AAPM Newsletter March/April 2013 Vol. 38 No. 2

AAPM

N E W S L E T T E R The American Association of Physicists in Medicine We advance the science, education and professional practice of medical physics

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MARCH/APRIL 2013 Volume 38 No. 2

AAPM President Hazle reflects on one constant in the world:

change.

For the times, they are a-changin’...Bob Dylan, Songwriter and poet Radiation Accreditation Meeting News. n ACR Accreditation FAQs. n Maintenance of certification for Medical Physicists.

Draft of the proposed CFR Part 35. n Recent changes in the guidelines for accreditation of CAMPEP education programs.

and more...

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: May/June Submission Deadline: April 10, 2013 Posted On-Line: Week of April 29, 2013

www.AAPM.org

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CONTENTS MARCH/APRIL 2013 Volume 38 No. 2

Articles in this Issue

Events / Announcements

AAPM President’s Column

03

2013 Summer School

09

Chairman of the Board’s Column

05

Career Services

19

AAPM Executive Director’s Column

07

AAPM Annual Meeting Programs

25

Editor’s Column

09

AAPM Spring Clinical Meeting

34

Professional Council Column

12

3rd CT Dose Summit

44

CAMPEP News

16 Editor’s Note

Legislative & Regulatory Affairs Report

20

ACR Accreditation FAQs

31

E&R Fund Contributors

35

Staff Announcements

38

New Professional Subcommittee Report

41

ABR Physics Trustees’ Report

45

I welcome all readers to send me any suggestions or comments on any of the articles or new features to assist me in making the tablet edition a more effective and engaging publication and to enhance the overall readership experience. Thank you.

AAPM President’s Column

John D. Hazle, Houston, TX

For the times, they are a-changin’... Bob Dylan, Songwriter and poet

W

ell, if there is one constant in the world --- it’s change! There are so many things going on right now that could have a dramatic impact on the future of our organization and profession, and healthcare in general, it is mind-boggling to try and work through all the permutations. However, we must do just that and it is very timely that we have been focusing on strategic planning the last couple of years. While I’ll leave the bulk of that discussion to Gary as Chairman of the Board and the Strategic Planning Committee, there are a few initiatives that I have started related to strategic planning that I would like to discuss.

First, a quick update on the ad hoc committee to address headquarters space needs that I discussed in the last Newsletter. That committee has been formed and I will chair it. Other members include John Bayouth, Stephanie Franz, Maryellen Giger and Susan Richardson. Angela Keyser and Michael Woodward will represent headquarters’ needs. We will begin to meet very soon.

With the merger of the American College of Medical Physics, the AAPM agreed to support the Spring Clinical Meeting as a replacement to the ACMP annual meeting for an unspecified period of time and to take over publishing of the Journal of Applied Clinical Medical Physics (JACMP). Now that we’ve had a couple of turns of the screw, we need to strategically address how the addition of these activities should be integrated into our overall plans for meetings and publishing. Therefore, we are forming an ad hoc committee on strategic organization of AAPM-sponsored meetings. While the member composition is not final, I am extremely happy to report that Bob Gould has agreed to chair this important committee. Bob is a past President and Scientific Program Director of the annual meeting. The charge of this committee is to take a step back and consider how our annual meeting, the meeting during RSNA, the spring clinical meeting, the summer school and other specialty meetings should be organized to best meet the needs of our members. This will be done in the context of the meeting content of our sister societies so that we have a highly polished offering of meeting programs that get the most bang for the buck in terms of the limited travel resources of our members and the limited headquarters staff resources for supporting meetings.

As for the journals, we are forming an ad hoc committee to make recommendations on how the

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association’s journals, Medical Physics and JACMP, should be managed going forward. While the journals will continue to have separate editors and editorial staff to support their differing priorities, how the journals’ businesses will be managed has not been fully addressed. Further, with on-line and open access publishing becoming more prevalent, we need to consider how we want to strategically position our publications in this new format. Finally, the American Institute of Physics (AIP), the publisher of Medical Physics, recently announced the formation of AIP Publishing, LLC, a wholly owned subsidiary of AIP. AIP Publishing, LLC will be run by a governing board consisting of representatives of organizations that exclusively publish with AIP. This presents AAPM with something of a dilemma since JACMP has not been published

by AIP and, therefore, the AAPM would not be accommodated a seat on the governing board.

It is heartening to report that the initiative to create new imaging residency fellowships is moving along pretty much at that aggressive pace we set out at RSNA under the guidance of Bob Pizzutiello. Bob chairs the oversight committee that will select programs and monitor their progress. AAPM members of the oversight committee include Don Peck and Chuck Willis.

RSNA representatives include George Bisset and Reed Dunnick. I would like to point out that George and Reed are the immediate past-President and President of RSNA, respectively, so we have support of this initiative from the highest levels of RSNA leadership. And thanks to Jackie Ogburn who is providing administrative support. The request for proposals was posted on the AAPM web site and communicated through various channels in early January. The deadline for submission was extended to March 1 to give programs a bit more time to respond. The plan is to announce recipients on April 1 with funding available on July 1. And yes, that is in 2013! Residents coming into programs funded in this first cycle must start by June 30, 2014.

Again, I want to thank Bob and the committee for making this happen in an expedited manner.

In closing, activity at AAPM is high --- as usual. The leadership looks forward to devoting more of our time and energy to strategically important issues now that the lawsuit is pretty much over. And finally, I look forward to seeing many of you in Phoenix next month at the Spring Clinical Meeting, in Indianapolis this summer for the Annual Meeting and in Chicago this fall at the joint meeting with RSNA. It is a quite an honor to serve with so many dedicated volunteers!

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Chairman of the Board’s Column

Gary A. Ezzell, Phoenix, AZ

Strategic Planning Committee of the Board meeting, radiation oncology accreditation, the need to create an adequate number of residency programs

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often feel fortunate to live in Phoenix, and one reason this year is that the AAPM Spring Clinical Meeting is here. Only half of our physics team are able to attend AAPM each year, so the Spring Clinical Meeting is a welcome alternative. I look forward to seeing a good number of AAPM members who are also taking advantage of the opportunity.

The Strategic Planning Committee (SPC) of the Board meets at the end of that meeting. The purpose of the SPC is to guide the Board’s long-range planning. One part of that is anticipating and preparing for changes in our environment, and we know that changes are coming. Reimbursements are likely to go down over the next few years in much of medicine, and CMS is specifically reviewing Radiation Oncology charge codes. We are going to need to improve efficiency if we are to assist our institutions in reducing costs while simultaneously improving quality and safety. This will require collaborations between physicists, physicians, administrators, and other team members within each organization, as well as collaborations with vendors and regulators. Those collaborations will not always be easy, because interests are not completely coincident. AAPM will need to work as an organization with other organizations, and will need to provide its members with tools to use within our individual facilities. How to best do these things will be a major focus of this upcoming meeting.

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We can expect that AAPM operations will also need to become more efficient, because it is likely that revenues from publications and meeting exhibitors will flatten or decrease in the future. The Board will be looking at those issues carefully, both in terms of maintaining revenues and decreasing costs.

