AAPM Newsletter July/August 2013 Vol. 38 No. 4

AAPM

N E W S L E T T E R The American Association of Physicists in Medicine

We advance the science, education and professional practice of medical physics

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JULY/AUGUST 2013 Volume 38 No. 4

See you at the 55thAnnual Meeting & Exhibition August 4-8, 2013 Indianapolis, IN AAPM Chairman of the Calling Board Garry A. Ezzell reveals Indiana is You AAPM’s Strategic Planning Process

55th Annual Meeting Scientific Program Inside Potential Amendments to CFR Part 20 Standards for Protection Against Radiation n Education Council Report n Call for Nominations n ACR Accreditation FAQs n Diversity in Medical Physics - A Personal Reflection n

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: September/October Submission Deadline: Aug. 14, 2013 Posted On-Line: Week of September 9, 2013

www.AAPM.org

CONTENTS JULY/AUGUST 2013 Volume 38 No. 4

Articles in this Issue

Events / Announcements

AAPM President’s Column

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Awards and Honors Call for Nominations

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Chairman of the Board’s Column

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Winner of the Egg Relay Competition

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AAPM President-Elect’s Column

07

Annual Meeting Scientific Program

37

AAPM Executive Director’s Column

11

OSRP Outreach

48

Editor’s Column

16

2013 Annual Meeting Mobile App

48

Legislative & Regulatory Affairs Report

19

Staff Announcements

49

Professional Council Column

25

2014 Spring Clinical Meeting

50

Education Council Report

28

Persons in the News

51

ACR Accreditation FAQs

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Obituary - Don D. Tolbert Ph.D.

56

Workshop Announcement

44 Navigation Help

Working Group Update on Clinical Trials

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Previous / Next Page

Ohio River Valley Chapter Report

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Swipe your finger horizontally to go to the next or previous page.

Letter to the Editor

58

A Personal Reflection: Diversity in Medical Physics

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CAMPEP News

62

Radiology Leadership Institute Update

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Editor’s Note

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

AAPM President’s Column

John D. Hazle, Houston, TX

Physics Pheud, new appointments, the lawsuit & more...

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reetings fellow medical physicists! We are rapidly approaching the 55th Annual Meeting and this year promises to be better than ever. I am excited about visiting Indianapolis and participating in the program that has been put together. Besides the usual scientific, professional and educational events, this year we will introduce a new event --- Physics Pheud!!! At 2:00 on Wednesday in the Main Ballroom, teams led by Gary “Joker” Ezzell and yours truly will vie for the title of most nerdy of the meeting and stake our claim to the Phuture of Physics. There will be prizes and surprises --- and audience participation is key to the game! Please congratulate producer Jeff “Smiley” Siewerdsen on coming up with this lunatic idea! The host will be the effervescent Marc “Full Monty” Kessler, so you know there will be lots of laughs and several places where the network censors will have to intervene! “Crazy” Kristy Brock will be our “woman-on-the-street”, doing her best to keep Marc out of trouble, while John “Badger” Bayouth will be moderator and judge. I hope many of you will come out to cheer, or jeer, for both teams.

I wanted to give you an update on the Editorial office for Medical Physics. As announced earlier, Jeffrey Williamson will be taking over as Editor-in-chief on January 1, 2014. Because the journal has continued to grow and now requires a full-time equivalent attention, the editorial office now includes two Deputy Editors, one in therapy and one in imaging. I am happy to report that Shiva Das from Duke University and Mitch Goodsitt from the University of Michigan have agreed to serve as the therapy and imaging deputy editors, respectively.

Shiva and Mitch were selected by a search committee from a pool of highly qualified candidates. Please join me in congratulating them and supporting all three in the service that they provide to our association.

One more note on publications is that George Kagadis from the University of Patras was recently selected as our new website editor. George has been an active member of AAPM since 2003 and presented a great vision for the website going forward. We look forward to having George take the website to new levels. We also want to thank Chris Marshall for his many years of service as website editor.

As you know, the ruling from the judge in the lawsuit is in and the AAPM prevailed. We are happy that the judge upheld our right to define and defend our criteria for accreditation of calibration laboratories. I would once again like to thank the member volunteers who invested significant effort into making sure that our policies, position and application had been clear and consistent. Gary Ezzell will be communicating more about this.

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This fall at the 20th International Conference on Medical Physics the International Organization of Medical Physics (IOMP) will celebrate it’s 50th anniversary. The AAPM was one of 4 initial member organizations that started the IOMP. We can be proud of the vision AAPM had in helping to start IOMP as an organization to promote medical physics around the world. As part of the 50th anniversary celebration, the ICMP is recognizing 50 medical physicists for their contributions during the last 50 years. Eleven AAPM members were selected by the ICMP Selection Group for recognition: Peter Almond, Herb Attix, John Cameron, Maryellen Giger, Bill Hendee, Larry Lanzl, John Laughlin, Paul Lauterbur, Clif Ling, Chuck Mistretta and Colin Orton.

Another meeting related event will be AAPM sponsoring a session on Image Guided Drug Delivery at the World Molecular Imaging Congress in September. This is the first time the AAPM has participated in the Congress. We will be joining several sister societies, including the Radiological Society of North America and the International Society of Magnetic Resonance in Medicine, in sponsoring sessions that deal with topics of special interest. The keynote speaker for our session will be Chrit Moonen, Ph.D. from Utrecht. Chrit is not only an expert in image guided drug delivery, but also in MR guided high-intensity focused ultrasound and is actively working on the MR-linac project at Utrecht. Chrit is a pastpresident of the World Molecular Imaging Society and is working with the AAPM on several issues of mutual interest related to MR guided therapy. Finally, we plan for WMIS to sponsor a session at the AAPM meeting next year in Austin, bringing their expertise to our meeting to supplement our own membership base in this hot-topic area.

As CAMPEP plays an increasingly important role in the education of medical physicists, it is important for us to recognize the contributions of Bill Hendee in serving as President of CAMPEP for the last five years. Bill has served tirelessly and kept CAMPEP on a steep trajectory to meet the needs of the community. Bill will be stepping down as President of CAMPEP as his tenure with the organization is completed at the end of this year. To replace Bill, we had an open announcement for volunteers for nomination to replace Bill as an AAPM representative on the CAMPEP board. We had about 30 outstanding candidates to consider.

In the end, we submitted four names to CAMPEP for consideration.

There has been some discussion on the bulletin board about how to get involved in AAPM. The easiest way is to surf around the committee trees along the branches of your interest.

When you find a committee or task group of interest, reach out to the chair. Or you can attend the group meetings at the annual meeting. Almost all AAPM meetings are open meetings and everyone is welcome to attend. It’s probably a good idea to let the chairs know that you will be attending and are interested in participating. Finally, if you have any questions, please contact me or John Bayouth for advice.

I’m looking forward to seeing many of you in Indianapolis!

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Chairman of the Board’s Column

Gary A. Ezzell, Phoenix, AZ

About the antitrust lawsuit that had been filed against AAPM

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n late May, AAPM learned that we had prevailed in the antitrust lawsuit that had been filed against us by K&S Associates. As I write this in early June, we are eight days away from the deadline for the plaintiff to file its intent to appeal. By the time you read this, we will know if this litigation has finally ended or if we still have a hurdle to clear.

That we won the case is a huge relief, but one we felt confident about from the beginning.

First, a one-sentence summary: in 2009, K&S, an Accredited Dosimetry Calibration Laboratory, filed an antitrust lawsuit against AAPM alleging that we, along with others, conspired against it after K&S was purchased by PTW (a manufacturer of dosimetry equipment) in order to revoke K&S’ accreditation and put it out of business. The antitrust allegations never made sense to me, since neither AAPM as an organization or any of the volunteers overseeing the accreditation of calibration labs had or have any financial stake in the success or failure of any lab. The judge’s ruling validated that AAPM’s actions in this matter have been legal, consistent with previous practice, and justified. His findings of fact and conclusions of law can be found here. In my earlier email to the membership, I promised to provide some excerpts in this newsletter. The ruling is 37 pages long, and so here I will reproduce three paragraphs from page 32.

21. The idea that the AAPM would conspire with ADCL laboratories and/or a manufacturer (Standard Imaging) to oust a competitor makes little, if any, sense. AAPM members are individual medical physicists who collaborate on professional education, scientific journals, and the oversight of dosimetry laboratories. This oversight of dosimetry labs is a service that provides the AAPM with no financial rewards, and the AAPM has no role in setting the prices that are charged by the ADCLs. 22. It is simply illogical for AAPM members to have conspired to achieve what K&S insists will be a virtual certainty upon its departure – a delay in calibrations and a rise in prices for those calibrations – because AAPM’s members need to have their dosimetry equipment calibrated, and AAPM’s stated goals under the Criteria are to provide “high quality secondary calibrations” for its members, and to “minimize the cost to membership,” (Def. Ex. 38).

23. There has also been no showing that the AAPM (or even the remaining ADCLs) have a commercial motive to eliminate K&S as a competitor. The only ADCL capable of

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making a commercial profit is K&S, as neither the MD ADCL nor the UW ADCL operate for profit, and K&S has not shown that the AAPM manifested a desire to insulate the UW ADCL and/or the MDA ADCL from K&S’s competition. Even if the remaining ADCLs might like to see K&S’s departure, Plaintiff has not presented evidence that the AAPM shares any such desire.

AAPM has consistently maintained that its stated criteria for accrediting calibration labs prohibit a lab from being owned by a manufacturer of the dosimetry equipment that it calibrates. Our concern has been the integrity of the calibration network and our ability to monitor it as a volunteer organization. That has been vindicated. Those members who have wanted more information about the case can finally read the judge’s ruling.

As of this writing, K&S remains accredited, and I sincerely hope that the ownership issue can be resolved and it can remain so. AAPM has never desired otherwise.

There are certainly lessons to be learned from this episode. At our meeting in Indianapolis, the AAPM Board will initiate a process of exploring legal and structural options that we have to better protect the AAPM while maintaining the ADCL network and AAPM’s role in supervising its technical accuracy. We have felt constrained from doing that during the litigation, but now we are free to do so.

There is an old saw that “no good deed goes unpunished.” Many AAPM volunteers, as well as staff members, have been drained by this experience but have been steadfast in their support of the organization and the ADCL network. Special thanks go to the two volunteers who have chaired the ADCL oversight committee during this period: Malcolm McEwen and Jan Seuntjens. They have endured much.

So – now to brighter topics. I am looking forward to our annual meeting in Indianapolis.

Our imaginative Scientific Program Committee Chair, Jeff Siewerdsen, has organized a “Physics Pheud” in which John Hazle and I are team leaders. I don’t recall this being in the job description, and going up against Big John can never be good, but I trust it will all end well.

See you in Indy.

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AAPM President-Elect’s Column

John E. Bayouth, Madison, WI

Get involved!

