AAPM Newsletter September/October 2012 Vol. 37 No. 5

Newsletter

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

AAPM Column VOLUME President’s 37 NO. 5

SEPTEMBER/OCTOBER 2012

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

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ow do we spend our money? Wisely or wastefully? On things that matter or things that don't? Those are important questions, and I believe that the upcoming membership vote on the proposed dues increase is a referendum on decisions that AAPM leadership has made in the past and can be expected to make in the future. The incremental change, $100/year for a full member, is not large, less than 0.1% of a typical salary, but people expect value for their money. So, does AAPM provide value, and what additional value will come with the added income? And can the leadership be trusted to make good decisions?

First, to the leadership question. AAPM is quite different from our sister medical societies like ASTRO and RSNA. Ours is a highly participatory, bottom-up organization, with a very large, representative Board. The Board is not a rubber stamp; Board operations have evolved over the past few years to make sure of that, with the latest change being the creation of the Strategic Planning Committee of the Board. AAPM is most emphatically not a back-room operation. As AAPM President I have almost no "power", other than that of persuasion. Decisions about big funding allocations are made by the full Board. So when the Board votes to recommend a dues increase and to decide how money should be allocated, you can be sure that the issues have been carefully and comprehensively discussed. AAPM is representative democracy in action. That is no guarantee of collective wisdom, but it is the best system out there.

Does AAPM provide value? AAPM is our tool for working together collectively and sharing information. For the past 50+ years, volunteers have been producing task group reports that most of us use routinely. Our meetings and publications provide venues for scientific exchange and continuing education. Are Medical Physics and JACMP valuable? Do you need SAM for maintaining certification?

Do you need a virtual library with online resources? AAPM is not only how we talk to each other, but how we speak with one voice to others that matter: to regulators, to payors, to other professional organizations. We work with CRCPD to write suggested state regulations; we collaborate with ACR on technical standards; we work with CMS on the valuation of the 77336 code used in therapy. And by "we", I mean the 20% of the membership who actively volunteer. That is a very high percentage for a professional society, but that means that 80% create cooperative value indirectly by supporting the organization financially.

So, specifically where does AAPM need to focus resources?

We are ramping down the efforts on licensure, which

Included in this issue: Chair of the Board President-Elect Executive Director Editor Professional Council Education Council CAMPEP News Website Editor ACR Accreditation Health Policy/Econ Issues Leg. & Reg. Affairs Inter-societal Memorandum of Understanding Person in the News Professional Services Report Obituary

p. 3 p. 5 p. 6 p. 9 p. 10 p. 11 p. 13 p. 15 p. 16 p. 19 p. 23 p. 25 p. 29 p. 30 p. 31

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continued - AAPM President’s Column

are only progressing in one state, and that opens up some budget. Nevertheless, all the Councils have projects that are in need of funding. Here are some examples. We need to augment efforts to create physics residencies, and Education Council has a proposal to provide administrative support for new residencies in private practices, which is especially important in imaging and to give opportunities to master's graduates. Professional Council has started developing Medical Physics Practice Guidelines that will guide regulatory and accreditation bodies, but fast progress will require more resources. AAPM has started working with ASTRO to create a national event reporting system for errors and near misses in radiation oncology; that is a collaborative effort that will take a couple of years to take shape, and we need to commit both time and money to develop a system that is useful and ultimately self sustaining.

I write this soon after returning home from Charlotte and an impressive annual meeting.

We do good work together, valuable work. Let's commit to keeping AAPM on a firm financial footing, so we and the next generation of medical physicists have a strong framework to support this work that we do together.

2013 AAPM Annual Meeting (Indianapolis, IN) Request for Proposals (RFP) for Symposia Symposia and Educational Courses are an integral and important part of the annual AAPM meeting. A number of scientific symposia, panel discussions, and workshops on various practical and emerging topics provide members with excellent learning opportunities and interesting discussions. Symposia and Educational Courses can be scientific, educational, or professional: • • • • • •

Therapy Symposium Imaging Symposium Joint Imaging/Therapy Symposium Educational Course SAMs Educational Course (click here for specific guidelines for SAMs courses) Note: If your SAMs proposal is accepted, a submission following the above guidelines will be required at a later time.

• Practical Medical Physics Course • Professional Course We would like to encourage you to submit ideas for our 2013 Annual Meeting in Indianapolis. To submit an application for a Symposium or Educational Course (including SAMs) click here. Please respond by October 8, 2012.

Proposals should include the following: 1.

2.

3.

4.

5.

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Type of session (see list above) Title Name of Lead Speaker or Moderator Short description (maximum 250 words) Learning objectives Proposed faculty

Please note your proposal is meant to serve as a suggested topic of interest, along with a recommended list of faculty. All proposals will be reviewed by the AAPM Program Directors, who will be responsible for the final selection of topic, content, organizer, and faculty. Proposal selection will also be based on criteria such as other topics for the 2013 meeting and topics presented in previous years. In short, we must include overall programmatic goals when reviewing proposals. Since there are a limited number of slots to fill, we expect that not all proposals will be accepted.

Regards, 2013 Program Committee

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

Intersociety Relationships and Importance to the AAPM‌..

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onnections and collaborations with our colleagues in other professional societies are extremely important, necessary, and most often mutually beneficial. The AAPM enjoys a long-standing and valuable relationship with the Radiological Society of North America (RSNA) chiefly through the RSNA annual meeting with leadership roles in the education and scientific programs, but many other efforts including the RSNA/AAPM physics web modules provide a distinct value-add for our members. Many AAPM volunteers provide expertise for the American College of Radiology (ACR) in collaboration with the Commission on Medical Physics and the Practice Guidelines and Technical Standards committees, and close contacts with the equipment/modality accreditation programs for medical physics input is maintained. Interactions with the Council on Radiation Control Program Directors (CRCPD) have enhanced our relationships with state regulators, provided great opportunities for education, and resulted in a national database registry for certified medical physicists. AAPM joint projects and publications regarding patient safety in Radiation Oncology with the American Society of Radiation Oncology (ASTRO) have been very helpful in defining our professional roles.

AAPM working in concert with the International Organization of Medical Physics (IOMP) and the International Atomic Energy Agency (IAEA) has assisted in defining / implementing an international presence for the benefit of those in countries more challenged to provide medical physics services and educational content. Even more closely interrelated efforts in North America with medical physics education, accreditation and certification programs are relationships forged with the Society of Directors of Academic Medical Physics Programs (SDAMPP), the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), and the American Board of Radiology (ABR).

Examples described above are but a few of the interactions that occur throughout the year, in which AAPM members serve as liaisons to and members of various professional societies, federal and state regulatory agencies, accreditation, and certification groups.

2012 AAPM Young Investigators Symposium The John R. Cameron Young Investigators Symposium a competition for new investigators within a special symposium in honor of Dr. John Cameron Congratulations goes to......

1st place: Steven J. Bartolac of the University of Toronto for his abstract: Experimental Validation of Fluence Field Modulation for Noise and Dose Management in CT 2nd place: Shane Krafft of The University of Texas MD Anderson Cancer Center for his abstract: Mean Regional Dose to the Esophagus Predicts Acute Toxicity Rate for Lung Cancer Patients 3rd place: Samuel Fahrenholtz of The University of Texas MD Anderson Cancer Center for his abstract: Uncertainty Quantification by Generalized Polynomial Chaos for MRGuided Laser Induced Thermal Therapy 3 3

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continued - AAPM Chair of the Board’s Column At the annual meeting in Charlotte, AAPM leadership through the Executive Committee (EXCOM) had several face to face meetings with the leaders of CAMPEP, SDAMPP, and ABR to discuss items of mutual interest and to implement action plans to move forward on a memorandum of understanding (MOU) regarding the specific roles and responsibilities of each organization. I would personally like to thank Ehsan Samei in his role as the President of SDAMPP for his initial and continuing efforts to see this MOU come to fruition, which has now been agreed upon by all. The final document describing the roles of each organization is found on page 25 of this Newsletter.

