AAPM Newsletter March/April 2015 Vol. 40 No. 2

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

AAPM NEWSLETTER Advancing the Science, Education and Professional Practice of Medical Physics

“We need to educate our institutions in the value of the medical physicist.”

AAPM PRESIDENT-ELECT BRUCE CURRAN

IN THIS ISSUE:

▶ 2015 CMS Payment Changes ▶ NCRP Statement No.11 ▶ Annual Meeting Program Details

▶ The Nature of the Medical

Physics Maintenance of Certification Exam

▶ Education Council 101 ▶ Code of Ethics ▶ Emerging Science Under

Spotlight

and more...

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

AAPM NEWSLETTER AAPM NEWSLETTER is published by the American Association of Physicists in Medicine on a bimonthly 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: E-mail: nvazquez@aapm.org AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse College Park, MD 20740 Phone: (301) 209-3390 PUBLISHING SCHEDULE The AAPM Newsletter is produced bi-monthly.

Next issue: May/June Submission Deadline: April 10, 2015 Posted Online: Week of May 4, 2015 CONNECT WITH US!

CONTENTS ARTICLES IN THIS ISSUE 3 5 8 10 11 22 29 41 43 46 50 53 55 56

President Elect’s Report AAPM Executive Director’s Column Editor’s Column Professional Council Report Legislative and Regulatory Affairs Report Health Policy & Economic Issues ABR News Education Council Report TG 109 Update Science Council Report Research Spotlight ILS Workshop Summary A Poem on Positron Emission Tomography AAPM at Your Service

EVENTS/ANNOUNCEMENTS 8 20 21 25 28 34 45

2015 AAPM Summer School 2015 AAPM Funding Opportunities AAPM New Member Symposium 2014 AAPM Education & Research Fund Contributors World Congress on Medical Physics & Biomedical Eng. 57th AAPM Annual Meeting & Exhibition 2016 AAPM Spring Clinical Meeting

NAVIGATION HELP Previous/Next Article Swipe your finger horizontally to go to the next or previous article.

Show/Hide the Menu Tap the top of the screen to show or hide the menu. Touch on the Table of Contents tab in the menu to return here.

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.

www.aapm.org

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

PRESIDENT ELECT’S REPORT Bruce Curran, Richmond, VA

T

he good news, at least for me, is that I’m here in Richmond as opposed to Providence, RI or Boston, MA where I’ve spent most of my career. It’s cold here (I’m writing this in mid-February), but there is not 7’ of snow on the ground. My sympathies to those in the Northeast, as I know what it’s like to experience that kind of snow (aka, the “Blizzard of ‘78”).

The last two years have been a time of extremes for me, laid off in May 2013, a new position at VCU this past July, the changes ongoing at the Veterans Health Administration (I spend 4 days/week as Chief Physicist at the Richmond VAMC under a VCU contract), 2014 recipient of the AAPM Quimby Award, and election as AAPM President-Elect.

It’s also a great time for me to look at the changes in AAPM as I return to a position on the AAPM Executive Committee (I was AAPM Secretary from 1991–3). I will also note that it’s been about the same length of time since I last wrote a Newsletter article.

AAPM has changed a lot “A continuing issue within AAPM is how to more effectively manage the since 1993. At that time we affairs of the Association.” had just moved our HQ from New York City to College Park and completely changed our staff of five. As we now plan the change from College Park to Alexandria, I have a feeling of déjà vu, though very fortunately without the need to replace our staff (now 25). There are great tools to help the Executive Committee, Council Chairs, and Board in leading AAPM, many of them thanks to the work of our HQ IT Staff lead by Michael Woodward, by keeping us up-to-date on the progress of our tasks (and reminding us when things need to be done). As Secretary in 1991–3, I took the minutes and typed them myself, typically around 150–200 pages/year, often leaving me little time to participate in the discussions in either the Board or EXCOM meetings.

HQ Staff support for EXCOM, the Board, councils, and committees has increased the effectiveness of AAPM in many ways, monitoring legislative and regulatory events, preparing budgets and meetings, and providing IT tools to help manage the flow of information throughout the organization.

There are also some topics that have not changed. In 1991–3, we were experiencing a downturn in the employment of Medical Physicists, as government regulations attempted to reduce medical spending.

Newly trained individuals were not finding jobs and there were numerous applicants for any position.

By 1995, 3D planning and delivery, followed by IMRT, IGRT, and other complex techniques and technologies appeared and resulted in strong employment and salary gains over the next 15 years.

Today we have much the same scenario. As we move forward we need to identify the technologies, techniques, and responsibilities that will help us in a similar fashion. For example, we have lost some of our voice in technology decisions and need to find ways to strengthen our position in these decisions. I believe that our activities in patient/staff safety and quality of care are under-recognized by many upper-level administrators. We need to educate our institutions in the value of the medical physicist.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

President Elect’s Column, cont.

AAPM has embarked on initiatives to help us in these areas. We recently kicked-off a project to help identify and communicate more effectively with varied audiences (physicists, physicians, administrators, legislators, general public, …) and measure how effectively we accomplish these interactions. The effort, led by Chair of the Board John Bayouth, is developing a plan for such communications, including training in media interaction, proactive talking points, and ‘toolkits’ for use by leadership and members. The initial meeting (held despite a major snowstorm in Chicago the day before) has already identified several components to be addressed. Stay tuned for more information.

