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
n JULY/AUGUST 2014 Volume 39 No. 4
See you in Austin, TX at the 56 Annual Meeting & Exhibition July 20-24, 2014 th
CT Dose Check and Possible Interference with CT-Guided Procedures n Medicare Set to Promote Adoption of CT Safety Technology n AAPM – ASTRO Announce RO-ILS: Radiation Oncology Incident Learning System on Capitol Hill and more... n AAPM/IOMP Presentation at the WHO Global 2013 for Medical Devices Affairs Committee n
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 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: September/October Submission Deadline: August 11, 2014 Posted Online: Week of September 1, 2014
www.AAPM.org
CONTENTS
Articles in this Issue
JULY/AUGUST 2014 Volume 39 No. 4
Events / Announcements
Chairman of the Board’s Column
3 Career Services
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AAPM President-Elect’s Column
5 2015 AAPM Spring Clinical Meeting
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AAPM Executive Director’s Column
7 AAPM 2014 Annual Meeting App
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Editor’s Column
12 56th Annual Meeting & Exhibition
14 36
Legislative & Regulatory Affairs Report 23 RO-ILS
44
Professional Council Column
31 IUPESM World Congress
Education Council Report
32 AM Keynote & President’s Symposium 48
Ohio Valley Chapter Report
45 Obituary: Warren Keith Sinclair
History Committee Report
49
Vendor Relations & Product Usability Subcommittee Report
51
AAPM/IOMP Presentation Report
53
Working Group Report
56
Website Editor’s Report
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Chairman of the Board’s Column
John D. Hazle, Houston, TX
I
t’s almost that time – Annual Meeting time that is! I’m looking forward to a great meeting in Austin and seeing many colleagues there. The program promises to be outstanding, with many proffered sessions and several carefully constructed specialty sessions across the board. Everyone involved in the meeting planning is to be commended for another great effort! Most of what I will be discussing this month is the result of discussions at the Strategic Planning Committee (SPC) meeting in Denver during the Spring Clinical Meeting. We had a series of very productive discussions and the group is maturing to really be more forwardlooking in their vision for where the association needs to be going in professional practice, research, education, and administration. With respect to education, one of the more critical topics for the short-term is the capacity of residency programs to meet the expected manpower needs. For the first time, candidates who applied to the American Board of Radiology examination process last year for this year’s exams were required to verify that they were currently enrolled in or had completed a CAMPEP accredited residency. As a reminder, until that time graduate students in CAMPEP accredited program could enter the examination process. This means that it will be 2-3 years before the M.S. degree seekers flush out of the graduate pipeline and another 2-3 years before the Ph.D. pipeline clears. Our best projections are that we will need approximately 125-150 new radiation therapy physicists and 25-30 imaging physicists per year to meet manpower needs. At this point we have 70 approved therapy physics residencies and another 11 in the accreditation process, turning out about 120 new trainees per year. On the diagnostic side we have 10 approved programs with another 10 in the application process, turning out about 15 trainees per year. There is one approved D.M.P. program with about 5 others in process. In summary, we are in pretty good shape on the therapy side and pretty close on the diagnostic side. Personally, I am pretty comfortable that the balance for trainees eligible for ABR certification is pretty good with respect to manpower needs. There is, however, a significant imbalance in the number of graduate students and available residency slots. While the AAPM has limited ability to affect any changes in the number of graduate students, we are encouraging graduate programs to harmonize their graduate slots with available residency slots, and to promote non-QMP career pathways for those who don’t get in residencies. We are also working with the Society of Nuclear Medicine and Molecular Imaging on how to support nuclear medicine residency programs. Finally, we are carefully monitoring a potential residency program through the Veterans Affairs hospitals that could support 20 or so therapy 3
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physics residents. We also discussed the reorganization of the Technology Assessment Committee and charged the chair, Maryellen Giger, to continue fine-tuning the direction of that group and to keep SPC abreast of where they are going so that their efforts can be harmonized with those of other groups in the association. We are also excited about the rollout of the ASTRO/AAPM radiation therapy incident reporting system (RO-ILS) that was announced on June 19. Several of the ad hoc committees reported in on their progress. The Ad Hoc on Journal Publications gave an update and indicated that they will have a final report ready by the annual meeting. The harmonization of the management of our journals, Medical Physics and Journal of Applied Clinical Medical Physics, is not only critical to the journals, but also to our more global plans for enhancing the relationships with our corporate partners. Speaking of that, the Ad Hoc on Corporate Relations has been active, reporting in on several strategies for enhancing the value of the support our corporate affiliates get for their support. The committee has spent considerable time discussing this and communicating with our vendors. All the feedback EXCOM has gotten from vendors about this initiative is very positive, so we are encouraged that we are going the right direction. The Ad Hoc on HQ Space Needs is increasingly active as we prepare for making a decision on where our HQ space will be located. While the current space has served us well for 20+ years, it is time to do a full assessment of our needs and what our options are moving forward. About the only thing that has been decided is that we will stay in the greater DC area. This is driven by the fact that our outstanding staff would be maintained and the general proximity to NIH and the Federal government has its advantages. We have engaged The Meyer Group to help us work through the space needs process, the space options (lease vs. purchase) and execution of the strategy. We are in a fortunate position financially that we can consider purchasing our own space, something that The Meyer Group suggests is usually cost effective, and which allows us to diversify our investment portfolio. The Ad Hoc is taking this task seriously and is diligently beginning the process so that we can put the Association in a strong position for the next 20 years. In conclusion, the association continues to be healthy, active, and productive. Positive consequences of the dues increase last year continue to place the AAPM in an excellent position to support our members in all aspects of association matters. Our individual investment in AAPM is, in my opinion, one that is paying huge dividends to us as healthcare professionals and scientists. We are also fortunate to have a virtual army of volunteers who give differentially of their time and energy to make the association successful.
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AAPM President-Elect’s Column
John M. Boone, Sacramento, CA
I
have visited a couple of the AAPM chapters at this point in my tenure as President-Elect, and it is great to get out into the communities where our members work and live. In my career, I have participated in four AAPM chapters – Southern California (as a grad student), Missouri, Mid-Atlantic, and the San Francisco Bay chapter. California is a populous but physically large state, so it is geographically challenging to get people together. For example, the SF Bay chapter routinely meets in the Bay Area but that is a 2½ hour drive each way from Sacramento and of course much further for physicists in the northern reaches of the state. To address this, I advocate a meeting format that I learned from my senior colleagues (then) in Missouri – outside of a formal chapter meeting, the physicists in Columbia get together once a month for breakfast at 7:00 am – no agenda, just a casual breakfast where folks can vent, share commissioning stories, berate hospital administration, or borrow an exposure meter. This meeting format was repeated when I moved to Philadelphia, and I actually made letterhead quasi-formalizing “The Philadelphia Medical Physics Breakfast Club”. These casual gettogethers combined therapy and diagnostic medical physicists, young and old, academic and consulting physicists, and helped to form bonds amongst colleagues; as a younger guy then, I have to say that I learned a lot – and it was not all physics that I learned. While AAPM chapter and national meetings serve many important functions, I believe that frequent (~monthly) meetings amongst local groups of medical physicists can be useful both professionally and personally. Last year, I spent a week lecturing in a training program for medical physicists from developing nations in Africa and South America sponsored by the International Atomic Energy Agency in Trieste, Italy. Most of these folks were from countries which had no formal Medical Physics societies, and I suggested to them that they adopt the Medical Physics Breakfast Club format. These are physicists who do not have chapter or national meetings, and thus the Breakfast Club format would be a primary form of contact with colleagues. In summary, as a medical physicist, it is hugely important to interact with colleagues who are also medical physicists. While there are many formal settings for such interaction, there are innumerable reasons why medical physicists in a local community (city or county) should get together in a more casual less-scripted fashion. Physical proximity is a huge factor in collaboration, and things like sharing phantoms or probes, helping out with machine commissioning, or getting candid restaurant reviews are more useful at the local level. Breakfast is one option, but I know in the distant past my former professors got together at a linear accelerator and did chamber comparisons, and then after all the buttons had been 5
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pushed, they broke out the wine and cheese.
