fees. The Meeting Coordination Committee reviews these fees each year and compares them with similar associations to ensure that we remain competitive in the market and that the meeting returns a fair percentage to the organization. In the past two years, vendor exhibit support for the meeting has remained flat. Many companies have merged and a number have reduced the amount of space they occupy on the floor.

Revenue by Major Category; 2012 Budget

The Medical Physics Journal contributes another 30% to our overall revenues, about 50% from subscriptions and $375,250 , another 50% from taxable $1,470,118 , 4.59% advertising.

Subscription $2,474,626 , 17.96% rates are raised between 30.24% 3 and 5 percent each year, but the number of libraries $595,600 , subscribing is declining. We 7.28% are all aware that paper will eventually go away, and with it Dues will go substantial advertising revenue.

We need to be Committee Projects prepared for this eventuality Education and the Journal Business Publications $3,268,126 , Management Committee Other 39.93% meets several times a year to discuss such strategic issues.

Total = $8,183,720 As with many professional societies, we must rely on membership support to continue to be successful. Dues income currently only provides about 18% of the total. The proposed dues increase would bring this total up by several percentage points, generating over $500,000 in additional income in 2013.

Expenses are broken out in the graph on the top of the following page.

All but 16% of our expenses goes directly to program support. In the most recent benchmarking study of associations, this percentage is significantly lower than many associations who average 20 to 30% or more.

Approximately $2 million directly supports the work of our volunteer committees and task groups. Some of our members question the validity of supporting a headquarters operation and point to years prior to the 1990s when almost all of the Association’s work was carried out by volunteers. Many of us may remember the days when our Treasurer kept the financial records on a spreadsheet. It is significant to note that since 1996, when we first went to our current accounting software system, our annual budget has doubled from $4 million to $8 million.

It took 7,300 staff hours in 2011 to simply manage our Annual Meeting, representing 3.75 FTEs. The Web site, Member Services, and the myriad technology services provided by headquarters in 2011 utilized almost 10,000 hours, or 5 FTEs. There are 8,000 individual member dues payments,

9 9

99

AAPM Newsletter

July/August 2012

continued - AAPM Treasurer's Column

Expenses by Major Category; 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

$1,508,884 , 18%

Publications Administration

$2,520,247 , 30%

Other

and more than 4,000 meeting payments to record and process each year adding up to the total of $8 million in income. Processing the accounting transactions alone takes 2 FTEs, plus temporary employees to manage the audit process.

While we may lament the costs of supporting a headquarters office, our association has succeeded over the last two decades because we made the decision to form a strong association management team of professionals at a headquarters location. What services would we choose to forego if we reduce the headquarters office footprint?

Status of our reserve funds The graph below provides a history of the growth of our reserves. The Board of Directors set policy that endorses retaining equal to a full year of expenses plus long term commitments. This totals to approximately $9 million.

Total = $8,464,610

Currently, our unrestricted reserve balance is $8.5 M. This value is down from its peak in 2007 of $9.7 M, but has recovered from its low in 2009 of $6.6 M. The current balance is over $500,000 short and the likelihood of this changing appears slim.

Perhaps the most important Historical Reserve Balances, YE1993 thru Budget 2012 reason that a dues increase is requested is the shortfall in our ability to support the important $12,000,000 efforts the profession needs for its future. Preparations for the 2012 $10,000,000 budget required significant cuts in worthwhile projects due to lack $8,000,000 of available funds. Each of our four councils (Education, Science, $6,000,000 Professional and Administrative) reduced their budget requests $4,000,000 significantly last year in order to comply with a balanced budget.

Support for numerous important, $2,000,000 volunteer initiated programs is far below desirable levels. These $0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 include summer undergraduate research fellowships, new residency program creation, Journal of Applied Clinical Medical Physics, establishment of clinical practice guidelines and research seed grants.

Budg 2012

Our association is vibrant and is increasingly being called upon to advocate on behalf of our profession, patient safety and for distribution of scarce national resources. We have all benefitted from the work of the volunteers and staff in the AAPM and we have not seen a dues increase for 5 years. The AAPM produces task group reports that help us in our everyday clinical practice, and advocates with national reimbursement agencies to preserve our comfortable salaries. Please support the proposed dues increase so that we may continue the important work that we are now doing so well.

10

AAPM Newsletter

July/August 2012

Ad Hoc Committee of the Board on Dues Strategy Report Dharanipathy Rangaraj, Scott and White Memorial Hospital

T

he members of the Ad Hoc Committee of the Board on Dues Strategy (AHCBDS) met by conference call several weeks ago to review the comments submitted thus far by the membership concerning the Board-proposed dues increase.

In addition to myself, the committee members include Jim Goodwin, Per Halvorsen, Mary Ellen Masterson-McGary, Janelle Molloy and Russ Tarver.

Of the comments received, several wrote in favor of the dues proposal and several opposed. These comments will be reported in full by the Secretary at the Annual Business Meeting in Charlotte on Wednesday, August 1st, and additional comments and questions will be taken from the floor. We hope you will be present to provide your input.

A very concise comment was submitted by one of our own Committee Members, Russ Tarver.

He summarizes his support with the following: “The AAPM has made every effort possible to continue providing great service to its membership with reduced income and should strive to maintain its status as the preeminent Medical Physics society. Doing so requires the continued effort of our task groups, working groups, and various committees and councils. Sufficient funds must be available to support these activities and the proposed dues increase will have a significant impact to our revenue.

The society can no longer accept a purely scientific role and must act in areas that are outside the clinical and research realms of Medical Physics, but impact upon the field of Medical Physics. This includes legislation, reimbursement, practice standards, education, etc. Efforts in these areas are often expensive and time consuming but should not be avoided due to lack of funds.”

Those opposed to the dues change commented on two major issues, the size of the increase and the need for cost of living adjustments. The following graph tracks dues rates for regular full membership since 1970. The pattern is one of fits and starts, but with a continuous upward trend.

Full Member Dues Rates 1970-­‐Present 500 450 400 350 300 250

Whether the dues increase or not, the AAPM is now an $8 million dollar a year 150 organization. The functions carried out by the organization and the market 100 conditions in which those functions are 50 performed are similar, in many ways, to 0 the realities faced by most corporations with similar annual budgets. The tangible products and services of the Association include production of the premier scientific Journal in the field, Medical Physics. Production costs for a product of this scope and quality also increase steadily.

1970 1972 1974 1976 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018

200

Likewise, the cost of renting a convention center to hold the Annual Meeting have increased dramatically just over the past ten years. All successful corporations have been forced to increase prices for products and services at some point in time.

11 11

11 11

AAPM Newsletter

July/August 2012

continued - Ad Hoc Committee of the Board on Dues Strategy Report The intent in the annual adjustments is to smooth out the line you see in the graph and eliminate the need for large jumps every few years. It allows the organization to plan its budgets and programs accordingly. Under our current system, it takes several years to obtain approval for a dues increase. Failed attempts make the process not only tougher, but make the size of the increase larger. In the meantime, worthwhile programs designed to move the profession forward are stalled, or canceled all together.

The following graph, based on our statistical model used in budgeting, projects anticipated expenses in the next few years. Every corporation, whether product- or service-oriented, can only continue to be successful by projecting their financial needs, adjusting prices and planning accordingly. The Strategic Planning Committee has put an enormous effort into developing a Strategic Plan to face the future of medical physics with certainty and security. The full plan clearly provides the justification for the need to budget appropriately to implement its goals and strategies. The Board of Directors is now charged with ensuring the resources are there to meet these objectives. A copy of the full plan can be found at: http://www.aapm.org/org/TheAAPMStrategicPlan-2011_Full_Version_final.pdf One of the respondents remarked that “I think the dues increase is excessive for a single increase ...... I think a 3%/year increase would be more palatable without the additional $100 initial increase.”

Total Expenses 1996 through est. 2018 14,000,000

Another comment was: “While I would support the $100 increase in the annual dues, the inclusion of the 3% automatic annual increase will preclude me from voting for the proposal.”