A continuing issue within AAPM is how to more effectively manage the affairs of the Association.

We have a very active volunteer organization with nearly 1,400 individuals serving on councils, committees, task groups, etc. Managing these efforts, as well as AAPM’s legal and fiduciary requirements, is the responsibility of the Board of Directors, consisting of 38 voting and 11 nonvoting members. By most standards today, our Board is very large, though it reflects the origins of our profession. In recent years we have seen ASTRO reduce the size of their Board to approximately 15 individuals. The American Institute of Physics, of which AAPM is one of ten members, reduced their Board in December from 42 to 15 as well. We need to explore if we can better manage the legal and fiduciary responsibilities of AAPM while maintaining our traditions of broad interaction and involvement of members in the Association’s activities. Some efforts, such as the Ad Hoc Committee on our Nominating Processes are already underway, but further work will, I believe, need to be done if we are to continue to effectively promote our position (and positions) to our administrative/clinical, corporate, legislative, and public audiences. I look forward to interacting with you and hearing your viewpoints, comments, and suggestions on this important topic.

In closing, thank you for the privilege of serving you as President-Elect. I look forward to talking with you; including the MP resident applicants I meet with next week, on how AAPM can help you as well as our profession. Please feel free to contact me. I want to hear from you.

AAPM ANNUAL COMPENSATION SURVEY In about three weeks, the AAPM will launch the survey gathering data on the work and compensation of medical physicists during 2014.

This survey series provides medical physicists like you with data on the vitality of the job market. The raw data is not provided to AAPM. Each year, aggregated data from this project are provided by AAPM as a service to our members. The value of the survey is increased when every AAPM member participates.

Please participate in this year’s survey when you receive your email invitation.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

EXECUTIVE DIRECTOR’S COLUMN Angela Keyser, College Park, MD

AAPM Funding Opportunities Research Seed Grant Application Deadline is March 20 Three $25,000 Research Seed Funding Grants will be awarded to provide funds to develop exciting investigator-initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. Funding for grant recipients will begin on July 1 of the award year. Research results will be submitted for presentation at future AAPM meetings.

AAPM/RSNA Graduate Fellowship Application Deadline is April 30 The AAPM/RSNA Graduate Fellowship i o or egree in e i y i o

w r e S n

or e fir S o er

wo ye r o gr u e re e igi e o pp y

u y e

ing o

AAPM Meeting News Mark your calendars for four upcoming AAPM meetings: AAPM Annual Spring Clinical Meeting March 7-10, 2015 Hyatt Regency St. Louis at the Arch, St. Louis, Missouri The Spring Clinical Meeting program is available online. Also, note that several AAPM groups plan to meet during the 2015 AAPM Spring Clinical Meeting. A list of AAPM activities is available online.

Please make time during the meeting to visit the vendors and thank them for their support of AAPM and the medical physics profession.

“Mark your calendar for upcoming 2015 Funding Opportunities and AAPM Meetings. Be sure to visit the various meeting websites for relevant program and venue information.”

IMPORTANT LINKS AAPM Summer School Register Here

AAPM/RSNA Graduate Fellowship Apply Here

AAPM 57th Annual Meeting & Exhibition Register Here View the Committees & Activities Schedule

AAPM Spring Clinical Meeting View the Program

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Research Seed Funding Grant Apply Here

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Executive Director’s Column, cont.

AAPM 2015 Summer School Proton Therapy: Physical Principles and Practice June 14-18, 2015, Colorado Springs, CO View program and register now! The deadline to register with discounted registration fee and reserve on campus housing is May 6th. This 4.5 day Summer School will provide collective knowledge in the form of lectures from some of the best experts in world. The objectives are: • To understand the physics and technical aspects of proton therapy • To understand the applications and challenges of proton dosimetry • To understand the challenges of proton therapy treatment planning • To learn about new technology for proton delivery and treatment verification

AAPM 57th Annual Meeting & Exhibition July 12-16, 2015, Anaheim, California The 2015 Annual Meeting focusing on “Reinvigorating Scientific Excellence” will be held in the Anaheim Convention Center. The AAPM Committee Schedule is available now online. Make sure you check out the helpful Anaheim information: Things To Do in the Anaheim Resort.

New for AAPM 2015 Residency Fair Wednesday, July 15 • 11:00 AM - 12:15 PM Platinum Ballroom 6 in the Anaheim Marriott The AAPM Students and Trainees Subcommittee, in collaboration with SDAMPP, is hosting a Residency Fair. This event will provide students an opportunity to learn more about individual residency programs and how they are structured. Come meet program directors and current residents from CAMPEP programs across the country.

Student Lunch: The Future of Research in the Field of Medical Physics Wednesday, July 15 • 12:15pm - 1:30pm Platinum Ballroom 6 in the Anaheim Marriott Tickets are $10 per person and space is limited. Registration deadline is June 17th.

The Working Group on Student and Trainee Research, the Students and Trainees Subcommittee, and Working Group to Promote Non-Clinical Career Paths are hosting a student luncheon to foster discussion of the future of research in the field of medical physics, including various representatives from within AAPM to review ongoing initiatives aiming to foster student growth. Come by and network with other research minded students in the field The AAPM orking roup T funds this event.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Executive Director’s Column, cont.

