AAPM Newsletter November/December 2014 Vol. 39 No. 6 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 NOVEMBER/DECEMBER 2014 Volume 39 No. 6

Volunteers Wanted: “FOR HAZARDOUS JOURNEY. SMALL WAGES, BITTER COLD, LONG MONTHS OF COMPLETE DARKNESS, CONSTANT DANGER, SAFE RETURN DOUBTFUL. HONOUR AND RECOGNITION IN CASE OF SUCCESS.” Outgoing AAPM COB John D. Hazle calls for volunteers and praises volunteerism despite the sacrifices it requires.

Updates on the ABR Medical Physics Oral Examination (Part 3) n Report on Recent Notable Clinical and Research Papers on IMRT n ACR Accreditation FAQs n How We Choose Our Leadership: The AAPM Election Process and more...

AAPM

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

EDITORIAL BOARD EDITOR Mahadevappa Mahesh, MS, PhD

Johns Hopkins University E-mail: mmahesh@jhmi.edu Phone: 410-955-5115 John M. Boone, PhD 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 bi-monthly. Next issue: January/February Submission Deadline: December 12, 2014 Posted Online: Week of January 5, 2015

www.AAPM.org

CONTENTS NOVEMBER/DECEMBER 2014 Volume 39 No. 6

Articles in this Issue

Events / Announcements

Chairman of the Board’s Column

2015 AAPM Spring Clinical Meeting

AAPM Executive Director’s Column

AAPM Evening Reception at RSNA

Editor’s Column

Upcoming AAPM Meetings in 2015

Education Council Report

57th Annual Meeting & Exhibition

Health Policy and Economic Issues

AAPM Headquarters Hotel Change

ABR News

Hands-on Workshop on Radiation Safety

ACR Accreditation FAQs

The Dream Summer Program

Professional Council Column

Working Group Report

Summer Undergraduate Fellowship Program COMP / OCMP CanadianWinter School

Ad Hoc Committee Report

2015 AAPM Summer School

Literature Quanta

Joint Workshop Report

Website Editor’s Report

AAPM / IOMP Report on Used Equipment Donation

30 31 35

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

Chairman of the Board’s Column

John D. Hazle, Houston, TX

“MEN WANTED: FOR HAZARDOUS JOURNEY. SMALL WAGES, BITTER COLD, LONG MONTHS OF COMPLETE DARKNESS, CONSTANT DANGER, SAFE RETURN DOUBTFUL. HONOUR AND RECOGNITION IN CASE OF SUCCESS.”

n this, my swan song Newsletter article as a member of the AAPM Leadership Team, I wanted to address our most prized asset – our volunteers. The advertisement above was posted by Sir Ernest Shackleton in a London newspaper to recruit the crew for his famed 1914 Imperial Trans-Antarctic Endeavor Expedition. 28 men ultimately embarked on that expedition, and with the inclusion of a stowaway in Argentina, 29 men set forth to cross the Antarctic continent. In short, they failed miserably. Their ship was caught in the ice floe within months and sank. However, the following 16-month tale of the Endeavor expedition is perhaps one of the most compelling stories of accomplishment in human history. These men not only survived on an ice floe for almost a year an a half, but a subset of them had to accomplish almost unimaginable feats of sailing and survival, crossing some of the most treacherous waters on the planet in a 22 foot boat with only a sextant for guidance. The course they had to navigate to safety required a precision of less than 1 angular second of accuracy – I think we can all appreciate the parallel to modern radiation oncology! So, what the heck does this have to do with Medical Physics and AAPM. Well, let’s start with the advertisement. This is basically representative of the ad that AAPM places every year when we call out for volunteers. No pay. Hard work. Constant struggle. No guarantee of success. The honor of serving your peers is your reward. I can tell you that after three and a half years in the executive chain, leading this organization is one of the most fulfilling jobs I have ever had and one of the highest honors attainable in our profession. To see the commitment of the vast majority of our member volunteers energizes all of us in AAPM leadership – from EXCOM to Council Chairs to Committee/TG leaders – because we want to support the efforts of our peers and see their hard work translated into valuable endpoints. We must never underappreciate the power and value of volunteerism. 3

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

While the vast majority of our members do appreciate the effort of those who volunteer for the organization, there is a very small cohort that don’t and who are quick to criticize those who do. I want to address this briefly. These are the folks who are quick to write diatribes, sometimes lengthy and occasionally vitriolic, about how AAPM volunteers aren’t doing what is, in their opinion, best for the organization. What I have found over the last three years is that these people typically, but not always, have done little to enhance AAPM and our profession by volunteering themselves. They consider it their right to criticize those who are volunteering because they have simply paid their dues. Well, dues are important no doubt, but they would be meaningless without the volunteers to put these dollars to good use. So, my challenge to you – and you know who you are – is that the next time you get ready to write that flaming bulletin board post about how so-and-so is doing something you don’t like, ask yourself what have you done to give you the right to criticize them? I think if you genuinely do that, and consider that these members are volunteering their time to AAPM, then you will be more sensitive about how you address your peers. Somewhat like Shackleton’s Expedition, my tenure in the AAPM leadership chain started with great aspirations for doing good things, but that energy was quickly redirected to protecting the organization from a major threat – a lawsuit that could not only affect our ability to do our business, but also impact our long term financial welfare. I am glad to say that because of the effort of many of people (shout out to Gary Ezzell), and clear vision by the Board, we were able to successfully navigate that challenge and reach as positive a result as possible for the organization. We learned from that and are taking measures to further insulate the organization from future threats like these. However, we must all realize that nothing significant can be gained. If we reduce our risk to zero – that means that we do nothing! There will always be risk, so our goal must always be to manage it against the potential rewards. I am also proud of several accomplishments of the organization during my time in the leadership chain. One that I would like to highlight is the development of additional imaging residency programs in collaboration with the Radiological Society of North America (RSNA). This accomplishment is important not just because it addressed a real and immediate need – more imaging residency programs to meet manpower projections – but because it demonstrated the outstanding relationship we enjoy with RSNA and that AAPM volunteers are able to achieve goals when we need to. Not only did RSNA provide significant financial support, but their leadership stepped up to the plate and participated through the giving of their time in the process. The selection team led by Bob Pizzutiello included Reed Dunnick and George Bissett (both past-RSNA Presidents). They met timelines for initiation that were considered uber-aggressive (and unattainable by some). This group rose to the occasion and completed their tasks on time! This is just one example of the strategic partnership we have with RSNA. They continue to support the partnership with AAPM to a degree that should be the standard for how we interact with our peer societies. The AAPM leadership is working to replicate this partnership with other strategically aligned organizations and they are making good progress on this front. 4

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Another activity critical to the future of the organization is a decision on where our Headquarters will be for the next 20 years. Our current lease for space in the American Center for Physics (ACP) building is up at the end of 2015. The decision to remain in the greater DC area has been made – it’s as good as anywhere and our staff retention is expected to be high if we move from the current ACP. Angela Keyser and I are leading a Presidential ad hoc committee to carefully weigh options and make a recommendation to the Board for how to move forward. The three options are staying at ACP with a renegotiated lease, leasing space elsewhere or purchasing space. Because of the sensitive nature of real estate transactions, you won’t be hearing much more about this until the Board decides how to proceed at the RSNA meeting. However, rest assured that the Board will be fully informed and will deliberate in depth on this strategic decision. In conclusion, I want to thank many people for the support they provided me in meeting the obligations of the last three years. First, the AAPM HQ staff for their highly professional support of the organization, and me. From Angela on down, they are a “dream team” to work with! A more dedicated group will be hard to find. To all you volunteers – over 2,000 strong – THANKS and keep up the good work!!! This organization is really YOU and it has been an absolute honor to have worked with so many of you. To the Executive Committee of the last three years – it’s been a ride! The comradery and commitment of this group is really unbelievable. It has been great working with each and every one of you!!! To the University of Texas M.D. Anderson Cancer Center, for not only giving me the time to fulfill my obligations to AAPM, but for encouraging me to do so. That goes double for our previous President, John Mendelsohn, who encouraged me to run. Thanks to the faculty of the Department of Imaging Physics. My only concern here is that they were able to make it an even stronger department while I was otherwise engaged! Your accomplishments of the last few years are a testament to the commitment you all have to our department, our institution and our profession. To my Assistant of over 20 years, Deanna, and our department administrator, Mai. Without you two I couldn’t have kept all the balls in the air the last three years! Finally, to my family. The time dedicated to AAPM not only took away from my work, but it meant I didn’t get to spend as much time with them. To Madeline for letting me do this tour of duty during her final years of high school and first year of college – go Badger swimming! To Grant, thanks for understanding when I missed games – I can’t wait for college ball! And the most special thanks to my wife Debbi – a working mother who runs her own business 5

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– for supporting, understanding and filling in for me when I couldn’t meet my half of the obligations to our family.