12,000,000 10,000,000 8,000,000 6,000,000

The Board of Directors is charged with the fiduciary duty of planning and resource 2,000,000 allocation that maintains the health and vitality of the organization. They have 0 1997 1999 2001 2003 2005 2007 2009 2012 2014 2016 2018 been elected by their peers to safeguard the association’s assets and ensure that the association provides services that keep up with the scientific, educational and professional needs of the membership. Aided now by a Strategic Planning Committee, along with Budget and Finance Committees, it is their best judgment that dues must increase to protect the future of the AAPM. 4,000,000

The Committee understands the concerns voiced by the members who do not wish to see the dues increase. We hope that these members will volunteer for one or more of the committees, work groups or task groups that are carrying out the vital functions of the AAPM. Service on a committee provides insight into the variety and scope of what the society is doing for its members for their dues dollars.

More than 1,100 volunteers give of their time to work for the AAPM. Time is a very scarce commodity among our members. It is important that the resources are there for them when a new project or program is launched.

This budget year, a number of extremely important programs were either underfunded, eliminated or delayed because the money simply was not available. The dues increase that was rejected in 2010 by an extremely small margin would have helped significantly.

One member suggested reducing the size of headquarters. Every three years the President appoints a committee with the specific task of reviewing headquarters operations. We invite any member to review the several Headquarters Site Visit reports on the web site at: http://www.aapm.org/org/organization.asp

12

AAPM Newsletter

July/August 2012

continued - Ad Hoc Committee of the Board on Dues Strategy Report With the reduced number of volunteer hours available, reductions in staffing would require eliminating or reducing the quality and quantity of many activities, including our education and professional development programs, council and committee support, as well as the business functions of the association.

In order for AAPM to continue to be a driving force in advancing the profession, it will take all of us making a small additional contribution to dues. Judging by the progress the AAPM has made in the last ten years, it is not difficult to predict the strides we can make in the future. The Committee encourages all members who wish to comment on the proposed dues increase, to attend the Annual Business Meeting in Charlotte, and the Town Hall Meeting which precedes it.

Comments and questions are welcome and the full Board of Directors will be present to address any concerns the members may have pertaining to both programmatic and operational issues.

See you in Charlotte.

vc AAPM Clr Ad 6.75x4.75 12May31.pdf

1

5/31/12

11:14 AM

AAPM Color Horizontal Ad 6.75 x 4.75 due 6/7/12 submitted 5/31/12

Unparalleled Accuracy & Sensor Choice Accu-Gold: Measure Dose, Rate, kV, Time, HVL, Filtration, mA, Scatter / Leakage, Luminance / Illuminance and more.

chamber 3 rev/s with Spiral scan, l-axis location. in centra

ACCU-GOLD THE NEXT GENERATION Wide Beam CT Ion Chamber 0.6cc thimble ionization chamber as described in the AAPM Report No. TG–111 “Comprehensive Methodology for the Evaluation of Radiation Dose in X-ray Computed Tomography.” Ideal for dose measurements in modern wide beam multi-slice CT.

Radiography, Fluoroscopy, Mammography, CT, Dental 0.6cc thimble ionization chamber “Actual Size”

Radcal

426 West Duarte Road Monrovia, CA 91016 USA

The Gold Standard in Radiation Measurement

13 13

13 13

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

AAPM Newsletter

July/August 2012

Professional Council Report Per Halvorsen, Newton, MA

Annual Meeting in Charlotte The upcoming Annual Meeting promises a diverse program with topics of interest to most members. To highlight some: • The Professional Council Symposium on Sunday is titled “Practice Standards: Driving forces, benefits, potential pitfalls” and features a panel of speakers who will address the multi-faceted considerations implied in the title.

• Monday sessions provide updates on Medical Physics Practice Guidelines, economic topics, and the ABR process.

• Tuesday sessions provide tips on establishing multidisciplinary research, practice management, effective communication, stress management, practice accreditation, updates on our workforce surveys and licensure initiative, and last but not least, the New Member Symposium.

• Wednesday sessions include the annual International Medical Physics Symposium, an interactive panel discussion on Ethics in Action, tips on preparing for the ABR exams in therapy and imaging, an overview of AAPM’s recent collaboration with Spanish and Russian medical physics organizations related to the introduction of new technologies, a review of the evolving landscape of scientific publishing (print journals are no longer the only credible venue), and an overview of medical physics’ role in federal and state governments.

• Thursday sessions review how to be a journal referee and the economics of light ion therapy.

With a program this diverse, there should be something of interest for everyone. I hope to see you in Charlotte!

Workforce Assessment Committee New for this year is the Workforce Assessment Committee, with Chair Michael Mills and Vice Chair Yan Yu. This Committee along with the Diagnostic Work and Workforce Sub-Committee Chaired by Ed Nickoloff are analyzing the results of a Diagnostic Physics Workforce Survey Conducted between October of 2011 and February of 2012. The report from this investigation is intended to update the recommendations contained in the 1991 AAPM Report No. 33: Staffing Levels and Responsibilities of Physicists in Diagnostic Radiology. The Workforce Assessment Committee is also representing the AAPM in the ASTRO Workforce Survey, due for publication later this year.

Supervision As I mentioned in an earlier column, the concept of appropriate professional supervision is crucial in clinical practice. While the AAPM has convened an Ad-Hoc committee to address this for the medical physics practice environment, healthcare reimbursement rules can be very influential in this regard. Look for the article by Jerry White in this issue for a more detailed review of the supervision requirements attached to some of the most common clinical procedures.

Vote!

As you may know, the Board of Directors has approved three motions that will come to the full membership for votes: a dues increase proposal and two By-Law changes. In addition, the annual election cycle for leadership positions within the AAPM will open soon. The Association can only be effective if the membership takes the time to be informed on the issues and to vote. I hope you will participate and ensure that your viewpoint is heard – by casting your vote.

14

AAPM Newsletter

July/August 2012

Education Council Report George Starkschall, Houston, TX

O

ne of the many tasks that a medical physicist faces is that of providing information to the general public about high technology in medicine as well as applications of radiation both in medicine and in our contemporary lives. We encounter two major audiences in such talks: the general public, who often have gross misconceptions about the risks and benefits of radiation in medicine, and students in our primary and secondary schools, who may also be intrigued by our chosen profession as a career pathway.

In our upcoming AAPM Meeting in Charlotte, the Education Council Symposium, entitled “Medical Physics and Technology Education for Society: Adults, Teenagers, and Elementary Students,” will address how we can educate various audiences in society about our role as medical physicists. Organized by Mary Fox, the Symposium will consist of two parts. First, Perry Sprawls will speak about educational activities for adults. Then Mary will speak about introducing medical physics to elementary and high school students. The Symposium will be held on Sunday, July 29, from 9:30 to 11 am in Ballroom B of the Convention Center, and I hope you will be able to attend. A special word of thanks goes to Mary for organizing this Symposium.

Please be aware of several other activities that address education at the Meeting. Later on Sunday, July 29, we will have a General Poster Discussion session from 3 pm to 6 pm in the Exhibit Hall that will include a set of posters on educational methods.

On Tuesday morning from 10:30 am to noon, a Practical Medical Physics session entitled “Effective Medical Physics Education” will be chaired by Perry Sprawls and Geoff Ibbott, and held in Room 218 at the Convention Center. Finally, the annual Innovations in Medical Physics Education session will be held Wednesday from 4:30 pm to 6 pm in Ballroom A. This year, for the first time, we are able to offer a cash prize for the best presentation in the Innovations in Medical Physics Education session.

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

2012 AAPM Annual Meeting App

For years, AAPM has published the Annual Meeting Scientific Program on-line, but with the popularity of smartphones and tablets, members and attendees have been requesting native apps that do not require Internet access so they are not tethered to their computers.

