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
MAY/JUNE 2013 Volume 38 No. 3
STRATEGY AAPM Chairman of the Board Garry A. Ezzell reveals AAPM’s Strategic Planning Process
Twelve steps to help you transition from planning to success professionally Radiation Oncology Payment Codes Under Scrutiny
The new code “Q9699” Education Council Report Overhaul of Radiation Oncology Reimbursements by CMS
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: July/August Submission Deadline: June 12, 2013 Posted On-Line: Week of July 1, 2013
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CONTENTS MAY/JUNE 2013 Volume 38 No. 3
Articles in this Issue
Events / Announcements
AAPM President’s Column
3
AAPM Career Services
15
Chairman of the Board’s Column
6
Summer School
15
AAPM President-Elect’s Column
9
ICMP Conference Invitation
16
AAPM Executive Director’s Column
11
Awards and Honors Winners
24
Editor’s Column
14
Election Announcement
35
Treasurer’s Column
18
Professional Council Column
22
2014 Spring Clinical Meeting
48
Legislative & Regulatory Affairs Report 27
Call for Deceased Members
54
44
Education Council Report
29
International Day of Medical Physics
ABR Physics Trustees’ Report
33
Staff Announcements
Health Policy & Economic Issues
37
Medical Physics International Journal 71
Risk of Medical Imaging
41
CAMPEP News
49
Editor’s Note
New Profess. Subcommittee Report
51
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.
54 2013 Spring Clinical Meeting Notes
56
Persons in the News
59
ISEP Workshop Report
61
AAPM History Committee Report
65
Medical Physics Education in Greece
67
63
AAPM President’s Column
John D. Hazle, Houston, TX
I
continue to be amazed at the level of commitment of our volunteers and their achievements. We have an active and vibrant organization in large part due to the 1,500 or so members who serve on councils, committees and task groups --- and who make contributions at their own institution that makes a difference in the lives of patients who seek care at our institutions. Our members often receive special recognition for the contributions they make to their own institutions as well. A case in point, on March 12 Columbia University honored Ed Nickoloff upon the occasion of his retirement. Larry Rothenberg attended this event along with many other of Ed’s friends and was kind enough to provide a summary. On this special occasion, Ed was accompanied by his wife Diane, daughter Andrea and son Edward, Jr. Columbia Radiology Chair, Dr. Lawrence Schwartz, gave the introduction of a special seminar by Dr. Joe Deasy in Ed’s honor and thanked Ed for his more than 30 years of valuable service to Columbia University. This service to Columbia is in parallel with the 30 years of service Ed gave to AAPM. At the conclusion of the lecture Ed thanked all of those with whom he has worked and collaborated during his career. The event was attended by many medical physicists and radiologists from around the US, the President and several Vice Presidents of NY Presbyterian Hospital (Cornell/Columbia). On March 15, the faculty of the Columbia University Medical Physics Graduate Program further honored Ed for his many years of dedicated teaching at a luncheon at the Columbia Faculty House. All of us in AAPM wish Ed great success and happiness in his retirement, and congratulate him on his contributions to the AAPM as he currently faces some challenging health issues. We continue to be knee-deep in the strategic planning process, which Gary will discuss further in his article. However, I did want to comment on how well that process is working relative to when I came into the executive chain almost two years ago. The process at that time, and strategic planning is a process, was maturing and in considerable flux. With outstanding leadership and a strong commitment from the Strategic Planning Committee (SPC), the last meeting of the SPC at the Spring Clinical Meeting was highly productive. The committee has settled into internal processes that allow for open and productive discussions. There was an obvious lack of self-serving posturing that can derail discussions where priorities are set, and a full helping of cooperation to achieve the best for the association from everyone at the meeting, which now includes the four council chairs as ex officio, non-voting members. Hats off to the
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
SPC for making great progress in helping position AAPM for a bright future! Following the SPC meeting, the Executive Committee decided to create an new ad hoc committee to evaluate how we are globally interacting with our corporate partners and to make recommendations on considerations on how to maximize these interactions in the future. We are fortunate that Rock Mackie has agreed to chair that committee. We are working to finalize the charge and membership. Rock brings not only enthusiasm to the task, but outstanding knowledge of the industry side of the equation from his prior commercial experience. Our corporate partners are important supporters of the organization and making sure that we are meeting their needs in a comprehensive manner will be important for our relationships going forward. The annual meeting in Indianapolis is rapidly approaching and I hope that all who can will attend. Jeff Siewerdsen and his team (Stan Benedict, Kristy Brock, Chris Diederich, Lei Dong, Paul Kinahan and Lifeng Yu) have put together an outstanding scientific program, Robin Stern and her team (Stan Benedict, Zhengfeng Lu, Nicole Ranger, Kamil Yenice) have put together an education program that is second to none, and Doug Pfeiffer and Russ Tarver have put together an exceptional professional program. Hats are also off to Bret Heintz and Chris Serago, the Meeting Coordination Committee chair and vice-chair, respectively, for making this a highly integrated program. The meeting really does have something for everyone! And if you are into game shows, you must attend the Physics Pheud Wednesday afternoon at the annual meeting. Gary Ezzell and I will be leading teams to demonstrate our knowledge --or lack thereof --- in all matters related to medical physics!!! I plan to wear my Houston Texans J.J. Watt jersey as a demonstration of my intent that his be a “full contact” event with no holds barred! The committee is putting together teams, I don’t even know who they are, to vie for the honor of being the Phirst Physcis Pheud champion! Plus, John “Badger” Bayouth will be moderator and judge, Marc Kessler is the host and Kristy Brock is the roving reporter --- so the entertainment value should be high! And for newer members, don’t forget about the New Member Symposium Tuesday afternoon in Room 137. This is a great way to learn about the association and meet new people. I plan to be there to mingle and chat. And if you want to address the Board, the Annual Business Meeting and Town Hall will be Wednesday afternoon at 6:15 in the Wabash Ballroom. All Board members, including the Executive Committee, will be in attendance to discuss some current topics and answer your questions. A final word on the annual meeting is to remind everyone of the Awards and Honors Ceremony and reception Monday afternoon. This is a time when we can celebrate the highest achievements of our colleagues. This years award recipients are truly outstanding. If you are an expeAAPM Newsletter | Volume 38 No. 3 | May/June 2013
rienced AAPM member, be there to celebrate with your peers --- if you are a newer member, be there to meet new people, including the award winners! So in closing for this Newsletter, thanks to all who give graciously of their time and energy. The association would not exist if not for your effort.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Chairman of the Board’s Column
Gary A. Ezzell, Phoenix, AZ
Recent ctivities of the Strategic Planning Committee of the Board
G
oing somewhere? It is important to know where you want to go. Getting somewhere? How do you know? The Strategic Planning Committee of the Board helps the AAPM set its direction and monitor its progress. The SPC met over two days at the Spring Clinical Meeting in March and welcomed Gene Cardarelli and Mark Oldham as they start their three-year terms. As Chairman of the Board, I chair this committee, and so will take this opportunity to report to the membership about its activities. The QVSQPTF PG UIF TUSBUFHJD QMBOOJOH QSPDFTT is to advance ""1. T GVOEBNFOUBM NJTTJPO BOE HPBMT by deciding which issues need primary attention now and over the next three to five years. These are also the issues that the Board wants to monitor most closely to make sure that our resources, both time and money, are deployed effectively. The Board’s Strategic Planning Committee reviews the plan and progress, surveys our changing environment, and makes recommendations for the full Board’s consideration. In this fashion, we try to blend the advantages of small group discussions with the broad representation provided by the full Board. We spent the first part of the meeting reviewing the current strategic plan that we refined last year. Each council and the Executive Committee reported on their major initiatives. Some highlights: Education Council has been charged with promoting new medical physics residencies, especially in imaging. Following action at the summer meeting, a promotional program was been set up (chaired by Bob Pizzutiello), funded by both AAPM and RSNA, to stimulate new imaging physics residencies by providing partial financial support. Applicant programs would provide the rest of the funds and commit to becoming sustained and CAMPEP-accredited. Nine potential new programs applied, and in early April the first three recipients were announced. Professional Council has been developing Medical Physics Practice Guidelines with Joann Prisciandaro as chair of the subcommittee overseeing imaging and therapy guidelines. These documents will guide regulators and accrediting agencies to appropriate assessments of
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
performance, combating the tendency to use task group reports as standards. The first two are nearing publication in JACMP, and the Board has increased the budget for 2013 to bring more to completion. Science Council is overseeing AAPM’s partnership with ASTRO in developing a national incident learning system in conjunction with a recognized Patient Safety Organization. Look for a session at the summer meeting describing how this important effort will work. President John Hazle has established ad hoc committees on Headquarters Space Needs, in advance of our lease renewal term, on Meetings Strategy (chaired by Bob Gould), to recommend how the Annual Meeting, Spring Clinical Meeting, Summer School, and specialty meetings can be organized cohesively, and on Journal Publications (chaired by Ken Hogstrom), to take on a number of issues related to the different models by which Medical Physics and JACMP currently operate. Last fall, the Budget Subcommittee struggled with decisions related to AAPM’s support of various international activities and asked for guidance from the Board. The SPC recommended continuing our practice of funding established regional educational programs at current levels (~0.8% of total budget) while expecting clear deliverables and metrics for evaluation. We confirmed the importance of participating in international standards activities, such as DICOM and IEC TAGs, but also discovered that support was being handled inconsistently within AAPM. Science Council was asked to establish a coordinating working group. The committee considered how our environment is changing and will be bringing some recommendations to the Board. Again, some highlights: 1.
2.
AAPM would be well served to be more careful and creative about our relations with vendors with respect to sponsorship and advertising. a.
Recommendation: HQ should request proposals from consultants with track records working with organizations such as ours
b.
Recommendation: EXCOM should establish an ad hoc committee of volunteers to work with HQ and make recommendations to the Board
Practice accreditation, tied to reimbursement, exists in some imaging contexts. How might this play out, and how should AAPM position itself? a.
7
Recommendation: a strategic goal is for recognition of the Qualified Medical Physicist to be part of accreditation standards in imaging and therapy that are tied to reimbursement. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
3.
Members/volunteers are progressively more stretched, and we could accomplish more with dedicated staff support. Can we re-allocate and possibly augment our staff in order to be more effective as an organization? Can we afford to do so? a.
