AAPM Newsletter January/February 2013 Vol. 38 No. 1 by AAPM Docs

AAPM

N E W S L E T T E R

The American Association of Physicists in Medicine JANUARY/FEBRUARY 2013 Volume 38 No. 1

AAPM Executive Committee

In this issue:

• “It was the Best of Times, it was the Worst of Times” by AAPM President John D. Hazle

• AAPM President-Elect John Bayouth Gives an Overview of AAPM

• AAPM Chairman of the Board Ezzell Discusses the Strategic Initiatives Taken by the Board at the Summer Meeting

• Science Council Report

• AAPM Executive Director Angela R. Keyser Reviews Important Dates and Events in 2013

• ABR Trustees Report

• Editor’s Column • Government & Legal Affairs Report • Persons in the News and more ...

2013 AAPM Annual Meeting is in Indianapolis, IN. August 4-8, 2013. See Important Dates Inside this Issue.

AAPM

NEWSLETTER

AAPM NEWSLETTER is published by the American Association of Physicists in Medicine on a bi-monthly schedule. AAPM is located at One Physics Ellipse College Park, MD 20740-3846

EDITORIAL BOARD EDITOR Mahadevappa Mahesh, MS, PhD

Johns Hopkins University E-mail: mmahesh@jhmi.edu Phone: 410-955-5115 John M. Boone, PhD Eileen Cirino, MS Robert Jeraj, PhD Christopher H. Marshall, PhD E. Ishmael Parsai, PhD Charles R. Wilson, PhD 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 PUBLISHING SCHEDULE The AAPM Newsletter is produced bimonthly. Next issue: March/April Submission Deadline: Feb. 13, 2013 Posted On-Line: Week of March 4, 2013

www.AAPM.org

CONTENTS JANUARY/FEBRUARY 2013 Volume 38 No. 1

3 7 10 12 15 20 24 27 31 35 39 42 44 47

AAPM President’s Column

Chairman of the Board’s Column

AAPM President-Elect’s Column AAPM Executive Director’s Column Editor’s Column

50 52 58 59 66

ACR Accreditation: FAQs for Medical Physicists Health Policy & Economic Issues Report AAPM Staff Announcements

Persons in the News

Letters to the Editor

Treasurer’s Report

Professional Council Column

Education Council Report

CAMPEP News

Science Council Report Legislative & Regulatory Affairs Report Website Editor’s Report ABR Trustees Report - Part One Continuous Certification ABR Trustees Report - Part Two Medical Physics Training

Events / Announcements

17 26 34 41 57 42

AAPM Annual Scientific Meeting

AAPM Spring Clinical Meeting

ROPA & AAPM Summer School

3rd CT Dose Summit Radiation Oncology Program Accreditation workshop

Touch on page numbers to navigate topage articles. Touch on numbers to navigate articles. Touch on to End-of-Article Markers in an article to return to this page.

AAPM President’s Column

John D. Hazle, Houston, TX

It was the Best of Times, It was the Worst of Times... Charles Dickens, A Tale of Two Cities.

reeting fellow medical physicists! This is my first Newsletter article as President and I am excited about what the association has going on this year. I want to bring you up to speed on a few of the many activities going on with the association. The quote above pretty much sums up how I see the landscape for healthcare. On the one hand, we are making strides in our understanding of disease, particularly cancer, and how to treat them that are unprecedented. I am working on finalizing my Presidential Symposium at the annual meeting on Medical Physics in the Age of Genomic Medicine. The speakers I’m working to have present are exemplary and I think will lay out an stimulating landscape for the future. On the other hand, the poor state of the world economy is placing strains on how we can efficiently deliver healthcare to the public, carry out innovative research to take advantage of the growing body of knowledge and train the next generation of medical physicists. Just about every decision we make over the next few years “We are making strides in our will be driven by this dilemma. Howevunderstanding of disease, er, we must remember that in times of particularly cancer, and how change, there are always opportunities. to treat them that are unprecedented” First, I’d like to extend a hardy thanks to Board members who have completed their terms and are rotating off, including Nzhde Agazaryan, PhD, John Antolak, PhD, Nesrin Dogan, PhD, Kevin Fallon, MS, Steven Jones, MS, Mary Ellen Masterson-McGary, PhD, Mark Rivard, PhD, John Wong, PhD, Raymond Wu, PhD and Eric Zickgraf, PhD. And welcome to our new Board members, including Cem Altunbas, PhD, Kristy Brock, PhD, Jessica Clements, MS, John DeMarco, PhD, Paul Imbergamo, MS, Lee Myers, PhD, Mark Pankuch, PhD, Todd Pawlicki, PhD, George Sherouse, PhD, and Barry Wessels, PhD. As a reminder, the AAPM is a “Board governed” organization and most everything that happens in the organization gets their approval.

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I would also like to extend my personal thanks to Janelle Molloy for her many years of service to AAPM, including the last three years as Treasurer. Janelle executed the duties of this office with a high degree of professionalism and an overriding concern for the future of AAPM. Another significant “retirement” from service is Jerry Allison as Rules Committee Chair and Parliamentarian. Jerry will continue to serve the interests of AAPM and medical physicists as an AAPM Trustee to the ABR. Finally, I want to extend a high five to Tony Seibert who is just finishing his tour of duty through the Presidential chain. Like Janelle, Tony has served the organization for many years. He performed the duties of President and Chairman of the Board with wisdom and patience, characteristics that served the organization well as we dealt with several sensitive issues. One happening at RSNA that I want to highlight is the significant headway made in the financing of new residency programs in imaging physics. The AAPM Board approved a proposal brought forth from Education Council to set aside $560,000 over the five years to fund four (4) new imaging residency programs. The format is to fund approximately 50% of a resident position ($35,000 per year) for up to four years at each program. Even more exciting, the RSNA Board approved $280,000 to fund two new residencies in partnership with us. This means we have committed funding for six AAPM/RSNA Imaging Physics Residency Fellowships! Bob Pizzutiello will be chairing a joint AAPM/RSNA to finalize the program announcement, select the best residency program applications and monitor program progress. I really can’t overstate the support we received from RSNA. They became engaged on the problem, made insightful suggestions on how to structure the fellowships to have the highest probability of sustainability, then they “put their money where their mouth is” and committed money to the project. One suggestion from RSNA was to engage the Society of Chairs of Academic Radiology Departments (SCARD) to obtain radiology chairs input and support for the project. As mentioned in an earlier Newsletter, SCARD immediately embraced the challenge and has put the weight of their organization behind the initiative. One of the suggestions from RSNA and SCARD to achieve sustainability of these programs was to highly engage the radiology chairs in these programs. The radiology chair commitment will be a major criteria in consideration of fellowship applications. Finally, to encourage timely CAMPEP accreditation, programs will have to completed a self-study and had that program plan approved by the CAMPEP Graduate Education Program Review Committee before funding of years 3 and 4 can be requested. If you have been considering getting your ongoing imaging physics residency program accredited --- or in starting a new program --- stay on the alert for the program announcement due out early next year!

Strategic planning continues to move along and has been refined to even better harAAPM Newsletter | Volume 38 No. 1 | January/February 2013

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monize with the budgeting process. This allows the association to define what our priorities are from the bottom (Councils) up (Board) and align our allocation of resources with those priorities. We will be launching two ad hoc committees in the next couple of months to look at HQ space needs for the future and to develop a comprehensive meeting strategy. These committees both have a strategic aspect to them as they will help us understand a couple of significant aspects of the organization. I will lead the HQ space needs committee with significant participation by Angela Keyser and Michael Woodward. The goal of this committee is to fully consider all options for our space needs into the future so that we will be in the best position possible to renegotiate the HQ lease when it comes up in a few years. Bob Gould has agreed to chair the ad hoc on meeting strategy. The charge of that committee will be to review the alignment of the annual meeting, spring clinical meeting, summer school, specialty and other meetings in terms of scientific content, professional and educational goals. The composition of that committee is being developed over the next few weeks. I’m also happy to announce that we have wrapped up the process of selecting Editors for our journals – Medical Physics and the Journal of Applied Clinical Medical Physics (JACMP). Michael Mills will be taking over as Editor of JACMP on January 1, 2013 and Jeffrey Williamson will take over as Editor-in-chief of Medical Physics on January 1, 2014. I want to thank the Ad Hoc Committee on Editor Compensation, the respective editor search committees and the respective Journal Business Management Committees for making this a seamless process and in selecting outstanding individuals to lead these outstanding journals. I want to thank all the applicants for the editor positions; it was heartening to see the excitement about these positions and the number of outstanding applicants. Selection of a single finalist for each position was difficulty because of the quality of the applicants. The AAPM is fortunate to have so many members who were willing to take on such responsibility.

Finally, I want to weigh in on the lawsuit situation. While EXCOM has been working almost weekly to address this challenge to the organization, we have been doing this with knowledge and support of the Board since the lawsuit was filed against us. We have twice reached out to the plaintiff to see if a compromise could be reached. Both times we were rebuffed. At the RSNA meeting, the Board met in executive session with our lawyers for over 3 hours. After extensive discussion and consideration of all options, the Board voted unanimously to move forward to defend our policy and go to trial. Believe me, no one in AAPM leadership is happy about the amount of time and money that has been invested in this situation. We would much rather be investing this energy and money into activities that would move the profession forward. But please remember, they sued us for alleging that we colluded with othAAPM Newsletter | Volume 38 No. 1 | January/February 2013

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ers, although we are the only defendant in the case, in upholding a long standing policy that our Accredited Dosimetry Calibration Labs canâ&#x20AC;&#x2122;t be owned by an equipment manufacture due to the conflicts associated with this situation. So, regardless of what a few people are suggesting on the list server, defending our policy is not a reckless action of EXCOM, but a measured response based on the direction of the Board after continuous consideration of the circumstances. In conclusion, I look forward to working with the AAPM members in moving the Association and the profession forward over the next couple of years! Thanks for your support and confidence in electing me to this very humbling position.

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Chairman of the Board’s Column

Gary A. Ezzell, Phoenix, AZ

Strategic Initiatives Taken by the Board at the Summer Meeting

he year turns, and I have changed hats. John Hazle takes over as President, John Bayouth as President-Elect, and Tony Seibert gets to put his well-earned ceremonial gavel on the mantle. Tony served AAPM exceptionally well during the threeyear cycle and deserves our thanks and deep respect. He chaired Board meetings this year with skill and grace, setting a fine example that I will do my best to follow. Nothing of lasting value happens quickly, but with patience and persistence good things can come to pass. This year the efforts that many have made to start, refine, and maintain a strategic planning process paid off in the creation of the 2013 budget. I am sure that sounds dry, but it is truly important. Where “Where and how we spend our money and how we spend our monmatters, and this year the Board ey matters, and this year the deﬁned strategic initiatives at the Board defined strategic initiasummer meeting so that the fall budget tives at the summer meeting process followed the Board’s priorities.” so that the fall budget process followed the Board’s priorities. As a result, the Board’s approval of the 2013 budget at RSNA was not a rubber stamp of others’ ideas. Credit for this improvement in our processes primarily goes to the Strategic Planning Committee of the Board, which in 2012 included Board members John Antolak, John Bayouth, Ed Jackson, Doug Pfeiffer, Mark Rivard, and Steve Rudin (officers and Council Chairs are also members.) John Bayouth and Steve Rudin rotate off for 2013, and Gene Cardarelli and Mark Oldham rotate on (John Bayouth also stays on in a different role as an officer.) Credit also must be given to Janelle Molloy, who as Treasurer for the past three years did more than anyone to refine the budget process and align it with the strategic planning efforts.

