AAPM Newsletter September/October 2014 Vol. 39 No. 5 by AAPM Docs

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 SEPTEMBER/OCTOBER 2014 Volume 39 No. 5

INNOVATE !

The key element to our successful future.

AAPM President John Bayouth considers innovation as key for future success. New Image Wisely Â® Radiation Safety Case on Technical Errors and Image Quality in Digital Radiography n ABR News n Cessation of the AAPM-Accredited Calibration Service for Sr-90 Ophthalmic Applicators n TG 100 FAQs n and more...

AAPM

NEWSLETTER AAPM NEWSLETTER is published by the American Association of Physicists in Medicine on a bi-monthly schedule. AAPM is located at One Physics Ellipse College Park, MD 20740-3846

EDITORIAL BOARD EDITOR Mahadevappa Mahesh, MS, PhD

CONTENTS SEPTEMBER/OCTOBER 2014 Volume 39 No. 5

Articles in this Issue

Events / Announcements

AAPM President’s Column

2015 AAPM Spring Clinical Meeting

AAPM Executive Director’s Column

Career Networking Webinar

Editor’s Column

Call for Nominations

Legislative & Regulatory Affairs Report 11 2015 AAPM Summer School 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: October 10, 2014 Posted Online: Week of November 3, 2014

14 14

Education Council Report

15 Vote for By-Laws Amendment

Health Policy and Economic Issues

19 AAPM E&R Fund Donor’s Lounge

ABR News

25 International Day of Physics

ACR Accreditation FAQs

27 Coolidge Award Introductory Speech 33

Notice of Cessation

Congratulations to Mark Seddon 30 and Erik Wahl

TG 100 FAQs

42 Coolidge Award Acceptance Speech 37

Image Wisely Radiation Safety Case

45 AAPM Headquarters Hotel Change 51

Literature Quanta

New Disposal Options for 47 Sealed Sources

2014 Award Winners

Person in the News: Richard L. Morin 55

www.AAPM.org

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

A True Celebration of Innovation!

he 2014 AAPM Annual Meeting held in Austin, Texas was a true celebration of innovation. This year’s meeting was filled with excellent scientific, educational, and professional sessions. Many of these sessions embraced the meeting’s theme of “Innovation,” which has been an integral part of our discipline from its origin. I hope you all enjoyed the meeting fully; please join me in thanking Meeting Coordination Committee Chair Bret Heinz, Scientific Program Subcommittee Chair Jeff Siewerdsen, Educational Program Subcommittee Chair Robin Stern, Professional Program Subcommittee Chair Doug Pfeiffer, and Technical Exhibits Subcommittee Chair Marc Kleiman. Also, of course, the AAPM Executive Director Angela Keyser and the entire AAPM HQ Staff for their tireless efforts to make these meetings possible. I hope as a society we can build on the energy and exchange of ideas created during our time together in Austin. We have made many positive steps forward as an organization, but we can do so much more. Opportunities and challenges surround us and the next few years will be critical in defining the future of Medical Physics. One area in particular that I’d like to address is the future set of tools and skills needed for Clinical Medical Physicists. I believe the future will require Clinical Medical Physicists to have strong skills in developing and implementing scientific methods, become an active communicator with all team members (especially hospital administrators, as well as physicians and technical staff), and a successful interface between healthcare institutions and industry. The responsibilities of the Clinical Medical Physicist are diverse and increasingly complex. Our clinics now utilize sophisticated imaging and treatment technologies routinely, and this is likely to be found in a community setting not simply in academia. For each technology where an academic institution is implementing and writing papers, there is likely ten times the number of small clinics implementing as well with far fewer resources. Clinical Medical Physicists are going to have to implement these technologies safely and effectively. This will happen before an AAPM Task Group report provides a prescriptive process to follow; the Clinical Medical Physics will have to use Scientific Methods to (i) develop a fundamental understanding of the technology, (ii) identify the potential modes of failure, their impact, and the methods and frequency needed for testing system conformance to clinically relevant specifications, and (iii) establish the methods needed to demonstrate these new technologies significantly improve

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

patient care. Clinical Medical Physicists who demonstrate value added will survive; we are the scientists in the clinic who can work with physicians and hospital administrators to demonstrate improvements in care provided by the successful implementation of the technologies at our disposal. We must demonstrate that technology or treatment procedure A is better than B. Each of us has earned a graduate degree in Science, either a master or doctorate degree in Science. It is crucial that we all continue to develop those critical thinking skills. Attend sessions with hypothesis-based science; not because you intend to perform basic science research in small animal imaging in your clinic, but because those skills will help you answer clinical questions you face daily. We all don’t need extramurally funded research or even annual publications in scientific journals to be recognized as applied scientists working in a clinical environment. The discipline of Medical Physics will not survive if we restrict our activities to technical execution of pre-defined tasks. We cannot become lulled into following the prescriptive recommendations; the AAPM will not have the task group recommendations for everything needed to be successful in the clinic. We must use critical thinking skills to develop a fundamental understanding of the problems we are trying to solve, the technologies we are trying to implement or extend well beyond the imagination of the developer, and to demonstrate the value added. Some Clinical Medical Physicists have said to me, “I have absolutely no time to do anything more than the technical execution of pre-defined tasks. That’s all my employer is willing to pay for.” Our employers are being reimbursed for rigorous cognitive effort on most of the work we perform; challenge them to provide staff time needed to do the work for which they are being reimbursed. I believe the environment is right to prove our value added; those who do will continue to have jobs, while those who do not may become replaced by technicians. As Medical Physicists we hold the stature we do in medicine because we develop and implement technologies into clinical care, enabling our physician colleagues to practice medicine at a much higher level than otherwise possible. That is how we have earned our position in medicine. We must continue to work hard to understand, fundamentally, the science of the problems we face in the clinic as well as the tools available (or needed) to significantly improve patient care. We could implement any of the technologies seen in the exhibit hall in Austin into our clinics, but does it matter? If so, we should work to prove it; if that’s not possible we may be wasting our time, the institution’s money, and finding disappearing reimbursement in the future. The key element to our successful future is innovation. Understand and think creatively to make it better; exercise your creativity and give yourself the latitude to try and fail. Attend scientific sessions that extend beyond what you know and routinely do. Challenge your observations in a radically different way. You need to do this as individuals and as an

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

organization AAPM needs to do the same. We need to create the infrastructure required to solve clinical problems and answer yet-to-be-asked clinical questions. We can increase our interaction with our industrial colleagues to develop failure modes and root cause analysis. We are the applied scientists in the clinical space with the necessary training in critical thinking to transform medical practice globally and locally.

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Executive Director’s Column

Angela R. Keyser, College Park, MD

AAPM 2014 Annual Meeting a Great Success! While the meeting surveys have not yet been compiled and reviewed, indicators are that the 2014 Annual Meeting was deemed a success. I am pleased to report that there were 4,318 registered attendees for the Austin meeting. This is an increase from the 4,146 attendees at the 2013 Indianapolis meeting, and second only to the 4,403 attendees from the 2011 meeting in Vancouver. In case you missed them, take a few moments to view the featured interviews from the Austin Meeting. Plans are already underway for the 2015 Annual Meeting in Anaheim. Please make note of the dates on your calendar, as they are a bit earlier than recent years. The 2015 Annual Meeting will be held July 12 – 16 in Anaheim, California.

IOMP Announces International Day of Medical Physics To raise awareness about the role medical physicists play in patient care, the International Organization for Medical Physics (IOMP) organizes annually the International Day of Medical Physics (IDMP) on November 7, an important date in the history of medical physics. On that day in 1867, Marie Sklodowska-Curie, known for her pioneering research on radioactivity, was born in Poland. The medical physics community will celebrate the 2nd IDMP on November 7, 2014. The theme of IDMP 2014 is “Looking into the Body: Advancement in Imaging through Medical Physics.” This is an excellent opportunity to promote the role of medical physicists in the worldwide medical scene.

Reminders October 15 is the deadline for nominations for the 2015 William D. Coolidge Award, Marvin M.D. Williams Award, Edith H. Quimby Lifetime Achievement Award, John S. Laughlin Young Scientist Award and AAPM Fellows. Make sure to register for the RSNA 2014 Centennial Meeting by November 7 to receive the complimentary registration provided to all AAPM members. AAPM’s Headquarters will now be housed at The Hyatt Regency Chicago, 151 E. Upper Wacker Drive. Please make note and consider this change in venue when making your hotel reservations for RSNA 2014. AAPM meetings and annual reception will be held at the Hyatt Regency Chicago. The AAPM Reception will be held on Tuesday, December 2 from 6:00 PM – 8:00 PM. 6

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Mark your calendars for the 2015 AAPM Spring Clinical Meeting to be held March 7 – 10 in St. Louis, Missouri.

AAPM Transparency Ever want to know more about the operations and governance of AAPM? AAPM’s volunteer leadership continues to provide a wealth of information about the management of the organization to Members via the web. I applaud current and past leaders for seeking to provide a high level of transparency. Won’t you take a few moments to review the information? Members will find: • • • • • • •

Audited financial reports dating back to 1992; AAPM’s current budget; Budget history; Minutes from AAPM Board meetings and background; Minutes from past Annual Business Meetings; Notes from Town Hall meetings; and, Reports from all the Headquarters Site Visit Committees, a group of volunteers that reviews HQ operations every three years.