Recommendation: AAPM should invest in staff support to implement important strategic initiatives, recognizing the limitations of volunteers to commit dedicated time. Examples may include, subject to recommendations from Councils: i. Developing practice guidelines ii. Supporting state regulatory initiatives and national accreditation programs iii. Developing and maintaining a residency match program
4.
Medical physicists need leadership and management skills not taught in graduate school. a.
Recommendation: it is a strategic need for medical physicists to be strong leaders and managers. Professional Council is investigating options for substantive training methods to address this need, and this should receive Board support.
I hope this summary illustrates how the Board’s Strategic Planning Committee is helping to provide direction that arises from the membership through your elected representatives. This is the goal – to meld the strengths of our large, broadly representative Board with those of a smaller subset that can meet longer and more frequently.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
AAPM President-Elect’s Column
John E. Bayouth, Iowa City, IA
O
ur professional society is driven by its membership. As members we often become passionate about particular causes; many of us have volunteered countless hours to AAPM activities to improve our organization, educate our members and other professionals, disseminate and promote science, and improve the lives of the patients we are so fortunate to serve. I am grateful to our members who invest so much energy and resources into these efforts. Progress is best achieved when great ideas are implemented by individuals with passion and skill. But even this may be inadequate to produce the desired results. AAPM leadership seeks to help our organization achieve its greatest successes. Great ideas, skills, and passion are necessary ingredients, but the proof is measured by outcome. Many of our planned projects struggle to make progress. Sometimes the task is too large for a volunteer effort to successfully move forwards. Other times the money that is allocated is never spent. These are not only failed attempts to make progress on a particular issue which we had recognized as important, but it takes potential funding away from other worthwhile projects that could have been accomplished if supported. The worst scenario is found in projects that do spend their allocation but have little (if anything) to show for their efforts. With the arrival of Spring comes the beginning of AAPM budget season. Nearly 250 different councils, committees, subcommittees, task groups, and working groups will be thinking about their activities for 2014 and putting together their budgets. Nearly all of these groups are filled with volunteer members who have excellent ideas, skill, and passion for their topics. What many of these groups lack are clear deliverables and accountability. As we consider how to best invest the resources of our organization several criteria need to be met: addressing an important need/problem, current or proposed approaches are likely to be successful, and current efforts to address the need/issue are making measurable progress towards the desired outcome. The focus should be on outcomes and value. These are concepts that apply to all aspects of Medical Physics. Research study sections are not going to fund research concepts that do not address significant problems nor will they fund proposals that are ill designed for success. Projects that are funded will not be renewed if substantial progress has not been demonstrated. In the clinical arena we are increasingly challenged to show that the implementation of new
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
technologies within the clinic will generate an adequate level of reimbursement to justify purchase of the technology. Meanwhile payers of healthcare services (insurance providers, Medicare/Medicaid) are beginning to request data that demonstrates improved outcomes for those advanced services to justify the reimbursement. I encourage all who seek AAPM support to clearly define what they would like to accomplish, along with their strategy for doing so and the work products. Requests range from hundreds of dollars to many thousands of dollars. Council Chairs (Administrative, Education, Professional, and Science) do an excellent job of ranking and prioritizing requests at the Council level, but how do we balance these requests for the organization as a whole? As requests make their way towards the Board of Directors at the RSNA for a final vote in November, I encourage all within the process to challenge all of our “great ideas� to articulate how can progress/success be demonstrated and the value in achieving outcomes.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
AAPM Executive Director’s Column
Angela R. Keyser, College Park, MD
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Editor’s Column
Mahadevappa Mahesh, Baltimore, MD
8
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
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 is Now Open. 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 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).
“AAPM Career Services now features a catalog of expert recruiting advice for employers hiring and expert ca
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
You are invited ! The International Organization of Medical Physics (IOMP), the European Federation of Organisations for Medical Physics (EFOMP), and the Institute of Physics and Engineering in Medicine (IPEM) are delighted to invite you to attend the International Conference on Medical Physics 2013 (ICMP 2013) This is going to be an exciting and significant event in the Medical Physics calendar, and will take place in Brighton, UK, from the 1st – 4th September 2013 at the Brighton Conference Centre, less than 40 minutes by train from Gatwick International Airport. The conference theme is broad: “New horizons; global and scientific.” It will showcase current research and provide insights into the future contributions of science and technology to healthcare. The conference also coincides with the 50th Anniversary Celebration of the foundation of the IOMP so will link both historic and future elements of medical physics. There will be a full program of parallel scientific sessions, satellite meetings, public engagement sessions and an exhibition. We look forward to seeing you in Brighton. ICMP 2013 organizing committee
Brighton
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
AAPM Treasurer’s Report
Matthew B. Podgorsak, Buffalo, NY
The udget ycle
I
would like to provide an overview of how the $9 million annual budget of the AAPM is developed. The figure labeled ‘Budget Process’ tells the story pictorially, with details following below. The first step in the budget process occurs when the Strategic Planning Committee of the Board of Directors meets annually in early spring. This meeting just took place in mid-March, where the committee reviewed progress on the current strategic objectives previously determined by the Board. This review and analysis establishes criteria for prioritizing projects for the next year.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Also in the spring, shortly after the books for the previous year have been closed, the accounting team, led by Cecilia Hunter, AAPM’s Director of Finance and Administration, applies the audited figures for the year just closed to a statistical model that is used to estimate both revenue and expenses for the upcoming year. This predictive model attempts to account for large inconsistencies in budgeting for projects carried out by the volunteers. Many proposed projects never reach fruition in their originating year and the model provides a rational bottom line based on historical income and expenses. The overall budget is then built to mirror the model’s projections. The next step in the process is definition, estimation and allocation of staff resources to both ongoing and strategic initiatives. In May of each year the AAPM Management Team meets to analyze the previous twelve months of staff time, evaluates the hours spent on programs and services, and reviews all job descriptions to ensure the personnel needed to meet objectives is in place. The Management Team makes an estimate of the staff hours needed for each program. Job descriptions are revised or edited as necessary and forwarded to the Human Resources Department at the American Institute of Physics (AIP). The AIP Compensation and Benefits Manager, Jonathan Goodwin, reviews and evaluates the positions and their relevant duties, and compares them with current market conditions in the scientific association community. A report is sent to Angela Keyser, our association’s Executive Director, who prepares the draft salary recommendations and sends them to the AAPM Compensation Committee. The Committee has responsibility for reviewing the Executive Director’s recommendations. Based on the evaluation of personnel needs, the budget process begins in earnest at Headquarters in June when the accounting team develops an estimate of general administrative and overhead needs. At the beginning of July, and again immediately prior to the Annual Meeting, committee chairs are notified to begin their budget planning process. Chairs are sent instructions, along with a timetable for submitting their group’s budget. All chairs are asked to put an agenda item regarding budget on their committee agenda during the meeting. Each group is required to submit a budget if they determine a project will need funding the following year. Examples are teleconference calls, report production, and travel, along with other initiative-specific costs. A pre-formatted spreadsheet showing the previous year’s actual revenue and expenses, along with the current budget and year-to-date figures, is distributed to each chair, who then enters his/her funding needs for the upcoming budget year. Chairs submit their requests to headquarters by the end of August. During the month of September, staff compiles the data into a total budget workbook. Council chairs work with their staff liaisons in putting together their Council budget, incorporating the requests of all of the committees, sub-committees, workgroups, and task groups that report to the Council. This
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function occupies the accounting team and the liaisons through the month of September. Chairs are encouraged through the Strategic Planning Committee to develop programs that meet the priorities established in the preceding spring. In early October, the Budget Subcommittee (BSC) receives a draft budget, including all of the backup documentation submitted by the committees. The sub-committee meets at AAPM Headquarters in mid-October and reviews all of the submissions. Council Chairs are invited to present their budgets and provide input on the funding they are requesting. BSC deliberates and approves a draft budget for submission to the full Finance Committee (FINCOM). Chairs of groups whose budgets were modified by the BSC, are notified by headquarters of the changes recommended by the BSC and are given up to ten days to appeal to FINCOM to have their original submissions reinstated. FINCOM meets via teleconference to review all appeals, and to approve a budget for submission to the Board of Directors at their RSNA meeting. Final appeals can be made to the Board from any group wishing to contest the recommendations of either BSC or FINCOM. The budget is deliberated by the full Board and the Treasurer calls for a motion to approve the budget either as submitted or as modified at the meeting. The new budget becomes effective on January 1. Fortunately, the AAPM leadership has been working diligently on strategic planning during the past several years. This goes a long way toward directing what the association’s priorities are with respect to allocating revenue, and is critical to effective budget development that allows the AAPM to satisfy its mission and achieve its goals.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
EXRADIN!W"!SCINTILLATOR Exradin W1 Scintillator imaged at 35 kVp in air
The Exradin W1 Scintillator is a new detector whose unrivaled near-water equivalent characteristics produce a more natural dose measurement.
reducing beam perturbation and negating measurement corrections necessary with other detectors. 1mm spatial resolution makes the W1 a perfect tool for SRS and SBRT with Gamma Knife®, Cyberknife®, BrainLab®, Varian®, Elekta® and TomoTherapy® systems. Pair the W1 with the SuperMAX Electrometer to effectively eliminate Cherenkov effect without the need for extraneous calculations. Other detectors imaged at 70 kVp in air
Visit us on the web! www.standardimaging.com/scintillator
Professional Council Column
Per Halvorsen, Newton, MA
A
s you may know, we are facing an unprecedented scope of review of the procedure codes (CPT codes) used to reimburse for radiation oncology services. As explained in further detail in Wendy Smith Fuss’ article elsewhere in this /FXTMFUUFS, in the 2013 Medicare Physician Fee Schedule final rule, CMS identified 23 radiation oncology codes that require further review and evaluation. Several of these codes will likely be revised with new payments effective in January 2014. The AAPM’s Professional Economics Committee, with Wendy’s able help, is actively working to ensure that CMS has reliable and realistic information to inform its review process. In addition, the AAPM is working with ASTRO and CMS to revalue the weekly medical physics consultation code (i.e., CPT 77336) for 2014. This year’s events highlight the importance of having a group of experts who understand the multi-faceted process for determining CMS’ dollar value for each CPT code so our small specialty can be fairly represented when the resources are allocated at the national level. We are fortunate to have several colleagues with significant experience in this area, led by the Committee Chair, Jim Goodwin. If you are a clinical radiotherapy physicist, look up the committee roster on the AAPM website and thank these volunteers for their tireless work on your behalf.