AAPM is happy to announce the development of the 2012 AAPM Annual Meeting App for iPhone, Android and Blackberry Download the App from: http://www.aapm.org/meetings/2012AM/

Sponsored by Mobius Medical Systems, LP

15 15

15 15

AAPM Newsletter

July/August 2012

ARC-EDGE Treatment Planning for Physicists     

40 Hour Virtual Training Personal 4 hour WebEx Introduction Log in/Password Protected Confidentiality Maintained Ten 3 hour modules by body site

ATTENTION PHYSICISTS:   

  

Move Beyond Mechanics in Plan Reviews!

Learn to Review Plans Clinically!

Develop Comprehensive Understanding Of Treatment Planning Protocols and Provide Guidance for the Planning Team.

Physicists Can Plan in the absence of Dosimetrists Reduce Error Risk Exposure due to High Case Load.

Physicists need to be Engaged.

Education for Clinical Excellence ABR Board Review Physics Written I & II Physics Oral Virtual Courses 

11+ hours of streaming video lecture



Unlimited Viewing



Access until you pass



Student Forum



PowerPoints and Practice Quizzes



Guided Manual for Study

Live and Virtual Courses are available.

Please visit us online for available dates:

www.arcphysics.net Experience why www.arcphysics.net (574)232-2305 info@rtuvt.com

our first time pass rate is over 80 %!

Guaranteed to Pass!

16

AAPM Newsletter

July/August 2012

CAMPEP News

William R. Hendee, CAMPEP President & Chair

P

assing the certification requirements of the American Board of Radiology (ABR) is a necessary step in the development of medical physicists wishing to enter clinical practice as a diagnostic, nuclear, or therapeutic medical physicist. The process is composed of both written and oral examinations which must be diligently prepared for by intense study and practice. In the past, candidates for certification have sought information from certified physicists, including their instructors and mentors, about the nature of the examinations and the types of questions that typically are asked. There is really nothing wrong with such inquiries.

More recently, there has been an organized effort to encourage candidates taking the examinations to remember and record the questions for study by future certification candidates. This organized practice appears to have been prevalent in one of the radiological specialties other than medical physics. Even so, medical physicists should be aware that the practice is considered unprofessional and is not considered to be permissible conduct by the ABR. Consequently, all medical physicists, radiologists and radiation oncologists who are enrolled in the certification process will be required to attest that they have not, and will not, participate in any effort to recall questions asked on the certification examinations.

Directors of CAMPEP-accredited graduate and residency programs recently received a letter from the ABR providing a link to an ABR exam security policy and asking them to sign a “CAMPEP Program Director Exam Security Agreement.” This letter is a bit misleading because the policy and the agreement have nothing to do with CAMPEP; they are initiatives solely of the ABR. They have no relationship to either CAMPEP or to the Society of Directors of Academic Medical Physics Programs (SDAMPP), and neither organization has been asked to approve or authorize their distribution.

Several program directors have asked CAMPEP how they should respond to these documents.

Since the documents are outside the jurisdiction of CAMPEP, it cannot advise program directors on how to respond. A few program directors have simply signed the “CAMPEP Program Director Exam Security Agreement” and returned it to the ABR. Other directors have expressed reluctance to sign the ABR agreement without the concurrence of their institutions, and intend to seek guidance from the institutions’ graduate school (for graduate programs) or graduate medical education office (for residency programs). Each program director will have to decide how to respond to the ABR agreement.

The ABR regards departmental assistance and/or encouragement of sharing of recalled ABR test questions as highly unprofessional. CAMPEP and SDAMPP are determined to promote and maintain the highest level of professionalism and ethics in medical physics education. This commitment includes the expectation that students and CAMPEP-accredited programs will not participate in any organized effort to recall examination questions. CAMPEP and SDAMPP have asked the ABR to clarify which materials are inappropriate when educating medical physicists, what is considered a reasonable effort to identify and eliminate inappropriate materials, and the consequences to a medical physics educational program if the program director does not sign the agreement or if one or more students do not honor the exam security policy, either with or without the knowledge of the program director.

17 17

17 17

AAPM Newsletter

July/August 2012

ACR Accreditation

Priscilla F. Butler, Senior Director & Medical Physicist ACR Quality and Safety 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.

T

his article is slightly different from my previous ones; there have been significant changes to both the ACR Mammography and Stereotactic Breast Biopsy Accreditation Programs and I wanted to bring your attention to these important revisions. ACR accreditation programs try to keep pace with evolving clinical practice, technology, and federal regulations. In addition, the ACR continuously explores new ways to reduce the administrative burden on applicants and make the process more efficient. As a result, the ACR implemented significant improvements that coincided with the launch of the new ACR website on May 21, 2012. Because of the numerous changes to documents, not all specific changes are listed, but instead are summarized below.

Changes for both mammography and stereotactic breast biopsy: ACR now uses Landauer’s state-of-the-art dosimeters (optically stimulated luminescence – OSLs) instead of thermoluminescent dosimeters (TLDs) for improved accuracy of dose assessments and ease of use. Since facilities currently undergoing accreditation still have the TLDs, this transition will be phased in as follows: • Any facility submitting an application on or after May 21, 2012, will receive the OSL dosimeters for all units, along with new testing instructions.

• Any facility that has already received a TLD dosimeter should expose the TLD, following the old testing instructions received with the dosimeter.

• Any facility that needs a replacement dosimeter will receive an OSL, with the new testing instructions.

• Beginning August 19, 2012, Landauer will no longer accept TLDs. Any TLDs received by Landauer on or after August 19 will be replaced with an OSL. Changes for mammography only: • All of the mammography digital manufacturer-specific and screen-film accreditation instructions and forms have been combined into 1 set of “universal” documents. (The only exceptions are the Medical Physicist QC Test Summary forms and the technologist’s QC checklists which must remain manufacturer-specific to comply with FDA QC regulations.)

• The ACR no longer requests laser printer or film processor QC charts for mammography accreditation review. (However, facilities must still check that they perform the required printer or processor QC on the appropriate checklist.)

Changes for stereotactic biopsy only: • The clinical image identification requirements have been changed to be consistent with current ACR guidelines: - Patient’s first and last names (required) - Identification number and/or date of birth (required) - Examination date (required) - Facility name (required) - Facility location (city, state and zip) - Designation of left or right breast (required) - Annotation of mammographic view (e.g., CC, MLO/ML/LM) - Technologist’s identification number or initials • The Testing Instructions and Test Image Data form have been revised and now outline the following: -- Applicants must submit BI-RADS® Category 4 or 5 calcification biopsy cases -- The 2-view mammogram must be printed “true size” (or have a scale) and must include the entire breast

18

AAPM Newsletter

July/August 2012

continued - ACR Accreditation -- Calcifications must be circled on the mammogram -- Calcifications must be visible on both stereotactic views -- Images must be submitted on 10 x 12-in film or smaller (facilities may trim the film to meet this requirement) -- New procedures for the phantom image reduce the number of exposures necessary for a larger FOV system -- New illustrations help clarify the required labeling You may link to all the new accreditation documents through: http://www.acr.org/QualitySafety/Accreditation Finally, as of June 1, 2012, I am no longer Senior Director for Breast Imaging Accreditation. The ACR’s Department of Quality and Safety has reorganized all accreditation programs under one Senior Director, Leonard Lucey, BA, JD, LLM. This will allow me the necessary time to attend to the many radiation and physics-related issues facing the ACR today. Although my new role is as Senior Director for activities that include Guidelines, Technical Standards, Appropriateness Criteria, Registries and Special Projects (including dose initiatives), with the support of ACR accreditation staff, I will continue this important AAPM column.