So much for process – what is the product? What are some of these initiatives that AAPM Newsletter | Volume 38 No. 1 | January/February 2013

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our resources (of which dues is a big part) are funding? Immediate Wireless available throughout the annual meeting convention center. Investing in our future: programs National error reporting system for Radiation Oncology (joint with ASTRO) AAPM is covering half the direct costs; target rollout late 2013 Accelerated development of Medical Physics Practice Guidelines Needed to provide regulators and accrediting bodies with practical guidance Task group on credentialing/competency of medical physicists Needed practice management topic Preparation for expected review of CPT codes in Radiation Oncology Could have a major impact on medical physics funding Full participation in international DICOM efforts for all disciplines So AAPM has a seat at the table for developing international standards Support for Medical Physics and JACMP editorial offices New editors in 2013 and 2014 Pilot project for developing approaches for the independent evaluation of computer-aided detection and computer-aided diagnosis systems: lung nodule detection database. First step toward collaborative technology assessment capabilities. Investing in our future: people Support for new imaging physics residencies Seed funding for new programs that will become CAMPEP accredited and permanent; RSNA is contributing to this also Administrative support for new residencies based in private practices Especially for imaging physics, consulting groups can provide the training but have difficulty maintaining the administrative overhead of residencies Workshop on creating residencies Needed to continue to grow the number of residencies in therapy and imaging More summer undergraduate fellowships 65% have entered medical physics graduate programs

A final note … at the RSNA meeting, the Board engaged in a 3.5 hour discussion in executive session about the lawsuit. It was a remarkable demonstration of thoughtful, respectful, insightful debate. People came in with different opinions and concerns, asked our lawyers good and sometimes pointed questions, and listened very AAPM Newsletter | Volume 38 No. 1 | January/February 2013

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carefully to each other. At the end, there was a unanimous decision to proceed to trial. You do not often see a group of 50 people engage with each other and a difficult subject so well. People joke about herding cats. Your Board members are not cats, they are owls.

AAPM Newsletter | Volume 38 No. 1 | January/February 2013

AAPM President-Elect’s Column

John E. Bayouth, Madison, WI

Overview of AAPM

resident-elect of the AAPM? Really? Like most of you, I never expected to receive a phone call from the current President of our organization to ask me to accept the nomination for this position. Now that I’ve completed my six months of AAPM “Presidency Residency,” I’m excited to begin and hope to make the best use of this opportunity to contribute to our profession. During the past six months I’ve used my time and access as President-elect-designate to try and better understand who we are as an organization. One answer to this question is anatomic in nature: we are a society comprised of over 8000 members (5592 full members) from 21 countries. AAPM is governed by a Board of Directors, a set of executive officers, and four councils which collectively “In the next six months I will be facilitates activities within 246 evaluating how effectively AAPM is volunteer-driven committees. using the assets and time of its We have an executive director volunteer members to meet our who leads a headquarters supcollective goals. I admire the efforts of port staff who provides inforour nearly twelve-hundred colleagues mation services, meeting and who are currently involved, and hope program management, legislato optimize their investment.” tive and regulatory activities, and finance operations. An alternative answer to who we are as an organization can be found in the work we do. AAPM is a scientific, educational, and professional organization. We manage and publish the premier journals in our field, define Medical Physics practice guidelines, define requirements for didactic and clinical training, provide continuing education, foster research and development, and maintain a national registry of qualified medical physicists. AAPM provides a comprehensive array of professional services to its members.

The work described above is accomplished through the efforts of many, but primarily within our four councils: Administrative, Education, Professional, and Science AAPM Newsletter | Volume 38 No. 1| January/February 2013

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Council. These councils are organized with the following general hierarchy: committees reporting to the council, sub-committees within the committee, working groups to oversee and perform on-going activities under the subcommittee, and task groups that focus on deliverables that meet a defined charge in a specified period of time. Each council reports their activities to the Board of Directors (Board) during the Board Annual Meeting and at RSNA. Additionally, the Board itself has several committees to maintain the organization (e.g., Finance, Rules, Strategic Planning) as well as the editorial boards of our two journals. Executive committee (EXCOM) acts for and reports to the Board, exercising general supervision of the business of the AAPM. EXCOM maintains continuous oversight of and provides guidance to council chairs and vice-chairs. Additionally, EXCOM has several adhoc committees which have been established to address an acute concern for the organization (e.g., selection of a new editor for the website). Over 20% of AAPM members volunteer their time and energy for AAPM activities. Like all of us, they receive benefits through their payment of dues, but they have also invested themselves to help achieve our collective goals. In the next six months I will be evaluating how effectively AAPM is using the assets and time of its volunteer members to meet our collective goals. I admire the efforts of our nearly twelve-hundred colleagues who are currently involved, and hope to optimize their investment. If you are interested in contributing to our profession through the activities of AAPM, then I strongly encourage you to spend some time understanding the breadth and depth of what we do as an organization, identify an on-going activity and become involved, or propose a new idea to a council chair. The AAPM Newsletter is one excellent source of information to better understand whatâ&#x20AC;&#x2122;s happening. Minutes of previous meetings can be found on our website http://www.aapm.org/ org/structure/, or join a meeting as a guest and listen in on the discussion.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

AAPM Executive Director’s Column

Angela R. Keyser, College Park, MD

Important Dates and Events in 2013 AAPM Meeting Updates Radiation Oncology Program Accreditation Meeting February 8-9, 2013, Dallas, TX Registration Now Open! Register by January 9 for discounted fees!

he Radiation Oncology Program Accreditation Meeting is a hands-on workshop aimed at providing information on how to prepare for radiation oncology accreditation, with representatives from accreditation programs participating alongside seasoned surveyors/surveyees who will provide their guidance and experiences. The meeting content is designed to provide information for the suggested accreditation team of Physician/Physicist/Therapist/Dosimetrist/Administrator. 3rd CT Dose Summit: Strategies for CT Scan Parameter Optimization March 15-16, 2013 - just prior to the Spring Clinical Meeting, Phoenix, AZ Registration Now Open! Register by February 8 for discounted fees! The 3rd CT Dose Summit will include enhanced content and new partners. AAPM is pleased to collaborate with the Webster Center for Advanced Research and Education in Radiation of the Massachusetts General Hospital. The focus of the 3rd CT Dose summit will remain on demonstration of how scan acquisition and image reconstruction parameters should be selected and managed to improve image quality and reduce radiation dose. Faculty members will explain the essential criteria for specific diagnostic tasks. The goal of the summit is to provide practical information for users that will help them operate their CT scanners wisely, improving the quality and usefulness of CT images while reducing the radiation dose to patients.

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The second annual AAPM Annual Spring Clinical Meeting March 16 - 19, 2013 - just after the 3rd CT Dose Summit The Pointe Hilton Tapatio Cliffs Resort, Phoenix, Arizona Registration Now Open! Early registration fee deadline is February 8, 2013! New this year! • The Radiation Therapy track program highlights the clinical application of several AAPM Science Council Task Group Reports. Foundations of clinical medical physics and their extension to newer technologies such as electronic records, VMAT and flattening filter free mode are highlighted. • There will be a Best Poster competition! A panel of judges will score poster displays according to criteria that includes clinical relevance, originality, and organization/presentation of the material. All abstracts submitted for posters must have a clinical focus. Funding Opportunities AAPM is pleased to announce the following 2013 Funding Opportunities: • Two $25,000 Research Seed Funding Grants will be awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. It is expected that funding will begin on July 1 of the year in which the award is made, and that subsequent research results will be submitted for presentation at future AAPM meetings. Deadline: March 1, 2013. • AAPM/RSNA Fellowship is offered for the first two years of graduate study leading to a doctoral degree in the field of Medical Physics. Deadline: March 18, 2013. • Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the program are

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placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a $4,000 stipend. Deadline: February 1, 2013.

• Minority Undergraduate Summer Experience Program (MUSE) is designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institution (university, clinical facility, laboratory, etc.). The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics. Each MUSE fellow receives a $4,000 stipend. Deadline: February 4, 2013. Additional program details and access to the NEW Online Applications can be found at: http://www.aapm.org/education/GrantsFellowships.asp 2013 Dues Payments 2013 renewal notices have been sent several times since October, with payments due by March 1. If you have an email address on file, the invoice was sent electronically in an effort to make it more convenient for you to pay your dues and to reduce administrative costs. There is a mechanism provided to print a copy of the invoice if you wish to mail your payment. Please go to the AAPM Homepage, log in and click on “Pay Your 2013 Dues Online.” Remember, you can pay Chapter dues with your AAPM dues for any Chapter of which you are already a member! The AAPM Rules are very specific regarding the cancellation of membership if dues are not paid by the deadline and the fees required for reinstatement. As the administrative staff of the AAPM, we must consistently enforce the rules of the organization. It would be very difficult to make exceptions for some members and enforce such fees on others. If you need any assistance or have any questions about the dues process, please contact Janet Harris at 301-209-3396.

AAPM Newsletter | Volume 38 No. 1 | January/February 2013

Editor’s Column

Mahadevappa Mahesh, Baltimore, MD

AAPM Newsletter is Coming to iPad and Android Devices

wish all of you a very Happy New Year. The AAPM Newsletter has some exciting new changes beginning with this first issue of 2013! In an effort to increase readership, the Newsletter will be available as a tablet edition for iPad and soon will be available for Android devices. Since this is a new product, we expect to have a few “bumps” and challenges in the beginning and appreciate your patience as we work through these. I look forward to and en“The AAPM Newsletter has some exciting courage your comments/suggestions renew changes beginning with this ﬁrst garding the new application and will conissue of 2013! In an effort to increase tinue to strive to make it better with each readership, the Newsletter will be available new edition. The Newsletter will continue as a tablet edition for iPad and soon will to be available on the AAPM website as a be available for Android devices... I look PDF, but with a new look. forward to and encourage your comments/ suggestions regarding the new As you may remember, when I started application...” as the Editor in 2007, the Newsletter was printed in glossy paper and sent to all members via first-class mail. To assist with reducing expenses related to the Newsletter, within the first year I chose to change the paper that was used to a regular, lighter stock and began mailing each issue via standard mail. Continuing to feel the pressure of reducing the cost of producing each issue of the Newsletter, in 2009 each issue was published for members in hard-copy and available on-line. This was a transitional year for the Newsletter as it was available on-line only beginning in 2010. The move to an on-line only Newsletter publication resulted in the budget for the publication being in the “black” and becoming a revenue source. My hopes for 2013 and in the future, is for the Newsletter to remain a main source of information for the AAPM Membership. As we begin the new-year, I like to welcome new members for the Newsletter Edito-

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rial Board â&#x20AC;&#x201C; John M. Boone, Robert Jeraj, E. Ishmael Parsai and Charles R. Wilson. I also like to thank the outgoing editorial board members - William R. Hendee, Allan deGuzman and Priscilla Butler for their invaluable service to the Newsletter and for all the valuable and constructive suggestions they provided me over the past six years. It has been quite exciting and challenging but gives me great pleasure to serve as the Editor of the Newsletter. Once again, I welcome all of you to the first edition of 2013 and wish everyone a very happy and productive year.

ABR to Provide List of Constants and Physical Quantities to Candidates Beginning with the 2013 Part 1 and Part 2 examinations in medical physics, the ABR will provide the candidates with a list of constants, physical values, and related information. The final list will be completed and published around May 15, 2013. While the list will include many constants and physical values, the ABR does not warrant the list as a compilation of all constants and physical values needed on the examinations. Candidates should review the list carefully before their examinations to familiarize themselves with the contents and organization of the list.