Recent activities of my own institution illustrate two other issues that affect our members. My department just became accredited, and it was a useful process to go through. We needed to improve in some ways to meet the standards, mostly in ways that we had wanted to for years but had never managed to accomplish until we committed to going for accreditation. There are presently two, and will soon be three, accrediting bodies for Radiation Oncology. AAPM does not support one over the others, but we do support the concept of accreditation and promote the use of our Medical Physics Practice Guidelines by those bodies. AAPM just held a workshop on accreditation of Radiation Oncology programs that was very well received, and we expect that this topic will continue to be important.

The other issue relates to people entering our profession. My facility has a residency program for physicists in Radiation Oncology, and we received 110 applications for the two available slots. Key questions are how many slots are available, how fast is the number increasing, and, for the future, how many new positions will there be each year for new physicists coming out of residencies. AAPM has no direct role to play in controlling the number of graduate students, MS, PhD, or DMP, but we can and are supporting the creation of an adequate number of residency programs, especially in imaging.

Finally, the trial over the K&S lawsuit against AAPM has concluded, but it will be some months before the judge issues his decision. Angela Keyser was present for the entire proceedings, and several of our volunteers were called to testify. They and our attorneys represented AAPM well; we now await the outcome.

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AAPM Executive Director’s Column

Angela R. Keyser, College Park, MD

Mark your calendars for upcoming AAPM meetings: 3rd CT Dose Summit: Strategies for CT Scan Parameter Optimization March 15-16, 2013 - just prior to the Spring Clinical Meeting, Phoenix, AZ

Register Now! 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.

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

Register Now! Several AAPM groups plan to meet during the 2013 AAPM Spring Clinical Meeting. A list of AAPM activities is available online. Please make time during the meeting to visit the vendors and thank them for their support of AAPM and the medical physics profession.

2013 AAPM Summer School

Quality and Safety in Radiotherapy: Learning the New Approaches in TG 100 and Beyond June 16 – 20, 2013, Colorado College, Colorado Springs Registration to open March 6th.

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Program Information Available NOW

AAPM Newsletter | Volume 38 No. 2 | March/April 2013

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.

Eight Self Assessment Modules (SAMs) credits will be included in this program (no extra fee).

55th AAPM Annual Meeting and Technical Exhibits August 4-8 – Indianapolis, Indiana Meeting Registration and Housing available on-line March 27

This year’s program will be held at the Indiana Convention Center.

What’s New This Year •

•

•

Special Ultrasound Program (Monday – Tuesday, August 5 - 6). A dedicated two-day program of invited and proffered talks is scheduled for Therapeutic Ultrasound (August 5) and Ultrasound Imaging for Therapy Guidance (August 6).

Complimentary Wi-Fi throughout the Indiana Convention Center (AAPM meeting rooms, exhibit hall and function space) Donors’ Lounge - Members who have made donations to the Education & Research Fund will have access to the Lounge. Comfortable seating, beverages and charging stations will be available in the Donors’ Lounge.

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 will 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; the American Planning Association recently named Monument Circle one of the “10 Great Public Spaces”. The Virginia Fairbanks Art & Nature Park features 100 acres of public art.

Fellowship Deadline March 18 The AAPM/RSNA Fellowship is offered for the first two years of graduate study leading to a doctoral degree in the field of Medical Physics. Additional program details and access to the NEW Online Applications can be found online.

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Editor’s Column

Mahadevappa Mahesh, Baltimore, MD

Welcome to the second issue of the 2013 Newsletter

W

elcome to the second issue of the 2013 Newsletter. We are still tinkering with the tablet edition in an effort to make it as reader friendly as possible. An important new feature for those who wish to contribute to the Newsletter is not only the option to submit text but submissions can also include short podcasts/video casts that can be embedded in articles. I would like to encourage all of our regular contributors, and any new submitters, to take advantage of this new feature.

This issue contains articles from our regular contributors providing updates on various issues related to our profession. In addition, it includes articles from CAMPEP regarding recent changes to programs’ accreditations, an ABR Physics Trustees report on MOC for Medical Physicists, the ACR Radiation Oncology Practice Accreditation FAQs along with the 55th AAPM Annual Meeting Scientific Program announcement.

g

row with

AAPM

I welcome all readers to send me any suggestions or comments on any of the articles or new features to assist me in making the tablet edition a more effective and engaging publication and to enhance the overall readership experience.

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 6!

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.

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Much of this school will use real-life, in-class exercises to enhance and facilitate understanding of 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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Professional Council Column

Per Halvorsen, Newton, MA

Radiation Oncology Program Accreditation meeting successfully concluded

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n February 8 and 9, the Professional Council hosted a practical workshop on how to prepare for radiation oncology accreditation, with representatives from the ACR and ACRO

Professional Council Workshop accreditation programs participating alongside seasoned surveyors. We had approximately 150 attendees, with a third of the attendees being non-physicists (radiation oncologists, administrators, dosimetrists and therapists). With accreditation gaining more prominence, an increasing number of applications to both accreditation programs, and a third program (ASTRO) is expected to launch soon, the meeting was timely and informative. Jessica Clements

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and Russ Tarver were the meeting co-directors, with support from Lynne Fairobent for program / speaker issues and from Karen McFarland for meeting logistics. Michael Woodward created a dedicated discussion forum for the meeting attendees on very short notice. Perhaps the best testament to the meeting’s success was the concluding comment by Dr. Peter Hulick, the ACR physician representative, who stated that “every radiation oncologist should attend an AAPM meeting during his/her career”. In addition to meeting the objective of providing useful information for individuals interested in accreditation, the meeting raised the AAPM’s profile in the context of practice accreditation specifically and with our non-physicist colleagues in general. Finally, we met or exceeded our budget – all in all, a very successful meeting.

Strategic Plan provides a useful roadmap for Council priorities

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ost of you are well aware of the AAPM’s strategic plan and the process of assigning objectives to each Council. Over the past year or so, we have incorporated the strategic plan objectives into the prioritization of our efforts and the allocation of resources. The Professional Council will meet in a few weeks, and we will again use the strategic plan to ensure that our activities are aligned with the Association’s stated priorities. It is reassuring to have a roadmap to refer to, and to know that our work addresses the concerns of the Board of Directors and, by extension, the AAPM membership. If you’re one of the members who has wondered if the strategic plan was all “fluff ”, rest assured that it has had a tangible effect on how the Council prioritizes its activities.

Have a request or a good idea? We’re all ears….

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he Professional Council’s primary interest is to meet the professional-practice needs of you, our colleagues in this wonderful profession. We (the members of the Council) all mean well and try our best to represent your needs, but we are a small group of volunteers and it is quite possible that we’ve overlooked some things. If you have a request or a suggestion you’d like us to consider, we want to hear from you! Send a note to myself, Dave Hintenlang (PC Vice Chair) or Lynne Fairobent (AAPM staff) – we will read every suggestion and will bring your suggestions forward to the Council for their consideration.