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AAPM Newsletter | Volume 39 No. 4 | July/August 2014
Executive Director’s Column
Angela R. Keyser, College Park, MD
AAPM At Your Service Remember to Vote by July 3! Elections for the 2015 President-Elect, Secretary, and Board Members-At-Large will close on July 3rd. 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 2013 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 Going to #AAPM14 in Austin? Download the AAPM Annual Meeting App for your device: • iPad/iPhone • Android • All other web browser-enabled devices Need to compile your schedule? Learn how New this year – dedicated time to Visit the Vendors on Wednesday, July 23 from 9:30 AM – 11:00 AM. No sessions are scheduled to conflict during this time so make sure to visit the Exhibit Hall. An online Buyers Guide is available, with information about the exhibiting companies. Exhibit hours are: –– –– –– ––
Sunday, July 20 – 12:30 – 5:30 PM Monday, July 21 – 9:00 AM – 5:30 PM Tuesday, July 22 – 9:00 AM – 5:30 PM Wednesday, July 23 – 9:00 AM – 2:00 PM
Make plans to attend the 2014 Annual Business and Town Hall Meeting on Wednesday, July 7
AAPM Newsletter | Volume 39 No. 4 | July/August 2014
23 from 6:15 PM - 7:30 PM in Ballroom FG of the Austin 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. 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.
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. • Jongmin Cho - UT MD Anderson Cancer Center • Grace Jianan Gang - Johns Hopkins University 2014 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. 8
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• • • • • • • • • • •
Brian Mark Anderson Molly Claire Cook Lianna Dora Di Maso Franklin W. Feingold Amy Leigh Freeman Frederick Jocelyn Mary Hoye Steven La Count Mark Leibensperger Kayla Rae Mendel Mary Elizabeth Peters Ashma Shiwakoti
2014 Diversity Recruitment through Education and Mentoring Program “DREAM” (formerly MUSE): Designed to increase the number of underrepresented groups in medical physics by creating new opportunities, outreach, and mentoring geared towards diversity recruitment of undergraduate students in the field of medical physics. Students participating in the program are placed into summer positions that are consistent with their interest. Students are selected for the program on a competitive basis to be a DREAM fellow. Each DREAM fellow receives a stipend from the AAPM. • • • • • • • • •
Arun Chockalingam Taylor Ashley German Alice Huang Morgan Killefer Duck Kyeom Kim Flavia Lopez Nyasha Gracious Maforo Helen Louise Sporkin Gabriella Tesfay
Staff News I would like to officially introduce you to AAPM’s newest team member, Robert McKoy. Robert joined the team on April 22nd as AAPM’s Controller. Robert brings with him over 25 years experience in finance, most recently as the Executive Vice-President of Operations and Chief Financial Officer of the National Multiple Sclerosis Society, Maryland Chapter and Central Virginia Chapter where he served since 2004. Prior to that, he was Controller for the NAACP in Baltimore for 4 years. I am pleased to report that Lisa Schober graduated with her Masters of Science in Nonprofit and Association Management from the University of Maryland University College in May 9
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with a 3.97 cumulative GPA. Many outside the Washington, DC area may not be aware that “Association Management” is a structured career path, with a special emphasis on management of nonprofit organizations; financial management; revenue generation and cost control issues; governance; recruitment and management of volunteers; and outcome and process evaluation of nonprofits. I’m sure you will join me in congratulating Lisa on this wonderful accomplishment. What a great asset she is to the AAPM team!
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 2014. I want to publicly thank them and acknowledge their efforts. Nancy Vazquez 18 years of service Jennifer Hudson 13 years of service Zailu Gao 13 years of service Karen MacFarland 11 years of service Lynne Fairobent 10 years of service Lisa Schober 9 years of service Laurie Allen 7 years of service Onasis Budisantoso 6 years of service Viv Dennis 4 years of service Melissa Liverpool 3 years of service Rachel Smiroldo 3 years of service
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MAKE SURE YOUR NEXT JOB INTERVIEW GETS YOU A THUMBS UP! The Placement Services Committee has pooled its members’ collective experiences from both sides of the interview table to present a new Interview Advice section for AAPM Career Services job seekers: http://www.aapm.org/careers/jobseekers/resources/interview/ Did you know that, during your interview, it is common to be asked both technical and behavioral questions? Access a list of the most commonly asked behavioral questions to give you a useful edge when interviewing. In addition, a back-to-basics interview bootcamp presentation is now available, designed to make you stand out from the pack. Use these tools to truly WOW your potential employer and secure the job you’ve been working so hard for!
Editor’s Column
Mahadevappa Mahesh, Baltimore, MD
From the Editor’s Desk
W
elcome to the pre-Annual Meeting issue of the Newsletter. As you open this issue, you will be reminded of the Annual Meeting that is going to take place in the Austin, Texas later this month. Hence, the main theme of many regular columns is related to the upcoming Annual Meeting and information about the sessions many have organized and are speaking. I would like to draw your attention particularly to Chairman of the Board’s column that provides an update regarding association needs in professional practice, research, education and administration. In addition to regular columns, there are two articles on CT dose standards, one by the MITA director and other from the CT working group. Overall, I wish all of you a happy summer and look forward to seeing many of you all at the Annual Meeting.
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.
2015 AAPM Call for Nominations
Nominations are now being accepted for the following 2015 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, 2014 and are to be submitted through the on-line nomination system at: http://www.aapm.org/org/callfornominations.asp Applicants will be notified of decisions by May 1, 2015. Recipients will be honored at the AAPM Awards and Honors Ceremony and Reception during the 57th Annual Meeting and Exhibition in Anaheim, California in July 2015.
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DOWNLOAD THE AAPM 2014 ANNUAL MEETING APP! AAPM is once again offering a smart device app for the 2014 AAPM Annual Meeting that allows off-line access to the Scientific Program, Committee Schedule, Exhibitor Information, Maps and much more. New this year the AAPM Annual Meeting App allows you to compile any sessions, talks and committee meetings you plan to attend into a personalized schedule. Get more information and download the AAPM Annual Meeting App here: http://www.aapm.org/meetings/2014AM/MeetingApp.asp
Sponsored by Mobius Medical Systems, LP
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Legislative and Regulatory Affairs Report
Lynne Fairobent, College Park, MD
Medical Physicists Provide Testimony Against the Recommendations of Texas Sunset Advisory Commission Staff ’s Report By Lynne Fairobent AAPM was notified June 3 that the Texas Advisory Commission had released a report recommending the sunsetting of the medical physicists licensure law. (Chapter 602, Texas Occupations Code). AAPM members licensed in Texas were asked to send letters to the Commission to encourage them to remove the medical physicists from the list of occupational licensing to be sunset. The report suggests that the programs listed for sunset are unnecessary because; (1) deregulation would have little impact on health and safety, (2) they cover professionals that operate in a highly regulated environment, (3) they have ‘regulation’ provided by another body or through private sector accreditation, and (4) they generate little regulatory activity.