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2013 AAPM Annual Meeting August 4-8, 2013 Indianapolis Convention Center

There is more to Indianapolis than its annual 500-mile race. There are more than 85 restaurants in the Wholesale District neighborhood surrounding the convention center. Visitors enjoy the famous local hospitality as well as the farm-to-table trend. Many chefs have partnered with Indiana farmers to bring the freshest ingredients to menus. Indy is a walkable city; Monument Circle was recently named one of the “10 Great Public Spaces” by the American Planning Association. A walk through the Virginia Fairbanks Art & Nature Park features 100 acres of public art. Make plans now to join us in Indianapolis for the AAPM 55th Annual Meeting and Exhibition.

New this year… • • • • • •

Expanded SAMS offerings. New session formats, including debates and panel discussions. Increased dawn-to-dusk content in scientiﬁc and educational tracks. Scientiﬁc symposia featuring increased interactive content. The Professional Track will have a proffered paper session. Special Ultrasound Symposium (Monday - Tuesday, August 5 - 6)

Joint Imaging-Therapy Track The 2013 Joint Imaging-Therapy Track will feature exciting topics highlighting the collaborative efforts between imaging and therapy medical physics. This track will include the following topics: a lively interactive session on the future of medical physics, the impact of OMICs on medical physics research, MR guidance in radiotherapy, and advanced applications in deformable image registration and proton range uncertainty.

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Therapy Track The 2013 Therapy Track will showcase the current hot topics in therapy with a focus on medical physics research and innovation. Symposia will include the following general topics: accuracy requirements and uncertainties in modern radiation therapy, automation in clinical procedures, intensity modulated proton therapy, novel dose calculation methods, safety processes, and new therapy applications beyond external beam radiotherapy or traditional brachytherapy.

Imaging Track The 2013 Imaging Track explores both near-and far-term directions of medical physics research and innovation. These directions include: Estimating risk for low radiation doses, virtual validation tools for x-ray breast imaging systems, as well as advanced imaging methods for breast cancer. Additional topics include advances in models of image quality, nanotechnology & molecular imaging, and multi modal imaging for therapy response. These sessions will explore the state of the art and also show some of the directions that our scientiﬁc envelopes are being pushed towards.

Educational Course Therapy Track The Therapy Physics CE series will feature a total of 31.5 hours of educational lectures. The emphasis of the program will be on safe and effective use of new technologies addressing the current issues in clinical practice. The program is designed to address the broad educational needs of our membership and will include topics in SRS, SBRT, IGRT, IMRT, VMAT, QA and safety, brachytherapy, electron and proton therapies as well as radiobiology. The program will feature six SAM sessions spanning over the entire meeting program and several new courses including ‘Evaluating beneﬁts and challenges of multi-modality co-registration, “ Quality Control of Lung SBRT: Minimizing Uncertainties from Simulation to Treatment,” and “Safety Improvement through Incident Learning”. Some highly popular subjects such as Small Field Dosimetry and Electron Therapy will also be available along with new subjects such as Plastic Scintillators and Imaging Needs for Proton Therapy. New development for the 2013 annual meeting program is two live point and counter point debates for subjects including Proton Therapy versus Heavy Ion Therapy for the Future and Brachytherapy versus External Beam Therapy for Accelerated Partial Breast RT as moderated by none other than Colin Orton. These debates will provide an instructive yet enlightening humor with a unique opportunity for audience participation.

Educational Course Imaging Track The 2013 Imaging Education Track will again be primarily focused on meeting the continuing education requirements of medical physicists including content relevant to clinical practitioners with interests in diagnostic, interventional/ﬂuoroscopy, computed tomography, magnetic resonance, and radionuclide tracer imaging. We are also excited to announce a new Imaging Informatics Education Symposia on the reporting of dose. Additional exciting new programming efforts are underway and will be reported in the next Newsletter.

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Practical Medical Physics Track The Practical Medical Physics Track offers presentations of use and interest to the practicing medical physicist. Topics for 2013 include four newly-published AAPM Task Groups reports (two imaging, two therapy); statistics, error analysis, and uncertainty; grantsmanship and funding; treatment planning system management; installing and commissioning new equipment; CT tools and protocols available through AAPM; elements of a highly effective educational session; total quality management; and a continuation of the popular session on contouring guidelines for therapy.

Professional Track The Professional Track continues to grow in depth and breadth to keep our members abreast of the latest professionally-related developments. Topics this year cover both clinical and research aspects of our profession. Among other topics, to be included in the track is: PQI, DOT Shipper Training, RSO Refresher Course, ABR Update and Exam Preparation, Practice Guidelines, Economics, Publishing, Radioactive Materials Increased Controls, Practice Guidelines, and the Second Annual International Medical Physics Symposium. The Professional Track will also have a proffered paper session in 2013.

Science Council Session

John S. Laughlin Science Council Research Symposium has been renamed Science Council Session

Topic: Multi-Modality Imaging in Radiation Therapy: Planning, Guidance, and Assessment of Treatment Response The Science Council Session includes proffered abstracts on a topic at the cutting-edge of medical physics research, presented in a special, high-visibility proffered oral session. For the 2013 Annual Meeting, the Scientific Program invites abstract submissions on the application of advanced, combined (two or more) multi-modality imaging for radiation treatment planning, guidance, or assessment of therapy response. Potential image modalities and techniques incorporated at clinical and molecular scales include: structural and physiological kV/MV CT and kV/MV CBCT; structural and biofunctional MR FDG and non-FDG PET-CT, SPECT, ultrasound, and optical imaging; 4D imaging; the use of targeted or nanotechnology contrast agents and radioligands; and novel hardware and software systems for multi-modality image fusion/registration, automated and quantitative image interpretation, and biophysical modeling of treatment and response. Scientific results for both pre-clinical and clinical studies are encouraged, as is the use of molecular imaging techniques combined with clinical imaging modalities. Competitive abstracts will include the use of two or more imaging modalities in complementary or coupled fashion within or across the processes of radiation treatment planning, guidance, or assessment of therapy response. The coupled use of two or more imaging modalities must be clearly presented and integrated within the scope of work. Criteria for abstract evaluation include novelty of the combination of image modalities and/or applications, their complementary nature, and level of integration. In addition, the impact and contributions to improved fidelity, quality, efficiency and efficacy of radiation treatment, image-based decision-making, and ultimately, patient response and prognosis will be used in the evaluation.

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AAPM Treasurer’s Report

Matthew B. Podgorsak, Buffalo, NY

AAPM 2013 Budget

would like to sincerely thank the Membership of the AAPM for the trust you have placed in me through my election to the position of our organization’s Treasurer. I look forward to serving the AAPM in this role, and in receiving your suggestions, questions, comments, and advice via e-mail at: Matthew.Podgorsak@RoswellPark.org. I would also like to extend my sincere thanks to Dr. Janelle Molloy for her outstanding service as Treasurer during the past three years, and for her help and assistance in my transition to the role. She has made a significant contribution to both the financial reporting and budgeting processes and I know we will continue to benefit from her past leadership as Treasurer. And finally, I would like to thank Cecilia Hunter, AAPM’s Director of Finance and Administration, for sharing her insight, judgment, and extensive knowledge of the mechanics of AAPM’s financial system with me during my orientation. The following data present the current financial picture, as well as that for 2013 as approved by the Board of Directors on November 28th, 2012. 2012 Estimated Year End Balance As of mid-December we anticipate that we will achieve a balanced budget for the 2012 year. Estimated income is $8.198 million, approximately $53,000 lower than budget, representing a variance of less than 1%. Expense estimates, based on the financial statements presented to the Board in Chicago in November 2012, were projected to be $8.449 million, leading to a deficit of approximately $250,000. However, if we take into account historical under-spending on projects, we expect the bottom line to be in the range of a positive $13,000 – or, as directed by the Board, basically break even.

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As of November 30, investments had gained substantially during the first eleven months of 2012. Assuming the market has not collapsed since writing this Newsletter article, we should expect a net unrealized gain somewhere in the range of $700,000. 2013 Budget Once again the Committee and Council Chairs worked diligently in developing their budgets to meet revenue expectations. I am very happy to report that, as a result of the dues increase approved by the Membership, direct spending on committee projects increased from $1.6 million budgeted in 2012, to over $2.1 million in the 2013 budget. Attention was focused on meeting the goals of the Strategic Plan. A number of ‘special’ projects identified by the Board as strategic initiatives are highlighted in the 2013 plan. Ongoing programs were reviewed in depth and the Budget Subcommittee, the Finance Committee and the Board approved the full budget. The 2013 budget summary appears here in the Newsletter and will be posted on the AAPM web site for your review. Revenue projections total $9.0 million and expenses total $9.5 million, producing a deficit of just under $500,000. This is approximately $200,000 above the suggested deficit defined in the predictive model and is a direct result of planning for necessary legal fees in 2013. Notwithstanding, the potential budget deficit remains less than 3% of budgeted revenue and is within the guidelines set forth by the Board of Directors. Should operating cash be insufficient to cover these costs, the funds will be taken from reserves thereby not affecting the work of our Committees. On the following pages you will find a summary of the approved Budget, together with graphs illustrating both the sources and expenditures of revenue. Also included is a table showing a comparison of the 2012 and 2013 budgets, highlighting the variances between them. In closing, as promised in my election candidacy write-up, I look forward to sharing further details of AAPM’s budget development process in future Newsletter articles. In the meantime, please feel free to contact me anytime with questions or concerns regarding AAPM’s financial situation at Matthew.Podgorsak@RoswellPark.org.

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Net Operating Income – 2008 through 2013 Budget

Expected to break even per model. As in 2011 & 2012.

Income by Major Source - Approved 2013 Budget Other $477235

Dues $2,063,045

Publications $2,584,724 Committee Projects $594,720

Education $3,494,032

Total: $9,213,756

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Expenses by Major Category - Approved 2013 Budget Other $417,265

Member Services $556,398 Governance $286,893

Administration $1,362,153 Committee Projects $2,741,388 Publications $1,703,525

Education $2,640,050

Total: $9,716,671

2012-2013 Budget Comparison Membership Dues increase approved by Members Councils, Committees, Task & Working Groups additional project spending Education & Professional Development, higher net income Publications, decrease in net income from Medical Physics & JACMP Administrative Expenses expected to be lower in 2013 Other Income & Expenses, decrease in revenue from management services provided to other organizations Headquarters, budgeted to increase approximately 1% Other, including Governance Total Difference 2013-2012 Budgets

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$598,267 -$582,712 $123,016 -$97,956 $15,000 -$120,715 -$38,013 -$4,099 -$126,162

Professional Council Column

Per Halvorsen, Newton, MA

Volunteer Service, CMS Reimbursement Schedules and Radiation Oncology Accreditation Specialty Meeting Volunteer Service

ith the end of the year, we have another “changing of the guard” in volunteer appointments. I would like to particularly recognize and thank Chris Serago for his 6 years of service as Chair of the Ethics Committee. The Chair of the Ethics Committee serves a crucial role in helping to resolve conflicts among members, providing advice to colleagues on handling difficult situations, and managing the Ethics Committee’s deliberations on formal ethics complaints. While the latter is, thankfully, an infrequent occurrence within our Association, the Chair is the only individual who knows the identities of the parties in a formal complaint (the Committee members only see documents with identities redacted), so discretion and a thoughtful, considerate demeanor are essential in this role. It would come as no surprise to anyone who knows Chris that he has performed this role in an exemplary manner for the past 6 years. We are also fortunate to have Jeff Limmer assume the responsibility as the new Chair in January. I would also like to recognize and thank Bill Roventine for his many years of service as the “insurance coordinator” for the Association. Though the formal title has evolved over the years into its current form as Chair of the Insurance Subcommittee of the Professional Services Committee, Bill has made it his mission to provide the members with a reliable and affordable range of professional practice insurance services. Many of us, particularly those who do independent consulting work, have benefited from his stewardship of this service over the past few decades. With Bill’s well-earned “retirement” from this function, David Jordan will assume the role of Chair of the Insurance Subcommittee in January.