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CAMPEP News Bruce Gerbi

Chester Reft

Recent changes in the guidelines for accreditation of CAMPEP education programs

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orking with its sponsors (AAPM, COMP, ACR, RSNA, ASTRO) and the ABR, CAMPEP has taken many steps to improve the quality and consistency of Medical Physics education. Many of the improvements and changes in policy and procedure have been evolving for a long time and have been extensively discussed and evaluated. The following is to inform the medical physics community and especially the students and the graduate and residency program directors of the changes in the guidelines for accreditation of CAMPEP education programs. The CAMPEP guidelines for both graduate and residency education are available for all to read on the CAMPEP website. The following summarizes the most recent changes in the guidelines.

1. Didactic undergraduate education to enter the field of medical physics and the Medical Physics courses required during the student’s graduate education have been extensively discussed. The residency program directors are responsible for ensuring that their residents have met both the undergraduate didactic and Medical Physics didactic expectations. This is a significant change in the residency Guidelines and will be implemented on January 1, 2014. To meet the undergraduate didactic expectation, students must have at least a minor in physics or the courses required at their institution to fulfill the requirements for a minor in physics. Students entering a CAMPEP-accredited Medical Physics residency program should have completed the six basic graduate-level courses described in AAPM Report 197S before completing their residency experience. Only two of those courses may be taken during a two-year residency experience and those courses must be taken in a CAMPEP-accredited graduate program or a CAMPEP-accredited certificate program. Two of the six courses can be taken and accepted outside of a CAMPEP-accredited program, at the discretion of the residency program director, if he or she believes the courses satisfy CAMPEP expectations. If a program director abuses this requirement by accepting courses that do not satisfy CAMPEP expectations, the accreditation of his/her program is in jeopardy. If a residency program offers one or two of the didactic courses during a residency, the program must have these courses approved by the Graduate Education Program Review Committee (GEPRC) of CAMPEP. A full description of this policy can be found in Section V.A. Residents Admission of the Guidelines for Accreditation of Residency Programs posted on the CAMPEP website.

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2. If there is a change in the residency program director, the institution must notify CAMPEP immediately and send an amended self-study to the Chair of the CAMPEP Residency Education Program Review Committee (REPRC). The CV of the individual assuming the role of Program Director must also be sent to the Chair of REPRC to ensure that he or she meets the requirements to fulfill the role.

3. Beginning July 1, 2013 there will be a requirement for Ethics and Professionalism education in the residency training. This education may take place in a mentoring environment, but must be documented as having occurred. The Program Director must ensure that residency program graduates have completed, either in their prior graduate program or in the residency program, didactic information on ethics and professionalism at the content level specified in AAPM Report 159. Programs can either design their own course to provide this content or can use the materials provided by the ABR/ACR/RSNA/AAPM/ASTRO/ARR/ARS Online Modules on Ethics and Professionalism.

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4.

CAMPEP encourages faculty in residency programs to mentor residents in research and in knowledge generation and dissemination during their residency. This is especially applicable for residents aspiring to a future academic position during their career. However, this cannot compromise any of the clinical education requirements or negatively impact the 24 months of clinical training which is the core of the residency program. Appendix 2 in the Self Study Guidelines for Residency Programs describes CAMPEP’s perspective on research during the residency.

5.

A program can be reviewed at any time and programs are now encouraged to apply for accreditation before accepting students. If a program is in the accreditation process before it accepts a resident, the self-study will be reviewed and if acceptable to the review team, the program will be granted Provisional Accreditation. The site visit will be conducted approximately one year after their first resident enters the program.

6.

There is no longer a financial requirement that the resident receive remuneration at the level of medical residents or at any other level of compensation (Section VII.B. Resources-Financial).

7.

CAMPEP has applied to the Council for Higher Education Accreditation (CHEA) for accreditation of its accreditation process. The new CAMPEP policies necessary to satisfy the CHEA accreditation requirements will be implemented on January 1, 2014.

Programs must have as part of their self-study and annual report, information that describes the program and the achievements of its graduates and students. This information must be posted on the program’s open-access website and include the number of students applying per year, the number of students accepted per year, the number of students graduating per year, and the number of students certified per year. Also, information describing the activity of students after completion of the residency such as the number in industry, the number in clinical positions, the number in academics, or the number in other activities shall be specified. The data shall not include student names or individual information of any sort.

AAPM Newsletter | Volume 38 No. 2 | March/April 2013

As the residency programs increase and evolve to adapt their structure and governance to their resources and staffing, CAMPEP will have to consider implementing additional changes in the guidelines for residency programs. If and when these guidelines are modified, we will make every effort to inform the medical physics community of them.

About the authors: Chester Reft, PhD is the Chair of the Residency Education Program Review Committee. Bruce Gerbi, PhD is the Former Chair of the Residency Education Review Committee.

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Legislative and Regulatory Affairs Report

Lynne Fairobent, College Park, MD

NRC Makes Available a Draft of the Proposed 10 CFR Part 35, “Medical Use of Byproduct Material”

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he U.S. Nuclear Regulatory Commission (NRC) has made publicly available an advanced draft of the proposed revision to 10 CFR Part 35. The version may also be accessed via ADAMS. Its ML accession number is ML13014A487. NOTE: this is an advanced copy and is subject to change before officially published in the Federal Register for public comment. I am bringing it to your attention early so that you can review it and provide me comments on any of the proposed changes.

The proposed amendments include: revising the preceptor attestation requirements, allowing ARSOs to be named on a medical use license, requiring increased frequency of testing for measuring molybdenum-99 (Mo-99) concentration in a Mo-99/technetium-99m (Tc-99m) generator, requiring reporting of failed tests of a Mo-99/Tc-99m generator and failed strontium-82 (Sr-82) and strontium-85 (Sr-85) tests of a rubidium-82 (Rb-82) generator, extending the 5-year inspection frequency for a gamma stereotactic radiosurgery unit to 7 years, and several clarifying amendments.

In addition, the proposed rule would address issues that were raised in a petition for rulemaking (PRM) (PRM-35-20, ADAMS Accession No. ML062620129) filed by E. Russell Ritenour, Ph.D., on behalf of the American Association of Physicists in Medicine (AAPM) on September 13, 2006. The petition requested that the training requirements for experienced RSOs and medical physicists in 10 CFR 35.57 be amended to recognize board-certified physicists and RSOs as “grandfathered” for the modalities that they practiced as of October 24, 2005. This issue is discussed in greater detail in Section III, Petition for Rulemaking PRM-35-20, of this document.