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APM is a remarkable organization for many reasons, one of which is the level of participation of its membership within the organization. Of the over 8,000 members of the AAPM, nearly 1,200 volunteer to support our many activities. Like so many of you I feel passionately about our profession and want to contribute my energies towards efforts that fundamentally improve the human condition. This shared passion can be seen quite clearly on a particular Saturday or Sunday each year, typically in late July or early August. It comes to light during the nearly 250 council, committee, sub-committee, working group, and task group meeting that precede the AAPM annual meeting. Most often these groups remain active during the entire year, but a crescendo of activity occurs prior to and during the annual meeting.

As indicated in the title of this article, my call to you is to volunteer. However, many of our members seem lost within the process. How do I volunteer? This is a common theme on the AAPM bulletin board service and at Town Hall discussions during our annual meeting. The process requires substantial effort to be successful; below I will outline some strategies I believe can improve your chances of being selected as a volunteer.

1. Find the right fit This first step is an important one. Remember, there are nearly 250 different groups. Which one(s) best match your skills and interests? Don’t pursue this effort randomly, rather review the AAPM website to understand what groups are available. Gain an understanding of what the organization is doing and identify a hand full of areas that have greatest interest to you. For each group the website lists important information, including the charge, date of origination and proposed date of completion, and minutes of previous meetings. To better illustrate my point, I’ll use TG-219 as an example. (Thanks to Sotirios Stathakis and Timothy Zhu, co-chairs, who have no idea I’m doing this to them). TG-219 is a task group who falls under the following structure: Science Council -> Therapy Physics Committee -> Radiation Dosimetry & Treatment Planning Subcommittee -> Workgroup on Treatment Planning -> TG-219. This task group is focused on Independent Dose and MU Verification for IMRT Patient Specific Quality Assurance. Many of us can relate to this topic, having spent so many hours performing IMRT QA. The charge of this task group is listed in this link, but I also provide the text below:

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Charge: To review and evaluate the algorithms of “independent/second check” of monitor unit calculations for IMRT. In light of the complexities of treatment planning and delivery, the TG will make recommendations on the clinical implementation of calculation programs (e.g., number of points, locations, accuracy, evaluation methods, and heterogeneities). Commissioning and benchmark QA of 2nd MU calculation programs, propose additional measurements, if necessary. Clinical testing and periodic quality assurance of 2nd MU calculation programs and recommendations on test tolerance.

Clearly, this group is doing more than performing IMRT QA. Being able to recommend methods of implementing calculation programs to perform independent verification requires one to define the specifications of these programs. How do the algorithms work, and under what conditions are they likely to fail? How to best test these situations? Just a couple of the important issues they will likely address; think about your experiences and how they distinguish you to contribute to this effort.

In addition to the charge, be sure to consider where the particular group is in their evolution.

This can be seen under the “Approved Dates” which is listed in the box containing the task group name and is just below the charge. TG-219 was formed officially as a task group in May of 2011 and is proposed end (sunset) its work by 12/31/2013. You are more likely to be able to join a group that is just beginning, unlike this one that is nearing its end.

Finally, review the minutes of past meetings. By looking on the committee tree below the box containing the task group name and charge, but above the Roster, you will find a link titled “AAPM Members Only Information (Financial/Minutes/Virtual Meetings).” Under this link you can find the minutes of past meetings. Read the minutes to better understand what the group has already accomplished and what work remains to be done. Look for areas where your experiences are a natural fit for the remaining work. We can see from the minutes of their meeting in July 2012 they have performed a survey that was extremely productive, are working through issues of how to best apply FMEA, and assignment of section writing. Their work is in the final stages, but is illustrative of the type of review you can perform to identify groups where you might be an excellent fit.

2. Join meetings as a guest Show up for meetings during annual meeting. Send a note to the chair before the meeting and ask if the meeting is open to guests, in most cases the answer will be yes. Ask the chair if you can receive a copy of the agenda and any other material that may be distributed. Prepare for the meeting to understand what is going on; you will get the most out of attending if you already understand nuisances of the issues being discussed. Be informed and attentive, but don’t interject with questions or come with the intent of changing the direction of the group, that’s unlikely to be well received. Remember the face-to-face meetings these groups hold are infrequent and precious time. The group has set this time aside to role up their sleeves and

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work; it is unlikely the will be able to afford time educating guests. Ask to speak with the chair about your questions and concerns after the meeting.

3. Apply through Classified Ads This process should be more like applying for a job then the type of popularity contests that occur in junior high student body elections. Be prepared to compete. Demonstrate to the chair you are among the best people within our organization to contribute to the effort, show your unique qualifications and the work you have done in this area. Provide examples of your work to the chair so they can see the quality of what you can produce, that you are organized and have strong written communication skills. Be so persuasive the chair enthusiastically brings you in the fold.

If you try and are not successful, recognize there are many who are applying for these positions. Chairs typically receive a factor of 20 more applications than positions they intend to fill. Groups must be manageable in size and focused, with few face to face meetings and a limited number of conference calls, chairs need to know those joining the group will be productive. This makes it challenging for first-time volunteers as they have yet to prove their merits, but this can be overcome. Do your homework regarding the different committees and find a group that is an excellent match for your skill set and interests. Ultimately, it may take several years to understand much of what our organization is doing. I encourage you to do that body of work and invest in the process for the long haul. It may take several years of attending as a guest before you find an excellent fit, but I encourage those with a passion for making this type of contribution to the AAPM to be persistent. I look forward to seeing many of you in the “meetings before the meetings.�

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

AAPM Executive Director’s Column

Angela R. Keyser, College Park, MD

Be a part of AAPM activities Remember to Vote by July 17!

Elections for the 2014 President-Elect and Board Members-At-Large will close on July 17th.

Remember to use the AAPM Bulletin Board System (BBS) during the election process to discuss issues of concern with the candidates and the election in general. The election process will be online only so be alert for email announcements and make sure to cast your online ballot.

AAPM Professional Information Survey The 2012 Professional Survey is available online. You can download a PDF from the web or have the document emailed to you. If you have any problems, please contact HQ.

AAPM Annual Meeting It’s Jeans and Jerseys Night -- wear your favorite NFL team jersey to the AAPM Night Out at Lucas Stadium in Indianapolis! Even non-sports fans will get a visual thrill in this Superbowl venue.

• On the field: Guests who prefer to be immersed in the full NFL experience will be directed by referees through on-field activities (punting, passing and kicking).

• Off the field: Guests who prefer to sit and chat with colleagues will have plenty of seating above the field; all the action will be on the Jumbotron.

For complete menu details, go online. Make sure to review the local information for other area attractions in Indianapolis.

Make plans to attend the 2013 Annual Business and Town Hall Meeting on Wednesday, August 7 from 6:15 PM - 7:30 PM in Wabash Ballroom of the Indiana Convention Center.

Members of the AAPM Board of Directors want to hear directly from the membership. What should AAPM be working on? How can the organization better serve you? Here’s your chance to be heard. AAPM’s President and Treasurer will report on the status of the organization.

Visit the Vendors!

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

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Exhibit hours are:

- Sunday, August 4 – 12:30 – 6:00 PM - Monday, August 5 – 9:30 AM – 6:00 PM - Tuesday, August 6 – 9:30 AM – 6:00 PM - Wednesday, August 7 – 9:30 AM – 2:00 PM

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

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

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

Important: September 4th is the last day to complete the online evaluation system and receive CAMPEP credits for the sessions attended and reviewed from the 2013 Annual Meeting.

Grants and Fellowship Recipients Congratulations to the following AAPM funding recipients: Research Seed Funding Grants: Two $25,000 grants are awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. It is expected that subsequent research results will be submitted for presentation at future AAPM meetings.

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Adam Wang - Johns Hopkins University Stephen Dowdell - Massachusetts General Hospital

AAPM/RSNA Fellowship for the training of a doctoral candidate in the field of Medical Physics: Awarded for the first two years of graduate study leading to a doctoral degree in Medical Physics.

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Xenia Fave - UT MD Anderson Cancer Center

AAPM Newsletter | Volume 38 No. 4 | July/August 2013

2013 AAPM Summer Undergraduate Fellowship: Designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. In this program, the AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the 10-week program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be an AAPM summer fellow.

Each summer fellow receives a stipend from the AAPM. • • • • • • • • • •

Alexander Antolak Grant Coulston Emery Rachel Ger Krystal Marie Kirby Celeste Ina Leary Erica Ellis Mason Matthew Scarpelli Rachel Christine Schmidt Andrew Jon Shepard Blake Robert Smith

2013 Minority Undergraduate Summer Experience (MUSE): Designed to expose minority undergraduate university students to the field of medical physics by performing research or assisting with clinical service at a U.S. institutions (university, clinical facility, laboratory, etc.).

The charge of MUSE is specifically to encourage minority students from Historically Black Colleges and Universities (HBCU), Minority Serving Institutions (MSI) or non-Minority Serving Institutions (nMSI) to gain such experience and apply to graduate programs in medical physics.

• • • • • •

Brian Norman Allen Michael Conner Clay Contee Yacinthe Dorsainvil Kaitlyn Sukovich Terrell White

Staff News Two members of the AAPM HQ tied the knot in May and I know you will join me in wishing them many wonderful years of wedded bliss! Lisa Giove married Erik Schober on May 4 at the Wild Dunes Resort in the Isle of Palms, outside of Charleston, SC. Noel Crisman-Fillhart married Chris Tyler on May 25 in a lovely ceremony at the Overhills Mansion in Catonsville, MD. Mrs. Schober and Mrs. Tyler have returned to the office after wonderful tropical honeymoons!

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I am pleased to announce that Debbie Bray Gilley will join the AAPM team as of September 1, 2013 as the Government Relations Specialist. Debbie is completing her assignment as a Radiation Safety Specialist with the Radiation Protection of Patients Unit of the International Atomic Energy Agency (IAEA) in Vienna in August. Her activities within the Agency include the development and implementation of the Safety in Radiation Oncology medical event reporting system (SAFRON) and assisting in other IAEA patient safety campaigns. She is the co- author of several upcoming IAEA publications on patient safety. Since 2004, she has participated in eight missions for the IAEA in North and South America, Africa, and the Caribbean assisting countries in developing radiation protection regulations for the safe and secure use of radiation devices. Before relocating to Austria, she was employed by the Florida Bureau of Radiation Control for 24 years. During this time she served as Manager of the Training and Quality Assurance Program, Manager of the Radioactive Materials Program, and Investigator for reported medical events. She served as the agreement state representative to the US NRC Advisory Council on the Medical Use of Isotopes (ACMUI) from 2008 until 2011. She is a past board member and chairperson of the Conference of Radiation Control Program Directors (CRCPD). Debbie has a BS and MPA from Florida State University, and has provided over 100 presentations to international, national, state and local audiences interested in radiation protection. Debbie will attend the AAPM Annual Meeting in Indianapolis.