Just after the annual meeting, Donald Peck and I traveled to attend the ACR 2012 Intersociety Summer Conference to represent the AAPM amongst a large number of professional radiologyassociated societies. This year’s conference was titled: “Radiology Online: Information, Education, and Networking.” There were several invited speakers from the largest societies (RSNA, ACR, ABR, and American Roentgen Ray Society-ARRS) to discuss how electronic media, tablet technology innovations, and social networking methods are utilized (and how the radiology community, despite its “high-tech” label, is far behind in adopting and implementing communication and information/ education products, particularly for intersociety sharing of information). Break-out sessions with the attendees discussed the pros and cons of the topics presented, with the intent of achieving an action plan to enhance future efforts of information exchange and networking. The consensus of the breakout discussions was the need for better utilization of electronic resources from all representative radiology organizations, with the effort to implement a single website portal and a single sign-on to all participants for transparent access and communication links to each other’s sites. In summary statements, ACR leadership suggested that they may be able to develop this site in cooperation with technology experts from interested participating organizations. While public openness of social media and networking is great for the distribution of “vetted” information, the challenge to the radiology community is the need for a secure forum to promote private discussions and communication between individuals or groups within the proposed portal website.

More is to come on this initiative in the near Training Academy future – certainly the AAPM will be part of the intersociety discussion and implementation MEDICAL SAFETY TRAINING of these directives.

Continued AAPM participation in the many intersociety efforts gives us a seat at the table amongst our professional and clinical colleagues, and a valuable voice for the profession of medical physics.

As always, if you have any questions or comments, please contact me, jaseibert@ ucdavis.edu.

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

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reetings post-Charlotte! What a great meeting. Congratulations to all involved in planning and executing our annual event. While I enjoy the science of the meeting (although I got to attend far fewer scientific sessions than I would like due to other commitments), I greatly enjoy interacting with all my fellow medical physicists. The energy that this group brings to the annual meeting, and all other aspects of the organization, is quite impressive, and humbling. I continue to be amazed at the level of enthusiasm of our volunteer council, committee, working group, task group and other functional unit chairs.

First and foremost on our mind at Executive Committee was the budget. In todays environment, keeping the organization fiscally healthy is perhaps more important than ever. So, looking forward to the budget development process, the strategic plan and our upcoming vote on a dues increase occupied a lot of Excom’s time and focus, as it should! In the words of General Eric Shinseki “If you don’t like change, you will like irrelevance even less.” If we are not financially able to address our changing environment (from NIH research funding to CMS changes in clinical funding), we will be SIGNIFICANTLY disadvantaged. Addressing these changes requires 1) effort from our volunteers and 2) the money to carry out these tasks. So, I encourage you all to think about the value that AAPM brings to your practice, whether it is purely clinical or mainly academic, and vote for the dues increase. As Gary Ezzell points out in his message leader for the vote, we have worked hard to make the organization “lean and mean”, but we need to keep up with the “cost of living” and the “cost of doing (more) business.”

So this month’s message is short and sweet. There are many issues working through the process of execution from thinking about leadership development issues in Professional Council to how the ever-changing research environment should be approached by Science Council to how we should be preparing the next generation of medical physicist through Education Council. I’m planning to address several of these in my next Newsletter article.

I look forward to seeing many of you at the RSNA meeting in Chicago!!!

2013 Awards and Honors Call for Nominations Nominations for the 2013 Awards and Honors are now being accepted through October 15, 2012. All of the nominations are now done through the NEW on-line nomination system. Winners will be recognized during the 55th AAPM Annual Meeting in Indianapolis, IN in 2013.

Nominations are being accepted for the following: • • • • •

William D. Coolidge Award Marvin M. D. Williams Award Edith H. Quimby Lifetime Achievement Award Fellow John Laughlin Young Scientist Award http://www.aapm.org/org/callfornominations.asp 5 5

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AAPM Executive Director’s Column Angela R. Keyser, College Park, MD AAPM Transparency ver want to know more about the operations and governance of AAPM? AAPM’s volunteer leadership continues to provide a wealth of information about the management of the organization to Members via the web. I applaud current and past leaders for seeking to provide a high level of transparency. Won’t you take a few moments to review the information? http://aapm.org/org/organization.asp. Members will find:

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• • • • • • •

Audited financial reports dating back to 1992; AAPM’s current budget; Budget history for the past four years; Minutes from AAPM Board meetings and background; Minutes from past Annual Business Meetings; Notes from Town Hall meetings; and, Reports from all the Headquarters Site Visit Committees, a group of volunteers that reviews HQ operations every three years.

Should you ever have any questions, please do not hesitate to contact me.

Reminders!

October 15 is the deadline for nominations for the 2013 William D. Coolidge Award, Marvin M.D. Williams Award, Edith H. Quimby Lifetime Achievement Award, AAPM Fellows and the new John S. Laughlin Young Scientist Award.

Make sure to register for the RSNA meeting by November 2 to receive the complimentary registration provided to all AAPM members. The AAPM Reception will be held on Tuesday, November 27 from 6:00 PM – 8:00 PM. Mark your calendars for the 2013 AAPM Spring Clinical Meeting to be held March 16 – 19, 2013 in Phoenix, Arizona.

APSIT – AAPM Member Benefit Each year AAPM members receive a letter from APSIT, the American Physical Society Insurance Trust, offering a range of insurance products. Many members probably have no idea why they get this letter or what APSIT is. The AAPM belongs to the APSIT through our relationship with the American Institute of Physics (AIP). To help AAPM members understand a bit more about this benefit of membership, I want to explain a bit about ASPIT and its insurance products.

The American Physical Society Insurance Trust (APSIT) was established in 1969 by the American Physical Society (APS) to provide members with a convenient source for quality insurance coverage at an affordable cost. The trust has offered Group Term Life insurance to APSIT member society members since February of 1970. Since then, they have expanded their product range and the number of member societies participating. The insurance plans are underwritten by the New York Life Insurance Company, established in 1845 and still a market leader today. New York Life regularly earns the highest ratings for its financial strength from leading rating services and even through the recent economic crisis remained in excellent fiscal health.

The plan is administered by a contracted administration company, Herbert V. Friedman, Inc., based in New York. They maintain a website about APSIT at www.hvfinc.com. All of the AIP member societies are APSIT participating organizations and any member of an AIP member society may purchase the insurance products provided by APSIT. Of course, the particular products offered by APSIT may not meet your own personal needs. The premiums are usually very affordable and the

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continued - AAPM Executive Director’s Column coverage provided is quite competitive with other providers. Additionally, because the members of AIP member societies, as a group, typically have a higher education, live conservative lifestyles and so on, the group rate provided can be far better than other group plans.

An additional benefit of APSIT is that representatives of the member societies themselves sit on the governing board and make decisions about the types of plans provided and other matters. I was asked to serve as a member of the APSIT Board beginning in 2009.

So, if you get a letter or informational pamphlet from the APSIT, you now know where it came from and why you received it. While it remains your decision as to whether any of the insurance products provided suit your own financial needs, I encourage everyone to take advantage of the offered products that are right for you. To learn more about other benefits of membership, please see our benefits of membership website: http://www.aapm.org/memb/default.asp 2013 AAPM Dues Renewals Dues renewal notices for the 2013 year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an official member.

Staff News I am pleased to report that Karen MacFarland has been recertified as a "Certified Meeting Planner" (CMP). The CMP designation recognizes those who have achieved the meeting industry's highest standard of professionalism. The requirements for certification are based on professional experience and an academic examination.

Visit the Vendor Complimentary Registration Winners!

This year during the 2012 AAPM Annual Meeting there was an opportunity for attendees to enter to win a "complimentary registration" for the 2013 AAPM Annual Meeting to be held in Indianapolis, IN next summer. The 2012 AAPM Annual Meeting "Visit the Vendor" program winners are: Congratulations go to......

Margaret Williamson of Largo, Florida Rachel McKinsey of San Antonio, Texas Alan Douglas of Flagstaff, Arizona

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Editor's Column

Mahadevappa Mahesh, Baltimore, MD

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elcome to the 5th issue of this year. This issue contains many post meeting articles along with regular columns that include updates on CAMPEP, ACR Accreditation and others. I thought the annual meeting was a great success with the range of sessions on educational and research topics that attracted attendees, even on the last day of the meeting.

Since many of us are now receiving/reading information via our mobile devices I am requesting funds, in next year's Newsletter budget, to use for development of a mobile app of the AAPM Newsletter. It is my hope to deliver the Newsletter to your mobile device early next year.

It is a great loss to the field of medical physics for having lost one of the pioneers in the field, Dr. Charles Metz of the University of Chicago. An obiturary for Dr. Metz is included on page 31 of this issue.