Basically the proposed change in response to the Ritenour (AAPM) petition states that “any individual certified by a specified certifying board need not comply with the training requirements of §§ 35.50, 35.51, or 35.55, respectively. After [DATE THAT IS 90 DAYS AFTER THE DATE OF PUBLICATION IN THE FEDERAL REGISTER], Radiation Safety Officers and authorized medical physicists identified in this paragraph must meet the training requirements in § 35.50(d) or § 35.51(c), as appropriate, for any new material or new medical use.” [Page 100

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of the NRC document] Finally, the proposed rule would modify the written directive (WD) requirements in10 CFR 35.40 and the ME reporting in 10 CFR 35.3045 to establish separate ME reporting criteria for permanent implant brachytherapy. The proposed rule adds a new section to 10 CFR § 35.3045 which states: “(2) For permanent implant brachytherapy, the administration of byproduct material or radiation from byproduct material that results in— (i) The total source strength administered differing by 20 percent or more from the total source strength documented in the post-implantation portion of the written directive; (ii) The total source strength administered outside of the treatment site exceeding 20 percent of the total source strength documented in the post-implantation portion of the written directive; (iii) An absorbed dose to the maximally exposed 5 contiguous cubic centimeters of normal tissue located outside of the treatment site that exceeds by 50 percent or more the absorbed dose prescribed to the treatment site in the pre-implantation portion of the written directive approved by an authorized user; (iv) An absorbed dose to the maximally exposed 5 contiguous cubic centimeters of normal tissue located within the treatment site that exceeds by 50 percent or more the absorbed dose to that tissue based on the pre-implantation dose distribution approved by an authorized user; or (v) An administration that includes any of the following(A) The wrong radionuclide; (B) The wrong individual or human research subject; (C) Sealed source(s) directly delivered to the wrong treatment site; (D) A leaking sealed source; or (E) A 20 percent or more error in calculating the total source strength documented in the pre-implantation portion of the written directive.”

What are the Issues the NRC is seeking Specific Comments On? 1. Compatibility Category for the Agreement States on § 35.3045, Report and notification of a medical event. Current level of compatibility for 10 CFR § 35.3045 is designated as Compatibility Category C for the Agreement States. This designation means the essential objectives of the requirement should be adopted by the State to avoid conflicts, duplications, or gaps. The manner in which the essential objectives are addressed in the Agreement State requirements need not be the same as NRC, provided the essential objectives are met. Under Compatibility

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Category C, Agreement States may require the reporting of MEs with more restrictive criteria than those required by the NRC. Some medical licensees having multiple locations in various states, both NRC-regulated and Agreement State-regulated would prefer a Compatibility Category B designation, for uniformity of practice and procedures among their different locations. Compatibility Category B are those program elements that apply to activities that have direct and significant effects in multiple jurisdictions.

The OAS has expressed a strong desire to retain a dose-based ME reporting criterion for the treatment site if NRC regulations are revised to include source-strength based criteria for determining MEs for permanent implant brachytherapy. The OAS has no objection to the introduction of the source-strength-based criteria, as long as the dosebased criteria can be retained by Agreement States, which requires § 35.3045 to remain as Compatibility Category C. With a Compatibility Category C designation, the Agreement States could require both the dose-based criterion and source-strength-based criterion; as long as the Agreement State reports to NRC include the information desired by the NRC. For some Agreement States, Compatibility Category B is difficult to achieve because their regulations have to also meet specific state requirements based on the state agencies in which the radiation control regulators reside. Also, Agreement States may have existing laws requiring the collection of additional information on medical diagnostic and therapy procedures. If the level of compatibility for § 35.3045 were to be raised to Category B, Agreement State requirements would need to be essentially identical to those of the NRC. Category B compatibility is applied to requirements that have significant direct trans-boundary health and safety implications. This designation would require that the Agreement State requirements could not include any additional requirements, such as diagnostic reports, shorter reporting times, or lower dose limits for reporting.

2. Volume for determining an absorbed dose to normal tissue for MEs under § 35.3045, Report and notification of a medical event. The proposed volume, 5 cubic centimeters of continuous normal tissue, is based on the recommendations from the NRC’s Advisory Committee on Medical Uses of Radioisotopes (ADAMS Accession No. ML12038A279).

Once published officially for public comment, AAPM will be preparing comments. If you have any comments you want considered, please email them to me at lynne@aapm.org. Remember, this draft may change before the formal public comment period is announced.

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Therapy Program Scientific Symposia • • • • • • •

Radiation Dose Calculations on Graphics Processing Units (GPUs): Advances and Challenges Accuracy Requirements and Uncertainties Considerations in Radiation Therapy Formal Radiation Therapy Safety Processes Collaborative Knowledge Modeling and Integration for Radiation Therapy Planning The impact of Intensity modulated proton therapy on proton therapy?

Science of Clinical Medical Physics Brachy Symposium

Proffered Abstract Submissions • • • • •

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Imaging for Planning Treatment Planning Treatment Delivery and Verification Dosimetry Techniques, Patient Safety and Quality Assurance Procedures Outcome Modeling and Assessment AAPM Newsletter | Volume 38 No. 2 | March/April 2013

• Radiobiology • Informatics • Small Animal Studies • Radiation Protection and Shielding • Targeted Radionuclide Therapies • Other Therapy Related Topics

Imaging Program

Scientific Symposia

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Virtual Tools for Validation of X-ray Breast Imaging Systems - Memorial Symposium for Fearghus O’Foghludha Estimating Risk of Low Radiation Doses Multi modal imaging for therapy response early prediction and therapy monitoring Image Quality Models in Advanced CT Applications Advanced Imaging for Breast Cancer: Screening, Diagnosis, and Assessing Response to Therapy Past, Present and Future Roles of ROC Analysis in Medical Imaging and Quantitative Image Analysis [In honor of Charles E. Metz] Nanotechnology & Molecular Imaging

Proffered Abstract Submissions

• Radiography • Fluoroscopy • Rotational Angiography • Helical CT • Dynamic Contrast Enhanced CT • Cone Beam CT • Dual Energy or Spectral CT • Mammography • Nuclear Medicine and PET • MRI • DCE-MRI • DWI-MRI • MR Spectroscopy • Optical • Novel Modalities • Multi-Modality Imaging • Modality Independent AAPM Newsletter | Volume 38 No. 2 | March/April 2013

• Display

• Other Imaging Related Topics

Joint Imaging/Therapy Program

Scientific Symposia

•

•

•

•

•

•

•

Advanced Applications in Deformable Registration MR-Guided Radiation Therapy How OMICs is going to impact research topics for medical physicists How do we couple quantitative imaging and models of tumor response to improve multimodal therapy?

New Technologies Addressing the Range Uncertainty of Proton Therapy Physics Pheud!