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The Professional Council’s work is performed by several dozen volunteers across the committee structure, and while I am not able to recognize every individual directly in this column, we are fortunate to have such strong volunteer support in our Association. When you see a colleague who volunteers a significant amount of their time to the AAPM or other professional societies, express your thanks – it is the only form of “payment” they receive, and means a lot. CMS Reimbursement Schedules for 2013 See the column by Wendy Smith Fuss elsewhere in this Newsletter for a summary of the final CMS rules for reimbursement in radiation oncology for 2013. The reductions in the final rule are smaller than the original proposal, with overall reductions of 7 to 9%. Of particular note, CMS has agreed to revalue the 77336 code (continuing medical physics consultation) in 2013, agreeing with AAPM and others that the code is most likely undervalued. This is the main CPT code which directly supports the ongoing clinical physics support for radiation oncology centers. The Professional Economics Committee is hard at work preparing information for CMS’ consideration in 2013. Radiation Oncology Accreditation Specialty Meeting As noted in the previous issue of the Newsletter, the Professional Services Committee is preparing for a hands-on workshop on how to prepare for radiation oncology accreditation, with representatives from all accreditation programs participating alongside seasoned surveyors who will provide “mock surveys” and practical tips. The meeting will take place on February 8 and 9 in the Texas Health Resources University Auditorium on the campus of Texas Health Presbyterian Hospital. Look for detailed information on the meeting website: http://www.aapm.org/meetings/2013ROPA.

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AAPM Spring Clinical Meeting March 16-19, 2013 The Pointe Hilton Tapatio Cliffs Resort Hotel, Phoenix, Arizona The AAPM Spring Clinical Meeting to be held at The Pointe Hilton Tapatio Cliffs Resort Hotel, will include practical information designed to help medical physicists integrate emerging technologies into the clinical environment, keep abreast of regulatory and accreditation related issues, and provide a forum for the exchange of ideas in support of practice quality improvement.

Registration & Housing now open! Important Dates to Remember: January 20 – Scientific Program Available February 8 – Deadline for discounted Registration fees February 18 – last day to make hotel reservations at the group rate New this year! • The Radiation Therapy track program highlights the clinical application of several AAPM Science Council Task Group Reports. Foundations of clinical medical physics and their extension to newer technologies such as electronic records, VMAT and flattening filter free mode are highlighted. • There will be a Best Poster competition! A panel of judges will score poster displays according to criteria that includes clinical relevance, originality, and organization/ presentation of the material. All abstracts submitted for posters must have a clinical focus. Application will be made to the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) for approval of the program in order to provide medical physics continuing education credits (MPCEC) to qualified medical physicists attending this Meeting. AAPM will apply to the ABR for Self-Assessment Modules (SAMs) which allow for interactive learning and self-assessment of knowledge gained during these sessions. We anticipate offering as many as 17 SAMs sessions.

For more information www.aapm.org/meetings/2013SCM/

The Pointe Hilton Tapatio Cliffs Resort Hotel

Education Council Report

George Starkschall, Houston, TX

A New Award to Encourage the Establishment of New Imaging Physics Residency Programs and the Disparity Between the Numbers of Graduates of Educational Programs and Residency Opportunities

uring the recent RSNA meeting in Chicago several items of interest to the educational mission of the AAPM were discussed, and I want to use this Newsletter article to share some of these items with you. High on the list of priorities of everyone involved in our educational mission is the need to ensure that there are adequate medical physics residency positions available to produce a sufficient number of well-educated and well-trained medical physicists to meet the clinical staffing needs in our discipline. To date, we have 59 CAMPEP-accredited residencies in radiation oncology physics with 16 in the accreditation pipeline, and 6 CAMPEP-accredited residencies in imaging physics with 4 in the pipeline. Several more programs have begun the application process but have not yet completed their applications. We are not quite at the point where we believe the number of medical physicists coming out of these residencies is sufficient to meet staffing needs, but we are getting close, and are cautiously optimistic that within one to two years, when medical physicists coming out of graduate programs will need residencies to qualify for the ABR examination, we can meet our goals. At the same time, however, we still need more residency positions. Thanks to the recent increase in AAPM dues, we now have funding to embark on several initiatives that we anticipate will increase the number of residency opportunities available. The first of these initiatives is a joint initiative involving collaboration between the AAPM and RSNA, with the support of the Society of Chairs of Academic Radiology Departments (SCARD). On November 28, the AAPM Board of Directors approved the expenditure of $560K over a five-year period to partially support 4 new imaging physics residencies, either in diagnostic imaging physics or nuclear medicine physics. With this funding AAPM will provide 50% support of several imaging physics residency positions, and the awardee institutions will provide the other 50% support.

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After the period of the award is over, the intent is that the awardee institutions will continue to fully support the imaging physics residencies. This award is designed to encourage the establishment of new imaging physics (diagnostic or nuclear medicine) residency programs. Consequently only those imaging physics residency programs that have not previously submitted an application to CAMPEP (prior to Nov 28, 2012) for accreditation are eligible. A letter of commitment from the department chair or senior officer in the practice must accompany an application. This letter must commit the department or practice to the following: • • • •

50% support of stipend for each resident Adequate resources to support an imaging physics residency program A commitment to support efforts to achieve CAMPEP accreditation A commitment to provide sufficient funding to sustain the residency program beyond the initial funding period.

The program must commit to applying for CAMPEP accreditation by July 1, 2014. More information will be forthcoming in January. The timeline for implementing this program is as follows: Timeline: Dec 10, 2012 – Program is advertised to the medical physics and radiology communities Jan 3, 2013 – Application details are posted on AAPM web site Feb 1, 2013 – Applications are due Mar 1, 2013 – Awards are announced July 1, 2013 – First residents begin training This program is being administered through the Medical Physics Residency Training and Promotion Subcommittee, chaired by John Antolak. Bob Pizzutiello has agreed to chair the Imaging Residency Support Project.

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The second initiative is meant to address a disparity between the numbers of graduates of educational programs and residency opportunities. Many more medical physicists are graduating from our graduate programs than there are residency opportunities. In 2011, for example, our graduate programs produced 215 graduates, 148 of which received a master’s degree, and 67 received a doctorate. That same year, the entering class of residents was skewed 2:1 in the opposite direction, with 65.8% of entering residents holding doctorate degrees. Residency programs are accepting twice as many individuals holding doctorate degrees as master’s degrees, while graduate programs are turning out twice as many individuals holding master’s degrees as doctorate degrees. Whereas in 2011 this may not have been a major problem, because many master’s degree graduates were able to take junior medical physics positions, this opportunity will not be available in a few years, when the requirement that individuals taking the ABR certification examination have completed a CAMPEP-accredited residency takes effect. It is possible that many who enter master’s degree programs with the intent of seeking a clinical career will find the pathway to a clinical career blocked because of an inability to find a residency program. Two alternatives have been presented in the past few years. One option is to integrate the medical physics clinical training with the didactic education into a fouryear program leading to the degree of Doctor of Medical Physics (DMP). Students completing a CAMPEP-accredited DMP program will have had sufficient didactic education and clinical training to meet ABR requirements. One such program has already been accredited, the program at Vanderbilt, while several more are in the development or accreditation process. A second alternative involves the establishment of so-called “hub and spoke” residency programs and the coordination of these residency programs with graduate programs to provide residency opportunities for graduates of such programs. Modeled after the system established by the graduate program at Louisiana State University, hub and spoke programs are designed to provide guaranteed residency positions for graduates of medical physics degree programs. The hub and spoke model allows one program to administer the training of several residents distributed among several clinical facilities. Whereas a single clinical facility may not have the breadth of clinical opportunities or resources to provide thorough training to a resident, the synergistic collaboration of several clinical facilities can provide adequate educational opportunities for resident trainees. Even if a potential residency program is not associated with a graduate program, development of a hub and spoke model can create a larger residency program by leveraging nearby (and sometimes not so nearby) practices that might not normally

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consider having a training program. This can make it easier for centers that might be considered too small for a residency program to participate in residency training. In order to assist potential hub and spoke residency programs to develop their applications for accreditation, John Antolak is organizing a workshop to be held on February 15-16 in New Orleans. The intended audience for this workshop includes program directors that are considering expanding their existing residency programs beyond the normal capacity dictated by normal residency models, and physicists in small practices that would like to be involved in residency training, but feel that they are too small to do so. The workshop may also be of interest to administrators and radiation oncologists as it will address how medical physics training programs can increase the quality and marketability of the practice. The workshop will touch on all aspects of hub and spoke models for residency programs. There will be descriptions of different models, the relationship between the hub and spokes, and how they have been working so far. There will also be guidance from CAMPEP regarding what they will be looking for when evaluating hub and spoke residencies. For more details, please see the AAPM website. Finally, in discussing the establishment of residency programs among potential sites, we have found that one of the perceived barriers hindering small practices from starting such residency program is the administrative overhead required of a residency program. Several medical physics practices have indicated that, although they would be interested in training potential medical physics residents and supporting such trainees, they could not justify support of the administrative overhead required to host a training program. In order to overcome this barrier, the Board approved funding in the 2013 budget to provide the administrative infrastructure to support small residency programs. This will also be administered through John Antolakâ&#x20AC;&#x2122;s Medical Physics Residency Training and Promotion Subcommittee. More details, as well as a Request for Proposals, will be forthcoming. The Education Council has been well aware of some of the issues our Association faces regarding the need for residency programs to prepare qualified medical physicists. Fortunately, as a result of the recent dues increase, we now have the funding to implement several proposals that we intend will overcome some of these issues. Thank you for your support.

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CAMPEP News

William R. Hendee, Rochester, MN

Actions Taken at the Recent Board of Directors Meeting

t its meeting during the RSNA, the CAMPEP Board of Directors took several actions, some of which are summarized in this report. A question arose in the Board deliberations of whether a residency program could apply for accreditation before residents were admitted into the program. The Board felt that prior accreditation is desirable so that residents would enter the program knowing that they would be eligible for certification once they had completed the residency program. The approved motion is worded as : Motion - Medical Physics Residency programs can apply for accreditation by CAMPEP at any time, and accreditation may be granted prior to admitting the first trainee. Residency programs are encouraged to apply for accreditation prior to accepting applicants into their programs. The CAMPEP Bord discussed the accessibility of fundamental medical physics courses described in AAPM Report 197S that are intended for persons pursuing the alternate pathway into a residency. The issue was whether these courses could be made available on-line by institutions approved by the CAMPEP Graduate Education Program to offer such courses, and that have the institutional capacity to offer on-line education. The motion passed by the Board reads as: Motion - CAMPEP will allow 197S courses to be offered under GEPRC review through remote means by CAMPEP-accredited certificate or graduate programs that are housed in institutions that already offer remotely directed courses and have institutional guidelines in place for such courses. The American Board of Radiology allows exceptional residents to shorten their clinical training in order to make several months of the residency program available for research. This option is referred to as the Holman pathway in honor of Leonard Holman MD. The suggestion of something similar to the Holman pathway for medical physicists was brought to the CAMPEP Board. The Board concluded that the 2-year

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residency requirement for medical physicists was too short to accommodate a Holman pathway. Residents interested in an extended period of research should plan to spend more time (e.g. another year or two) following or preceding their residency. The ABR Physics Trustees has asked CAMPEP to disseminate the information following this sentence. ABR News Release: Beginning with the 2013 Part 1 and Part 2 examinations in medical physics, the ABR will provide the candidates with a list of constants, physical values, and related information. The final list will be completed and published around May 15, 2013. While the list will include many constants and physical values, the ABR does not warrant the list as a compilation of all constants and physical values needed on the examinations. Candidates should review the list carefully before their examinations to familiarize themselves with the contents and organization of the list.