Lastly, I want to congratulate the ‘Person in the News’ - Dr Cari Borras for the award she received at the World Congress on Medical Physics and Biomedical Engineering in Beijing, last May 2012.

Call for Nominations for the ICRU Gray Medal The International Commission on Radiation Units and Measurements (ICRU) is seeking nominations for the sixteenth award of the ICRU Gray Medal. The Gray Medal was established by the ICRU in 1967. It is awarded for outstanding contributions to basic or applied radiation science of interest to the ICRU and honors the late Louis Harold Gray, former member and Vice-Chairman of the Commission.

The first award of the medal was made to Lewis V. Spencer in 1969. Subsequent recipients have been John W. Boag, Mortimer M. Elkind, Maurice Tubiana, Harald H. Rossi, Dietrich Schulte-Frohlinde, H. Rodney Withers, Paul Lauterbur, Herman Suit, R.J. Michael Fry, Martin Berger, Charles Metz, Eric Hall, and Albert van der Kogel.

The fifteenth award was presented to Dudley Goodhead at the14th International Congress of Radiation Research on the 31st of August 2011 in Warsaw, Poland.

For the sixteenth Gray Medal award, the Commission will give preference to individuals who have made major contributions to imaging science.

Nominations for the medal may be made by any person or organization. They must include a complete biographical sketch (curriculum vitae) of the nominee and letters of support evaluating the importance of contributions to the field of imaging science. Nominations should be directed to the Chairman of the ICRU, Suite 400, 7910 Woodmont Avenue, Bethesda, Maryland, USA 20814 and must be received by the ICRU no later than February 28, 2013.

For further information contact: Patricia Russell, Executive Secretary, ICRU 7910 Woodmont Avenue, Suite 400 Bethesda, Maryland 20814 USA Phone: (301) 657-2652, Ext.31 Fax: (301) 907-8678 Email: icru@icru.org

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Professional Council Report Per Halvorsen, Newton, MA

Charlotte re-cap

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any thanks to all our colleagues who volunteered their time to create an excellent program for the 2012 Annual Meeting, and to the AAPM staff who consistently provide excellent support at our conferences.

Particular thanks to Professional Program Co-Directors Chris Serago and Doug Pfeiffer for producing an interesting program.

From the sessions as well as the hallway conversations, I gleaned some common themes in terms of professional-practice concerns: • The CMS proposal for the 2013 fee schedules, with significant cuts to freestanding radiation oncology practices, and how such shifts in resources could impact our practice environment; • The increasing importance of accreditation and the wide variation in practice standards between the accrediting entities, particularly in imaging; • The need for a new skill set and a different approach to our roles in imaging and radiation oncology clinics as the technological complexity increases and error prevention becomes more multi-faceted. Skill sets such as project management, prospective risk analysis, process control, and simulation training are becoming more important but are typically not part of a standard medical physics training program.

Luckily, the AAPM is already actively engaged on most of the aforementioned topics, and the Professional Council will assess the need for new initiatives such as project management training modules. If you have suggestions for topics we should be more focused on, please send a note to Lynne Fairobent (lynne@aapm.org) or myself.

“Safety is no Accident” publication is available As many of you know, ASTRO led the effort to develop a guidance document outlining the conditions which must exist to provide a safe radiation oncology service. A total of 12 other organizations participated in the development of this document, including the AAPM. The final document provides a wealth of information which should be useful when discussing program development with hospital and clinic leaders. The four sections of the report cover the process of care, the radiation oncology team including staffing requirements, the safety culture in a clinic, and quality management.

The AAPM endorsed the publication after reviewing the final draft, which included an appropriate level of detail in the crucial section on staffing requirements. Unfortunately, ASTRO decided to revise the staffing requirements section just prior to publication, and the final publication contains significantly less detailed guidance on staffing ratios compared to the version we endorsed. I am hopeful that a correction, or at least a clarifying statement, can be issued by ASTRO very soon.

Even with this unfortunate aspect of the process (we were not informed of the revision), the publication is a strong statement of support for safety and quality in radiation oncology and will have a significant impact in the years ahead. I encourage you to read it – you can download a copy from the ASTRO website at the following link: https://www.astro.org/Clinical-Practice/ Patient-Safety/Safety-Book/Safety-Is-No-Accident.aspx.

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Education Council Report George Starkschall, Houston, TX

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012 has become a foreboding year for many individuals, for December 21, 2012, marks the end of a 5,125-year cycle in the Mayan Long Count calendar, and some believe that the world will come to an end on that date. 2012 has become a foreboding year for many other individuals, for October 31, 2012, marks the last date that an individual can register for the American Board of Radiology examination without having completed a CAMPEP-accredited residency program, and some believe that the world will come to an end on that date. The concern is that we may not have a sufficient number of medical physics residency programs to meet the anticipated need for qualified clinical medical physicists.

While I am not qualified to address the first issue of the possibility of the world’s coming to an end (although I am reasonably confident it won’t), I am able to address the second issue.

About 5 years ago the AAPM leadership recognized that a problem was approaching, and called a series of summit meetings to address this issue. At these meetings, educational leaders from the AAPM, ACMP, CAMPEP, and ABR met to identify strategies that might enable us to produce a sufficient number of qualified medical physicists to meet our clinical needs. Since that time, the medical physics community has taken several initiatives to address the manpower issue, and, after examining the present data regarding medical physics training capabilities and the need for qualified medical physicists, I am quite pleased to call myself “cautiously optimistic” that the world will not end (at least for the medical physics community) in 2012.

Here is why I say that: First of all, if the manpower crisis occurs, it will not occur in 2012, or even 2013. Students entering CAMPEP-accredited graduate programs as late as the fall semester 2012 are still eligible to register for the ABR examination under the old rules, which require that an applicant be enrolled in a CAMPEP-accredited educational (graduate or residency) program to take the ABR examination, provided they apply for the examination by October 31, 2012. It is the cohort of students entering in the fall semester of 2013 who will be required to complete a residency programs. These students would be completing their graduate programs in the spring of 2015 at the earliest, and that is the target date for having a sufficient number of residency programs to meet our staffing needs.

So, will we have a sufficient number of places available in residency programs in 2015? I think so, and here is why.

Although there is a variation in the data regarding manpower needs, the most recent estimates place our needs to be in the vicinity of 125-150 new radiation oncology physicists per year and 2025 new diagnostic imaging physicists per year. If we look at all the CAMPEP-accredited residency programs as well as all those programs in the CAMPEP pipeline, and assume a residency capacity of 1.5 residents per year per program, we have the capacity of turning out approximately 110 radiation oncology physicists per year and approximately 15 diagnostic imaging physicists per year.

Although we’re not quite there yet, we are getting close.

Before we identify strategies for getting us over the hump, we need to identify another problem, which is the mismatch between degrees of graduates of accredited programs and degrees of residents. The most recent data indicates that twice as many medical physics students are completing graduate programs with an MS degree than a PhD degree. At the same time, residency programs are accepting twice as many applicants with PhD degrees than those with MS degrees.

Students entering programs leading to the MS degree are more likely to desire clinical careers than those entering PhD programs, but without residency opportunities, these students may not be able to pursue careers as clinical medical physicists.

Education Council is funding two initiatives that we hope will mitigate this problem somewhat, both initiatives under the auspices of the Medical Physics Residency Training and Promotion Subcommittee. The first initiative is the hosting of another residency workshop that will

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continued - Education Council Report work with potential residency program directors in developing their Self-Study, a requirement for CAMPEP accreditation. The workshop will be focused primarily on developing a hub and spoke model, in which a single large residency program coordinates clinical training in several affiliated clinical facilities. A graduate program can work with community-based clinics to provide residency positions for which its graduates would have preferred access. Such a program has been achieved with considerable success by the graduate program at Louisiana State University, and we hope that it could serve as a model for additional such programs. With such a hub and spoke arrangement, a graduate program could guarantee access to a residency program for its MS (as well as PhD) graduates.

A second initiative just received funding from the AAPM Board of Directors. Although medical physics residency programs housed in academic institutions often have restrictions limiting their residents to individuals holding the PhD degree, such restrictions do not hold in private clinical practices, which are a major source of hiring of MS-level medical physicists. We are aware of several private medical physics practices that are interested in training medical physics residents, but do not have the administrative resources to support the significant administrative overhead that is required of an accredited residency program. Funding has been made available for a pilot program in which the AAPM would support a 0.25 FTE administrative assistant as well as providing an honorarium to a medical physicist to work with a private practice in developing a Self-Study and providing the administrative infrastructure for an accredited residency program.

