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
MARCH/APRIL 2014 Volume 39 No. 2
What is happening in our Ad Hoc Committees? AAPM President John Bayouth on Ad Hoc Committee activities. Inside this issue.
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
CONTENTS MARCH/APRIL 2014 Volume 39 No. 2
EDITORIAL BOARD EDITOR Mahadevappa Mahesh, MS, PhD
Johns Hopkins University E-mail: mmahesh@jhmi.edu Phone: 410-955-5115 John M. Boone, PhD Robert Jeraj, PhD George C. Kagadis, PhD E. Ishmael Parsai, PhD Charles R. Wilson, PhD SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse College Park, MD 20740 E-mail: nvazquez@aapm.org Phone: (301) 209-3390 PUBLISHING SCHEDULE The AAPM Newsletter is produced bimonthly. Next issue: May/June Submission Deadline: April 11, 2014 Posted Online: Week of May 5, 2014
Articles in this Issue
Events / Announcements
AAPM President’s Column
Career Services
AAPM President-Elect’s Column
2014 AAPM Summer School
AAPM Executive Director’s Column
56th Annual Meeting & Exhibition
Editor’s Column
Radiation Oncology Program Accreditation Meeting
Legislative & Regulatory Affairs Report
AAPM Spring Clinical Meeting
Education Council Report
ABR News
Professional Council Column
Expanding Horizons Meeting
ACR Accreditation FAQs
Working Group on Prevention of Errors
Health Policy & Economic Issues
E&R Fund Contributors
Website Editor’s Report
www.AAPM.org
Contact us with your feedback
Editor’s Note Follow us on Facebook, Twitter and LinkedIn.
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 Bayouth, Madison, WI
What’s Happening in our Ad Hoc Committees?
T
he AAPM is truly a volunteer driven association, where over 20% of our 'ull .embers participate in the 250+ councils/committees/task groups. These groups tackle a wide spectrum of issues faced by our members. Many of these groups will spend years working on their charge, going into great breadth and depth, and producing published reports that guide our science and clinical practice for years. Another unique mechanism to address a pressing issue is the presidentially appointed Ad Hoc Committees. The presidential Ad Hoc committees are established to address issues that are both acute and important for the future of the organization. I want to spend my allocated space in this Newsletter summarizing the charges of our current Ad Hoc committees; by knowing where efforts are being made I hope you can better understand what we are trying to achieve. Ad Hoc Committee - AAPM & SNMMI Joint Task Force (Chair – Beth Harkness) AAPM has had tremendous success in growing the number of residency programs, first in therapy and most recently in diagnostic imaging. However, we have not made much progress in Nuclear Medical Physics. The mission of this task force is to assemble a representative group of stakeholders to (1) estimate the demand for board-certified nuclear medicine physicists in the next 5-10 years, (2) identify the critical issues related to supplying an adequate number of physicists who have received the appropriate level of training in nuclear medicine physics, and (3) identify approaches that may be considered to facilitate the training of nuclear medicine physicists. Ad Hoc Committee on External Communications (Chair – Gerald White) AAPM has many communication needs; in many instances we respond rapidly to inquiries from the press or sister organizations. This Ad Hoc is focused on external communications, where the target audiences are outside AAPM, focusing on material that falls under the general categories of news or positions. This Ad Hoc should recommend to the Board which audiences are most important to reach, on what types of topics, and by what means. For external communications on topical issues needing rapid response, who are the targets? how can they best be reached? and how can our messages be created in the appropriate time frame? For position statements that are crafted deliberately, who are the targets? how can they best be reached? and how should the position statements be created and vetted? Ad Hoc Committee on Journal Publications (Chair – Kenneth Hogstrom) AAPM Newsletter | Volume 39 No. 2 | March/April 2014
The AAPM now publishes two journals, Medical Physics and the Journal of Applied Clinical Medical Physics. This Ad Hoc committee will review and make recommendations regarding future AAPM journals by addressing: (1) the appropriateness of the number and scope of the current two journals, (2) changes in business management for its journals to maintain quality of content, to maintain a healthy financial position (coordination of marketing to corporate affiliates), and to be widely available to medical physicists throughout the world, and (3) to maintain a process of editorial review that appropriately balances speed of publication versus quality of review. Ad Hoc Committee on Corporate Relations (Chair – Rock Mackie) AAPM has a strong history of collaboration with our corporate sponsors that add value to our organization in many ways. A practical reality is the revenue streams from corporate sponsors are a significant part of our budget, especially the exhibits program and journal advertising. These programs have grown in scope and number in a very piece-meal fashion with little attention given to organization, efficiencies and how the corporate sponsors would prefer to do business with AAPM. In this regard, our corporate sponsors are our customers, and it’s important for AAPM to know how we can best meet our customers’ needs. The Ad Hoc Committee is tasked with engaging outside expertise to assist AAPM in an overall strategic review of how AAPM interacts with corporate sponsors and propose a revised Corporate Sponsorship Program. Ad Hoc Committee on Headquarters Space Needs (Chair – John Hazle) The AAPM HQ site is in College Park, MD, and has been in the American Center for Physics building at One Physics Ellipse for many years. As our lease is coming up for renewal, this Ad Hoc has been asked to determine the future requirements for AAPM’s physical headquarters space and study the options available to the AAPM at the termination of the current lease. Questions they’ve been asked to address include: what space will be needed in the future to support AAPM programs? Should AAPM Mease or purchase office space? Should AAPM stay at the American Center for Physics? What will the impact on staff be under each scenario? What are the cost factors in each scenario? How will the AAPM finance each scenario? Ad Hoc Committee on Meetings Strategy (Chair – Robert Gould) AAPM’s meeting portfolio has increased to include the Annual Meeting, Joint meeting with RSNA, Spring Clinical Meeting, Summer School and Speciality Meetings. The AAPM also collaborates with many sister societies to jointly sponsor meetings, both domestically and internationally, and our members participate in other parallel meetings as well. AAPM should have a clear and coherent vision for how these different meetings compliment one another. This Ad Hoc has been asked to consider several issues: How do these various meetings fit together? Timing, content and focus. What are the expectations of AAPM members for each specific meeting? What is AAPM seeking to accomplish with each specific meeting? Is AAPM offering the right mix of science, clinical practice, professional development and CE opportunities? What role/impact do AAPM endorsed/co-sponsored meetings have on AAPM meetings? Does the AAPM committee structure provide the appropriate oversight and AAPM Newsletter | Volume 39 No. 1 | January/February 2014
support for the various meetings? Ad Hoc Committee for Review of TG100 Report (Chair – Daniel Low) This newly appointed committee is charged to define the mechanism to present the concepts of the proposed TG 100 report and develop an implementation plan for the next generation of radiation therapy quality management. This well written document has the potential to fundamentally change how we approach quality assurance in the clinical environment, and may impact regulators and practice accreditation bodies in addition to clinical practitioners. I am so very grateful to the large number of members who are joining me in contributing their time and talents to our organization. If you believe AAPM should address an acute and important issue that’s currently being ignored, I would appreciate hearing your opinion.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM President-Elect’s Column
John M. Boone, Sacramento, CA
My challenge to you: Do something new and fun
M
y year as 1resident-&lect has started out busy, and with the other “John’s” (Hazle and Bayouth) I have attended the Education Council retreat and the Science Council retreat. Much, if not most, of the activity of the AAPM takes place at the Council level; it is exciting to see the work that is being done to further the many initiatives in education and science for our organization.