AAPM Newsletter | Volume 38 No. 1 | January/February 2013

AAPM

row with

Radiation Oncology Program Accreditation Meeting (ROPA)

Dallas

February 8-9, 2013 • Dallas, TX

Deadline to receive early registration fees is January 9! The Radiation Oncology Program Accreditation Meeting is a hands-on workshop aimed at providing information on how to prepare for radiation oncology accreditation, with representatives from accreditation programs participating alongside seasoned surveyors/surveyees who will provide their guidance and experiences. There will be breakout sessions designed to address speciﬁc concerns and issues with the preparation and submission process. The meeting content is designed to provide information for the suggested accreditation team of Physician/Physicist/Therapist/Dosimetrist/Administrator.

2013 Summer School

June 16-20, 2013 • Colorado College, Colorado Springs, CO Quality and Safety in Radiotherapy: Learning the New Approaches in TG 100 and Beyond. Registration Opens March 13! New approaches to patient safety and quality in radiotherapy increasingly are becoming major commitments for practicing medical physicists. The pending report of Task Group 100 will change the methods physicists use to establish their quality management programs. The 2013 AAPM Summer School will help medical physicists learn about and understand the new approaches to safety and quality. Much of this school will use real-life, in-class exercises to enhance and facilitate understanding the concepts. Panel discussions will bring out the multiple facets of many of the topics. By the end of the school, attendees should have a good understanding of the new approaches to safety and quality and know how to use them to determine the quality assurance for their facility. Four Self Assessment Modules (SAMs) will be included in this program (no extra fee).

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Science Council Report

Daniel A. Low, Los Angeles, CA

Science Councilâ&#x20AC;&#x2122;s October Retreat

t has been a year since I took over the leadership of the Science Council from John Boone. I have enjoyed working with the AAPM staff and the members of the Science Council, finding everyone eager to move forward the AAPM scientific agenda. The past year has been an active one in the Science Council and I want to take advantage of this opportunity to update you as to our current activities and those in the past year. On October 22-23 the Science Council had a face-to-face retreat in Ann Arbor, Michigan, hosted by Jean Moran. Thanks Jean! We discussed progress of the committees that report to Science Council, the renaming of the symposium formerly known as the Laughlin symposium. We decided to just call it the Science Council symposium for now. Imaging Physics Committee: They are forming a flat panel CT working group. TG 217, the radiation dose from airport x-ray scanners is progressing. There is a need to improve the effectiveness of liaison and delegate reporting. Therapy Physics Committee: Two reports were published in the October 2012 issue of Medical Physics; Dosimetry of 125I and 103Pd COMS eye plaques for intraocular tumors: Report of Task Group 129 by the AAPM and ABS; also the Report of the Task Group 186 on model-based dose calculation methods in brachytherapy beyond the TG-43 formalism: Current status and recommendations for clinical implementation. Formation of the TAC: Bill Hendee realized that there was a gap in the Science Council structure dealing with technology assessment across all disciplines. In 2011 he formed the Technology Assessment Committee and began to develop working groups to address critical needs in technology assessment. To date, he has active working groups dealing with computer-aided diagnosis, the standardization of CT

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nomenclature and protocols, the development of model quality assurance programs, and the assessment of technologies for image-guided interventions. While all of these working groups are new, they have made progress on their charges. Recently, the TAC has proposed more working groups dealing with technology assessment. Passage of the dues increase: The passage of the dues increase has impacted the Science Council’s ability to conduct our business, including generate task group and other reports that help AAPM members to more effectively conduct their clinical work. We had been so strapped for cash in the past years, face-to-face meetings to finalize reports, small focused meetings to discuss issues of strategic scientific importance to the AAPM, and other activities were scuttled to maintain a flat budget.

Science Council Retreat. Yue Cao explaining the MR QA phantom in Radiation Oncology.

The dues increase allowed us to move some of these initiatives forward, as well as integrate more effectively with the relatively new strategic planning initiative of the AAPM. For example, the FUTURE working group chaired by Thomas Bortfeld and Robert Jeraj are organizing a meeting in April entitled “Expanding Horizons of Medical Physics: Connecting Medical Physics and OncoPhysics Centers”. The

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concept behind this meeting is that there are numerous scientific advances taking place in biological physics and oncology physics that medical physicists are neither aware of nor participate in. While it is a shame that there is little communication at this stage, it would be much worse if clinical protocols or modalities were developed by oncology physics groups and were implemented without the benefit of medical physicists. It is therefore our responsibility to connect with these groups and see if there are areas of common interest. National Event Reporting System for Radiation Oncology: AAPM and ASTRO have begun the process of developing an error registry that will allow participating institutions to log errors to provide feedback to that institution about its event record and to collect and analyze event records to determine national trends and to ultimately avoid systematic errors from occurring at multiple institutions. ASTRO and AAPM are developing a memorandum of understanding to formulate details of the relationship between the two organizations and the event reporting system. Eric Ford, Gary Ezzell, and Sasa Mutic are the AAPM representatives of the organizing committee. ASTRO has hired a patient safety organization called Clarity to develop the event reporting system. The Science Council is forming a working group to communicate with Clarity, ASTRO, and the organizing committee to provide advice and feedback as well as communicate with the AAPM membership. The AAPM now has an agreement with the FDA Center for Devices and Radiological Health under which we will provide expertise to the Centerâ&#x20AC;&#x2122;s staff when they are investigating a medical device or procedure. This effort was led by Bill Hendee, in communication with the Government and Regulatory Affairs Committee. One of the challenges of the Science Council is the dissemination of information via task group reports. The reports themselves are always well researched, thorough, and accurate. However, nothing beats the effectiveness of face-to-face communication when attempting to disseminate information. Jean Moran and Demitris Mihailidis are developing sessions for the Spring AAPM Clinical Meeting taking place in Phoenix. These sessions will be devoted to presenting and explaining the task group reports and their recommendations and will provide the attendees the chance to connect with the presenters and ask questions. Finally, we are excited to work with the AAPMâ&#x20AC;&#x2122;s new initiative: The Strategic Plan, in defining projects of strategic importance and allocating suitable resources. The Event Reporting System and the subsequent Science Council working group are two examples of programs that match the Strategic Plan priorities. The meeting about Expanding Horizons of Medical Physics is another example of a Science Council

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initiative that dovetails with the Strategic Plan. The Science Council is continuing to examine the Strategic Plan and provide suggestions for new initiatives. The Science Council and all of its committees, subcommittees, working groups, and task groups are working diligently to move medical physics forward and improve the care for our patients. I have enjoyed the past year and I look forward to the year to come.

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Legislative and Regulatory Affairs Report

Lynne Fairobent, College Park, MD

IAEA’s New “Safety in Radiation Oncology” System... ARR’s Distinguished Investigator Award Winning AAPM Members ARR Names Distinguished Investigators

n November 26, 2012, I had the pleasure of attending an induction ceremony for members of the Academy of Radiology Research Council’s Distinguished Investigators. The Distinguished Investigator Award recognizes individuals for their accomplishments in the field of imaging research and significant contributions to the record of scientific progress and innovation. Over the past few decades the medical imaging community has been responsible for many important advances in health care. As a member of the Academy of Radiology Research, the AAPM is proud to be a part of this important tradition. Nominations for the 2013 Academy of Radiology Research Distinguished Investigator Award can be found at: http://www.acadrad. org/investigator2013.php Please join me in congratulating the following AAPM members on their accomplishments: Paul A. Bottomley, PhD, Paul L. Carson, PhD, Heang-Ping Chan, PhD, Rebecca Fahrig, PhD, Jeffrey Brian Fowlkes, PhD, David Gur, Joseph A. Helpern, PhD, Michael A. Jacobs, PhD, Andrew D.A. Maidment, PhD, Sandy Napel, PhD, Stephen J, Reiderer and Min-Ying Lydia Su, PhD. IAEA Launches ‘Safety in Radiation Oncology’ (SAFRON) A Tool for Patient Safety in Radiotherapy

To improve patient safety in radiotherapy, the IAEA has established SAFRON, a web-based user system for improving the safety and quality of patient care in radiation therapy by sharing knowledge about incidents and near incidents. AAPM Newsletter | Volume 38 No. 1| January/February 2013

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SAFRON allows radiotherapy centers to contribute information on incidents and near misses to an international learning system, allowing the participating centers to share and receive information on patient safety issues. SAFRON will collect information on treatment setup errors - what caused the error and what has been done to reduce the likelihood of repeating it. By reviewing this information, centers can learn from these mistakes such as requiring a second independent check of patient set up prior to treatment. SAFRON is designed to be both a facility based and an international incident reporting system. Institutions submitting information to SAFRON can review their own incidents and incidents that have been submitted by other participating centers. However, the identity of each contributor remains anonymous to the reviewer. Not disclosing the identity of a contributing facility protects it from punitive action and provides a means to encourage participation and to learn and let others learn from such reports. SAFRON is the newest among many tools the IAEA provides to the radiotherapy community in support of the safe and beneficial uses of radiation. Information on SAFRON can be found at: https://rpop.iaea.org/RPOP/RPoP/Modules/login/safron-register.htm or visit the Radiation Protection of Patient website and look for the SAFRON icon at http://rpop.iaea.org

AAPM Newsletter | Volume 38 No. 1| January/February 2013

3rd CT Dose

SUMMIT

The most comprehensive forum on optimizing CT parameters for physicists, technologists and imaging physicians.