New Subcommittee on Accreditation Accreditation of clinical programs in imaging and radiation oncology is rapidly gaining prominence, fueled in large part by the 2008 MIPPA law affecting advanced imaging facilities and state-level initiatives to require accreditation (or external reviews) in both imaging and radiation oncology. In response, we are in the process of forming a Subcommittee on Accreditation which will be focused on how the AAPM can support the various accreditation programs to promote consistent standards for the programs’ medical physics and patient safety aspects. Hopefully the subcommittee will be constituted in time for the Annual Meeting, so stay tuned for more information in the months ahead.
Medical Physics Practice Guideline on Supervision in Clinical Medical Physics 8JUIJO NFEJDBM GBDJMJUJFT JU JT PGUFO OFDFTTBSZ PS EFTJSBCMF GPS JOEJWJEVBMT PUIFS UIBO UIF
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Qualified Medical Physicist (QMP) to perform functions generally designated as the practice of med-ical physics, such as for the training of medical physics students or residents, or for the efficient and cost-effective collection of data. In such circumstances, the individuals performing these functions must be appropriately supervised and the scope of the functions to be performed must be carefully defined. Building on the work begun by the 2011 Ad-Hoc Committee on Su-pervision in Imaging Physics, this practice guideline aims to establish appropriate supervision and scope for non-QMP individuals performing medical physics related tasks in both imaging and radiation oncology. As with all Medical Physics Practice Guidelines, the draft guideline will be made available for a 30-day Open Comment period for all AAPM members to provide input into the draft before it is finalized. The draft document should be available for your re-view and input later this year.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Congratulations to the recipients of the following awards,
achievements & honors in 2013! William D. Coolidge Award: Benedick Fraass, PhD
Edith Quimby Lifetime Achievement Award: Caridad Borras, DSc Norbert J. Pelc, ScD George Starkschall, PhD
Marvin D. Williams Award: Marilyn Stovall, PhD
John Laughlin Young Scientist Award: Habib Zaidi, PhD
Honorary Membership: Donald L. Miller, MD
The following are named Fellows in 2013 for their distinguished contributions to the AAPM: Jon A. Anderson, PhD Kish Chakrabarti, PhD Lili Chen, PhD Carl R. Crawford, PhD Jun Deng, PhD Michael J. Dennis, PhD Nesrin Dogan, PhD David M. Gauntt, PhD Kalpana M. Kanal, PhD Jeffrey P. Limmer, MSc Chihray Liu, PhD Osama R. Mawlawi, PhD Todd R. McNutt, PhD Christopher F. Njeh, PhD Douglas E. Pfeiffer, MS Karl L. Prado, PhD
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Fellows in 2013 for their distinguished contributions to the AAPM continued: Frank Van den Heuvel, PhD D. Allan Wilkinson, PhD
Medical Physics Journal Paper Awards: Anatomical complexity in breast parenchyma and its implications for optimal breast imaging strategies, Lin Chen, Med. Phys. 39, 1435 (2012) Effects of protocol and obesity on dose conversion factors in adult body CT, Xiang Li, Med. Phys. 39, 6550 (2012)
Journal of Applied Clinical Medical Physics Paper Awards: The Award of Outstanding Radiation Oncology Article in 2012 entitled:
Feasibility of a remote, automated daily delivery verification of volumetric-modulated arc therapy treatments using a commercial record and verify system, Jonas D. Fontenot, The Journal of Applied Clinical Medical Physics, 13, 113 (2012)
The Award of Excellence for the Best Medical Imaging Article in 2012 entitled:
Mechanisms and prevention of thermal injury from gamma radiosurgery headframes during 3T MR imaging, Marcus C. Bennett, David B. Wiant, Jacob A. Gersh, Wendy Dolesh, X. Ding, Ryan C. M. Best, J.D. Bourland, The Journal of Applied Clinical Medical Physics, 13, 54 (2012)
The Award of Excellence for the Best Radiation Measurements Article in 2012 entitled:
Ion recombination correction factors (Pion) for Varian TrueBeam high-dose-rate therapy beams, Stephen F. Kry, Richard Popple, Andrea Molineu, David S. Followill, The Journal of Applied Clinical Medical Physics, 13, 318 (2012)
The Editor In Chief Award of Excellence for an Outstanding General Medical Physics Article in 2012 entitled:
Medical physics staffing for radiation oncology: a decade of experience in Ontario, Canada, Jerry J. Battista, Brenda G. Clark, Michael S. Patterson, Luc Beaulieu, Michael B. Sharpe, L. John Schreiner, Miller S. MacPherson, Jacob Van Dyk, The Journal of Applied Clinical Medical Physics, 13, 93 (2012)
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
You are Invited All of the award, achievement and honor recipients will be recognized during the 2013 AAPM Annual Meeting in Indianapolis, Indiana at the Awards and Honors Ceremony and Reception. Please join us in congratulating all of the recipients: DATE: Monday, August 5, 2013 TIME: 6:30 PM PLACE: Grand Ballroom J.W. Marriott
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Legislative and Regulatory Affairs Report
Lynne Fairobent, College Park, MD
“Q9969�?
I
n January 2013, the American Medical Isotope Production Act of 2012 went into effect.  The main objective is to establish a stable source of medical isotopes without using highly enriched uranium (HEU), weapons grade uranium enriched above 20%.  The Act essentially phases out the use of HEU commercially. This was passed as part of the National Defense Authorization Act for Fiscal Year 2013 and was signed into law by President Obama on January 2, 2013 [P.L. 112–239—JAN. 2, 2013; see section Division C—Department Of Energy National Security Authorizations And Other Authorizations Title XXXI—Department Of Energy National Security Programs; Subtitle F. American Medical Isotopes Production]. Also in January, as part of the Hospital Outpatient Prospective Payment System ()OPPS) the Centers for Medicare and Medicaid Services (CMS) established a temporary reimbursement code for Medicare patients treated in hospitals. The new code “Q9699� states that you will receive an additional $10 reimbursement for each patient administration of a Tc99m labeled dose, when that Tc99m is generated from Mo99 derived from a non-HEU source.  These sources may be low enriched uranium (LEU), or non-uranium target materials such as Mo98 or Mo100. CMS based this payment on the best available estimations of the marginal costs associated with non-HEU radioisotope production, pursuant to CMS’ authority described in section 1833(t)(2)(E) of the Act. This section allows CMS to establish “other adjustments as determined to be necessary to ensure equitable payments� under the )OPPS. The CMS reimbursement, consistent with White House Office of Science and Technology Policy, is an effort to encourage preferential procurement of non-HEU Tc99m before using HEU generated Tc99m.  This is an important part of the US government’s global threat reduction initiative under the Department of Energy’s National Nuclear Security Administration (NNSA). As non-HEU production ramps up, currently representing about 20-30% of global production, there is concern that the cheaper HEU Mo99 will be purchased over the slightly more costly non-HEU Tc99m.  The additional $10 is intended to cover the additional production costs of the non-HEU generated Tc99m.  In effect CMS has established a temporary two-tiered reimbursFNFOU TZTUFN GPS OPO )&6 BOE )&6 TPVSDFE 5D N UP SFGMFDU UIFTF IJHIFS DPTUT DPOTJTUFOU XJUI OBUJPOBM TFDVSJUZ QPMJDZ
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
When HEU is eventually eliminated commercially for Mo99 production, the temporary code, with the letter “Q”, will be eliminated. The reimbursement, which is set annually and always subject to change, will no longer be tiered to differentiate between the HEU and non-HEU sources. HEU is expected to phase out when global reactors shutdown or stop using HEU in the next few years. Most hospital administrators familiar with CMS reimbursement codes consider this a simple code to administer. However, it has not be widely advertised, so many stakeholders are either unaware or confused over the nature of this additional $10 reimbursement. Additional information can be found at the CMS’ Department of Health and Human Services Page and at the CMS Manual Sytem.