The pilot program is to be a four-year program after which time it will be assessed to determine its success in producing additional qualified medical physicists.

Education Council is appreciative of the support of the AAPM Board of Directors, and we are hopeful that in two to three years, we can report to our AAPM membership that we are successful in producing a sufficient number of qualified medical physicists to meet our manpower needs.

Now to get back to work on the Mayan calendar.

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CAMPEP News

William R. Hendee, CAMPEP President & Chair

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n my last CAMPEP News article, I described the decisions of the CAMPEP Board of Directors concerning criteria for admission into the alternate pathway to a CAMPEP-accredited residency. These decisions reflect intense discussion by the Board at its retreat last March, and reflect how far we were able to progress in the discussion at that time.

We recognize, however, that the decisions are an interim step in an ongoing discussion about the alternate pathway, and that they raise additional issues that must be addressed. To address these issues, the CAMPEP Board will meet for a one-day retreat in early November. In the meantime, we have postponed the implementation date until January 1, 2014 for decisions concerning the alternate pathway.

Residency programs continue to be submitted and accredited by CAMPEP, thanks in part to the hard work of the Residency Education Program Review Committee (REPRC) chaired

by Bruce Gerbi. The rate of approval makes us optimistic that in a couple of years we will reach our goal of 125 residency positions available per year. This number coincides with workforce openings projected by Michael Mills. The profession still has not resolved the shortage of residency positions in medical imaging, but a couple of consulting groups are considering the possibility of adding a resident.

The projected number of residency openings does not come close to accommodating the number of individuals graduating from CAMPEP-accredited graduate programs. Graduates who do not secure admission into a residency can, of course, seek employment outside the clinical arena – for example in industry or regulatory agencies. It is unlikely, however, that these avenues will accommodate all of the graduates. This dilemma is not specifically a CAMPEP issue; it is a problem of the profession that is best addressed by the Society of Directors of Academic Medical Physics Programs. Nevertheless, CAMPEP is concerned about the resolution of the problem.

Three members of the CAMPEP Board of Directors are retiring on December 31, 2012, following years of dedicated service. The retiring members are Richard Maughan, Geoff Clarke and Tim Solberg. Speaking on behalf of the profession of medical physics, I am very grateful for their many contributions to medical physics education and CAMPEP activities over the years. In addition to their Board activities, Richard chaired the task group that developed the Report 197s recommendations for the alternate pathway, Geoff has served as Secretary/Treasurer of CAMPEP for several years, and Tim is the current CAMPEP Vice-chair. Richard, Geoff and Tim will be replaced by three new members to the CAMPEP Board of Directors: Joann Prisciandaro, John Antolak and Ed Jackson. We are pleased to welcome Joann, John and Ed to the CAMPEP Board of Directors (Ed is presently a non-voting member of the Board by virtue of being chair of the Graduate Education Program Review Committee (GEPRC)).

Beginning in 2013, Ed Jackson will serve as CAMPEP treasurer and Wayne Beckham has agreed to be the CAMPEP Vice-chair.

A few months ago Bruce Thomadsen retired as chair of the CAMPEP Continuing Education Program Review Committee (CEPRC) after many years of directing this activity. This is a highly responsible position because the CEPRC reviews and approves applications for continuing education credit submitted by directors of many diverse educational programs for medical physicists. We are very grateful to Bruce for his service. His successor is Steve Goetsch, who has appointed Jacqueline Gallet as the Vice-Chair of the CEPRC. Ed Jackson has chaired the GEPRC for many years, and he is retiring from that position on December 31, 2012 (and joining the Board of Directors as a voting member, as mentioned earlier). We are indebted to Ed for his service to CAMPEP and to the directors, faculty and students in medical physics graduate programs. Brenda Clarke, a former CAMPEP chair and current member of the GEPRC, has agreed to accept the chair of this important committee.

The workload of the REPRC has been intense over the past 2-3 years, and will continue to be intense over the near term. Bruce Gerbi has handled this workload with a calm demeanor and

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continued - CAMPEP News a dedication that is nothing short of awesome. Bruce is retiring from the chair at the end of the year, and will be replaced by Chester Reft, a member of the CEPRC. Thank you, Bruce, for all that you have done for CAMPEP and the profession of medical physics.

In my next newsletter article I will report on the outcome of the CAMPEP retreat in early November.

2013 AAPM MEETINGS OF INTEREST 3rd International CT Dose Summit: Strategies for CT Scan Parameter Optimization Pointe Hilton Tapatio Cliffs Resort Phoenix, Arizona March 15-16, 2013 (just prior to the Spring Clinical Meeting)

2013 AAPM Spring Clinical Meeting Pointe Hilton Tapatio Cliffs Resort Phoenix, Arizona March 16-19, 2013 2013 AAPM Summer School: Quality and Safety in Radiotherapy Physics Colorado College Colorado Springs, Colorado June 16-20, 2013 55th AAPM Annual Meeting & Technical Exhibits Indianapolis, Indiana August 4-8, 2013 www.aapm.org/meetings

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Website Editor

Christopher Marshall, New York, NY “Statistics can be made to prove anything - even the truth” (anon).

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he following figure shows the growth in traffic to the website since we started to track this through Google Analytics. “Visits” includes multiple visits by members and nonmembers alike. What I find intriguing is the step-like increase in the percentage of new visits – did we do something to stimulate this or was this caused by an external factor such as a change in the way that search engines find or track us? In any case we have about 90K visits a month and about half are from individuals who did not visit us previously (or did not have a tracking cookie). Of the rest, most visit us more than once each day. The next figure shows the growth in pages viewed by those who reach us – which currently averages about 4.5 pages per visit. This has significant seasonal fluctuation but totaled over 4 million in the past 12 months.

About 78% of our traffic comes from the US, about 5% from Canada and 1.5 – 0.8% from each of Japan, UK, India, Germany, Australia and China in descending order, About 50% of our visitors use IE as their browser (down significantly from earlier years) with the rest mainly using Firefox, Chrome and Safari in roughly equal proportions.

Only about 5% of visits originate from mobile devices with the iPad and iPhone representing the lion’s share of such devices in roughly equal proportions. Not surprisingly, the use of mobile devices to access the website increases by an order of magnitude during the annual meeting.

The member directory, the AAPM reports, the meetings site and careers are our most frequently accessed pages.

I am pleased to report that AAPM Linkedin membership continues to grow rapidly; it is now close to 3000. This raises a question: what is the future role of social media within the AAPM?

I hope that you find the Website useful, visit it often, and send me your feedback at http:// www.aapm.org/pubs/newsletter/WebsiteEditor/3705.asp

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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.

The following questions are a part of CT. Please feel free to contact us at ctaccred@acr.org if you have questions about CT accreditation.

Q. My scanner uses a “flying-focal spot”. How do I enter Nmax in the phantom data form and the N values in the clinical protocols?

A. Nmax is the maximum number of tomographic sections that can be acquired in a single rotation. N = the number of actual data channels used. For example, a Siemens Somatom Sensation 64 scanner utilizes a flying focal spot and has an Nmax = 64. However when a site uses the collimation setting identified on the scanner as “64x0.6” (for example, for the clinical adult abdomen protocol), then N = 32 and T = 0.6 mm. because the 32 actual detectors are used and sampled twice via the flying focal spot. Another example is the Siemens Definition Flash, which also utilizes a flying focal spot. For this scanner, Nmax=128 and the collimation setting on the scanner is identified as “128x0.6”, but the actual number of data channels is 64, so N=64 and T=0.6 in the clinical protocol table (in this scanner, 64 actual detector rows are used and sampled twice via the flying focal spot in a manner similar to the scanner above). Other scanners use “flying focal spot” technology and should be handled similarly. For dosimetry testing, it is the radiation beam width that is needed for recording in the dosimetry spreadsheet and two possible solutions may arise. (1) If the scanner allows the same detector configuration in both axial (sequential) mode as well as helical scan, then the value of N and T described above should be used. The table increment in the dosimeter spreadsheet must be adjusted to yield the proper clinical pitch as indicated in the phantom data form. Please see the examples below; (2) if the scanner does not allow the same detector configuration in helical and axial (sequential) modes, then please see the discussion in the next FAQ. Example 1: Siemens Sensation 64 scanner Adult Abdomen Protocol: 120 kVp, 200 Quality Reference mAs, 64x0.6 mm collimation (using z-flying focal spot), pitch 1.0 In protocol table, use values: N=32, T=0.6 mm, I = 19.2 mm/rotation However, 32 x 0.6 mm is not allowed in sequential mode on this scanner, so for dosimetry testing, please see the next FAQ Example 2: Siemens Definition Flash Scanner Adult Abdomen Protocol: 120 kVp, 200 Quality Reference mAs, 128x0.6 mm collimation (which uses z-flying focal spot), pitch 1.0 N=64, T=0.6 mm, I = 38.4 mm/rotation In this case, 128x0.6 mm is allowed in sequential mode, so no need to change settings for dosimetry: N=64, T=0.6 mm, I=38.4 mm/rotation Q. How do I make CTDI measurements using a detector configuration that is not available in the axial mode?