UPCOMING IMPORTANT DATES MARCH 4

Meeting Registration and Housing Information available online

Abstract Submissions: DEADLINE • Deadline for receipt of 300 word abstracts and supporting data.

5:00 PM • This deadline recognizes other conference schedules that have conflicted in the past and has been US LOCAL TIME extended accordingly.

• There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be (8:00 PM ET) considered for review.

MARCH 12

BY APRIL 20

Authors notified of presentation disposition

BY MAY 12

Meeting Program available online

MAY 27

Deadline to receive early registration fees

JUNE 17

• Housing reservation deadline • Deadline to cancel housing reservation without a $25 cancellation fee • Fees for registration will be refunded in full if written notice of cancellation is received by June 17, 2015 • Last day to register for SAMs

JULY 12-16

57th Annual Meeting & Exhibition

AUGUST 20 11:59 PM ET

Deadline to complete the online evaluation in order to receive CAMPEP Credit (equivalent to CME

AUGUST 27

Credits released for meeting attendees

category 1), SAMs Credit (equivalent to SA-CME),MDCB and RLI Credits

Staff News Lisa Schober, aka isa , and her husband rik welcomed their first child unnar illiam Schober (Little G) on Sunday, January 18th. Mother and son are doing well and the AAPM HQ Team is looking forward to a visit in the near future. I visited the Schober family in mid-February and remain convinced that Baby already recognizes my voice isa will return to the office in mid April. In the meantime, other members of the team are covering Lisa’s duties, so please let us know how we can assist!

AAPM welcomed Richard Martin to the team on January 5th as the new Government Relations Specialist. See more details in the “AAPM at Your Service” article in this issue.

Penny S. Slattery 4/26/1962 – 3/3/2015

The AAPM HQ has lost a dear friend and valued team member. Penny served as AAPM’s Journal Manager since September 1996.

Each of us not only grieves at the passing of a remarkable person but also for the loss her family suffers.

Please click for details regarding the service.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

FROM THE EDITOR’S DESK Mahadevappa Mahesh, Baltimore, MD

W

elcome to the March/April issue of the newsletter. This is my 50th column and it is indeed a great honor to have this opportunity to share with all of you about the various articles that are published in the newsletter. The newsletter continues to evolve in terms of formatting for various platforms. After receiving feedback regarding the new format, I decided to revert back to a single-column format, however, some of the new aspects from the two-column format remain. I hope you enjoy this format, and if not please let me know. As each issue is a breathing document of our professional society, so is the format.

Regarding this issue, it starts of with a message from the President-Elect and contains articles from our regular contributors who are providing updates on various issues related to our society. The article from AB Physics Trustee on The Nature of Medical Physics Maintenance of Certification Examination’ that impact most of us should not be missed. Program detail of 57th AAPM Annual Meeting & Exhibition is also listed in this issue.

In addition to feedback regarding the layout, I welcome all readers to send me suggestions or comments on any of the articles in order to make the Newsletter more effective and enhance the readership experience.

REGISTRATION & HOUSING AVAILABLE ONLINE!

Proton Therapy: Physical Principles and Practices June 14 –18, 2015 | Colorado Springs, CO www.aapm.org/meetings/2015SS/

There is significant momentum for proton beam acquisition and its usage worldwide. Proton beam therapy has established its niche in radiation oncology for cancer treatment due to its unique physical dose distribution with Bragg peak without delivering any exit dose beyond the range of the particle. In the USA there are currently 12 proton centers operating and several under construction.

We see institutions operating various types of devices from multi-room to single room from cyclotron to synchrotron based units. Manpower issue in this field is critical at this stage due to lack of education and training. A broad scope (physics, biology and clinical) of education with comprehensive material is missing.

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This 4.5 day Summer School will provide collective knowledge in the form of lectures from some of the best experts in world. Each registrant will also receive a newly published text book (plus ebook) to include every aspect of proton beam therapy: • Clinical Perspective • Biology • Production • Interactions • Simulation • Commissioning • Treatment Planning • Dose Calculation • Optimization • Motion Management • Treatment Verification • Uncertainty in Scattered and Pencil Beam Scanning • Advance Treatments Such as SRS and IMPT

1351-22, 1/15 PIPSproâ„¢ Software

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

PROFESSIONAL COUNCIL REPORT Douglas E. Pfeiffer, Boulder, CO

O

ne of the great services provided to AAPM members is in the realm of reimbursement for therapy physics activities, monitoring activity and advocating in defense of our profession. Wendy Smith Fuss has been a great asset to this end for many years, and Jim Goodwin, Vice-Chair of Professional Council and past Chair of the Professional Economics Committee has been very close to this subject for quite a few years. He writes this month’s column, focusing on these economic issues.

2015 CMS Payment Changes Jim Goodwin, Burlington, VT As many of you know, there were significant changes in Medicare billing and reimbursement effective January 1. Many of the changes were a result of an unprecedented number of CPT code deletions and additions. The AAPM Professional Economics Committee presented two webinars in December outlining the 2015 changes. If anyone missed them or would like to see them again, they are available on the AAPM website. Go to Meetings and look under the Webinars tab. Audio and video streaming of the presentations as well as the slide sets are available. A FAQ set from the presentations is available by going to the Government Affairs section of the website and choosing Centers for Medicare and Medicaid Services (CMS). You will see them as well as two other code change articles under CY 2015 Coding. Other Members Only resources that may be found under the CMS section of our website include copies of our comment letters that are submitted to CMS each year in response to the proposed rules as well as summaries and payment tables for both the proposed and final rules that are prepared by AAPM Health Policy Consultant, Wendy Smith Fuss.