CARE Bill Introduced in U.S. House and Senate The Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy bill, S. 642, was introduced in the U.S. Senate on March 21. Sponsored by Sen. Mike Enzi, R-Wyo.; Sen. Tom Harkin, D-Iowa; and Sen. Al Franken, D-Minn., the CARE bill would set federal education and certification standards in the Medicare program for the technical personnel providing, planning and delivering all medical imaging examinations and radiation therapy treatments. With the introduction of S. 642, both chambers of Congress currently have versions of the CARE bill awaiting committee hearings. Rep. Ed Whitfield, R-Ky., introduced H.R. 1146 in the House of Representatives on March 13. AAPM continues to monitor both bills.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Education Council Report
George Starkschall, Houston, TX
M
any of you are by now familiar with the AAPM Strategic Plan. The AAPM Strategic Plan is a document that was recently developed to give our organization guidance in setting priorities for activities and initiatives for the next several years. The Plan consists of a set of objectives and strategies, all keyed to the goals of the AAPM. On a regular basis, the senior leadership of our organization provides updates to all of you as to the status of the implementation of the Strategic Plan. In a manner analogous to the AAPM Strategic Plan, the Education Council (EC) also has its own strategic plan, identifying a set of objectives and strategies and associating them to the goals of the AAPM. The EC Strategic Plan is not as formalized as the AAPM Strategic Plan, but it, too, provides guidance for the EC to set priorities for its activities and initiatives for the next several years. During the third week in March, after attending the AAPM Strategic Planning meeting in Phoenix, I attended the EC Strategic Planning meeting in Chicago. During this meeting, we reviewed the EC Strategic Plan, assessed our progress on the Plan, and made appropriate mid-course corrections to ensure our ability to complete the tasks identified in the plan in a timely manner. I would like to take this opportunity to share with you some of our accomplishments, and some of the directions in which we hope EC will be heading in the next few years.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Clearly, one of our highest priorities in education is to ensure that we have a sufficient number of residency positions that can provide clinical training to medical physicists to meet the manpower needs of our profession. We are making good progress towards meeting these goals, but we still have to make significant efforts to encourage more institutions to generate residency positions. One of the successes of an institution’s increasing its residency capability is the hub-and-spoke model developed by the Mary Bird Perkins Cancer Center (MBPCC) residency program. In order to increase the number of residency opportunities, primarily for graduates of the closely-affiliated Louisiana State University graduate program, the MBPCC program recruited the collaboration of several other clinical facilities in Louisiana and Mississippi, in which the MBPCC would provide administrative infrastructure and oversight (hub), while the affiliated facilities would provide the specific clinical training (spoke). In mid-February, AAPM held a workshop in New Orleans that provided the medical physics community the opportuni-ty to learn from the MBPCC experience. The workshop, organized by John Antolak, chair of Medical Physics Residency Training and Promotion Subcommittee, involved approximately 30 participants, some from hub programs wishing to set up spokes, others from potential spoke programs, wishing to affiliate with hubs. John Gibbons, Program Director of the MBPCC residency program, along with administrators and physicists from the spoke programs, gave presentations identifying the key issues in setting up their hub-and-spoke program. Initial response to the workshop was quite positive, but time will tell us how successful the workshop was in encouraging the establishment of more hub-and-spoke systems. Another issue that we are looking at involves providing administrative infrastructure for small residency programs. Several medical physics practices have indicated to us that they would be interested in establishing a residency program with perhaps a single resident, but they do not have the resources to provide the administrative infrastructure necessary to support a residency program. We have obtained funding from the AAPM Board of Directors to support a parttime administrator who can provide this support to a small residency program, but we need to get a better picture of what the specifics are of the administrative support that is needed. In the near future, we plan to issue a Request for Proposal from sites that desire administrative support. In this proposal we hope to obtain the specifics needed to move forward with providing one or more programs with this support. "OPUIFS BDUJWJUZ PO PVS MJTU PG TIPSU UFSN QSPKFDUT JT PVS POMJOF DPOUJOVJOH FEVDBUJPO FGGPSUT 8F CFMJFWF UIBU NBOZ PG PVS POMJOF PGGFSJOHT NBZ CF PG JOUFSFTU UP OPO NFNCFST PG UIF ""1. .BSLFUJOH UIFTF PGGFSJOHT UP OPO NFNCFST NBZ CF B EFTJSBCMF TPVSDF PG SFWFOVF UP PVS PSHBOJ[BUJPO 8F BSF MPPLJOH JOUP PCUBJOJOH DPOUJOVJOH FEVDBUJPO DSFEJU GPS PUIFS HSPVQT TVDI BT EPTJNFUSJTUT GPS PVS POMJOF PGGFSJOHT UP NBLF UIFN BQQFBMJOH UP UIFTF QPQVMBUJPOT Looking now at a longer-range project,we have found that we have been devoting much effort to clinical education, ensuring that there will be a sufficient number of residency slots to
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
meet manpower needs, and ensuring that the clinical curriculum is appropriate to meet the changing demands of the practice of medical physics. We have been making good progress on clinical education, but we also need to ensure that medical physicists who plan to enter career paths that primarily involve research have the appropriate education to meet the needs of the research world. A Working Group has been formed in Science Council, the Working Group on Future Research and Academic Medical Physics, with the stated charge “To initiate, coordinate and lead activities to secure sustainable growth and improvement in the long-term future environment for high- quality research and academic training of physicists in medicine.� Our goal in EC is to determine how the medical physics graduate curriculum can continue to meet the research needs identified by this Working Group. In order to do so, we need to establish lines of communication between this Working Group and the Working Group on Medical Physics Graduate Education Program Curriculum. The modification of the medical physics curriculum to meet changing needs, both research and clinical, is a continuing activity of EC. These are just a few of many projects and initiatives that EC discussed at its recent retreat. Keep tuned to this column to learn more about EC activities.
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AAPM Newsletter | Volume 38 No. 3 | May/June 2013
ABR Physics Trustees’ Report
5
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5P BTTJTU EJQMPNBUFT JO DPNQMFUJOH UIF SFRVJSFE OVNCFS PG 4" $& DSFEJUT UIF "#3 IBT CSPBE FOFE JUT EFGJO UJPO PG 4" $& UP JODMVEF “enduring materials” CE. ThFTF FOEVSJOH NBUFSJBMT IBWF UISFF DIBSBDUFSJTUJDT t t t
ThFZ QSPWJEF BO BTTFTTNFOU PG UIF MFBSOFS UIBU NFBTVSFT BDIJFWFNFOU PG UIF FEVDBUJPOBM QVSQPTF BOE PS PCKFDUJWF T PG UIF BDUJWJUZ XJUI BO FTUBCMJTIFE NJOJNVN QFSGPSNBODF MFWFM FYBNQMFT JODMVEF CVU BSF OPU MJNJUFE UP QBUJFOU NBOBHFNFOU DBTF TUVEJFT B QPTU UFTU BOE UIF BQQMJDBUJPO PG OFX DPODFQUT JO SFTQPOTF UP TJNVMBUFE QSPCMFNT ThFZ DPNNVOJDBUF UP UIF QBSUJDJQBOUT UIF NJOJNVN QFSGPSNBODF MFWFM UIBU NVTU CF EFNPOTUSBUFE JO UIF BTTFTTNFOU JO PSEFS UP TVDDFTTGVMMZ DPNQMFUF UIF BDUJWJUZ GPS "." 13" $BUFHPSZ $SFEJU ThFZ QSPWJEF B SFGFSFODF UP BQQSPQSJBUF CJCMJPHSBQIJD TPVSDFT UP BMMPX GPS GVSUIFS TUVEZ
The key characteristic of “enduring materials” SA-CE is that there is a post-test with a required score for successful completion. 5IF ""1. 0OMJOF -FBSOJOH $FOUFS DPOUBJOT FYDFMMFOU FYBNQMFT BOE PUIFS FYBNQMFT BSF BWBJMBCMF GSPN "4530 34/" 4/..* BOE "$3 BT XFMM BT NBOZ PUIFS TPDJFUJFT BOE KPVSOBMT #FDBVTF PG UIF XFBMUI PG 4" $& UIBU JT BWBJMBCMF JO UIF GPSN PG 4".T BOE UISPVHI UIF ""1. 0OMJOF -FBSOJOH $FOUFS BMM PG UIF 4" $& SFRVJSFNFOUT NBZ CF PCUBJOFE GSPN UIF ""1. 4JODF UIF CFHJOOJOH PG .0$ UIF "#3 IBT BMTP FODPVSBHFE NFEJDBM QIZTJDJTUT UP QBSUJDJQBUF JO .0$ CZ VUJMJ[JOH Self-Directed Educational Projects (SDEPs) *O BO 4%&1 UIF EJQMPNBUF EF TJHOT B MFBSOJOH QSPKFDU UIBU NFFUT IJT PS IFS QSBDUJDBM DMJOJDBM OFFET 5IiT JODMVEFT EFTDSJCJOH t t t t
4JHOJGJBODF B TUBUFNFOU PG UIF FEVDBUJPOBM OFFE "QQSPBDI B MJTU PG BDUJWJUJFT EFTJHOBUFE UP BEESFTT UIF OFFE &WBMVBUJPO PG BDIJFWFNFOU *NQBDU PO QSBDUJDF PVUDPNF TUBUFNFOU ""1. /FXTMFUUFS ] 7PMVNF /P ] .BZ +VOF
5IF QIZTJDJTU NBZ DMBJN VQ UP $& DSFEJUT GPS TVDDFTTGVMMZ DPNQMFUJOH BO 4%&1 5IF 4%&1 EPFT OPU OFFE UP CF TVCNJUUFE UP UIF "#3 GPS BQQSPWBM CVU MJLF BMM TFMG BUUFTUFE NBUFSJBM DBO CF BVEJUFE 3FDFOUMZ UIF "#3 EFDJEFE UP DPVOU UIF 4%&1 BT 4" $& &YBNQMFT PG 4%&1T BSF BWBJMBCMF PO UIF "#3 XFCTJUF To summarize: SA-CE is available in the form of SAMs, “enduring material” CE, and SDEPs.