The missions of Education Council and Science Council become synergistic when MEDICAL SAFETY TRAINING we discuss the AAPM "nnual .eeting, where programs are led by Administrative, Available Courses Education, Science, and Professional Medical Radiation Councils. With respect to meetings, I would Safety Officer Course CAMPEP Accredited. like to bring the attention of members Fluoroscopy Training and to several specific opportunities. Several Refresher Course years ago, Science Council introduced the Custom Courses concept of the focused research meeting – Designed to meet your needs. the FOREM. FOREM’s are intended to be small (20-25 attendees), member-initiated Available Formats Classroom meetings which focus on a specific scientific (Las Vegas NV, Gaithersburg MD topic. Modest planning infrastructure or Oak Ridge TN) can be provided by the AAPM to those On-site (your choice) scientists interested in putting together On-line Courses a FOREM (an application process is Webinar Courses required!). Many of us attend one or more 1-800-871-7930 very large meetings each year (e.g., AAPM Complete online catalog at "nnual .eeting, RSNA, ASTRO, etc.), and www.moellerinc.com/academy they of course provide an important Offering Medical Physics and Radiation Safety Consulting Services and useful function to attendees. A small meeting such as the FOREM format is a very different experience, and allows attendees to present, discuss, and interact on a very specific scientific topic, and in many cases a FOREM meeting can be the genesis of several scientific collaborations on that topic. I encourage AAPM members who are interested in potentially running a FOREM meeting at their institution to contact either Science Council chair Dan Low, or AAPM staff Debbie Gilley. Training Academy
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
I am exploring the potential of the AAPM hosting special educational programs within the organizational structure of the AAPM "nnual .eeting. Specifically, the mini-course concept would involve about 7 or 8 one-hour classes focused on a specific topic pertinent to medical physics; the classes would be held throughout the week of the "nnual .eeting, in the morning and late afternoon to avoid overlap with the regular meeting. The mini-courses would require special registration, and would also involve online course material and knowledge-strengthening opportunities (i.e., quizzes). It is envisioned that upon completion of one of these mini-courses, paid registrants would receive appropriate documentation of completion, including a plaque suitable for framing. Potential topics include particle-beam therapy, Brachytherapy, ACR accreditation for CT and MR, radiation biology, etc. I am interested in feedback from the members with respect to this mini-course concept, and am also interested in hearing opinions about appropriate topics which would strengthen the skill set of the practicing medical physicist. In closing, I want to challenge every AAPM member to do a little something different this year professionally – go to a meeting that you have not been to before, read some scientific or clinical papers (in Medical Physics or JACMP, for example) on topics outside of your field, collaborate on a project with somebody you haven’t collaborated with before, attend Grand Rounds in a different department, or find a piece of measurement equipment in your facility (air kerma meter, phantom, etc.) that you haven’t used before - and figure out how to use it. Do something new, add to your skill set, make yourself more valuable to your group and in the process, find more satisfaction in your job. The profession of Medical Physics is both important and rewarding – do something new (and fun?) this year to make it even more so!
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM Executive Director’s Column
Angela R. Keyser, College Park, MD
Mark your calendar for these important dates Research Seed Grant Deadline March Two $25,000 grants will be awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. Funding for grant recipients will begin on July 1. Research results will be submitted for presentation at future AAPM meetings. Additional program details and access to the application can be found online.
Fellowship Deadline April 17 The AAPM Graduate Fellowship is awarded for the first two years of graduate study leading to a doctoral degree in Medical Physics. A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year is assigned to the recipient. Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP). Additional information on CAMPEP accredited programs can be found at http://www.campep.org. Additional program details and access to the NEW Online Applications can be found online.
AAPM Meeting News Mark your calendars for four upcoming AAPM meetings: Radiation Oncology Program Accreditation Meeting March 14 – just prior to the AAPM Annual Spring Clinical Meeting Denver Marriott Tech Center, Denver, Colorado Register Now! The Radiation Oncology Program Accreditation Meeting is a one day, focused, interactive workshop aimed at providing information on how to prepare for radiation oncology accreditation, with material and content specific to existing accrediting bodies. Material will be presented by experienced surveyors on requirements, preparation, application, and maintenance. The target audience is Physicists, but Physicians, Administrators, Dosimetrists, and Therapists involved in the accreditation process will also benefit. AAPM is pleased to welcome program participation from the following accreditation bodies: ACRO, ASTRO’s Accreditation Program for Excellence (APEx) AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM Annual Spring Clinical Meeting March 15 - 18 - just after the Radiation Oncology Program Accreditation Meeting Denver Marriott Tech Center, Denver, Colorado Register Now! Several AAPM groups plan to meet during the 2014 AAPM Spring Clinical Meeting. A list of AAPM activities is available online. Please make time during the meeting to visit the vendors and thank them for their support of AAPM and the medical physics profession. AAPM 2014 Summer School SRS/SBRT/SABR: Safely and Accurately Delivering High-Precision, Hypofractionated Treatment June 22 – 26, 2014, University of Vermont, Burlington, Vermont Program information now available Registration will open on March 12 During this Summer School, participants will gain a comprehensive knowledge base of stateof-the-art SRS/SBRT practice from clinical experts in the field. There will be a round-table session for equipment-specific, focused discussion in addition to the lectures. By the end of the school, participants will have the tools to implement and maintain a high-quality, safe SRS/ SBRT practice in their clinic. 11 Self Assessment Modules (SAMs) will be included in this program (no extra fee). 56th AAPM Annual Meeting July 20 – 24, Austin, Texas The meeting focusing on “Innovation” will be held in the Austin Convention Center. Come discover why Forbes named Austin “One of America’s Coolest Cities.” Within a few walkable blocks you will find the swanky 2nd Street District, the Warehouse District on 4th Street, rooftop bars, historic 6th Street or slow the pace with a walk along Lady Bird Lake. Upcoming Important Dates MARCH 12 BY APRIL 17 BY MAY 2 JUNE 4 JUNE 25
Meeting Registration and Housing Information available online Authors notified of presentation disposition Meeting Program available on-line Deadline to receive early registration fees Housing reservation deadline Deadline to cancel housing reservation without a $25 cancellation fee
New in 2014 •
John R. Cameron Young Investigator Symposium will take place on Monday, July 21. AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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President’s Symposium and Innovation in Medical Physics – will take place on Tuesday, July 22. Special 2-Day Program on Quantitative Imaging (Monday - Tuesday, July 21-22). The Science Council Session – The Physics of Cancer. In addition to Symposia and regular Sessions, new Keynote Sessions on topics of special interest. Joint scientific symposium with the World Molecular Imaging Society. Joint scientific symposium with ESTRO – Imaging for Proton Therapy. Major expansion of SAMS offerings in Education, Professional, Practical, and Scientific Programs. Expanded meeting program from 7:30 AM – 6:00 PM. Interactive Hands On Question Writing Workshop Partners in Solutions – an exciting new venue on the exhibit floor. Vendors will provide physics-level applications training classes in a special-purpose lecture room built on the exhibit floor. Topics this year are solutions for TG-142 imaging QA and CT scanner dose optimization capabilities. These are not sales pitches but practical information for the clinical physicist from the people who know the system in depth. CE credit will be offered.