MR Guided Therapy Planning

•

•

•

•

•

•

•

•

•

•

•

•

Science Council Session: Multi-Modality Imaging in Radiation Therapy: Planning, Guidance, and Assessment of Treatment Response Image Registration and Fusion Image Segmentation and Visualization for Planning or Therapy Simulation for Planning Patient Immobilization Motion Assessment/Management at Planning or Therapy Image Guidance and Localization at Therapy Targeted Radionuclide Therapies Image Guidance for Surgical, RF, Thermal, and Other Interventions Therapy Assessment Uncertainty Assessment/Management (e.g. adaptive RT & Margins) Other Joint Imaging/Therapy Topics

Proffered Abstract Submissions

Ultrasound (Special Conference)

27

Scientific Symposia

• • • •

US guided Radiation Therapy- Intervention & Novel Technologies US guided Systems for RT and Treatment Planning Clinical Delivery and Advanced Techniques in Therapeutic Ultrasound Image Guidance and Assessment of Ultrasound Therapy AAPM Newsletter | Volume 38 No. 2 | March/April 2013

• •

Advanced Novel Technologies & Therapeutic Strategies Treatment Strategies, Modeling, & Control for Ultrasound Therapy

Proffered Abstract Submissions

• • •

Therapeutic Ultrasound Ultrasound for Radiation Therapy Guidance Ultrasound for Diagnostic Imaging

Practical Medical Physics Program

•

•

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•

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TG151: Radiographic System Quality Control Strategies for Total Quality Statistics, Error Analysis, and Uncertainty Reporting in Medical Physics The Elements of a Highly Effective Educational Session Clinical implementation for advanced brachytherapy dose calculation algorithms beyond the TG-43 formalism TG132: Image registration and fusion A Roadmap for Installing and Commissioning New Equipment TG118: Parallel Imaging in MRI: Technology, Applications, Quality Control CT Tools and Protocols Available Through AAPM Grantsmanship and Funding Radiation Therapy Contouring: CNS and Cardiac/Thoracic Managing Treatment Planning Systems

Professional Program

28

• Professional Council Symposium • How to be a Journal Referee • Challenges of Increased Controls of Radioactive Materials • HazMat Shipping DOT Training • International Medical Physics Symposium • Preparing for the ABR Therapy Exam • Preparing for the ABR Diagnostic Exam • Managing and Leading Others • The Business of Medical Physics • Medical Physics Practice Guidelines • ABR Update • Project Management • PQI AAPM Newsletter | Volume 38 No. 2 | March/April 2013

• • • • • • •

In-House Credentialing Controlling Stuff, Beating Stress, and Finding Work-Life Balance New Member Symposium Professional Liability and Risk Management in Medical Physics Practice Open Access Publishing and Medical Physics RSO Refresher Training Medical Physics Economics

Proffered Abstract Submissions

• • • • •

Professional Practice of Medical Physics Education (Clinical) Legislation and Regulation Administration and Management Compliance and Quality Management

More than 50 hours of educational courses in medical imaging and radiation therapy physics will be offered. This will include SAMS courses for diagnostic, medical nuclear, and radiation therapy physicists.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

ACR Accreditation FAQs

Priscilla F. Butler, Reston, VA

ACR Accreditation: Frequently Asked Questions for Medical Physicists

D

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 type of peer review documentation is required for a medical physicist (solo vs.

multi practice)?

A. For solo-physicist sites, please follow the guidance provided in AAPM TG 103. For

multi-physicist sites, an annual evaluation or process must be checked by a different

medical physicist who did not perform the original work.

Q. Do I need a policy and procedure for high dose (> 300cGy/fraction) treatments?

A.

Q.

Yes. In the physics manual, there should be a policy that specifically states that the plan/ calculation will be checked prior to treatment. However, if your policy states that all plans and calculations have to be reviewed prior to treatment, no additional policy is needed.

Are weekly chart checks by a medical dosimetrist acceptable?

A. Yes, weekly chart checks by a medical dosimetrist are acceptable if they are performed

under the supervision of a qualified medical physicist (QMP) and if allowed by the local

insurance carrier.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Q. What is considered an end of treatment (EOT) chart check?

A. An EOT chart check is a final review of all plans, calculations, and patient dosimetry

readings, weekly chart checks, etc. An EOT chart check must be performed within

one week of the patient’s treatment completion.

Q. What is required for brachytherapy radiation safety documentation?

A. Brachytherapy radiation safety documentation must include, at a minimum, evidence

of a post procedure survey. (Please refer to NRC regulations.)

Q. What is required for brachytherapy source calibration?

A. Brachytherapy source calibration documentation must show that it was performed

using an ADCL Well Chamber and the calibration check was done prior to source

usage.

Q. What are the responsibilities of the quality assurance committee?

A. The Quality Assurance Committee is responsible for: ◊

Reviewing/following up on »» »» »» »» »»

»» »» »»

◊ ◊

Medical events Machine down time Percentage of weekly chart checks and EOT checks Any treatment complications Department clinical statistics (e.g., morbidity and mortality, outcome and focus studies, etc.)

Patient satisfaction surveys MD peer review Medical physicist QA reports

Establishing and reviewing clinical processes Discussing process and clinical errors, establishing cause, effect and solutions

Q. What published material should I reference for the Radiation Oncology Practice

Accreditation (ROPA) Program?

A. Please reference the following materials for ROPA:

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

◊ ◊ ◊ ◊

ACR/ASTRO Practice Guidelines and Technical Standards

AAPM Task Group reports

ASTRO White Papers QUANTEC

About the author: Priscilla F. Butler, M.S. is the Senior Director and Medical Physicist, for ACR Quality and Safety.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

AAPM Spring Clinical Meeting 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.

The Pointe Hilton Tapatio Cliffs Resort Hotel

It’s not too late to Register!

• The AAPM Spring Clinical Meeting has been approved by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) for continuing education credit hours.

• AAPM has applied 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 13 SAMs sessions - exact number to be disclosed after ABR approval.

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

34

March 16-19, 2013

our

Focus on

future

AAPM wishes to acknowledge and thank the following individuals for their 2012 contributions: AAPM Education & Research Fund Wally Ahluwalia Hassaan Alkhatib Scott J. Alleman Steven J. Amzler John A. Antolak David M. Applebaum Samuel G. Armato Ben A. Arnold Michael J. Bailey Thomas J. Baker Morris I. Bank Clyon Wayne Bell Carl E. Bergsagel Kenneth J. Bernstein Sareth Bhaskaran Anthony P. Blatnica Arthur L. Boyer Vera Burtman Carlos A. Caballero Robert L. Carver Maria F. Chan Edward L. Chaney Sha X. Chang

35

Jean Jacques Chavaudra Zhe (Jay) Chen Kenneth A. Coleman Kevin W. Corrigan Joanna E. Cygler Edmund P. Cytacki Maximian Felix D’Souza Andrew Daniel Indra J. Das Jesus E. Davila Paul M. DeLuca Jun Deng Colleen M. Desrosiers Nicholas A. Detorie Steven R. Dolly Lei Dong Anonymous Donor Anonymous Donor Godwin Dorbu Kai Dou Sean A. Dresser Benjamin P. Fahimian Karl J. Farrey Jennifer Hann Fisher Doracy P. Fontenla Martin W. Fraser

D. Jay Freedman G. Donald Frey Shannon G.Fritz William R. Geisler Charles E Geraghty Bruce J. Gerbi Maryellen L. Giger Gurtej S. Gill Michael T. Gillin Steven J. Goetsch David Lloyd Goff Lee W. Goldman Bennett S. Greenspan Madhup Gupta Nilendu Gupta Per H. Halvorsen Homayoun Hamidian Russell J. Hamilton Oliver D. Hanson Joanna M. Harper Vijay A. Harwalkar Chris M. Hearn Joseph P. Hellman Frank William Hensley Jung T. Ho Donald E. Holmes

AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Ching-Yi Hsieh Cecilia A. Hunter Abrar M. Hussain Tobin C. Hyman Lynda C. Ikejimba Gulkan Isin Edward F. Jackson Mary Ellen Jafari Daniel J. Januseski Andrew D. Jeffries Zheng Jin Steven M. Jones Philip F. Judy Kalpana M. Kanal Haejin Kang Alexander Kapulsky Alireza Kassaee Sunil A. Kavuri Dennis J. Kehoe Jeffrey R. Kemp Timothy R. Keys Angela R. Keyser Tseggy T.S. Kharkhuu Jong Oh Kim Jong-Hyo Kim Steven A. Kirkpatrick Assen S. Kirov Nels C. Knutson Xiang Kong Michael E. Kowalok M. Terry LaFrance Lena S. Lamel Donald W. Laury David A. Lightfoot Liyong Lin Venkata Narayana Lingampally Dale W. Litzenberg Eric Lobb Dale Michael Lovelock Gary Luxton Lijun Ma Thomas R. Mackie Gig S. Mageras Eugene Mah Mahadevappa Mahesh William Malloy Lesley Ann Malone

36

Sivasubramanian R. Manoharan James R. Marbach Christopher H. Marshall Mary K. Martel Melissa Carol Martin James E. McDonough Sharon K. McMillan Michael F. McNitt-Gray Matthew A. Meineke Albert V. Mesa Tariq A. Mian Ira D. Miller Shantilata Mishra George Mitev Monica Moldovan Mary E. Moore Jose A. Morales Monzon Lee T. Myers David M. Nelson Francisco D. Nunez James H. O’Rear Sachio Ogawa Olabode Thomas Ogunleye Arthur J. Olch Mark Oldham Sandra L. Paige Brent C. Parker E. Ishmael Parsai Baldev R. Patyal Daniel C. Pavord Angelica Perez-Andujar Joseph Perl Cristiana M. Peroni Douglas E. Pfeiffer Yakov M. Pipman Robert J. Pizzutiello Jerimy C. Polf Robert A. Praeder James J. Prete Lihong Qin Prema Rassiah-Szegedi Chester S. Reft Roger K. Rice Miguel A. Rios Mark J. Rivard Donald M. Roback Gene E. Robertson

Lawrence N. Rothenberg Scott Sample L. John Schreiner Alexander W. Scott J. Anthony Seibert Christopher F. Serago Anil Sethi Jan P. Seuntjens Shakil Bin Shafique Anil Kumar Sharma S. Jeff Shepard Thomas B. Shope Deborah J. Shumaker Justin D. Silkwood Douglas J. Simpkin Larry D. Simpson John P. Skrobola Koren S. Smith Michael G. Snyder Jerry Soen Donna M. Stevens Palmer G. Steward Thomas G. Stinchcomb Steven G. Sutlief John W. Sweet Daniel P. Talenti Russell B. Tarver Michael Tassotto Philip M. Tchou Charles R. Tenney James A. Terry Earl A. Trestrail Jacob Van Dyk Elisabeth C. Van Wie Dongxu Wang Steven J. Wang Xiaoyang Betsy Wang John T. Washington Christopher J. Watchman Adam M. Watts Jared H. Weatherford William G. West Gerald A. White Thomas A. White Brian D. Wichman Kendrick J. Williams Mark Bennett Williams

AAPM Newsletter | Volume 38 No. 2 | March/April 2013

John D. Willins Robert John Wilson Charles Wissuchek Margaret A. Wolf John W. Wong Susu Yan Yulong Yan Ellen D. Yorke Ning J. Yue Pengpeng Zhang Qinghui Zhang Ronald Zhu Timothy C. Zhu Jeananne M. Zink

Krohmer Memorial

Steven M. Jones Robert A. Praeder Thomas A. White

Jennifer Hann Fisher Mary E. Moore Thomas A. White Latin American Affairs SC

E. Webster Memorial Bennett S. Greenspan Thomas A. White Ed Fund Members Memorial

African Affairs SC Wolfgang W. Baus Maximian Felix D’Souza Jong-Hyo Kim Yakov M. Pipman

Chester S. Reft Thomas A. White European Affairs SC Joanna E. Cygler Glasser Memorial

Asia/Oceania SC

Lawrence N. Rothenberg Thomas A. White

Klaus Borkenstein Xiang Kong Lihong Qin Charles Y. Shang Shikuan She Dongxu Wang Cameron Memorial Morris I. Bank Jean Jacques Chavaudra Edmund P. Cytacki Maximian Felix D’Souza Cupido Daniels Jesus E. Davila Martin W. Fraser William R. Geisler Bennett S. Greenspan Steven M. Jones David M. Nelson Robert A. Praeder Lawrence N. Rothenberg Thomas A. White

37

D. Jones Memorial

Carlos A. Caballero Jesus E. Davila Renato Dimenstein Domingo N. Mejia Yakov M. Pipman Javier Santos Laughlin Memorial Anonymous Donor Radhe Mohan Mary E. Moore Yakov M. Pipman Lawrence N. Rothenberg Larry D. Simpson Thomas A. White Qinghui Zhang

International Scientific Loevinger Memorial Exchange Program Michael E. Kowalok Domingo N. Mejia Hassaan Alkhatib Thomas A. White Maxine A. Barnes Giovanni Borasi Jean Jacques Chavaudra Eugene P. Lief William Malloy Ailsa J. Ratcliffe Donna M. Stevens Thomas A. White Raymond K. Wu

John Hale Memorial Fund

Middle East Affairs SC Muthana S.A. L. Al-Ghazi Waleed H. Al-Najjar Parham Alaei Issam M. El Naqa Yakov M. Pipman Jahangir A. Satti John D. Willins

Mary E. Moore Thomas A. White

AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Staff Announcements

Angela Keyser , College Park, MD

HQ Team... At Your Service!

AAPM IS Team AAPM has an Information Services team of seven professionals who are hard at work in support of AAPM’s growing electronic presence. Although their valuable work is often behind the scenes, the IS team plays a vital role in all HQ service areas.

Michael Woodward joined the staff in October 1996 as Internet Services Manager. As AAPM’s first Webmaster, Michael worked closely with the newly formed Electronic Media Coordinating Committee (EMCC) to develop AAPM’s web presence. With the reorganization of the IS department in 1998, Michael was promoted to Director, Information Services. Michael continues to play a critical role in AAPM’s HQ operations, as a member of the Management Team, leading the IS efforts and overseeing the Membership and Journal areas.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Farhana Khan started with AAPM in May 1998, as a temporary staff

person and was later hired full-time to gear up for AAPM’s management of the Chicago 2000 World Congress. After the World Congress, Farhana was named as AAPM’s Webmistress. Farhana works closely with Website Editor Chris Marshall to maintain and enhance AAPM’s web presence. She is also responsible for AAPM email services and a number of other sites hosted by AAPM. She is our resident “graphic designer” and works closely with the staff to create logos for meetings and other programs.

Zailu Gao joined the IS team in March 2001 as an Applications Develop-

er and was promoted to Senior Applications Developer at the end of 2003.