John Hazle, AAPM Chairman of the Board and Nikos Papanikolaou, President of the Southwest Regional Chapter of the AAPM in the rotunda of the Texas Capital, Austin, TX June 24, 2014.
AAPM and SWAAPM filed written comments on June 24th. In addition, the Texas Radiologic Society, the American Society for Radiologic Technologists, the American Society for Radiation Oncology, and others filed comments supporting AAPM’s position that licensure of medical physicists and medical radiologic technologists be continued. In addition to the written responses to the Commission, John Hazle, PhD, Chairman of the Board of AAPM and Niko Papanikolaou, President of the Southwest Regional Chapter of the AAPM spent the day at the Capital in Austin supporting our efforts to preserve the Medical Physicists Licensure Law in Texas.
AAPM also extended an invitation for the members of the Sunset Advisory Commission and their staff to attend the annual meeting in Austin to learn firsthand what medical physicists do and their importance in ensuring quality medical care for patients. Please contact Debbie Gilley, Government Relations Specialist at debbie@aapm.org or Lynne Fairobent, Senior Manager of Government Relations at lynne@aapm.org.
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AAPM – ASTRO Announce RO-ILS: Radiation Oncology Incident Learning System on Capitol Hill By Lynne Fairobent On June 19, 2014 AAPM President John Bayouth participated in a Congressional briefing on Capitol Hill regarding RO-ILS: Radiation Oncology Incident Learning System. This briefing was co-hosted by U.S. Representatives Frank Pallone, (D-N.J.) and Ed Whitfield (R-Ky.). ASTRO Chair Colleen A.F. Lawton, MD, FASTRO, and AAPM President John E. Bayouth, PhD, FAAPM, unveiled the details of RO-ILS™. Jeffrey Brady, MD, MPH, Director of the Center for Quality Improvement and Patient Safety at the Agency for Healthcare Research and Quality (AHRQ) also provided comments and perspective on RO-ILS. In his remarks, Rep. Pallone commended ASTRO and AAPM for taking the lead for this ROILS system. We always felt on the Energy and Commerce Committee that the safety of patients is vital and a critical component is engendering a learning environment that fosters an culture of safety as well as quality.” During the 2010 hearing we identified a need for a national system for incident reporting and learning within radiation oncology. We all know that radiation has played an important role in medical treatment across the country however, the critical data collected from RO-ILS will help to educate the radiation oncology community on how to improve safety and patient care. Co-sponsored by AAPM and ASTRO, RO-ILS is the only medical specialty society-sponsored radiation oncology incident learning system, working with a federally recognized Patient Safety Organization (PSO), Clarity PSO. View the webcast of this event. The RO-ILS program is designed as a comprehensive solution for the documenting, tracking, analyzing and trending of patient safety related incidents in radiation oncology. It is a centerpiece of ASTRO’s Target Safely patient protection plan, established in 2010. Some of the benefits of participation: • Submit information on incidents or near misses in a confidential, non-punitive system. Track and analyze internal incidents and near misses. • Receive reports on events from the national database with information on • equipment, technique and dosimetric severity scale. Receive quarterly, institution-specific benchmarking reports. • MOC PART 4: PQI — Plus, this activity is qualified for physicians and • physicists by the American Board of Radiology (ABR) in meeting the criteria for practice quality improvement, toward the purpose of fulfilling requirements in the ABR Maintenance of Certification Program.
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There is no cost to participate in RO-ILS. For details on the program and to enroll, visit www. astro.org/ROILS. If you have questions on RO-ILS, please contact Debbie Gilley, Government Relations Specialist at debbie@aapm.org.
Washington, DC, June 19, 2014 – “U.S. Representative Frank Pallone (D-N.J.), speaking at a Congressional Briefing to announce RO-ILS: Radiation Oncology Incident Learning System, a new patient safety initiative sponsored by ASTRO and AAPM to facilitate safer and higher quality care in radiation oncology. U.S. Representative Frank Pallone (D-N.J.) – Co-host of the Congressional Briefing to announce RO-ILS: Radiation Oncology Incident Learning System, sponsored by ASTRO and AAPM.” Photo copyright: ASTRO/American Society for Radiation Oncology. Photo credit: ASTRO/Steven Purcell. Contact: Michelle Kirkwood, michellek@astro.org.
Washington, DC, June 19, 2014 – “John E. Bayouth, PhD, speaking at a Congressional Briefing to announce RO-ILS: Radiation Oncology Incident Learning System, a new patient safety initiative sponsored by ASTRO and AAPM to facilitate safer and higher quality care in radiation oncology. John E. Bayouth, PhD – President, AAPM, Professor and Chief of Physics, Department of Human Oncology, University of Wisconsin.” Photo copyright: ASTRO/American Society for Radiation Oncology. Photo credit: ASTRO/Steven Purcell. Contact: Michelle Kirkwood, michellek@astro.org.
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Washington, DC, June 19, 2014 – “Colleen A.F. Lawton, MD, FASTRO, speaking at a Congressional Briefing to announce RO-ILS: Radiation Oncology Incident Learning System, a new patient safety initiative sponsored by ASTRO and AAPM to facilitate safer and higher quality care in radiation oncology. Colleen A.F. Lawton, MD, FASTRO – Chair, ASTRO’s Board of Directors, and Vice-Chair of the Department of Radiation Oncology, Clinical Director of Radiation Oncology and Professor of Radiation Oncology, Medical College of Wisconsin, Milwaukee.” Photo copyright: ASTRO/American Society for Radiation Oncology. Photo credit: ASTRO/Steven Purcell. Contact: Michelle Kirkwood, michellek@astro.org.
Washington, DC, June 19, 2014 – “Jeff Brady, MD, MPH, speaking at a Congressional Briefing to announce RO-ILS: Radiation Oncology Incident Learning System, a new patient safety initiative sponsored by ASTRO and AAPM to facilitate safer and higher quality care in radiation oncology. Jeff Brady, MD, MPH – Captain, United States Public Health Service, Director, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ).” Photo copyright: ASTRO/American Society for Radiation Oncology. Photo credit: ASTRO/Steven Purcell. Contact: Michelle Kirkwood, michellek@astro.org.
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Improving Patient Access to Safer Imaging: Medicare Set to Promote Adoption of CT Safety Technology Based on the number of inquiries and questions I have received regarding the new legislation requiring the use of XR-29, I asked Gail Rodriguez, Executive Director of MITA to provide the following background.