Changes in medical physics and dosimetry code reimbursements for 2015 were generally minor with the exception of the new teletherapy and brachytherapy isodose codes. Under the Hospital Outpatient Prospective Payment System (HOPPS) which covers outpatient departments, new code 77307 (Complex Teletherapy Isodose Plan) has been switched from APC 305 to APC 304 which also includes code Simple Teletherapy Isodose plan) yielding a significant reduction in reimbursement ($311.37 in 2014 to $113.12 for 2015). The other isodose codes have reimbursements similar to those of 2014. This, however, is a step backward since all of the isodose codes are now bundled with a basic calculation (77300) and therefore have not yet increased in reimbursement to reflect this. Because PPS payments are based on hospital billing data from two years earlier, it will most likely take two years before we see these reimbursements catch up. Under the Medicare Physician Fee Schedule (MPFS), which covers freestanding centers, the new isodose planning codes have increased in value, generally reflecting the bundling of into them.

The bundling of 77300 into these codes can affect departments in two ways. First, changes in reimbursement levels will change total revenue for Medicare patients. Second, the bundling also results in a loss in charge volume which in many departments is a significant productivity metric.

Members should be aware of this and modify their internal and work record keeping to reflect this loss.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

LEGISLATIVE AND REGULATORY AFFAIRS REPORT Lynne Fairobent, College Park, MD NCRP Issues Statement No. 11

P

atient radiation management and feedback are essential elements of clinical fluoroscopic uality assurance programs. n ecember , , the National Council on adiation Protection and Measurements NC P) published Statement No. , utline of Administrative Policies for uality Assurance and Peer eview of Tissue eactions Associated with luoroscopically uided Interventions NC P, ), derived from NC P eport No. . NC P, ). The Statement provides structured recommendations for uality assurance processes for review of radiation use in fluoroscopically guided interventional I) procedures. It is available as a free download here.

NC P recommends recording, collecting, tracking and periodically analyzing all available radiation dose metrics, documenting the clinical need for the radiation dose, and providing patient follow up when the radiation dose e ceeds the Substantial adiation ose evel S ). S and other terms mentioned here are defined in the Statement.)

NC P also recommends that when a tissue reaction skin injury) occurs after an I procedure, dosimetric and clinical data from the procedure shall be evaluated as part of the interventional service’s routine uality Assurance Peer eview A P ) process. This is both simpler and more encompassing than the approach used by The oint Commission T C). It is simpler because skin dose estimation is comple and subject to large uncertainties, and summing skin doses ac uired from multiple procedures over time is subject to additional uncertainties. It is more encompassing because it provides for review of all cases that result in a clinically important tissue reaction, while the T C approach is limited to review of cases where a y skin dose is ac uired over a period of time a sentinel event). T C, ) NC P recommends that, regardless of the skin dose, a sentinel event shall not be considered to have occurred when a skin tissue reaction results from one or more I procedures, if all I procedures that irradiated the affected skin were performed in accordance with recognized practice parameters.

The A P process is intended to assess performance of the procedure, including justification, radiation dose optimization, the time course over which radiation doses were administered, and patient outcomes. The outcome of the A P process is identification and implementation of any appropriate improvements.

This Statement provides tables that summarize model policies and processes for the management of radiation dose for I procedures, essential elements of a A P program, criteria for evaluation of tissue reactions relative to recognized practice parameters, and outcomes and actions following the A P evaluation of a clinically important tissue reaction.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Legislative and Regulatory Affairs Report, cont.

References NC P ). National Council on adiation Protection and Measurements. adiation ose Management for luoroscopically uided Interventional Medical Procedures, NC P eport No. National Council on adiation Protection and Measurements, Bethesda, Maryland) NC P ). National Council on adiation Protection and Measurements. utline of Administrative Policies for uality Assurance and Peer eview of Tissue eactions Associated with luoroscopically uided Interventions, NC P Statement No. National Council on adiation Protection and Measurements, Bethesda, Maryland) T C ). The oint Commission. adiation verdose as a eviewable Sentinel vent, accessed ecember , ) The oint Commission, akbrook Terrace, Illinois)

NRC Extends Comment Period for ANPR for 10 CFR Part 20 Standards for Protection Against Radiation n November , , N C published in the Federal Register, an e tension for the comment period for advance notice of the C Part proposed rulemaking by days. Comments should be le n later t an Marc ( ). ec

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N C issued the Advance Notice for Proposed ulemaking ANP ) for C Part Standards for Protection Against adiation which was published in the ederal egister on uly , 79 ). In addition to the ANP , N C also published Issue Papers as well. This information is contained on the N C website

• Advance Notice of Proposed ulemaking Potential Changes to adiation Protection egulations.

• Issue Paper pdate Protection Publication

C Part to Align with International Commission on adiological Methodology and Terminology.

• Issue Paper

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Individual Protection A A A Planning.

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posure.

I look forward to hearing from all of you about this very important topic that will affect your adiation 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 ynne airobent, Senior Manager for overnment elations.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Legislative and Regulatory Affairs Report, cont.