Austin is “One of America’s Coolest Cities” Local information to assist you in planning your trip to Austin: Experience Austin like a local. True Austin allows you to contact local experts. Live Music Venue Guide Austin Interactive Map The Austin Chronicle - Best of Austin: Food • • • • • • • • •
Best Barbecue: Franklin’s Best Breakfast: Kerbey Lane Cafe Best Breakfast Tacos: Tacodeli Best Burgers: Hopdoddy Burger Bar Best Chips & Salsa: Chuy’s Best Coffee: Houndstooth Coffee Best Pizza: Home Slice Best Restaurant of the Year: Sway Best Restaurant Service: Uchiko
Staff News Noel (Crisman-Filhart) Tyler left her position as AAPM Administrative Assistant in midFebruary to focus on her family. While we are pleased that Noel is able to take this step for her family, she will be greatly missed after serving as a valuable member of the AAPM team since AAPM Newsletter | Volume 39 No. 2 | March/April 2014
2005. Fortunately, I was able to promote Viv Dennis to the position and am confident that the transition will go very smoothly. Viv has served as the Customer Service Representative since joining the team in 2010. Along with the support for Career Services and the Common Application Process (CAP) for residencies, Viv will retain her responsibilities providing support for the Medical Physics journal.
AAPM Career Services
Make sure you’re putting your best self forward to potential employers with an excellent resume! AAPM’s Placement Services Subcommittee recently posted resume advice and templates to the Career Services site; visit www.aapm.org/careers/jobseekers/resources/resume/ to review this helpful information. And as always, apply for the latest medical physics job openings at the Career Services site (www.aapm.org/careers)! Now With New Resume Advice and Templates
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Editor’s Column
Mahadevappa Mahesh, Baltimore, MD
From the Editor’s desk
W
elcome to the second issue of the Newsletter this year. This issue contains articles from our regular contributors providing updates on various issues related to our profession. In addition, this issue includes articles from the ACR on new QC requirements for Ultrasound accreditation, ABR Physics Trustees’ article on Practice Quality Improvement (PQI) projects along with the 56th AAPM Annual Meeting and Exhibition announcement and many other informative articles. I also welcome readers to peruse the AAPM Website Editor’s column highlighting various website features that are currently available. Polar Vortex has dipped south again and we are still digging out from snow here on the east coast and hoping spring is just around the corner.
Editor’s Note 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.
2014 AAPM SUMMER SCHOOL SRS/SBRT/SABR: Safely and Accurately Delivering High-precision, Hypofractionated Treatments
REGISTRATION OPENS MARCH 12!
University of Vermont • Burlington, VT June 22-26, 2014
http://www.aapm.org/meetings/2014SS/
During this Summer School, participants will gain a comprehensive knowledge base of state-of-the-art SRS/SBRT practice from
In the last decade, SRS/SBRT has moved from a special procedure to widespread adaptation. Similarly, technology has evolved from frame-based systems to frameless, image-guided and motion-tracked procedures. Dose-fractionation schemes and OAR tolerances have been established, and our knowledge of Radiation Biology in hypofractionated treatments is catching up to the clinical reality as well.
By the end of the school, participants will have the tools to implement and maintain a high-quality, safe SRS/SBRT practice in their clinic. Self Assessment Modules (SAMs) will be included in this program.
AAPM Newsletter | Volume 39 No. 2| March/April 2014
Information on the Radiation Oncology Incident Learning System mailed to AAPM members
The AAPM and ASTRO released information on the new Radiation Oncology Incident Learning System (RO-ILS). RO-ILS will facilitate safer and higher quality care in radiation oncology by providing a mechanism for shared learning in a secure and non-punitive environment. Learn more:Â www.astro.org/ROILS.
Professional Liability Insurance Program Change in Name Please be advised that, effective January 1, 2014, our third-party insurance administrator will change its name from Marsh U.S. Consumer, a service of Seabury & Smith Inc., to Mercer Consumer, a service of Mercer Health & Benefits Administration LLC. Mercer is a global leader in talent, health, retirement and investments. Mercer and Marsh are both subsidiaries of Marsh & McLennan Companies, Inc. (MMC). This is an internal realignment within MMC only, allowing Mercer Consumer the ability to provide our membership with the best possible products and services. While you will notice the name will change on our website, in bills, and in other communications, you can expect a seamless transition, with no effect to your current insurance coverage or the services provided.
AAPM Newsletter | Volume 39 No. 2| March/April 2014
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New this year… • John R. Cameron Young Investigator Symposium will take place on
Monday, July 21. • President’s Symposium and Innovation in Medical Physics will take
place on Tuesday, July 22. • Special 2-Day Program on Quantitative Imaging
(Monday - Tuesday, July 21-22). • The Science Council Session – The Physics of Cancer (see below). • In addition to Symposia and regular Sessions, new Keynote Sessions
on topics of special interest. •
Society. Imaging for Proton Therapy.
• •
• Dedicated time in the meeting program for Visit the Vendors. • • •
(see below). • Legendary live music • A burgeoning restaurant scene • Unique culture
… and a list of other things that you just have to experience for yourself to truly understand why Forbes named Austin ‘One of America’s Coolest Cities’.