Strategies for CT Scan Parameter Optimization Deadline to receive early registration fees is February 8! Phoenix

March 15-16, 2013 AZ Yes! We are back with the 3rd CT Dose Summit with enhanced content and new partners. Enhanced content will span from the more elementary components of good scan protocols to the most advanced and recent technological developments, which will be invaluable for both in-training and practicing CT physicists and technologists for managing CT radiation dose. Additional content on specific diagnostic requirements, pictorial relation of scan parameters to image quality, and the art of building indication-driven scan protocols makes the 3rd Dose Summit a must-attend for imaging physicians in CT. The focus of the 3rd CT Dose Summit will remain on demonstration of how scan acquisition and image reconstruction parameters should be selected and managed to improve image quality and reduce radiation dose. Faculty members will explain the essential criteria for specific diagnostic tasks. The goal of the summit is to provide practical information for users that will help them operate their CT scanners wisely, improving the quality and usefulness of CT images while reducing the radiation dose to patients. We are delighted to partner with the Webster Center for Advanced Research and Education in Radiation of the Massachusetts General Hospital Imaging for the 3rd CT Dose Summit.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Website Editor Report

Christopher H. Marshall, New York, NY

Evolution of AAPM’s Web Presence

s I complete my second term I am thinking about the changes that have occurred during my tenure, which has been roughly defined by the disappearance of paper and the emergence of web 2.0. When I applied for the position the website was essentially a static repository. (Click on the image to link to the Internet archive known as the WaybackMachine and wander through the years). In the intervening years the Internet has become the dominant interface between the AAPM, its membership and the world beyond. We have made the AAPM website more colorful and dynamic but navigation remains a constant challenge. While the website is a means by which the AAPM provides information to its members, changes made to the BBS in response to criticism posted there have increased feedback – itself a nice example of the value of feedback. There were >60K visits to the AAPM website last month with the majority or members visiting at least once. Paper has almost disappeared as a means of communication within the AAPM - replaced by email and online voting and laptops or tablets at meetings. The Newsletter and JACMP are online-only products and while MedPhys retains a paper version the economic arguments for that version (primarily advertising income) are under constant scrutiny. We know that social media must play a role in our future because 3.5K individuals now follow us on Linkedin, 1.7K on Twitter and 0.3K through our relatively new Facebook site. These numbers are growing rapidly but few members post to these sites so I do wonder what they represent, other than “presence”, but we certainly need to be there or others will fill that vacuum. I also wonder how members cope with information overload as competing information sources multiply. Does access through smartphones and tablets help and how many subscribe to our many selective content feeds (RSS) to bring content directly to their desktops? We certainly try to make visits to our websites efficient

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by customizing content on the AAPM website, and by enabling you to do this on the meetings sites and on the Journal platform. We can do so by identifying you by login - otherwise we present pages that are more tailored to the general public. “MY AAPM” on aapm.org is your personal portal to the AAPM website; the potential to customize this section is constrained by our ability to capture your profile of interests. I personally advocate knowing more about each member so we can carry this concept further. We can do this by asking you more questions. Whether that is an intrusion of privacy is a debatable issue, although probably minor in the context of all the personal information you unwittingly gave up if you invested in a smartphone and downloaded a few apps. I have indicated my desire to hand over to someone else who will no-doubt see the future more clearly than I can, although I am willing to hold the fort until reinforcements are available. I have also suggested that the role should relate to our web presence and not just to the website. It is tempting to say “plus ça change, plus c’est la même chose” but since content translation is just a click on our website maybe I should not. It is an honor serving you as the website editor. Any fault is mine; any success is to the credit of our wonderful IS group with particular thanks to our incredible webmistress Farhana Khan. I hope that you find the Website useful, visit it often, and send me your feedback at feedback to the Website Editor .

AAPM Newsletter | Volume 38 No. 1| January/February 2013

ABR Physics Trustees Report By ABR Medical Physics Trustees Jerry D. Allison, PhD, Geoffrey S. Ibbott, PhD, Richard L. Morin, PhD and Jerry D. Allison, PhD

Continuous Certiﬁcation -The Details

n the new continuous certification system, ABR certificates have no expiration date. Instead, each new and renewed certificate notes the effective date, accompanied by the statement that “ongoing validity of this certificate is contingent upon meeting the requirements of Maintenance of Certification.” An annual look-back will take place on March 15 (see Chart 1 below). If a diplomate is meeting all requirements, he or she will be reported as “meeting the requirements of Maintenance of Certification” on both the ABR and ABMS websites. If not, the diplomate will be shown as “certified, not meeting the requirements of Maintenance of Certification.” If deficiencies have not been removed by the next look-back, he or she will be listed as “not certified.” An important point is that as soon as the deficiencies are removed, the diplomate again will be shown as “meeting the requirements of Maintenance of Certification.” Please note that the ABR will honor older certificates with “valid-through” dates; diplomates with these certificates who do not meet MOC requirements will be reported as “certified, not meeting requirements of Maintenance of Certification” until their certificates expire. Lifetime-certified diplomates who are not enrolled in MOC will be reported as “not required to participate in Maintenance of Certification.” They will receive a “letter of MOC enrollment” as soon as they complete the application process. When public reporting begins, they will be reported on the ABMS and ABR websites as “meeting the requirements of MOC.” After they meet their first complete three-year lookback requirements in March of their fourth year of MOC participation (see Chart 1 below), they will be issued an MOC certificate. Their first look-back for the MOC exam will be in their tenth year. If for some reason a lifetime certificate holder fails to meet requirements, he or she will revert to the “not required to participate in MOC” status and will never be shown as failing to meet MOC requirements. The ABR strongly encourages lifetime certificate holders to enroll in MOC. Some program changes, such as allowing the exam to be taken in any year, were made at the

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request of lifetime certificate holders. The Elements of Continuous Certification The elements of continuous certification are very similar to those in the current MOC program. There have been some minor changes to Part 1 (Professional Standing), Part 2 (Lifelong Learning and Self-Assessment), and Part 4 (Practice Quality Improvement, or PQI). The new requirements are as follows. Element Licensure CE SA-CE QI-SDEP Exam PQI Fees

Compliance Requirement At least 1 valid license or professional standing attestation in previous 5 years At least 75 Category 1 CE in previous 3 years At least 25 Self-Assessment CE (SA-CE) in previous 3 years At least 1 Quality-Improvement Self-Directed Educational Project (QI-SDEP) related to quality improvement in medical physics in previous 10 years Passed MOC exam in previous 10 years Completed at least 1 PQI project in previous 3 years Current with MOC fees at any time during the previous three years.

Chart 1. Status check for meeting requirements. The Changes For Part 1 (Professional Standing), physicists who do not have a valid state license must have letters of attestation from a certified medical physicist and an ABR-certified diagnostic radiologist or radiation oncologist submitted on their behalf every five years. The ABR is making major revisions in its Personal Database (PDB) functions, which will make this process much easier. For Part 2 (Lifelong Learning and Self-Assessment), the number of credits has not changed but one-third (25) of the credits must be of the self-assessment type. This includes both SAMS and enduring continuing education materials. (The ABR defines “self-assessment CE” as interactive learning opportunities that use self-assessment tools to help learners reflect on their practices and identify their individual needs.) In addition, the limit on total credits per year has been dropped, and a Quality-Improvement Self-Directed Educational Project (QI-SDEP) to document learning activities in PQI is required every ten years. (The QI-SDEP was previously required, but it has been moved from Part 4 to Part 2 to simplify the process.) For Part 4 (PQI), because of the many complaints and confusion about PQI cycles, the ABR will require completion of a project every three years.

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The Annual Look-backs The first look-back for the new program will be on March 15, 2013. This will only include licenses for medical physicists who live in Florida, Hawaii, New York, and Texas. The first complete three-year look-back will be on March 15, 2016. Subsequently, complete look-backs take place every year on the same day (see Chart 2 below). MOC Year 2012 2013 2014 2015 2016 2017 2018 20XX

Look-back Date Element(s) checked 3/15/2013 Licensure or Professional Standing Attestation/Exam 3/15/2014 Licensure or Professional Standing Attestation/Exam 3/15/2015 Licensure or Professional Standing Attestation/Exam Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, 3/15/2016 Exam, PQI, and Fees Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, 3/15/2017 Exam, PQI, and Fees Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, 3/15/2018 Exam, PQI, and Fees Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, 3/15/2019 Exam, PQI, and Fees Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, 3/15/20XX Exam, PQI, and Fees

Chart 2. How does continuous certification work?

AAPM Newsletter | Volume 38 No. 1| January/February 2013

ABR Physics Trustees Report By ABR Medical Physics Trustees Geoffrey S. Ibbott, PhD, Richard L. Morin, PhD and Jerry D. Allison, PhD

Medical Physics Training: Early Results of CAMPEP Trained Residents

ntil recently, the clinical training of medical physicists was not standardized. In some cases, graduates of classical physics programs took clinical positions without any specific medical physics education. Others attended graduate programs in medical physics, but these programs offered widely disparate curricula. In particular, some educational programs provided extensive clinical training while others did not. Some graduates subsequently obtained clinical training through a fellowship. Other fellowships were largely research, with only a minor clinical component. Many medical physics graduates went directly to employment in a hospital, clinic, or consulting group. Some of these employment situations offered a wide spectrum of early experience while others encouraged the physicists to specialize in narrow areas of practice. This diversity of training was reflected in low passing rates for the oral board exams in medical physics. The typical passing rate was slightly over 55 percent (see Figure 1 on next page). Discussions with oral board examiners noted that a variety of issues led to the low passing rate: • Candidates often showed extensive knowledge in narrow areas but lacked knowledge in other areas. • Diagnostic physics candidates demonstrated a lack of knowledge in US and MRI. • Candidates often showed an inability to relate medical physics activities to the broad clinical care of the patient. In the later years of the 20th century, significant progress was made toward addressing this problem by the development of residencies for medical physicists. These are usually two years in length, although several residencies are three years. Soon afterwards, residency training was recommended as the preferred pathway to medical physics. The content was standardized by an AAPM Task Group, and in 1997

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Figure 1. The passing rate on the oral exam has averaged 55 to 60 percent for many years. CAMPEP began accrediting residencies. In response to a recommendation from the AAPM, the ABR then changed its requirements so that candidates applying for the first time in 2013 to take the Part 1 exam in 2014 must have completed a CAMPEP-approved residency to sit for the Part 2 and Part 3 (oral) examinations. There are presently 75 CAMPEP-accredited residencies, and the number is expected to rise to more than 85 in 2013. Most are in the United States and Canada, but there is also one in Ireland. More programs are needed, so we strongly encourage support for additional programs. In 2012 there were enough candidates from CAMPEP-accredited residencies to provide meaningful oral exam performance statistics. A total of 390 medical physics candidates took the exam; of these, 287 were taking the oral exam for the first time. Forty-seven candidates had completed a CAMPEP-accredited residency; these statistics are shown in the table below. Number Total Pass Condition Fail Rate Pass Condition Fail

All Takers 390 218 59 113

First Time Takers 287 171 42 74

CAMPEP Residency 47 41 4 2

56% 15% 29%

59% 15% 26%

87% 9% 4%

Table 1: Passing rate percentages for the 2012 oral examination in medical physics.

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All Takers

First Time Takers

CAMPEP Residency

Figure 2: Graphics illustrating passing rate percentages for the 2012 oral examination in medical physics.

The performance of the CAMPEP residents was clearly better than that of the total medical physics candidates and was similar to that of physician candidates who had completed a diagnostic radiology or radiation oncology residency. We recognize that this is a select group; nevertheless, these statistics are very positive and suggest the benefit of having completed a CAMPEP-approved residency.

The performance of this group of residents provides gratifying support to the decisions that were made by the AAPM, CAMPEP, and the ABR a decade ago. While there is still much to be done, we are on the path to serving the public better by certifying medical physicists with comprehensive, standardized clinical training. AAPM Newsletter | Volume 38 No. 1| January/February 2013

ACR Accreditation FAQs

Priscilla F. Butler

Frequently Asked Questions on ACR Accreditation

oes 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 for ACR Radiation Oncology Practice Accreditation. Please feel free to contact us at rad-onc-accred@acr.org if you have questions about radiation oncology accreditation. Q.

What kind of QA documentation is expected in the ACR’s Radiation Oncology Practice Accreditation (ROPA)?

A. The following QA documentation is required: • Commissioning: Treatment unit, treatment planning, and new treatment techniques such as IMRT, SRS/SBRT. • ADCL records. • RPC output independent check. • Treatment machines: Daily, monthly, and annual QA. Q.

What is a physics QA manual?

A. A physics QA manual is a set of policies and procedures describing all aspects of the Radiation Oncology physics program. Q.

What is required for treatment planning system QA?