Staff Recognition Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of high-performing professionals. The following AAPM team members celebrated an AAPM anniversary in the first half of 2013. I want to publicly thank them and acknowledge their efforts.

Nancy Vazquez 17 years of service Jennifer Hudson 12 years of service Zailu Gao 12 years of service Karen MacFarland 10 years of service Lynne Fairobent 9 years of service Lisa (Giove) Schober 8 years of service Laurie Allen 6 years of service Onasis Budisantoso 5 years of service Viv Dennis 3 years of service Melissa Liverpool 2 years of service Rachel Smiroldo 2 years of service Chris Oronsaye 1 year of service

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An RSO’s Dream Come True • Increase dosimetry compliance • Dose information captured daily • Lower dose for high risk employees

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To experience this new system call us today at: 800-251-3331

Dosimetry Services Division iPad and iPhone are trademarks of Apple Inc., registered in the U.S. and other countries.

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Editor’s Column

Mahadevappa Mahesh, Baltimore, MD

Editorial column

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s you open this newsletter you are reminded of the annual meeting that is going to be in the first week of August in Indianapolis, IN. The main theme of many regular columns is related to the upcoming annual meeting and information about the sessions many have organized and are participating in as speakers. I draw your attention particularly to the Chairman of the Board’s column that goes into detail about the outcome of the antitrust lawsuit in which the Judge ruled in favor of the association. Also, those providing accreditation services for Ultrasound modalities may find the article on ACR accreditation to be of value as it provides updates on ultrasound accreditation that are effective June 1, 2014.

Overall, I wish all of you a happy summer and look forward to see many of you all at the annual meeting.

Call for Nominations Nominations are now being accepted for the following AAPM Awards: • • • • •

William D. Coolidge Award Marvin M.D. Williams Award Edith H. Quimby Lifetime Achievement Award John S. Laughlin Young Scientist Award AAPM Fellows

All nominations are due by October 15, 2013 and are to be done through the online nomination system. Applicants will be notified of decisions by May 1, 2014. Recipients will be honored at the AAPM Awards and Honors Ceremony and Reception during the 56th Annual Meeting in Austin, Texas in the year 2014.

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And the Winner of the ACP 2013

Egg Relay is...

On Wednesday, June 12th the American Center for Physics (ACP) held its Annual Staff Picnic. Every year, AAPM, along with the other three societies in the building (American Institute of Physics (AIP), American Physical Society (APS), American Association of Physics Teachers (AAPT)), sends 3 representatives to compete in an Egg Relay Race. We are proud to say that after eight years of coming thiiiis close, the AAPM team finally sealed the deal!! The winning team consisted of: Rachel Smiroldo, Exhibits & Meetings Assistant Angela Keyser, Executive Director Lisa Schober, Senior Executive Assistant

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Legislative and Regulatory Affairs Report

Lynne Fairobent, College Park, MD

Potential amendments to 10 CFR Part 20 Standards for Protection Against Radiation

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he U.S. Nuclear Regulatory Staff (NRC) staff has been working on a potential revision to 10 CFR Part 20 Standards for Protection Against Radiation for a number of years. This effort began with a December 18, 2008 submittal by the NRC staff of a Policy Issue Notation Vote Commission Paper, SECY-08-0197, requesting approval to revise Part 20 and related guidance documents to achieve greater alignment with the 2007 Recommendations of the International Commission on Radiological Protection (ICRP Publication 103). [The NRC’s Synopsis of ICRP Publication 103, which is available through the NRC’s Agencywide Documents Access and Management System (ADAMS), discusses the broad implications of the new recommendations.]

In order to align with ICRP 103, changes to the regulatory framework would affect the regulatory framework provided by Title 10, Part 20, of the Code of Federal Regulations (10 CFR Part 20), “Standards for Protection Against Radiation”; 10 CFR Part 50, “Domestic Licensing of Production and Utilization Facilities”; and Appendix I to 10 CFR Part 50, “Numerical Guides for Design Objectives and Limiting Conditions for Operation to Meet the Criterion ‘As Low as is Reasonably Achievable’ for Radioactive Material in Light-Water-Cooled Nuclear Power Reactor Effluents.”

Background: The Commission subsequently accepted the staff ’s recommendation through the related Staff Requirements Memorandum (SRM-SECY-08-0197), dated April 2, 2009, which instructed the staff to begin engagement with stakeholders and interested parties to initiate development of the technical basis for possible revision of the NRC’s radiation protection regulations, as appropriate and where scientifically justified, to achieve greater alignment with the 2007 ICRP recommendations. Beginning in 2009, NRC held a number of public meetings on the proposed revisions. Information from these public meetings can be found here. Written comments on the issues discussed at the workshops submitted to NRC can be found at (Regulations.gov) under Docket ID NRC-2009-0279.

Based on the information received, the NRC staff provided a set of policy and technical recommendations to the Commission on April 25, 2012, SECY-12-0064. The Commission issued the Staff Requirements Memorandum (SRM-SECY-12-0064) to the staff on December 17, 2012. The Commission approved in part, and disapproved in part, the staff ’s recommendation from SECY-12-0064.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

The Commission approved the staff ’s development of the regulatory basis for a revision to 10 CFR Part 20 and parallel alignment of 10 CFR Part 50, Appendix I, to align with the most recent methodology and terminology for dose assessment. The Commission stated: •

Appropriate steps should be taken to assure that conforming changes are made as soon as practical to make these methods consistent throughout all NRC regulations.

•

The staff should develop improvements in the NRC guidance for those segments of the regulated community that would benefit from more effective implementation of ALARA (as low as is reasonably achievable) strategies and programs to comply with regulatory requirements.

•

The Commission has disapproved the elimination of traditional units from the NRC regulations. Both units should be maintained.

•

The staff should continue discussions with stakeholders regarding dose limits for the lens of the eye and the embryo/fetus.

•

The staff should pursue its activities, and the development of any regulatory basis for ac- tion in these areas, with the extensive engagement of other Federal and State government partners (DOE, EPA, FEMA, and OSHA), including, both Agreement and non-Agree - ment States, as well as the regulated community and the public. In particular, any future recommendations that propose a change in the dose limits should include the views of Federal, State, and other stakeholders.

As part of the continued outreach effort, Cindy Flannery, NRC will present Next Steps Toward Revising Radiation Protection Regulations at the AAPM annual meeting on Thursday, August 8th at 1:00 PM (TH-E-105-1 Thursday 1:00PM - 1:55PM Room: 105).

To assist you with questions for NRC, the following summarizes key points NRC raised at the Conference of Radiation Control Program Directors meeting: 1.

20

Updated Methodology and Terminology a. Commission Direction: i. Develop a regulatory basis for a revision to 10 CFR Part 20 to align with the most recent methodology and terminology for dose assessment.

b. Proposal: i. TEDE becomes TED ii. New WT and WR values incorporated into definitions iii. Part 20, Appendix B revised with new ALI and DAC values c. Key Questions: i. What would be an appropriate time frame and approach to transition of terminology AAPM Newsletter | Volume 38 No. 4 | July/August 2013

2.

3.

4.

5.

6.

21

ii. Consistent methodology for calculations Individual Protection a. Commission Direction: i. Continue discussions with stakeholders on alternative approaches to deal with individual protection at or near the current effective dose limit.

b. Objective i. Regulatory Requirements and guidance that will ensure that cumulative exposures are examined, and that progressive restrictions can be taken as cumulative exposure increase. c. Options: i. Performance based requirement added to ALARA and Radiation Protection Programs, with guidance, or ii. Prescriptive requirements Individual Protection Performance Options a. Require licensees to establish an administrative control level (ACL) as part of their radiation protection program and to establish specific procedures for individual protection, such as: i. ACL 20 mSv per year. ii. ACL average 20 mSv over 5-year period. iii. ACL to use NCRP 10 (mSv) x N (age) cumulative approach. iv. ACL to restrict individuals to 20 mSv if cumulative exposure exceeds xxx mSv. v. Other Options.

Individual Protection Prescriptive Options a. Require licensees to have a record of all occupational doses (lifetime) if exposures are permitted to exceed 20 mSv per year. b. Require that licensees not allow occupational exposures to exceed 20 mSv in a year if the cumulative occupational exposure exceeds xxx mSv. c. Require licensees be provided with record of all other sources of occupational expo sure. d. Other Options Individual Protection Questions a. Key Questions: b. How does each approach work for different classes of licensed use? c. Is there another mechanism to look at cumulative exposures? d. Should States be allowed to use prescriptive requirement if NRC decides to use performance based approach? e. What is impact on licensee activities? State regulatory programs?

Lens of the Eye a. Commission Direction: i. Continue discussions with stakeholders regarding possible revisions to the dose limit (150 mSv (15 rem)) for the lens of the eye b. Proposal: AAPM Newsletter | Volume 38 No. 4 | July/August 2013

7.

8.

9.

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i. Reduction to 50 mSv (5 rem) LDE c. Key Questions: i. Are there alternatives to keep cumulative exposure below threshold? ii. Viewpoints on the relative importance of health endpoint? iii. What methods should be allowed for measurement or assessment? iv. What methods should be allowed for recording dose when eye is protected? v. What is impact on licensee activities? State regulatory programs?

Embryo/Fetus a. Commission Direction: i. Continue discussions with stakeholders regarding possible revisions to the dose limit (5 mSv (0.5 rem )) for embryo/fetus b. Proposal: i. Reduction to 1 mSv (0.1 rem) c. Key Questions: i. Apply to post declaration or entire gestation period? ii. What should be done if 1 mSv has already been reached at declaration? iii. What methods should be allowed for measurement or assessment? iv. What is impact on licensee activities? State regulatory programs?

Traditional vs. SI Units a. Commission Direction: i. Disapproved the elimination of traditional units from NRC regulations. Both traditional and SI units should be maintained. b. Proposal: i. Implement Commission Policy Statement – SI first, traditional in parenthesis c. Key Questions: i. How do we avoid confusion? ii. Should Appendix B be given in SI, or traditional, or both? iii. Should licensees be allowed to report in SI? iv. What is impact on licensee activities? State regulatory programs?

Reporting of Occupational Exposure

a. Commission Direction: i. Improve reporting of occupational exposure by NRC and Agreement State licensees, some of which do not currently submit reports. b. Proposal: i. Add categories of licensed use: e.g., Part 35 ii. Modify requirements for compatibility iii. Explore mechanisms for central repository of data for all to use. c. Key Questions: i. What categories should be included? ii. What is the rationale for reporting? iii. What are health and safety, and/or trans-boundary considerations? iv. How to deal with occupational exposure of machine produced radiations? v. What is impact on licensee activities? State regulatory programs?

AAPM Newsletter | Volume 38 No. 4 | July/August 2013

Update from the American Board of Medical Physics The American Board of Medical Physics (ABMP) is approaching its twenty-fifth anniversary.