Save the Date!

AAPM2015 SCIENTIFIC EXCELLENCE

57 Annual Meeting & Exhibition July 12–16 • Anaheim, CA th

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Executive Director’s Column

Angela R. Keyser, College Park, MD

Your Online Member Profile This is a reminder to keep your AAPM Membership Profile information up-to-date by visiting your AAPM Member Profile Page and making any changes necessary. Please, upload your picture if you have not already done so. Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy.

AAPM Events During RSNA 2014 REMINDER! AAPM’s Headquarters during the RSNA meeting will now be housed at: The Hyatt Regency Chicago located at 151 E. Upper Wacker Drive. AAPM Committee Meetings and the Annual Reception will be held at the Hyatt. Make plans to join your colleagues on Tuesday, December 2 from 6:00 PM – 8:00 PM for the Annual AAPM Reception. Special thanks to Landauer and RTI Electronics for their financial contributions to offset the costs for this event. Visit AAPM at Booth 1111 in McCormick Place - South Building - Hall A to charge your mobile devices! Pick up information on association programs, the current list of AAPM publications, and complimentary copies of Medical Physics as well as check out the recent advancements in the AAPM Virtual Library. The most up-to-date schedule for AAPM meetings during RSNA 2014 is available online.

New AAPM Reports The following reports are now available on the AAPM Reports list: • AAPM TG Report 220 “Use of Water Equivalent Diameter for Calculating Patient Size and Size-Specific Dose Estimates (SSDE) in CT” • AAPM TG Report 192 “AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy” 7

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Upcoming 2015 Meetings - Mark Your Calendar Now! AAPM will host a hands-on workshop on Incident Learning Systems and Root Cause Analysis for Safer Radiation Oncology on February 12–13 at the University of California, San Diego. The Spring Clinical Meeting is scheduled for March 7–10 at the Hyatt Regency St. Louis at the Arch in St. Louis, Missouri. The 2015 Summer School, Proton Therapy: Physical Principles and Practice, will be held June 14-18 at Colorado College in Colorado Springs, Colorado. The 57th AAPM Annual Meeting & Exhibition will be held July 12–16 at the Anaheim Convention Center in Anaheim, California Details will be online very shortly so stay tuned to email announcements!

2015 Dues Renewal: 2015 dues renewal notices were distributed in early October. You may pay your dues online or easily print out an invoice and mail in your payment. Twenty-one AAPM Chapters have elected to have HQ collect chapter dues. Make sure to check if your chapter is participating. If it is, we hope that you will appreciate the convenience of paying your national and chapter dues with one transaction!

AAPM’s Headquarters Team I firmly believe that part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of highly performing association management professionals. The years of service documented below is very telling; the AAPM HQ team is very committed to serving the AAPM membership. The following AAPM team members have celebrated an AAPM anniversary in the last half of 2014. I want to publicly thank them and acknowledge their efforts. Lisa Rose Sullivan Penny Slattery Michael Woodward Farhana Khan Yan-Hong Xing

21 years of service 18 years of service 18 years of service 16 years of service 8 years of service

Tammy Conquest Corbi Foster Jackie Ogburn Janet Harris Abby Pardes

7 years of service 7 years of service 7 years of service 2 years of service 1 year of service

The AAPM Headquarters office will be closed Thursday, November 27 – Friday, November 28, Thursday, December 25 – Friday, December 26 and Thursday, January 1 – Friday, January 2. I wish you and your loved ones a happy and healthy holiday season.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Editor’s Column

Mahadevappa Mahesh, Baltimore, MD

From the Editor’s Desk

elcome to the final issue of the 2014 AAPM Newsletter. This is the 12th issue delivered through digital platform (since 2013), including mobile devices. The transition to the new format has gone smoothly and I have received favorable remarks from those who regularly access the Newsletter, but there is always room for improvement and I encourage all readers to send any suggestions/comments. Before I realized it, the time had come for me to work on my last Editorial column for this year. This Newsletter issue contains several regular articles including the cover page that aptly captures the topic of the outgoing Chairman of the Board, Dr. John Hazle’s, article on “Call for Volunteers.” Along with the regular featured articles, I would like to draw your attention to the Ad Hoc Committee report on “How We Choose Our Leadership: The AAPM Election Process” and the ABR Physics Trustees report on “Update on the ABR Medical Physics Oral Exam.” For those planning to attend the RSNA meeting, please note that the AAPM Headquarters Hotel has moved to the Hyatt Regency Chicago, a hotel which is closer to the Michigan Street ‘Magnificent Mile’. As this is the last issue of the year, I would like to thank all of the Corporate Affiliates who continue to support the Newsletter and its new platform as we continue to strive to provide a greater opportunity for the Affiliates to reach out to the readers. In addition, I would like to thank Nancy Vazquez, for all of her work on the Newsletter, Farhana Khan for facilitating the posting of each issue on the AAPM website throughout the year, and Al Tokel of NeoPromo Media Group as well as his staff with whom we contract to format and deliver the Newsletter. I would also like to express my sincere thanks to Angela Keyser, Michael Woodward, the Headquarters Staff and the Newsletter Editorial Board for their support and timely advice. Last but not least, sincere thanks goes to my wife and kids for their cooperation with this task. As this issue arrives to your desk, we are entering the holiday season and I wish you and your family Happy Holidays.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

THE AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

cordially invites you to attend the

AAPM Tuesday Evening Reception at RSNA during the 2014 AAPM / RSNA Meeting Tuesday, December 2, 2014 • 6:00 pm – 8:00 pm Crystal Ballroom BC, Hyatt Regency Chicago • Chicago, Illinois

light hors d’oeuvres AAPM gratefully acknowledges the following sponsors for their contribution to this reception:

SAVE THE DATE!

March 7–10, 2015 • Hyatt Regency St. Louis at the Arch • St. Louis, MO th Registration and Housing Open December 4

SPRING CLINICAL MEETING www.aapm.org/meetings/2015SCM 10

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

2015 Mark Your Calendar for These Upcoming Meetings FEBRUARY 12–13 Incident Learning Systems and Root Cause Analysis for Safer Radiation Oncology

MARCH 7–10

Incident Learning Systems and Root Cause Analysis for Safer Radiation Oncology: A Hands-on Workshop University of California | San Diego, CA www.aapm.org/meetings/2015ILS/

AAPM Spring Clinical Meeting Hyatt Regency St. Louis at the Arch | St. Louis, MO www.aapm.org/meetings/2015SCM/

JUNE 14–18

Proton Therapy: Physical Principles and Practice Colorado College | Colorado Springs, CO www.aapm.org/meetings/2015SS/

JULY 12–16

AAPM 57th Annual Meeting & Exhibition Anaheim Convention Center | Anaheim, CA www.aapm.org/meetings/2015AM/

AAPM | One Physics Ellipse, College Park, MD 20740 301-209-3350 | 2014.aapm@aapm.org | www.aapm.org

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Education Council Report

George Starkschall, Houston, TX

Private Practice Residencies

everal years ago, the medical physics community faced a crisis. The American Board of Radiology (ABR) had mandated that effective with the examination year 2014, all candidates for the certifying examination in any of the branches of radiological physics had to have completed a CAMPEP-accredited residency program. At the time the requirement was set, we did not know how many residents we needed to train to meet the needs of the job market, but we knew that the number of accredited residency programs we had at that time was not sufficient to meet the job needs, whatever those numbers were. Since that time, we have tried to obtain a better understanding of the job market, and even more important, encouraged the establishment of residency training programs. At of the time of this writing (October 1, 2014), we have 84 therapy physics residencies that have either been accredited by CAMPEP or in the process of achieving accreditation, 13 imaging physics residencies, and 2 DMP programs. With an estimated goal of producing 125-150 new therapy physicists per year and 25-30 imaging physicists per year, we are making good progress towards meeting what we perceive to be our professional clinical staffing needs. In the process of encouraging the development of residency programs, however, we have uncovered another issue â&#x20AC;&#x201C; one that we have discussed in a previous Newsletter article. Many academically-based residency programs only accept individuals with PhD degrees. In some cases, this is due to an institutional policy consistent with requirements of graduate medical education programs that mandate that participants hold the highest academic degree for that discipline, which is the MD for physicians and the PhD for physicists. In other cases, the choice is that of the program, which may express a preference for training medical physicists who intend to pursue academic careers. Whatever the reason, there appear to be more residency opportunities for graduates of PhD programs than there are for graduates of MS medical physics programs. It is our belief that one way to address this imbalance is for private medical physics practices to offer residency opportunities. In the past, it was not uncommon for a private medical physics practice to fill a staff vacancy by taking a graduate of a medical physics educational program and providing that individual with on-the-job training. As the candidate acquired medical physics practice skills, the individual could be awarded increasing responsibility until the individual reached such a point 13