A. This situation arises when a scanner manufacturer limits the available scan modes. For example, some manufacturers simply do not allow an axial 64 x 0.6 mm detector configuration (where the outer images might suffer from considerable cone beam artifacts). This can make it difficult to perform CTDI measurements when 64 x 0.6 mm collimation is used for helical scans.

Now there are fundamentally two options. The first is to use user tools specifically developed to assist in making axial CTDI measurements using clinically relevant parameters and detector configurations that might not be available in an axial (sequential) scan mode. One example is

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continued - ACR Accreditation that Siemens has developed a “customer CTDI” measurement tool. This is available on Definition scanner models with software version VA34, VA40, or VA44, and Emotion or Sensation scanners with software version VB40. Instructions for use of the mode are included in the online operator manual (Life Card).

If this option is not available, then the user can perform the axial CTDI measurements using settings (including collimation) that are “as close as possible” to the clinical setting. The site should describe this situation as well as the settings chosen to perform the CTDI measurements.

These new settings should be reported in the dosimetry spreadsheet with a note that they are different from those used clinically (and reported in the clinical protocol table). Please note that if collimation is changed for dosimetry testing purposes, then the table increment value (I) should also be changed to yield the same pitch value used clinically. An example is provided below.

Example 1: Siemens Sensation 64 scanner Adult Abdomen Protocol: 120 kVp, 200 Quality Reference mAs, 64x0.6 mm collimation (using z-flying focal spot), pitch 1.0 In protocol table, use values: N=32, T=0.6 mm, I = 19.2 mm/rotation However, 32 x 0.6 mm is not allowed in sequential mode on this scanner, so for dosimetry testing, there are two choices: Option 1 –use the customer CTDI measurement tool if it is available on your scanner.

Option 2 - use settings that are “as close as possible” to the clinical setting, which in this case could be: N=24, T=1.2 mm With a Table feed (I) necessary to give same pitch (Pitch = 1.0), I=28.8 mm/rotation Q. My scanner scans with a 420 degree tube rotation (an extra 1/6 of a rotation) for each axial scan for our head protocol. We use 200 mAs with a 1.0 second rotation time, however, the actual time for each scan is 1.167 seconds which makes the mA about 171. How should the scanning parameters be entered on the phantom data form and dose calculator spreadsheets?

A. If the scan is done in a 420 overscan mode, then record the rotation time as 1.167 seconds and the mA as 171.

Q. Our protocols include iterative reconstruction to reduce noise and ultimately allow us to use a reduced technique on our patient exams. How should this be used for the phantom scanning for accreditation?

A. If iterative reconstruction is used clinically, then it can be used on the phantom scanning. Tube current modulation should be turned off and iterative reconstruction should be noted as a “Dose Reduction Method” in the phantom scanning data form.

Q. When I look at the exposure time tag (0018, 1150) in the DICOM header of an image, I see a number that is some factor greater than the acquisition rotation time and it doesn’t correspond to the time for one complete gantry rotation. How should I report this and will reviewers think we used the wrong rotation time?

A. Some manufacturers use a value other than the time for one complete rotation in this particular DICOM tag (0018, 1150). Unfortunately, this is set at the factory and the user does not have control over this. You can check and see if the scanner reports the “revolution time” DICOM tag (0018,9305) as this is reported on an increasing number of scanners. If so, this can be pointed out in your submission. ACR is making its CT reviewers aware of this potential discrepancy as well.

Q. My scanner passes the manufacturer’s QA specification for water calibration (e.g. water is 0 +/- 5 HU), but the CT number of some of the cylinders in module 1 of the ACR phantom are not within the appropriate range. What can I do to correct this situation without causing a failure due to poor testing procedures?

A. The ACR phantom can be scanned in the opposite direction (from section 4 toward section 1 instead of from section 1 to section 4). This will result in the phantom images appearing in the reverse order on the CD, but this will be acceptable. Alternatively, a water phantom or CTDI phantom can be positioned on the patient table in a manner that effectively extends the ACR

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continued - ACR Accreditation phantom somewhat, and fills the air gap that causes the problem (see figure 1). The water or CTDI phantom may have to be raised a bit to match the ACR phantom height; anything that is not a major attenuator will serve as a shim (such as a few towels or folded up bed linens). In this case, the scan acquisition directions could be followed per the original instructions (from section 1 toward section 4). Additionally, phantom reviewers may use an image that is closest to Module 2, further reducing the impact of the helical interpolation. If this is indicated, please put a note to this effect in with the CD so that the reviewer is alerted.

Attention AAPM Committee Chairs: The 2013 Committee Appointment process is well underway. Please review your current and 2013 committee rosters.

If you would like to make any new appointments to your committee, we strongly encourage you to utilize AAPM’s Committee Classifieds: http://www.aapm.org/aapm_advertising/ committee_classifieds/

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

Radiation Oncology Codes

T

he Centers for Medicare and Medicaid Services (CMS) recently released the 2013 Medicare Physician Fee Schedule (MPFS) proposed rule. The MPFS specifies payment rates to physicians and other providers, including freestanding cancer centers. It does not apply to hospital-based facilities. Changes in payment for hospital-based outpatient facilities are described in a second article below.

Overall, payments for primary care specialties would increase and payments to select other specialties, including radiation oncology would decrease due to several changes in how CMS proposes to calculate payments for 2013. Several 2013 CMS proposals negatively impact the practice expense (PE) relative value unit (RVU) of radiation oncology services, and technical component services realize the largest RVU reductions.

First, 2013 is the fourth and final year of the 4-year transition to the PE RVUs calculated using the AMA Physician Practice Information Survey (PPIS) data. This proposal reduced RVUs for many radiation oncology codes with low equipment costs. The policy has a redistributive effect on Medicare payments, which favors primary care specialties.

Capital-intensive specialties, including radiation oncology, are projected to decrease due to proposed changes in how the interest rate used in the PE calculation is estimated. CMS proposes to revise the interest rate assumptions used to establish payment for practice expense from 11 percent to a range of 5.5 to 8 percent based on the Small Business Administration maximum interest rates for different categories of loan size (equipment cost) and maturity (equipment useful life).

Under the "Potentially Misvalued Codes" initiative, CMS proposes to adjust the payment rates for two common radiation oncology treatment delivery methods, intensity-modulated radiation treatment (IMRT), and stereotactic body radiation therapy (SBRT) to reflect more realistic time projections based upon publicly available data. While CMS is proposing to include the costs of seven equipment items omitted for IMRT delivery code 77418 in 2012, they are also proposing to adjust the intraservice time for IMRT from 60 to 30 minutes, which yields a 40 percent decrease in payment next year to $286.60. In addition, CMS proposes to adjust the intraservice time of SBRT delivery code 77373 from 90 to 60 minutes, which results in a 28 percent payment decrease in 2013. Opponents of this proposal submit that CMS adjusted the time of these codes based on patient brochures and went outside of the established process to review practice expense inputs.

In addition CMS has requested a re-valuation of a number of other radiation oncology codes that they believe may be overvalued.