By Gail Rodriguez, Ph.D. Executive Director, Medical Imaging & Technology Alliance Widely considered one of the most important advances in modern medicine, computed tomography (CT) has revolutionized health care, allowing doctors to find disease earlier than ever and facilitate better treatments. In the last 10 years, manufacturers have undertaken a concerted effort to maximize patient benefits and minimize risks for patients. To that end, CT equipment manufacturers have researched, developed, and brought to market groundbreaking new technologies that allow clinicians to reduce radiation dose from CT procedures while maintaining, or even improving, image quality. While these technologies – and others under development – are important contributions to public health, their adoption in clinical practice remains inconsistent. In discussions with the Food and Drug Administration (FDA) and others, we have learned that simply providing dose recording, reporting and optimization features and associated training are not enough. More needs to be done to encourage their use 1, 2. In addition to exciting new scanner capabilities such as automatic exposure control, MITA member companies, with valuable input from AAPM, ACR and the FDA, published three CT dose standards (XR-25 Dose Check, XR-26 Access Controls and XR-28 User Information) between 2010 and 2013 (PDF documents of these standards can be downloaded here at no charge). In early 2013, MITA combined two standards (DICOM Structured Dose Reporting and Dose Check) with two product features (reference protocols and automatic exposure control) into a new standard: XR-29 ‘Standard Attributes on CT Equipment Related to Dose Optimization and Management’ – or ‘MITA Smart Dose CT.’ MITA Smart Dose CT’s release was applauded by the FDA and others in the imaging community including the public health campaigns Image Gently and Image Wisely. 3 We believe that CT imaging should be performed on Smart Dosecompliant scanners. Patients deserve access to the safest equipment available, and therefore regulators and others in the imaging community encourage imaging departments to install and use these technologies. Since some previously-installed CT equipment in use today do not meet the MITA Smart Dose CT standard, equipment manufacturers are working with health care providers to upgrade older equipment to make sure it meets the safety standard. Most machines are already 27
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upgraded or can be upgraded to comply with MITA Smart Dose CT; however, approximately 35% of older scanners do not have the capacity to receive an upgrade. As a result, that equipment will not be compliant with this safety standard. Medicare payment policy in the SGR law In recognition of the substantial public health benefit associated with the application of these dose reduction technologies, Congress voted in March 2014 to provide an incentive to promote the adoption of these safety features in the SGR patch legislation. With this new law, Medicare joins health coverage programs around the world that have already established similar approaches to incentivizing better, safer care. Beginning in January 2016, Medicare will pay less for CT services that use equipment not compliant with the MITA Smart Dose standard. Specifically, CT scans performed on noncompliant CT and hybrid scanners will receive a 5% reduction. In January of 2017, the reduction will increase to 15%. The reductions apply to the hospital outpatient setting as well as services billed under the physician fee schedule. This payment reduction would apply to radiological imaging codes for CT, identified as of January 1, 2014, by HCPCS codes 70450-70498, 71250-71275, 72191-72194, 73200-73206, 73700-73706, 74150-74178, 74261-74263, and 75571-75574. The reduction would also apply to any succeeding codes. The Centers for Medicare and Medicare Services (CMS) will determine exactly how this policy will work and will issue formal regulations that implement this policy. CMS has not yet specified when it will release the draft or final regulations that will govern Medicare’s implementation of the policy. Other applications of XR-29 As part of its commitment to dose optimization, MITA has also approached accrediting bodies to request their adoption of XR-29 in their accreditation processes. MITA Smart Dose CT is being reviewed favorably by equipment and provider accreditors. The Joint Commission and the Intersocietal Accreditation Commission support XR-29 and are currently considering the best fit for it in their review processes. The American College of Radiology (ACR) has also agreed to take XR-29 under consideration. Future MITA Smart standards MITA Smart is part of a larger MITA initiative to improve patient safety by establishing and promoting safety-related standards for medical imaging equipment. Medical imaging manufacturers created MITA Smart as an integral part of the industry’s ongoing dedication to putting patients first. MITA Smart Dose CT is the first official MITA Smart standard, and 28
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industry experts are working to develop additional safety standards, e.g., for other radiationemitting imaging equipment. Determining compliance The best way to determine if your CT equipment is compliant with MITA Smart Dose CT is to contact the manufacturer of that equipment. The CT companies work very hard to develop and disseminate information and training materials on dose optimization and management and are eager to help providers put these technologies to work on behalf of the patients they serve. Please visit the MITA Smart Dose CT Web page for more information and for links to CT company information. More work ahead MITA appreciates the contributions that AAPM and its membership make to patient safety. We are grateful for the opportunity to work with you on key issues, and look forward to your continued insights into how we can collaborate to encourage the use of dose optimization technologies and to build new ones for the future. 1. Slovis, Thomas L., Frush, Donald P. and Goske, Marilyn J., ‘An Amazing Accomplishment – CT Manufacturers deserve our thanks.’ Pediatric Radiology 43:2, Feb 2013. 2. A partial list of references 99can be found at http://www.medicalimaging.org/wp-content/ uploads/2014/06/Selected-Research-Support-for-MITA-Smart-Dose.pdf 3. See http://www.medicalimaging.org/2013/03/12/new-mita-smart-dose-standard-enhancesdose-optimization-and-management-in-ct-equipment/ 4. Both Australia and France reduce reimbursements for older diagnostic imaging equipment by 50 percent. Japan has three reimbursement categories for CT, based on equipment capabilities, with a 33 percent reimbursement differential between the top and the bottom categories.
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Professional Council Column
Per Halvorsen, Newton, MA
2014 Annual Meeting
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his is the last issue of the Newsletter before the Association’s Annual Meeting in Austin. The Professional Program Directors, Doug Pfeiffer and Russ Tarver, have arranged a program that should be of interest to most attendees. Sunday’s Professional Council Symposium focuses on the changing healthcare delivery system in the US and how the medical physics profession may need to adapt. During the week, there are professional-track sessions on job-interview skills, how to communicate risk, clinical training of medical physicists, grantsmanship and funding, and QA usability metrics, to name a few topics. If you’re a new member of the AAPM, don’t miss the New Member Symposium on Tuesday afternoon, hosted by Robin Miller 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. Our Annual Meeting is the culmination of countless hours of volunteer effort by the Program Directors, volunteer reviewers, Meeting Coordination Committee, and lots of behind-thescenes work and coordination by the AAPM staff. Please take a moment to thank them for their efforts, and provide feedback to the Program Directors on what was helpful and what was not.