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

that they were prepared to take their ABR certification examination. Passing the examination would demonstrate the ability to work independently. In order for a practice to convert such on-the-job training to a residency training program, the practice needs to formalize the training program and document the training. A large number of physicists in private practice hold MS degrees and, based on the principle that like begets like, are more likely to be favorably inclined to recruit MS physicists into their residency programs. If more private medical physics practices were to establish residencies, this would provide more opportunities for graduates of MS programs, who, incidentally, are those individuals who are more focused on a clinical, as opposed to academic, career. Several arguments have been presented that may discourage a private practice from taking on a resident, but, in my opinion, all of these arguments can be overcome. The first argument is that a private practice may not have the breadth of procedures required for residency program. The CAMPEP Standards for Accreditation of Residency Educational Programs in Medical Physics identifies a rather long list of procedures with which a medical physicist trainee needs to become familiar as a prerequisite for taking the certification examination, and some of these procedures may be found only in large, academic medical centers. A private practice, however, can resolve this shortcoming by affiliating with a larger academic program via what we have termed a â&#x20AC;&#x153;hub-and-spokeâ&#x20AC;? arrangement. With a hub-and-spoke the resident can receive the bulk of training at the private practice spoke, and receive the training in the specialty procedures at the large practice hub. AAPM Report 133, Alternative Clinical Training Pathways for Medical Physicists, discusses the hub-and-spoke arrangement, and even provides a sample of an affiliation agreement between a participating hub and a spoke. A second argument that a private practice may have against establishing a residency program is that, although the practice may have the resources to provide the clinical training for a resident, the practice may not have the resources to administer such a program. The cost of developing an infrastructure to support a single resident is significant, but cost of providing the infrastructure for an additional resident added to an existing program is much lower. The solution again is for the private practice to join with a hub program and use the hub to provide the infrastructure to support the resident. Yet another concern a prospective program director might have is that the prospect of preparing a Self-Study for CAMPEP accreditation is formidable. However, it is not as bad as one might think. CAMPEP has developed a set of standards for residency programs, which are accessible on the CAMPEP website. Preparing a Self-Study simply requires that applicants document for the CAMPEP Residency Education Program Review Committee how these residency standards are met in the residency program. If one is developing a training program, it would be a good idea for a prospective program director to review the CAMPEP standards; the standards identify good practices for a residency training program.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Several resources exist to assist the private practice physicist in preparing a Self-Study. An example of a Self-Study that was developed by a private practice residency is available on the CAMPEP website. This Self-Study could be used as a model for prospective program directors to develop Self-Studies for their own programs. In addition, AAPM is planning to hold a workshop to assist prospective programs in developing a Self-Study, with a focus on private practice residencies. Please pay attention to the AAPM website for more information about this workshop. In conclusion, private practices can contribute greatly to the training of clinical medical physicists by establishing residencies in collaboration with larger institutions via a hub-andspoke model. AAPM encourages medical physicists in private practice to investigate this method for ensuring that our community has an adequate supply of highly-qualified medical physicists. And, as many program directors of private practice residencies can attest, it makes good business sense as well.

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AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Knowing what responsibility means

AAPM 2015 DATES TO REMEMBER DECEMBER 2014

2015 Annual Meeting website activated. View the site for the most up-to-date meeting and abstract submission information. http://www.aapm.org/meetings/2015AM/

JANUARY 21

Web site activated to receive electronic abstract submissions.

MARCH 12 AT 5 PM EASTERN

Deadline for receipt of 300 word abstracts and supporting data. This deadline recognizes other conference schedules. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review.

EARLY MARCH

Meeting Housing and Registration available online.

BY APRIL 20

Authors notified of presentation disposition.

BY MAY 12

Annual Meeting Scientific Program available online.

MAY 27

Deadline to receive Discounted Registration Fees.

For more information, please visit:

www.aapm.org/meetings/2015AM

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

RSNA 2014

100 Scientiﬁc Assembly and Annual Meeting November 30 – December 5, 2014 Chicago, IL th

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

Health Policy/Economic Issues

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

AAPM Submits Comments on 2015 Medicare Proposed Rules AAPM recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the 2015 Medicare proposed rules that apply to hospital outpatient departments, freestanding cancer centers and physician payment. CMS will address public comments in the 2015 final rules, which will be published on November 1st. Read the complete AAPM comment letters to CMS here.

Medicare Hospital Outpatient Prospective Payment System CMS finalized a comprehensive payment policy, effective January 1, 2015, that bundles or “packages” payment for the most costly medical device implantation procedures under the Hospital Outpatient Prospective Payment System (HOPPS) at the claim level. CMS defines a comprehensive APC as a classification for the provision of a primary service and all adjunctive services provided to support the delivery of the primary service. Under this policy, CMS calculates a single payment for the entire hospital stay, defined by a single claim, regardless of the date of service span. The 2015 proposed policy applies to several radiation oncology services including intraoperative radiation therapy (IORT), breast brachytherapy catheter placement and single session cranial stereotactic radiosurgery (SRS) procedures assigned to comprehensive APCs 0067 and 0648. In general, AAPM supports the concept of comprehensive APCs but cautions CMS that focusing on expensive device-dependent procedures initially may preclude expansion and development of future comprehensive APCs. In the comment letter, AAPM suggests that CMS focus on clinically coherent services as the basis for comprehensive APCs. In addition to being clinically coherent, all procedures in a comprehensive APC should also be similar in resource costs. AAPM also advised the Agency that the selection of procedures to include in a comprehensive payment bundle is a complex process best developed through reliance on expert panels. AAPM commented that choosing a bundling benchmark such as “on the same claim” is not a good foundation for a comprehensive payment procedure set. There is ample support in the literature related to comprehensive/bundled payments to support a carefully constructed 18

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procedure or episode of care based approach. A â&#x20AC;&#x153;per claimâ&#x20AC;? approach will lead to confusion, variation in the payments to different facilities based on their claim process and induce incentives for claim timing not in the best interests of payment reform. The comment letter also cited concerns about the proposed complexity adjustment, which seems generally reasonable, but would not apply to comprehensive APCs 0067 Single Session Cranial SRS or 0648 Level IV Breast and Skin Surgery. In summary, the AAPM recommended that CMS reconsider the creation of comprehensive APCs based on clinical coherence, similarity of resource cost, and appropriate complexity adjustment, in a way that does not focus initially on expensive device-dependent procedures.

Medicare Physician Fee Schedule AAPM also provided written comments to CMS regarding the 2015 Medicare Physician Fee Schedule (MPFS) proposed rule. CMS proposes to remove the radiation treatment vault as a direct practice expense input from multiple radiation treatment delivery codes (i.e., 77373, 77402-77416, 77418), producing a significant negative impact on freestanding radiation therapy centers. AAPM advised CMS that a radiation treatment vault should be allocated as a direct practice expense. Given that the radiation treatment delivery codes, which represent 50 percent of radiation oncology allowed charges, have been revalued and the interim final RVUs will be published in the 2015 MPFS final rule, AAPM recommended that CMS delay a final policy decision on the radiation treatment vault until after the 2015 radiation oncology coding changes are implemented. AAPM agrees with the CMS proposal to migrate from film to digital practice expense inputs for radiology and radiation oncology codes and concurs that many of the medical supply and equipment costs associated with film technology no longer apply to typical resource inputs for digital technology. AAPM, however, does not support the CMS proposal to assign a desktop computer as a direct practice expense proxy for the PACS workstation. AAPM encourages CMS to delay the migration from film to digital practice expense inputs until CMS is able to obtain accurate pricing for the PACS workstation to determine the direct practice expense inputs associated with this technology. In addition, CMS proposes to modify the current process to make all changes for new, revised and potentially misvalued codes that is more transparent and allows for notice and comment rulemaking beginning with the 2016 MPFS proposed rule. AAPM advised CMS that it is supportive of a more transparent process that allows professional societies that are not formally part of the CPT and RUC processes (like AAPM) to participate in the notice and comment period during the annual proposed rule as opposed to commenting on interim final RVUs published in the annual final rule. AAPM would strongly support the proposal if the AMA agrees to modify their CPT and RUC processes and timelines to meet the new CMS 19

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deadline. Lastly, AAPM advised CMS of significant concerns regarding the overall proposed reductions to radiation oncology and freestanding radiation therapy centers in the 2015 MPFS. AAPM wrote that, “Cuts of this magnitude could harm cancer care, especially in rural areas, and will negatively impact Medicare beneficiary access to life-saving treatments. Since for many facilities fixed investments of buildings and capital equipment have already been made based on certain pro forma revenue assumptions that CMS proposes to change suddenly, it is almost certain that a cut of this scope and depth in projected operational revenue will immediately and directly result in reductions of expenditures for non-physician clinical labor, of which the Medical Physicist is the highest incremental cost. AAPM is deeply concerned that the loss of substantial necessary Medical Physicist work under the proposal can be expected to result in a decrease in both quality and safety of the radiation services delivered to the patients insured by CMS, an outcome that AAPM would prefer to see avoided.”