State egi lati e

p ate

e ruar

ic ar Martin

The AAPM overnment elations ffice keenly follows legislative activities that may impact the practice of medical physicists in both the .S. Congress as well as state legislatures. ew bills are passed in the same form in which they are introduced. Accordingly, we look for opportunities to advance the important role medical physicists play in patient and worker safety by shaping proposed laws as they move through the legislative process. anuary marks the beginning of new lawmaking sessions for state legislatures. It is a time when legislators introduce new bills for consideration during the session. After a bill is introduced, it is assigned to a committee or committees for consideration. Before a bill becomes law, however, both legislative chambers must agree upon bill provisions, and the bill must be presented to the governor.

The enacted legislation is then implemented through rulemaking.

Some of the key issues we are following in state legislatures are

icen ing Cre entialing

Me ical P

ici t an

t er a iati n Me icine Pr e i nal

Several states, including Massachusetts, Alaska, North akota, and Te as are now considering bills to license or certify medical radiation professionals. A key legislative proposal is the licensing of Medical Physicists in Massachusetts. ouse Bill was introduced last year, and it has been reintroduced this year by ep. arballey M) as ouse Bill . At AAPM’s urging, the te t of last year’s bill was modified to include a definition for ualified Medical Physicist. In addition, the language describing the make up of the State Board for Medical Physics was modified to include nine members, instead of the eight proposed in last year’s bill. ouse Bill provides that the board will include five licensed medical physicists, including one from diagnostic radiological physics, two from therapeutic radiological or radiation oncology physics, one from medical nuclear physics and one from medical health physics. In addition, board members will include three licensed physicians represented by one from diagnostic radiology, one from radiation therapy or radiation oncology, and one from nuclear medicine, and a representative of the public at large.

Alaska ep. Tuck M) introduced ouse Bill , which provides ualifications for licensing of radiologic technologists and limited radiologic imagers. That bill is now in committee. North akota Sen. ee P) and ep. Porter P) introduced Senate Bill for the regulation and licensure of medical imaging and radiation therapy personnel. The bill would establish a five member board of e aminers that would include one medical physicist to establish licensure standards for nuclear medicine technologists, radiation therapists, radiographers, radiologist assistants, and sonographers.

The uman Services Committee is scheduled to address this bill on ebruary .

In addition, the Te as legislature is considering certification of medical radiologic technologists ep. our Price P) introduced ouse Bill and Sen. Charles Schwertner P) introduced the corresponding Senate Bill . These are large bills, which affect broad areas of health care, and update numerous laws.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Legislative and Regulatory Affairs Report, cont. rea t en it Screening

ti cati n Man ate

n urance C

erage

r Alternate rea t Cancer

A number of states have introduced bills that re uire providers to notify women undergoing mammography, who are found to have dense breast tissue, and advise them about ramifications for diagnosis of breast cancer. Some bills re uire insurers to provide coverage for alternate breast cancer screening procedures for women who have dense breast tissue.

Connecticut ep. larides P) introduced ouse Bill tomosynthesis for patients with dense breast tissue.

that would provide insurance coverage for

In Te as, ep. ernandez una M) introduced ouse Bill to provide for insurance coverage for supplemental breast cancer screening, and in New ork, ep. yan M) introduced AB to provide for coverage of follow up screening. Illinois Senate Bill introduced by Sen. Mulroe M) with co sponsor Sen. aine M) which e pands coverage for breast screening includes tomosynthesis in the definition of low dose mammography. These bills are under consideration by committee.

In addition, lawmakers in Iowa S introduced by Sen. ochum M) , Michigan SB introduced by Sen. ildenbrand P), klahoma B introduced by ep. enney P) , South Carolina S introduced by Sen. ourie M) , and ashington SB introduced by Sen. ’Ban P) are considering patient notification bills.

Certi cate

ee

C

a

Some states are proposing new C N laws or seeking modification of e isting laws. These laws seek to restrain health care facility costs through mandating coordinated planning schemes. e review C N legislation for provisions that may limit or adversely impact medical physicist practices, or radiation therapy diagnostic facilities or services.

In South Carolina, ep. Smith P) introduced ouse Bill that would amend the state’s C N law to include new and emerging technology for consideration of need. This amendment could be significant for radiation therapy and diagnostic serves because of the rapidly technology environment.

The bill has been referred to the Committee on ays and Means.

Pr t n

erap

n urance C

erage

klahoma ep. Cooksey P) introduced an interesting bill, ouse Bill , which would prohibit insurance plans from holding proton therapy to a higher standard of care than other therapies in making coverage decisions. The bill is now under consideration by the Insurance Committee.

The following table captures pending state legislation that may impact the practice of medical physics.

If you have any uestions on these or other state legislative or regulatory issues, please contact ichard Martin, AAPM’s overnment elations Specialist.

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Legislative and Regulatory Affairs Report, cont.

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Legislative and Regulatory Affairs Report, cont.

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Legislative and Regulatory Affairs Report, cont.

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Legislative and Regulatory Affairs Report, cont.

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Legislative and Regulatory Affairs Report, cont.

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AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

2015 AAPM FUNDING OPPORTUNITIES

2015 APPLICATION DEADLINES •

March 20: The Research Seed Funding Grant

• April

30: AAPM/RSNA Fellowship for the Training of a Doctoral Candidate in the Field of Medical Physics

GRANTS

FELLOWSHIPS

The Research Seed Funding Grant

AAPM/RSNA Fellowship for the Training of a Doctoral Candidate in the Field of Medical Physics

Three $25,000 grants will be awarded to provide funds to develop exciting investigatorinitiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources. Funding for grant recipients will begin on July 1 of the award year.