Should you ever have any questions, please do not hesitate to contact me. 2015 AAPM Dues Renewals Dues renewal notices for the 2015-year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an official member. Staff News “Lisa G” Schober and her husband Erik are expecting their first child in January 2015. The HQ team is looking forward to welcoming “Baby Schober” to the family and wish both Mom and Dad all the best!

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Editor’s Column

Mahadevappa Mahesh, Baltimore, MD

From the Editor’s Desk

elcome to the post Annual Meeting issue of AAPM Newsletter. This issue contains post-meeting reports, including the Education Council report discussing the launching of the ‘MedPhys Match’ Program, news from the ABR about the certification exam and the MOC program, news from ACR on the Radiation Oncology Practice Accreditation and Image Wisely campaign and many others. Also included in this issue, as per tradition, are the William D. Coolidge Award introductory, given by Dr. Dave Rogers, and acceptance speech by Dr. Thomas Rockwell Mackie. I would like to invite readers to note a new feature named ‘Literature Quanta’ facilitated by my good friend and colleague, Dr. Nikos Papanikolaou. The idea behind this new feature is to highlight short descriptions of notable clinical and research papers on a particular medical physics area (such as IMRT in this issue) published in the previous months. I welcome anyone interested to provide highlights on publications in other areas to contact Dr. Papanikolaou. Finally, I would like to stress the importance of innovation, as discussed in the President’s column, in order to avoid commoditization in our profession.

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.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

SAVE THE DATE!

2015

SPRING CLINICAL MEETING March 7 – 10 • Hyatt Regency St. Louis at the Arch • St. Louis, Missouri

NETWORK YOURSELF TO A GREAT CAREER! REGISTER NOW for this essential webinar, being held October 1, 2014 at 2 pm EDT, to learn how to appropriately promote your work and expertise in order to build professional networks. Discover how to “work a room,” start conversations with people you haven’t met before, and obtain information that can set you on a path to a rewarding career. Space is limited - only 1000 seats are available - so sign up today!

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

ULTRASOUND ACCREDITATION QUALITY CONTROL PHANTOMS

Essential Components for the Annual Survey CIRS Ultrasound Accreditation Phantoms are available for immediate compliance with new accreditation requirements. Evaluate ultrasound system performance including: Image Uniformity, Geometric Accuracy and System Sensitivity and comply with requirements to evaluate ultrasound system performance annually. Together, the Model 551 and 552 enable cost-effective testing of all parameters requiring the use of a phantom. Both phantoms offer a simple, compact design for easy transport and storage. Phantoms may also be purchased separately.

Accreditation Phantom for Image Uniformity Ê Ê Ê

UÊ ÃÃiÃÃÊÕ v À ÌÞÊ>ÃÊ«>ÀÌÊ vÊ «Ì > ÊÃi > Õ> Ê continuous QC program and required annual survey UÊ- vÌÊ« > Ì Ê >ÌiÀ > ÊV v À ÃÊÌ ÊÌ iÊÃ >«iÊ vÊ ÃÌÊ ultrasound transducers. UÊ ÕÀ>L iÊ >ÌiÀ > ÃÊv ÀÊiÝÌi `i`Ê« > Ì Ê vi

Accreditation Phantom for Geometric Accuracy Ê Ê Ê

UÊ*iÀv À ÊÀiµÕ Ài`Ê> Õ> Ê>ÃÃiÃÃ i ÌÊ vÊÃÞÃÌi Ê sensitivity and geometric accuracy UÊ1ÃiÊ`ÕÀ }Ê>VVi«Ì> ViÊÌiÃÌ } UÊ Û> Õ>ÌiÊ}i iÌÀ VÊ>VVÕÀ>VÞÊ vÊÛiÀÞÊ } vÀiµÕi VÞÊ transducers using Near Field targets

Model 551

Model 552

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Knowing what responsibility means

Legislative and Regulatory Affairs Report

Lynne Fairobent, College Park, MD

NRC Issues Proposed Rule and Guidance Document for 10 CFR Part 35 Medical Use Of Byproduct Material On July 21, 2014, Nuclear Regulatory Commission (NRC) published in the Federal Register a proposed rule to revise certain sections in 10 CFR Parts 30, 32, and 35, as well as a notice of availability of the draft guidance to go with these proposed changes. The full guidance document can be found here. The proposed rule would amend the Commission’s medical use regulations in part 35. First, this rule proposes amendments to the reporting and notification requirements for a medical event for permanent implant brachytherapy. Second, the rule proposes changes to the training and experience (T&E) requirements for authorized users, medical physicists, Radiation Safety Officers, and nuclear pharmacists; to the requirements for measuring molybdenum (Mo) contamination and reporting of failed technetium and rubidium generators; and to allow Associate Radiation Safety Officers to be named on a medical license. Third, the rule proposes changes to address a request filed in a petition for rulemaking (PRM), PRM-35-20, to exempt certain board- certified individuals from certain T&E requirements (i.e., “grandfather” these individuals) so they may be identified on a license or permit for materials and uses that they performed on or before October 24, 2005, the expiration date of the prior T&E requirements.

What are the Issues the NRC is seeking Specific Comments On? 1. Specific Comments on Medical Event Definition a. The NRC is seeking specific comments, in defining MEs, on the proposed volume of 5 contiguous cubic centimeters dose-volume specification for an absorbed dose to normal tissue located both outside and within the treatment site. b. The NRC is also seeking specific comments on whether the application of the proposed medical event definition for normal tissue based on the absorbed dose to the maximally exposed 5 contiguous cubic centimeters during permanent implant brachytherapy is appropriate for all potential treatment modalities, or whether it may result in unintended consequences for tissues or organs adjacent to the treatment site. 2. Implementation Period. In Section IV.B of this document, the NRC is proposing the effective date of the final rule 11

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

to be 180 days from the date it is published in the Federal Register. The NRC is seeking specific comments on whether a 180 day effective date for the final rule is sufficient to communicate the changes to all practitioners, revise procedures, train on them, and implement the changes. 3. Impact on Clinical Practice. The NRC is seeking comments on whether any of the proposed changes in this rulemaking are likely to discourage licensees from using certain therapy options or otherwise adversely impact clinical practice, and if so, how. 4. Compatibility Category for the Agreement States on § 35.3045,Report and notification of a medical event. Currently § 35.3045, Report and notification of a medical event, is designated as Compatibility Category C for the Agreement States. This designation means the essential objectives of the requirement should be adopted by the State to avoid conflicts, duplications, or gaps. The manner in which the essential objectives are addressed in the Agreement State requirements need not be the same as NRC requirements, provided the essential objectives are met. Under Compatibility Category C, Agreement States may require the reporting of MEs with more restrictive criteria than those required by the NRC. Some medical licensees have multiple locations, some of which are NRC-regulated and some which are Agreement State-regulated. These licensees would prefer a Compatibility Category B designation for uniformity of practice and procedures among their different locations. A Compatibility Category B designation is for those program elements that apply to activities that have direct and significant effects in multiple jurisdictions. Because of these divergent positions (the OAS favoring Compatibility Category C and some medical use licensees and the ACMUI favoring Compatibility Category B), the NRC invites comments on the appropriate compatibility category for ME reporting under § 35.3045. Comments for both the proposed rule and its guidance to the NRC are due on November 18, 2014. However if you have comments that you want AAPM to consider, I will need all comments by October 1st for AAPM reviews and finalization of AAPM’s comment letter. Please send any comments for AAPM’s consideration to Lynne Fairobent, Senior Manager for Government Relations at lynne@aapm.org.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

NRC Issues ANPR for 10 CFR Part 20 Standards for Protection Against Radiation NRC issues the Advance Notice for Proposed Rulemaking (ANPR) for 10 CFR Part 20 Standards for Protection Against Radiation was published in the Federal Register on July 25, 2014. In addition to the ANPR, NRC also published 6 Issue Papers as well. This information is contained on the NRC website: • Advance Notice of Proposed Rulemaking: Potential Changes to Radiation Protection Regulations • Issue Paper 1: Update 10 CFR Part 20 to Align with International Commission on Radiological Protection Publication 103 Methodology and Terminology. • Issue Paper 2: Occupational Dose Limit for the Lens of the Eye. • Issue Paper 3: Dose Limit for the Embryo/Fetus of a Declared Pregnant Occupational Worker. • Issue Paper 4: Individual Protection - ALARA Planning. • Issue Paper 5: Metrication - Units of Radiation Exposure and Dose. • Issue Paper 6: Reporting of Occupational Exposure. NRC will also be holding a series of public meetings specific to the six issues identified in the ANPR, however the dates and locations of these meetings has not been announced. NRC states that information on the meetings will be noticed on the NRC’s public meeting Web site at least 10 calendar days before the meeting. They suggest that stakeholders should monitor the NRC’s public meeting Web site for additional information about the public meetings. Comments to the NRC are due on November 24, 2014. However if you have comments that you want AAPM to consider, I will need all comments by October 10th for AAPM reviews and finalization of AAPM’s comment letter. I look forward to hearing from all of you about this very important topic that will affect your Radiation Protection Programs in the years to come and I thank you in advance for your assistance! Please send any comments for AAPM’s consideration to Lynne Fairobent, Senior Manager for Government Relations at lynne@aapm.org.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Call for Nominations Nominations are now being accepted for the following AAPM Awards: William D. Coolidge Award • Marvin M.D. Williams Award Edith H. Quimby Lifetime Achievement Award John S. Laughlin Young Scientist Award • AAPM Fellows All nominations are due by October 15, 2014 and are to be done through the online nomination system. 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 in Anaheim, California in the year 2015.

http://www.aapm.org/org/callfornominations.asp

Save the Date!