SAVE THE DATE! Incident Learning Systems and Root Cause Analysis for Safer Radiation Oncology: A Hands-on Workshop This workshop will provide the participant with the tools necessary to identify and analyze a near miss or medical error in radiation oncology. Radiation oncology is a complex, high technology system where incidents (both events and near misses) inevitably occur in the course of clinical operations. To improve quality and safety, clinics must study these incidents and their causes. Though incident learning and root-cause analysis have proven beneficial, there is presently a lack of understanding and expertise of these tools. This hands-on workshop is designed to address these needs.

FEBRUARY 12–13, 2015 | UNIVERSITY OF CALIFORNIA | SAN DIEGO, CA

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

ABR News

ABR Physics Trustees

Jerry D. Allison

Geoffrey S. Ibbott

J. Anthony Seibert

ABR News of Interest Initial Certification: Updates on the ABR Medical Physics Oral Examination (Part 3) The intent of the oral examination is to test knowledge and fitness to practice applied clinical medical physics in the specified area of expertise. This is achieved by evaluation of the candidate in five physics categories by five examiners, each of whom asks one question from each of the five categories. Each exam period is 30 minutes, with several minutes allowed between examiners. Thus, the exam is 2Â˝ hours in duration. Historically, the five general exam categories for all medical physics disciplines have been as follows: (1) Radiation Protection and Patient Safety (2) Patient-related Measurements (3) Image Acquisition, Processing, and Display (4) Calibration, Quality Control, and Quality Assurance (5) Equipment While these categories provide a full cross section of clinical medical physics areas of practice in each of the disciplines, evaluations of past examinations and feedback from the candidates have revealed some imbalance among the areas of clinical practice in diagnostic medical physics and nuclear medical physics, which are substantially organized by modalities. With reorganization of the categories, a balance across modalities is naturally achieved. The reorganized categories better define deficiencies in the areas of practice. In addition, candidates who conditioned a specific category under the reorganized oral exam category 21

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

scheme in diagnostic or nuclear medical physics have better delineation of the possible areas/ modalities that could be tested during the conditioned oral exam. For the 2015 administration of the oral examination, the medical physics trustees reorganized the oral exam categories for diagnostic medical physics and nuclear medical physics. They maintained the categories for therapeutic medical physics, but with more specific description of therapy content. Further details of the individual categories and specific exam areas are now described on the ABR website. For oral exams beginning in 2015, the major categories are as follows: Diagnostic Medical Physics (1) Radiography, Mammography, Fluoroscopy, and Interventional Imaging (2) Computed Tomography (3) MRI and Ultrasound (4) Informatics, Image Display, and Image Fundamentals (5) Radiation, Dosimetry, Protection, and Safety Nuclear Medical Physics (1) Radiation Protection (2) PET and Hybrids (3) SPECT and Hybrids, Including Gamma Cameras (4) Radiation Measurements (5) Clinical Procedures Therapeutic Medical Physics (Unchanged) (1) Radiation Protection and Patient Safety (2) Patient-related Measurements (3) Image Acquisition, Processing, and Display (4) Calibration, Quality Control, and Quality Assurance (5) Equipment The current oral exam content and questions are being reorganized into the specific categories (mentioned above) and subcategories (described in detail on the website) to achieve a balanced portfolio of questions for 2015 and beyond. All three ABR medical physics oral exam committees are making a substantial effort to ensure the questions regarding clinical medical physics practice are timely, relevant, and up to date. Steps are also being taken to provide a more consistent examination process, with pre-examination discussions among the examiners regarding key components of responses from the candidates and potential follow-up questions. Please be aware that candidates who conditioned the oral exam in 2014 or earlier will continue to be examined in the categories in which they were conditioned. Candidates who are conditioned in 2015 and subsequent years will be examined in the new categories. 22

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Maintenance of Certification (MOC) – Don’t Forget Upcoming Look-backs A few years ago, the MOC process began transitioning to a series of annual look-backs to determine a diplomate’s MOC status. This new process, known as Continuous Certification, has many advantages in terms of assuring that the process is continuous rather than episodic. To give candidates time to prepare for the new process, the first full look-back has been scheduled for March 2016. At the March 2016 look-back, the following parts of MOC will be reviewed: • Professional Standing (Attestation or Licensure) • Lifelong Learning: CE and SA-CE • Cognitive Expertise: Exam • Practice Quality Improvement (PQI) • Fees All medical physics diplomates should log in to myABR and check to see where they stand on each part of MOC. There is still well over a year to make up any deficiencies. If the deficiency persists through March 2016, a diplomate’s status will change to “Enrolled in MOC but not meeting requirements.” The diplomate then would have a year to clear any deficiencies.

ABR Exam Statistics The ABR exams are criterion referenced, i.e., a standard is set, and the purpose of the exam is to determine if each candidate meets the standard. For the exam to be valid, an appropriate reference population should be used to determine the passing score. For many years, the statistic reported by the ABR was “pass rate for first-time takers.” In recent years, with the CAMPEP educational degree or residency becoming a requirement, it makes more sense to use this group as the standard. Therefore, in the statistics below and in future reports, the pass rate will be reported for first-time takers who are enrolled in or have completed a CAMPEP degree or residency. The Part 1 Examination: General and Clinical This year saw a significant reduction in applications for Part 1. The number of first-time takers, almost all of whom were enrolled in a CAMPEP program, fell to about one-half of previous years. This was probably because in previous years, a large number of applicants wished to initiate the certification process before CAMPEP residency completion became a requirement. New applicants wishing to take Part 1 in 2014 and future years must be enrolled in a CAMPEP-accredited graduate program before being accepted for Part 1. The pass rate was 70 percent for the general exam and 75 percent for the clinical exam.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

The Part 2 Examination The number of first-time applicants for the Part 2 exam was about the same as in previous years, and 20 percent of candidates had a CAMPEP residency. The pass rate for this exam has been decreasing slightly in recent years and is now about 75 percent.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Part 3: The Oral Examination The oral exam results remained very similar to those in recent years when graduates of CAMPEP educational programs or residencies are considered. Reported passing rates were somewhat lower in the past, due to the significantly better performance of CAMPEP graduates.

In addition to the approximately 75 percent of candidates who pass the oral exam, about 15 percent condition the examination. About two-thirds of those candidates pass the conditioned oral exam at the first opportunity. 25

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE Diversity Recruitment through Education And Mentoring

The DREAM program is a 10 week summer program designed to increase the number of underrepresented groups in medical physics by creating new opportunities, outreach and mentoring geared towards diversity recruitment of undergraduate students in the ﬁeld of medical physics.

“In my summer research, the objective was to isolate and detect a neutron signal produced during proton therapy treatments. It will aid me in the future as a medical physicist to be able to better serve and care for patients who suffer with cancer.” — Danielle Nicholson

ELIGIBILITY • Undergraduate Juniors and Seniors majoring in Physics, Engineering, or other science degrees • U.S. Citizens, Canadian Citizens, or Permanent Citizens of the U.S. HOW TO APPLY • Complete application • Ofﬁcial transcript • 2 Letters of recommendation • Self statement

APPLICATION DEADLINE: FEBRUARY 2, 2015 Additional information and applications are available at: www.aapm.org/education/grantsfellowships.asp

PROGRAM CONTACT: Jacqueline Ogburn, jackie@aapm.org or 301-209-3394

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.

I am interested in becoming a medical physicist surveyor for the ACR Radiation Oncology Practice Accreditation (ROPA) program. How do I become a surveyor?