ABMP continues to certify candidates in Medical Health and MRI Physics. Currently ABMP has some 500 active diplomates that continue to meet our recertification requirements, including many who were previously certified in Therapy or Diagnostic Physics.

The American Board of Medical Physics recognizes the importance of continuing professional development and awards certification on a time-limited basis (initial ABMP certification is for 5 years and must be renewed every 5 years thereafter in order to maintain certification. If your recertification application is not received with appropriate CE’s and supporting documents, you will be removed from the list of duly certified diplomates.)

ABMP defines Continuing Education (CE or CME) as “educational activities that serve to maintain, develop or increase the knowledge, skills and professional performance and relationships that a professional uses to provide services for patients, the public, or the profession.”

ABMP has currently issued a new Recertification CE/CME policy that will begin in 2014.

Effective January 1, 2014, ABMP recertification will require at least 125 continuing education (CE) credits every five years. For the past 5 years recertification candidates have been informed that their next 5-year recertification would require 150 CE credits. The ABMP Board has recently reduced the number of CE credits required from 150 to 125 in order to be more consistent with requirements of other certifying bodies. The 125 CE credits may be met by a combination of Category 1 credits and Category 2 credits.

Category 1 Credits: At least 65 of the 125 required CE credits must be Category 1. In order for an activity to be designated for Category 1 credit it must be planned by an accredited CE provider. Category 1 credits can be obtained during attendance at National and or Local Meetings of organizations such as AAPM, HPS, ISMRM, SNM, ACR, ASTRO, NCRP, ICRP, RSNA, etc. These are formally planned meetings that include documentation of acceptable needs assessment, learning objectives, educational design, an evaluation method, and disclosure. Additional Category 1 activities include lectures and meetings in which learners are physically or remotely present and “Enduring Materials” - CE activities based on recorded or published content (i.e., printed materials, CD-ROMs, audio CDs, DVDs, Internet presentations). Some organizations such as AAPM have online learning centers that allow diplomates to obtain Category 1 credits for successfully passing quizzes associated with informational sources such as journal articles, presentations, task group reports, and other publications.

Category 2 Credits: No more than 60 of the 125 CE credits required can be Category 2 credits. These are “self-assessment” credits and include informally planned activities such as

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practice-based self-study, consultations with colleagues, teaching, conferences, journal clubs, in-service presentations, books or chapters read or published and journal articles read or published. Credits can also be obtained for technical committee memberships and vendor sponsored educational classes. In order to simplify the assignment of Category 2 CE credits to publications and some other activities, see the details on the table below: Publication of technical article; peer reviewed; meets Index Medicus/Medline criteria.

All material must be relevant to Medical Physics, Medical Health Physics, MRI Science or Radiation Biology. Maximum in any one category is 30 credits per year.

Category 2 Credit List 1st author 2nd author All other authors Original textbook Chapter in original textbook Revision of original textbook Revision of chapter(s) in textbook Paper presented at professional mtg.

Poster presentation at national mtg Lecture prep for college course (1st yr only) National or State technical committee membership International technical committee membership Vendor sponsored educational classes In-service lecture(s) - different topics Technical article(s) read Technical book chapter(s) read

Credits

Required Documentation

15 10 3 (30/# of Authors x number of Pages)/100 12

10

Copy of 1st page of article Copy of 1st page of article Copy of 1st page of article Copy of title page and copyright page Copy of title page, chapter and copyright page Copy of title page and copyright page Copy of title page, chapter(s) and copyright page Copy of listing from meeting agenda Copy of listing from meeting agenda Copy official course listing

4 per yr.

Copy of official committee listing

6 per yr.

Copy of official committee listing

1 per hr.

Copy of certificate of attendance – hrs specified Copy of lecture topic and audience given to Self attestation (Maximum 30 per year) Self attestation (Maximum 30 per year)

(20/# of Authors x number of Pages)/100 4 ea.

8 8

1 per hr.

0.5 each 0.5 each

ABMP requests that diplomates only submit CMEs for the current 5-year recertification period and that you separate your Category 1 and Category 2 credits and show the five-year totals for each. Additional questions should be directed to Cynthia Archer at 281-944-9482, FAX 866-861-8280 or email to abmpexdir@comcast.net.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

Professional Council Column

Per Halvorsen, Newton, MA

Professional symposia in Indianapolis

T

his is the last issue of the Newsletter before the Association’s Annual Meeting in Indianapolis. The Professional Program Directors, Doug Pfeiffer and Russ Tarver, have arranged an impressive program (made possible, of course, by the many strong proposals submitted). To name just a few: On leadership: The Professional Council Symposium on Sunday morning is focused on “The Medical Physicist as a Professional Leader: The Importance of Leadership Development”, with talks by Bill Hendee, John Hazle and Jessica Clements. On Wednesday, a panel of 4 speakers will address the topic “Managing and Leading Others.”

On practice environment issues: “Your First Job: Finding and Keeping It”, followed by “Inhouse Credentialing”, “Professional Liability and Risk Management in Medical Physics Practice”, and “Medical Physics Economics.”

On compliance: The ever-popular “HazMat Shipping DOT Training” series, followed by “RSO Refresher Training.”

On scientific publications: “How to be a Journal Referee”, followed by “Writing and Reviewing Papers for Medical Physics” and “Open Access Publishing and Medical Physics.”

On the Boards: The three ABR Physics Trustees will present an ABR update on Monday, followed by sessions on preparing for the ABR Therapy and Imaging exams on Wednesday.

If you’re a new member of the AAPM, don’t miss the New Member Symposium on Tuesday afternoon, hosted by Jessica Clements and George Sherouse. Most of the Association leadership attends the symposium as well, to answer any questions you may have and to hear your suggestions for what the AAPM should prioritize.

I’m happy to see such breadth and strength of submissions for the Professional Track at this year’s conference. Please provide feedback to the Program Directors on what was helpful and what was not, so we can continue to refine the program and offer useful and informative sessions.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

New Professional Survey is now available In case you hadn’t noticed, the 2012 Professional Survey is now available on the AAPM website.

As in past years, this report contains a wealth of information and has been analyzed by the Statistical Research Center of the American Institute of Physics. If you have suggestions for questions to be included in future surveys, please contact John Sweet, Chair of the Professional Survey Subcommittee.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

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Education Council Report

George Starkschall, Houston, TX

Education Council will be busy at the AAPM Meeting

T

he AAPM is involved in many aspects of medical physics education, including the education of medical physicists, medical physics graduate students, physicians, allied health personnel, and the general public. One aspect of medical physics education in which the AAPM is involved that, perhaps, many of its members are not familiar, is our efforts in international education. The International Educational Activities Committee, chaired by Yakov Pipman, is charged with ensuring that the AAPM provides medical physics educational programs and educational resources to medical physicists working outside of the USA and Canada and ensuring coordination between these international educational activities of the AAPM and those of related Training Academy organizations.

MEDICAL SAFETY TRAINING

In our upcoming AAPM Meeting in Indianapolis, the Education Council Medical Radiation Symposium, entitled “AAPM and Safety Officer Course International Education: What, Why CAMPEP Accredited.

Fluoroscopy Training and and How?” is designed to familiarize our Refresher Course AAPM membership with current activities Custom Courses in international education. The stated Designed to meet your needs. objectives of the Symposium are (1) to Available Formats learn about challenges for Medical Physics Classroom education in developing countries, (2) to (Las Vegas NV, Gaithersburg MD look at ways and opportunities to “do good” or Oak Ridge TN) while engaging in exciting work, (3) to On-site (your choice) discuss ways to help our colleagues abroad On-line Courses while expanding our own understanding Webinar Courses and improving our skills, and (4) to learn 1-800-871-7930 how collaborating on projects can leverage Complete online catalog at www.moellerinc.com/academy the educational offerings and generate opportunities for growth. The Symposium Offering Medical Physics and Radiation Safety Consulting Services will be chaired by Yakov Pipman, and will consist of talks by the following well-known medical physicists: Jake Van Dyk, Cheng Saw, Robert Jeraj, and Gerald White. The Symposium will be held on Sunday, August 4, from 11 am to 12:30 pm in the Wabash Ballroom of the Convention Center, and I hope you will be able to attend. A special word of thanks goes to Yakov for organizing this Symposium.

Available Courses

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

Please be aware of several other activities that address education at the Meeting. On Sunday morning from 9:30 to 11:00 am, in Room 141 at the Convention Center, the Students and Trainees Subcommittee of the Education and Training of Medical Physicists Committee will be holding its annual Student Meeting. The meeting will include two presentations on the subject of pathways to a career in medical physics. With the American Board of Radiology requirement that candidates for the certification examination complete a CAMPEP-accredited residency program, career options for medical physics students have become increasingly more complex. Two speakers, Wendy Smith, from the Tom Baker Cancer Centre in Calgary, and I, will be giving presentations on career opportunities in medical physics. Later on Sunday, August 4, we will have a General Poster Discussion session from 3 pm to 6 pm in the Exhibit Hall that will include a set of posters on educational methods. On Tuesday morning, from 10:30 am to 12:30 pm, in Room 116, Perry Sprawls will be conducting a session entitles “The Elements of a Highly Effective Educational Session.” Finally, the annual Innovations in Medical Physics Education session will be held Monday from 4:30 pm to 6 pm in Room 134.

We have six proffered presentations, and once more, a cash prize will be awarded to the best presentation in the session.

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

One last note: One of our Education Council success stories is the summer program (actually two programs) we have in which talented undergraduate students interested in a career in medical physics are paired with AAPM-member mentors. A report on the two programs that we sponsor, the Summer Undergraduate Fellowship Program (SUFP) and the Minority Undergraduate Summer Experience (MUSE), can be found in a recent issue of the Journal of Applied Clinical Medical Physics (J Smilowitz, S Avery, P Gueye, GA Sandison, “Report on the American Association of Medical Physics undergraduate fellowship programs,” JACMP 4(1):289-298 (2013)). Enjoy reading it; we’re proud of this work.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

ACR Accreditation FAQs

Priscilla F. Butler, Reston, VA

ACR accreditation: Frequently asked questions for medical physicists

D

oes your facility need help on applying for accreditation? In each issue of this Newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists.

You may also check out the ACR’s accreditation web site portal for more FAQs, accreditation applications and QC forms.

The American College of Radiology recently published new QC requirements for their Ultrasound and Breast Ultrasound Accreditation Programs. Effective June 1, 2014, all accredited facilities or facilities applying for accreditation must comply with the minimum quality control tests and frequencies listed in the Program Requirements. The new requirements call for Acceptance Testing and Annual Surveys to be performed by a qualified medical physicist (or “appropriately trained personnel with ultrasound imaging equipment experience” who has been approved by the lead interpreting physician) as well as routine QC by appropriately trained sonographers or service engineers. On June 1, 2014, as part of the accreditation application, facilities must demonstrate compliance with the ACR requirements for QC by providing: • •

Reports from the most recent ultrasound Annual Survey performed by the medical physicist or designee Documentation of corrective action (if the Annual Survey and/or QC data identified performance problems)

Please feel free to contact us at ultrasound-accred@acr.org or breastultrasound-accred@acr.org if you have questions about ultrasound or breast ultrasound accreditation.