Part 3: Cognitive Expertise "O JNQPSUBOU DIBOHF JO UIF 1BSU SFRVJSFNFOU JT UIBU UIF .0$ FYBN DBO CF UBLFO JO BOZ ZFBS BT MPOH BT JU IBT CFFO QBTTFE JO UIF QSFWJPVT ZFBST *O PUIFS XPSET UIF FYBN IBT B ZFBS MPPL CBDL QFSJPE.) ThF .0$ FYBN JT CBTFE PO DPSF LOPXMFEHF BOE DVSSFOU FWPMWJOH UFDIOPMPHJFT &YDFMMFOU TUVEZ HVJEFT BSF BWBJMBCMF PO UIF "#3 XFCTJUF. ThF .0$ FYBN JT OPU MJLF UIF 1BSU BOE 1BSU XSJUUFO FYBNT *U IBT WFSZ GFX DBMDVMBUJPOT BOE JT JOUFOEFE UP TIPX UIBU UIF EJQMPNBUF JT LFFQJOH DVSSFOU XJUI UIF JNQPSUBOU BTQFDUT PG DMJOJDBM QSBDUJDF
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""1. /FXTMFUUFS ] 7PMVNF /P ] .BZ +VOF
Health Policy and Economic Issues
Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant
Radiation ncology eimbursement to e verhauled y CMS
A
s an agency of the Department of Health and Human Services (HHS), the Centers for Medicare and Medicaid Services (CMS) develops and proposes adjustments to federal payments for health care services. CMS has focused much of its recent attention on freestanding cancer centers, which are reimbursed under the Medicare Physician Fee Schedule (MPFS). The Affordable Care Act (ACA) of 2010 gives HHS the authority to annually review the MPFS and to adjust services that it finds to be misvalued. In evaluating the relative value units (RVUs) for services provided by physicians and in freestanding centers, CMS takes into account recommendations it receives from stakeholders, including the American Medical Association’s Relative Value Scale Update Committee (AMA RUC), Medicare Payment Advisory Commission (MedPAC) and others. For a number of reasons, among them a finding that IMRT and SBRT treatment delivery was overvalued, CMS has focused on the technical component of radiation oncology reimbursement to freestanding cancer centers. CMS finalized a proposal to review and make adjustments to CPT codes with “Stand Alone” procedure time assumptions used in developing practice expense RVUs, which includes clinical labor, medical equipment and medical supplies. CMS defines “Stand Alone” codes as services with a technical component that do not include physician work. In the 2013 MPFS final rule, CMS identified 23 radiation oncology codes that require further review and evaluation (see table below). The amount of work for professional society staff and volunteers involved in the significant number of revaluations for a small specialty in one year is perhaps unprecedented. Several of these codes will be revised with new payments effective in January 2014 and we anticipate that the Medicare reimbursement will likely decrease for many of these services.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Services with Stand Alone Practice Expense Procedure Time 77280 Set radiation therapy field 77285 Set radiation therapy field 77290 Set radiation therapy field 77301 Radiotherapy dose plan imrt 77338 Design mlc device for imrt 77372 Srs linear based 77373 Sbrt delivery 77402 Radiation treatment delivery 77403 Radiation treatment delivery 77404 Radiation treatment delivery 77406 Radiation treatment delivery 77407 Radiation treatment delivery
77408 Radiation treatment delivery 77409 Radiation treatment delivery 77412 Radiation treatment delivery 77413 Radiation treatment delivery 77414 Radiation treatment delivery 77416 Radiation treatment delivery 77418 Radiation tx delivery imrt 77600 Hyperthermia treatment 77785 Hdr brachytx 1 channel 77786 Hdr brachytx 2-12 channel 77787 Hdr brachytx over 12 chan
In addition, AAPM is working with ASTRO and CMS to revalue the RVUs for the weekly medical physics consultation code (i.e. 77336). We are cautiously optimistic that the RVUs will increase for this service in 2014. ASTRO recently reported to their membership that they have submitted a proposal to the AMA CPT Editorial Panel to revise IMRT, IGRT, and other treatment delivery codes to better reflect clinical practice. ASTRO states that this proposal is intended to protect the specialty and patients’ access to care and was developed by ASTRO in response to specific issues raised by CMS. ASTRO has asked the CPT Panel to revamp the entire family of treatment delivery codes. They have proposed new code descriptors reflecting the way IGRT and tracking are performed, new IMRT code descriptors to recognize both simple and more complex treatment delivery, and a simplification of the conventional treatment delivery codes. ASTRO notes that these changes would not take effect until 2015 and, if approved, could result in significant payment reductions. Specifically: • • •
The 12 conventional radiation therapy codes (i.e. 77402-77416) will be collapsed into 3 codes that describe simple, intermediate and complex treatment delivery (stratification by energy will no longer be done). IMRT treatment delivery codes (i.e. 77418 and 0073T) will become 2 new codes stratified by complexity, with 1 add-on code for procedures over 45 minutes. These codes will include the technical component of image guidance. The 3 IGRT codes (i.e. 76950, 77014 and 77421) along with the Tracking code (i.e. 0197T) will be condensed into one procedure code that describes image guidance and tracking AAPM Newsletter | Volume 38 No. 3 | May/June 2013
when reported with conventional radiation therapy only. ASTRO notes that the redesign of these key radiation treatment delivery codes are part of a larger ASTRO payment reform action plan, which also includes implementing quality-based incentive payments and incentivizing cost-effective care. AAPM recognizes that the next few years will likely yield a volatile payment environment for providers in freestanding cancer centers. This will be extremely challenging and may be harmful to the provision of high-quality cancer care. AAPM will continue to work with the other professional societies and with CMS to mitigate these reductions to protect patient access to high-quality care.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
William R. Hendee, Rochester, MN
O
ver the past few years articles have appeared in the scientific literature that predict thousands of cancers and cancer deaths each year in populations of patients receiving medical imaging procedures (primarily computed tomography) employing ionizing radiation. The predictions in these articles are computed by estimating very small and hypothetical risks at low radiation doses and multiplying these speculative estimates by large numbers of patients experiencing medical imaging. The public media use these articles to develop print and electronic news releases that raise anxiety in parents, families and patients, at times causing them to delay or defer needed imaging procedures. Decisions to delay or defer examinations constitute real risks to patients, as contrasted with the hypothetical risks presented in the articles. Professional organizations, including the American Association of Physicists in Medicine and the Health Physics Society, have developed policy positions in an effort to illuminate the controversy over the risks of low-level radiation exposures (see MJOLT below). Scientific advisory groups such as, The International Commission on Radiological Protection, The National Council on Radiation Protection and Measurements and, The United Nations Scientific Committee on the Effects of Atomic Radiation have also addressed the controversy (see the links below). Now the International Organization for Medical Physics, representing 80 national and 6 regional medical physics organizations and 18,000 medical physicists worldwide, has developed its own policy statement which is reproduced below. One can only hope that the policy statements issued by these knowledgeable organizations will have some deterrent influence on the continued propagation of unsupportable cancer risk estimates related to medical imaging procedures conducted with minimum doses of radiation consistent with high quality studies. IOMP Policy Statement This policy statement addresses predictions of induced cancers and cancer deaths in a population of patients exposed to low doses (<100 mSv) of ionizing radiation during medical imaging procedures.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
•
Prospective estimates of cancers and cancer deaths induced by medical radiation should include a statement that the estimates are highly speculative because of various random and systematic uncertainties embedded in them. These uncertainties include dosimetric uncertainties; epidemiological and methodological uncertainties; uncertainties from low statistical power and precision in epidemiology studies of radiation risk; uncertainties in modeling radiation risk data; generalization of risk estimates across different populations; and reliance of epidemiological studies on observational rather than experimental data. Such uncertainties cause predictions of radiation-induced cancers and cancer deaths to be susceptible to biases and confounding influences that are unidentifiable.
•
Paragraph A86 of Report 103 of the International Commission on Radiological Protection (ICRP) states that “There is, however, general agreement that epidemiological methods used for the estimation of cancer risk do not have the power to directly reveal cancer risks in the dose range up to around 100 mSv”. Further, UNSCEAR Report A-6746, approved in May, 2012, states that “The United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) does not recommend multiplying very low doses by large numbers of individuals to estimate numbers of radiation-induced health effects within a population exposed to incremental doses at levels equivalent to or lower than natural background levels.”
•
Predictions of radiation-induced cancers and cancer deaths from medical imaging procedures should be accompanied by estimates of reductions in patient morbidity, mortality and cost resulting from the same medical imaging procedures.
•
If effective dose is used to generate predictions of cancers and cancer deaths, a statement should be included that the ICRP has expressed caution in the use of effective dose for purposes of estimating risks to individuals or populations exposed to ionizing radiation. Paragraph 151 of ICRP Report 103 states: “The use of effective dose for assessing the exposure of patients has severe limitations that must be considered when quantifying medical exposure”, and “The assessment and interpretation of effective dose from medical exposure of patients is very problematic when organs and tissues receive only partial exposure or a very heterogeneous exposure which is the case especially with x-ray diagnostics.”
Supporting Documents and Additional Reading •
National Research Council. Health risks from exposure to low levels of ionizing radiation: BEIR VII – Phase 2. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation. Washington, DC. National Academies Press. 2006
•
The 2007 recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37 (2-4) 1-332. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
•
Health Physics Society. Position statement of the Health Physics Society. Radiation risk in perspective. July, 2010.
•
American Association of Physicists in Medicine. Position statement of the American Association of Physicists in Medicine. Radiation risks from medical imaging procedures. December, 2011, affirmed November, 2012.
•
W. Hendee, M. O’Connor. Radiation risks of medical imaging: Separation fact from fantasy. Radiology 2012. 264:2 312-321.
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United Nations Scientific Committee on the Effects of Atomic Radiation. Report of the United Nations Scientific Committee on the Effects of Atomic Radiation. 59th session (May 21-25, 2012. General Assembly Official Records. 67th session, Supplement No. 46.
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P. Zanzonico, M. Stabin. Benefits of medical radiation exposures. Health Physics Society.
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National Council on Radiation Protection and Measurements. Uncertainties in the Estimation of Radiation Risks and Probability of Disease Causation. NCRP Report 171. National Council on Radiation Protection and Measurements. Bethesda, MD. 2012.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
August 4-8, 2013 Indianapolis
See you there. 2013 Professional Program • • • • • • • • • • • • •
Professional Council Symposium: The Medical Physicist as a Professional Leader – The Importance of Leadership Development ABR Update How To Be A Journal Referee Challenges of Increased Controls of Radioactive Materials Writing and Reviewing Papers for Medical Physics HazMat Shipping DOT Training Your First Job: Finding and Keeping It PQI International Medical Physics Symposium - Making a difference in the world: Are you willing to be part? In-house Credentialing Controlling Stuff, Beating Stress, and Finding Work-Life Balance New Member Symposium Preparing for the ABR Therapy Exam AAPM Newsletter | Volume 38 No. 3 | May/June 2013
• • • • • • • •
Preparing for the ABR Diagnostic Exam Professional Liability and Risk Management in Medical Physics Practice Open Access Publishing and Medical Physics Managing and Leading Others RSO Refresher Training Medical Physics Economics Medical Physics Practice Guidelines Next Steps Toward Revising Radiation Protection Regulations
2013 Practical Medical Physics Track Highlights • • • • • • • • • • • •
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 MRI Safety CT Tools and Protocols Available Through AAPM Grantsmanship and Funding Radiation Therapy Contouring: CNS and Cardiac/Thoracic Managing Treatment Planning Systems
2013 Therapy Physics Educational Courses • • • • • • • • • • •
Volumetric Modulated Arc Therapy Monte Carlo Treatment Planning in RT Treatment Planning in Proton Therapy Point and Counter Point Debate: The More Important Heavy Charged Particle Radiotherapy of the Future Is More Likely to Be with Heavy Ions Rather Than Protons Clinical Applications of Surface Imaging High Energy Brachytherapy dosimetry as it applies to Accelerated Partial Breast Irradiation (APBI) Radiobiological Principles of Fractionated Radiotherapy and the Potential for Hypofractionation Advanced Technologies for Breast RT Point and Counter Point Debate: Brachytherapy is better than external beam therapy for partial breast irradiation Small Field Dosimetry Plastic Scintillation Detectors: Present Status and Their Application for Quality AAPM Newsletter | Volume 38 No. 3 | May/June 2013
• • • • • • • •
Assurance and in Vivo Dosimetry Imaging Needs for Proton Therapy Solutions for Interconnectivity Issues in Radiation Oncology: Integrating the Healthcare Enterprise-Radiation Oncology (IHE-RO) Safety Improvement through Incident Learning A Report on Flattening Filter Free C-arm Linear Accelerators from the Therapy Emerging Technology Assessment Work Group Accuracy and Precision in Cranial Radiosurgery Radiobiological models in brachytherapy planning and evaluation Implementing MR-Guided Adaptive Brachytherapy for Cervical Cancer Status of ART in the Clinic
Therapy SAMS: SAM Session 1: Future of Radiation Therapy Safety SAM Session 2: Deformable Image Registration, Contour Propagation and Dose Mapping: 101 and 201 SAM Session 3: Evaluating benefits and challenges of multi-modality co-registration SAM Session 4: Quality Control of Lung SBRT: Minimizing Uncertainties from Simulation to Treatment SAM Session 5: Electron Radiotherapy, Past, Present, and Future
2013 Diagnostic Imaging Educational Courses The Imaging Education Program at the 2013 Annual Meeting has been designed to meet the continuing education needs of physicists at all stages of professional development and this year course content has been balanced to meet both clinical and basic educational objectives of attendees. In addition to 8 hours of SAM session programming there are “back to basics” sessions on advances in instrumentation in digital radiography, CT, and PET/MRI and Informatics courses on the role of informatics in imaging system acceptance and an update on the status of the DICOM structured dose report standard. New also this year is an all-day Imaging Education Symposium on Wednesday entitled “The Management and Reporting of Imaging Procedure Dose”. The strong line-up of Imaging Education course content throughout the annual meeting program culminates with new sessions on Wednesday and Thursday on lens of the eye dosimetry, parallel imaging in MRI, and the “art” of diagnosing imaging artifacts in projection radiography.