In order to apply to become a medical physicist surveyor for the ACR ROPA program, you must meet the following requirements: 1. Be ABR-certified in Therapeutic Medical Physics (previous medical physics certification categories including Radiological Physics and Therapeutic Radiological Physics are also acceptable.) 2. Have a minimum of 5 years of post-certification clinical experience. 3. Be a full member of the ACR or AAPM. 4. Be in active clinical practice. In addition, you must complete an application, submit it to the ACR and attend a ROPA Surveyors’ Workshop.

How do I apply to be a medical physicist surveyor for the ACR ROPA program?

Please contact an ACR staff member by phone 800-770-0145 or email rad-onc-accred@ acr.org for an application.

Is the ACR hosting a ROPA Surveyors’ Workshop in the near future?

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Yes, the ACR will be hosting an ACR ROPA Surveyors’ Workshop on: • Date: February 5, 2015 • Time: 5:00 to 7:00 PM PST • Where: Manchester Hyatt San Diego, San Diego, CA

Q. A.

Can anyone attend this workshop? No, the workshop is only for new or current ACR ROPA Surveyors.

Q. A.

How do I sign up for the workshop? Space is limited. Please click here to sign up.

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AAPM Newsletter | Volume 39 No. 6 | November/December 2014

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The Exradin W1 Scintillator is a new detector whose unrivaled near-water equivalent characteristics produce a more natural dose measurement. • Minimal Disturbance, Fewer Corrections The W1’s components closely mimic water, significantly reducing beam perturbation and negating measurement corrections necessary with other detectors. • Ideal Characterization and Measurement of Small Fields 1mm spatial resolution makes the W1 a perfect tool for SRS and SBRT with Gamma Knife®, Cyberknife®, BrainLab®, Varian®, Elekta® and TomoTherapy® systems. • Automatically correct for Cherenkov Effect Pair the W1 with the SuperMAX Electrometer to effectively eliminate Cherenkov effect without the need for extraneous calculations. Other detectors imaged at 70 kVp in air

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AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE Interested in applying your physics or engineering knowledge in medicine? Want to make a clinical impact this summer?

Then the SUMMER UNDERGRADUATE FELLOWSHIP PROGRAM is for you!

We provide opportunities for excellent undergraduates to gain experience in medical physics at leading clinical and research institutions. A large menu of mentordeﬁned projects is available and Fellows select their mentor according to their mutual interests. Fellowships are offered for 10 weeks during the summer (May through September) and available to students not in their ﬁnal year. For more details, visit: www.aapm.org/education/GrantsFellowships.asp

Sponsored by the AAPM Educational Council through the AAPM Education and Research Fund

Canadian Winter School École d’hiver canadienne

CANADIAN WINTER SCHOOL

QUALITY AND SAFETY IN RADIATION ONCOLOGY

February 1 – 5, 2015 Kelowna, BC

QUALITY MATTERS TRAVAILLONS ENSEMBLE For all professionals in radiation oncology

6TH CANADIAN WINTER SCHOOL ON QUALITY & SAFETY IN RADIATION ONCOLOGY A four day continuing education course at the Delta Grand Okanagan Resort and Conference Centre, Kelowna, BC.

Highlights

Learning Objectives in brief • Learn strategies to improve quality and safety at your centre

• Patient participation

• Learn change management techniques to help put the strategies into practice

• CPQR incident reporting software demo

Curriculum

• Proffered presentations

• Patient centered care

(abstracts due 17 Nov 2014)

• Peer review

• Radiation therapist scholarship competition

• Human and team performance

• Workshops on in- vivo dosimetry, change management, incident reporting/learning

• Event reporting

• New and returning faculty One hour from BC’s second largest ski resort!

Endorsed by the AAPM

• In-vivo dosimetry • Change management • Maintaining standards

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Professional Council Column

Per Halvorsen, Newton, MA

Passing the Baton

his is my last column as Professional Council Chair. Serving the Association in this capacity has been an incredible experience. The Association wisely has “term limits” for most appointments, so after 6 years of serving in this role it is time for new leadership. Doug Pfeiffer will take over as PC Chair in January, and I’m eager to see how Doug’s vision and fresh energy will positively impact the Council’s work. Since Bruce Curran begins his term as President-Elect in January and will therefore step down from the Council Vice Chair role, Jim Goodwin has agreed to assume this role. As many of you know, he has done a tremendous job as Chair of the Professional Economics Committee in recent years, so he is very familiar with the Council’s work. With Jim finishing his term as Chair of Professional Economics, the current Vice Chair, Blake Dirksen, will take over as Chair in January. With all the potential changes in the reimbursement system in the near future, we’re fortunate to have good continuity in the membership and leadership of this committee. Similarly, Michael Mills completes his term as Chair of the Workforce Assessment Committee, and current Vice Chair Yan Yu will assume the role of Chair in January. Serving the Association as a Committee or Council Chair is a significant commitment of volunteer time and effort. Many thanks to all who freely give their time and expertise to strengthen our profession!

AAPM Newsletter | Volume 39 No. 6 | November/December2014

Working Group Report

Sean M. Tanny, Toledo, OH

Report of the Working Group to Promote Non-Clinical Career Paths for Medical Physicists As members of the newly created Working Group to Promote Non-Clinical Career Paths for Medical Physicists, our mission is to explore potential opportunities for medical physicists and to educate students and trainees about these non-clinical careers. This working group was formed in response to the stark lack of resources related to alternative medical physics careers and studentsâ&#x20AC;&#x2122; concerns of securing highly competitive residency positions. The lack of resources for these pathways likely reflects the fewer number of physicists in these careers. For example, The Professional Survey Model performed in 2010 estimated that approximately 30 new non-clinical physicists would enter the workforce per year, with that trend continuing past 2018. On the other hand, almost 200 new clinical physicist positions are estimated to be filled each year in radiation oncology. Despite being such a small community, non-clinical physicists contribute a great deal to the world of medical physics, and these careers should remain an option for aspiring physicists. Non-clinical careers can be a rewarding and empowering path for a new physicists, presenting opportunities in industry, as dedicated researchers and academics, and as regulatory advisors and radiation safety officers. From recent interviews with current physicists in non-clinical careers, benefits of working outside of a clinic include less demanding work hours, satisfying work-life balance, autonomy in choosing oneâ&#x20AC;&#x2122;s focus, and solving problems that have an impact for clinicians nationwide. Furthermore, non-clinical physicists stay active within scientific and professional organizations, such as AAPM, ASTRO, and the ABR, alongside their clinical peers. According to our interviewees, preparing for non-clinical opportunities is similar to preparing for clinical ones: take both medical physics and other classes to broaden your knowledge, polish your communication skills with other medical physicists and nontechnical individuals, become comfortable with reading and understanding regulatory standards, and seek internships with potential employers. Our initial research found that non-clinical careers have a clinical impact on the lives of thousands of patients. There are a wide range of problems to solve and studies to conduct in both academic and industrial medical physics. These branches have played a critical role in developing some of our most advanced treatment techniques, such as IMRT and VMAT. Medical physicists have contributed to the development of novel treatment machines, such as Tomotherapy and CyberKnife, or the improvement of technology integration from previous 33

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

machines in the newest generation of accelerators and afterloaders. Detector technology has benefited greatly from insights and improved techniques to delve into small-field dosimetry and non-equilibrium conditions with the help of medical physicists in industry and academia. Non-clinical medical physicists are essential in shaping informed policy that directly affects clinical care, making regulations safe for patients and clear and concise for clinical physicists to follow. Many of these paths do not require the same credentialing as clinical careers (e.g. ABR certification). Some non-clinical employers do offer to assist physicists who desire to become ABR certified or maintain their certification, but this is over and above the typical requirements. In other careers, it may be beneficial to pursue an alternative certification or specialization, a common one being the Certified Health Physicist (CHP). The current ABR training and maintenance of certification requirements can present issues when transitioning back into a clinical career. Despite remaining active within the field of medical physics, nonclinical physicists do not meet these new requirements to become ABR-certified clinical physicists following an extended tenure away from the clinic. This is one of the current issues being discussed by non-clinical physicists within AAPM — the possibility of maintaining a connection to the clinic and maintenance of certification such that a transition to industry or academia does not become a hindrance to pursuing clinical work. As an example of an alternative career pathway, the Nuclear Regulatory Commission (NRC) hires physicists in a number of roles. Inspectors are able to travel throughout their designated regions, while policy makers enjoy the luxury of more routine schedules. In an interview with a representative of the Medical Radiation Safety Team, we learned of the very positive atmosphere maintained within the group. Despite earning less than clinical medical physics colleagues, this individual believes that a lower salary “is balanced by more flexibility, lower stress, and better benefits. Federal employees receive excellent benefits.” They have worked on several projects that include implementing revisions to 10 CFR 35. Not all inspectors have experience working in the clinic, so they strove to ensure that other inspectors fully understood how to implement the new changes. Positions in non-clinical careers are an attractive alternative to the traditional clinical medical physics pathway, and the awareness and support for these roles are increasing. The theme of this year’s Annual Meeting was innovation; non-clinical physicists are a key piece to push innovation in technology, in research, and in policy to improve the clinical experience for patients throughout the country. Several groups are proposing symposia for the upcoming Annual Meeting in Anaheim to promote and educate attendees about non-clinical careers. These meetings will be excellent opportunities for medical physics trainees with interests beyond the clinic. Our working group will continue to explore non-clinical career opportunities for aspiring physicists, as well as the skills required to thrive in these parallel professions. What advice do 34

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you have for students and trainees interested in non-clinical careers? What might our fellow students and trainees expect to find when they begin pursuing these options? Your feedback, insights, and suggestions would be greatly appreciated. Please feel free to send me an email at sean.tanny@utoledo.edu.