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Education Council Report
George Starkschall, Houston, TX
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nce again, the AAPM Annual Meeting in Austin, Texas, is scheduled to have many sessions designed to improve the ability and performance of medical physicists as educators. This year the Education Council Symposium will address an issue that is becoming increasingly relevant to the teaching of medical physics, and that is the role of online education. The Education Council Symposium, chaired by James Dobbins of Duke University, is entitled “Online Education in Medical Physics.” The stated objectives of the Symposium are (1) to understand the range of opportunities available for online education in medical physics, (2) to learn of existing resources available for medical physics education, (3) to understand how to use software tools to create online educational content, and (4) to understand a collaborative model of medical physics education using online resources. The Symposium will include talks by the following well-known medical physicists: James Dobbins, Joann Prisciandaro, Charles Bloch, Eric Gingold, George Starkschall, Mark Oldham, Perry Sprawls, and Ying Xiao. The Symposium will be held on Sunday, July 20, from 9:30 am to 11:00 am in Ballroom F of the Convention Center, and I hope you will be able to attend. A special word of thanks goes to James for organizing this Symposium. Please be aware of several other activities that address education at the Meeting. On Sunday morning from 9:30 am to 11:00 am, in Ballroom E of the Convention Center, the Students and Trainees Subcommittee of the Education and Training of Medical Physicists Committee will be holding its annual Student Meeting. As many of you know, graduate programs are turning out more graduates than there are residency positions available. As a consequence, some medical physics graduates will not be able to pursue clinical careers and may have to look towards other careers in which their knowledge of medical physics is desired. The student meeting presentation, “Beyond Clinical Medical Physics: Entrepreneurship and Opportunities in Industry,” will include two speakers, Bob Pizzutiello and Michelle Svatos, who will talk about entrepreneurship and opportunities in industry as a valuable part of our profession. Also Sunday, from 3:00 pm to 6:00 pm, a general poster session will be held in the Exhibit Hall featuring posters addressing education. This poster session will be an opportunity for meeting attendees to meet with poster exhibitors to discuss the content of their posters. On Monday, from 10:15 am to 11:10 am, in Room 9A, a session entitled “Effective medical physics educational activities: Models and methods” will be held. Perry Sprawls, who frequently contributes to the educational content of the AAPM meeting, will talk about how to develop effective medical physics educational sessions. Immediately after Perry’s 32
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presentation, in the same room, I will be chairing a session from 11:15 am to 12:15 pm entitled “Stop lecturing me! – New methods for teaching medical physics”. I will be joined by two of my colleagues, Rebecca Howell and Stephen Kry, in presenting examples of teaching methodologies such as Flipped Learning, Project-Based Education, and Peer Instruction that remove the traditional lecture from the classroom and allow for more classroom interaction among faculty and students. Finally, from 1:45 pm to 3:45 pm, in Room 18C, the annual Innovation in Medical Physics Education session will present six proffered presentations on innovative methodologies for medical physics education. The outstanding presentation will be recognized with a cash prize. On Tuesday morning, from 10:15 am to 12:15 pm, in Room 16A, Cari Borras will chair a Joint AAPM/SEFM/AMPR educational workshop on “Education of radiotherapy physicists”. Speakers include well-known AAPM members Cari Borras, Mahadevappa Mahesh, and Don Frey, as well as several other distinguished medical physicists from Spain and Russia. On Wednesday, from 11:00 am to 12:15 pm, in Room 19A, Sonja Dieterich will be chairing a symposium entitled “Clinical Training of Physics Residents: How Do We Efficiently Teach Residents to Become Excellent Clinical Physicists?” Speakers will include John Gibbons, George Sherouse, and Alf Siochi. Presentations at this symposium include “Training and Evaluation of Residents in a Distributed (“Hub and Spoke”) Residency,” “Apprenticeship is the Pathway to Mastery,” and “Clinical Experience Accountability through an In-House Database.” Finally, on Thursday, from 1:00 pm to 1:55 pm, in Room 16A, Eric Klein will chair a symposium entitled “Building, maintaining, and improving a physics residency program”, in which he and Jonathan Nye will discuss the key steps for building, maintaining, and improving a physics residency program, both in radiation oncology physics and in imaging physics. This year at the AAPM meeting there appear to be more opportunities than ever to improve your knowledge in medical physics education, and I shall be looking forward to seeing you in Austin in July.
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Ohio Valley Chapter Report
Bryon M. Murray, Dublin, OH
Ohio River Valley Chapter Spring Clinical Symposium
T
he 2014 Ohio River Valley Chapter Spring Educational Symposium was held April 11th and 12th at the beautiful Hueston Woods State Park Lodge and Conference Center in Oxford, Ohio (Home of Miami University). The Symposium was organized and hosted by the Chapter Officers: Bryon M. Murray (President), David Pearson (President-Elect) and Aaron Odom (Secretary/Treasurer) with generous support from 22 vendors! There were over 60 member attendees at the meeting and some brought families to enjoy the nice spring weather in a beautiful Ohio State Park Lodge. The meeting began on Friday with a “Meet and Greet” dinner and happy hour with poster presentations by students/residents representing the 7 medical physics programs in our 3 state region. The “Meet and Greet” was a great opportunity not only to see poster presentations on the great research work being done in our region, but an excellent way to catch up with colleagues and talk to vendors in a relaxed way. The Saturday Symposium was a chance for 12 selected students/residents to present their work and be judged with the top 3 presentations receiving cash awards. The winner also received the newly-implemented “OHINKY Trophy” designed to be passed on each year to the school that represents the best scientific presentation at our annual Spring Educational Symposium. The trophy is made up of a Lichtenburg sculpture on top of a walnut base that has small plaques for the winning school each year. Our esteemed judges for this year’s competition were: Chris Allgower, Ph.D., Indra Das, Ph.D., E. Ishmael Parsai, Ph.D., and Michael Gossman, M.S. The results of the competition were: 1st Place – Michael Hardin (Master’s candidate – University of Cincinnati); 2nd Place (tie – no third place) – Sean Tanny (Doctoral candidate – University of Toledo) and Gregory Warrell (Doctoral candidate – University of Toledo). Please visit the ORVC recent meeting webpage for a full list of all the student presenters and their presentations. The ORVC James G. Kereiakas Honorary Keynote Speaker for the Spring Symposium was Michael Knopp, M.D., Ph.D., Professor of Radiology and Novartis Chair of Imaging Research at The Ohio State University Wexner Medical Center. Dr. Knopp was recently named co-Chair 45
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of the Imaging and Radiation Oncology Core Group (IROC - part of the National Cancer Institute’s Clinical Trial Program) and he presented the key components of the collaboration of imaging and oncology scientists from which the IROC was derived. The Symposium ended with a presentation by Howard Elson, Ph.D., Professor of Radiology at the University of Cincinnati and member of the Working Group on a Professional Doctorate Degree of Medical Physics for the AAPM. Dr. Elson reported on the mission and questions of the Working Group and presented curriculum and current potential needs for the DMP Program at UC.
Figure 1: Meet and Greet event with poster presentations in the beautiful lodge atrium.
Figure 2: Dr. Pearson (ORVC President Elect, right) presents Michael Hardin (left) with the OHINKY Trophy for best student/resident scientific presentation.
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Figure 3: Mr. Murray (ORVC President, left) presents Dr. Knopp the Honorary James G. Kereiakis Keynote Speaker Plaque.
Figure 4: The University of Toledo Medical Physics Program is always well represented (advisors Dr. Pearson, second from left and Dr. Parsai far right).
Check out our website for more information and pictures. There you can also see our NEW logo! We are very grateful for artist Kim Veldenz who graciously allowed us to use a print of her oil painting titled (appropriately), “Ohio River Valley�.
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History Committee Report
Lawrence N. Rothenberg, New York, NY
AAPM History Symposium in Austin Evolution of Radiation Treatment Planning
T
he 2014 AAPM History Symposium entitled “Evolution of Radiation Treatment Planning” is scheduled as Session WE-G-16A and occurs on Wednesday, July 23, 2014 in Room 16A of the Austin Convention Center. The speakers comprise an All-Star Cast of AAPM Members: Radhe Mohan will provide the Overview and conclude with the Summary; Jacob Van Dyk will present “When the World was Flat: The Two-Dimensional Radiation Therapy Era”; Benedick Fraass will discuss “More than Pretty Pictures: 3D Treatment Planning and Conformal Therapy”; and Thomas Bortfeld will bring us to the present with “From the Art to the State of the Art: Inverse Planning and IMRT”. We hope that you plan to attend. Information on previous AAPM History Symposia including “Early Developments in Teletherapy Machines” (Indianapolis 2013), “Historical Aspects of Cross-Sectional Imaging” (Charlotte 2012), “Historical Aspects of Brachytherapy” (Vancouver 2011), “50 Years of Women in Medical Physics” (Houston 2008), and “Roentgen’s Early Investigations” (Minneapolis 2007) can be found in the Education Section of the AAPM Website. Watch AAPM Historical Video Interviews on-line Almost all of the AAPM video interviews of Physicists (and a few Physicians) of Note are now available on-line. These include not only the contemporary series of interviews recorded at Annual Meetings by Blue Sky from 2005 - 2013, and conducted by Robert Gould, Azam Niroomand-Rad, Rene Smith and myself, but also more than 120 interviews conducted mainly by Robert Gorson from 1990 through 2004. AAPM will be forever indebted to Professor Gorson for his great dedication in conducting the interviews, and providing his own video equipment to record them. These earlier interviews can now be viewed on-line due to Gorson’s incredible initiative in converting all of his original video files to Flash Video (.flv) format. These Flash files have been made available on our website due to the further efforts of Michael Woodward and Farhana Khan at AAPM Headquarters and Chris Marshall, our previous Website Editor. To access these interviews, go to www. aapm.org, choose “AAPM” on the left side of the main
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page, then “History & Heritage”, then the “Historical Interviews” tab. View AAPM Chapter History Posters in Austin We are pleased to announce that once again newly updated Chapter history posters will be presented in a central area of the Convention Center for viewing in Austin. The Chapter History Poster project has again been coordinated by Michael Gossman, who has received major assistance from the AAPM HQ Staff. Of course, we are also greatly indebted to the many AAPM Chapter members who have made contributions to their Chapter History posters.