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Adapt-a-Thon – Texas Holdem Invitational Determination, Minimization and Communication of Uncertainties in Radiation Therapy
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Photon Beams Biomedical Informatics for Medical Physicists
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Immobilization Technology
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Brachytherapy Particle Therapy (Protons and Heavy Ions)
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Photon Therapy – SBRT/SRS
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The Status of Intensity Modulated Proton and Ion Therapy
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Informatics Radiobiology Small Animal Radiation Therapy Radiation Protection and Shielding Targeting Radionuclide
IMAGING
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Radiography/Fluoroscopy Multi-detector CT Cone Beam CT Mammography/Tomosynthesis
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Developments in Monte Carlo Methods for Medical Imaging
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Dual-energy CT Imaging in Diagnostic Imaging and Radiation Therapy
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The Promise and Potential Pitfalls of Deformable Image Registration in Clinical Practice
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Multi-Modality Imaging PACS/Informatics Ultrasound for Diagnostic Imaging
The Physics of Cancer Image Registration and Segmentation for Planning and Treatment MRI in Radiation Therapy Image-Guided Radiation Therapy Motion and Uncertainty Assessment and Management Treatment Response Assessment Imaging Techniques for Particle Therapy
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Genomics and Image-omics for Medical Physicists
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Practice Best Practice in Pediatric Imaging Radiation Dose Reducing Strategies in CT, Fluoroscopy and Radiography ACR Accreditation Updates in CT, Ultrasound, Mammography and MRI
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Stereotactic Breast Biopsy
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MRI Innovations MRI Safety
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Fundamentals and Automated Techniques Radiation Biology for Radiation Therapy Physicists
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Lean Tools and Methods
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Professional Practice of Medical Physics
Devices
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Professional Council Symposium
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Communicating Risk
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Legislation and Regulation Administration and Management
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(Therapy / Diagnostic) Building, Maintaining, and Improving Physics Residency Programs International Medical Physics Symposium Meet the Press – Talking to the Media Grantsmanship MBA’s for Medical Physicists
Partners in Solutions offer a new way for physicists to interact with our vendors. Vendors will provide physics-
be offered. Come learn with us!
nnovation Dates to Remember March 3 at 5 PM Eastern: Deadline for receipt of 300 WORD ABSTRACTS and supporting data. This deadline recognizes other conference schedules. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review.
March 12: Meeting Housing and Registration available online. By April 17: By May 12: June 4: Deadline to receive Discounted Registration Fees. June 25: Housing reservation deadline; deadline to cancel housing reservation without a $25 cancellation fee.
July 1: Deadline to receive full registration fee refund with written notice of cancellation. Last day to register for SAMs/ audience response unit.
July 20-24: August 20 – 11:59 PM ET: August 27: Credits released for meeting attendees.
innovation
Lynne Fairobent & Debbie Gilley, College Park, MD
Trust but Verify
I
n today’s world there are many opportunities to mislead others with credentials that are not as they seem. In 2002, such a situation happened in the state of Virginia and resulted in the 2005 conviction of a person for falsifying his qualifications and mail fraud conviction. (1) Again in 2007, in the Western District of Virginia Federal Court another individual was convicted of mail fraud and perjury as a medical expert. (2) Fortunately these are isolated situations and do not reflect the ethics of the profession as a whole. However, because of these events, the medical community and regulatory officials became concerned about obtaining information directly from an individual that could not be verified. This has impacted the ability for some medical professions to provide time sensitive care awaiting confirmation of credentials. Medical Physicists have had to provide multiple copies of their qualifications to each state they wish to provide services. This is burdensome to the medical physicists as well as the regulatory agency. More and more employers are also verifying the credentials of potential employees and this will become more important as new medical physicists meet the educational requirements for maintenance of certification. To further complicate the issues, the medical facility human resource offices and regulatory agencies may need to search not one but four different certification systems to identify if a medical physicist is qualified to perform the requested services. The American Board of Medical Specialists provides some of this information to the regulatory agencies and medical facility human resource offices, but the ABMS limits the number of “free times” you can request this information. As the need for verification increases over the coming years, both the medical facilities and the government regulatory agencies will need to verify information more frequently. The days of self-reporting by individuals are likely to disappear. In 2010 with the support of AAPM, the Conference of Radiation Control Program Directors (CRCPD) developed the Qualified Medical Physicist Registry. The registry is a clearinghouse of information of board certified medical physicists. The following boards provide information to the registry: •
American Board of Radiology
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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American Board of Medical Physics American Board of Health Physics American Board of Science in Nuclear Medicine Canadian College of Physicists in Medicine QMP Registry Search Information Provided by the Conference of Radiation Control Program Directors
International Inquiries
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
* The registry also includes the Canadian College of Physicists in Medicine
https://www.aapm.org/pubs/newsletter/references/UnqualifiedMedPhys.asp accessed January 14, 2014 2 Bogdanich, W and Rebelo, K (2010, January 11). They Check the Medical Equipment, but Who Is Checking Up on Them? New York Times http://www.nytimes.com/2010/01/27/us/27sideradiation.html?_r=0 , accessed January 14, 2014. 1
Radiation Oncology Program Accreditation Meeting
March 14, 2014 Denver, Colorado Denver Marriott Tech Center
It’s Not Too Late to Register! http://www.aapm.org/meetings/2014ROPA/
The Radiation Oncology Program Accreditation Meeting
is a one day, focused, interactive workshop aimed at providing information on how to prepare for radiation oncology accreditation, with material and content specific to ACR, ACRO and ASTRO's accrediting bodies. Material will be presented by experienced surveyors on requirements, preparation, application, and maintenance. The target audience is Physicists, but Physicians, Administrators, Dosimetrists, and Therapists involved in the accreditation process will also benefit.
AAPM is pleased to welcome
program participation from the following accreditation bodies: ACRO, ASTRO's Accreditation Program for Excellence (APEx)
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
MACHINE MLC IMAGING
QA
RITCognition™ (patent pending) New in V6.2: The RIT Cerberus system has been expanded to include a FILE HUNTER feature in addition to the powerful file watcher capability. File hunter allows you to search swiftly through directory structures for files meeting your criteria and then automatically processes them through analysis and reporting. Combine the newly streamlined Cerberus interface with the Artificial Intelligence capabilities of RIT Cognition true automated analysis!
Model Training System Updated Models
Training Sets
Clients upload new anonymized image recognition data.
Clients download updated models.
Elekta Hancock Test New in V6.2: This unique test that measures both leaf position and jaw setback on Elekta machines has more refinements to make it even more accurate and robust. We have added independent control over jaw and leaf thresholding to give you even more control over the analysis along with a number of algorithm choices to match your precise situation.
3D Stereotactic Alignment Test New in V6.2: We added the ability to choose amongst a number of alternate coordinate systems in this routine so that the results are relevant to your system’s configuration.
RIT EPID New in V6.2: We have added HD MLC versions of tests so that you can enjoy the same speed and accuracy analyzing your HD picket fence patterns as you do with your Millennium MLCs. We have also automated the recognition of the pixel value polarity so no more requirement to scale images from your True Beam machines.
RIT Version 6.2 Is Here - Download Now Download RIT software upgrades, documentation and even demo images. Call 719-590-1077, option 2 or email sales@radimage.com.
radimage.com © Radiological Imaging Technology, Inc., December, 2013
Education Council Report
George Starkschall, Houston, TX
Education Council activities
E
very year, the members of Education Council meet for a day and a half to review what we have done during the past year and to set our goals for the coming year. We are guided, in part, by the AAPM Strategic Plan, and in part by our own strategic planning document we developed several years ago. This year we met in February in frigid, snowy Chicago. I want to take this opportunity to share some of the meeting highlights with you.