Save the Date!

Proton Therapy: Physical Principles and Practices June 14 â&#x20AC;&#x201C;18, 2015 | Colorado Springs, CO http://www.aapm.org/meetings/2015SS/

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Ad Hoc Committee Report

Barry W. Wessels, Cleveland , OH

How We Choose Our Leadership: The AAPM Election Process

ost 2013 election and leading up to the meeting of the Board of Directors (BOD) in July 2013, the AAPM bulletin board posting (BBS) and the “talk in the hall” had many members reexamining how the AAPM selects the slate of candidates for national Office and Board Members-at-Large (BMAL). Questions of “good old persons” network based on nomination input from existing leadership, potential barriers to involvement in committee structure of the AAPM by general membership and diversity of the nominations slate were central to the discussion. For example in a BBS posting, Board Member Dr. Sherouse pointed out that “An open call for nominees from the general membership could be one useful tool of many in identifying underutilized talent, especially coming from the demographic of members who practice in community clinics.” Then Chair of the Board, Dr. Gary Ezzell called for the formation of an “Ad Hoc Committee to investigate the current nomination process for officers and BMAL, primarily if or how to establish criteria and guidance for the nominating committee, ensuring that the slate is diverse and reorganization of the Nominating Committee.” So how do we choose our leadership today? In brief, Article I, Section 3 of our By-Laws defines the process for election to the Board of Directors: Representative Board Members shall be elected by Regional Chapters at such a time that the results can be reported to the Secretary before the Annual Business Meeting and in a manner specified by their own rules of procedure. The Nominating Committee shall make at least eight nominations for the four annual vacancies for Members-at-Large. All nominees must be Members in good standing and give their written consent to the nomination. A list of those nominated by the Nominating Committee shall be provided to each Member and Emeritus Member at least twelve weeks before the Annual Business Meeting. Further nominations for Board Members-at-Large may be made by at least two Members after written consent has been obtained from the nominee. The Secretary must receive such nominations, together with the written consent and biographical information, at least ten weeks before the Annual Business Meeting. 36

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

As for Officers, Article II, Section 2 of our By-Laws states: The Nominating Committee, with concurrence of the Board, shall make nominations for President-Elect, Secretary, and Treasurer. Nominees must be current or previous Board members in good standing and they must give their consent. There shall be at least two nominees for President-Elect. Biographical information for all nominees will be attached to the ballot. The balloting procedure shall be as for Board Members-at-Large. In the Fall of 2013, members of the Ad Hoc Committee on Nominating were established. The committee is composed of those who eloquently spoke up in town hall meetings, BBS authors, members of the Board, two past Presidents and a Chapter Rep as Chair (me), who was not on record with a stated position. Charges to the committee were set forth below with an eye on the future and gratefully recognizing the outstanding leadership of our past and present officers and BMAL. Charges: Ad Hoc Committee on Nominating shall: 1. Evaluate relevant statements in the AAPM By-Laws, i.e. Section 10. Nominating Committee. 2. Identify other professional organizations with similar governance structures and reference their nominations process (e.g. ACR, ASTRO, SNMMI and others). 3. Consider the historical results of nominations and elections for officers and BMAL to the AAPM (terminal degree, sub-specialty occupation, area of interest in the AAPM, years of service, nomination origin, diversity, etc). 4. Assess the membership of the nominating committee, how it is formed and the potential need for modification of the By-Laws to ensure an unbiased selection process. 5. Evaluate the perceived or actual bias created by the current nominating procedure for the AAPM Officers and Board Members-at-Large. 6. Consider the barriers to involvement of under-represented groups in AAPM Officers and Board Members-at-Large selection process. 7. Prepare a set of â&#x20AC;&#x153;specific deliverablesâ&#x20AC;? regarding the nominating process to the Board and election of Officers as a guidance statement, proposed policy or recommended change to the By-Laws. The AAPM HQ staff provided the committee with historical and membership data associated with these charges. We evaluated the distribution of different diversity specifications in the following categories: all Full Members of AAPM, all Full Members who have served as a member of an AAPM committee, all Full Members who are currently serving in 5 or more AAPM committees, and all current Board Members-at-Large. A summary of this data is as follows:

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

1. The majority of AAPM Full Members have a radiation oncology specialty (63%), this is similar in the representation of those who have served on a committee (55%), are currently serving on 5 or more committees (56%) and is slightly higher in the current Board Members-at-Large (81%). The percentage of members who have not disclosed their specialty was 11-15% for group evaluated, however, only 3% of the Board Members-at-Large have an undisclosed specialty. 2. The majority of AAPM Full Members have not disclosed their employment (60%). 48% of members currently serving on 5 ore more AAPM committees have a primary clinical employment (20% undisclosed) and 60% of the Board Members-at-Large have a primary clinical employment (22% undisclosed). 3. 47% of Full Members have a PhD, 41% a masters and 12% are undisclosed. 70% of members serving in a committee have a PhD, 23% a Masters, and 6% undisclosed. 78% of members currently serving in 5 or more committees have a PhD, 16% a Masters, and 5% undisclosed. Of the current Board Members-at-Large, 75% hold a PhD and 25% a Masters degree. 4. 78% of the Full Membership is male, with this percentage being similar among committee members (80%), members currently serving in 5 ore more committees (78%) and current Board Members-at-Large (78%). Only 1-2% was undisclosed in each category. 5. Trends in racial diversity could not be evaluated due to the low rate of disclosure. After three face-to-face meetings of the committee, two presentations to EXCOM, a presentation of findings to the Board in July 2014 - Preliminary findings and suggestions for action “as deliverables” may include: a. Expanding the Official Nominating Committee to 5 to 8 members – composition to be determined (Items b–e). b. Ad Hoc committee on Nominating solidly recommending that the Nominating Committee still retain a majority voting members to be senior members of AAPM as reflected by past participation (former officers and other experienced members) in order to foster “institutional memory.” c. The sitting President should not be part of the Nominating Committee. Reasons – appearance of Conflict of Interest and is explicitly ruled out in Roberts Rules of Order. Recommend the outgoing Chair of the Board to fill this role. d. A specified minimum number of Nominating Committee members may include members from represented or apparent underrepresented groups relative to the membership at large (e.g. clinical physicists at non-academic hospitals, members of industry, regulatory organizations, etc.). A presently unresolved question: Is it necessary or practical for “any or every” underrepresented group of the Association be exactly duplicated in the Nominating Committee in proportion to their occurrence in full membership population?

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e. Item d must be reconciled with the observation that these apparent underrepresented groups in BMAL also may be represented in the composition of elected Chapter Board representatives. f. We have not been asked, nor is it in our charge, to evaluate the composition and specific number of members to the BOD. Evaluation of Nominating Committee selection process is based on the current Board composition. g. Nominating Committee process details are still being worked out. Selection and election to the Nominating Committee (by whom), rotating terms of service, nomination from the General Membership and the Board are being addressed. As we move forward in the Committee and Board deliberations in the Fall of 2014, we welcome input from the general membership on the overall direction of what proposed above. A thorough review of our sister society nominating processes, as well as, extensive analysis on who we are as an Association has been performed thankfully by AAPM staff and individual efforts from our committee members. A summary of these findings, which were presented to the Board in July 2014, are included in the slide set below. Overall summary: It is apparent that a recommendation for a change to the Association ByLaws is in the future regarding this matter. Ad Hoc on Nominating Committee Members: Kristy K. Brock, PhD, Co-Chair Jeffrey A. Garrett, MS John P. Gibbons Jr., PhD Maryellen L. Giger, PhD Daniel C. Pavord, MS Barry W. Wessels, PhD, Chair Gerald A. White, MS AAPM Board Members Characteristics Analysis Composite data (2009-2014), primary specialties, employment and degrees for full and committee members and the summary of findings on diversity follow.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Literature Quanta

Niko 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 the AAPM Working Group on IMRT Planning for Adaptive Radiotherapy Heijkoop et al. reported on a clinical implementation of a simple online adaptive IMRT planning technique, by creating a plan library to enable plan selection for changes in patient geometry such as the bladder volume based cervix-uterus motion model. The actual implementation is carried out in two phases: the first phase builds the plan library consisting of one IMRT plan and one 3D conformal plan; the more accurate second phase uses two constructed IMRT plans, which correspond to two typical daily bladder volumes.