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Vendor Relations & Product Usability Subcommittee Report
Sugata Tripathi, Marshfield, WI Gig Mageras, New York, NY
T
he Vendor Relations and Product Usability subcommittee of the Clinical Practice Committee of the Professional Council continues to evolve. Since its inception during late 2006 as a working group, led by Sugata Tripathi, and then as a subcommittee, and currently chaired by Gig Mageras, efforts are continuing to facilitate an active dialogue within the AAPM membership to determine and address specific issues of concern. Product Usability, availability of exposure index in CT scanners, Patient Safety, need for a universal Error reporting database etc. have been some of the early issues that had been taken up for discussion at the subcommittee in the past. Opportunity for collegial dialogues with representatives from hardware and software vendors usually comes at the annual committee. During July 2012, the Radiation Oncology Safety Stakeholders Initiative (ROSSI) usability group aligned with the subcommittee’s efforts, and the chairs of the various ROSSI usability subgroups started contributing directly to the subcommittee to advance this dialogue. Notably, at the Annual Meeting in Austin, TX, two such efforts are underway. The leaders of FUTURE, in collaboration with the VRPUSC, are putting together a symposium about the need for innovation and research in medical physics, and the importance of participation of the leaders of industry in funding and enhancing this effort. Some of the present day pioneers in research and industry will share their personal stories, motivating factors and lessons learned. We hope this will spur some lively discussion, stimulate AAPM member involvement and sustain this conversation long after the symposium is over. Our goal would be to get most of us in clinical medical physics practice excited about integrating research and more importantly, the ways of research in our day to day clinical practice and thinking process. VRPUSC is also spearheading another symposium at the Annual Meeting, in the professional track. The aim is to open up a dialogue in reviewing QA procedures and metrics in light of TG 100, and possibly start an official search for QA usability metrics. This attempts to answer some of the questions that are pertinent in a clinical medical physicists’ daily practice, namely, the effectiveness and usefulness of one’s QA program. Since resources are always limited, how can we best use those resources for a safe and high quality patient care? And finally, is it possible to design a QA usability metric that gives us a number that says yes, or no? We hope that this year’s Annual Meeting brings a lot of innovative ideas about our practice and invigorates us to get to new professional and academic heights. Hopefully, safe and effective treatment delivery continues to be perfected as an important means to an end and continues 51
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to makes our work stimulating as well.
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AAPM Newsletter | Volume 39 No. 4 | July/August 2014
Knowing what responsibility means
AAPM/IOMP Presentation
Mohammed K. Zaidi, Houston, TX
AAPM/IOMP Presentation at the WHO Global 2013 for Medical Devices
M
ohammed Zaidi was invited to attend the Second World Health Organization (WHO) Global Forum on Medical Devices held at the International Conference Centre (CICG), Geneva, Switzerland, in November 22-24, 2013 and to present his report, “The AAPM/IOMP Used Equipment Donation Program” as a poster introducing this program. It was very well presented and liked by visitors and we had received very good response and requests for donations of UE, technical books, and journals. We also had been offered a big collection of old journals – HPS, MP, ASTRO, Red Journal, and SNM. AAPM’s International Affairs Committee supported his travel. There were many participants from Africa and 70 other countries. Seven shipments of used equipment were made to African countries in the last three years showed that we are anxious to provide them the necessary equipment and also create knowledgeable trained staff. IOMP President-elect, Dr. S. Tabakov, has also developed a project for “Development of Medical Physics in Africa”. In addition, UEDP is supporting requests from International Organization for Migration (IOM) – Dr. Arifa Sherif. Mr. Martin Mukosai, Clinical Radiographer Technologist at Mwandi Mission Hospital in Livingstone, Zambia requested some technical publications to pursue a master’s degree in Sonography. Seeing the need, I purchased these five books on Ultrasound techniques. There titles are: Emergency Ultrasound, Emergency Ultrasound Made Easy, Essentials Sonography Patient Care, Sonography, and Ultrasonography Examinations. They were shipped to Zambia and it took four months to reach there. Mr. Mukosai wrote: “I am so grateful for the books that just a year from now you can see myself acquired with knowledge and skills in Echocardiography and Vascular Sonography practices. They are helpful so far and very informative, educative and many more. Medical sonography as a branch of diagnostic medicine imaging, make use of non-ionizing ultrasound to produce images of the body. Sonography has become a valuable diagnostic tool as it is: widely available, non-invasive, risk free, easily accessed, and less expensive than other options such as MRI or CT scans. The sonography study materials received would be very helpful in the improvement of AAPM Newsletter | Volume 39 No. 4 | July/August 2014
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12th Annual
SunNuclear User Meeting and In-Booth Talks at AAPM Austin, Texas | July 20-23, 2014 Learn how the latest developments in QA and Dosimetry are being applied to enhance patient safety.
examination / imaging of most body tumors and cancerous related conditions. Female breast and pelvis are the most affected with benign and cancerous tumors. Hence, sonography examinations will play a pivotal role in the differentiation of these two conditions. In addition, masses in males either prostate cancer or scrotal non-cancerous condition will be easily differentiated sonographically.
AIDS patients present with a wide spectrum of clinical manifestations involving the body organs. The detection and evaluation of potential treatable conditions in AIDS, management, and follow-ups are mostly to be enhanced as result of improved practice skills and knowledge gained from the study materials. Ultimately, it is with sincere acknowledgments for the donation of a gift of such magnitude and a rare opportunity. Every use on the books will count as gain on improved health care service provision. Thank you so much.� Other requested items are: an Ultrasound machine, a laptop computer, gamma camera, well counter, and a dose calibrator for nuclear medicine. If someone can donate used books, journal or equipment – it will meet his present needs. 54
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The UE donated in this period were older than 10 years so none of the donations offered were accepted and we are looking forward to donors contributing useable UE which should be less than 10 years old. The equipment donated to our Program is in good working condition but we don’t guarantee its usefulness. The donations of used equipment are sometimes tax deductible. AAPM/IOMP will not be responsible for any warehousing expenses or loss if the used equipment donated couldn’t be shipped. If you want to donate, or want specific used equipment donated to your organization, please contact the UEDP Manager. For more information, please email your request to zaidimk@ gmail.com.