General Q. Why is ACR requiring that QC be conducted for ultrasound and breast ultrasound as part of their accreditation programs?

A. Both the Committees on Ultrasound and Breast Ultrasound Accreditation understand that QC is a vital part of quality imaging and patient safety. For many years, the ACR has alerted accredited facilities through the Program Requirements that “although the ACR will not initially use this [QC] information to determine whether a facility passes or fails accreditation, it may be used in the future to set criteria.” Since most facilities are per forming QC as a result of the above notification, the committees decided that it was time

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

to begin requiring QC as part of accreditation. Medical physicist and radiologist members of the 2 committees decided on the tests and frequencies to be performed, as well as who is responsible for their performance. In addition, the committees strongly recommended that QC be done under the supervision of a qualified medical physicist.

Q. Will not having Annual Surveys or routine QC prevent a facility from becoming accredited?

A. Yes. Effective June 1, 2014, the ACR will not grant accreditation if documentation of compliance with ACR QC requirements is not provided.

Q. If a facility is applying for accreditation between June 1, 2013 and May 31, 2014 (before the new requirements go into effect) should they submit the Annual Survey report?

A. No. Facilities will not be asked to submit documentation of an Annual Survey if we receive their application between June 1, 2013 and May 31, 2014. However, they should use his time period to begin establishing a QC program if they have not done so before.

The currently required semi-annual routine quality control testing for the Ultrasound Accreditation Program and the medical physicist or service engineer report for Breast Ultrasound Accreditation Program must still be submitted.

Q. What is the difference between Acceptance Testing, Annual Surveys and routine QC Testing? Many of the tests appear to be the same.

A. Acceptance testing is the initial performance testing of newly installed or repaired imaging equipment (or components) that is completed before clinical use. Acceptance testing should be comprehensive and include all tests done for the Annual Survey to provide complete performance baselines for comparison with future test results. Annual Surveys are complete tests performed once a year by the medical physicist (or designe to assess the performance of the equipment. Although Annual Surveys include all of the same tests conducted during routine QC testing, it is intended to be more extensive.

Having the medical physicist annually perform the measurements included in the routine QC can verify that routine QC is being performed accurately, and serve as an additional educational opportunity for the sonographers to understand the QC. In addition, Annual Surveys include an evaluation of the facility’s routine QC program. Routine QC testing is less extensive and is performed semiannually by the facility’s sonographer (or a service engineer).

Q. May we count the tests performed during the medical physicist’s (or designee’s) Annual Survey as counting towards the sonographer’s (or service engineer’s) routine QC Testing?

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

A. No. The semiannual routine QC testing must be performed in addition to the tests performed during the Annual Survey. The Annual Survey tests must be performed once a year by the medical physicist or designee; the routine QC tests must be performed 2 times a year by the sonographer or service engineer.

Acceptance Testing and Annual Surveys Q. Will facilities have to provide proof that “appropriately trained personnel with ultrasound imaging equipment experience” conducting Acceptance Testing and Annual Surveys have been trained when they apply for accreditation?

A. No. Presentation of documentation of training is not required as part of the accreditation application. However, the facility must be sure all requirements for personnel are met when they apply for accreditation with the ACR. During ACR Site Visits, the surveyors will request to see verifying documentation. Failure to demonstrate that personnel are qualified could adversely affect accreditation status.

Q. Who must provide the training for “appropriately trained personnel with ultrasound imaging equipment experience” conducting Acceptance Testing and Annual Surveys?

A. The ACR strongly recommends that the training for the “appropriately trained personnel with ultrasound imaging equipment experience” be provided by a qualified medical physicist. If unable to acquire training by a qualified medical physicist, training can be achieved through the ultrasound equipment manufacturer or through an appropriate course. Documentation of such training is strongly encouraged. Facilities should keep such documentation on file, but should not submit this documentation with accreditation submissions.

Q. If our medical physicist fails a test performed during the annual survey, how long do we have until we must contact service and take corrective action?

A. If acceptance or Annual Survey test results fall outside of the acceptable limits, corrective action must be taken. Appropriate action must occur immediately if there is imminent danger to patients or staff using the equipment due to unsafe conditions. However, for other cases there is no specific time-frame required by the ACR. You should consult your medical physicist regarding the seriousness of the failure to determine how quickly corrective action should be implemented. In any event, effective June 1, 2014, the ACR will not grant accreditation if documentation of compliance with ACR QC requirements is not provided; if any tests fail, you must provide documentation of corrective action with your accreditation material.

Q. Is there an ACR-provided form the medical physicist must use to record his/her acceptance testing or Annual Survey test data and results?

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

A. The qualified medical physicist (or designee) may use whatever forms he/she deems appropriate for their Annual Survey. However, effective June 1, 2014, the medical physicist (or designee) must also provide a summary of the acceptance testing or Annual Survey pass/fail test results. They may complete the ACR-provided Annual System Performance Evaluation Report Summary form or provide their own summary as long as it itemizes the pass/fail results for each required test.

Q. We have had our ultrasound unit for several years prior to the effective date of this new accreditation requirement and had no acceptance testing performed upon installation. What documentation must we maintain for acceptance testing if none was performed?

A. Since no acceptance testing was performed, no documentation of such testing can be maintained. The ACR understands that. As long as Annual Surveys are performed routinely and appropriate documentation is maintained, this will be sufficient.

Routine Quality Control Testing Q. After June 1, 2014, must we submit documentation of routine QC performed by the sonographer as part of the accreditation application?

A. No, the ACR will not ask for documentation of routine QC performed by the sonographer as part of the accreditation application. This is because your medical physicist (or designee) is responsible to check that all required routine QC tests were performed as part of the Annual System Performance Evaluation. The ACR will check that this review was done when the Annual Survey report is reviewed.

Q. Who must perform the routine QC tests?

A. The routine QC tests must be performed by an appropriately trained sonographer or service engineer.

Q. Who must provide the training for “appropriately trained sonographers or service engineers” conducting routine QC? A. The ACR strongly recommends that the training for “appropriately trained sonographers or service engineers” conducting routine QC be provided by a qualified medical physicist.

If unable to acquire training by a qualified medical physicist, training can be achieved through the ultrasound equipment manufacturer or through an appropriate course.

Q. Should a facility assign the lead sonographer to perform routine QC tests? If so, do we need to notify ACR who that person will be?

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

A. It is not required that the lead sonographer be assigned the duty of conducting routine QC. This is the facility’s decision. You do not need to notify ACR of the designated staff performing QC. Q. Is there an ACR-provided form that we must use to record our data and results from our routine QC tests?

A. No. At this time, the ACR does not provide forms to record data from routine QC tests.

We suggest working with your qualified medical physicist to help develop your own forms or contact the equipment manufacturer to see if any are available through them.

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

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

55th Annual Meeting

Scientific Program Items of Note: • • •

Meeting begins: Sunday, August 4 at 9:30 am Meeting ends: Thursday, August 8 at 2:50 pm An Exciting Sunday Schedule Kicks Off the Week 1:30 – 3:00 pm SNAP Oral Sessions 3:00 – 6:00 pm Refreshments, Technical Exhibits, and Poster Discussion 3:30 – 4:00 pm Best-in-Physics Poster Discussion 4:00 – 6:00 pm John R. Cameron - Young Investigators Symposium

Campus Posters - include a cluster of posters on a specific theme identified by the Program Directors to be of special interest to attendees of the scientific program. These poster presentations will occur in a specially designated ‘campus’ integrated with the poster presentation area in a format promoting lively discussion and scientific exchange. A ‘Provost’ will moderate these campuses from 3:00 – 4:00 pm on Sunday during the General Poster Discussion Session.

SNAP Oral Sessions - Similar to regular Scientific Sessions, the SNAP Oral Sessions feature proffered abstracts presented in an accelerated presentation format.

Therapy Program Scientific Symposia • The Impact of Intensity Modulated Proton Therapy on Proton Therapy?

• Accuracy Requirements and Uncertainties Considerations in Radiation Therapy • The Science of Clinical Medical Physics • Research and Relevance of Brachytherapy Dose Calculation Advancements • Radiation Dose Calculations on Graphics Processing Units (GPUs): Advances and Challenges • Collaborative Knowledge Modeling and Integration for Radiation Therapy Planning • Formal Radiation Therapy Safety Processes

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

SNAP Oral Sessions • Devices and Detectors for Online and Offline Measurements • Patient Safety and Machine QA • Delivery and Verification - Photons and Electrons • Dose Calculations - Protons, Photons, and Brachytherapy • Patient Specific QA and Informatics • Biological Modeling and Outcomes Analysis • Brachytherapy • Small Animal Studies • Planning and Delivery - SRS and SBRT • Protons - Planning, Optimization, and Range Uncertainty Scientific Sessions • Treatment Planning: Optimization Techniques, Plan Evaluation, and Robustness Analysis • Calculation Tools for Patient Safety and QA • Treatment Planning, Delivery, and Verification: Particle Therapy • Devices and Detectors for Offline and Online Measurements • Treatment Delivery and Verification: Photons and Electrons • Outcomes Analysis • Planning, Delivery, and Verification: Brachytherapy • Dose Calculations • Preclinical Studies • Calibration, QA, and Safety • Advances in Monte Carlo Dose Calculations • Informatics and Patient Specific QA • Planning and Delivery: SRS, SBRT, and VMAT • IMRT Optimization, Plan Evaluation, and Robustness Analysis • External Beam Treatment Planning • Proton Range Uncertainty • Radiobiology and Biological Modeling Imaging Program Scientific Symposia • In Memoriam of Fearghus O’Foghludha: Virtual Tools for Validation of X-Ray Breast Imaging Systems • Estimating Risk of Low Radiation Doses • Multi Modal PET/CT Imaging for Therapy Response Early Prediction and Therapy Monitoring • Image Quality Models in Advanced CT Applications • Advanced Imaging for Breast Cancer: Screening, Diagnosis, and Assessing Response to Therapy • Session in Memory of Charles E. Metz - Past, Present and Future Roles of ROC Analysis

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

•

in Medical Imaging and Quantitative Image Analysis Nanotechnology & Molecular Imaging

SNAP Oral Sessions • CT Topics • Mammography/Tomosynthesis • Nuclear/PET/New Modalities • CT Dosimetry/QA • Radiography/Fluoroscopy/Ultrasound • CT Reconstruction/Processing/Correction Scientific Sessions • PET/Optical/Multimodality Imaging • Session in Memory of Moses Greenfield: CT Dosimetry 1 • Radiography/Fluoroscopy • CT Image Quality • CT Dosimetry 2 • MRI 1 • Multi-Detector CT • MRI 2 • Ultrasound for Diagnostic Imaging • X-Ray Breast Imaging • Cone-Beam CT • Novel Modalities/MV Imaging • Spectral CT and Breast CT • Cone-Beam CT and CT Image Reconstruction Joint Imaging/Therapy Program Scientific Symposia • MR-Guided Radiation Therapy • How OMICs is Going to Impact Research Topics for Medical Physicists • How Do We Couple Quantitative Imaging and Models of Tumor Response to Improve Multimodal Therapy?