If you have any questions, please contact the ACR Accreditation Program at 800-770-0145 or email the specific accreditation program at: ctaccred@acr.org mri@acr.org nmap@acr.org ultrasound-accred@acr.org rad-onc-accred@acr.org

For Breast Imaging Accreditation Programs, call 800-227-6440, or email the specific program at: breastmri-accred@acr.org buap@acr.org mamm-accred@acr.org sbbap@acr.org

Programmable Motion for Image Acquisition, Treatment Planning & Dose Delivery TISSUE EQUIVALENT RESPIRATORY MOTION WITH 3 AXES OF CONTROL • Commission 4D imaging and 4D radiotherapy systems • Quantify volumetric and positional aliasing of CT in the presence of 3D target motion • Evaluate static and dynamic target localization accuracy of onboard imaging systems • Test accuracy and consistency of tumor tracking and respiratory gating devices • Assess dosimetric accuracy of temporally modulated radiation therapy • Train and evaluate personnel during implementation of new equipment and techniques Model 008A

Visit our website for additional product information.

www.cirsinc.com

2428 Almeda Avenue, Suite 316 Norfolk, VA 23513 USA • 800.617.1177

Visit our website for additional product information.

Tissue Simulation & Phantom Technology

19 19 AAPM Headquarters

19 19

AAPM Newsletter

July/August 2012

Health Policy/Economic Issues Gerald A. White Jr., Colorado Springs, CO Supervision – Musical or Mystery?

I have a song from Fiddler on the Roof playing over and over in my head: Supervision, Supervision! Supervision!

Supervision, Supervision! Supervision!

[TEVYE & PAPAS] Who, day and night, must scramble for a living, Feed a wife and children, say his daily prayers?

And who has the right, as master of the house, To have the final word at home?

The Papa, the Papa! Supervision.

The Papa, the Papa! Supervision.

The song becomes louder each time I field a question about issues related to supervision in the Radiation Oncology Department. So much concern, so much confusion, and so much bad or incomplete information, where is a person to turn for something more substantive? Sing along as I offer some thoughts on the subject.

Much of the recent concern is related to the Centers for Medicare and Medicaid Services (CMS) missives over the last several years related to physician supervision of the technical component of services provided to patients. These transmittals are not Radiation Oncology specific, but rather apply to all of the nearly 8,000 procedures described by the various CPT and HCPCS codes.

Don’t feel as though our profession has been singled out, rather we are one small note in a much larger musical of medicine addressed

by CMS. One conductor, lots of notes. In our case, for example, a physician in Radiation Training Academy Oncology might prescribe external beam treatments for a patient.

The physician MEDICAL SAFETY TRAINING delegates much of the work to other staff but is expected to exercise supervision over Available Courses the treatment delivery. CMS describes three Medical Radiation levels of supervision, and the definitions are Safety Officer Course quite specific: CAMPEP Accredited.

General Supervision: The procedure Fluoroscopy Training and is furnished under the physician’s overall Refresher Course direction and control, but the physician’s Custom Courses presence is not required during the Designed to meet your needs. performance of the procedure.

Direct Supervision: The physician must be Available Formats present and immediately available to furnish Classroom assistance and direction throughout the (Las Vegas NV, Gaithersburg MD performance of the procedure. It does not or Oak Ridge TN) mean that the physician must be present in On-site (your choice) the room when the procedure is performed.

On-line Courses Personal Supervision: The physician must Webinar Courses be in attendance in the room during the performance of the procedure.

1-800-871-7930 Most Radiation Oncology services require Direct Supervision by the physician, and thus the Radiation Oncologist should be on campus and available in a timely fashion to

20

Complete online catalog at www.moellerinc.com/academy

Offering Medical Physics and Radiation Safety Consulting Services

AAPM Newsletter

July/August 2012

continued - Health Policy/Economic Issues furnish assistance and direction if necessary. CMS does not define “how far” or “how quickly” regarding the spatial or temporal leash for the physician, but generally, on campus and not involved in another uninterruptable procedure is assumed.

Further, CMS has clarified their position on who may provide the supervision. The supervising practitioner (typically a physician, but could be a Nurse Practitioner, etc.) must have, within their scope of practice, hospital or facility privileges and state authorization, the ability to perform the procedures being supervised (not merely act in an emergency or order a stop to the procedure).

In Radiation Oncology this effectively excludes physicians who are not Radiation Oncologists from supervising these procedures, and also excludes Nurse Practitioners, Physician Assistants, Dosimetrists, Medical Physicists, etc. One could postulate that there may be facilities or states where practitioners other than Radiation Oncologists provide these services for patients, but I think those situations are vanishingly rare. The reality is that a Radiation Oncologist must be available. [Note that there are exemptions for certain rural “critical access “facilities; if you practice in one of these you probably already know the details.]

If we are treating or simulating patients (CPT codes such as 77401-77418, or 77280-77295) the Radiation Oncologist should provide Direct Supervision and be immediately available to participate in the procedure.

Radiation Oncology is unusual in that some services or portions of services are performed without the patient present. Since the Direct Supervision description relates to physician intervention in the patient procedure, the supervision imperative would not apply for these activities. For example, the verification measurements performed by the physicist in association with the IMRT planning code 77301 don’t require patient presence, and thus the question of physician Direct Supervision is moot. Similarly, some or all of the work associated with other isodose planning codes, Special Medical Physics Consultation, Continuing Medical Physics Consultation, etc. is done without the patient present, again making the Direct Supervision question inapplicable.

One bright spot in the supervision discussion relates specifically to medical physics (all subspecialties) in the regulatory arena. Although the CMS definitions apply only to supervision by physicians, they can be useful in describing the level of supervision interaction required by regulators of those who provide medical physics services.

2012 History Symposium Some states include regulatory Historical Aspects of Cross-Sectional Imaging language describing tasks that must be performed “by or under Wednesday, August 1, 2012, the Personal Supervision” of a 4:30 - 6:00 PM, Room 211 Qualified Medical Physicist (QMP), Lawrence Rothenberg, Moderator or perhaps "by or under the Direct Supervision of a Qualified Medical Physicist” or even “under the General Supervision of a Lawrence N. Rothenberg Qualified Medical Physicist.” There Cross-Sectional Imaging is potential here to use the wellComputed Tomography accepted CMS definitions to describe the responsibilities of the QMP in either licensing or regulatory language, an opportunity we Geoffrey D. Clarke should continue to explore as the Origins and Development of concept of “supervision” gains Magnetic Resonance Imaging more specificity and sanction.

James A. Zagzebski Development of Ultrasound Imaging Equipment

21 21

21 21

In the future, we may look back on this period and proclaim: “Because of our supervision, we’ve kept our balance for many, many years.”

AAPM Newsletter

July/August 2012

Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

Information on the Source Collection and Threat Reduction (SCATR) Collection of Certain “Class A” Sealed Sources for Disposal at the Energy Solutions Clive, UT Facility

T

he Source Collection and Threat Reduction Program (SCATR) administered by the Conference of Radiation Control Program Directors (CRCPD) is providing sealed source licensees in states which do not have access to a low level radioactive waste disposal facility an opportunity to dispose of certain unwanted radioactive sealed sources. The collection, which is supported by the Department of Energy’s Global Threat Reduction Initiative (GTRI), the State of Utah Division of Radiation Control, and Energy Solutions of Utah, will include a range of sealed sources that meet the definition for Class A waste and will last for a period of one year from the date the first waste is received at the Clive, UT facility. CRCPD is offering financial assistance equal to half the cost of disposal to generators who participate in the effort.