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A. Please refer to the report of the AAPM Radiation Therapy Committee Task Group 53 for treatment planning system QA information. Q.

Do I need a second (backup) dosimetry system?

A. Yes, you will need at least one backup dosimetry system. You should have documentation that it has been inter-compared periodically to the calibrated system. Q.

What type of documentation do I need for treatment machine imaging QA (e.g. CT, EPID, kV imagers)?

A. Your documentation should show evidence of daily, monthly and annual QA following the report of the AAPM Quality Assurance and Outcome Improvement Subcommittee Task Group 142 and other pertinent AAPM guidelines. Q.

What is required for periodic imaging QA (e.g. CT simulator, simulator, PET/CT)?

A. For periodic imaging QA, please refer to the report of the AAPM Radiation Therapy Committee Task Group 66. There should be an annual system dose check performed by a qualified diagnostic medical physicist. Q.

What is an independent verification of output of each treatment unit beam?

A. Independent verification of output can be measured by TLDs or by a separate independent medical physicist using their equipment. Q.

What QA is required for my barometer and thermometer?

A. For QA of your barometer and thermometer, you should perform an annual comparison of these field instruments to a standard system.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Health Policy and Economic Issues

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

2013 Final Rule Eases Payment Decreases to Radiation Oncology

he Centers for Medicare and Medicaid Services (CMS) released the 2013 Medicare Physician Fee Schedule (MPFS) final 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. CMS accepted the recommendation to revalue the continuing medical physics consultation code 77336 in 2013. 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 in early 2013 regarding the costs associated with clinical labor and equipment involved in this service. Overall, payments for primary care specialties increase and payments to select other specialties, including radiation oncology decrease due to several changes in how CMS calculates payments for 2013. Several 2013 CMS policies negatively impact the practice expense (PE) relative value unit (RVU) of radiation oncology services. Calendar year 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 policy 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. Payments to capital-intensive specialties, including radiation oncology, are projected to decrease due to changes in how the equipment interest rate is calculated. For 2013, CMS revised 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).

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Under the “Potentially Misvalued Codes” initiative, CMS finalized their proposal to adjust the payment rates for two 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. CMS finalized their proposal to adjust intra-service procedure time assumptions for IMRT delivery (CPT 77418) from 60 to 30 minutes and SBRT delivery (CPT 77373) from 90 to 60 minutes. However, CMS adjusted other direct practice expense inputs for these services, which results in 2013 interim RVUs of 11.92 for 77418 and 37.30 for 77373 with decreases from 2012 payment of 14.7% and 20.5%, respectively. A significant change from the proposed rule with less negative impact. In addition CMS has requested a re-valuation of 23 other radiation oncology codes that they believe may be overvalued. The final rule reflects the Administration’s priority on improving payment for primary care services. Primary care payments would increase because of an additional 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 reductions in payments for other specialties. Because of the budget-neutral nature of this system, decreases in payments in one service result in 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 the four key policies discussed above. Based on AAPM and other radiation oncology stakeholder comments to CMS, the overall specialty impacts were significantly reduced for radiation oncology (from -15% proposed to -7% final) and radiation therapy centers (from -19% proposed to -9% final). All payments and policies are effective on January 1, 2013.

Speciality

Radiation Oncology Radiation Therapy Centers Radiology IDTF Total

-4.0%

2.0%

-3.0%

-1.0%

Total (Cumulative Impact does not include -26.5% reduction to 2013 CF) -7.0%

-5.0%

4.0%

-5.0%

-1.0%

-9.0%

-2.0% -5.0% 0%

0% 0% 0%

-1.0% -2.0% 0%

0% -1.0% 0%

0% 0% 0%

-3.0% -7.0% 0%

New/Revised Codes, MPPR, End of PPIS New UtilizaTransition tion, Other Factors

Updated Equipment Interest Rate

Input Changes Transitional for Certain RaCare Managediation Therapy ment Procedures

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Lastly, based on the currently flawed sustainable growth rate (SGR) calculation, CMS estimates a 26.5 percent reduction to the current 2012 conversion factor of $34.04. Without legislative action, CMS projects a 2013 conversion factor of $25.00. If Congress does not pass legislation the 2013 conversion factor would reduce all payments by an additional 26.5 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 payment cut will occur. To read a complete summary of the final rule and to review impact tables go to: http://aapm.org/government_affairs/CMS/2013HealthPolicyUpdate.asp

2013 Payments for Hospital Outpatient Departments Released by CMS The Centers for Medicare and Medicaid Services (CMS) published the 2013 Hospital Outpatient Prospective Payment System (HOPPS) final rule. The projected increase in payment rates for hospital outpatient services is 1.8 percent for 2013. The majority of the radiation oncology procedure codes have slight payment increases projected for 2013, with medical physics codes 77336 & 77370 in APC 304 receiving a 1.9 percent increase (see table below). The Level II Proton Beam Therapy APC 667 has a significant 56 percent payment decrease due inaccurate outpatient claims data reporting by 1 of the 3 hospitals that billed Medicare for proton beam therapy in 2011. That hospital has corrected the coding error so that APC 667 payment in 2014 should be corrected and reflect accurate coding. The Centers for Medicare and Medicaid Services (CMS) published the 2013 Hospital Outpatient Prospective Payment System (HOPPS) final rule. The projected increase in payment rates for hospital outpatient services is 1.8 percent for 2013. The majority of the radiation oncology procedure codes have slight payment increases projected for 2013, with medical physics codes 77336 & 77370 in APC 304 receiving a 1.9 percent increase (see table below). The Level II Proton Beam Therapy APC 667 has a significant 56 percent payment decrease due inaccurate outpatient

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SUMMARY OF 2013 RADIATION ONCOLOGY HOPPS PAYMENTS Description

CPT Codes

Level I SRS

G0251, 77424, 77425

$902.36

$978.25

8.4%

66 67 127 299

Level II SRS Level III SRS Level IV SRS Hyperthermia & Radiation Treatment Level I Radiation Therapy Level II Radiation Therapy

G0340 G0173, G0339 77371

$2519.86 $3373.00 $7458.55

$2354.79 $3300.64 $7910.51

-6.6% -2.1% 6.1%

77470, 77600-77620

$394.85

$392.41

-0.6%

77401-77407, 77789 77408-77416, 77422, 77423, 77750 77332-77334 77280, 77299, 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399 77285, 77290, 77315, 77321, 77327, 77328, 77338 32553, 49411, 55876, 77295, 77301, C9728 77761, 77762, 77763, 77776, 77777, 77799 77785, 77786, 77787, 0182T 77418, 0073T

$99.51

$95.50

-4.0%

$169.02

$179.52

6.2%

$200.27

$201.76

0.7%

$107.65

$109.73

1.9%

$263.87

$290.99

10.3%

$954.38

$984.49

3.2%

$378.32

$410.83

8.6%

$700.57 $458.64

$687.68 $483.70

-1.8% 5.5%

77778

$841.40

$875.52

4.1%

77520, 77522 77523, 77525

$1183.77 $1548.54

$1136.61 $682.36

-4.0% -55.9%

55875 + 77778

$3339.39

$3254.67

-2.5%

300 301 303 304

Treatment Device Construction Level I Therapeutic Radiation Treatment Prep

305

Level II Therapeutic Radiation Treatment Prep Level III Therapeutic Radiation Treatment Prep Radioelement Applications

310 312 313 412 651 664 667 8001

Brachytherapy Level III Radiation Therapy Complex Interstitial Radiation Source Application Level I Proton Beam Therapy Level II Proton Beam Therapy LDR Prostate Brachytherapy Composite

2012 Payment 2013 Payment

% Change 2012-2013

APC

APC reassignments for 2013 are highlighted in red.

claims data reporting by 1 of the 3 hospitals that billed Medicare for proton beam therapy in 2011. That hospital has corrected the coding error so that APC 667 payment in 2014 should be corrected and reflect accurate coding. New 2013 CMS policies include: • Unpackage intraoperative radiation treatment (IORT) delivery codes 77424 and 77425 and assign them to APC 0065 Level I Stereotactic Surgery. These codes

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will receive separate payment beginning in 2013 with a payment of $978.25. 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. • 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 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. All payments and policies are effective on of January 1, 2013. A complete summary of the final rule and impact tables is on the AAPM website at: http://aapm.org/government_affairs/CMS/2013HealthPolicyUpdate.asp

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Radiation Oncology Program Accreditation

Workshop

Jessica Clements Dallas, TX - Co-Chair

Russell Tarver Ft. Worth, TX - Co-Chair

LAST CALL!

Who?

Radiation oncology department physicists, physicians, administrators, dosimetrists and therapists.

What?

A how-to workshop for achieving radiation oncology program accreditation from ACRO and/or ACR. The meeting is officially endorsed by both organizations with speakers from both. Break out sessions will cover writing policies and procedures and QA forms, how to complete your application with each organization, and the most common deficiencies with each organization and how to avoid them.

When / Where? February 8-9, 2013. Texas Health Presbyterian Hospital Dallas. Why?

There is a growing need for radiation oncology practice accreditation and hence a need to know how to do it! Continuing education credits have been requested from CAMPEP, MDCB, and ASRT.

Registration is open now at http://aapm.org/meetings/2013ROPA/CategoriesFees.asp and a discount is offered for team registration of a 3-person team from a single practice (teams must be composed of a physicist and/or oncologist and/or therapist and/or dosimetrist and/or administrator - no more than one of each type). Early bird registration ends January 9. We look forward to seeing you there!

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Staff Announcements

Angela Keyser , College Park, MD

AAPM HQ Team... At Your Service.

Lisa Giove joined the AAPM team in 2005 as the Receptionist. Her hard work and dedication was quickly evident, and she now serves as Senior Executive Assistant and the Executive Director’s right-hand! Lisa supports the Executive Committee and Board on governance-related projects, maintains the AAPM Policy Manual, handles elections, and manages the headquarters office at various AAPM association meetings. She is also the HQ liaison to AAPM chapters. Noel Crisman-Fillhart started her career with AAPM in 2005 as part of the Accounting team. In 2008, Noel transitioned to a new role as the Administrative Assistant. In this capacity Noel coordinates the AAPM E-News process, serves as staff support for Career Services and assists with numerous office service functions. Viv Dennis has served as the “voice of AAPM” since 2010. As the Customer Service Representative, Viv answers the main phone line, handles general inquiries, and assists with setting up WebEx meetings and conference calls. She also assists with the Medical Physics journal.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Persons in the News

Stephen R. Thomas - RSNA Gold Medalist

The Gold Medal award presentation itself was at the beginning of the afternoon plenary session in the Arie Crown Theater on Tuesday, Nov. 27, 2012.

minent physicist whose distinguished contributions to medical physics have advanced the specialty of radiology. Stephen R. Thomas, PhD is a professor emeritus of radiology and medical physics at the University of Cincinnati Medical Center. For

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his achievements in diagnostic radiology and nuclear medicine and his influence on the subspecialty through volunteer leadership and education, RSNA is proud to present Stephen R. Thomas, PhD, with its Gold Medal. 2012 RSNA President George S. Bisset III, M.D. stated: “His passion for life, his commitment to research, his devotion to his family and career, and his dedication to the RSNA make Dr. Thomas an obvious choice for this award.” Dr. Thomas co-chaired the RSNA Scientific Program Committee from 1987 to 1992 and served as third vice-president of RSNA in 1994. While a member of the RSNA Research and Education Foundation Board of Trustees from 2000 to 2006, Dr. Thomas started the Exhibitors Circle program aimed at attracting smaller annual meeting exhibitors as contributors to the Foundation. He currently serves as chair of the R&E Fund Development Committee and is also a member of the RSNA Centennial Committee. Dr. Thomas has contributed significantly to the American Association of Physicists in Medicine (AAPM). He spearheaded the entry of the AAPM into the magnetic resonance (MR) imaging era by founding and chairing the Task Group on NMR. He also chaired the AAPM Program Committee from 1988 to 1992 and served as AAPM president in 1997. In July 2012, Dr. Thomas received the William D. Coolidge Award, the AAPM’s highest award. For the Society of Nuclear Medicine and Molecular Imaging (formerly SNM), Dr. Thomas was a long term member of the Committee on Medical Internal Radiation Dose (MIRD). The society awarded him its Loevinger-Berman Award for excellence in internal dosimetry in 2009. Dr. Thomas was a founding member of the Society for Magnetic Resonance Imaging (SMRI) and served as an interim board member during the 1993 merger of the Society of Magnetic Resonance in Medicine (SMRM) and SMRI into the Society of Magnetic Resonance (now the International Society of Magnetic Resonance in Medicine). Dr. Thomas also played a significant role in the development of the American Board of Radiology (ABR) Maintenance of Certification (MOC) program, chairing the first MOC Coordination Committee from 2003 to 2006 as the initial elements of MOC were developed and implemented. Dr. Thomas served as an ABR Trustee from 2001 to 2005 and associate executive director for medical physics from 2006 to 2011. Principal or co–principal investigator on more than 20 grants, Dr. Thomas has authored more than 100 publications and edited six books and 20 book chapters.