Proton Beam Therapy

June 14 –18, 2015 | Colorado Springs, CO http://www.aapm.org/meetings/2015SS/

Education Council Report

George Starkschall, Houston, TX

am very pleased to report that before and after the recent AAPM meeting in Austin, a great deal of progress is being made on two issues regarding the education and training of medical physicists. As you well are aware, we are facing an imbalance between the number of graduates from CAMPEP-accredited graduate programs and the number of available openings in CAMPEP-accredited residency programs. As consequence, many of our program graduates may not be able to pursue careers as Qualified Medical Physicists. One of the initiatives that the AAPM has undertaken to address this problem has been to make available to students information regarding non-clinical career opportunities. A Working Group to Promote NonClinical Career Paths for Medical Physicists has been established under the Students and Trainees Subcommittee to provide such information to our medical physics students. This Working Group, under the Co-Chairs Sean Tanny and John Ready, met in Austin, and I had the pleasure of attending their initial meeting. The students in this Working Group appear to be very charged-up about their task, and I shall be looking forward to hearing of more progress on their activity in the near future. We have not solved the problem of the imbalance, but we are at least making progress. The second issue that we needed to address is that of placement of applicants in residency programs. As a consequence of the fact that there are many more residency applicants than residency positions, competition among programs for qualified applicants has gotten fierce over the past few years. Although a “Gentleman’s Agreement” among residency program directors has established a date for programs to make offers to qualified applicants, the need became evident for a formalized matching program analogous to that used by medical residencies. A formalized matching program has been shown to be the fairest way for candidates to select their most desirable residency programs and programs to bring on their most desirable candidates. The establishment of such a program has been a goal of both the Education Council and the Society for Directors of Academic Medical Physics Programs (SDAMPP), and I am pleased to inform you that such a program is going to be in place for the upcoming year. I have asked John Antolak, who has been instrumental in establishing the matching program, to describe the medical physics residency matching program for you. John has written the following: At the American Association of Physicists in Medicine (AAPM) Annual Meeting in Austin, Texas, the AAPM Board of Directors voted unanimously to endorse a national match for recruitment and placement of applicants into medical physics residency programs 15

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(see PP-28A). The Board of Directors for the Society for Directors of Academic Medical Physics Programs (SDAMPP) also endorsed a national match at their meeting in Austin. Importantly, both Boards approved funding to fully subsidize the cost of the match for both residency programs and applicants for 2 years, with a partial subsidy for 2 additional years. The Board votes are further evidence of the strong support for a national match program for medical physics residency positions. A survey of medical physics residency program directors conducted by AAPM and SDAMPP this Spring indicated that over 80% of those recruiting for the July 1 timeframe would or would likely participate in a match program. A straw poll of attendees at this yearâ&#x20AC;&#x2122;s SDAMPP meeting tallied 40 votes for a match with 0 against (7 abstained). The support may be even greater among students, who will benefit significantly from a match system. Over 90% of those attending the Students and Trainees symposium at the AAPM meeting stated they would participate in a match program. As a result, AAPM and SDAMPP are pleased to announce the launch of the MedPhys Match, a national matching program for medical physics residency positions. AAPM and SDAMPP are encouraging all residency programs recruiting for positions beginning on or about July 1, 2015, to register to participate, although programs recruiting for start dates later in the year may also want to participate and seek residents from the larger applicant pool. The MedPhys Match will be run by National Matching Services Inc. (NMS), a company we have been working with for the past several months to design and run a matching program for medical physics residencies. NMS has over 35 yearsâ&#x20AC;&#x2122; experience operating matches for a number of professions, including for residency placement in medicine, dentistry, pharmacy, psychology, optometry and others, so they are more than capable of meeting our needs. An oversight committee with AAPM and SDAMPP representation is working with NMS to create a fair and equitable process. On August 7, an email was sent to all residency and graduate program directors with a brief description of the MedPhys Match process and FAQ to answer anticipated questions. This information has also been posted to the new MedPhys Match website. By the time this newsletter article is published, NMS will be sending information out to medical physics residency programs with instructions on registering for the MedPhys Match for positions beginning in 2015. Applicants will be able to register with NMS starting in October. As an added incentive to use the MedPhys Match program, the AAPM Common Application Program (CAP) will be also made available at no cost to match participants (applicants and programs). If you have any questions regarding the MedPhys Match, please feel free to visit the MedPhys Match website or to contact any of us.

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John Antolak Chair, AAPM Medical Physics Residency Training and Promotion Subcommittee Radiation Oncology, Desk SR Mayo Clinic 200 First St SW Rochester, MN 55905 antolak.john@mayo.edu John Gibbons Chair, AAPM Education and Training of Medical Physicists Committee Mary Bird Perkins Cancer Center 4950 Essen Lane Baton Rouge, LA 70809 john.gibbons@marybird.com Dan Bourland President, Society of Directors of Academic Medical Physics Programs Dept. of Radiation Oncology Wake Forest University Medical Center Blvd Winston-Salem, NC 27157 bourland@wakehealth.edu We owe John a great deal of gratitude for his efforts in making the MedPhys Match a reality.

AAPM BY-LAWS AMENDMENT The proposed By-Laws Amendment, regarding the Audit Committee, will open for online voting on October 1, 2014. Deadline to submit your vote electronically: October 22, 2014

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Health Policy/Economic Issues

Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant

CMS Proposes Comprehensive Payment for Radiation Oncology The Centers for Medicare and Medicaid Services (CMS) recently released the 2015 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. AAPM will submit comments to CMS by the September 2nd deadline. The final rule will be published by November 1st, with an effective date of January 1, 2015. Payments for freestanding radiation therapy centers and physicians are covered under a separate rule and those changes are described in a separate article (see below). The CMS is moving ahead with a plan to shift hospital outpatient payments to a more complete prospective payment system that bundles payments for certain primary procedures. For 2015, CMS establishes a comprehensive payment policy that focuses on the most costly medical device implantation procedures. CMS defines a new type of code grouping, a comprehensive ambulatory payment classification (APC) as taxonomy for the provision of a primary service and all adjunctive services provided to support the delivery of the primary service. Under this policy, CMS designates each service described by a HCPCS code assigned to a comprehensive APC as the primary service and, with few exceptions (e.g. brachytherapy sources), considers all other services reported on a hospital Medicare Part B claim to be related to the delivery of the primary service. Under this policy, CMS calculates a single payment, defined by a single claim, regardless of the date of service span. The 2015 policy applies to intraoperative radiation therapy (IORT), breast brachytherapy catheter placement and single session cranial stereotactic radiosurgery (SRS) procedures. Specifically for 2015, CMS is proposing the following changes to the comprehensive APCs payment packaging policy: • Payment of $9,767.98 for comprehensive APC 67 Single Session Cranial Stereotactic Radiosurgery, which includes SRS codes 77371 Cobalt-60 based treatment delivery (i.e., Gamma Knife) and 77372 Linear accelerator based treatment delivery as the primary service “trigger” codes. CMS uses 2013 claims for 2015 rate setting and will use the data from the previous HCPCS G-code G0173, which is now CPT 77372. • Reassign IORT codes 77424 (x-ray) and 77425 (electrons) to comprehensive APC 648 Level IV Breast and Skin Surgery. • Payment of $7,329.67 for comprehensive APC 648 Level IV Breast and Skin Surgery, 19

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which includes the aforementioned IORT codes, as well as breast brachytherapy catheter placement codes 19296 and 19298, along with other breast surgery codes as the primary service “trigger” codes (see table below). • Package all of the add-on procedure codes, which includes CPT 19297 Placement of breast catheter for radiation; concurrent with partial mastectomy. APC 648 Level IV Breast and Skin Surgery HCPCS Code

Short Descriptor

19296

Placement breast catheter for radiation following partial mastectomy

19298

Placement of breast brachytherapy catheters (multiple tube and button type) for radiation at the time of or subsequent to partial mastectomy

19325

Enlarge breast with implant

19342

Delayed breast prosthesis following mastopexy, mastectomy or in reconstruction

19357

Breast reconstruction

77424

IORT treatment delivery by x-ray

77425

IORT treatment delivery by electrons

This policy significantly increases payments for the radiation oncology procedure codes assigned to comprehensive APCs for 2015. At the same time this policy would increase bundling so that many codes would no longer be paid separately. The overall revenue change will vary from hospital to hospital depending on the length of time for an outpatient claim that includes the primary service “trigger” code. AAPM is studying the comprehensive APC policy to better understand its overall impact. It is CMS’s goal to pay hospitals under more of a per-patient prospective payment system and under less of a per-service fee schedule system. It is longstanding HOPPS policy to package or bundle charges for services that it sees as supporting some larger primary service. CMS says they expect to consider more packaging in the future. The 2015 HOPPS payment rule also proposes to: • Reassign prostate needle placement code 55875 from APC 163 Level IV to APC 162 Level III Genitourinary Procedures, which results in a 28% payment reduction in 2015. • Reassign insertion of uterine tandem and/or vaginal ovoids from APC 193 Level IV to APC 192 Level III Female Reproduction Procedures, which results in a 64% payment 20