Services with Stand Alone PE Procedure Time 77280 Set radiation therapy field

77408 Radiation treatment delivery

77285 Set radiation therapy field

77409 Radiation treatment delivery

77290 Set radiation therapy field

77412 Radiation treatment delivery

77301 Radiotherapy dose plan imrt

77413 Radiation treatment delivery

77338 Design mlc device for imrt

77414 Radiation treatment delivery

77372 Srs linear based

77416 Radiation treatment delivery

77373 Sbrt delivery

77418 Radiation tx delivery imrt

77402 Radiation treatment delivery

77600 Hyperthermia treatment

77403 Radiation treatment delivery

77785 Hdr brachytx 1 channel

77404 Radiation treatment delivery

77786 Hdr brachytx 2-12 channel

77406 Radiation treatment delivery

77787 Hdr brachytx over 12 chan

77407 Radiation treatment delivery

88348 Electron microscopy

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continued - Health Policy/Economic Issues On a more positive note, CMS accepted the recommendation to revalue the continuing medical physics consultation code 77336 in 2013. CMS received nominations to revalue 36 "potentially misvalued" codes and only 77336 met the rigorous criteria for review. The RVUs for the weekly physics consult have been eroding for the past several years and this code has not been reviewed since 2002. AAPM will provide data to CMS during the public comment period regarding the costs associated with clinical labor and equipment involved in this service.

This proposed rule reflects the Administration’s priority on improving payment for primary care services. Primary care payments would increase because of a proposed payment for managing a beneficiary’s care when the beneficiary is discharged from an inpatient hospital, skilled nursing facility, and specified outpatient services. Primary care payments also would increase due to redistributions from proposed reductions in payments for other specialties. Because of the budgetneutral nature of this system, proposed decreases in payments in one service result in proposed increases in payments in others.

As noted in the impact table below, the most widespread specialty impacts of the radiation oncology RVU changes are related to four key proposals. The most significant factor is the proposed changes to the inputs for certain radiation therapy procedures, including IMRT and SBRT treatment delivery codes (-7.0%). Second, CMS is implementing the final year of the 4-year transition to new PE RVUs using the AMA PPIS data, which significantly impacts many radiation oncology codes (-3.0%). Third, the CMS proposal to update the interest rate assumption used in the medical equipment calculation in the practice expense RVU methodology (-3.0%). The final factor contributing to the proposed 2013 impacts is the post-discharge transitional management proposal (-2.0%) that benefits both family practice and primary care physicians.

Specialty

Baseline (PPIS transition, new utilization, other factors)

Updated Discharge Equipment Transition Interest Care Mgt. Rate

Input Changes Total (Cumulative Impact for Certain does not include -27.0% Radiation reduction to 2013 CF) Therapy Procedures

Radiation Oncology

-3.0%

-3.0%

-2.0%

-7.0%

-15.0%

Radiation Therapy Centers

-4.0%

-5.0%

-2.0%

-8.0%

-19.0%

Radiology

-2.0%

-1.0%

-1.0%

0%

-4.0%

IDTF

-5.0%

-2.0%

-2.0%

1.0%

-8.0%

0%

0%

0%

0%

0%

Lastly, based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 27 percent reduction to the current 2012 conversion factor of $34.04. Without legislative action, CMS estimates a 2013 conversion factor of $24.84. If Congress does not pass legislation the 2013 conversion factor would reduce all payments by an additional 27 percent to the impacts shown above. Based on the history of congressional intervention to avoid large decreases in reimbursement due to the SGR formula, it is extremely unlikely that this additional 27 percent cut will occur.

AAPM will submit comments to CMS by the September 4th deadline.

To read a complete summary of the proposed rule and to review impact tables go to: http://aapm.org/government_affairs/CMS/2013HealthPolicyUpdate.asp The final rule will be published by November 1st, with an effective date of January 1, 2013.

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continued - Health Policy/Economic Issues 2013 Policies & Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) recently released the 2013 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. The projected increase in payment rates for hospital outpatient services is 2.1 percent for 2013.

The majority of the radiation oncology procedure codes have slight payment increases proposed for 2013, with medical physics codes 77336 & 77370 in APC 304 receiving a 1.9% increase in 2013 payments. The proton beam treatment delivery codes have significant payment decreases due to proposed reassignment of procedure codes to different payment groups. (See table below) Summary of 2013 Proposed Radiation Oncology HOPPS Payments APC

Description

CPT Codes

2012 Payment

2013 Proposed Payment

Proposed % Change 2012-2013

65

Level I SRS

G0251

$902.36

$966.87

7.1%

66

Level II SRS

G0340

$2519.86

$2361.16

-6.3%

67

Level III SRS

G0173, G0339

$3373.00

$3294.23

-2.3%

127

Level IV SRS

77371

$7458.55

$8011.12

7.4%

299

Hyperthermia & Radiation Treatment

77470, 7760077620

$394.85

$393.42

-0.4%

300

Level I Radiation Therapy

77401-77407, 77789

$99.51

$96.18

-3.3%

301

Level II Radiation Therapy

77408-77416, 77422, 77423, 77750

$169.02

$179.58

6.2%

303

Treatment Device Construction

77332-77334

$200.27

$201.90

0.8%

304

Level I Therapeutic Radiation Treatment Prep

77280, 77300, 77310, 77331, 77370,

77299, 77305, 77326, 77336, 77399

$107.65

$109.68

1.9%

305

Level II Therapeutic Radiation Treatment Prep

77285, 77290, 77315, 77321, 77327, 77328, 77338

$263.87

$290.58

10.1%

310

Level III Therapeutic Radiation Treatment Prep

32553, 49411, 55876, 77295, 77301, C9728

$954.38

$984.86

3.2%

312

Radioelement Applications

77761, 77762, 77763, 77776, 77777, 77799

$378.32

$435.72

15.2%

313

Brachytherapy

77785, 77786, 77787, 0182T

$700.57

$685.02

-2.2%

412

Level III Radiation Therapy

77418, 77424, $458.64 77425, 0073T

$483.63

5.4%

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continued - Health Policy/Economic Issues 651

Complex 77778 Interstitial Radiation Source Application

$841.40

$944.22

12.2%

664

Level I Proton Beam Therapy

77520, 77525

$1183.77

$450.40

-62.0%

667

Level II Proton Beam Therapy

77522, 77523

$1548.54

$1110.23

-28.3%

8001

LDR Prostate Brachytherapy Composite

55875 + 77778

$3339.39

$3279.03

-1.8%

APC reassignments for 2013 are highlighted in bold New 2013 CMS proposals include: • Unpackage intraoperative radiation treatment (IORT) delivery codes 77424 and 77425 and assign them to APC 412. These codes will receive separate payment beginning in 2013 with a proposed payment of $483.63. The IORT management code 77469 will not be payable under the HOPPS in 2013, which is consistent with the CMS payment policy for other radiation management codes (e.g., 77431, 77432).

• Based on outpatient claims from 3 hospitals, reassign the simple proton beam therapy code 77522 to the highest paying proton beam APC 667; and reassign the complex proton beam therapy code 77525 to the lowest paying proton beam APC 664.

• Use the geometric means costs of services within an APC to determine the relative payment weights of service, rather than the median costs that CMS has used since the inception of the HOPPS in 2000.

Maintain existing key policy proposals in 2013 to: • Continue to pay separately for each of the brachytherapy sources on a prospective basis, with payment rates to be determined using the 2011 claims-based mean cost per source for each brachytherapy device.

• Continue packaging of radiation oncology imaging guidance services.

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

• Continue the payment adjustment to 11 designated cancer hospitals. CMS estimates that on average, payments to all other non-cancer hospitals is approximately 91 percent of reasonable costs. Therefore, CMS proposes an additional payment needed to result in 91 percent of reasonable cost for each of the 11-designated cancer hospitals.

A complete summary of the proposed rule and impact tables is on the AAPM website at: http://aapm.org/government_affairs/CMS/2013HealthPolicyUpdate.asp The final rule will be published by November 1st, with an effective date of January 1, 2013.