On everyone’s mind is our progress in establishing a sufficient number of medical physics residency programs to meet the need for qualified medical physicists. The goal of 125-150 residents per year in radiation oncology physics and 25-30 residents per year in imaging physics is in use now; this may not be a wholly accurate projection of clinical employment needs, but we believe these numbers to be reasonable, and no one has presented an argument why these numbers should not be used. To meet this goal, as of February 1 of this year, seventy radiation oncology physics residency programs have been accredited by CAMPEP, and ten programs are in the process of accreditation. Nine imaging physics programs have been accredited, and three are in the process. In addition, eight imaging physics residency programs were recipients of grants from a joint program funded by the AAPM and RSNA to provide 50% stipend support to imaging physics residents. Finally, one professional doctorate (DMP) program has been accredited, and at least three institutions have indicated in a CAMPEP survey that they are in the process of developing a DMP program. Given this number of programs, we believe we are making very good progress on reaching our goal of having a sufficient number of residency programs to meet our manpower needs. However, we still have an imbalance in graduate production vs residency opportunities that we are required to address. Our graduate programs are producing a large number of MS degree holders, yet residency programs tend to accept a larger percentage of PhDs. This selection bias is understandable; most residency programs are housed in academic institutions in which the program leadership is populated with PhD medical physicists who tend to prefer candidates who share the same credentials as themselves. However, we still maintain that adequate didactic preparation for a clinical residency is a two-year graduate program leading to a master’s degree. One solution to this imbalance problem is to encourage private medical physics practices to become involved in the clinical education of medical physicists and to support residency programs. Many private practices have the resources to train a resident, but they find it difficult to justify the administrative overhead necessary to support a residency. We are encouraging private practices that have the interest in becoming residency sites to affiliate with larger residency programs in a “hub-and-spoke” model, in which the AAPM Newsletter | Volume 39 No. 2 | March/April 2014
administration of the program would be handled by the larger site and the actual clinical training handled by the smaller practice. To encourage establishment of such programs, we are planning to host a residency workshop in which potential programs will be assisted in preparing a CAMPEP Self-Study involving a hub-and-spoke model. Stay tuned to your AAPM communications for more information about this workshop. Another issue that was discussed at some length at the Education Council retreat was the idea of a residency matching program. Recruitment of qualified graduates of CAMPEP-accredited graduate programs or certificate programs for residency programs has become a highly competitive activity. Incidents have been noted of programs forcing residency applicants to accept or reject an admissions offer at the time of their interview, depriving them of the opportunity to evaluate additional residency programs. A matching program, analogous to the medical residency match, provides a mechanism that is fair to both the residency candidates and the residency programs. The economist who developed the matching algorithm (and received a Nobel Prize for it) demonstrated that an individual program and individual candidate will do best if they adhere to the results of the matching algorithm and do not try to go outside the matching program. At our retreat, Education Council reiterated its support of the idea of a residency matching program and we are working in close cooperation with the Society of Directors of Academic Medical Physics Programs (SDAMPP) to develop such a program. Another focus of Education Council is continuing education for medical physicists, and in particular, our online continuing education program. In the last issue of the Newsletter you had the opportunity to read about our newly revised Virtual Library, which is now hosted internally. We are now prepared to expand the Virtual Library to include capture of presentations from our Specialty Meetings as well as our Annual Meeting and Spring Clinical Meeting. Our intent is to provide this information to our membership at no additional charge. We are also working on developing a business model for nonmember access to online content. This model would institute a charge for nonmember access, while keeping free access to AAPM members. Many of the presentations on the Virtual Library would be of interest to other healthcare professionals and should be accessible to them for a fee. We see this as enabling us to provide a service to our professional colleagues while creating another source of revenue for our online services. The online presence of the AAPM is another issue that Education Council is addressing. Increasing educational content is now being placed online, and we want to determine what role the AAPM should take in the development and presentation of online education. Last year Task Group 250, under the direction of Jim Dobbins, was constituted to address this question. Work on this Task Group is still in progress, with an initial presentation occurring at this summer’s AAPM Meeting, when the Task Group will present the Education Council Symposium on the topic of online education. More details on the Symposium will come as we get closer to the meeting. AAPM Newsletter | Volume 39 No. 2 | March/April 2014
For the past several years, Education Council has devoted a great deal of effort to clinical education, especially in the establishment of clinical residency programs, but some of our concern is now being focused towards research education. The landscape of medical physics is continually changing, and we want to make sure that students coming out of our educational programs are adequately prepared to move our profession forward in this changing landscape. We have begun talking with members of Science Council, and especially WG FUTURE, to determine better ways of preparing our students for future research in medical physics. Finally, let me remind you that the AAPM Suggestion Box is now online. The Suggestion Box is designed for you to provide input into our Council activities. Please take advantage of it. I shall be looking forward to hearing from you.
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AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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AAPM Spring Clinical Meeting
March 15-18, 2014 Denver, Colorado Denver Marriott Tech Center
It’s Not Too Late to Register! http://www.aapm.org/meetings/2014SCM/
T
he 2014 meeting promises a program teeming with practical information designed to help medical physicists integrate emerging technologies into the clinical environment, keep abreast of regulatory and accreditation related issues, and provide a forum for the exchange of ideas in support of practice quality improvement.
New This Year: The Radiation Therapy track program highlights the clinical application of several AAPM Science Council Task Group Reports, Advanced Treatment Planning and Safety topics.
Credit: Steve Crecelius VISIT DENVER
Credit: Bruce Boyer VISIT DENVER
Credit: Rich Grant VISIT DENVER
The AAPM Spring Clinical Meeting has been approved by the Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP) for continuing education credit hours. AAPM will offer up to 18 ABR approved SAMs Sessions. AAPM will also apply to the Medical Dosimetrist Certification Board (MDCB) for MDCB credits and the Radiology Leadership Institute (RLI) for RLI continuing education credit hours.
Professional Council Column
Per Halvorsen, Newton, MA
Professional Council news and announcements The Joint Commission’s new imaging standards As many of you may know, The Joint Commission has announced new accreditation standards pertaining to diagnostic imaging procedures, which include requirements for annual physicist testing and evaluation of most imaging equipment and a somewhat controversial requirement for CT “dose” reporting [the word “dose” is in quotes for good reason…]. At the time of this writing, the effective date for this requirement is July 1, 2014. The AAPM provided extensive comments on the draft standards during their comment period, but we did not receive a formal response to those comments. The Science Council is evaluating the standards relative to AAPM’s published guidance documents and evaluating whether there are inconsistencies or significant ambiguities in the standards, and the new Imaging Accreditation Subcommittee under Clinical Practice Committee is prepared to work with the Science Council’s Imaging Physics Committee to address any need for additional guidance to our medical physics community as these standards go into effect. Should you have suggestions for their consideration, please contact Tyler Fisher who chairs the Imaging Accreditation Subcommittee.