• Advanced Applications in Deformable Registration • New Technologies Addressing the Range Uncertainty of Proton Therapy • Physics Pheud! (Interactive Session) • MR Guided Tx Planning SNAP Oral Sessions • Image Registration and Segmentation • Motion and Dosimetric Uncertainties • Image Guidance and Localization

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• • • •

Multi-Modality Imaging Imaging for Planning and Adaptive Radiotherapy Quality Assurance Motion Management

Scientific Sessions • Therapy Assessment - Multi-Modality Imaging • Deformable Image Registration • Motion Uncertainties and Dosimetric Effects • Volumetric Imaging and Motion Management • Real-time Imaging and Motion Management • Science Council Session: Muli-Modality Imaging in Radiation Therapy: Planning, Guid ance, and Assessment of • Treatment Response • Novel Imaging Techniques and Applications • MR-Guided Radiation Therapy • Quality Assurance and Imaging Dose in IGRT Procedures • PET/SPECT/Nuclear/CT/Optical Imaging for Functional Evaluation • Image Segmentation and Atlas • Use of MR Imaging in Radiation Therapy Practical Medical Physics Program • • • • • • • • • • • •

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 Be yond the TG-43 Formalism TG132: Image Registration and Fusion 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

Professional Program • • •

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Professional Council Symposium: The Medical Physicist as a Professional Leader – The Importance of Leadership Development ABR Update How To Be A Journal Referee AAPM Newsletter | Volume 38 No. 4 | July/August 2013

• • • • • • • • • • • • • • • • • • •

Challenges of Increased Controls of Radioactive Materials Controlling Stuff, Beating Stress, and Finding Work-Life Balance HazMat Shipping DOT Training Your First Job; Finding and Keeping It PQI International Medical Physics Symposium - Part 1: Making a Difference In the World: Are You Willing To Be Part?

In-House Credentialing Writing and Reviewing Papers for Medical Physics International Medical Physics Symposium - Part 2: Making a Difference In the World: Are You Willing To Be Part?

New Member Symposium Preparing for the ABR Therapy Exam 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

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 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

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• • • • •

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 Diagnostic Imaging Educational Courses • CT Image Quality from the Radiologist’s Perspective • Iterative Reconstruction Methods in CT • Advances in Instrumentation in PET/MRI: Technical Design Challenges & Innovations • Review of X-Ray Tube Technology • An Update on Imaging Detector Technologies in R/F and CT • Breast MRI QA • Implementation of a Breast Tomosynthesis Program: A clinical medical physicist’s experience • Buying Imaging Equipment for Interoperability and Compliance: Beyond DICOM • Informatics for the Acceptance Testing of Imaging Equipment • An update on the DICOM Standard for Structured Dose Reports • CT Dosimetry Basics • The Role of Physics in CT Protocol Optimization: Recommendations and Misconceptions • MRI Applications in Radiation Oncology • The Management and Reporting of Imaging Procedure Dose: Interventional, CT, NM & Informatics Perspectives • Lens of the Eye Dosimetry • The Art of the Image: The Identification, Remediation and Prevention of Imaging Arti facts in Projection Radiography • Hands-on “Image Clinic” • Technology, Applications and QA in MRI Parallel Imaging

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Imaging SAMS: SAM Session 1: Nuclear Medicine Regulatory Guidelines & Computational Methods for the Safe Release of Radioactive Patients SAM Session 2: Mammography QA: (1) 2D Digital Mammography – An Update on Vendor-Recommended QC Tests (2) Stereotactic Breast Imaging System QC SAM Session 3: MRI QC: Homogeneity Testing, RF Coil Testing, Technologist’s QC Tests SAM Session 4: Ultrasound QA: (1) Ultrasound QC: Overview of testing methods and ACR Accreditation Requirements (2) AAPM Working Group on Quantitative B-mode US QC: Software for analysis of transducer condition (3) Techniques for Rapid Periodic Quality Assurance of Gray-scale Ultrasound Scanners Ultrasound Guidance and Therapy (Special Two Day Conference) Scientific Symposia • High-Intensity Focused Ultrasound Therapy Hands-on Workshop • Ultrasound Guided RT Intervention & Novel Technologies • Ultrasound Guided Systems for RT and Treatment Planning • Clinical Delivery and Advanced Novel Technologies/Strategies • Advanced Novel Technologies & Therapeutic Strategies • Image Guidance and Assessment Treatment Strategies, Modeling, Control Proffered Abstract Submissions • Therapeutic Ultrasound • Ultrasound for Radiation Therapy Guidance • Ultrasound for Diagnostic Imaging For additional information: www.aapm.org/meetings/2013AM

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Workshop Announcement

Juilan Malicki, Poznan, Poland Peter Dunscombe, Calgary, AB Canada

European Workshop on Risk Management in Radiotherapy. Poznan, Poland June 4-6, 2013.

T

he European Union (EU), representing 27 countries, issued a Directive in 1997 (Medical Exposure Directive 97/43) requiring Member States to ensure that all reasonable steps to reduce the probability and magnitude of accidental or unintended doses to patients from radiological practices are taken. In practice, this means that effective risk management strategies are in place and used.

ACCIRAD is an EU funded project, the objective of which is to study the implementation of this directive (within radiotherapy) across the EU and to develop practical guidelines to facilitate compliance. The ACCIRAD initiative itself is a consortium of 6 institutional partners with a Scientific Committee of 10 people.

Several face-to-face meetings have been held with much behind-the scenes-work and this effort has culminated in a 224-page draft document entitled “Patient safety in external beam radiotherapy – Guidelines on risk assessment and analysis of adverse events and near misses.” The Poznan meeting, with 140 participants, was held primarily to obtain input on the draft report but with a few

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sessions on sharing experience with event analysis and preventive measures.

Following an introduction to the ACCIRAD project, an overview of the results of a Europe wide survey on implementation of the EU directive was presented. The data amassed are very comprehensive. To give an idea of the type of data collected, the survey indicated that the majority of respondent countries had currently neither guidelines nor legislation and regulations for the classification of adverse events and near misses. Altogether, sixteen pie charts were necessary in the report to represent summary results of the survey so only a sample could be presented at the Workshop.

ACCIRAD invited 13 organizations, including the AAPM, to review and comment on the report. Reviewers on behalf of the AAPM were Brenda Clark, Steven Sutlief and Peter Dunscombe whose opinion was that the report was extremely comprehensive, well structured and contained an excellent scan of the risk management landscape in radiotherapy. The AAPM’s “Consensus recommendations” (Med Phys 39 (2012) 7272-7290) figured prominently in both ACCIRAD’s draft report and the Workshop.

One session each was devoted to sharing experiences with event analysis at local and national levels and with prospective risk assessment using FMEA and risk or hazard matrices. There are clearly pockets of high level activity across Europe although the challenge would appear to be to encourage more individual institutions and national bodies to become more fully engaged. A further session included presentations on the IAEA’s clinical audit program and the Dutch PRISMA-RT incident learning system.

Just before the close of the meeting there was an open and spirited discussion on harmonization of classification scales for adverse events and near misses. Although there was no clear resolution there was considerable interest in the AAPM approach of having both a dosimetric and medical severity scale as opposed to one joint scale which is more common.

The one recommendation that all agreed on was to abandon the use of the word “accident” in the context of risk management in radiotherapy. It was widely felt that this term has too negative a connotation, is not generally used in other areas of health care and is not really helpful in facilitating safety and quality improvement in radiotherapy, which is the primary purpose of the initiative.

The next step for the ACCIRAD group is to finalize the report on the basis of the written and workshop comments received and submit the revised Guideline Document to the European Union as the conclusion of the project. Once the Document has been approved by the EU it will be published by the European Commission as a recommendation that European Union Member States should implement. At that point, which will be in 2014, it will be publicly available.

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Working Group Report

Susan Richardson, Seattle, WA Andrea Molineu, Houston, TX

Upcoming changes in the National Cancer Institute’s (NCI) Cooperative Group Program

A

s a member of the Working Group on Clinical Trials, I would like to describe some upcoming changes in the National Cancer Institute’s (NCI) Cooperative Group Program. As we all know, cooperative group trials are critical to the advancement of cancer care. However, inefficiencies and barriers to progress have been identified by the Institute of Medicine (IOM). A new NCI Clinical Trials Network will represent a consolidation of the ten existing groups and structures to accelerate and broaden clinical research in oncology. Together, these ten groups involve more than 3,100 institutions and 14,000 investigators who enroll more than 25,000 patients in clinical trials each year. The new plan is based in-part upon recommendations from a 2010 report from the Institutes of Medicine (IOM), A National Clinical Trials System for the 21st Century: Reinvigorating the NCI Cooperative Group Program. The goal of the consolidation is four fold:

1.

2.

3.

4.

Adam Wang - Johns Hopkins University Improve the speed and efficiency of development and conduct of trials Incorporate innovative science and trial design Improve trial prioritization, selection, support, and completion Incentivize the participation of patients and physicians in clinical trials

In an effort to meet these goals, the NCI plans a more consolidated and integrated program called the National Clinical Trials Network (NCTN) that will support 5 clinical trial groups.

The Cooperative group currently consists of 10 separate entities in the United States: 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

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ECOG (Eastern Cooperative Oncology Group) CALGB (Cancer and Leukemia Group B) SWOG (Southwest Oncology Group) ACOSOG (American College of Surgeons Oncology Group) COG (Children’s Oncology Group) GOG (Gynecologic Oncology Group) ACRIN (American College of Radiology Imaging Network) NCCTG (North Central Cancer Treatment Group) NSABP (National Surgical Adjuvant Breast and Bowel Project) RTOG (Radiation Therapy Oncology Group) AAPM Newsletter | Volume 38 No. 4 | July/August 2013

The new line up of groups will consist of 4 adult groups and one pediatric group.

COG will remain as the sole pediatric group, which includes over 200 centers worldwide and is the world’s largest organization devoted exclusively to childhood and adolescent cancer research. ACOSOG, CALGB, and NCCTG have formed the ALLIANCE group. The vision of the group is “to reduce the impact of cancer by uniting a broad community of scientists and clinicians from many disciplines that are com-mitted to discovering, validating and disseminating effective strategies for the prevention and treatment of cancer.” ECOG and ACRIN will merge forming ECOG-ACRIN with a goal to design and conduct biomarkerdriven cancer research involving adults with a specialty in therapeutic and diagnostic imaging research.