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

reduction in 2015. â&#x20AC;˘ Delete APC 65 IORT, MRgFUS & MEG; APC 299 Hyperthermia & Radiation Treatment Delivery; and APC 664 Level I Proton Beam Delivery and reassign procedure codes to other Radiation Therapy APCs. â&#x20AC;˘ Revise and rename APC 667 formerly Level II Proton Beam Delivery to Level IV Radiation Therapy; and APC 66 formerly Level I Stereotactic Radiosurgery to Level V Radiation Therapy. The 2015 proposed payments for radiation oncology codes are as follows (see table below). Summary of Proposed 2015 Radiation Oncology HOPPS Payments 2015 Proposed Payment

Payment Change 2014-2015

Percentage Change 2014-2015

APC

Description

CPT Codes

2014 Payment

IORT, MRgFUS & MEG

Proposed APC Deletion

$1,248.28

Level V Radiation Therapy

77373 & other non-radiation oncology codes

$1,921.30

$1,892.88

($28.42)

-1.5%

67*

Single Session Cranial SRS

77371, 77372

$3,591.65

$9,767.98

$6,176.33

172.0%

299

Hyperthermia & Radiation Treatment

Proposed APC Deletion

$413.22

Level I Radiation Therapy

77401, 77402, 77403, 77404, 77407

$104.26

$101.97

($2.29)

-2.2%

301

Level II Radiation Therapy

77406, 77408, 77409, 77411, 77412, 77413, 77414, 77416, 77422, 77423, 77600, 77750, 77789

$192.28

$196.28

$4.00

2.1%

303

Treatment Device Construction

77332, 77333, 77334

$213.49

$216.43

$2.94

1.4%

304

Level I Therapeutic Radiation Treatment Prep

77280, 77299, 77300, 77305, 77310, 77326, 77331, 77336, 77370, 77399

$114.65

$114.62

($0.03)

305

Level II Therapeutic Radiation Treatment Prep

77285, 77290, 77315, 77321, 77327, 77328, 77338

$311.37

$316.95

$5.58

1.8%

310

Level III Therapeutic Radiation Treatment Prep

32553, 49411, 55876, 77295, 77301, C9728

$1,036.39

$1,041.75

$5.36

0.5%

312

Radioelement Applications

77761, 77762, 77763, 77776, 77777, 77799

$361.29

$338.65

($22.64)

-6.3%

313

Brachytherapy

77785, 77786, 77787, 0182T

$733.80

$725.98

($7.82)

-1.1%

412

Level III Radiation Therapy

77418, 77470, 77520, 77605, 77610, 77615, 77620, 0073T

$510.46

$515.06

$4.60

0.9%

648*

Level IV Breast and Skin Surgery

19296, 19298, 77424, 77425 & other breast surgery codes

$4,846.71

$7,329.67

$2,482.96

51.2%

651

Complex Interstitial Radiation Source Application

77778

$997.90

$996.67

($1.23)

-0.1%

300

This table continues on the next page.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

664

Level I Proton Beam Therapy

Proposed APC Deletion

667

Level IV Radiation Therapy

77522, 77523, 77525

$1.205.27

$1,056.25

($149.02)

-12.4%

8001

LDR Prostate Brachytherapy Composite

55875+77778

$3,844.64

$3,504.02

($340.62)

-8.9%

$872.37

n/a

APC reassignments for 2015 are highlighted in bold *Comprehensive APC in 2015 A complete summary of the proposed rule and impact tables is on the AAPM website.

2015 Proposed Rule Reduces Treatment Delivery Payments to Freestanding Cancer Centers CMS recently released the 2015 Medicare Physician Fee Schedule (MPFS) proposed rule. The final rule will be published by November 1st, with an effective date of January 1, 2015. The MPFS specifies payment rates to physicians and other providers, including freestanding radiation therapy centers. It does not apply to hospital-based facilities. As proposed, the rule would significantly decrease payments for several treatment delivery codes in 2015. CMS proposes to reallocate the costs of a radiation treatment vault, which yields a negative impact of 4% for radiation oncology and 8% for freestanding radiation therapy centers. Radiation oncology treatment delivery codes affected by the CMS proposal to remove the radiation treatment vault include: Procedure Code 77373 SBRT delivery 77402 Radiation treatment delivery 77403 Radiation treatment delivery 77404 Radiation treatment delivery 77406 Radiation treatment delivery 77407 Radiation treatment delivery 77408 Radiation treatment delivery 77409 Radiation treatment delivery 77411 Radiation treatment delivery 77412 Radiation treatment delivery 77413 Radiation treatment delivery 77414 Radiation treatment delivery

Proposed 2015 Payment Decrease -5.8% -2.1% -12.5% -10.4% -10.5% -15.6% -12.0% -10.6% -10.1% -3.0% -12.2% -10.6% This table continues on the next page.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

77416 Radiation treatment delivery 77418 IMRT radiation treatment delivery

-23.1% -10.7%

In previous rulemaking, CMS indicated that they included the radiation treatment vault as a direct practice expense (PE) input for several recently reviewed radiation treatment delivery codes for the sake of consistency with its previous inclusion as a direct PE input for some other radiation treatment services, but that they intended to review the radiation treatment vault input and address whether or not it should be included in the direct PE input database for all services in future rulemaking. Specifically, CMS questioned whether it was consistent with the principles underlying the practice expense methodology to include the radiation treatment vault as a direct cost based on a perception that the vault is more similar to building infrastructure costs than to medical equipment costs. Moreover, CMS indicates that it is difficult to distinguish the cost of the vault from the cost of the building. In response to this action, CMS received comments and invoices from stakeholders who indicated that the vault should be classified as a direct cost. However, upon review of the information received, CMS believes that the specific structural components required to house the linear accelerator are similar in concept to components required to house other medical equipment such as expensive imaging equipment. In general, the electrical, plumbing, and other building specifications are often unique to the intended function of a given building, including costs that are attributable to the specific medical equipment housed in the building, but do not represent direct medical equipment costs in the CMS established practice expense methodology. Therefore CMS believes that the special building requirements indicated for the radiation treatment vault to house a linear accelerator do not represent a direct cost in the practice expense methodology, and that the vault construction is instead accounted for in the indirect PE methodology, just as the building and infrastructure costs are treated for other MPFS services including those with infrastructure costs based on equipment needs. AAPM opposes the CMS proposal and will provide written comments to CMS by the September 2nd deadline. In addition, AAPM is working with ASTRO and other stakeholders to have Members of Congress weigh-in on the proposal. Given that a number of radiation treatment delivery codes are slated for change and revaluation effective January 1, 2015, and the impact will not be known until later this year, Congress may request that CMS not address the radiation treatment vault issue until after 2015. The American Medical Associationâ&#x20AC;&#x2122;s Relative Value Scale Update Committee (RUC) has provided a recommendation regarding the direct practice expense inputs for digital imaging. Specifically, the RUC recommended that CMS remove a list of items associated with radiographic film since these items are no longer a typical resource input. The RUC also recommended that a Picture Archiving and Communication System (PACS) be substituted for these imaging services since these items are now typically used to furnish imaging services. CMS notes that they did not receive appropriate pricing for the PACS input. CMS proposes to accept the RUC recommendation to remove the film supply and equipment items and 23

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to allocate minutes for a desktop computer as a proxy for the PACS. This proposal impacts multiple radiation oncology and radiology codes. Other 2015 proposals that impact radiation oncology payment include: • CMS has identified 2 radiation oncology codes as being “potentially misvalued.” The RUC may review and revalue the complex radiation treatment planning code 77263 and the complex treatment device code 77334. • CMS is soliciting comment on the current 5% allocation of equipment cost as maintenance cost used to determine an equipment cost per minute. This might have a significant impact for complex medical systems that have high maintenance costs such as linear accelerators, CT and MRI scanners. • CMS plans to refine post-operative bundles by revaluing 90-day global periods to a 0-day global period effective in 2018. The global surgical package includes all necessary services normally furnished by a surgeon before, during, and after a procedure for a specified period of time. This proposal impacts all of the low dose rate intracavitary (77761-77763) and interstitial (77776-77778) brachytherapy codes with a 90-day global period and will likely reduce the relative value units (RVUs) and associated payment for these services. • CMS proposes to revalue services that include moderate sedation, which includes the SRS single cranial treatment with Cobalt-60 code 77371 and hyperthermia treatment codes 77600-77615. • CMS plans to recognize only the CPT codes for payment of stereotactic radiosurgery (SRS) services 77372 and 77373 and proposes to delete the HCPCS G-codes used to report robotic delivery of SRS (i.e., G0339 and G0340). They believe that the CPT codes accurately reflect the resources used in furnishing typical SRS and that no coding distinction between robotic and non-robotic delivery methods are necessary. • CMS proposes to implement new malpractice RVUs in 2015 based on updated malpractice premium data. CMS states that there is 0% impact to radiation oncology. Read a complete summary of the proposed rule and to review impact tables here.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

ABR News

ABR Physics Trustees

Jerry D. Allison

Geoffrey S. Ibbott

J. Anthony Seibert

ABR News of Interest Deadlines for Part 1 and Part 2 Candidates If you were approved for Part 1 before January 1, 2011, the deadline for passing Part 1 is December 31, 2016. If you do not pass Part 1 by that date, you will be required to take an additional year of academic medical physics training at a CAMPEP-accredited educational institution that offers a graduate program if you wish to re-enter the process. The Part 1 exam is given once a year in August. If you were approved for Part 2 before January 1, 2011, the deadline for becoming certified is December 31, 2016, which requires passing Part 3 (the oral exam). At present, you are â&#x20AC;&#x153;board eligibleâ&#x20AC;? but will lose that status if you are not certified by that date. To re-enter the process, you would need to complete a year of additional clinical medical physics training at an institution with a CAMPEP-accredited residency program. The Part 2 exam is offered annually in August, and the Part 3 oral exam is given annually in late spring. To meet the December 31, 2016 deadline, you would need to pass Part 2 no later than 2015.