Physicist Assistants The healthcare delivery model in the United States is changing, with active consideration of broader delegation of duties across the healthcare system. We cannot expect that the medical physics specialty will be exempted from such consideration. Physicist assistants have been a key part of the practice model in many large institutions, but consideration of a broad adoption of this model in different practice settings gives rise to many potential concerns, broadly summarized as appropriate training, scope of work, and level of supervision. The existing Medical Physics Practice Guideline (MPPG) Task Group on Supervision is limited to medical physicists in training, and we intend to form another MPPG Task Group to address physicist assistants and other non-physicist colleagues who perform physics-related tasks. In the meantime, this topic is actively under consideration in some states and larger health systems. Formal guidance from the AAPM will be an important contribution to shaping the evolving practice model in this regard. Should you have suggestions for the Task Group, please send them to Lynne Fairobent (AAPM staff) or Tony Seibert, Task Group Chair.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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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 new QC requirements for the Ultrasound and Breast Ultrasound Accreditation Programs are effective June 1, 2014 for all accredited facilities or facilities applying for accreditation. 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. Q.
Who must perform the routine ultrasound QC tests?
A.
The routine ultrasound QC tests are typically performed by appropriately trained sonographers or service engineers. However, medical physicists may also perform these tests in addition to their annual survey.
Q.
The Image Uniformity and Artifact Survey test for both the Annual System Performance Evaluation and the Routine QC discusses the use of an “in air” test to detect superficial artifacts. May we perform the “in air” test instead of using a phantom to do the entire Image Uniformity and Artifact Survey test?
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
A.
Yes, for Routine QC you may perform the “in air” test instead of using a phantom to do the entire Image Uniformity and Artifact Survey test. A good implementation would be to provide baseline images of the reverberation/interference pattern for comparison, to aid in detecting potential uniformity problems. However, for the Annual System Performance Evaluation, an appropriate phantom or test object must be used. The “in-air only” approach has limitations (e.g., limited sensitivity, especially for sector/vector probes) which would interfere with a complete and valid assessment. In-air images could be used in this evaluation along with other assessment data, e.g. phantom images.
Q.
Under the Routine QC’s Image Uniformity and Artifact Survey it states, “All transducer ports on each scanner should be tested using at least 1 transducer”. If the scanner only has one transducer, should all the QC tests be repeated in each port or does verifying that the transducer connects properly in each port satisfy the requirement?
A.
It depends if more than one port is used clinically. Ideally, each transducer and port should be tested. However, in the case of single probe, it is likely left plugged into the same port all the time, and the other ports are not clinically used. If the transducer is never clinically used with the other ports, it is not necessary to perform Routine QC on the unused ports. This should be documented in the QC records.
About the author: Priscilla F. Butler, M.S. is the Senior Director and Medical Physicist, for ACR Quality and Safety.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Health Policy/Economic Issues
Blake Dirksen, Coralville, IA Vice-Chair, Professional Economics Committee
Continuing medical physics consultation receives a boost – How and why
F
oundational to the reimbursement for medical physics services in Radiation Oncology is CPT© 77336 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist reported per week of therapy
The previous issue of the AAPM Newsletter contained an article by Wendy Smith Fuss with the headline, “AAPM succeeds in 62% payment increase for weekly medical physics consult.” The headline is certainly reporting great news and as a member of the Professional Economics Committee (PEC) committee I am hoping to shed some light on some of the details relating to the revaluation of the 77336 code.
Figure 1: CMS Medicare Physician Fee Schedule payment for 77336 from 2006 to 2014
As the complexity of our treatments has increased, the work to ensure accuracy and patient safety has become more complicated as well. At the same time, as can be seen in Figure 1, the reimbursement for 77336 has fallen dramatically. The AAPM recently recommended to the AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Centers for Medicare and Medicaid Services (CMS) that the CPT code required revaluation under the Medicare Physician Fee Schedule, which provides reimbursement to freestanding cancer centers. This process requires that the AAPM prove that there have been changes in the technique, equipment, or effort required to complete the work associated with 77336. Fortunately, AAPM was successful at demonstrating that these criteria have been met and CMS has adjusted the inputs for the valuation of the CPT code. Two key components that led to the rate increase for 77336 are time and equipment. Over time, the work associated with 77336 has transitioned from being performed by a mix of staff to being performed exclusively by the medical physicist. This change has been acknowledged by CMS with rate setting now using only medical physics time as opposed to a medical physicist and dosimetrist mix. This change results in part of the rate increase for 77336. There are also inputs in the 77336 rate setting to take equipment costs into account. These inputs were adjusted to reflect the increased cost of commonly used physics tools such as ion chambers, water tanks, and other equipment as well as equipment that was not taken into account in the previous valuation. The work of 77336 covers the ongoing support of patients undergoing radiation therapy by a medical physicist which includes a broad scope of tasks. Tasks ranging from consultation with radiation oncologists and therapists about issues that arise during treatment to beam characterization and validation to imaging system alignment and system error interrogation are all part of the work included in 77336. What is traditionally referred to as the weekly chart review is also an important component and includes reviewing the prescription, patient imaging and shifts, daily and cumulative dose tracking, plan approval status, and set up parameters. In addition, radiation field set up is reviewed to ensure that no treatment parameters have changed incorrectly. Overrides or interlocks are reviewed as well as any pertinent notes from the clinical team. All discrepancies must be documented and reviewed with the radiation oncologist. The chart review should be documented with a list of the items reviewed and a signature of the medical physicist. To perform this work it is vital that the medical physicist is routinely involved in the clinic. This includes attending chart rounds, consulting with the radiation oncologist, and being present at the treatment machine when required and when issues arise. The physical presence of the medical physicist is not only a part of the 77336 but essential to safe and effective treatment delivery. The change in the relative value unit (RVU) for the 77336 code was only accomplished with a great deal of effort and leadership provided by a workgroup from the Professional Economics Committee which included James Goodwin, George Sherouse, Robert Paul King, Lena Lamel, Marilyn Wexler, and Gerald White with the support of Wendy Smith Fuss as well as the partnership of ASTRO. It is a time of great change in health care economics and we are fortunate that the value of the medical physicist was recognized. AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Website Editor Report
George C. Kagadis, Rion, Greece
Take advantage of AAPM’s growing online resources
W
e are all getting prepared for the AAPM Annual Meeting, which this year is going to take place in Austin, TX (July 20-24). The major issue is that the 56th AAPM Annual Meeting & Exhibition website is now up and ready to receive your submissions. AAPM HQ staff has already uploaded 1,089 videos to Vimeo (as of February 10, 2014). The AAPM Virtual Library is also in the process of being added to Vimeo. We continue to work on the migration and when it is complete we will let the membership know. Since AAPM began uploading those videos to Vimeo, there have been 7,270 plays (as of February 10, 2014) most of which oriented from the U.S. (2,877), India (465), Turkey (238), Canada (218), Spain (184) and Saudi Arabia (183). We expect that when all past meetings are uploaded these presentations will be a valuable toolkit for all our colleagues. What you might have seen lately on our website is that a Suggestion Box has been added where you can submit your suggestions/comments directly to the Chair of any of the four AAPM Councils. All available introductory videos are available for presentation on our website and will be presented in the Spring Annual Meeting in Denver, CO (March 15 -18) and the Annual Meeting in Austin, TX. I urge the Chairs of other AAPM Committees and Subcommittees to prepare such an introduction and send it to us to put together with the other introductions for presentation in the fast approaching Annual Meeting. I am pleased to report that as of February 10, 2014 we have 36,222 images posted to AAPM’s Flickr, 1,705 likes on Facebook, 5,768 members on LinkedIn and 2,445 followers on Twitter. I hope you find the AAPM website useful, visit it often and send me your feedback or directly at george@mail.aapm.org.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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ABR News
Jerry Allison, Geoffrey Ibbott and J. Anthony Seibert
Practice Quality Improvement Projects (PQI)
P
ractice Quality Improvement (PQI) projects have been part of the process of maintaining certification since the introduction of the program in 2002. These projects are powerful tools for improving the quality and safety of the environments in which we practice medical physics. In the current version of Maintenance of Certification (MOC), known as “Continuous Certification,” a medical physicist must have completed a PQI project within the previous three years, at the time of the ABR’s annual look-back each March. For the first “full” annual look-back in March 2016, diplomates will be given an additional year, so that a PQI project completed in 2012, 2013, 2014, or 2015 will fulfill this requirement. The PQI initiative is a framework to facilitate improvement of medical care and/or its delivery as an individual, a group, or an institution. Quality and safety in medical care have become a national priority, and the PQI part of MOC (Part 4) permits medical physicists to demonstrate both their commitment to quality and safety and, in some instances, their compliance with associated external requirements. Medical physicists bring special skills to the patient care process. These include: • • •
Familiarity with designing quantitative projects; The ability to apply statistical techniques to the analysis of data; and A knowledge of statistical quality control processes.