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Legislative and Regulatory Affairs Lynne Fairobent, College Park, MD

White House Issues: FACT SHEET: Encouraging Reliable Supplies of Molybdenum-99 Produced without Highly Enriched Uranium

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n June 7, 2012 the White House issued a fact sheet outlining steps to ensure the reliable supply of medical isotopes while minimizing the use of highly enriched uranium (HEU) for civilian purposes. In order to maintain access globally to reliable supplies of the isotope molybdenum-99 (Mo-99) for legitimate medical purposes, the United States is accelerating commercial projects that produce Mo-99 domestically without the use of HEU. The United States will support these efforts by taking the following actions, consistent with policy principles developed and adopted by the international community, including those outlined in the Communiqué of the Seoul Nuclear Security Summit in 2012 and by the Organization for Economic Cooperation and Development’s Nuclear Energy Agency: • Calling upon the Mo-99 industry to voluntarily establish a unique product code or similar identifying markers for Mo-99-based radiopharmaceutical products that are produced without the use of HEU; • Preferentially procuring, through certain U.S. government entities, Mo-99-based products produced without the use of HEU, whenever they are available, and in a manner consistent with U.S. obligations under international trade agreements; • Examining potential health-insurance payment options that might promote a sustainable non-HEU supply of Mo-99; • Taking steps to further reduce exports of HEU that will be used for medical isotope production when sufficient supplies of non-HEU-produced Mo-99 are available to the global marketplace; • Continuing to encourage domestic commercial entities in their efforts to produce Mo-99 without HEU during the transition of the Mo-99 industry to full-cost-recovery, and directing those resources to the projects with the greatest demonstrated progress; and • Continuing to provide support to international producers to assist in the conversion of Mo-99 production facilities from HEU to LEU. The full details can be found at: http://www.whitehouse.gov/the-press-office/2012/06/07/ fact-sheet-encouraging-reliable-supplies-molybdenum-99-produced-without2013 Policies & Payments for Hospital Outpatient Departments Released by CMS As part of the 2013 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule the Centers for Medicare and Medicaid Services (CMS), announced that CMS is proposing to make an additional payment of $10 for diagnostic radiopharmaceuticals that utilize the Tc-99m radioisotope produced by non-HEU methods. CMS is proposing to base this payment on the best available estimations of the marginal costs associated with non-HEU radioisotope production, pursuant to CMS’ authority described in section 1833(t)(2)(E) of the Act which allows CMS to establish “other adjustments as determined to be necessary to ensure equitable payments” under the HOPPS. The proposed policy in further detail in section III.C.3. of this proposed rule. (link: http://www.gpo.gov/fdsys/pkg/FR-2012-07-30/html/2012-16813.htm, Section III.C.3 begins on page 45121).

In general AAPM is supportive of this approach and it is consistent with AAPM’s support of S. 99 “American Medical Isotopes Production Act of 2011” (link: http://thomas.loc.gov/cgi-bin/ query/z?c112:S.99:). AAPM is working with the Society of Nuclear Medicine and Molecular Imaging on comments in response to this proposal.

2013 HPS Midyear Topical Meeting "Medical Health Physics and Accelerator Dosimetry" The Health Physics Society invites members of the HPS and AAPM to participate in the 46th Midyear Topical Meeting of the Health Physics Society to be held in Scottsdale, Arizona, January

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continued - Legislative and Regulatory Affairs 27-30, 2013. The HPS has applied for CAMPEP credits for attendance at this meeting. Abstract Due Date: September 7, 2012. For this meeting, HPS is especially looking for participation by AAPM members, particularly with reference to the many patient dose issues. AAPM Members who will be able to attend may contact HPS Accelerator Section Past President and AAPM member Mike Grissom as to their interest in presenting papers or co-chairing sessions. Information on this meeting will be posted on this webpage http://hps.org/meetings/meeting33.html as the program and arrangements are updated.

Source Collection and Threat Reduction Program SCATR

(sponsored by the National Nuclear Security Administration, Los Alamos National Labratory and the Conference of Radiation Control Program Directors, Inc.)

A new one year program – Source Collection and Threat Reduction Program (SCATR) – is available for disposal of radioactive sources. It began in Jan 2012 and only runs through this calendar year. The first step is to register your sources with the Off-Site Recovery Project at Los Alamos National Lab. For more details and websites, please see this brochure.

Do You Have Unwanted Sources?

Register them at http://osrp.lanl.gov

The SCATR Program: • Solicits registration of any radium and other nontransuranic radioactive material • Establishes collection compaigns with assistance of radiation control agencies, user groups and certain manufacturers • Assists in funding disposition of collected materials • Notifies owners of other opportunities for disposition as they arise

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Medical Physics Education: Inter-societal Memorandum of Understanding Ehsan Samei, Chairman of the Board Society of Directors of Academic Medical Physics Programs (SDAMPP) There are four key organizations that have a strong interest in medical physics education. They include the AAPM, the American Board of Radiology (ABR), the Commission on Accreditation of Medical Physics Educational Programs (CAMPEP), and the Society of Directors of Academic Medical Physics Programs (SDAMPP). Given the complexity of interests and areas of potential overlap, there has always been a felt need to clearly identify what is the role that each organization can (and should) play in medical physics education.

Initiated over a year ago, the leadership of these four organizations initiated a dialogue toward bringing about this clarity. The individuals who were actively engaged in this initiative included Anthony Seibert, Gary Ezzell, and John Hazle (representing the AAPM), Steve Thomas and Donald Frey (representing the ABR), Bill Hendee and George Starkschall (representing the CAMPEP), and Ehsan Samei, Jim Dobbins, and John Bayouth (representing the SDAMPP). Born out of this effort and worked out over many meetings and discussions, at the AAPM meeting in Charlotte, a Memorandum of Understanding (MOU) was ratified by the respective leadership of the four organizations. The MOU is reproduced verbatim below.

This MOU is the first ever such statement of clarity and unity amongst these four organizations.

Being able to reach a consensus across such a broad range of activities and missions is quite an achievement, a reflection of the exceptional unity of our community and the maturity of our field.

It is very much hoped that this MOU will provide enabling definition of how each organization can take a unique yet collaborative role in the advancement of our educational enterprise. Across the multiplicity of missions, constituencies, and activities, we all share the same goal, the best education of the next generation of medical physicists towards the advancement of human welfare.

August 7, 2012 Relative roles of SDAMPP, AAPM, CAMPEP, and ABR For the Education of Medical Physicists in the United States

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Objective: Medical physics education in the United States is an enterprise defined, implemented, and monitored by four primary organizations: AAPM, CAMPEP, ABR, and SDAMPP. Each organization provides an indispensible component necessary to enable and to advance medical physics education. However, given the multiplicity of input, there is the possibility of redundancy, gaps, and overlapped areas of authority. This MOU is meant to serve as a guiding document to define the relative roles of the four organizations as an effort to clarify the landscape and to foster more synergistic engagement of the organizations towards the advancement of medical physics education in the United States.

This document focuses on the education of medical physicists seeking ABR certification, which

AAPM Newsletter

September/October 2012

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AAPM Newsletter

September/October 2012

continued - Medical Physics Education: Inter-societal Memorandum of Understanding can lead the candidate to achieve the recognition of Qualified Medical Physicist (QMP) as defined by the American College of Radiology, and the explicit roles that the participating organizations play towards that end. The MOU is not meant to capture the broader scope of the activities pursued by the respective organizations. Furthermore, the “primary audience” in the sections below pertains only to the primary constituencies of the respective organizations. Those are not meant to be exclusive. Furthermore, the “primary audience” in the definitions below is not meant to capture all the constituents that each organization serves, rather only the primary ones.

AAPM Scope: 1. Defining the didactic and clinical training pathways towards becoming a Qualified Medical Physicist (QMP), with input and feedback from SDAMPP, ABR, CAMPEP and other appropriate professional organizations.

2. Defining the educational content for graduate and residency programs (e.g., AAPM reports), as well as minimum educational requirements for those entering medical physics from other professions.

3. Promoting the establishment of medical physics programs based on need (joint with SDAMPP) 4. Providing continuing education opportunities to assist in maintenance of certification (MOC).

5. Recruitment of highly talented individuals into medical physics, with an emphasis on minorities and undergraduates (joint with SDAMPP).

Primary audience: Entire community of medical physicists SDAMPP Scope: 1. Providing a forum for discussion and coordination within and between graduate and residency programs – communicating with students and residents.

2. Defining and fostering best practices for medical physics education.

3. Encouraging improved consistency in medical physics education.

4. Collecting and monitoring statistics pertaining to medical physics education.

5. Assisting new medical physics programs in getting started (eg, leadership structure, financial models, curriculum implementation, best educational models, number of faculty, etc) (joint with AAPM and CAMPEP).