Application for the Part 2 Exam In 2013, the ABR stopped sending an annual update form to candidates who had passed Part 1. Candidates now submit an application for Part 2 when they are ready to take the exam, and they do not need to submit any paperwork until they are ready to take Part 2. This means that candidates need to be aware of the deadline and submit the form provided online. Candidates should remember to check both the ABR website and log in to myABR on a regular basis.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

The ABR Part 3 (Oral) Exam Will Remain in Louisville The ABR previously announced that starting in 2015, the oral exam would move to Dallas. The move was predicated on lower expenses for the candidates. Upon further analysis, it was determined that while air travel to Dallas is cheaper, the lower airfares are more than offset by higher hotel, cab, and meals expenses. Therefore, the ABR oral exam will remain in Louisville at least through 2016.

New Oral Exam Categories The ABR Part 3 (oral) exam categories have not changed in many years. In recent years, it was noted that the categories in diagnostic medical physics and nuclear medical physics were not aligned well with actual practice in these fields. An example from diagnostic medical physics relates to non-ionizing radiation: ultrasound (US) and magnetic resonance imaging (MRI). Mixing US and MRI questions with other topics made it difficult to evaluate specific knowledge in these areas. The new category topics should improve the ability of the exam to discriminate among candidates. The chart below lists the new categories. DMP Category 1 Category 2

Radiography, Mammography, Fluoroscopy, and Interventional Imaging Computed tomography

Category 3

MRI and ultrasound

Category 4

Informatics, image display, image fundamentals

Category 5

Radiation dosimetry, protection, and safety

NMP

TMP

Radiation Protection

Radiation protection and patient safety

PET and hybrids

Patient-related measurements

SPECT and hybrids, including gamma cameras

Image acquisition processing and display

Calibration, quality control, Radiation measurements and quality assurance Clinical procedures

Equipment

2015 Updates to the Maintenance of Certification (MOC) Program The ABR seeks to make the MOC (Continuous Certification) program more meaningful. We receive input from individual diplomates, the AAPM, and other advisory committees, as well as from the American Board of Medical Specialties. Beginning in 2015, there will be a requirement to document some safety-related activities. This could be in the form of continuing education, a Practice Quality Improvement (PQI) project, or a Self-Directed Educational Project (SDEP), which would count toward fulfillment of current MOC Part 2 or Part 4 requirements. Details will be published soon, and the ABR believes that this will strengthen the program, make it more meaningful to everyday practice, and be a minimal burden for diplomates. 26

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

ACR Accreditation FAQs

Priscilla F. Butler, Reston, VA

ACR Accreditation: Frequently Asked Questions for Medical Physicists

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 following questions are for ACR Radiation Oncology Practice Accreditation. Please feel free to contact us at rad-onc-accred@acr.org if you have questions about radiation oncology accreditation. Q. Does the ACR Radiation Oncology Practice Accreditation program accredit practices that use proton therapy equipment? A. Q. A.

Q. A.

Yes. As of July 1, 2014, the ACR Radiation Oncology Practice Accreditation program is accepting applications from facilities that perform proton therapy treatment. Does the ACR Radiation Oncology Practice Accreditation program have members on their committee and surveyors that have experience with proton therapy? The ACR has committee members and accreditation program surveyors with years of experience in proton therapy. Some of our committee members and surveyors authored the ACR–ASTRO Practice Parameter for the Performance of Proton Beam Radiation Therapy (formerly Guidelines) and the ACR–AAPM Technical Standard for the Performance of Proton Beam Radiation Therapy. The practice parameters and technical standards were officially published in May 2013. Where can I find the practice parameters and technical standards for proton therapy? The ACR Practice Parameters and Technical Standards can be found on the ACR website at www.acr.org or http://www.acr.org/Quality-Safety/Standards-Guidelines/Practice-Guidelines-by-Modality/Radiation-Oncology. If my practice is interested in applying for ACR Radiation Oncology Practice Accreditation, what do I need to do?

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

You should create an account and apply on the ACR Radiation Oncology Practice Accreditation website. If you have any specific questions please contact an ACR staff member at rad-onc-accred@acr.org or call 800-770-0145.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Notice of Cessation

Malcolm McEwen, Ottawa, Canada

Cessation of the AAPM-Accredited Calibration Service for Sr-90 Ophthalmic Applicators Notice of Cessation of Sr-90 Calibration In May 2014, the National Institute for Standards and Technology (NIST) indicated that they would no longer be providing a standard for Sr-90 ophthalmic applicators. Further to this fact, the UW ADCL has notified the AAPMâ&#x20AC;&#x2122;s Calibration Laboratory Accreditation SC (CLA) that they will no longer be offering a calibration service for Sr-90 ophthalmic applicators beyond December 2014. The CLA has monitored demand of these sources and the service has had very limited requests in the last 5 years. The CLA therefore concluded that no recommendation for continuation of the service to AAPM users was required. Also, the opinion of the CLA is that it is unlikely that this calibration capability, once ceased, will be restarted. Users are therefore encouraged to review their long-term usage of Sr-90 ophthalmic applicators and seek calibration/recalibration before the end of 2014. Due to the very long half-life of these sources, a calibrated source, if stored and handled correctly, should hold its calibration for many years without recalibration. The user, if not already doing so, should implement QA procedures to monitor source stability. Although the calibration service will no longer be available, the expertise will not be lost and the CLA will work with the NIST and the UW ADCL to ensure that guidance is available for end users in developing such QA procedures.

Background - Accreditation by the CLA The accreditation of ADCLs by the AAPM, through the Calibration Accreditation Subcommittee (CLA), stands on two pillars: i) A recognized quality system that is consistent with the requirements of the AAPMâ&#x20AC;&#x2122;s Criteria ii) A demonstration of technical competence through regular comparisons or the exchange of reference standards. The first is addressed through site visits by trained assessors, while the second is demonstrated through proficiency tests (PTs) of each ADCL with the primary standards laboratory, NIST. Each ADCL has a scope of accreditation that covers the calibration services it offers and the 30

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

CLA has developed a PT schedule for each service. For example, PTs for Co-60 absorbed dose are carried out every two years (to reflect the two-year calibration cycle of users). For other services, where long-term stability of the calibration procedure and reference standard have been demonstrated, the interval between PTs is longer but never more than four years. Calibration of long-lived sources, such as Sr-90 and Cs-137, would fit in this latter category. Typically, if an ADCL does not have the desire or capability to provide a certain calibration to users they do not participate in the PT, and therefore have a reduced scope of accreditation. However, the question has arisen recently as to the AAPM policy regarding accreditation of services if the primary laboratory cannot provide the PT; in this case, NIST ceasing to provide a standard for Sr-90 ophthalmic applicators. Based on historical calibration data, the CLA made a decision to extend accreditation of these services, without a PT, until 31st December 2014. At the same time, the ADCLs were encouraged to develop QA procedures that could robustly maintain the reference standard for user calibrations (but perhaps with increased uncertainty). This could be done, for example, through intercomparison of two reference standards to monitor drift, or the use of a different PT to demonstrate competence. This intercomparison procedure was done by the UW ADCL and the laboratory can therefore provide an accredited calibration until December 2014. Users of Sr-90 ophthalmic applicators, who have concerns regarding calibration of such sources, are encouraged, in the first instance, to contact the UW ADCL.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Thomas Rockwell Mackie

William D. Coolidge Award Introduction

Dave W. O. Rodgers, Ottawa, Canada

t is my great pleasure and honor to introduce Rock Mackie, my longtime friend and a collaborator in the 80s and 90s, and the winner of this year’s William D. Coolidge Award, the highest honor of the AAPM. In the 4 minutes I have been allotted it is almost impossible to do justice to Rock’s outstanding accomplishments. Rock was born in the Canadian province of Saskatchewan (that’s just north of Montana and North Dakota – if you didn’t know where Saskatchewan was, don’t feel bad, I had to check a map to find which states were south of it!). Canadians are proud that Rock and his wife Pam are still Canadian citizens and the Canadian Organization of Medical Physicists made him a Fellow of COMP this year. Among Rock’s many significant accomplishments is raising, with a lot of help from his wife Pam, 4 wonderful children (Jack, Peter, Tom and Jessica) who are here with us tonight, a little older than in this 1997 photo.

Given how much Dad travels, the children get to travel a lot and the picture shows them a few years later at the 2003 World Congress in Sydney, Australia.

Rock got his BSc at the University of Saskatchewan in 1980 and his PhD from the University of Alberta in 1984. His doctoral work used Monte Carlo techniques and developed the convolution technique that is still widely used in radiotherapy treatment planning. Rock’s talent was recognized early. He won the AAPM’s Young Investigator Symposium in 1983

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

in New York City and the resulting paper on convolution, co-authored with Jerry Battista and Rock’s supervisor John Scrimger, won the AAPM’s 1986 Farrington Daniels Award for the best dosimetry paper of the year (Med. Phys.12 (1985) 188). His ensuing 1988 paper on energy deposition kernels, which are needed for convolution/superposition algorithms, won the Sylvia Fedoruk Prize for the best Canadian medical physics paper of the year (PMB 33 (1988) 1). After a brief period at the Saskatchewan Cancer Foundation’s clinic, Rock joined the faculty at the University of Wisconsin in 1987 where he has been for the last 27 years, becoming a full professor in 1999 and emeritus recently. Since 2010 he has been the Director of Medical Devices at the Morgridge Institute.