Imaging SAMS: SAM Session 1: Nuclear Medicine: Regulatory Guidelines and Compu AAPM Newsletter | Volume 38 No. 3 | May/June 2013
• •
Nuclear Medicine Therapy - Unsealed Sources and Regulations Brachytherapy - Sealed Sources
SAM Session 2: Mammography QA • •
2D Digital Mammography – An Update on Vendor-Recommended QC Tests Stereotactic Breast Imaging System QC
SAM Session 3: MRI QA • • • •
Homogeneity Testing: Spectral Peak and Phase Mapping Homogeneity Testing: The Bandwidth Difference Method RF Coil Testing Technologist’s QC Tests
SAM Session 4: Ultrasound QA • • •
Ultrasound Quality Control: a practical overview of tests, methods, and ACR accreditation requirements AAPM Working Group on Quantitative B-mode Ultrasound Quality Control: Software for analysis of transducer condition Phantom and User-friendly Automation Software for Rapid Periodic Quality Assurance of Gray-scale Ultrasound Scanners
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
CAMPEP News
Brenda Clark,
Update on the CAMPEP Accreditation of raduate rograms
T
he article in the last issue of this Newsletter by Bruce Gerbi and Chester Reft summarized recent changes to the CAMPEP accreditation guidelines that strengthen the didactic requirements for entry into the profession. This article provides an update on the activities of the CAMPEP Graduate Education Program Review Committee (GEPRC) and the impact of the guideline changes on the accreditation process.
Graduate programs accredited by CAMPEP, distributed across North America As of this writing at the end of March, there are 40 graduate programs accredited by CAMPEP, distributed across North America, approximate location shown by the white asterisks on the diagram BCPWF. (The program in Seoul, S Korea is not shown.)
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
One of these universities also offers a DMP program, and another university is indicating they will submit an application for a DMP program within a year. There are also 4 new program accreditations in the review process As a result of the tightening of the academic requirements to enter the profession, individuals with terminal degrees in other areas of physics who wish to move into a residency in clinical medical physics will be required (starting in January 2014) to address a set of basic didactic requirements before or during their residency. To provide a pathway for these individuals to meet these requirements, CAMPEP has accredited 7 certificate programs since 2011. A certificate program is a program of didactic coursework, recommended in AAPM Report 197S and adopted by CAMPEP, that is intended to enable individuals with a PhD or equivalent terminal degree in physics or a related discipline to meet the didactic requirements needed to enter the profession of medical physics. A certificate program may be offered only by an accredited graduate or residency program. To date, all certificate programs are housed within accredited graduate programs. Application of an accredited graduate program to be approved as a certificate program is a streamlined process that requires no additional expenditure by the graduate program. This process is described on the CAMPEP website. A recent poll of the 7 certificate programs indicates that these programs are quite popular, with more than 20 students currently registered. As indicated by the program directors, the programs graduates to date have had no difficulty securing residency positions. The program directors report fielding a high number of enquiries but have restricted the class size to between 2 and 5 students. The current students have backgrounds in a variety of disciplines such as: medical biophysics, biomedical engineering, atomic physics, solid state physics, nanotechnology, nuclear engineering, high energy physics, experimental condensed matter physics, experimental particle physics and optical physics to name a few. A quote from one program director: â&#x20AC;&#x153;0ver the past 7 years we have had 18 students enter our graduate programs who already had a PhD in physics. he majority of those completed an MS in medical physics and presumably many of them would have chosen the Certificate Program if we had offered it back then.â&#x20AC;?
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
The New Professional
Scott Wyler, Hunt, TX
Choose our hilosophy on rofessionalism
T
he official AAPM/ABR components of this article were presented in a previous newsletter edition. This second part is more in line with the initial idea for this article: basic pointers for development on a routine basis in the working environment. While researching professionalism, I discovered quite a few articles in the vein of how to look like, dress like, and shake hands like a professional. Convincing others that you are a professional appears to be at least as important, if not more so, than actually fulfilling the responsibility itself. I came across a great series of presentations from the TED website and will provide a link to them at the end of the article. One of the presentations discusses great leadership, with the take-home message being that successful people and businesses have a solid idea of the “Why” of their goals. Choosing your philosophy on professionalism starts with the “Why” of your goals or expectations of being a Medical Physicist. Does your “Why” reside in money, prestige, autonomy, or does it resemble the Scope of Practice on the AAPM website? In addition to these TED presentations, a book also got my attention, True Professionalism by David Maister. It helped to focus attention on furthering the process of professional goals. In this book the author describes the workforce as falling into three categories: Dynamos, Cruisers, and Losers. As a professional with a career, we fall into the category of Dynamos. A few expectations of these Dynamos are to continually add to your skill set and to have a plan that you are working to fulfill. So add having a plan to knowing your personal “Why” and you have the foundation for your personal professionalism philosophy. The book has many more valuable lessons that can aid in developing and attaining professionalism that will not be covered here. But how to transition from planning to success? I wish this was when I could say “Read my book”, but the truth is not that far removed. Read, research, take classes, attend conferences. There is no across-the-board pathway to success. It is a personal goal and that requires very specific input from you. Here is a short list of items that may help you get started along the path:
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
1. Work on communication skills. No one has perfected the art of communication. Politicians should be incredibly skilled in this area, but the Presidential debates from last year prove otherwise. Improving communication skills is a lifelong task with numerous books and articles on the subject. Pick a few and start building on your communication skills. Here is one example in which it is surmised that physicians can learn from baristas, so physicists can look in any number of directions as well. 2. Learn to manage your manager. This could be a chief physicist, department manager, or CMO. Or it could be all of them. By undertaking this, it challenges you to learn why people make the decisions they make, what motivates them, and how you can make their lives easier. 3. It is not enough to do something well, you have to demonstrate that you are capable. You donâ&#x20AC;&#x2122;t have to demonstrate excellence, just demonstrate involvement. Take notes at all meetings. Follow up on questions and be very specific, people like it when you show that you listen to them. I like to give weekly update emails to administrators and supervisors as this shows a willingness to communicate, provides a degree of transparency that is not normally present in medical physics, and shows your value. I also like to have a list of action items or outstanding tasks that provides similar results to the weekly update. 4. Pick the people you emulate carefully. The workplace is not a meritocracy. Sometimes good people fail and bad people succeed. Likewise, a successful situation for someone else might not be a successful situation for you. 5. Realize that you represent the entire profession of Medical Physics. Whatever you do at your current position will be expected from the next person in that spot. Set the bar high, do the right thing, be a team player. Basically you are expected to be a professional. Too often the expectations of a physicist in a certain position are poorly represented. If the person before you did not strive to be seen as a professional, then you have an uphill battle. 6. Did I mention communication skills? By far the most important item on this list. Just in case you missed it the first time. 7. Set yourself up to succeed. This is more of a life coach item, but your personal life will affect your work and vice versa. If you are not in a good situation, then there is a higher likelihood of a bad result. This does not mean that you should give your two weekâ&#x20AC;&#x2122;s notice after reading this; instead look to improve your skills and marketability so that you can find a good situation or, through hard work and diligence, have the ability to transform a bad situation into a better one. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
8. Be a team player. Our work is not more important than that of anyone else in the clinic. It’s the overall product that matters. Degrees and certifications do not mean anything if the patient is not benefiting. The standard of care is a moving target, what you do today will not be the standard in the near future. The team should be improving on a constant basis. Ideally, the physicist would be a leader in this but each situation is different. There have been days when my biggest contribution has been getting ice chips for a patient. I don’t recall a board question on that. 9. Diplomacy, Perspective, and Tongue-Biting. These three are closely related. You can win the battle but lose the war. Pick your battles. Take a step back and put a situation in context, making sure to remove the emotion of the moment. The things you do not say are often more important than the ones you do say. Control is an illusion, just do the best that you can with the resources at hand. 10. Admit when you do not know something. I like to say, “I don’t know, but I will research it and get back to you.” No one has all the answers. Following up demonstrates your participation in the process. 11. Volunteer. In the workplace and with professional organizations. You want to be a professional, then do what professionals do. You’re supposed to be a Dynamo. This will also expose you to other professionals and you can pick up good habits and ideas from them. 12. Learn appropriate bedside manner. As a medical professional, this will be expected of you, but it is unlikely that this is something you will have been taught. Primarily this will be learned by observing the patient interactions of physicians and senior physicists and by emulating them. In summation: find your “Why,” make a plan to achieve your goals and continuously work on improvement, and reach out and take the knowledge that is available, both within Medical Physics and from other industries, via electronic and printed media, and from other professionals. As an industry we are growing by leaps and bounds from a technological standpoint, but we still struggle to grow socially to a certain degree. It’s not just the new professionals that can benefit from improving social and professional skills, and it’s not just individuals, but the profession as a whole that has room for improvement. The TED talks that I relied on most heavily during my research: Work Smarter What doctors worry about AAPM Newsletter | Volume 38 No. 3 | May/June 2013
3rd CT Dose
The 3rd CT Dose Summit focused on scan acquisition and image reconstruction parameters, and how to select and best manage to improve image quality and reduce radiation dose. The goal of the summit was to provide practical information for users to help them operate their CT scanners wisely, improving the quality and usefulness of CT images while reducing the radiation dose to patients. AAPM partnered with the Webster Center for Advanced ReCoffee break conversation during the 3rd search and Education in Radiation of the Massachusetts General Hospital. CT Dose Summit.