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ASTRO Award Winners George Chen, Eric E. Klein, and Jatinder Palta.

t this Year’s Annual meeting of the American Society for Radiation Oncology (ASTRO), 3 physicists, George Chen, Eric Klein, and Jatinder Palta all received prestigious awards. Dr. Chen received a Gold Medal, while Drs. Klein and Palta, became ASTRO Fellows.

Gold Medal Award Winners listed left to right: George Chen, Eric Klein and Jatinder Palta The Gold Medal is the Society’s highest honor. It is bestowed on revered members who have made outstanding contributions to the field of radiation oncology, including research, clinical care, teaching and service. Recipients are drawn from any of the scientific disciplines represented by the members of the Society. Dr. Chen received his BS and PhD in physics from MIT and Brown University and his postdoctoral training in medical physics at the Joint Center for Radiation Therapy, Harvard Medical School under Dr. Bengt Bjarngard. He then joined the Heavy Ion Radiotherapy Project at Lawrence Berkeley Laboratory. Following this, Dr. Chen

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was Professor and Head of the Radiation Physics Divisions at the University of Chicago and Massachusetts General Hospital, Harvard Medical School. Dr. Chen’s medical physics interests include multimodality image registration, charged particle beam treatment planning, visualization, and 4D imaging and planning for proton therapy. Former students and postdocs include Drs. Marc Kessler, James Balter, John Roeske, Lei Xing and others. He has been a member of the AAPM and ASTRO for more than 35 years and is a Fellow of both societies. Members of ASTRO are eligible to become a Fellow if they have been part of the Society for at least 15 years, have given significant service to ASTRO and have made a significant contribution to the field of radiation oncology. The primary pathways to becoming a Fellow are excellence in research, patient care, education and leadership/ service. The Society values contributions to all four areas, however, each nominee needed to have a truly outstanding contribution to at least one of the pathways to be named a Fellow.

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Dr. Eric E. Klein was nominated as a Fellow based on Education and Leadership/ Service. Dr. Klein’s accomplishments include starting the first accredited physics residency program in the U.S. at Washington University School of Medicine, which has served as a model for more than 60 accredited programs that have followed. Over 30 graduates have gone onto successful careers. He also led the task group on linear accelerator quality assurance, TG-142. He recently became the senior physics editor for the International Journal of Radiation Biology and Physics. Dr. Klein was the Scientific or Education Director for 8 consecutive AAPM meetings. Klein, a professor of radiation oncology and co-director of the Medical Physics Division at Washington University School of Medicine, is also lead physicist at the S. Lee Kling Center for Proton Therapy. Jatinder R. Palta, PhD, is well known in the field for his pioneering work in the arena of quality and safety of advanced radiotherapy techniques. His research over the last 30 years spans all aspects of clinical physics. He is one of those rare individuals who have deep knowledge of clinical physics issues. Dr. Palta has published more than 150 original research papers in peer-reviewed journals and edited 4 books on advanced radiotherapy. He has received numerous research grants from the National Cancer Institute, Department of Energy, National Science, and sponsored research agreements with industry, most of them as principal investigator. He has served as a member of several ASTRO, ACR, AAPM, ACMP, and ABR, committees, and on the Board of Directors of both ASTRO and AAPM. He has contributed as a member and Chair on several AAPM task groups that provide scientific guidance on clinical issues.

Keith Strauss Plays Key Role in Radiation Protection for Children Through the Image Gently Campaign. By Marilyn J. Goske

K 63

eith Strauss is an internationally recognized medical physicist with particular expertise in pediatric imaging and radiation protection. Dr. Marilyn Goske, Chair of the Image Gently campaign states, “There would be no Image Gently campaign without the expertise and guidance from Keith Strauss. His passion for promoting safer

AAPM Newsletter | Volume 38 No. 1| January/February 2013

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use of imaging equipment customized for children has made him a leader both nationally and internationally. We truly are indebted to him for his help and enthusiasm in making our campaign more scientifically rigorous and bringing medical imaging physics expertise to our multi-disciplinary steering committee.” Mr. Strauss completed a Master of Science degree in Radiologic Physics at the University of Chicago. He was the diagnostic radiologic physicist at Michael Reese Hospital in Chicago and subsequently worked for twenty-seven years as the Director of Radiology Physics and Engineering at Children’s Hospital Boston. In 2011, he assumed the position of Clinical Imaging Physicist at Cincinnati Children’s Hospital Medical Center where he is an Assistant Professor in Radiology at the University of Cincinnati College of Medicine. Keith has served as a radiologic physics consultant for over forty institutions. Mr. Strauss has participated in national and international committees for such prestigious institutions as the National Council on Radiation Protection and the International Atomic Energy Agency. He currently chairs the Pediatric Imaging Subcommittee of the American Association of Physicists in Medicine (AAPM). He served as a liaison to the Conference of Radiation Control Program Directors (CRCPD) from the AAPM for more than 20 years building better communication. Keith currently serves on the CT Accreditation Committee of the American College of Radiology (ACR) and serves as a physicist reviewer of phantom images for both CT and mammography. He was a member of the ACR Blue Ribbon Panel on Radiation Dose in Medicine. He is also the medical physicist for the Quality Improvement Registry in CT Scans in Children, a component of the ACR’s Dose Index Registry (DIR).

More recently, he has focused his expertise as a critical steering committee member of the Alliance for Radiation Safety in Pediatric Imaging, sponsors of the Image Gently campaign since 2007. He was a co-director of the Society for Pediatric Radiology (SPR) ALARA program on Pediatric Interventional and Fluoroscopic Imaging as well as a CT Vendor Summit for Image Gently. He is a reviewer for the following jourAAPM Newsletter | Volume 38 No. 1| January/February 2013

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nals: Radiographics, Pediatric Radiology, Medical Physicists, and the American Journal of Roentgenology. Keith is a fellow of both the AAPM and ACR and has received numerous honors and awards including the John C. Vilforth Lecture on Radiation Protection from the CRCPD and the Presidentâ&#x20AC;&#x2122;s Recognition Award of the SPR. He is a highly regarded lecturer and teacher particularly of radiology residents in medical physics with over one hundred invited presentations and publications and chapters. His expertise in better design and configuration of imaging equipment that impacts children was recognized by the US Food and Drug Administration (US FDA) with the FDA Leveraging and Collaboration Award in 2012. Keith has been a passionate advocate for reducing radiation dose to patients of all sizes and personnel while maintaining or improving image quality.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

Letters to the Editor

Ali Kakakhel, Greeley, CO

Post-graduation Predicament

fter graduating with my Master’s in Medical Physics, I thought I was on the straight and narrow path to a clinical position. I searched for a junior physicist or residency position, fully expecting it would eventually lead me to a position as a clinical medical physicist. After over a year on the job market, I am at a position where I lack the work experience to complete Part 2 of the ABR licensing exam while at the same time my lack of licensure disqualifies me for a board/board-eligible Medical Physicist position. Yet I am unable to land a position due to my lack of experience. What happens when you are stuck in limbo? • Junior positions are few and far between. • Residency positions are very few but still in the process of being added. In the Nov/Dec AAPM Newsletter, John Bayouth wrote: “Today there are 65 CAMPEP-accredited Medical Physics Residency programs; 59 in therapy and 6 in imaging, training over 100 residents. There are also 38 CAMPEP-accredited graduate programs, educating nearly 915 students who are currently enrolled.” The number of graduates in the market far exceeds the number of residencies and junior positions. • I also tried looking for work abroad. Hospitals in Australia and Canada were interested in me, however, since I was not yet ABR certified, they declined their offer. I hear the same from employers in the UK, Germany, Middle East, and New Zealand. We have no idea how long the economic downturn in this country will last, and we also lack access to finding work abroad without completing ABR certification. • As the years pass, newer graduates become familiar with newer technologies reducing our expertise making us less relevant. I am located in such a place where the policies are not favorable for me to get a volunteer position so as to keep abreast. • I know graduates that are still looking for work over two years post graduation. How is this surplus of graduates supposed to move forward in their dreams? • We have a six figure debt and are forced to seek temporary menial work to pay back debts and support our families. Few among us have the financial resources to take out another loan to study for another career.

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• MD graduates have requirements similar to our own, but they have enough residency positions and a matching system to guarantee them a training position. • Some medical physics residencies do not advertise and rely on word of mouth so only a few applicants can apply while the rest of us are shut out of these opportunities. After searching for over a year, I have come to know as a fact that there are more licensed/board certified positions than there are candidates to fill them. At the same time there are more graduates than there are residency or junior positions to accommodate them. These same graduates are stuck because they lack the experience both to proceed with their licensure, to qualify for boarded or board-eligible positions and to qualify for junior positions on the job market. As badly needed as they are, creating more accredited residency positions is time consuming. While we wait, we need to find another solution. One such solution is to allow medical physics graduates to take Part 2 of the ABR exam without the 2-3 years of formal clinical employment. As a written exam, passing Part 2 displays the same level of knowledge regardless of the length of the examinee’s work experience. Removing this requirement will allow graduates that are stuck still seeking work to qualify for positions that accept board-eligible candidates. Such a solution would solve the problem of non-boarded job seekers in the market and continue their licensure while also filling the empty boarded/board-eligible positions.

AAPM Newsletter | Volume 38 No. 1| January/February 2013

2013 AAPM Annual Meeting August Indianapolis Convention Center

4-8, 2013

55th Annual Meeting Dates to Remember

January 16

By April 18

Web site activated to receive electronic abstract submissions.

Authors notiﬁed of presentation disposition.

February 28 28 February

By May 10

Deadline for receipt of 300 word abstracts and supporting data. This deadline recognizes other conference schedules that have conﬂicted in the past and has been extended accordingly. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review.

Annual Meeting Scientiﬁc Program available on-line.

June 12 Deadline to receive Discounted Registration Fees.

FOR MORE INFORMATION PLEASE VISIT:

March 27 Meeting Housing and Registration available on-line.

http://www.aapm.org/meetings/2013AM

SEE YOU THERE !