In the early 90s, a group consisting of Rock, Paul Reckwerdt (in photo), Mark Gehring, and Cam Sanders developed the convolution/superposition algorithm and in 1992 spun off a company called Geometrics which produced the Pinnacle radiotherapy treatment planning system. In 1996 the company was sold to ADAC and was later sold to Philips. At the same time Rock’s group at the university was involved in the Ottawa Madison Electron Gamma Algorithm (OMEGA) project for doing Monte Carlo dose calculations. Rock is a co-author of the 1995 BEAM paper (Med Phys 22 (1995) 503) which is the most cited research article ever published in the journal Medical Physics. In the late 90s, Rock and Paul took the profits from the sale of Geometrics and set up a company to develop the Tomotherapy concept of helical radiotherapy. This concept has revolutionized radiotherapy delivery and approaches like VMAT and Rapid Arc are in many ways a response to the brilliant idea in Tomo (Med. Phys. 20(1993) 1709). Tomo treated its first patient in 2002 at UW and the first 2 non-UW machines, A and a (named to avoid priority arguments) went to 2 Canadian clinics – A and , a neat Canadian idea, eh?

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Tomo was sold to Accuray in 2011 at which point there were more than 700 employees and 350 units around the world.

Not satisfied with these accomplishments Rock continues to innovate. How many other medical physicists have had their work covered in the Economist? – in this case, for his work with open-source for medical devices which is a Morgridge project (When code can kill or cure’, June 2, 2012 edition.) In addition he is PI on a major project to create a US-based supply of Mo-99 in conjunction with Shine Medical Isotopes. At this point Rock has 32 patents and either had or currently has 10 corporate affiliations. Although many of us know about Rock’s research and commercial endeavors, he is also a well-respected teacher, having taught over 500 medical physics graduate students and having supervised more than 30 PhD students and many post-docs. He has also codirected 3 of the AAPM’s most popular Summer Schools (1996, 2003, 2011) and lectured at 2 others. In addition, Rock has played a major role in the AAPM. He has been on a multitude of committees, many of them very senior ones like the Science Council, Research Committee, Board of Directors etc. Rock’s current AAPM involvements span a wide range,

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

from Chairing the Ad hoc committee on Corporate Relations to being on the task group on Model QA Programs. He has many contributions in the AAPM’s on-line virtual library which indicates the high quality of his teaching. In addition to these AAPM activities he has been the co-chair of an ICRU committee and a lead author on its report 83 on “Prescribing, Recording, and Reporting Intensity-Modulated Photon-Beam Therapy (IMRT)”. In short, Rock Mackie is a most deserving recipient of the AAPM’s highest honor, the William D. Coolidge Award and I am proud to call him my friend.

Congratulations to Mark S. Seddon, MS for winning two “innovative” paintings by internationally recognized graffiti artist, author and entrepreneur Erik Wahl, at this year’s President’s Symposium!

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

William D. Coolidge Award Acceptance Speech

Thomas Rockwell Mackie, Madison, WI

oolidge Award speeches are traditionally on three themes; thanking your trainees and colleagues, giving advice to your peers, and giving a vision about where the field of medical physics is going. I will do all three with the help of about 58 slides. I should be finished in about 90 minutes so please get comfortable. Actually, I will try to finish on schedule in about 7 minutes. I have a long list of people to thank but I want to first thank my good friend and mentor, Dr. Dave Rogers. He helped me from my graduate career, through my early clinical days when I was trying to make a name for myself in research and up to the present. We shared grants together but more importantly we shared friendship, family time and lots of laughs. A theme of this speech is that work is also about having fun along the way. Other formative mentors were John Scrimger, an excellent clinical medical physicist who always preached that the patient comes first and Jerry Battista a great researcher but an unbelievably good educator. Peter Dickof, who I worked with in Regina Saskatchewan, along with Bhudatt Paliwal and Bruce Thomadsen at Wisconsin also contributed to my appreciation for the importance for excellence in clinical medical physics. Being at the University of Wisconsin with the presence of John Cameron, Herb Attix and Paul DeLuca was definitely an inspiration but they and all of my mentors did not take life too seriously and knew how to enjoy themselves. An example was the virtuosity of John Cameron playing familiar tunes using his teeth as a plucked instrument.

A swim in a natural pool in the Atlantic Forest near Rio de Janeiro following the World Congress of Medical Physics and Biomedical Engineering in 1994. (foreground l to r) myself, Joanna Cygler, Dave Rogers, and Lech Papiez. Our tour guide is in the background.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Research trainees are the engines of academic research. I have been very fortunate to have access to the University of Wisconsinâ&#x20AC;&#x2122;s pool of young graduate and post-doctoral talent. Always hire people smarter than yourself and I was almost universally blessed in doing so. I have mentored more than 40 graduate students and nearly 10 post-docs and while the median of this group finished only in 2003 and so their impact has not yet been fully felt, a very many have gone onto research or clinical leadership positions in the best institutions. This includes Joe Deasy at Memorial Sloan Kettering, Robert Jeraj, Jeni Smilowitz and Michael Kissick into professorships at the UW, Harry Keller at the University of Toronto, Cindy Thomason and Doug Simpkin in Milwaukee, Sam Beddar and James Yang at MD Anderson, Jason Sohn in Cleveland, Nikos Papanikolaou and Alonso Gutierrez at UT San Antonio, Todd McNutt at Johns Hopkins, Ke Sheng Bhudatt Paliwal and Peggy Lescrenier (CEO of at UCLA, and Ryan Flynn at the University of Gammex-RMI) at Carnival following a medical Iowa. Many of my trainees have spent time in or physics symposium in Rio de Janeiro. have devoted their careers to industry where they have likely been even more impactful. These include Tim Holmes, Mark Holmes, Ben Nelms, Michelle Svatos, John Balog, Ken Ruchala, Jeff Kapatoes, Weiguo Lu, Sarah Boswell, and Evan Sengbusch. My philosophy for training students and post-docs is to bombard them with crazy ideas, listen carefully to their crazy ideas, and work with them on what seems most promising. Why crazy ideas? If an idea does not seem crazy to the majority of listeners it is usually not worthy of innovation. Imagine how crazy a smart phone would seem in 1990. Let trainees work at their own pace and encourage them to have fun along the way. For most PhDs their graduate years are the best years of their life. Pushing, prodding and poking them spoils the fun and robs them of independence and creativity. Ironically, most of my students have finished their PhDs faster than most because they were allowed the freedom to work hard or play hard when they wished. I very much appreciate that the AAPM rewarded me in part because of my career working with industry and entrepreneurship. William Coolidge worked for GE for almost 40 years and was the first recipient of this award so there was obviously precedence. I believe that it is becoming more critical for an academic researcher to have ties with industry. More than 80% of the R&D in medical physics is done at companies. Working with and for companies is a great way to have your ideas actualized. Most importantly working with companies will give you friendship with a greater variety of people in your life and I guarantee you that will have more fun. However if you start companies you should at least, if only cautionary, have your head examined!

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Stuart Swerdloff (in suit) and Paul Reckwerdt. Stewart was a co-inventor of the binary collimator and Paul was the co-founder of both Geometrics (which developed Pinnacle) and TomoTherapy. Shown at a wedding reception in Madison.

The most valuable service the AAPM gave me was the opportunity to get involved in committee work. Like all volunteer work committee service is two-way. You help the mission of the society but you in turn get to meet people who are amazing. Many of my closest friends and those I most respect (not mutually exclusive) were met at AAPM committee meetings. Serving on committees is a powerful form of peer review. You are asked to serve because your peers think that you can help share the burdens but are also prepared to share the benefits of membership. My advice for the young is to avoid the long-standing committees until you have lots of experience and patience. Get on the task groups and ad hoc committees that can be a lot more innovative and are less set in stone. Hang around at the end of committee meetings and ask someone to have coffee or a beer. As inherent in its name a meeting is mostly about meeting people and getting to know people better. Science is sometimes best learned over a pint of pale ale. The overt benefits of getting involved in service to the AAPM, doing innovative research, or being an excellent teacher can be substantial. I have been invited to many European and Asian meetings that are a direct result of leadership roles in the AAPM. Being a jet setter on other people’s money is definitely the way to go. It does take a lot of time but remember that the plane rides are for finishing your talks and polishing your arguments. Try to take at least one day off so that you can have fun wherever you are. You will regret not taking that day off to ride the elephants in Thailand. Stay the weekend and visit the Tower of London. Work hard and have fun. To alter a cliché, use the journey and enjoy the destination. Like many recent Coolidge Award recipients I must rise to the bully pulpit – but I will try to

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preach for only a minute. We need to include significant clinical research training for medical physics residencies. This is because a substantial fraction of the work of an outstanding clinical medical physicist involves solving clinical research questions. A way to achieve this is for CAMPEP accreditation to include assessment of research productivity both for the trainers and the trainees. If there is no research going at the institution, accreditation should

A road trip through Provence during the World Congress of Medical Physics and Biomedical Engineering in Nice, 1997. (l to r) Paul Keall, myself, Lois Holloway, Robert Jeraj, Marietta Jeraj, Chantel Audet, and Peter Hoban.

not be granted. If there are no grants to do research the institution should provide research resources and funding or risk losing their accreditation. Medical physics has to expand beyond radiation oncology and radiology into biophysics and other forms of biomedicine (e.g., pathology, surgery, microscopy, etc.). To reflect this perhaps the AAPM should rename itself the “Worldwide Association of Physical Scientists and Engineers in Medicine and Biology” (WAPSEMB – pronounced “wap-sembee”). Perhaps not but the AAPM is becoming a worldwide association and it needs to expand into other biomedical fields where physical scientists and engineers can provide clinical and research leadership. As my 7 minutes are nearly up I propose that in the future we need to allot more time for Coolidge Award speeches at the Awards Ceremony. I could not have achieved success in my career without the support of my wife Pamela and my four children; Tom, Peter, Jack and Jessica. My wife stayed at home to raise our kids and has sacrificed a career for us. I will be retiring as an academic at the end of the year but I will continue to work with some medical physics startup companies. I will reserve much more time for Pam and I to pursue the arts and to travel.