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Working Group Report
Mark P. Supanich, Chicago, IL
CT Dose Check and Possible Interference with CT-Guided Procedures CT Dose Check: The CT dose check feature described in NEMA XR 25 is now available on many scanners, and may be used in support of quality assurance and patient safety initiatives. The dose notification feature compares CT dose index values (CTDIvol or DLP) for a prescribed scan element (e.g. one acquisition or one series of an exam) against a preset dose notification value. If the prescribed scan will result in a dose index value that exceeds the user-designated notification value, a window pops up before the scan to notify the CT operator that the prescription may result in a dose index above the user-defined level. This quality assurance feature allows the operator an opportunity to double-check the acquisition parameters to ensure that nothing is amiss. However, a dose index exceeding the notification value does not mean that that the parameters are inappropriate. For example, for large patients a higher dose index prescription may be necessary to obtain adequate image quality. Provided that the scan parameters are appropriate for the specific patient or exam, the operator should document the rationale (such as large patient or metal implants) and proceed with the scan. A second feature of Dose Check, the dose alert, produces a pop-up window when a scan element is prescribed that will result in a cumulative CTDIvol that exceeds the defined alert value. This dose alert feature is a mechanism to avoid possible acute effects, such as hair loss or skin reddening. The FDA recommends a CTDIvol alert value of 1000 mGy, which is the default setting on most systems. Valid clinical reasons exist when it is appropriate to exceed this value, which in no way should be considered a dose limit. The dose alert feature may be configured to require that the user enter a password before the scan is allowed to proceed. Some scanners have the password requirement activated as the default condition, while others require the user to activate this feature. It is essential for practices to check the configuration of newly installed software to ensure that the password, if required, is known. Additional information about Dose Check, and recommended notification values, are available as a PDF located in CT Protocols section of the AAPM website. This material was developed in conjunction with the FDA, ACR, ASRT, and manufacturers, by the AAPM’s Working Group on Standardization of CT Nomenclature and Protocols. 56
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Dose Check and CT-Guided Procedures: It was recently noted that the dose alert feature may interfere with the workflow of some CTguided procedures. During CT guided procedures such as ablations, it is not uncommon for a large number of scans to be acquired that cover the same anatomic location. In these instances, it is possible for the cumulative CTDIvol at a single anatomic location to exceed the configured dose alert value. If a dose alert occurs and additional scans need to be acquired, the operator can proceed with scanning after entering an explanation. However, performing such additional steps may negatively impact the clinical workflow. Of greater concern, if a password is required and none of the individuals present know the password, an unacceptable delay in proceeding with the case may occur. Even after the necessary information is provided and the scan performed, dose alerts may continue to appear for each subsequent acquisition at the same location, which may further interfere with the clinical workflow. The AAPM Working Group on Standardization of CT Nomenclature and Protocols has developed a PowerPoint document that provides guidance on the use of Dose Check, particularly with regard to its use on scanners where CT guided procedures are performed. Several suggestions are provided to assist in avoiding any negative impact on CT-guided procedures: • Increase the dose alert value on scanners used for interventional procedures. The maximum value allowed by XR 25 is 2000 mGy. • Ensure that the password that is required in order to proceed with scanning following a dose alert is available to all interventional CT operators. ◊ Alternatively, disable the feature that requires that a password be entered. • Disable the dose alert feature during interventional procedures. A mechanism must be established to ensure that this happens, and that the dose alert feature is turned back on for diagnostic exams. ◊ Alternatively, turn off the dose alert feature completely. The dose alert feature was developed to assist in preventing acute radiation effects from diagnostic examinations such as CT brain perfusion imaging. Complex CT-guided interventions that provide important medical benefits may require that the dose alert value be exceeded. The AAPM Working Group on Standardization of CT Nomenclature and Protocols has provided educational material on this topic to ensure that use of the Dose Check feature does not allow a dose alert event to interfere with the safe and timely performance of such medically necessary procedures. All medical physicists who support a clinical CT practice should familiarize themselves with the material provided in these educational materials, and ensure that all physicians, supervisors, and operators are trained in the appropriate use of CT Dose Check prior to its implementation. 57
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Website Editor Report
George C. Kagadis, Rion, Greece
I
t’s already summer and we are all getting prepared for our big event; the fast approaching 56th AAPM Annual Meeting & Exhibition which is going to take place in Austin, TX (July 2024). If you haven’t looked at your AAPM Membership Profile recently, please take a moment to view the changes that have been made, one of which allows for you to add your Employment Function. If you happen to find that your function isn’t listed, please contact AAPM HQ who will work with EMCC to add. AAPM HQ staff continues to transfer material to Vimeo, where 1,264 videos (as of June 3, 2014) are publicly available. The AAPM Virtual Library transfer to Vimeo is expected to be complete later this summer. Details on AAPM’s Vimeo of Total Loads, Total Plays and Geographic Statistics are seen on Figures 1 and 2. Since the commencement of broadcasting those videos through Vimeo, most of the traffic has oriented from the USA (76,107), Canada (3,690) and Taiwan (3,447).
Figure 1: Vimeo Total Loads and Total Plays Statistics
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Figure 2: Vimeo Geographic Statistics I extend my invitation to the Chairs of AAPM Committees, Subcommittees, Task Groups and Working Groups to prepare short video introductions to put them together with the others for presentation during the Annual Meeting and consequent meetings. We already have 9 videos (from Brian Wang – SCM, Cari Borras – WGNIMP, Harald Paganetti – TG256, Eugene Lief – IA, Colin Orton – DEV, Sam Armato – JBMC, Rock Mackie – AHCR, Bijan Arjomandy – TG224, Jonathan Farr – TG185) on file. Those introductions aim to provide key information to the membership on the work done by the various Committees, Subcommittees, Task Groups and Work Groups of our association. I am pleased to report that as of Jun 3, 2014 we have 36,226 images posted to AAPM’s Flickr, 1,963 likes on Facebook, 6,281 members on LinkedIn and 2,655 followers on Twitter. I am looking forward to seeing as many of you as possible next month in Austin! I hope you find the AAPM website useful, visit it often and send me your feedback or directly at george@ mail.aapm.org
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Obituary International Expert in Radiation Protection, Science, and Medicine Warren Keith Sinclair (1924 to 2014)
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r. Warren K. Sinclair, a giant in the field of radiation protection, science, and medicine, passed away on May 14, 2014 at 90 years of age, following a stroke the preceding day. Warren was one of the founding fathers of modern radiation protection, an outstanding teacher, a superb radiation physicist, and a good friend and colleague. Our world is smaller with his passing but we are all better and grateful for his rich life, leadership, and friendship. Warren Sinclair was born on March 9, 1924, in Dunedin, New Zealand. He was one of six children with three sisters and two brothers. He was a 1941 graduate of Otago Boys’ High School in Dunedin. Warren was an accomplished rugby player during his high school and university days. During 1942–43, while a student at the University of Otago, he served in the New Zealand Army and manned an anti-aircraft battery near Christchurch Harbor waiting to fend off the Japanese who never came. His first professional job was for the New Zealand Government after earning his B.Sc. in 1944 but was sent back to Otago University the next year by Ernie Marsden (a colleague of Ernest Rutherford) to study for his Master’s degree in physics. After graduating with first class honors in physics in 1945, Warren was appointed the first hospital physicist in New Zealand in his hometown of Dunedin. After working in radiotherapy physics with Dr. Peter Jerram (Radiotherapist) he realized additional training was essential and made his way to London in 1947 to obtain it. In London, Warren studied under the leading medical physicist of his time Professor Valentine (Val) Mayneord of the Royal Cancer Hospital, obtaining a Ph.D. in Physics at the University of London in 1950. He was the leader of the radioisotope center of the Royal Cancer (later Marsden) Hospital and developed many techniques for radiotherapy with the new radioisotopes that had become available from the nuclear reactors in Oak Ridge, Tennessee and Harwell, United Kingdom. These included tantalum-182 wires for localized 60