General Plan Optimization Pyshniak et al. compared two commercial treatment planning system’s (Monaco and Oncentra MasterPlan) performance with 9-fields IMRT and single-arc VMAT (both on prostate and complex head and neck cases). The authors are trying to answer the question of whether biological optimization can produce a better plan than physical optimization. It was concluded that “biological optimization seems beneficial in terms of plan conformity and homogeneity in addition to achieving lower OAR doses for prostate cases.” However, it might be difficult to draw some general conclusions from this work, due to the limited scope of the study. Purdie et al. reported on a clinically oriented study on automation of breast IMRT planning. A very large number of 1661 breast IMRT cases were included in the study, which make the method clinically valid and robust. The method could be of great interest for centers using IMRT for breast treatment, especially if they are using the same treatment planning system as in the reported study. Ureba et al. presented a hybrid direct MLC aperture optimization method which was then implemented in their Monte Carlo based TPS (“CARMEN”). To reduce computation time, the fluence map was replaced by a “biophysical map” (BM). At each gantry angle, a BM is generated by ray-tracing to account for ROIs, radiological length and PET values. These BM values were then used as input for an MLC leaf sequencer algorithm. The method was 43

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

tested on three complex cases (head and neck, partial breast and concave prostatic bed) to demonstrate that deliverable MLC apertures can be obtained in a reasonable amount of time (55 minutes to 169 minutes).

IMRT QA Dosimetric Analysis Gagneur and Ezzell presented a study of the use of statistical process control (SPC) methods to set clinical action limits for the evaluation of IMRT quality assurance. A large sample of IMRT QA gamma pass rates for three beam matched linacs at the authorsâ&#x20AC;&#x2122; clinic were analyzed using SPC, and the results of the analysis were used to adjust MLC parameters in the treatment planning system with the goal of increasing the machine-to-machine consistency of QA results. The authors conclude that SPC analysis allowed a closer matching of the three linacs, and resulted in the ability to create tighter clinical action limits for IMRT QA results. Pulliam et al. reported a six-year review of IMRT QA results to characterize the typical overall failure rates as a function of treatment site. For both point and planar dose evaluation, a statistically significant difference in plan failure rates between sites was observed. An overall historical failure rate was noted to be 2.3%, and it was suggested by the authors that institutions seeing less frequent IMRT QA failures may need to increase the sensitivity of their IMRT QA procedures. Huang et al. presented an investigation of the dependence of gamma pass rates on the spatial resolution of the dosimeter used and the introduction of noise into the planar dose maps. It was found that increasing the resolution and noise in a measured distribution can increase the gamma pass rate a non-trivial amount (>5%) when the planned distribution is used as reference.

Dosimetric and QA Applications of EPIDs Gimeno et al. evaluated the use of a commercial EPID dosimetry software package for both pre-treatment and transit dosimetry. The authors reported fairly large dosimetric discrepancies between the calculated and measured doses, particularly in areas shadowed by heterogeneous media. It was concluded that, while transit dosimetry in particular has great potential, this particular EPID based solution requires improvements in accuracy in order to be viable. Podesta et al. presented a calibration methodology for EPID based dosimetry. The method is intended for the dosimetry of VMAT fields in particular, with a focus on providing the ability to analyze the accuracy of a sub-arc of arbitrary size. The authors found that using their EPID calibration technique in combination with their sub-arc analysis procedure, it was possible to distinguish discrepancies in the VMAT plan delivery that may not be seen in whole-arc composite analysis. 44

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Sabet et al. presented a measurement based approach to calibrating an EPID for transit dosimetry. The authors contrast their calibration approach to others which make use of manufacturer specific scatter kernels to account for unique aspects of the individual EPID systems. The authors find their measurement-based calibration approach to provide sufficient accuracy for transit dosimetry, and to be more broadly applicable than other calibration approaches. Angew et al. presented a method for measuring MLC positional errors using an EPID for both IMRT and VMAT deliveries. The measurements of the leaf positions were compared to those determined using the log files for over 800 deliveries. It was found that the determination of leaf position was inherently more uncertain for the EPID based analysis than for the log file based analysis. However there were several instances of leaf position errors seen using the EPID methodology that did not appear in the log files. The authors attributed this to the assumed relationship between motor turns and leaf position in the log filesâ&#x20AC;&#x201D;a relationship that may not be maintained at leaf motor end of life. Fidanzio et al. reported on the use of EPIDs for â&#x20AC;&#x153;quasi real time in vivo dosimetryâ&#x20AC;? for VMAT treatments. A methodology was developed to assign equivalent square fields to individual control points of VMAT plans, and to thereby associate the expected dose due to that control point at the isocenter as a function of the measured EPID signal, expected radiological pathlength through the patient, and pre-tabulated data relating the equivalent square signals to measured doses at isocenter. Gamma analysis was also performed between treatment day #1 EPID signal maps and those measured on other treatment days. It was found that the gamma analysis in particular was helpful in determining deviations in treatment day to day, and that reconstructed doses at the isocenter were also indicative of setup errors. Seco et al. provides a thorough review of radiation detector characteristics, with useful background information on flat panel radiation detectors specifically.

General Dosimetric Devices Perez et al. presented a method for using all color channels in radiochromic film dosimetry to compensate for film heterogeneity. The approach assumes a theoretically equivalent response of the film in all three color channels to an equivalent dose, and treats deviations from this equivalent response as channel-dependent perturbations to the measured dose. Using this method, correction maps can be created and applied to films used in dosimetry, with the intent of improving the pixel-by-pixel accuracy of the measured distribution. The authors found their methodology to be an improvement over other, similar methodologies, and found a statistically significant increase in gamma pass rates between their correction methodology and others. Goulet et al. reported on a novel method for performing real-time 3D dosimetry of IMRT or 45

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

VMAT plans. The system described involves a plastic scintillation volume embedded in a transparent, water equivalent plastic phantom. The phantom is visualized during radiation delivery using a plenoptic camera â&#x20AC;&#x201D; a specialized camera that collects light in such a way that the depth of focus of the field of view can be altered after the image has been taken, thus allowing the back-projection of light intensities at multiple distances from the camera. The authors were able to successfully perform IMRT QA using this setup, with reports of millimeter-scale spatial resolution. Ehler et al. reported on the use of 3D-printed, patient-specific IMRT QA phantoms. The authors attempted to replicate a RANDO phantom using a variety of software packages to translate a TPS created structure-set into a 3D printable format where specific dosimeter locations could be included. The preliminary study showed the ability to create such a phantom, with adequate film results at the designated measurement planes.

Dosimetric Indices Podesta et al. presented a time-dependent gamma index. The time-dependent index is meant for the QA of sub-sectors of a full arc during VMAT delivery, and was used in the above referenced study for EPID dosimetry of VMAT plans. The index 46

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AAPM Newsletter | Volume 39 No. 6 | November/December 2014

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introduces an ability to evaluate distributions at “time distances” away from the starting and stopping points of an arc-sector as defined by the planning system. The authors propose that this extra degree of freedom will allow for better comparison of sub-arcs during VMAT QA. Visser et al. evaluated the inclusion of DVH-based IMRT QA verification parameters into the typical gamma pass rate methodology. It was found that out of 700 plans that were previously deemed acceptable using only gamma pass rate analysis, 2 plans were found unacceptable when also considering DVH criteria. Both plans that were deemed unacceptable involved dose deviations in the PTV that were higher than expected, one involving a PTV extending outside the external contour of the patient, and the other involving the placement of the isocenter 6 cm outside of the treatment volume. While it therefore could be argued that the introduction of a DVH-based analysis did not demonstrate any advantage over gamma pass rate analysis in this clinical analysis—especially with respect to the types of errors gamma pass rate analysis is meant to diagnose—the authors did note that the DVH-analysis did provide more clinically relevant information to the physicist and physician than would not have otherwise been known using only gamma pass rate analysis, and on that basis alone may be a useful adjunct to the typical IMRT QA procedures.