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My family stopping off in Banff Alberta on a road trip to the Vancouver AAPM Summer School on Teletherapy in 1996. (l to r) Tom, myself, Peter, Jack, my wife Pamela and Jessica.

Finally, I sincerely thank all of you; my colleagues, former trainees, current students, family and friends alike. I would not be on this podium without your help and support.

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TG 100 FAQs

TG 100: Frequently Asked Questions M. Saiful Huq (Chair)

Benedick Fraass

Arno Mundt

Frank Rath

Ellen Yorke (Vice Chair)

John Gibbons

Sasa Mutic

Bruce Thomadsen

Geoffrey Ibbott

Jatinder Palta

Jeffrey Williamson

Peter Dunscombe

What is TG100? TG 100 is a task group that was formed officially in 2003. Its charges are the following: i) Identify a structured systematic QA program approach that balances patient safety and quality versus resources commonly available and strike a good balance between prescriptiveness and flexibility and ii) After the identification of the hazard analysis for broad classes of radiotherapy procedures, develop the framework of the QA program. Why do we need to change the way weâ&#x20AC;&#x2122;re doing things? Traditionally weâ&#x20AC;&#x2122;ve approached quality and safety in a device centric manner. However, many recent studies of safety in radiation therapy show that the clinical processes we engage in have at least as much impact on patient outcome as the equipment we use. In fact, the majority of radiotherapy misadministrations happened because of failure in a clinical process. Hence, properly managing quality and safety requires us to take an integrated approach covering both clinical processes and equipment QA. Once the TG 100 report comes out, are previous prescriptive documents from the AAPM, such as TG 40/142, obsolete? The short answer is no. The methods discussed by TG 100 provide a different, more comprehensive approach to the management of quality and they will ultimately influence quality measures in the clinic including equipment quality control and quality assurance. However, as we transition to this new way of working it is vital that we all stay well within our comfort zones and that will 42

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almost certainly mean that changes to current practice be made in an incremental and thoughtful fashion. Are we the first area of medicine to go down this path of prospective risk assessment? Not by a long way. For example, the Joint Commission requires that an institution carry out two risk assessments, such as Failure Modes and Effects Analyses, each year. If our colleagues in other branches of medicine have figured out how to do it routinely and efficiently then we should be able to as well. Prospective risk assessment looks very complicated and seems to entail a huge resource commitment. Can we really cope with this on top of our heavy clinical workload? It’s true that some resources may have to be diverted from other activities to deal with this new paradigm. However, it is not necessary to start with risk assessment of all department processes – TG100 suggests starting with small-scale processes involving a few dedicated individuals. For large-scale processes, although the learning curve can be steep, most experience suggests that once you get into it, and the multidisciplinary team is working well together, an FMEA can go quite quickly ((Ford et al. http://dx.doi.org/10.1118/1.4875687)). Will TG 100’s approach solve all our problems? In a word, no. We know that FMEA will not predict everything that can go wrong (Yang et al. Med Phys 41 (2014) 434 (abstract)). There is no way of guaranteeing perfect quality and safety. However, it is widely recognized in high reliability industries that prospective risk assessment should be an important pillar of any quality management program. Apart from being able to develop a more comprehensive quality management program are there any other benefits of adopting prospective risk assessment methodologies? Process Mapping, Failure Modes and Effects Analysis and Fault Tree Analysis are most effective when conducted by a multidisciplinary group. If you adopt the multidisciplinary approach you’ll find communication between members of your clinical team will be greatly enhanced. Effective communication across disciplines is a very important dimension of a safety culture. Is anyone going to help us to move to this new paradigm or are we on our own? The higher echelons of the AAPM are actively considering how the Association might facilitate adoption of TG 100. Initiatives include workshops, mentoring and an accessible repository of member developed Process Maps, FMEAs and FTAs. So, no, we’re not on our own. Efforts will 43

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be made to facilitate the transition to prospective risk assessment as means of managing quality in a resource constrained environment. And, finally, where’s the report? We’ve been hearing about TG 100 for a decade and have yet to see the final product. You’re right. TG 100 has been around for a long time. The first version of the report was finished about six years ago. Since then, it’s been reviewed, very comprehensively, by many different AAPM committees and councils: the working group and sub-committee within the Therapy Physics Committee, the Therapy Physics Committee, Professional Council and Science Council. After each review, recommendations had to be incorporated. It’s only right that such a significant change in the way we go about our business should be considered in great depth. However, we do now see light at the end of the tunnel. It is our intention to generate a final version by the end of August (yes, this year!). After that we will ready to enter the pathway to publication.

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Image Wisely® Safety Case

Donald J. Peck, Detroit , MI

New Image Wisely Radiation Safety Case on Technical Errors and Image Quality in Digital Radiography, Now Available ®

Reston, Va. (August 6, 2014) — The fourth Image Wisely® Radiation Safety Case — Technical Errors and Image Quality in Digital Radiography — is now available to help radiologists, imaging technologists and medical physicists to assess their understanding of important radiation safety concepts — including dose monitoring and optimization. This is the latest in a series of free, online and mobilecompatible educational offerings, developed with the assistance of the American College of Radiology (ACR). “Significant, but not insurmountable challenges were introduced during the transition from screen-film to digital radiography, including concerns about poor image quality and unnecessary patient radiation exposure. Because digital X-ray systems are so tolerant of over- and under-exposure it is critical that imaging professionals review the quality of the image in conjunction with the default settings used. This case is helpful because it presents critical technical parameters to evaluate when assessing image quality and radiation dose in digital radiography,” said Charles Willis, PhD, the case author. Six radiation safety cases are presented throughout the year. Case content includes embedded questions that provide expert feedback as well as references and resources for further study. Continuing education credit for radiologists, imaging technologists and medical physicists is available. “Radiation is an invaluable diagnostic resource, and attention to its appropriate use is paramount to patient safety,” said Donald Peck, PhD, director of the Image Wisely Radiation Safety Case series and member of the Image Wisely Executive Committee. “Imaging professionals are encouraged to complete these free radiation safety cases to reinforce their knowledge on these important topics.” The fourth case, Technical Errors and Image Quality in Digital Radiography, offers a total of 45

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0.5 AMA PRA Category 1 Credits™; 0.5 MPCEC credits by the Commission on Accreditation of Medical Physics Education Programs, Inc.; and 0.5 Category A credits of the American Registry of Radiologic Technologists. Image Wisely is an initiative of the ACR, the Radiological Society of North America, the American Association of Physicists in Medicine and the American Society of Radiologic Technologists with the objective of lowering the amount of radiation used in medically necessary imaging studies and eliminating unnecessary procedures. Image Wisely offers resources and information to radiologists, medical physicists, other imaging practitioners and patients. For additional information about Image Wisely, visit imagewisely.org. To speak with an Image Wisely spokesperson, contact Heather Williams at 703-390-9822 or PR@acr.org.

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Literature Quanta

Nikko Papanikolaou, San Antonio, TX

This new section in the AAPM Newsletter is facilitated by Dr. Niko Papanikolaou and serves as a quick read of notable clinical and research papers published in the past three months.

A Report of WGIMRT Planning for adaptive radiotherapy In general, all adaptive planning methods are either online or offline. Taoran Li et al. reported an automatic fast 2 minutes online re-optimization approach for prostate IMRT, using a clinical commercial treatment planning system. They studied the effectiveness of the method by changing a few parameters, including DVH objective settings, starting stage (initial optimized fluence maps) and iteration numbers. It is concluded that “excellent coverage and conformity to the daily target” are obtained by the proposed fast online re-optimization technique. Peng Ji et al. reported an offline adaptive planning technique for prostate + pelvis lymph nodes IMRT treatment. The main issue addressed in this paper is how to account for independent movement of prostate target and pelvis lymph nodes (PLN) targets, in offline adaptive planning. The authors used an expanded version of their previous method – MAP (Multiple Adaptive Planning). For each simulated patient, 9 MAP-IMRT plans are developed to account for simulated prostate/PLN movement in both A-P and/or S-I directions. One of these 9 plans will be applied as an offline adaptive plan, based on collected CBCT images. The conclusion is “the MAP strategy with nine IMRT plans to accommodate the prostate motions in two major directions achieved good dose coverage to the prostate and PLNs”. Zarepisheh et al. recently proposed an interesting optimization approach on ART (adaptive radiotherapy) re-planning. The main idea is that to use a good reference plan DVH as the guidance, and then the proposed algorithm would adjust weights assigned to voxels (this could be a very large scale optimization), and thus generate a plan that is better than or as close as possible to the reference plan, in term of DVH merit (or on a Parento surface). Authors were able to prove the concept in three clinical IMRT cases (prostates and head neck), by implementing the method in GPU based computing for faster optimization. One potential limitation of the method is local minima due to DVH being high degenerate with respect to dose voxel spatial distributions. This was partially resolved by forcing permutation of dose 47