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bladder therapy, colloidal gold-198 for pleural and peritoneal effusions, precisely machined gold-198 seeds to replace radon seeds for interstitial therapy and a gun to implant them, highly active solutions for first sodium-24 and then bromine-82 introduced into the bladder to treat generalized bladder cancer. Many of these highly specialized radiotherapy techniques attracted worldwide attention and Sinclair’s laboratory in London was constantly populated with visitors from overseas anxious to observe and learn the new techniques. Some are still in use today (e.g., gold-198 seeds for interstitial therapy). In 1954, Dr. Sinclair moved to Houston as head of the Physics Department at M.D. Anderson Hospital. He then turned to enhancing the clinical application of new x-ray and gamma-ray beam therapy techniques that had just been developed. M.D. Anderson had the world’s first cobalt-60 teletherapy unit (2,000 curies) installed shortly after Warren arrived and one of the first four betatrons in the world producing very high energy 22 MeV x rays. At that time no one knew how successful they would be in therapy and Gilbert Fletcher (Radiotherapist) started a program to compare them clinically with conventional 250 kVp x rays. Warren recognized that sound calibration techniques were essential to intercomparisons of clinical effectiveness not only at M.D. Anderson but at all radiotherapy centers. Cobalt-60 or betatrons, for example, were installed at Memorial Hospital in New York, Mallinkrodt Institute in St. Louis and Chicago, Illinois and elsewhere. He undertook the first measurement intercomparisons ever and recalibrated the St. Louis and Chicago betatron units to agree with those in New York and Houston. At the same time he made detailed comparisons of the biological effects of these radiations on yeast cells, mice, rats and chick embryos and was the first to settle, or at least comprehensively address, the question of relative biological effectiveness (RBE). An RBE of 0.9 compared with 250 kVp conventional x rays was estimated, addressing a significant clinically important problem at the time where previous RBE values where highly uncertain and ranged from 0.4 to 2.0. This intercalibration work and the growing interest of the National Cancer Institute (NCI) in uniform therapy across the United States resulted in the setting up of the Radiological Physics Centers in Houston and elsewhere, which provided calibration for therapy instruments and ensured uniformity in dose across all the many radiotherapy departments in the area. It was Warren Sinclair’s work and his influence at NCI that led to the establishment of these centers and made dosimetry in radiotherapy essentially uniform nationwide and indeed, through the international intercomparisons with the National Bureau of Standards (now the National Institute of Standards and Technology), worldwide. Warren became a U.S. citizen in 1959. From 1960 to 1983, Dr. Sinclair was Senior Biophysicist at the Argonne National Laboratory, engaged in research involving radiation effects in cultured cells. He served also as Director of the Division of Biological and Medical Research from 1970 to 1974 and as Associate Laboratory Director until 1981. Dr. Sinclair was also Professor of Radiation Biology at the University of Chicago and subsequently Emeritus Professor of the University. In 1977, Warren was elected the second President of the congressionally-chartered National Council on Radiation Protection and Measurements (NCRP). He was a more than worthy 61
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successor to Lauriston S. Taylor who led the NCRP since its inception in 1929. Warren was already a prominent member of the International Commission on Radiological Protection (ICRP), chairing its committee on biological effects for many years; the International Commission on Radiation Units and Measurements (ICRU), where he specialized in neutrons and heavy particles; and the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) (chairing its biological program). Dr. Sinclair was the only person to be a member of all three organizations at the same time (1977 to 1985) while also directing the program of NCRP as its President. He performed remarkably in these roles, and received a rare public acknowledgement by UNSCEAR in 2000 on leaving the Committee. Understanding the needs of radiation protection, the induction of cancer at low doses, and the importance of the study of the Japanese atomic-bomb survivors for risk estimation, Warren altered the focus of NCRP to enhance the scientific basis of radiation protection. NCRP was transformed into an important and integral part of the fabric of radiation protection in the United States. The number and breadth of NCRP committees, reports, commentaries and statements markedly increased during his tenure as President and covered all aspects of radiation protection from basic science to environmental issues to occupational exposures to medical uses of radiation and many more topics of importance to the nation and the world. Dr. Sinclair insured that the NCRP Annual Meeting became a major event in the field of radiation protection and the proceedings are published each year in the scientific literature. Dr. Sinclair established the Lauriston S. Taylor Lecture in honor of the NCRP founder. Starting in 2004, the Warren K. Sinclair Keynote Address became a significant part of NCRP’s Annual Meeting and remains a lasting recognition of his legacy. This lectureship was made possible by a generous financial gift from Dr. Sinclair to NCRP. A gift that keeps on giving! Dr. Sinclair was greatly sought after to serve on advisory bodies within the Unites States such as those affiliated with the U.S. Department of Energy, the National Institutes of Health, the Environmental Protection Agency, the U.S. Department of Veterans Affairs, and the National Aeronautics and Space Administration. In 1982, Warren was asked by the European Community to chair the first program review of its Life Sciences Program. He was a consultant to the World Health Organization and served on the National Academy of Sciences as Chairman of its Board of Radiation Effects Research. Although Warren “retired” from NCRP in 1991, he continued to frequent the NCRP offices in Bethesda, producing a number of seminal reports until 1999 when a heart operation to repair a defective mitral valve caused him to move to the better climes of Southern California to be closer to his family. A person of remarkable scientific scope and accomplishment, Warren published over 200 scientific papers and contributed in a major way to many books and reports of national and international organizations (another 100 or so). In retirement in California he continued to be consulted by staff members of NCRP and committees of ICRP. In 2010, Warren’s extensive 62
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collection of reports, publications, and historical documents related to radiation protection and measurements were donated to the Colorado State University. In addition to his leadership roles in NCRP, ICRP and ICRU, Dr. Sinclair was a past President of the Radiation Research Society (RRS), and the American Association of Physicists in Medicine (AAPM), which he helped found. Internationally he was an Emeritus Member of ICRP, member of the World Health Organization Expert Advisory Panel on Radiation, and the Board of the Radiation Effects Research Foundation, Japan. He delivered a number of important named lectures including the RRS Failla Lecture in 1987, the H.M. Parker Lecture of the Battelle Foundation in 1992, and the L.S. Taylor Lecture of NCRP in 1993. He received the Coolidge Award of the AAPM in 1986 and was a National Sigma Xi Lecturer from 1992 to 1994. Warren is survived by his loving wife Elizabeth (Joy), son Bruce W. Sinclair of Chicago, daughter Roslyn E. Munn and son-in-law Harry A. Munn of Escondido, California and two grandchildren, Kyle J. Munn of Noblesville, Indiana and Erin C. Bertelsen of Flagstaff, Arizona and four great grandchildren. Mrs. Sinclair has asked that donations be made to NCRP in Dr. Sinclair’s honor. This can be done through the NCRP donations page . We ask that you state that the donation is in honor of Dr. Sinclair in the comments box. Checks can be mailed to NCRP, 7910 Woodmont Avenue, Suite 400, Bethesda, MD 20814. John D. Boice, Jr. NCRP President ICRP Main Commission UNSCEAR Delegate
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End of this issue.
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David A. Schauer NCRP Executive Director Emeritus ICRU Executive Secretary