Research results will be submitted for presentation at future AAPM meetings.

Must be a member of AAPM at time of application (any membership category).

Pending membership status not accepted. **No Exceptions** Application Deadline: 3/20/2015

The AAPM Fellowship for the training of a doctoral candidate in the field of Medical Physics is awarded for first two years of graduate study leading to a doctoral degree in Medical Physics. Both BSc. and MS holders are eligible to apply.

A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year will be assigned to the recipient.

Graduate study must be undertaken in a Medical Physics Doctoral Degree program accredited by the Commission on Accreditation of Medical Physics Education Programs, Inc, (CAMPEP).

Application Deadline: 4/30/2015

APPLY: www.aapm.org/education/GrantsFellowships.asp

NEW MEMBER SYMPOSIUM Tuesday, July 14 • 4:30pm – 6:00pm • Room 304, Anaheim Convention Center

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s a new member of AAPM, it is easy to feel overwhelmed by the size and complexity of the association and to be unaware of the benefits and opportunities available to members. At this year’s AAPM Annual Meeting in Anaheim, we will host a New Member Symposium where you can learn more about the organization, member resources, opportunities to get involved, and about topics of particular interest to new professionals. We encourage you to take advantage of this great opportunity to learn valuable information and to grow your professional network.

Following an introduction from Dr. John Boone, AAPM President, Justin Keener, Chair of the New Professional Subcommittee, will speak on, “Physics of the AAPM.” Next will be Dr. George Sherouse sharing invaluable information in his talk, “Things You Won’t Be Able to Say Somebody Should’ve Told You.”

Get Your Picture Taken. There will be a photographer there to ta e pictures for our profile in the AAPM directory.

Registered attendees will receive a raffle ticket. Enter to win a complimentary registration for the 2016 Annual Meeting in Washington, DC!!

In addition, all new members who register for the Symposium will receive a drink ticket, good for one complimentary soda or beer served after the New Member Symposium during the social with committee chairs from four AAPM Councils: Science, Education, Professional and Administrative.

www.aapm.org/meetings/2015AM/

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

HEALTH POLICY & ECONOMIC ISSUES Wendy Smith Fuss, MPH, AAPM Health Policy Consultant

The National Correct Coding Initiative (NCCI)

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re your claims denied for bundling? Bundling continues to be a top claim denial reason for providers. It may be due to the National Correct Coding Initiative (NCCI), which was implemented in 1996. The Medicare claims payment processing system has “edits” to identify and eliminate the incorrect billing of medical services.

What are Correct Coding Initiative (CCI) edits?

Correct Coding Initiative (CCI) edits are pairs of Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) Level II codes that are not separately payable except under certain circumstances. The edits are applied to services billed by the same provider for the same beneficiary on the same date of service.

What are the Column 1/Column 2 edits?

Although the Column 2 code is often a component of a more comprehensive Column 1 code, this relationship is not true for many edits. In the latter type of edit, the code pair edit simply represents two codes that should not be reported together, unless an appropriate modifier is used. or example, reporting of 77280 (Simple Therapeutic Radiology Simulation – e.g. block check) and 77336 (Continuing Medical Physics Consultation) on the same day. If the 2 are performed independently of each other, then adding a modifier will allow both to be charged. therwise, the would be unpaid.

Mutually Exclusive edits exist when two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations. An example of a mutually exclusive edit is a prostate seed implant on the same day as a high dose rate cervical/uterine tandem and ovoid.

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Modifiers may be appended to CPCS CPT codes only if the clinical circumstances justify the use of the modifier. A modifier should not be appended to a CPCS CPT code solely to bypass an NCCI edit. In the modifier indicator column, the indicator , , or shows whether an NCCI associated modifier allows the code pair to bypass the edit. The means no modifiers are allowed, the means modifiers may be used when appropriate, the means the edit was deleted retroactively.

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Modifier should be appended to an evaluation and management another procedure on the same day of service. Appending modifier

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M) code when reported with to the M code indicates

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

Health Policy & Economic Issues, cont. to payers that, as a result of the patient’s condition, the physician performed a significant, separately identifiable M service above and beyond the other services provided.

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Modifier is used to indicate a distinct procedural service. To appropriately report this modifier, append modifier to the column code to indicate that the procedure or service was independent from other services performed on the same day. The addition of this modifier indicates to payers that the procedure or service is distinct from others billed on the same date of service. In other words, this may represent a different session, different anatomical site, separate incision/excision, different lesion, or different injury or area of injury in e tensive injuries). hen used with a CCI edit, modifier indicates that the procedures are different surgeries when performed at different operative areas or at different times.

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The purpose of the National Correct Coding Manual is to promote correct coding nationwide and to assist physicians in coding services correctly for reimbursement. The policies included in the manual are based on coding conventions as defined by the American Medical Association AMA) CPT manual.

tain t e CC

it Manual

The Centers for Medicare and Medicaid Services (CMS) website contains a listing of the CCI edits, by specific CPT sections, which is available for free to the public. The CCI dits manual is also available on the CMS website. These edits are updated quarterly by Correct Coding Solutions, LLC. The updates occur in anuary, April, uly, and ctober. It is important to review these updates to see if the services/procedures you provide are up to date. To view and or download this information, visit the CMS National Correct Coding web page. CMS also provides a document on “How to Use the National Correct Coding Initiative Tools. or more information go here.