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values corresponding to the same DVH. Multi-criteria treatment planning Alexander Schlarfer et al. reported a study on “how to consider spatial dose distribution using a multicriteria optimization approach”. Note that this study extends multi-criteria optimization beyond its conventional means of including only DVH based constraints and/or simplistic dose statistics. Instead, they used a software tool trying to communicate with the optimization engine about desirable 3D dose distribution in localized critical space/area – such as rectal wall sparing from target volume. It is reported “the approach facilitates a systematic exploration of the optimal shape of the dose distribution”. David Craft et al. reported a new method to average multiple optimal Pareto surface plans (IMRT or VMAT) so that the averaged plan will deliver a dose distribution very close to the average dose that would be delivered by original Pareto optimal plans. The result is very useful in clinical implementation of multi-criteria optimization, where typically multiple Pareto plans are to be evaluated and sorted. General plan optimization Taewoo Lee et al. reported a work on optimizing objective function weights for prostate IMRT cases. This is really a technique to optimize an objective function itself, which is to be optimized by TPS. It demonstrates a “proof of concept” that such objective function weights can be optimized for itself, if given certain patient geometrical information (anatomy). David Papp and Jan Unkelbach reported a new direct leaf position optimization technique for VMAT. The method breaks a single 360 degree VMAT into 20 small arc segments, which are optimized for direct leaf movement. It is found that this method will be able to generate comparable or better (than IMRT plans) if treatment time can be allowed for 3-4 minutes. PMB has two papers on this topic. Grelewicz et al. challenge the concern over the excess kV imaging dose cost to the patient when imaging in continuous fluoroscopic mode with IGRT. They investigated the use of convex optimization tools to optimally integrate the excess kV imaging dose in real-time kV intrafractional tumor tracking into the MV therapeutic dose. Deufel et al. presented a QA method to verify that optimization results for HDR optimized brachytherapy plans are reasonable. Results from the simple optimization that the authors developed as the QA technique, are surprisingly similar to the results from the complex, commercial optimization solutions for several clinical cases that were tested.

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IMRT Quality Assurance Pulliam et al. reported on the “Comparison of 2D and 3D gamma analyses”, Med. Phys. 41(2), 021710-1. For many plans, dose distributions calculated with two different calculation algorithms are compared using both 2D and 3D gamma analyses. 3D gamma analysis is found to produce higher passing rates. When evaluating indices to include in updates to TG-119, it may be valuable to consider benchmarking 3D gamma pass rates, since there currently do not exist broad recommendations for using such indices. The mere fact that many more points are included in a 3mm radius sphere than are included in a 3mm radius circle should indicate a consistently higher pass rate for the 3D methodology. Markovic, et al. reported on the “Characterization of a two-dimensional liquid-filled ion chamber detector array used for verification of the treatments in radiotherapy”, Med. Phys. 41 (5), 051704-1. This is an evaluation of PTW Octavius 1000 SRS array, liquid filled ionization chambers, spanning over a 10x10 field size. Found to be accurate and useful for patient specific measurements. Possible device to be benchmarked in a TG-119 update. Stambaugh, et al. reported on the “Evaluation of semi-empirical VMAT dose reconstruction on a patient dataset based on biplanar diode array measurements”, JACMP 15 (2), 169-180 Measurements using Delta4 were used to calculate or interpolate volumetric dose distributions in patient and compared with a similar procedure using 3DVH and ArcCheck. Bedford, et al. reported on the “Portal dosimetry for VMAT using integrated images obtained during treatment”, Med. Phys. 41 (2) 021725-1. Dose through phantoms was projected to EPID, integrated images expected for VMAT treatments calculated. In vivo dosimetry interesting, but accuracy remains questionable. Agnew, et al. reported on the “Monitoring daily MLC positional errors using trajectory log files and EPID measurements for IMRT and VMAT deliveries”, Phys. Med. Biol. 59 (2014) N49-N63. The average positional deviations of MLC leaves are recorded in MLC dynalog files and recorded in addition via EPID measurements. Deviations are very small (<0.01 mm) when comparing the two methodologies. McCaw, et at. reported on the “Development and characterization of a three-dimensional radiochromic film stack dosimeter for megavoltage photon beam dosimetry”, Med. Phys. 41 (5), 052104-1. Radiochromic film was placed in planes separated by 1mm. Measured and calculated doses were compared and the method was shown to provide a viable 3D comparison. Li et al. reported on the “Two-dimensional high spatial-resolution dosimeter using europium doped potassium chloride: a feasibility study”, Phys. Med. Biol. 59 (2014) 1899-1909. This is a new thin OSLD film material for 6MV dosimetry (KCL:Eu2+) providing sub-millimeter 49

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spatial resolution with a large dynamic range (0.01cGy minimum dose, 500Gy maximum dose). Glaser et al. reported on the â&#x20AC;&#x153;Video-rate optical dosimetry and dynamic visualization of IMRT and VMAT treatment plans in water using Cherenkov radiationâ&#x20AC;?, Med. Phys. 41 (6) 062102-1 The total number of Cherenkov photons emitted per unit mass in water is proportional to the number of secondary electrons, and therefore dose. Cherenkov radiation is measured for a C-shape IMRT plan using a real-time integrated video technique in a 2D plane. Gamma analysis shows good results.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Important Announcement Regarding RSNA 2014:

AAPM HEADQUARTERS HOTEL CHANGE AAPM’s Headquarters will now be housed at

The Hyatt Regency Chicago 151 E. Upper Wacker Drive Please make note and consider this change in venue when making your hotel reservations for 100

RSNA 2014 th

November 30 – December 5, 2014 Chicago, IL

AAPM meetings and annual reception will be held at the Hyatt Regency Chicago. AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE | WWW.AAPM.ORG

New Disposal Options for Sealed Sources

Russ Meyer, CRCPD Technical Assistant

SCATR Provides New Disposal Options for Unwanted Sealed Sources The Conference Radiation Control Program Directors (CRCPD) Source Collection and Threat Reduction (SCATR) Program will begin its 2014-2015 disused and unwanted radioactive sealed source collection and disposal effort in October 2014. CRCPD/SCATR provides costshared support for the packaging, transport, and disposal of Class A, B, and C sources with access to a commercial disposal facility. Licensees in all 50 States and U.S. territories are potentially eligible for program participation. The Source Collection and Threat Reduction (SCATR) program is a cooperative arrangement between CRCPD and the Global Threat Reduction Initiative/Offsite Source Recovery Project (OSRP) of the Department of Energy’s (DOE) National Nuclear Safety Administration, and has been in operation since 2007. Its primary purpose continues to be the reduction in the numbers of unwanted, sealed sources stored at facilities throughout the U.S. via disposal at commercial disposal sites. The program allows for radiation control agencies, users’ groups, or in some cases manufacturers to organize a collection effort in coordination with the CRCPD. For the majority of collections, however, CRCPD with the assistance of the states involved organizes and provides financial assistance for all collection efforts under this program. Until April 2012, only 14 states had access to low-level radioactive waste compact disposal sites for class B and C low level radioactive waste. These states thus defined the niche in which SCATR worked. Between 2007 and 2014 the SCATR program collected 6817 sealed sources from the 14 sited states. In April of 2012, Waste Control Specialists (WCS), operator of the Texas-Vermont Low-level Radioactive Waste (LLRW) Compact disposal site, was issued a license to accept waste. The license also allows WCS to accept LLRW from out-of-compact states. Now all fifty states and U.S. territories have a place to dispose of their LLRW. Upon completion of its most recent collection, which is being conducted in 28 states across the U.S. in 2013-14, the CRCPD projects it will have collected and disposed of approximately 7,000 additional, sealed sources. CRCPD is anticipating a new collection in 2014-15 which will target all states. To encourage participation, the DOE thru the CRCPD will offer financial assistance by paying 45% of the total cost of disposal of a participating facility’s unwanted sources. If a facility is located in a state that belongs to a compact that has an operating LLRW disposal site, the CRCPD will pay 52

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50% of the total cost of disposal. Additional information about the new collection can be found on the CRCPD’s web site under the heading New Opportunities for disposal. CRCPD encourages facilities that have unwanted sealed sources and sealed or sources of radium-226 to register those sources with OSRP now. Registration is a prerequisite for participation in the SCATR program. Facilities in both “sited” and “un-sited” states can download a registration form for unwanted sealed sources from GTRI’s Off-Site Recovery Program at here. The email address is provided on the form for return once it is completed. Registrants will normally receive and acknowledgement of registration in a day or two of emailing the form. If you have questions please contact Russ Meyer, CRCPD’s Technical Assistant, by telephone at 512-761-3822 or email at rmeyer@crcpd.org.

AAPM Newsletter | Volume 39 No. 5 | September/October 2014

Person in the News

Radiology Leadership Institute Leadership Luminary Award

ichard L. Morin, PhD, FACR received the Radiology Leadership Institute (RLI) Leadership Luminary Award on Thursday, August 7, 2014 at the RLI Leadership Summit. The award is the highest honor of the RLI. Dr. Morin is the 1st Medical Physicist to receive this honor.

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End of this issue.