Only sealed sources which meet the criteria specified below will be considered for the program: • Each source by itself must meet the definition of Class A waste as defined in 10 CFR § 61.55: ◦◦ The quotient of the current activity of the radionuclide in the source divided by the volume of the source cannot exceed the Class A limit as specified in 10 CFR § 61.55 tables; ◦◦ This includes any radionuclide not specifically listed in the 10 CFR § 61.55 tables with a half-life < 5 years; ◦◦ Commonly used radionuclides that could qualify for the collection include:

Isotope

Class A Limit

Isotope

Class A Limit

Isotope

Class A Limit

60

700 mCi/cm3

125

I

700 mCi/cm3

192

Ir

700 mCi/cm3

137

1 mCi/cm3

109

Cd

700 mCi/cm3

65

Zn

700 mCi/cm3

153

700 mCi/cm3

133

Ba

Unlimited

204

Tl

700 mCi/cm3

55

700 mCi/cm3

68

700 mCi/cm3

22

Na

700 mCi/cm3

57

700 mCi/cm3

152

Eu

Unlimited

54

700 mCi/cm3

700 mCi/cm3

147

Pm

700 mCi/cm3

195

Co Cs Gd

Fe Co

210

Po

Ge

Mn Au

700 mCi/cm3

• The sealed source must be registered with the Off Site Source Recovery Project (OSRP) before it can be accepted for disposal. Go to http://osrp.lanl.gov/PickUpSources.aspx for information about how to register your source(s). If your sources are already registered, you may wish to update your registration.

• Each source must be uniquely identified by a serial number or other unique identifier and the site should have ready any documentation available pertaining to a particular source’s activity, isotope, and date of manufacture or original assay upon broker’s packaging and acceptance of material.

• Other restrictions may apply.

22

AAPM Newsletter

July/August 2012

continued - Legislative and Regulatory Affairs A list of the sealed sources you have registered with OSRP will be sent to a broker included in the list below. A broker will contact you to schedule a date and time for collection of your sources. If you have additional questions regarding the collection effort, please call or email Russ Meyer at CRCPD (512-761-3822 or rmeyer@crcpd.org).

Clive Qualified Radioactive Material Brokers ALARON

Wampum, PA

Barnwell Processing Facility

Barnwell, SC

Bear Creek (Energy Solutions)

Oak Ridge, TN

Studsvik Processing Facility Erwin, LLC

Erwin, TN

TOXCO

Oak Ridge, TN

Bionomics (Clive-Qualification Pending)

Oak Ridge, TN

Qualified Medical Physicist (QMP) Registry Reminder

If you have not checked the QMP Registry maintained by the Conference of Radiation Control Program Directors (CRCPD) please stop by the CRCPD booth at the annual meeting and verify your information.

AAPM has contracted with the CRCPD to maintain 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 physicists working in their state.

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 • The American Board of Health Physics Currently there is 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, it 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: http://www.crcpd.org/QMP/aboutQMP.aspx.

23 23

23 23

AAPM Newsletter

July/August 2012

AAPM Work Group on the Prevention of Errors in Radiation Oncology: A Safety Profile Self-Assessment Tool Peter B. Dunscombe, Tom Baker Cancer Centre Eric Ford – University of Washington Medical Center

T

he focus on improving patient safety in radiation oncology continues, and the AAPM Work Group on Prevention of Errors (WGPE) has several projects currently underway to support safety improvement, one of which is reaching its final stages of development. This project is an on-line question-and-answer survey which would allow radiation oncology facilities to rate their safety performance. The tool is designed to gauge performance in key areas of patient safety.

The development of the Safety Profile Self-Assessment Tool began at the July 2011 meeting of the WGPE and was approved by the WGPE’s parent committee, the Quality Assurance and Outcome Improvement Sub-Committee. A seven member group was formed to lead the development of the tool. This group consists of WGPE members and other interested volunteers. The group suggested a series of radiotherapy safety performance indicators. These indicators were derived from a variety of sources including: the burgeoning radiotherapy safety literature recommendations, a detailed process map designed by the WGPE in 2011 (“Consensus recommendations for incident learning database structures in radiation oncology”, in preparation, Ford et al.), as well as a national safety culture survey from the Agency for Healthcare Research and Quality. As an example, one proposed survey question is the following: “Therapists review the chart prior to treatment start.”

The person(s) completing the assessment tool respond to each such statement on a five point Likert scale with a possible response ranging from “Always” to “Never.”

It is the intention of the WGPE that this tool will be used principally for quality/safety improvement.

Thus, in its first use by a facility, the tool will help identify areas for improvement in the safety program. Broad areas include: institutional culture of safety, quality management, managing change and innovation, and clinical processes and safety barriers. Repeated use of the tool will also provide quantitative evidence of improvement after structure and process changes are made within a department. The most effective way to summarize the output of the tool is still under discussion but it is likely that display options such as bar and pie charts will be available for comparison.

A draft prototype of the Safety Profile Tool is currently under review. This prototype was refined at a Workshop held 4-6th June in Seattle. Funding for the workshop was granted by the AAPM. In addition to the seven-member development group, representatives of our affiliate organizations were invited to attend at their own expense. The level of interest in this project is evidenced by the fact that invitations were accepted by the AAMD, ASRT, ASTRO, and SROA, all of whom sent at least one representative. The Workshop was participatory but structured with a clear deliverable and resulted in a prototype on-line Safety Profile Self-Assessment Tool which, thanks to the skill and commitment of Michael Woodward (AAPM HQ), was made available to all Workshop participants within a few days of the Workshop itself. By the end of June it is hoped to have incorporated all the comments of the Workshop group and have released Version 1 for feedback and pilot testing from a larger audience.

We now are looking for 15-20 facilities which would be prepared to assist us by field testing this instrument. Our recommendation is that a multidisciplinary team, particularly including front line clinical staff, arrives at consensus responses to each question on the survey. Following the experience of actually using the tool, participating facilities will be asked to provide feedback on the tool’s utility and functionality to the WGPE to guide the development of the final version of the instrument for general release. We will also assess the time required to complete the survey which we expect will vary depending on who and how it is completed. Our timelines include this field testing step taking place during the month of August.

If you and your facility would like to contribute to field testing this practical tool to make radiotherapy safer please contact Eric Ford at eford@uw.edu.

24

AAPM Newsletter

July/August 2012

Women’s Professional Subcommittee Report Andrea Molineau, UT MD Anderson Cancer Center

L

ast year the Women’s Professional Subcommittee (WPSC) sponsored two activities at the annual AAPM meeting. One was a professional track symposium entitled Successful Career Strategies in Medical Physics and the other was a luncheon for women medical physicists.

Following the success of these programs, the WPSC will sponsor two programs at this year’s AAPM annual meeting in Charlotte, NC.

The first is a Professional Symposium entitled Rosalyn Yalow: Contributions and Legacy, a Memorial Session moderated and organized

by Jean St. Germain. The session will be on Monday, July 30, 2012 at 5:15 in Ballroom B. Rosalyn Yalow was one of the scientists who developed the radioimmunoassay technique and she and her colleagues received the Nobel Prize in Physiology or Medicine in 1977 for this accomplishment. She was only the second American woman to receive this honor. Dr. John Humm will talk about Dr. Yalow’s Contributions and Legacy to medical physics. Dr. Stan Goldsmith will present Rosalyn S. Yalow, PhD: A Personal and Scientific Memoir. Please join us at the session Monday afternoon to learn more of Dr. Yalow’s inspiring and impressive life and career.

The second event hosted by the WPSC is the 2nd annual Women’s Luncheon. The luncheon, planned by Nicole Ranger, Jessica Clements, and Laura Cervino with support from Karen MacFarland, will be on Tuesday this year at 12:30. Registration is required prior to the event and is available as a line item for $10 through the AAPM meeting registration. The deadline to register is July 20. Seating is limited so sign up soon--close to 100 attendees have already registered. The remaining cost of the luncheon will be covered by the sponsors listed below. This year’s speaker will be Etta Pisano, MD, PhD. Dr. Pisano is the Vice President for Medical Affairs, Dean of the College of Medicine and Professor of Radiology at Medical University of South Carolina. She is the first woman to hold the office of Dean at MUSC. By all accounts she is a gifted and engaging speaker. This is a special opportunity to learn about leadership in medicine. We expect the event to be a wonderful networking opportunity with y other women in the field. Please come join us.

We would like to thank the sponsors of our luncheon: IsoAid, Landauer, MD Anderson Dosimetry Lab, Siemens, Unfors/Raysearch, Varian, and Vision RT.

.