Zailu’s primary responsibility is the e-commerce systems that AAPM uses for everything from dues payment to donations. Zailu is also responsible for the Medical Physics Continuing Education Credit quiz system and the meeting evaluation systems used during the Annual and Spring Clinical Meetings. His next big project is working to integrate a mobile meeting evaluation system into the iOS and Android meeting apps that were introduced at the 2012 meeting.

Jennifer Hudson began her career with AAPM in April 2001 as the Re-

ceptionist and was promoted to Membership Services Coordinator in 2004 and Membership Manager in 2012. In 2006, the membership process was moved to the IS team in recognition that the AAPM database and website are an integral part of the membership process. Jennifer serves as the first point of contact for membership questions and works closely with the Membership Committee in the review and processing of membership applications and requests.

Yan-Hong Xing, AAPM’s Database Administrator, joined the team in

October of 2006. She handles all technical matters related to the Associations’ databases as well as fulfillment of mailing list orders.

Tammy Conquest came on board in November of 2007 as an Applica-

tions Developer. Tammy is responsible for design and implementation of new and existing database programs. One of Tammy’s first projects was the complete rewrite of the CAMPEP CEC database. Since then she has rewritten the interface for meeting abstract submission, streamlined the systems used to manage committee rosters and created a document management system to handle changes to AAPM’s governance documents. She also teaches a class at the annual meeting on committee wikis.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Onasis Budisantoso, joined the IS team in May of 2008 as an Appli-

cations Developer. He has been instrumental in developing the “AAPM events that pertain to you…” functionality on the web site. He has also written several programs that assist with HQ administrative functions like an automated timekeeping system, committee scheduling, and tracking of fellowship and scholarship applications. His most recent program was the AAPM Residency Common Application (CAP), which is building the framework for an eventual match system.

Coming next issue….group profile of the AAPM Accounting team.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

The New Professional

Scott Wyler, Hunt, TX

Medical Physics as a profession

T

his article was initially intended to provide some basic principles on professional development for Medical Physicists, especially for newer AAPM members. It became evident that an understanding of the development of Medical Physics as a profession would also be beneficial.

A brief description of efforts by the AAPM to establish Medical Physics as a profession will be provided, followed by current resources available through official AAPM and AAPM-sponsored channels, and, finally in the second part, some basic information on professionalism and professional development from resources supplemental to the official offerings.

This article is written under the guidance of the New Professionals Sub-Committee, so it would appear that as Medical Physicists we have an assumption of earning and being respected as professionals, maybe even as Medical Professionals. There are several basic steps that are universally accepted for formation of a profession: 1.

2.

3.

4.

5.

6.

7.

Became a full-time occupation Establish first training school Establish first university school Establish first local association Establish first national association Introduce codes of professional ethics Establish State licensing laws

These ideas, as well as the importance and challenges of establishing and maintaining professionalism, are also echoed in a presentation by the ABR Executive Director in November 2012.

The presentation by the ABR Executive Director was especially impressive, as the importance of the topic was not something that has been overly evident in the Medical Physics community.

Why put effort into obtaining a professional standing? Being a member of a profession implies quite a bit, if you read the entirety of the Wikipedia link in the second paragraph of this article.

Those items are: autonomy, power, status, and prestige. Additionally, the items are automatically achieved, deservedly so or not, by each member of the specific profession. The Medical Physics community has a little bit of an identity crisis anyway; adding some automatic qualifi-

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

ers would go a long way in helping pin down that identity. This topic was covered at the 2008 AAPM Annual Meeting and is available in the Virtual Library. All five presentations in this series are extremely valuable and entertaining.

Looking at the seven steps for formation of a profession, it appears, from the standpoint of Medical Physics, that the first five are complete and the last two are works in progress.

The ABR presentation described the process of developing professionalism on the first informative slide, slide 3, with indications that a key part of the process occurs in residency. Residency is the key mechanism for introducing the practical aspects of professional ethics and the general understanding of professionalism. The CAMPEP residency requirements for ABR certification in Medical Physics have been the topic of discussion and projections for the last several years. Regardless of what other reasoning was behind these requirements, it was a necessary step for Medical Physics to achieve profession status. With the CAMPEP residency requirements has come additional information provided by the AAPM to achieve the intentions of developing professionalism: 1.

2.

3.

4.

CAMPEP residency guidelines, specifically page 14, with requirements for standardizing professional and ethical curriculum by July 2013.

TG 159, published in 2010.

A group focused on the Education of Medical Physicists in the United States, established in August 2012.

On-line modules on Ethics and Professionalism, co-sponsored by seven organizations.

The on-line modules are currently the standard for ethics and professionalism among the resources listed above for Medical Physics, with the CAMPEP requirements of utilization or development of a similar curriculum. It should not be a surprise that the multi-organizational sponsored modules have very limited direct mention of Medical Physics, but it is still the standard. The standard for non-curriculum instances would be the actual Code of Ethics from the AAPM developed by Task Group 109 and quick guidance on use and understanding.

The last step in the development of a profession is state licensing. Currently there are four states that license Medical Physicists and seventeen that do not even register Medical Physicists, with the remainders falling in the middle as requiring registration or in the process of requiring licensure. Fulfilling this last step in establishment of Medical Physics as a profession will require initiating licensure in 92% of the individual States, not including the District of Columbia and Puerto Rico. The long-awaited CARE Bill, if passed, could go a long way in seeing the licensing component achieved, or may provide a push to get the idea rolling.

As you can see, the idea of professionalism and being a member of a profession still re-

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

quire effort by the Medical Physics community. The CAMPEP requirement for residency is a promising step that meets the intent of the sixth step of the formation of a profession. These global challenges for Medical Physics should not deter you from developing professionally and establishing your working conditions and professional behavior locally. The skills to being a good professional are debatable, just like the skills to being a good parent, spouse, and other roles. Ultimately, it is up to each person to actively add skills that can be utilized to enhance their careers as professionals and to raise the overall level of professionalism in Medical Physics.

The second part of this article will be presented in the next Newsletter. It will provide a few helpful ideas pertaining to professionalism, along with links to presentations that demonstrate those ideas much better than a short article could.

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AAPM Newsletter | Volume 38 No. 2 | March/April 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 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.

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

ABR Physics Trustees’ Report

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

Maintenance of Certification for Medical Physicists Component Two: Lifelong Learning and Self-Assessment

T

he second part of Maintenance of Certification (MOC) focuses on lifelong learning and self-assessment. The major function of this part is continuing education. For physicists, continuing education developed later than it did for physicians. In the 1920s, it was recognized that continuing education was important because knowledge atrophied as one moved farther and farther away from training, and new medical skills needed to be learned. In 1934, urology became the first specialty to make continuing education mandatory.

As the need for continuing education evolved, the necessity of a regulatory body to ensure that education programs met some minimum standards was acknowledged. In 1981, the American Medical Association (AMA) created the Accreditation Council for Continuing Medical Education (ACCME). The Commission on Accreditation of Medical Physics Educational Programs (CAMPEP), which was incorporated in 1994, provides a similar role for medical physics continuing education standards.