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AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Joint Workshop Report

Cari Borrás, Washington DC

Joint AAPM/SEFM/AMPR Educational Workshop on "Education of Radiotherapy Physicists" A session titled, “Education of Radiotherapy Physicists” was presented at the AAPM Annual Meeting in Austin, Texas, as an Educational Workshop. It was organized by the ‘Working Group on Implementation of Cooperative Agreements between the AAPM and other National and International Medical Physics Organizations’ (WGNIMP), chaired by Dr. Cari Borrás.

From left to right: Mahadevappa Mahesh (AAPM), Facundo Ballester (SEFM), Montserrat Ribas (SEFM), Cari Borrás (AAPM & SEFM), Pavel Kazantsev (AMPR) and Dmitry Kostylev (AMPR)

The Workshop, which was moderated by Drs. Borrás and Mahadevappa Mahesh, had invited speakers from the Spanish (SEFM) and Russian (AMPR) medical physics societies, along with a representative from the American Board of Radiology as well as AAPM members. The main purpose of the session was to exchange ideas and challenges in educating medical physicists in the respective countries. After some welcome remarks by Dr. Mahesh, Cari Borrás gave an overview of regulatory requirements for medical physics education at the international and European levels, making emphasis on the recently approved European Union Council Directive “Laying down basic safety standards for protection against the dangers arising from exposure to ionizing radiation”, and the recommendations of the European Federation of 48

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Organizations in Medical Physics (EFOMP) regarding its implementation, a theme which was expanded later by Dr. Montserrat Ribas, focusing on the Spanish challenges. The US perspective was given by Dr. Geoffrey Ibbot, Physics Trustee of the American Board of Radiology, with a presentation on ‘The American Board of Radiology Guidelines for Radiotherapy Physics Certification’ and by Dr. Mahesh who focused on ‘What imaging aspects should a radiotherapy physicist know today?’ His presentation was followed by talks from Drs. Ballester and Ribas from the SEFM titled, ‘Challenges of medical physics education in Spanish Universities’ and ‘The Spanish Curriculum for the hospital radiation physicist and the projected impact of recent European directives’ respectively. While Facundo Ballester focused on the undergraduate training, Montserrat Ribas discussed the current challenges faced by the mandatory clinical residencies medical physicists need to take to become qualified as professionals, given the difficult economic situation in Spain. She explained that once the medical physicist gets his/her specialization, salary and benefits are identical to those of any other medical specialty. The AMPR was represented by Pavel Kazantsev and Dmitry Kostylev, whose respective talks, ‘Radiotherapy physics education in the Russian Federation Today’ and ‘Plans for future radiotherapy physics education in the Russian Federation’, addressed the problems they have to educate medical physicists given the deployment of highly sophisticated radiotherapy technologies in the country and the lack of training programs. Both AMPR representatives made a plea to AAPM to have the Educational AAPM/AMPR Agreement originally signed in 2010, renewed. The session ended with a discussion on the various challenges the three societies face in educating radiotherapy physicists and exchanged ideas for implementing training programs adequate to the respective environments. Overall, the joint session highlighted the importance of working together and understanding the available resources for educating radiotherapy physicists. For AAPM members it was an opportunity to see how a country in Europe, although with great educational difficulties, has solved so well professional issues. Wouldn’t all medical physicists in the US like to get the same recognition (and make the same salary) as their physician counterparts? As for the AMPR, the European and American models can be analyzed and the best of each, adapted. The Workshop met its goal. The organizers thank AAPM, SEFM and AMPR for their participation and hope the WGNIMP can continue offering this type of session. Individual presentations can be found in the AAPM Virtual Library.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Website Editor Report

George C. Kagadis, Rion, Greece

t’s already fall and the majority of us are getting prepared for the 100th RSNA Annual Meeting which is going to take place in Chicago, Illinois (November 30 – December 5). Last month I had the privilege to see a few of you at the European Federation on Medical Physics meeting, which was held in Athens, Greece. The AAPM had a good presence through scientific lectures and there was also a joint AAPM-EFOMP meeting co-organized by Gene Lief (AAPM) and Peter Sharp (EFOMP) on the importance of building links between the two societies that was of great interest. AAPM HQ staff has finished transferring the available material to Vimeo, where 1,496 videos (as of October 9, 2014) are publicly available. Details on AAPM’s Vimeo of Total Loads, Total Plays and Geographic Statistics are seen on Figures 1 and 2. Since the commencement of broadcasting those videos through Vimeo, most of the traffic has oriented from the USA (139,336), Canada (6,551) and Japan (4,663).

Figure 1: Vimeo Total Loads and Total Plays Statistics August 29, 2013 – October 9, 2014. (Total Loads: 200,806 with a peak in July 2014 of 34,335. Total Plays: 36,591 with a peak in May 2014 of 4,774.)

Figure 2: Vimeo Geographic Statistics.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

Early next year AAPM is required to close their data center at the American Center for Physics (ACP) in College Park, MD. For this reason, AAPM is working on migrating their servers to the cloud. Since bandwidth is not an issue with cloud computing, we are going to host the AAPM Virtual Library ourselves. You will not experience any issues during this migration since we are already working hard on making the transition as smooth as possible. Be sure to check out the latest offerings in the AAPM Virtual Library - the 2014 AAPM Annual Meeting and Summer School. I would like to extend my invitation to the Chairs of AAPM Committees, subcommittees, task groups and working groups to prepare short video introductions to put them together with the others for presentation during the upcoming RSNA Annual Meeting and consequent meetings. We already have 14 videos on file and we would like to have as many as possible. Those introductions aim to provide key information to the membership on the work done by the various committees, subcommittees, task groups and work groups of our association. I am pleased to report that as of October 9, 2014 we have 37,895 images posted to AAPMâ&#x20AC;&#x2122;s Flickr, 2,390 likes on Facebook, 6,743 members on LinkedIn and 3,104 followers on Twitter. The Website Editorial Board will meet during RSNA 2014 on Monday, December 1 in the Columbian (Bronze Level/West) Room of the Headquarters Hotel, the Hyatt Regency Chicago. There is always space for members interested in knowing what we do firsthand or possibly want to join. Please stop by! I am looking forward to seeing as many of you as possible next month in Chicago! I hope you find the AAPM website useful, visit it often and send me your feedback or directly at george@ mail.aapm.org.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

AAPM/IOMP Report

Mohammed K. Zaidi, Houston, TX

AAPM/IOMP Used Equipment Donation Program Report Mr. Martin Mukosai, Clinical Radiographer Technologist, Mwandi Mission Hospital, Livingstone, Zambia requested for some technical advice and related publications to pursue for a master’s degree in Sonography. I had sent him some books and also advised him to review the new ACR QC Requirements for Ultrasound and Breast Ultrasound Accreditation Program and the article by Pricilla Butler published in the AAPM Mar/Apr 2014 Newsletter entitled ACP Accreditation FAQs and Practice Quality Improvements (PQI). He wrote me an e-mail message that stated: “It is very helpful to my practice and will do me good. I will make good use of it.” One of my roles is, when asked, to provide technical support to individuals having difficulties in practicing good medicine in their countries. Dr. Francis Hasford, from the Ghana Society for Medical Physics had requested for the Radiological and Medical Sciences Research Institute (RAMSRI), Accra, Ghana: X-ray machine, Gamma Camera, Ultrasound machine, Dose calibrator and Phantoms for Nuclear Medicine QC. Other requested items include a laptop computer and a well counter. We are hopeful that useable equipment, which should be less than 10 year old, will be donated. Some recently donated items, still looking for a home, include: water tanks, hydraulic lift assembly, dual channel electrometer – this system is controlled by Wellhofer’s OmniPro Accept software. TLD reader, farmer ionization chambers and stack of ready pack x-ray films, USG Doppler, Video-EEG equipment and a CT machine. Please note that the equipment donated to our Program is in good working condition but we are unable to guarantee its usefulness. The donations of used equipment are often times tax deductible. AAPM/IOMP will not be responsible for any warehousing expenses or loss if the equipment donated cannot be shipped. If you would like to donate gently used equipment, or would like specific used equipment donated to your organization, please contact the UEDP Manager. For more information, please email your request to zaidimk@gmail.com.

AAPM Newsletter | Volume 39 No. 6 | November/December 2014

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