Unfors Instruments has changed its name to Unfors RaySafe Continuing to bring you world class solutions for quality assurance and service of diagnostic x-ray.

Contact us to learn more! +1 508 435 5600 (866)-4UNFORS www.raysafe.com

25 25

25 25

AAPM Newsletter

July/August 2012

tg-142 Made Easy

PIPSPro Software new version 4.4 PIPSpro consolidates QA workload by incorporating over 30 of the recommended TG-142 imaging and machine procedures into a single, intuitive platform for database storage, trending and reporting.

• New IGRT Module Easily track and trend daily imaging and treatment coordinate coincidence

1281-27, 03/12 PIPSpro™ QC Software REF 91310, PIPSpro™ Comprehensive Software REF 91320

• Monthly MV and kV imaging tests Spatial resolution, contrast-to-noise, overall noise • Complete MLC QA Comprehensive, quantitative analysis of MLCs including individual leaf positions, multi-port, leakage and leaf width • Automatic CATPHAN analysis for monthly CBCT QA tests Geometric distortion, spatial resolution, HU constancy, contrast, noise • Stereotactic QA Easily check in-plane, cross-plane and the three dimensional stand offset for Winston-Lutz test images • Machine QA Radiation field, light field, jaw position testing and starshot analysis Visit us on the web! www.standardimaging.com/pipspro

26

AAPM Newsletter

July/August 2012

New Professionals Subcommittee Report Justin Keener, Forsyth Medical Center

New Members Symposium Invitation

T

he New Professionals Subcommittee would like to invite you to the New Member Symposium at the AAPM meeting, Tuesday, July 31st from 4:30pm-6:00pm in Room 211 of the Charlotte Convention Center.

This session is specifically targeted towards members who have joined the AAPM within the past 3 years, but all members are welcome to attend. Only new members may register, which is done by just checking “New Member Symposium” during your general meeting registration.

Registrants will receive a raffle ticket for a chance to win a free registration for next year’s meeting, as well as a drink ticket for our meet the experts session immediately following the New Member Symposium.

This year’s symposium speakers are Michael Woodward of the AAPM staff, who will share about the AAPM as an organization, and Michael Mills who will present on the current state of the U.S. medical physicist workforce, covering staffing, supply & demand, and residency slots. There will be an opportunity to ask questions following each session.

During our meet the experts session, you will be able to network with members of the AAPM leadership, ask questions, and meet other new members. This is an excellent opportunity to learn about ways to become involved in the AAPM. New members should also be aware of the Committee Meetings component of the annual meeting taking place on Saturday and Sunday; see schedule here: http:// Items of Note: aapm.org/meetings/2012AM/ • Meeting begins: Sunday, July 29 at 9:30 am CommitteeSchedule.asp Non committee members are welcome • Meeting ends: Thursday, August 2 at 2:50 pm to attend meetings of interest • An Exciting Sunday Schedule Kicks Off the Week to them. Doing so can be a step 1:30 – 3:00 pm Short Oral Sessions towards joining a committee 3:00 – 6:00 pm Refreshments, Technical and a great chance to see the

Exhibits, and Poster Discussion organization at work.

See the 3:30 – 4:00 pm Best-in-Physics Poster Committee Classifieds, posted Discussion

on the AAPM website, to find 4:00 – 6:00 pm John R. Cameron - Young committees actively looking for new

Investigators Symposium members. The AAPM is a volunteer run organization and new members Interactive Sessions - Twelve interactive are highly encouraged to become sessions have been organized which will involved. require an audience response unit (ARU) in order

to participate interactively. Note: The sessions are open to everyone. An audience response unit is not required to attend.

Offering 1 Scientific SAM Symposium: Personalizing Medicine: Adapting to the Individual, Monday, 2:00 PM – 3:50 PM View the complete Meeting Program at:

http://www.aapm.org/meetings/2012AM/ ProgramInfo.asp

27 27

27 27

AAPM Newsletter

July/August 2012

AAPM at the USA Science and Engineering Festival Mary F. Fox, Minneapolis , MN Chair of Public Education Committee

T

he USA Science and Engineering Festival is the largest celebration of science in the US. The 2nd celebration was held in Washington, DC on April 28-29, 2012. This event featured over 3,000 fun, interactive exhibits, and more than 100 stage shows. The AAPM participated by sponsoring a booth, which simulated a virtual linac treatment room complete with a patient, contours, radiation beams, MLC modulation, laser lights, and CT images.

Over 150,000 elementary through college age students attended the 2-day event.

Participants donned 3D glasses (with AAPM logo) and were invited to “play” in this vault using an X-box 360 controller to move the gantry, couch, collimator, apply radiation beams using IMPRT, project contours, and others.

Our thanks go to the local AAPM chapter members in Maryland, Virginia and Washington DC for volunteering at the booth. Volunteers explained who are medical physicists and what role they play in the hospital setting and also answered questions about medical physics careers. On both days of the festival, the AAPM booth attracted large numbers of attendees. The software for display was provided by the Vertual Company (www.vertual. co.uk). Special thanks to James Ward, and Andy Beavis for supplying the “fun” for this event.

Big THANKS to the following AAPM Volunteers: Amy Bornholdt

Bob Greig

Mahadevappa Mahesh

Greg Betzel

Brian Hames

Todd McNutt

Cari Borras

Lydia Levinson

Lee Myers

Mary Fox

Kaile Li

Viji Rudraraju Paula Salanitro

28

AAPM Newsletter

July/August 2012

SEAAPM Chapter Report Kevin L. Junck, President Birmingham , AL

T

he SouthEastern chapter of the AAPM (SEAAPM) held its annual Symposium and Meeting at the Downtown Marriott in Atlanta, Georgia on April 18-21, 2012. The Symposium theme was “Quality, Safety, and Compliance – How to address the triple challenge of modern imaging and therapy” organized by co-chairs Dr. Ehsan Samei, PhD of Duke University Medical Center and Dr. Lawrence Marks, MD of University of North Carolina at Chapel Hill. Faculty from across the country led an informative symposium addressing the basics of quality and safety; achieving and maintaining accreditation; and effectiveness and limitations of clinical implementations.

Ehsan Samei of Duke University Medical Center opens the 2012 SEAAPM Symposium on “Quality, Safety and Compliance”

The Symposium was followed by the annual SEAAPM scientific meeting which highlighted presentations from several SEAAPM members focusing on clinical implementations of quality control practices and metrics; demonstration of quality through achievement and maintenance of American College of Radiology accreditation; providing education to the next generation of medical physicists and radiology residents. In addition we were pleased to welcome current AAPM president Dr. Gary Ezzell, PhD of Mayo Clinic Scottsdale who spoke on "AAPM Initiatives, 2012 and beyond."

During the meeting, a number of annual awards were presented. This year the best paper award was given to “A Software-Based X-Ray Scatter Correction Method for Breast Tomosynthesis” by Steve S. Feng, BS and Ioannis Sechopoulos, PhD of Emory University published in the Dec 2011 edition of Medical Physics.

Dr. Dan Bourland was the 2012 recipient of the Jimmy O. Fenn Award given each year by the SEAAPM to recognize an individual having a significant record of service to the field of Medical Physics and the SEAAPM. Dan received his PhD in Medical Physics at UNC-Chapel Hill. He then held a faculty/consultant position at Mayo-Rochester and is now a Professor of Radiation Oncology at Wake Forest School of Medicine where he has been a faculty member since Michael Munley SEAAPM President (left) presents 1995. Dan has previously served as the SEAAPM the best paper award to Steve Feng (center) and Chapter President and is a Fellow of the AAPM. He is Ioannis Sechopoulos (right) of Emory University. also the current President of the Society of Directors of Academic Medical Physics Programs (SDAMPP). Dan’s research interests include the Gamma Knife and bioanatomic imaging applications in radiotherapy. He has and continues to be very active in Medical Physics education with both graduate students and postdoctoral fellows.