Most states and many medical institutions made continuing education (CE) mandatory for physicians. A common requirement is an average of 50 hours per year. In medical physics, CE activities are part of the Mammography Quality Standards Act (MQSA) requirements, are included in the American College of Radiology (ACR) accreditation process, and are required by many institutions and some states.

With the advent of time-limited certification for medical physicists in 2002, MOC became mandatory for new medical physicist diplomates. At that time, it was recognized that self-assessment should be a significant requirement of MOC because individuals tend to seek continuing education in areas where they are already comfortable, and not necessarily in areas where they are weak. As a consequence, they may ignore continuing education opportunities in the areas where they most need them. Thus, self-assessment modules (SAMs) were included in the MOC process to encourage diplomates to explore weaknesses in their knowledge. The original requirement was: • 20 Self-assessment Modules (SAMs)

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

• 250 hours of continuing education over a 10-year MOC cycle General and Specific Issues with MOC Part 2 Continuing Education Certain general issues regarding continuing education have been observed in many areas. In

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

terms of MOC requirements, one problem was that at seven years into the 10-year cycle, a diplomate could reach a point where it would be impossible to meet the requirements, and a loss of certification was inevitable. There was also an issue associated with the limited availability of SAMs. While it was not too difficult to complete 20 SAMs in 10 years, it was somewhat difficult to find SAMs in various areas of practice. The ACCME, the American Board of Medical Specialties (ABMS), and the ABR recognized these issues and revised the requirements for continuing education under Part 2 of MOC. Revised MOC Part 2 Requirements The general requirements for the revised MOC process were described in the January/February 2013 AAPM Newsletter and are available on the ABR website. The biggest change is an increase in the number of required self-assessment continuing education hours and an expansion in the activities that may be considered self assessment. The current requirement is 75 hours of continuing education credits in the past three years. At least 25 of the 75 CE credits must be self-assessment continuing education (SA-CE). SAMs will still be included in this category, and the ABR has been making it easier to qualify SAMs material. In addition, the ABR will count all AMA Category 1 CME activities in “enduring materials” (including web-based and print) and “journal-based CME” formats toward the MOC self-assessment requirement.

According to recently adopted AMA policy for CME, these activities include the following features that suit them for use as self-assessment tools:

• They provide an assessment of the learner that measures achievement of the educational purpose and/or objective(s) of the activity with an established minimum performance level; examples include, but are not limited to, patient-management case studies, a post-test, and/or the application of new concepts in response to simulated problems.

• They communicate to the participants the minimum performance level that must be demonstrated in the assessment in order to successfully complete the activity for AMA Physician Recognition Award (PRA) Category 1 Credit™.

• They provide a reference to appropriate bibliographic sources to allow for further study.

Credits from the AAPM Virtual Library are an example of SA-CE, but there are many others as well. The ABR has been working with CAMPEP to make a clear distinction between CE and SA-CE on CAMPEP transcripts, but that will take some time.

Decennial SDEP on Quality Improvement Theme

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

Medical physicists can be important assets in the design, execution, and analysis of a quality improvement project. Their training in scientific analysis, data collection, and planning brings skills to the quality process that are, in many cases, unique to medical physicists. In order to meet this need, medical physicists must learn the unique details of quality improvement that are relevant to medical physics, diagnostic radiology, nuclear medicine, and radiation therapy.

Thus, there is an MOC Part 2 requirement that each medical physicist diplomate complete a quality improvement self-directed educational project (QI-SDEP) once every 10 years. Guidelines for QI-SDEP are the same as for traditional SDEP, with the educational need focused on quality improvement.

How Part 2 Fits With Overall Continuous Certification Under continuous certification, which was implemented in 2012, new ABR certificates no longer have “valid-through” dates. Instead, on each new certificate, the date of initial certification is noted and accompanied by the statement that “ongoing validity of this certificate is contingent upon meeting the requirements of Maintenance of Certification.” For each diplomate who is currently enrolled in MOC, continuous certification has replaced the 10-year MOC cycle.

Progress will be evaluated annually on March 15, using a rolling calendar-year “look-back” (see Table 1). The March 15, 2013, look-back will evaluate licensure/professional standing and passage of the MOC exam within the past 10 years (see Table 2). The first “full” annual look-back, including MOC Parts 1-4 and fees, will occur in March 2016. As indicated in the tables below, the Part 2 look-backs cover the past three years for continuing education (SA-CE) and the past ten years for QI-SDEP. The first full look-back for Parts 2 and 4 will be on March 15, 2016.

The MOC status of ABR diplomates will soon be posted on the ABMS website, following the 2013 look-back. Each diplomate will be reported as: • Meeting the Requirements of Maintenance of Certification • Not Meeting the Requirements of Maintenance of Certification • Not required to Participate in Maintenance of Certification (lifetime-certified diplomates) The ABMS website will refer users to the ABR website (www.theabr.org), where further information will be found. The ABR’s website is being enhanced to include its own online verification database of our diplomates, which will also be available in spring 2013. Diplomates who are meeting the requirements of MOC will be listed as such. If they are not, they will be listed as “certified, not meeting the requirements of MOC.” If they do not remove the deficiency within one year, they will be listed as “not certified.” At any time, they can go back to the “certified, meeting the requirements of MOC” status by removing the deficiency. Lifetime certificate hold-

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013

ers enrolled in MOC revert to their “certified, not required to participate in MOC” status if they do not meet the requirements.

Table 1. How Does Continuous Certification Work?

MOC Year Look-back date

Element(s) checked

2012 3/15/2013 Licensure or Professional Standing Attestation/Exam 2013 3/15/2014 Licensure or Professional Standing Attestation/Exam 2014 3/15/2015 Licensure or Professional Standing Attestation/Exam 2015 3/15/2016 Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, Exam, PQI, and Fees 2016 3/15/2017 Licensure or Professional Standing Attestation, CE/ SA-CE, QI-SDEP, Exam, PQI, and Fees 2017 3/15/2018 Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP , Exam, PQI, and Fees 2018 3/15/2019 Licensure or Professional Standing Attestation, CE/ SA-CE, QI-SDEP, Exam, PQI, and Fees 20XX 3/15/20XX Licensure or Professional Standing Attestation, CE/SA-CE, QI-SDEP, Exam, PQI, and Fees Table 2. Status Check for “Meeting Requirements”

Element

Compliance Requirement

Licensure CE SA-CE QI-SDEP

Exam PQI Fees

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 3 years

MOC is a constantly evolving process that changes as the needs of the diplomates and the public change, but the ABR tries to minimize the frequency of such changes. The change to continuous certification should make MOC easier and more meaningful to diplomates. The

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ABR is always glad to answer questions about any aspects of certification or Maintenance of Certification.

Questions?

MOC Questions: (520) 256-2152 email: abrmocp@theabr.org Initial Certification Questions: (520) 790-2900 email: icnotification@theabr.org

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AAPM Newsletter | Volume 38 No. 2 | March/April 2013