6. Disseminating structured mentorship requests from international medical physicists to program directors (joint with ABR and CAMPEP).

Primary audience: Leaders of medical physics educational programs CAMPEP Scope: 1. Establishment of criteria and guidelines for accreditation of graduate and residency educational programs in medical physics.

2. Review and approval of applications for accreditation of educational programs in medical physics to insure that these programs are meeting accepted standards for the training of medical physicists.

3. Monitoring of accredited educational programs to ensure ongoing compliance with criteria and guidelines for program accreditation.

4. Consideration in accreditation criteria and guidelines of desirable attributes of medical physicists, including research experience, educational skills, clinical expertise, and professional and leadership behavior.

Primary audience: Medical physics educational programs seeking accreditation ABR Scope: 1. Certifying that diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, understanding, and performance essential to the safe and competent practice of medical physics.

Primary audiences: The public and individual medical physicists

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AAPM Newsletter

September/October 2012

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AAPM Newsletter

September/October 2012

Person in the News Cari Borrás receives the Award of Merit of the International Union for Physical and Engineering Sciences in Medicine (IUPESM)

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t the World Congress on Medical Physics and Biomedical Engineering in Beijing, last May 2012 (WC 2012), Cari Borrás, D.Sc., FAAPM, FACR, received the Award of Merit of the International Union for Physical and Engineering Sciences in Medicine (IUPESM), the umbrella organization that encompasses the medical physics (IOMP) and the biomedical engineering (IFMBE) international organizations. The IUPESM bestows the Award every three years to a medical physicist and a biomedical engineer “for outstanding achievements in physical and engineering sciences in medicine.”

AAPM_halfhorizontal_R1

4/21/11

2:41 PM

Above, Dr. Borrás is receiving the Award (for medical physics) from Dr. Barry Allen, IUPESM President, during the WC 2012 Opening Ceremony.

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Experimenting with your hiring process?

Finding the right medical physics job or hire shouldn’t be left to chance.

The American Association of Physicists in Medicine (AAPM) Career Services site is your ideal recruitment resource, targeting thousands of expert researchers and qualified top-level managers in medical physics, radiation oncology, medical ultrasound, nuclear medicine, clinical medical physics, radiation health, and other related fields worldwide. Whether you’re looking to hire or be hired, AAPM provides real results by matching relevant jobs with this hard-to-reach audience each month.

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

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AAPM Newsletter

September/October 2012

Professionals Services Report

Jessica Clements, Texas Health Presbyterian Hospital Dallas

AAPM Affiliation with the ACR Radiology Leadership Institute and the Launch Event

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APM has provided offerings in leadership development for medical physicists, mostly through professional programming at the annual meeting. For the past few years, there has been a desire to offer a more formalized approach to leadership development. The American College of Radiology (ACR) launched the Radiology Leadership Institute (RLI) in July of 2012. Just prior to the launch event, the AAPM formally affiliated with RLI, which is a step forward in the advancement of leadership development within the AAPM. RLI is an educational structure where participants can earn credits from live or web-based courses. Accumulated credits can be applied to the following five levels: I. Leadership Fundamentals – 12 RLI credits II. Leadership Proficiency – 30 RLI credits III. Advanced Leadership Proficiency – 50 RLI credits IV. Leadership Mastery – 20 RLI credits, Certificate of Leadership Mastery V. Leadership Luminary – honor/award To launch the RLI, an inaugural event was held in Evanston, Illinois, at the Northwestern University Kellogg School of Management July 12-15. Sessions were presented by Kellogg faculty and radiologists.

Approximately 150 attended the launch including three medical physicists: B. (Wally) Ahluwalia, Jessica Clements, and Heidi Edmonson.

Media coverage including several detailed articles of the launch is available at: http:// www.imagingbiz.com/imaging/statread/ tag/radiology_leadership_institute.

CEO of General Electric, Geoffrey Immelt, and Cynthia Sherry, MD, Chief Medical Officer of RLI at the Launch Event Keynote Address.

There are seven core areas to the RLI Common Body of Knowledge: Finance and Economics, Ethics and Professionalism, Legal and Regulatory, Strategic Planning, Practice Management, Professional Development, and Service Quality and Safety. Anyone can enroll in RLI for free at www.radiologyleaders.org/enroll, which includes access to the RLI leadership community.

Upcoming events include the Harvard Emerging Leaders Seminar (fall session is sold out, another is open now for the spring at http://www.radiologyleaders.org/Harvard. html) and other offerings through the Kellogg School of Management, Harvard Business Publishing, the Radiology Business Management Association, the American College of Physician Executives, the AHRA and AAWR. Just announced are new RLI Leadership Modules which include courses on Basic Ethical Principles in Radiology, The Importance of Quality and Service to the Specialty, Leadership Lessons Learned from History's Great Leaders, and Legal, Regulatory and Policy Issues Impacting the Specialty. For more information and to register, please visit: http://www. radiologyleaders.org/leadership-modules.html.

By affiliating, AAPM members will have the opportunity to register for RLI events at affiliate membership prices. In addition, the AAPM is working to provide content specific to medical physicists.

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Participants on the campus of Northwestern University at the launch event.

AAPM Newsletter

September/October 2012

Obituary

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harles E. Metz, Ph.D., Professor of Radiology and the Committee on Medical Physics at the University of Chicago, died from pancreatic cancer on July 4 at his home in Burr Ridge. He was 69 years old. [http://news.uchicago.edu/article/2012/07/10/charles-metzpioneer-imaging-science-1942-2012]

Professor Metz was a pioneer in image science and was instrumental in elucidating the mathematical foundations of imaging science.

Metz contributed to nuclear medicine imaging and reconstruction methods, and developed the Metz filter, an image processing filter that concurrently enhances resolution and suppresses noise in nuclear medicine images.

Metz was internationally known for both his mathematical and statistical developments in ROC (Receiver Operating Characteristic) analysis and the corresponding practical software, which he freely distributed to scientists and clinicians throughout the world. Currently there are over 15,000 register users (http://metz-roc.uchicago.edu). His paper, “Basic principles of ROC analysis”, which was published in 1978, has been cited nearly 3,000 times. He also advised many on rigorous study designs for both reader studies (including those used in FDA submissions) and CAD (computer-aided diagnosis) evaluations.

Metz was an extraordinary teacher and communicator, known for his clear, thorough, and careful discussions and explanations. He was also generous with his time and was highly sought by students, researchers, and faculty -- he advised or served on dissertation committees for at least 40 students. In the award’s inaugural year and once again, he received the “Kurt Rossmann Award of Excellence in Teaching” from the students in the Graduate Program in Medical Physics at the University of Chicago.

Among his various awards, Metz was also elected as a Fellow of the American Association of Physicists in Medicine in 2004, received the Paul C. Hodges Alumni Society's Excellence Award in 2004, and was awarded the 12th L.H. Gray Medal by the International Commission on Radiation Units and Measurements in 2005—cited for his “fundamental contributions to basic and applied radiation science.”

Metz was born September 11, 1942, in Bay Shore, N.Y., was raised in Freeport, Long Island, and graduated with honors in 1964 from Bowdoin College with a bachelor’s degree in physics. He earned a master’s degree in 1966 and the Ph.D. degree in 1969 in Radiological Sciences from the University of Pennsylvania.

In 1969, Metz came to the University of Chicago as an Instructor in Radiology and the Argonne Cancer Research Hospital, rising to assistant professor in 1971, associate professor in 1975, and professor in 1980. He served as Director of the Graduate Program in Medical Physics at the University from 1979 to 1986. His academic career included the publication of over 250 scientific papers and service on multiple institutional as well as national and international committees and advisory boards, including study sections for the National Institutes of Health Metz was also a humble leader in other areas including the model airplane world, having amassed an impressive collection of books and models of WWII airplanes, which is being donated to the Pritzker Military Library in Chicago.

The field of imaging science has lost a true scientist, educator, and collaborator of the highest caliber, and many of us have also lost a thoughtful and witty mentor, colleague, and friend.

Metz is survived by his daughters, Becky Metz Mavon of Western Springs, Illinois and Molly Metz of Seattle, Washington; grandchildren Charlie, Avery and Oni; and former wife, Maryanne Metz of Chicago.

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

Editor

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

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

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• Next issue: November/December • Submission Deadline: October 4, 2012 • Posted On-Line: week of Nov. 5, 2012