SUMMIT
a success
Mannudeep Kalra, MD, Massachusetts General Hospital and Dianna Cody, PhD, M.D. Anderson Cancer Center, program directors for the 3rd CT Dose Summit.
Our condolences The following members have passed away in the last year:
Calvin P. Myers, Ph.D. - Lees Summit MO Harold Marcus, Ph.D. - Butler NJ Nasser Maleki, Ph.D. – Savannah GA Charles E. Metz, Ph.D. – Chicago IL Fearghus O’Foghludha, Ph.D. – Durham NC Moses A. Greenfield, Ph.D. - Los Angeles CA Robert D. Forrest, M.S. – Philadelphia PA Larry Pallas, M.S. - Grand Junction CO Our condolences are extended to their families. If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honors Ceremony at our upcoming Annual Meeting. We respectfully request the notification via e-mail to: 2013.aapm@aapm.org Please include supporting information so that we can take the appropriate steps. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Spring Clinical Meeting
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he Second Annual AAPM Spring Clinical Meeting was held in Phoenix, Arizona, March 16-19, 2013. The meeting continues to gain momentum with increasing attendance numbers and vendor participation. Word seems to be spreading that this meeting provides a great opportunity for clinical physicists to fulfill CEU and SAMs requirements while gaining knowledge on topics that relate directly to their daily practice in medical physics. With about 250 attendees the meeting size is large enough to encompass two parallel sessions over the 4 meeting days, but small enough for attendees to have the chance to have plenty of informal discussions with presenters and vendors during meals and breaks, as well as accommodating multiple joint sessions of general interest to clinical physicists. Feedback from many meeting attendees is that this is becoming their meeting of choice for the richness in clinical topics and ability to glean useful clinical techniques from presenters and other attendees.
Attendees visiting the vendors The meeting took place at the Pointe Hilton Tapatio Cliffs Resort in Phoenix, a beautiful com-
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
plex nestled into a mountains park area in Phoenix. A number of groups took advantage of the mountain top restaurant to have social events overlooking downtown Phoenix. The pleasant weather permitted outdoor lunches and opportunities for hiking, biking and golf at the resort. The main event of course, was the wide variety of interesting sessions that provided a wealth of knowledge and frequent opportunities for audience participation and discussion. Updates on the ABR continuous certification process were particularly timely and the meeting provided the opportunity for attendees to collect a large number of SAMs credits as the required MOC number has increased.
Attendees enjoying lunch outside This year the meeting offered the opportunity for attendees to present posters representing their clinical work, and the award for Best Poster was awarded to Dorin Todor, Virginia Commonwealth University, for the poster entitled, “Is Similarity a Useful Tool in Assessing Quality of Prostate Brachytherapy Seed Implants?” The Young Investigator Symposium provided opportunities for young physicists to present topics of clinical research. A panel of judges evaluated twelve Young Investigator presentations. The presentations were exceptionally well done and the competition was very tight among these excellent young presenters. The competition winners were: 1st Place: Anna Mench, University of Florida, “Investigation of X-Ray Attenuation Properties of Organs Within the Body and Head of Cadaveric Subjects Vs. Living Patients for the Validation of CT Organ Dose Measurements,” A. Mench, L. Sinclair, T. Griglock, B. Cormack, J. Sirera, M. Arreola. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
2nd Place: Lindsay Sinclair, University of Florida, “Direct Organ Dose Measurement for Multi-Detector Computed Tomography Utilizing Cadaveric Subjects,” L. Sinclair, A. Mench, T. Griglock, B. Cormack, S. Bidari, M. Arreola. 3rd Place: James Roberts, University of Victoria, “A Rapid 1D in Vivo Dose Measurement Technique for VMAT Treatments Using Single Integrated Portal Images,” J. Roberts, W. Ansbacher. And Ke (Colin) Huang, University of Michigan, “Volume Based Evaluation of Geometric Distortion in Magnetic Resonance Imaging Using 3D Template Matching,” K. Huang, Y. Cao, U. Baharom, J. Balter.
Young Investigator Award Winners: (left to Right) Ke (Colin) Huang (3rd Pl), Anna Mench (1st Pl), Lindsay Sinclair (2nd Pl), James Roberts (3rd Pl) Make plans to participate in the 2014 Spring Clinical Meeting, which will be held in Denver, March 15-18, 2014. The Denver location should provide opportunities for spring skiing and discussions of the latest developments in the clinical practice of medical physics!
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Persons in the News
J. Brian Fowlkes, Professor of Radiology and Biomedical Engineering University of Michigan Health Systems
J. Brian Fowlkes, Professor of Radiology and Biomedical Engineering at the University of Michigan Health Systems, has been appointed associate vice president for research-health sciences by Vice President for Research Stephen R. Forrest. His three year appointment, approved Thursday by the Board of Regents, is effective March 1. “Professor Fowlkes’ administrative experience, his extensive participation in major committees, his active involvement in sponsored research and his commitment to multidisciplinary collaborative research make him an excellent candidate for this position,” Forrest says. Fowlkes’ responsibilities will include assisting the Office of the Vice President for Research in its administration and oversight of the research and creative activity in the health sciences arena; providing leadership for OVPR in new initiatives; and oversight and involvement with OVPR units where appropriate. He will be a member of the senior OVPR administrative staff. Fowlkes is a distinguished researcher whose work focuses on biomedical imaging, biomedical ultrasonics and image-guided therapy. A prolific researcher, he is the author of 148 peer-reviewed articles, and he has been the principal investigator or co-investigator on a wide range of research projects. Fowlkes earned his bachelor’s degree from the University of Central Arkansas. He earned his Master of Science and doctoral degrees from the University of Mississippi. He began his UM career in 1991 after completing a postdoctoral fellowship in radiology at UM. In addition to his faculty appointments in the Medical School and College of Engineering, Fowlkes has served as the executive director of the laboratory animal use and care program and a deputy institutional official since 2011. He will retain this position moving forward. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
William R. Hendee, Ph.D., FAAPM, FACMP ICMP selection of William R. Hendee, Ph.D., FAAPM, FACMP The International Congress on Medical Physics (ICMP) has selected William R. Hendee to be among a group of medical physicists whose contributions to healthcare will be acknowledged in a display of posters at the 50th annual ICMP meeting in Brighton, England this fall. National and regional medical physics organizations were invited to nominate medical physicists, and other closely related professionals, who have made an outstanding contribution to the advancement of medical physics and healthcare through research, clinical developments, education and training activities, service development, and to professional matters over the last 50 years. The AAPM nominated 21 individuals for consideration. Out of the 21 individuals, along with Dr William R. Hendee, the following AAPM Members were also selected: Peter R. Almond, PhD F. Herb Attix, MS John R. Cameron, PhD Maryellen L. Giger, PhD Lawrence H. Lanzl, PhD John S. Laughlin, PhD Paul C. Lauterbur, PhD C. Clifton Ling, PhD Charles A. Mistretta, PhD Colin G. Orton, PhD
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
ISEP Workshop Notes Mahadevappa Mahesh, Baltimore, MD
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he Argentine Society for Medical Physics (SAFIM) and the American Association of Physicists in Medicine (AAPM) jointly organized a Diagnostic Imaging Workshop in Argentina. This program was also sponsored by the International Organization for Medical Physics (IOMP) and the Latin American Association of Medical Physics (ALFIM). Every year, the AAPM through its ISEP (International Scientific Exchange Program) organizes such workshops and courses in order to foster the interaction between medical physicists from developing countries and the AAPM, as well as to contribute to the education and good practice of Radiotherapy Physics and Diagnostic Imaging. SAFIM currently has 130 members, of which approximately 100 specialize in Radiation Therapy and the remaining in Nuclear Medicine and other specialties. There is a need to encourage educational programs on Diagnostic Imaging such as ISEP, a first of its kind in a country that has both undergraduate and graduate university careers on Medical Physics. ISEP 2012 was held at the Oncology Institute â&#x20AC;&#x153;Angel H. Roffoâ&#x20AC;? in Buenos Aires City, October 24 â&#x20AC;&#x201C; 27. The Workshop hosted approximately 100 participants, mostly Physicists, Bioengineering and Medical Physics students, including visiting fellows from Brazil, Uruguay and Venezuela. This year ISEP faculty included John Boone (UC Davis), Robert Gould (UC San Francisco), Robert Jeraj (Wisconsin-Madison), Mahadevappa Mahesh (Johns Hopkins), Osama Mawlawi (MD Anderson), Anthony Seibert (UC Davis), Doracy Fontenla (Sloan-Kettering, NY) and Dario Sanz (FUESMEN, Argentina). The official program consisted of 23 hours of classroom lectures on several topics such as $PNQVUFE 5PNPHSBQIZ 3BEJPHSBQIZ %PTJNFUSZ 'MVPSPTDPQZ .BNNPHSBQIZ 41&$5 1&5 .BHOFUJD 3FTPOBODF BOE *NBHF HVJEFE 3BEJPUIFSBQZ. One afternoon was dedicated to practi-
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
cal sessions on PET/CT at nearby Fundaciรณn Centro Diagnรณstico Nuclear. In summary, this successful workshop was extremely beneficial in motivating both students and young professionals in the field of diagnostic imaging, to update knowledge of those who already work in the field, to update educational programs on Medical Physics and to establish international cooperation between AAPM and SAFIM on current and future events.
Images from the ISEP Diagnostic Imaging Workshop Buenos Aires City, October 24-27, 2012
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Staff Announcements
Angela Keyser , College Park, MD
AAPM ACCOUNTING Team It is with mixed emotions that I formally announce that Cecilia Hunter will retire from the AAPM HQ team effective May 24. The Atlantic Ocean is calling and she is heading to the Delaware coast. I cannot adequately express my admiration for Cecilia and my sincere gratitude to her for 10 years of dedication to AAPM, the HQ team and to me personally.
Cecilia Hunter joined the HQ Team in June 2003 as the Director, Fi-
nance and Administration, in preparation for Sal Trofiâ&#x20AC;&#x2122;s retirement at the end of 2003. With her extensive background in non-profit association management, Cecilia has worked tirelessly to guide AAPMâ&#x20AC;&#x2122;s financial and administrative functions. While her contributions are too many to list here, I would like to highlight a few of her accomplishments that have had a major impact on the continued success of the organization. Cecilia has provided invaluable guidance to the AAPM Board of Directors on long range AAPM Newsletter | Volume 38 No. 3 | May/June 2013
financial planning and proposed a statistical model for budgeting in 2009 that has greatly improved the ability of the Board to budget and forecast future revenues and expenses. Soon after joining the team, Cecilia identified a problem with the burgeoning size of the AAPM General Ledger and tackled an overall re-write that led to efficiencies in financial reporting. Cecilia was also the first staff liaison assigned to assist the Science Council back in 2004 and did an impressive job supporting the council volunteers and 140+ groups within the council. While Cecilia will be greatly missed, she has established an Accounting Team that is well poised to proceed after her departure in support of the activities of the Association. Like the IS team, profiled in the last issue, the valuable work of the Accounting team takes place primarily behind the scenes.