The SEAAPM has incorporated a poster presentation session into the annual meeting to encourage participation by students, residents, fellows or post-doctoral students. The poster session provides a casual and interactive format to provide feedback and mentoring to some of the next

29

29

29 29

AAPM Newsletter continued - SEAAPM Chapter Report

Michael Munley SEAAPM President (left) presents the best poster award to Joshua Wilson (right) of Duke University.

July/August 2012

generation of medical physicists. Now in its second year, the poster session included a dozen papers. The winner of the best poster was “Evaluating the effects of tube current modulation, body size, and iterative reconstruction using a new CT phantom” by Joshua Wilson of Duke University.

Each year the SEAAPM pays tribute to eminent chapter members who have recently passed away. This year two memorials were presented during the meeting: Henry C. Karp Sr., long time director of Radiation Safety and RSO at Emory University presented by Dr. Perry Sprawls, PhD of Emory University; and Dr. Nasser Maleki , PhD Associate Professor of Medical Physics at Armstrong Atlantic State University and Georgia Tech presented by Dr. Mike Munley, PhD of Wake Forest University.

The annual Night-Out event was held at the Georgia Aquarium. Following time in all of the aquarium’s exhibits we were treated to dinner in the aquarium’s dolphin exhibit. Numerous tricks were performed by the dolphins for the amusement of the medical physicists, vendors, and families in attendance and a few tricks were also performed by the medical physicists which we believe amused the dolphins as well.

Presentations from the Symposium and Meeting are available for review on the SEAAPM website (http://www.seaapm.org). Photos from the Symposium, Meeting, and Night-Out can be seen on the SEAAPM Facebook page.

4D in Motion

Discover a new era in 4D patient IMRT QA.  Measurements inside the entire phantom volume, always perpendicular to the beam  3D volume analysis and patient CT overlay  True independent quality assurance  Compatible with other PTW detector arrays and FFF LINACS

NEW Knowing what responsibility means

WWW.OCTAVIUS4D.COM

30

AAPM Newsletter

July/August 2012

AAPM-IPEM Travel Grant Report Jun Deng, New Haven, CT

(Travel completed April 2012) April 16th, 2012, Castle Hill Hospital After a long train ride from London to Hull, I finally arrived at the Castle Hill Hospital where Dr. Andy Beavis, the head of the Radiation Physics Department, was the host of my first stop during this trip in UK. My visit started with a tour of the department led by Dr. Beavis. The whole oncology center is very new with eco- and patient-friendly designs everywhere, which to me seems rather like a hotel than a cancer center for radiotherapy. Then I gave a lecture talking about the kVCBCT imaging doses and the associated cancer risks, after which we had a roundtable meeting for physics staff so that everyone can get involved in a more interactive discussion.

The primary concerns were about the imaging doses and why CT manufacturers did a better job than the linac manufacturers for CBCT in terms of imaging dose reduction, protocol optimization and patient safety. I also learned that a virtual CT reconstructor has been developed by this group so that virtual CT scans can be simulated to study the correlation between the imaging doses and the images quality without actually performing the scans on the patients. I was very interested in this project and indicated that our group was developing a similar tool dedicated to CBCT virtual simulation and reconstruction. Finally, I was lucky enough to experience a state-ofthe-art technology named VERT developed and co-founded by Dr. Beavis. VERT, coded for virtual environment for radiotherapy and training, is a linac simulator set in a 3D virtual environment, which can help the users get trained with full access to the linac functionality without interfering with the clinical workflow. We actually took a picture as shown in Figure (a) with VERT displayed in the background.

April 17th, 2012, Clatterbridge Center for Oncology The following day I visited Clatterbridge Center for Oncology where Dr. Alan Nahum was my host. We actually started our conversation with our fond memory of the past. I was fascinated by all sorts of legendary stories told by Alan about our common friends. Alan's postdoc Dr. Julien Uzan gave me a brief introduction to their latest research tool called Biosuite aimed to facilitate biologically based treatment planning and optimization. The software analyzed the DVH data exported from conventional treatment planning systems and computed TCP and NTCP based on published Marsden and LKB models. In addition, the software was able to optimize the plan with fixed NTCP value, the so called isotoxic planning scheme and generate a series of plans with different TCP values corresponding to different fractionations. Later on, I gave a lecture on kVCBCT and was engaged in a very interactive discussion with dozens of physicists and research staff. I liked some tough questions raised by Alan and Dr. Geoff Lawrence. Finally, I was kindly given a tour of the only proton radiotherapy facility in the UK, Douglas Cyclotron shown in Figure (b) by Dr. Andrzej Kacperek. It produced a single energy of 62 MeV proton beams dedicated to radiotherapy of eye tumors due to its limited treatment depth of 3 cm in tissue. The highly acclaimed professionalism and rigorous efforts to quality control the clinical practices at every step made it a highly successful facility, which treated one third of eye patients in the UK and dozens of patients across the world. It was a busy day for me. In fact, I was so involved with the intensive discussions that I forgot my room number when I got back. Luckily I did not forget which hotel I stayed.

April 18th, 2012, St James's Institute for Oncology My third day visit took place at St James's Institute for Oncology at Leeds where Dr. Vivian Consgrove was my host and the head of radiotherapy physics, as shown in Figure (c). There are ten Elekta linacs for clinical treatments and two for research. With about 6500 patients treated annually at this center, it is quite a challenge to manage the whole clinical workflow seamlessly without errors. I noticed three major factors contributing to their high efficiency:

31 31

31 31

AAPM Newsletter

July/August 2012

continued - AAPM-IPEM Travel Grant Report (1) a well thought-out design of the clinic such that patients received professional care from a dedicated group of clinicians while maintaining a high degree of privacy; (2) a clear structure of management and easy-to-follow guidelines and policies; and (3) all the photon beams are matched throughout the department. Later on, I gave a lecture on imaging doses from kVCBCT and their associated cancer risks. Although my study indicated large imaging doses from CBCT procedures, I emphasized more than once that people should not be scared by the potential cancer risks associated with the medical imaging procedures as long as those procedures are administrated in a prudent way and clinically justified. The risk of not having those procedures done would be much greater for most of the cancer patients. Dr. Jonathan Sykes, one of the physicists doing research work on IGRT and kVCBCT, exchanged his ideas with me on how to correlate CBCT with CT as planning CT has always been considered as reference to the CBCT images in determining the shifts. I pointed out that another possible approach would be to use online CBCT image dataset as the reference instead of planning CT as long as the Hounsfield number in CBCT images are accurately determined.

April 19th, 2012, Royal Marsden Hospital I visited Royal Marsden Hospital (RMH) at Sutton the next day. My host was Dr. Phil Evans who was the head of Radiation Physics Department and gave me a detailed introduction to the organization of RMH, as shown in Figure (d). Then he showed me a copy of 2010 annual report of RMH and discussed some of the fascinating projects being conducted during 2010. I delivered my oral presentation to a large audience including the staff members at Chelsea site. My lecture generated quite a few questions regarding the CBCT applications in the clinic. I also emphasized in my talk that prudent medical imaging procedures always outweighed the potential cancer risks, because missing the tumor target would lead to greater cancer risks in the future if necessary medical imaging procedures were not performed. Later on, I had the opportunity to have a oneon-one discussion with some of the research fellows, postdocs and PhD students at RMH. The topics were very interesting and significant, covering imaging dose, toxicity and margin reduction correlations in breast cancer radiotherapy with CBCT, patient fatigue study in IMRT treatments of head and neck cancer, a CT x-ray energy spectrum simulator, breast tissue segmentation for better and more accurate contouring and dose painting, dynamic leaf tracking for Elekta MLC, as well as a new CMOS technology developed to replace current EPID for better and quicker responses to high dose radiation. I had a pleasant and in-depth discussion with each one of them and caught a glimpse of what was going on in each project. In fact, it was quite an unforgettable experience for me as I was exposed to so many different projects within such a short period of time.