Many high-quality PQI projects are collaborations between medical physicists and their physician colleagues. Both must contribute to the process, and when this happens, the results can be especially useful to their institutions. This collaborative effort relates to the competency of Systems-Based Practice. PQI projects are intended to be quantitative in nature so the project should deal with real numerical data, should set numerical goals, and should be evaluated in a statistical fashion. The general outline of a PQI project is shown in the figure below. The cycle begins with the selection of a project, which can be individual, local, or national in scope. Projects that are clinically relevant and meaningful are a better choice than projects that are strictly administrative, academic, or educational. When one knows that a project will have a beneficial effect on the practice in which one operates, then the individual or team working on the project is more likely to be enthusiastic and well-motivated. It also will be easier to encourage others to contribute, and the results will be more satisfying. AAPM Newsletter | Volume 39 No. 2 | March/April 2014
After a project is selected, it begins with the collection of initial data. Depending on the nature of the project, this may be relatively simple or quite complex. It is important, though, not to make assumptions about the situation in this phase. After the initial data are collected, they must be analyzed. This frequently leads to more data collection, which may be necessary for a complete understanding of the situation. After the project team feels that the data are well understood, an improvement plan can be formulated. The improvement plan is perhaps the most important aspect of the project. An improvement plan works best when it takes into account the following: • •
Assessing multiple processes to improve the situation; Involving everyone who deals with parts of the project; AAPM Newsletter | Volume 39 No. 2 | March/April 2014
• •
Taking into account any social factors that affect the project; Setting numerical goals that have subgoals divided by time and substeps.
After the improvement plan is agreed upon by the individuals involved, it is ready for implementation. If possible, some motivational publicity is helpful at this point. As the improvement plan progresses, additional data are collected and analyzed. At some point, it will appear that no further improvements to the project are likely. The project then should be moved to a monitoring status and should be followed to ensure that the gains are maintained. The completion of a PQI project can bring great satisfaction to the medical physicist(s) involved. Knowledge that one has contributed to quality and safety in one’s own practice can be a source of pride for an individual and can serve as additional motivation when one is designing one’s next PQI project. Guidelines for PQI projects are available of the ABR website. Two Common Questions Do I have to send my data to the ABR? You do not routinely have to send PQI project data to the ABR. A template with summary details is available on myABR. The template must be completed for each PQI project. If you are selected for a random audit, you will be asked to send your project data to the ABR. The ABR will not analyze your data; the data are requested for the audit simply to ensure they were collected. What happens if we do not achieve the PQI goals we set? As long as you have made a good-faith effort on the project, this is acceptable. The ABR would rather have diplomates tackle meaningful projects that carry with them some risk than embark on safe but unimportant projects.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Expanding Horizons
Thomas Bortfeld, Boston, MA
Expanding Horizons 2013: Connecting AAPM and PS-OC Network
T
he primary objective of the Expanding Horizons 2013 meeting in Bethesda, MD, on Nov 7-8, 2013 was to look into exciting new applications of physics in medicine. The meeting was co-organized by the American Association of Physicists in Medicine (AAPM, Robert Jeraj and Thomas Bortfeld), National Cancer Institute (NCI), Office of Physical Sciences-Oncology, and the Stanford Physical Sciences - Oncology Centers (Stanford PS-OC, Jan Liphardt). Given that the two groups of physicists working in medicine met for the first time, an important objective of this first joint meeting was also to identify synergies between AAPM and PS-OCs. The meeting was organized around six themes, each consisting of two presentations, one from AAPM and one from the PS-OC. The program and presentations are available here. In the first session, dedicated to cancer complexity Soren Bentzen (AAPM, University of Maryland, Baltimore) summarized what we know about the vast complexity and heterogeneity of the disease. An important lesson was that linking genomics to patient-to-patient variability requires large validation patient studies, as small studies often give false negative results, such as in the case of single nucleotide polymorphisms (SNPs) correlation to the late radiotherapy toxicity. Given the enormous complexity and heterogeneity, it is actually somewhat surprising that we are able to treat so many patients successfully. Robert Austin (Princeton PS-OC, Princeton University, Princeton), pointed out that the heterogeneity of cancer may give rise to ecological niches, which in turn allow cancer evolution to happen, possibly resulting in resistance to therapy. His main message was the application of evolutionary game theory to cancer. Based on his models and experiments with bacteria, he came to the provocative conclusion that there may be no cure for cancer – our best chances are to manage the disease, i.e. to keep the cancer at bay over many years, without actually eliminating it. The progress in finding a cure for cancer was controversially discussed in this session, as well as throughout the rest of the conference. In the second session, Parag Mallick (USC PS-OC, Stanford University, Stanford) highlighted the importance of multiscale modeling for understanding cancer and response to therapy. Multiscale modeling was picked up by speakers in other sessions as well and became a recurring theme of the conference. Mallick discussed the many levels of scales relevant for cancer development, starting from the gene and protein level to cells, tissues, organs, and finally the whole organism. Jeff Siewerdsen (AAPM, Johns Hopkins, Baltimore) presented a different side of modeling – related to imaging. He presented a number of exciting and AAPM Newsletter | Volume 39 No. 2 | March/April 2014