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thank

following individuals for their 2014 contributions: AAPM Education & Research Fund Rami Abu-Aita Bipin Agarwal B. (Wally) Ahluwalia Waleed Al-Najjar Hassaan Alkhatib Scott Alleman John Antolak David Applebaum Samuel Armato Elwood Armour Alfred Asprinio Luther Aull Shahid Awan Rajeev Badkul Gary Barnes J. Ed Barnes Clyon Wayne Bell Carl Bergsagel Arthur Boyer Chandra Burman Vera Burtman Wayne Butler Christopher Cain David Carlson Dev Chakraborty Sha Chang Jean Jacques Chavaudra Lili Chen Zhe (Jay) Chen Xudong Chen Kenneth Chu Joseph Conlon Kevin Corrigan

Gregory Courlas Wesley Culberson J. Adam Cunha Zhong Das Jaydev Dave Joseph Deasy Domenico Delli Carpini Bruce Curran John DeMarco Jun Deng Colleen Desrosiers Nicole Detorie William Donahue Lei Dong Kai Dou Emmanuel Ekwelundu Issam El Naqa Scott Emerson Tony Falco Jonathan Farr Karl Farrey David Followill Doracy Fontenla Mary Fox Martin Fraser D. Jay Freedman Stephanie Frost Azucena Garzon William Geisler John Gibbons Maryellen Giger Cal Glisson Steven Goetsch David Lloyd Goff Lee Goldman Paul Goodwin

you!

Michael Gossman Rebecca Graciano Edward Grant Anne Greener Bennett Greenspan Madhup Gupta Per Halvorsen Russell Hamilton Oliver Hanson Joanna Harper Vijay Harwalkar Colleen Heelan Joseph Hellman Frank William Hensley Donald Herbert James Hevezi Jung Ho Russell Hobbie Kenneth Hogstrom Michael Huberts Abrar Hussain Gulkan Isin Shima Ito Michael Jacobs Mary Ellen Jafari Loretta Johnson Steven Jones Kalpana Kanal Haejin Kang Alireza Kassaee Sunil Kavuri James Kereiakes Timothy Keys Angela Keyser Kevin Khadivi Jong-Hyo Kim

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AAPM wishes to acknowledge and thank the

Stefano Peca Yong Peng Angelica Perez-Andujar Joseph Perl Paula Petti Douglas Pfeiffer Bhaskaran Pillai Robert Pizzutiello Jerimy Polf Bradley Pollard Robert Praeder Michael Price Jennifer Pursley Lihong Qin Mitchell Randall Prema Rassiah-Szegedi John Ready Chester Reft Miguel Rios Mark Rivard Daniel Robertson James Sample Stephen Sapareto Vikren Sarkar L. John Schreiner Alexander Scott Christopher Serago Anil Sethi Jan Seuntjens ha il in hafi ue Douglas Shearer S. Jeff Shepard Jungwook Shin Deborah Shumaker Douglas Simpkin Jennifer Smilowitz Michael Snyder Flavio Augusto Soares Senthamizhchelvan Srinivasan Palmer Steward Keith Strauss Steven Sutlief Larry Sweeney John Sweet Russell Tarver Philip Tchou James Terry Benjamin Titz Sean Thomas Toner Suzanne Topalian Earl Trestrail Kenneth Ulin Frank Van den Heuvel Jacob Van Dyk

Rafaela Varela Rohena Arivazhagan Vasudevan Linda Veldkamp Dongxu Wang Lu Wang Steven Wang Xiaoyang Betsy Wang John Washington Christopher Watchman Richard Wendt Barry Wessels William West Gerald White Thomas White Brian Wichman D. Allan Wilkinson John Willins Charles Wissuchek John Wochos Margaret Wolf John Wong Kenneth Wright Raymond Wu Jun Yang Ellen Yorke Ning Yue Pengpeng Zhang Hualin Zhang Qinghui Zhang Jun Zhang Bo Zhao Timothy Zhu X. Ronald Zhu Jeananne Zink

African Affairs SC Sarah Ashmeg Wolfgang Baus Emmanuel Ekwelundu Ravimeher Errabolu Steven Jones Chandra Prakash Joshi Colville Osborne Chester Reft Margaret Wolf

Asia/Oceania SC J. Adam M Cunha Shidong Li Charles Shang D. Allan Wilkinson Raymond Wu

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Assen Kirov Nels Knutson Michael Kowalok Roger Ladle Lena Lamel Edwin Leidholdt Lisa Lemen Shidong Li David Lightfoot Liyong Lin Dale Litzenberg Gary Luxton Jingfei Ma Thomas Mackie Paul Maggi Eugene Mah Mahadevappa Mahesh Christopher Marshall Kenneth L. Matthews Martha M Matuszak James McDonough Ross McGurk Sarah McKenney Robert McLawhorn Sharon McMillan Michael McNitt-Gray Todd McNutt James Meade Albert Mesa Tariq Mian Ira Miller George Mitev Raj Mitra Radhe Mohan Jose Morales Monzon Mary Moore Herbert Mower Lee Myers Dinesh Kumar Mynampati Daniel Neck David Nelson Robert Nishikawa James O’Rear Olabode Thomas Ogunleye Arthur Olch Shuichi Ozawa Sandra Paige Xiaoning Pan Niko Papanikolaou Brent Parker Norris Parks E. Ishmael Parsai Kishor Patel Daniel Pavord