NRG is made up of the former NSABP, RTOG, and GOG groups (the acronym was created from the first letter of each founding group). This union creates a large alliance which can more easily compete for NCI grants. All three organizations are based in Pennsylvania. The SWOG has remained a lone entity. Its network includes 22 NCI-designated cancer centers as well as cancer centers in almost a dozen other countries.

In summary, cooperative group trials are critical to the advancement of cancer research and care. Inefficiencies were identified by the IOM which led to a reduction in the number of total groups. The new network represents a consolidation of structures and new opportunities. The NCI has stated that members of any of the study groups can enroll a patient in a trial from any other group, thus facilitating cooperation between the groups and enhancing patient treatment opportunities. The role radiation oncology plays in these newly founded groups may be strengthened.

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

2013

App

Annual Meeting

AAPM is pleased to announce we will once again be offering a native app for iOS, Android and Blackberry that will allow off-line access to the Annual Meeting Scientific Pro-

gram, Committee Schedule, Exhibitor maps and much more. New this year is the opt-in ability to message

one another directly through the app. Get more information and download the app at this link.

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Sponsored by Mobius Medical Systems, LP

Staff Announcements

Angela Keyser, College Park, MD

AAPM HQ Team...at your service!

Lisa (Giove) Schober joined the AAPM team in 2005 as the Reception-

ist. Her hard work and dedication was quickly evident, and she now serves as Senior Executive Assistant and the Executive Director’s right-hand! Lisa supports the Executive Committee and Board on governance-related projects, maintains the AAPM Policy Manual, handles elections, and manages the headquarters office at various AAPM association meetings. She is also the HQ liaison to the Administrative Council and AAPM chapters.

Noel (Crisman-Fillhart) Tyler started her career with AAPM in 2005

as part of the Accounting team. In 2008, Noel transitioned to a new role within the office and is now the Administrative Assistant. In this capacity Noel coordinates the AAPM E-News process and assists with numerous office service functions. audits.

Viv Dennis As the AAPM Customer Service Representative since 2010,

Viv Dennis answers the main phone line, handles general inquiries, and assists with setting up conference calls. She also provides support to the Medical Physics journal.

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Persons in the News

J. Anthony Seibert, Professor of Radiology and Medical Physics and Associate Chair of Radiology Informatics University of California Davis Medical Center

American Board of Radiology elects J. Anthony Seibert, PhD, as a trustee for medical physics The American Board of Radiology (ABR) has elected J. Anthony Seibert, PhD, as a trustee for medical physics, effective July 1, 2013. Dr. Seibert has been a professor of radiology and medical physics at the University of California Davis Medical Center since January 1983 and is currently associate chair of radiology informatics. Dr. Seibert will replace Richard L. Morin, PhD, who served two two-year terms as secretary-treasurer for the ABR Board and is currently Brooks-Hollern professor and professor of radiologic physics at the Mayo Clinic in Jacksonville, Florida.

A diplomate of the ABR in diagnostic and therapeutic medical physics since 1986, Dr. Seibert has actively participated as a volunteer within the ABR since 1995 as an oral examiner, former chair of the Diagnostic Radiological Physics Exam Committee, and current member of the General Radiological Physics Exam Committee. He earned his undergraduate and graduate degrees from the University of California, Irvine.

Dr. Seibert is past president and chair of the American Association of Physicists in Medicine.

He has received numerous honors, awards, and funded grants, and also has been active in the American College of Radiology, the Radiological Society of North America, the Society for Imaging Informatics in Medicine, and the Institute of Electrical and Electronics Engineers.

He assisted in the development and founding of the American Board of Imaging Informatics, where he is currently a member and chair of the Board of Trustees.

A prolific writer, Dr. Seibert is co-author of a popular physics text, The Essential Physics of Medical Imaging, and is extensively involved in physics education and training. He is credited with approximately 80 published papers and 100 published abstracts, as well as numerous book chapters. He recently served as associate editor and member of the editorial board for the journal Radiology.

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Established in 1934, the mission of the American Board of Radiology (ABR) is to serve patients, the public, and the medical profession by certifying that its diplomates have acquired, demonstrated, and maintained a requisite standard of knowledge, skill, understanding, and performance essential to the safe and competent practice of diagnostic radiology, radiation oncology, and medical physics. The ABR is one of 24 Member Boards of the American Board of Medical Specialties.

Bruce R. Thomadsen, Professor, Medical Physics University of Wisconsin School of Medicine and Public Health

NRC Advisory Committee on the Medical Use of Isotopes names new leadership The Nuclear Regulatory Commission has named Bruce Thomadsen, Ph.D., as Chairman of the Advisory Committee on the Medical Use of Isotopes and Milton Guiberteau, M.D., as Vice-Chairman. The chairman and vice chairman are appointed by the director of NRC’s Office of Federal and State Materials and Environmental Management Programs.

The ACMUI, a group of experienced health care professionals, advises the NRC on policy and technical issues that arise in the regulation of medical uses of radioactive materials in diagnosis and therapy. The ACMUI members come from various disciplines and comment on changes to NRC regulations and guidance; evaluate certain non-routine uses of radioactive material; provide technical assistance in licensing, inspection and enforcement cases; and bring key issues to the Commission’s attention for appropriate action.

A complete listing of the ACMUI membership, their bios and public meeting schedule can be found on the ACMUI web page.

News releases are available through a free Listserv subscription or by clicking on the EMAIL UPDATES link on the NRC homepage. E-mail notifications are sent to subscribers when news releases are posted to NRC’s website. For the latest news, follow the NRC on Twiter,

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Congratulations! At the recent ACR Meeting, the following AAPM members became ACR Fellows: Geoffrey D. Clarke, PhD (Fellow 2013) – (San Antonio, TX) Anne W. Greener, MS (Fellow 2013) – (Chatham, NJ) Paul J. Imbergamo, MS (Fellow 2013) – (Worcester, MA) Frederick W. Kremkau, PhD (Fellow 2013) – (Winston-Salem, NC) William S. Kubricht Jr., MMSc (Fellow 2013) – (Lubbock, TX) Ronald R. Price, PhD (Fellow 2013) – (Franklin, TN) Beth Ann Schueler, PhD (Fellow 2013), (Rochester, MN) Timothy D. Solberg, PhD (Fellow 2013) – (Dallas, TX)

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Chapter Reports

Chris Allgower, Bloomington, IN

Ohio River Valley Chapter activities

T

he Ohio River Valley Chapter’s (ORVC) annual Spring Educational Symposium was held at the METS Center in Erlanger, KY on March 1-2, 2013. The keynote speaker was Dr. M. Saiful Huq of the Univ. of Pittsburgh Cancer Institute and UPMC Cancer Center, who gave a very well received keynote lecture, entitled “Medical Physics Beyond Borders.” This talk outlined the state of medical physics outside the United States and the dire need for more medical physicists as well as training and accreditation programs worldwide. We will be posting his presentation on the chapter web site under the recent meetings section. It contains many references to efforts to improve medical physics both inside and outside the AAPM, and deserves a wider audience.

ORVC president, Chris Allgower (center) with the first and second place award winners for best research presentations. Arkajyoti Roy (left) of Purdue University took first place and Ganesh Narayanasami of the University of Kentucky (right) was second.

Not shown is the third place winner, Jingcui Jia from Indiana Univ.

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The tradition in the ORVC is to use the Spring Symposium primarily as a forum for short research talks given by students, residents, and not-yet-board-certified physicists from within the chapter’s geographic region. Abstracts are submitted in advance of the meeting. Ten of those are selected for oral presentations, with the remainder invited to present posters. The oral presentations are judged by a panel, and awards are given to the top three. There were sixteen abstracts submitted, covering topics in diagnostic, therapy, and nuclear medicine physics. The first place presentation was a talk entitled “Time-Resolved Stochastic IMRT Planning” given by Arkajyoti Roy of Purdue University. Second and third places were awarded to Ganesh Narayanasami of Kentucky University and Jingcui Jia of Indiana University. The photo with this article is courtesy of Dr. Chin Ng of the Univ. of Louisville, who also gave the final talk of the program, outlining highlights from his career in the field of molecular imaging research.

The meeting had an attendance of roughly one hundred participants, including representatives from twenty-eight exhibitors. Planning is in progress for the upcoming fall meeting, which will be a joint meeting with the Penn-Ohio chapter to be held in October 2013 in the Cleveland area. Please see the chapter web site for further details.

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Obituary - Don D. Tolbert Ph.D. Don D. Tolbert passed away on Sunday, April 28, 2013 at his home in Beloit, Kansas, a few miles from where he grew up.

After completing his PhD. in Nuclear Engineering at the University of Kansas in 1968, he worked as a Post Doc in experimental Nuclear Physics at Florida State University in Tallahassee. He then completed a one-year ReTrainee Post Doc in Medical Physics with the University of Wisconsin Medical Physics Section.

He served as the Chief of the Radiation Therapy Medical Physics Section at the University of Wisconsin Hospital in Madison for nearly seven years before relocating to Hawaii in 1977 to be the head of the Hawaii Medical Physics Outreach Program.

In 1981 he became Managing Partner of the consulting group, Mid-Pacific Medical Physics in Honolulu. MPMP provided Medical Physics services for a number of Hawaii and South Pacific hospitals, including the Queen’s Medical Center and Kuakini Medical Center.

He completed his career at the Tripler Army Medical Center before retiring in 2000.

He was active in the AAPM and chaired the Professional Council in the early 1990s, during which he helped educate medical physicists about Medicare and the CPT codes. He went on to chair the Medical Physics Commission of the American College of Radiology and helped raise the profile of medical physics in that organization. In both roles, he was a member and a major player in the Trilateral Commission. He is the first author on seven of nineteen peerreviewed articles regarding medical physics.

Don was considered to be the Godfather of Medical Physics in Hawaii and connected with colleagues everywhere.

After he retired to Kansas and his cabin above Colorado Springs, Don worked on a book about empowering the diabetic patient, written from the patient’s perspective.

Another major activity was making several visits a day to a home for seniors in Beloit to give logistical and emotional support, which was greatly appreciated by the residents. Don’s philanthropic side had many outlets including the American Indian College Fund.

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He devoted himself to spiritual practices focused on Native American Culture of which he was a part. There is sadness today in Hawaii, Colorado, Kansas, Wisconsin, and any place where those whose lives he touched may live.