April 20th, 2012, Churchill Hospital My last stop was the Churchill Hospital located at Oxford, a beautiful college town and host to the University of Oxford. Dr. Elizabeth Macaulay, head of radiation physics, was my host in this visit and gave me a quick tour of the facility, as shown in Figure (e). My talk on kVCBCT was well received and generated a lot of discussions on CBCT applications and imaging doses.

Three research scientists from diagnostic imaging remained after my talk and we had further discussions on the status and future directions of CBCT as compared to the CT technology. I acknowledged that our current CBCT technology was still not mature yet, and more research work would be needed from both academia and industry to further improve it to be more efficient and safer for the patients. As our colleagues in CT are doing everything they can to optimize the scan protocol and reduce the dose to patients, we should also be engaged in efforts to optimize our clinical routines so that low dose CBCT can be administered to the patients in an optimal and individual way.

This concluded my ten-day visit to five great institutions in UK. During this trip, I not only met many wonderful colleagues in UK and learned a lot about their research projects and clinical practices, but also shared my experiences with them on some mutually interesting topics, which was indeed an invaluable experience to me and my future career development. I would like to take this opportunity to express my sincere gratitude to Drs. Andy Beavis, Alan Nahum,

32

AAPM Newsletter

July/August 2012

continued - AAPM-IPEM Travel Grant Report Vivian Consgrove, Phil Evans and Elizabeth Macaulay for their valuable time and genuine hospitality. Finally, I’d like to thank AAPM and IPEM for this wonderful travel grant that allows me to visit UK and exchange ideas and share my research work with my fellow physicists in UK.

The five UK institutions I visited during my trip in April 2012: (a) Dr. Andy Beavis and Jun at Castle Hill Hospital; (b) Dr. Andrzej Kacperek, Dr. Alan Nahum and Jun at Clatterbridge Center for Oncology; (c) Dr. Jonathan Sykes, Dr. Vivian Consgrove and Jun at St James's Institute for Oncology; (d) Jun, Dr. Jim Warrington, Dr. Margaret Bidmead, Dr. Ellen Donovan and Dr. Phil Evans at Royal Marsden Hospital; and (e) Dr. Elizabeth Macaulay and Jun at Churchill Hospital.

AAPM New Member Symposium Tuesday, July 31 • 4:30pm - 6:00pm Charlotte Convention Center Are you a new AAPM member (joined in the last 3 years)?

Don't forget to select the ticket option for the New Member Symposium when you register for the AAPM Annual Meeting in Charlotte.

Following an introduction from the AAPM President, Gary Ezzell, Michael Woodward of the AAPM staff will provide a crash course on the AAPM structure and organization, as well as some pointers on navigating the website. Next will be Dr. Michael Mills presenting on the current state of the U.S. Medical Physics Workforce and Residencies.

Registered attendees will receive a raffle ticket -- enter to win a complimentary registration for the 2013 Annual Meeting in Indianapolis!

In addition, all new members who register for the Symposium will receive a drink ticket, good for one complimentary beer served at the New Member Symposium during the social with committee chairs from 4 AAPM Councils: Science, Education, Professional and Administrative.

33 33

33 33

AAPM Newsletter

July/August 2012

International Scientific Exchange Program Report Report on AAPM/ISEP workshop on “Physics of Advanced Radiotherapy” Tata Memorial Hospital, Mumbai; India, March 17 - 19, 2011 D. D. Deshpande (Host Co-Director) Jatinder R Palta (AAPM Co-Director) Objective: - To update the knowledge of Medical Physicists in India about the advanced radiotherapy planning and delivery techniques.

Goals:- In India large number of centers have come up in last decade and are equipped with the advanced state of art machines and are practicing techniques like IMRT, IGRT, rotational IMRT, motion management techniques etc. However, Physicists & other team members need to be updated with various aspects of these techniques in order to achieve the precision in the treatment.

American Association of Physicists in Medicine (AAPM) supported a workshop focusing on these advanced techniques under International Scientific Education Program (ISEP). Departments of Medical Physics and Radiation Oncology at Tata Memorial Hospital, Mumbai hosted this workshop titled, “Physics of Advanced radiotherapy” from March 17 - 19, 2011.

Scientific Program: - The Scientific Program was designed in consultation with the local host. The faculty members from AAPM included; Drs. Howard Amols, M. Saiful Huq, Daniel Low, Radhe Mohan, Jatinder Palta, S. Rao and David M. Shepard. From India experts were Drs. D Deshpande, P.S. Negi, Paul Ravindran, S.D. Sharma, and Sathyanarayan.

The faculty reviewed and discussed the implementation of advanced radiotherapy technologies in India both from clinical AAPM Faculty and physical aspects. There were didactic lectures and discussion sessions on advanced Imaging, IMRT, IGRT, adaptive radiotherapy, motion management, dose calculations, quality assurance, and safety.

In the IGRT session, various commercial solutions and associated challenges were discussed.

There was a separate session on QA of all advanced techniques. The clinicians from the host institution discussed their perspective of precision in clinics. The session on dosimeters dealt with Commissioning & QA issues of treatment planning systems and computer controlled treatment delivery. A separate session on small field dosimetry was also conducted.

The workshop also included practicum sessions in the afternoons. There were 4 work stations for 2 days. On the first day 4DCT Simulator, Eclipse TPS Planning system were demonstrated in four groups, followed by IGRT demonstration on Varian Trilogy and motion management on Novalis TX. Tomotherapy QA Process was demonstrated. A special session; “Meet the expert”, provided an opportunity for the participants to closely interact with the invited faculty members.

In the concluding session, dosimetry audit in US and India were discussed. There was some discussion on AAPM and AMPI collaboration in the future.

Feedback from Participants:- Overall the delegates were extremely satisfied with AAPM faculty lectures and the content of the course. The majority opinion was to conduct such workshop on a frequent basis; may be yearly or biannual. The participants, who were new to the advanced technology, were very satisfied with on-site practical demonstrations by the host faculty members and the visiting faculty members from AAPM. The informal and personal interactions amongst participants and AAPM faculty during the afternoon practicums were very well received.

34

AAPM Newsletter

July/August 2012

continued - ISEP Report

Workshop participants with AAPM Faculty members.

Summer Undergraduate Fellowship Program Report Jennifer Smilowitz, Madison, WI

AAPM Summer Undergraduate Fellowship Program receives donation from Southern California Chapter

(SUFP)

The summer of 2012 will be the 12th year of the AAPMâ&#x20AC;&#x2122;s Summer Undergraduate Fellowship Program. This year we are able to fund one additional student beyond our budget due to a gracious donation from the Southern California Chapter. The SUFP fellows are matched with professional medical physics mentors working in clinical and research settings for a 10-week summer program. As in all previous years, the applicant pool was excellent (60 applicants with an average GPA of 3.5). It was a challenge for the subcommittee to choose only five recipients. The Southern California Chapterâ&#x20AC;&#x2122;s donation of $4000 allowed the funding of a sixth student. In previous years, the SUFP has been able to support up to fourteen fellows. The North Central and North West Chapters are both considering donating funds to support students for the 2013 summer. In these current times of shrinking budgets, the subcommittee is very grateful that Chapters have chosen to and are considering donating extra funds for AAPM summer fellows. If any chapters are interested in funding full or partial fellowships, please contact the SUFP subcommittee chair, Jennifer Smilowitz.

The 2012 Summer Fellowship Recipients (and mentors) are: Paul Leo (Dr. Anil Sethi), Hannah Ponek (Dr. Mahadevappa Mahesh), Stephanie Sodergren (Dr. Jean Pouliot), Sean Rose (Dr. Rob Mooij), Lauren Rigsby (Dr. George Ding) and Jaebum Chung (Dr. Dimitre Hristrov)

35 35

35 35

American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846

Editor

Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115

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

PRINT SCHEDULE • The AAPM Newsletter is produced bimonthly.

• Next issue: September/October • Submission Deadline: August 9, 2012 • Posted On-Line: week of Sept. 3, 2012