clinically relevant innovations in imaging technology, and image guided interventions. While the modeling goals (e.g., model-based image reconstruction vs model-based tumor evolution) might be different, the modeling approaches are often remarkably similar. The next session focusing on treatment response and outcome modeling had the most clinical focus. Shelley Hwang (Stanford PS-OC, Duke Medical Center, Durham), a breast cancer surgeon reported on her interactions with physicists from the clinician’s perspective. She mentioned the importance of “traditional” medical physics approaches in advancing imaging (specifically tomosynthesis) and radiation therapy. She also discussed her work with Stanford PS-OC, namely physical measurements of the mechanical properties (stiffness) of breast tissue and its relation to breast cancer risk, as well as measurements of circulating tumor cells (CTCs) and their prognostic value. Randy Ten Haken (AAPM, University of Michigan, Ann Arbor) provided a fantastic example of a several decade-long joint effort between physicists and radiation oncologists to refine our understanding of induction of radiation therapy toxicity in liver. He explained how the modeling of the response of liver tissue to radiation has had a substantial practice changing impact in radiation oncology. He pointed out that this modeling and model refinement effort, along with corresponding clinical trials, is a long-term process that may take decades. Like several other speakers, Ten Haken quoted George Box “Essentially, all models are wrong but some are useful”. The liver dose response model belongs to the group of extremely useful models, but only after putting a lot of effort into it. The last session of the first day was devoted to the AAPM and PS-OC vision. AAPM president John Hazle summarized the 55 year long history of AAPM and its focus on clinical and translational work, mainly in imaging and radiation therapy. Only 10% of the AAPM members are primarily involved in research and education. However, with 8000 AAPM members in total, those 10% constitute a significant work force. Part of Hazle’s vision is that some non-traditional “wild physics” should be promoted. The PS-OCs, represented by the program director Larry Nagahara, have a much younger history (5 years) but unlike AAPM they were created to do the “wild physics” from the get-go. 12 centers taking a fresh look at the cancer problem from many different (but all physical sciences related) angles are currently supported by the NCI. The program announcement for the next PS-OC program funding cycle will come out soon and will highlight two suggested themes: the physical dynamics of cancer, and the spatial organization and cancer. The second day started with a session on advanced technologies. Peter Kuhn (Scripps PSOC, The Scripps Research Institute, La Jolla) discussed “fluid biopsies”: new technologies to measure circulating tumor cells (CTC) in the bloodstream. One of their goals is to better understand the fluid dynamics of blood and its implications for cancer metastasis. These experimental methods investigating metastasis are matched with the modeling efforts in a form of a Markov chain model to derive metastatic pathways from a large number of autopsies. Their simple “spreaders and sponges” model, based on the algorithm employed in the Google search engine, led to results that agree surprisingly well with common knowledge AAPM Newsletter | Volume 39 No. 2 | March/April 2014
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about where certain tumors tend to metastasize. On the other part of the spectrum, Rock Mackie (AAPM, University of Wisconsin, Madison) then talked about “large technologies”. He gave several examples of successful large technology projects and reported specifically on his own experience with “tomotherapy”, in which he has been intimately involved as an inventor, developer, and entrepreneur. One of his key points was the importance of project management for the success of any big project. An active discussion evolved around the question of how important project management is to win the war against cancer, and the related question about the balance between goal driven research/engineering and curiosity driven research.
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The last session was dedicated to precise targeting. David Jaffray (AAPM, University of Toronto) presented advances in targeting radiation, in particular the development of innovative technologies for image-guided therapy. He also gave an outlook into the use of gold nanoparticles as radiation sensitizers, and nanoparticles for better imaging, which led to the last talk of the workshop. Mauro Ferrari (The Methodist Hospital Research Institute PS-OC, Houston) gave an overview of the fascinating potential of nano-medicine. Many physics-related questions are left to be answered in this field. Ferrari mentioned the example of shaping nano-particles for optimal targeting. It turns out that spherical particles are the least effective, because they do not remain attached to the target. Other shapes such as disk-shaped particles are much preferred. Based on the successful exchange of ideas between PS-OCs and AAPM at this workshop, a few action items were agreed upon that will bring AAPM and PS-OC closer together in the future. First of all, a joint working group between AAPM and PS-OCs, will be formed to coordinate future joint activities. Second, participation of PS-OC investigators at the Annual AAPM Research Meeting and AAPM researchers at the Annual PS-OCs’ Network Investigators’ AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Meeting will be enhanced. In light of this collaboration, the topic selected for the prestigious Science Council session at the annual AAPM meeting will be devoted to the “Physics of Cancer”, which will be of clear interest to members of both groups. Similarly, both groups will actively participate in the next Horizons meeting anticipated in 2014 and devoted to “Bridging the Scales”. Finally, and most importantly, the research collaboration between the two groups is foreseen through exchange of multiple types of data and models. The 1 ½ day of the Horizons 2013 meeting clearly achieved its main objective – Expanding Horizons for everyone of the 75 participants, all being excited about future potential of synergies between AAPM and PS-OCs to jointly attack one of the most pressing problems of our time – how to effectively fight and defeat cancer.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
Working Group Report
Peter Dunscombe, Calgary, Canada Eric Ford, Seattle, WA
In August 2013 the AAPM released a new online tool, the Safety Profile Assessment (SPA)– spa.aapm.org. The tool is designed to be a practical, collaborative aid to improve safety and quality around the radiotherapy clinic by soliciting responses to 92 questions, preferably by a multidisciplinary group. Use of the tool provides a snapshot of the current safety/quality profile of the clinic and allows benchmarking against the performance of other institutions. It also incorporates facilities for tracking and measuring improvement over time. SPA was developed by the AAPM Work Group on Prevention of Errors with input from colleagues in ASRT, ASTRO, AAMD and SROA and significant assistance from AAPM headquarters IT staff. As of the end of January 2014 it had been accessed from 7 countries, principally the US, with 203 registered users and 69 completed surveys. Comments by users have been positive, with over 70% responding that the survey was easy or very easy to complete and over 65% stating they will definitely or very probably use SPA at some time in the future to gauge the success of their safety/quality improvement efforts. SPA is completely free and confidential. The system developers and administrators at AAPM HQ are unable to identify users. It takes just a few moments to register and roughly one to two hours to complete. We encourage you to check it out as a potential means to both improve safety in the clinic and document the improvement achieved. For a short two-minute video on the SPA visit spa.aapm.org/SPAVideo.aspx or click on the image below.
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM Newsletter | Volume 39 No. 2 | March/April 2014
AAPM Newsletter | Volume 39 No. 2 | March/April 2014