By Harry Palmer, Scott Dube, Bill Hendee and Geoff Ibbott

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Letter to the Editor

Ivan L. Cordrey, Cookeville, TN

Reflections on the Spring Clinical Meeting

I

attended the Spring Clinical Meeting for the first time this year, and I am now an advocate for this meeting. I believe it is important for AAPM to offer more than one high quality national meeting per year. In my practice I work with one other physicist and we have traditionally alternated attendance at AAPM and ASTRO – each goes to one meeting a year and every other year that is the summer AAPM Annual Meeting. ASTRO is always an expensive meeting and while interesting to see the MD perspective, it is often less applicable to my daily practice than the AAPM Annual Meeting or this Spring Clinical Meeting (SCM). My physics co-worker attended the SCM for the first time last year, and based on his recommendation I attended this year. I was impressed with what was offered and it is now part of my meeting rotation schedule (as it is for my co-worker).

AAPM is both a scientific organization and a clinical organization and we need both. At this point in my career I am a purely clinical therapy physicist, so I tend to focus on the clinical sessions. But I also see the value and need for the scientific research. Having both clinical and scientific sessions at the Annual Meeting facilitates the rapid transfer of knowledge to clinical practice that improves patient care, and keeps the scientific research in contact with clinical practice so it can continue to advance in directions that give additional value to the scientific endeavor. The SCM provides a clinically focused meeting that is of value to the medical physics community. It provides an efficient way for over-worked clinical physicists to stay current and maintain the clinical certification (MOC) that is critical to maintaining the overall competence of practitioners and public confidence in those practitioners of Medical Physics.

I personally need both meetings to continue if I hope to maintain my ABR certification and continue to provide the best care to my patients.

I am grateful to the organizers of both the SCM and the Annual Meeting. You dig the “knowledge well” that concentrates the information and wisdom I need so I can draw from it and remain competent. Thank you for your efforts. Thank you for your time.

Now back to the “salt mine”…

Ivan L. Cordrey, is the Chief Medical Physicist at the Cookeville Regional Medical Center Cancer Center at Cookeville, TN.

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A Personal Reflection

Bob Pizzutiello, Victor, NY

Diversity in medical physics - a personal reflection

“A

ll Italians are in the Mafia.” This is easily recognizable as improperly labeling a group of people and putting them in a box, a limiting and derogatory one at that! Whether we work in Therapy, Imaging or Medical Health Physics, earned a Masters or Doctoral degree, work in academia, community hospitals, private practice, regulatory or industry, each of us contributes to our profession. The diversity of our work environment reflects the range of our impact on patient care. It is difficult for me to see this as anything other than a good thing.

I would like to comment on the issue of diversity and the opportunities for individuals to participate in the vibrant life of AAPM, using my personal experience as an example. I started my career in Radiation Oncology Physics at the University of Rochester in the 1970’s, under the OJT model. When I accepted a position at a nearby community hospital as a solo physicist, I remember feeling isolated and insignificant with respect to the AAPM and its eminent founding fathers and mothers. One day I recall being unsure if I had properly interpreted the method for estimating fetal dose from a barium enema. In the era long before the internet and list-servers, I eventually summoned the nerve to call Dr. Lou Wagner (who “wrote the book”), and apologetically asked for advice. To my amazement, he spent time with me on the phone, treated me like a colleague, and reassured me. Later I had a similar experience with Dr. Joel Gray. These were my first tastes of one of the finest aspects of our profession: a commitment to patient care and to teaching fellow medical physicists. This has served as my personal model for professional behavior ever since. In subsequent years, with more encouragement from other senior AAPM members, I became active in the Upstate NY Chapter and eventually attended my first AAPM Meeting, and met the gang from RAMPS.

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Being young, and eager, I seized every opportunity to learn from the many physicists in these two chapters, and soon to the larger national AAPM. Some of these mentors invited me to volunteer on AAPM and ACMP committees, and with the new ACR Mammography Accreditation Program. At first, I was unsure about getting involved because I did not carry the title “Doctor,” Over the years, I have been consistently and pleasantly surprised to learn that AAPM is among many organizations (AAPM, ACR, FDA, IAC, CRCPD, etc.) that welcomed a perspective based on my experience with community hospitals and the private practice environment. Rather than marginalizing me for not holding a doctorate, they seemed more interested in the fact that a stakeholder was willing to contribute to the process, work as a responsible and respectful team member, and genuinely sought the best solution to benefit our profession and the patients we serve. When I look back at professional successes to which I have contributed, each one included respectful teamwork among diverse and collaboratively minded colleagues, holding different degrees, leadership roles, and representing different points of view.

AAPM Newsletter | Volume 38 No. 4 | July/August 2013

Of course I did (and still do) occasionally encounter colleagues and leaders who want to put me in a box with any number of labels. Yet I know that I am bigger than any single label.

Overwhelmingly I experience colleagues with all degrees (including MD’s and regulators) welcome the input of those who genuinely seek, and who are willing to work to achieve, the greater good.

We often hear that those with academic positions have more time and funding allocated for professional activities, hence they tend to occupy more visible positions in AAPM leadership.

As a medical physicist in private practice for 34 years, I made the decision a long time ago that AAPM’s professional activities were a good use of my time, during and beyond the “work day”. I have followed the lead and serve in the company of other respected and like-minded consultants. Some questioned whether taking time away from revenue generating work was a wise business decision. Looking back, I can confidently say that I received at least as much as I have given, and that dollars alone are a wholly inadequate metric for assessing value.

Look at the AAPM Council chairs, appointed by the President (with concurrence from the Board), and you will see an amazingly even distribution of diverse professional backgrounds, and closely resemble the demographics of the membership. But don’t be fooled by those limiting demographic labels. These are individuals who contribute a varied personal experience and a deep personal commitment to the AAPM as a whole, and have been appointed to these critical roles for their individual contributions, and not to represent any narrow constituency within AAPM. The non-trivial question of how to engage a wider and broader segment of our membership has been on the AAPM table for as long as I can remember, and produced many creative ideas. Look at the progress we have made encouraging women and young professionals, to name just two. Let’s not stop searching for more and better solutions!

If we want to see a greater voice in AAPM leadership from those in community hospital and private practice in AAPM leadership, we need more members to see the value of professional involvement. After recognizing the value, individuals make that personal commitment of resources and become professionally active. For some that might mean lobbying for funding in a shrinking budget - not trivial indeed. Perhaps AAPM could (i.e. “We” could) come up with some marketing materials our members could use to help to “sell” their institutional budgeteers on the value of attending meetings, joining committees and becoming professionally active. In other situations, it might be necessary for members to invest some personal resources for professional time and travel. In my experience, every dollar and every hour I have invested was well spent. I continue to learn so much, be challenged beyond my comfort zone, stimulated by amazing colleagues, and strive to be a contributing member of our professional community.

In summary, I ask that we direct our energies towards recognizing each of us as individual stakeholders, with different points of view. Let’s spend less time putting colleagues into boxes with inadequate and limiting labels. If we continue our efforts to find creative solutions to

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engage more members in the truly vibrant life of AAPM, we will get there!

Gotta go now. Time to watch episode #47 of The Soprano’s...

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AAPM Newsletter | Volume 38 No. 4 | July/August 2013

CAMPEP News

Steven J. Goetsch, South Bend, IN

CAMPEP Continuing Education Program Review Committee news

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AMPEP (Commission on Accreditation of Medical Physics Educational Programs, Inc.) was formally incorporated in 1994. It is divided administratively into three sections: Graduate Educational Programs (M.S. and Ph.D.) administered by the Graduate Education Program Review Committee, currently chaired by Brenda Clark, the Residency Education Program Review Committee, currently chaired by Chet Reft, and the Continuing Education Credit Program Review Committee (CECPRC), which I currently chair.

CAMPEP began reviewing Continuing Education programs in 2002. The number of applications and approved applications has increased steadily every year (see graph). So far 2013 is on pace for nearly 350 programs. The number of CAMPEP Medical Physics Continuing Education Credits (MPCEC) units approved closely parallels the number of approved program. In Calendar Year 2012 the total number of CEU’s approved was 6831.

Approved Programs 300 225 150 75 0

2005

2007

2009

2010

2012

CAMPEP MPCECs are necessary for those physicists undertaking Maintenance of Certification (MOC). Credit may be obtained in many ways: attendance at a program accredited by our committee, completing online credits from an approved course (Remotely Directed Continuing Education), creating a new original CAMPEP graduate education course (credit can’t be obtained for teaching the same course year after year), WEBEX webinars, reviewing scholarly articles for Medical Physics. In recent years many commercial corporations have sought and received CAMPEP accreditation for continuing education courses such as training in linear accelerators, treatment planning systems and quality

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assurance techniques. Another large contributor to the annual pool of MPCEC programs is several large corporations that provide live or online programs for a fee around the country.

Local AAPM chapters also receive credit for local chapter meetings ranging from 1 hour to several days.

Earlier this year our committee was informed that ABR has changed requirements for MOC candidates. As of January 1, one third of all MPCEC credits must be in the form of SelfAssessment Modules (SAMs). SAMs can either be earned in a live session at a meeting or from certain online courses. We are expecting an upsurge in requests for more SAMs courses in response to this new requirement.

Our committee continues to adapt to changing technology. Whereas most programs CAMPEP accredited used to be live sessions at meetings, now many programs are online, and applications for hybrid programs that are both real-time in a lecture hall and simultaneously broadcast live as WEBINARs are now being received. With increasingly expensive and difficult travel in recent years, we expect this trend to continue.

I would like to thank the volunteers on my committee: former Chair Bruce Thomadsen, Vice Chair Jacqueline Gallet, Wayne Beckham, Caridad Boras, Robert Dahl, Doracy Fontenla, Samuel Rhoades, Palmer Steward and Yun Yang.

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Radiology Leadership Institute Update

Jessica Clements, Dallas, TX

About the Radiological Leadership Institute

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ast summer, the AAPM officially affiliated with the American College of Radiology’s Radiology Leadership Institute (RLI). According to the program website: The RLI is a comprehensive leadership academy designed specifically for radiology professionals. Its multi-level learning cycle will offer a range of advanced leadership courses, designed for various levels of professional experience, which will build to higher levels of leadership acumen demonstrated by:

• • •

Certificate of Leadership Proficiency (CoLP™) Certificate of Advanced Leadership Proficiency (CoALP™) Opportunities to pursue MBA, MMM and MPH degrees from top-tier business schools

RLI enrollment is completely free and includes the opportunity to receive consultation with a RLI curriculum advisor. During that consultation, you will have the opportunity to complete a RLI credit recognition request which maps your personal experience to the RLI Common Body of Knowledge. Experience can be from formal academic course work, other training such as continuing education, or leadership life experiences such as activities within a professional organization.

At this time, RLI credits are primarily available through RLI and ACR events. We are working to make it easier for medical physicists to receive RLI credits in additional venues. We were able to credential 4 professional track offerings at the 2013 Spring Clinical Meeting and anticipate receiving more RLI credits in Indianapolis in the professional sessions. In addition, Professional Council is identifying AAPM members that can partner with ACR members to create webinars of particular interest to medical physicists.

Mark your calendars 55th AAPM Annual Meeting & Exhibition August 4-8, 2013 Indianapolis, Indiana 64

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