Christopher Oronsaye was named AAPM’s Controller in February of
this year and will assume many of Cecilia’s financial responsibilities. In his role as AAPM CFO, Chris will oversee financial operations including preparation of the annual budget. Before officially joining AAPM, Chris worked with the Accounting Team to prepare for the 2010 and 2011 audits.
Melissa Liverpool joined the staff in January 2011 as the Staff Accoun-
tant and was promoted to Accounting Manager at the beginning of this year. She has responsibility for daily and monthly accounting functions, including management of general ledger functions, production of financial reports, management of cash and reconciliation of accounts.
Janet Harris, the newest member of the Accounting team, came on board in October 2012. Janet processes dues renewals and other cash receipts, records accounts payable, prepares checks and does the invoicing.
The team together is responsible for handling the receipt and disbursement of over $8 million annually, including hundreds of transactions monthly. Thousands of dues payments are processed annually, along with meeting registrations and exhibitor payments for the various meetings managed by HQ. Coming next issue…. group profile of the AAPM Meetings team. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
AAPM History Committee Report
Lawrence N. Rothenberg,
We are writing history History Symposium in Indianapolis We are most pleased to report that the 2013 History Symposium will be presented by two very esteemed members of AAPM, Peter Almond and Colin Orton, both past AAPM Presidents and Coolidge Award recipients. The symposium is scheduled from 4:30 until 6:00 PM on Wednesday, August 7, 2013, and is entitled “Early Developments in Teletherapy Machines.” Peter will speak on “From Radium Teletherapy to Cobalt Teletherapy” and Colin will discuss “Early X-Ray Therapy Machines.” We hope that you will be able to attend.
AAPM Video Interviews on-line We are delighted to announce that almost all of the AAPM video interviews of Physicists (and a few Physicians) of Note are now available on-line. These include not only the previously available series of interviews recorded at Annual Meetings by Blue Sky from 2005 - 2012, and conducted by Robert Gould, Azam Niroomand-Rad, and myself, but also more than 120 interviews conducted mainly by Robert Gorson from 1990 through 2004. AAPM will be forever indebted to Professor Gorson for his great dedication in conducting the interviews, and providing his own video equipment to record them. These earlier interviews can now be viewed on-line due to Gorson’s incredible initiative in converting all of his original video files to Flash Video (.flv) format. These Flash files have been made available on our website due to the further efforts of Michael Woodward and Farhana Khan at AAPM Headquarters and Chris Marshall, our Website Editor. To access these interviews, go to www.aapm.org, choose “AAPM” on the left side of the main page, then “History & Heritage”, then the “Historical Interviews” tab.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
We are pleased to announce that newly updated Chapter history posters will be presented in a central area for viewing in Indianapolis. The Chapter history project has been spearheaded once again by Michael Gossman. Of course, we are also greatly indebted to the many AAPM Chapter members who have made contributions to their Chapter posters.
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
George Kagadis
M
edical Physics practice in Greece has started to be connected to education in the middle â&#x20AC;&#x2DC;50s, when a first laboratory of radioisotopes and a 60Co radiation therapy unit were installed in the University of Athens Therapeutic Clinic. From 1962 to almost 1992 the Greek Atomic Energy Commission GAEC, founded on 1954, organized Hospital Physicists Schools educating medical physicists. The first medical physics academic position was occupied by Professor C. Proukakis in 1971 at the Medical School of the University of Thessaloniki. The first academic programs offering MSc diplomas commenced officially in 1993.
Typical lecture day in the Patras course. There are currently two post-graduate courses offering studies in the field of Medical Physics in Greece. One is an Inter-University program, organized by the School of Medicine (administration of the course), the Departments of Physics and Biology of Athensâ&#x20AC;&#x2122; University and the Medical Schools of the Universities of Thessaloniki, Ioannina, Thrace and Crete in collab-
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
oration with the Greek Atomic Energy Commission (GAEC) and the NCSR “Democritos.” Lectures are given at the premises of the GAEC, the School of Medicine and the Department of Physics (Athens course). The other is an interdepartmental course organized by the departments of Medicine and Physics of the University of Patras with courses taught in Patras (Patras course). Both courses have a long lasting history and have educated more than 170 (Athens course) and 350 (Patras course) medical physicists respectively. The Patras MSc course on Medical Physics is a two years course where in the first year of studies students are taught all the basic topics of Medical Physics ranging from basic medical sciences like Anatomy, Physiology and Biochemistry to advanced topics like Physics of Radiation Therapy I, Medical Image Analysis & Pattern Recognition, etc. In the second year of studies, students follow some elective topics like Molecular Imaging, Magnetic Resonance Imaging & Spectroscopy, etc. and have the obligation to develop a thesis in a medical physics topic. The Athens MSc course is a 1.5 years course where in the first year of studies the students are also taught all the basic topics of Medical Physics, more focused on Medical Radiation Physics. In the Athens course the MSc thesis is taking place on the last 6-month semester. The choice of the thesis topic lies upon the interests of the student. A member of the Academic faculty of the course supervises the development of the thesis which has to be defended by the student at the end of the fourth semester against a threesome examining committee. After the successful defense of the thesis the student is awarded an MSc diploma in Medical Physics and may pursue further Medical Physics studies towards a PhD degree. In this occasion there is one supervisor, a threesome advisory committee and the defense of the PhD thesis is against a seven-person examining committee (the threesome advisory committee, plus four more members from the academic faculty). Graduates from both courses have the opportunity to follow Medical Physics residency. Medical physics residency is a 12 months full time one, on the fields of diagnostics, therapy, nuclear medicine and radiation protection. After this residency the resident applies for medical physics certification in the Ministry of Health. He/She is examined in all four topics; diagnostics, therapy, nuclear medicine and radiation protection and after successful examination he/she is awarded the Medical Physicist professional certification. Medical Physicists in Greece can work in Hospitals and other healthcare enterprises dealing with diagnostics, therapy and/or nuclear medicine applications. Additionally, some of them are working in medical schools with academic and healthcare responsibilities. Of note is that there are a lot of graduated medical physicists in Greece not working in the healthcare sector but doing research in academic and other research institutions. The graduated medical physicists’ professional society is the Greek Medical Physicists Association founded in March 15, 1969. The Association currently lists 240 full members. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
The author would like to thank Professor P. Dimitriou (University of Athens) and Assistant Professor G. Fountos (Technical Educational Institute of Athens) for providing historical information. George C. Kagadis Assistant Professor of Medical Physics â&#x20AC;&#x201C; Medical Informatics, Department of Medical Physics, School of Medicine University of Patras Rion, Greece
Personal opinion of a young PhD candidate As a graduate from the School of Applied Mathematical and Physical Sciences, I had the chance to attend the Master program of Medical Physics in the University of Patras, in Greece. It was a great opportunity for someone who has love for the science of physics to attend such a course; the specialization in medical physics may give various advantages for either academic
AAPM ISEP 2011 Diagnostic Workshop in Patras, June 2011. career or for practicing medical physics in hospitals and other healthcare enterprises. In my country the field of Medical Physics has been developing rapidly over the last 20 years. The international conferences organized around the country quite often give to students of various academic levels the chance to broaden their knowledge and familiarize with the state-of-theart on current research and clinical technology. A great opportunity for Greek, as also for international, students was the recently organized summer course by the AAPM ISEP in 2011. AAPM Newsletter | Volume 38 No. 3 | May/June 2013
Actually, it was a real surprise to see how Greece can attract so many famous scientists together to the beautiful coastline of Patras for such an interesting meeting ! The potential of the country in the field, can be also represented by the plethora of groups specialized on different parts of medical physics. Graduate students have the possibility to work in such groups and be specialized in MRI, CT, SPECT, PET, Dosimetry or Radiotherapy fields, during their master thesis. After graduating, and in order to be able to obtain medical physics certification, an 1 year residency is required which includes practice in Diagnostics, Nuclear Medicine, Radiation Protection and Radiation Therapy. Today, in the beginning of my academic career, as a PhD candidate, I realize that the Greek Academic community is very active in the field of Medical Physics. There are many distinguished scientists in either universities or hospitals, educated abroad or in Greece who work really hard, and at the same time encourage and trust young scientists giving priority to their education. During the last decade, research in Greece is growing rapidly and opportunities are given to young people in cooperating with scientists all over the world. Enhancement of new technologies and know-how is an important aspect that young people can face in Greece. Even if Greek hospitals are not very modernly equipped; the academic education tends to be modern and forceful in order to discuss cutting edge subjects with students. So, a new physicist, having this wide knowledge, is stimulated to bring new ideas and to deal with cutting edge topics in the Medical Physics community. Concluding, I feel very grateful for being educated in Greece trying to broaden my knowledge from scientists all around the world.
Panagiotis Papadimitroulas PhD candidate, Department of Medical Physics, University of Patras, Greece
AAPM Newsletter | Volume 38 No. 3 | May/June 2013
MEDICAL PHYSICS International, a New Online Journal MEDICAL PHYSICS International (MPI), the Journal of the International Organization of Medical Physics (IOMP), is now available with open access. With the First Edition published in April 2014 the MPI introduced a new realm of publishing for the field of Medical Physics. The purpose is to provide publishing opportunities that are not available with the other traditional journals. The MPI does not publish research papers, as in other journals, but provides literature to support a variety of Medical Physics activities including education, professional development, recent innovations in medical physics procedures and technology, and the sharing and preservation of the professionâ&#x20AC;&#x2122;s history and heritage. With the advances in worldwide communications Medical Physics has become a highly-connected global community in which all will benefit by sharing ideas, information, experiences, and resources. The vision is that the MPI journal will serve as a major node in this global network. The journal will be published twice each year. Learn more and begin to benefit from this publication. Announcement submitted by Slavik Tabakov, Ph.D. and Perry Sprawls, Ph.D.,Co-Editors