Carson/Zagzebski Endowment

Glasser Members Memorial

Paul Carson James Zagzebski

S. Jeff Shepard Thomas White

Cameron Memorial

nternati nal cienti c Exchange Program

Jean Jacques Chavaudra Cupido Daniels Juan Filomia Martin Fraser William Geisler Jayne Knoche Colville Osborne Chester Reft L. John Schreiner David Spencer Thomas White

D. Jones Members Memorial David Spencer John Washington Thomas White

E. Webster Members Memorial Thomas White

Ed Fund Members Memorial S. Jeff Shepard Thomas White

European Affairs SC

Muthana Al-Ghazi Jean Jacques Chavaudra Dustin Jacqmin Jayne Knoche Eugene Lief Stephanie Anne Parker Kishor Patel Lihong Qin David Spencer Donna Stevens John Washington Thomas White John Willins

John Hale Memorial Fund Mary E. Moore Thomas A. White

Krohmer Memorial

Chandra Burman Paul Goodwin Margie Hunt David Lightfoot Gig Mageras Dennis Mah Radhe Mohan Mary Moore Chester Reft Lawrence Rothenberg Jean St. Germain Thomas White Qinghui Zhang

Loevinger Memorial Edwin Leidholdt Chester Reft Thomas White Qinghui Zhang

Middle East Affairs SC Parham Alaei Hassaan Alkhatib Issam El Naqa Osama Mawlawi Omar Zeidan

James Goodwin Edwin Leidholdt Mary Moore David Spencer Raymond Tanner Thomas White

Joanna Cygler

Latin American Affairs SC

Future Graduate Program

Jose Morales Monzon Javier Santos Rafaela Varela Rohena

Hassaan Alkhatib Maryellen Giger Shidong Li Chester Reft S. Jeff Shepard Thomas White

Laughlin Memorial

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www.aapm.org/education/edfundintro.asp

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Access to all ScientiďŹ c and Continuing Education Sessions Access to the Exhibit and Poster Hall Congress bag, program and handouts CD containing full papers presented at the Congress Welcome Reception and Networking Breaks Early bird registration deadline:

March 31, 2015

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

ABR NEWS Jerry D. Allison, Geoffrey S. Ibbott, J. Anthony Seibert

The Nature of the Medical Physics Maintenance f erti cati n a inati n

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urrent statistics show that 2,534 medical physicists have enrolled in the Maintenance of Certification M C) program since it became mandatory for time limited certificate holders in . The number of lifetime certificate holders who have enrolled, while still modest, has been growing steadily. All AB volunteers, including AB trustees, are re uired to participate in the M C program. In general, the M C program has been well received, and most medical physicists see the value of participation. The M C component that most concerns our medical physics diplomates is the re uirement for a cognitive e amination. iplomates do not like being tested and find the e am somewhat stressful. This article will review the cognitive e am with the intention of showing that it is useful, well balanced, and fair.

Value of the Exam hile specific research on certification e aminations in medical physics M C programs is lacking, there is strong evidence that a cognitive e amination is valuable for our physician colleagues. ata shows that clinical performance decreases with time from initial certification, and that the decrease is halted by additional e aminations. urther, the actual clinical performance of physicians is improved by participation in cognitive e aminations. This research contributed to the decision by the American Board of Medical Specialties to stipulate that all of their member boards re uire a periodic cognitive e am.

The MOC Cognitive Exam Requirement The M C program for medical physicists re uires that, for each primary certificate, the cognitive e amination must have been passed within the past years. The e am may be taken multiple times, so many diplomates begin taking it in years seven or eight.

Not passing the e am in each primary certificate within the past years will result in an M C public reporting status downgrade or certificate lapse. or those whose certificate lapses, there is a reentry path that does not re uire additional formal education or residency training.

Content of the Examination The content of the AB M C e amination is defined by committees of volunteers, all of whom participate in M C. These committees are composed of both MS and Ph physicists and those in private practice, consulting, and academic medical physics.

The committees’ goal is to develop an e am that covers material that a physicist in clinical practice is e pected to know. Material that is included must be in common use.

The e am covers the entire range of each specialty since most private practice and

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

ABR News, cont. consulting physicists span the entire range of medical physics in their clinical practice. Some academic physicists are highly specialized and are somewhat at a disadvantage compared to those who have a wider range of clinical practice, but many medical physicists also fre uently change jobs, so they must e pect to practice in any area of their specialty.

Study guides posted on the AB website for each discipline define the scope of the M C e ams.

Items in the study guides are reviewed periodically for clinical relevance. Appro imately percent of the e am is designed to be basic medical physics information. The remaining percent of the content is selected from areas that focus on developments in medical physics from the previous years. The e am uestions are based on a series of documents that the committees review and revise periodically, and that list of documents is published in the study guides. uestions are developed from and referenced to documents in the study guides. All uestions on recent developments in medical physics are referenced to a document in the study guide, and the basic uestions are referenced to common te tbooks.

The e am consists of multiple choice uestions. The candidate is e pected to select the one correct answer from three or four possible answers. Illustrations are used when appropriate. The e am includes no comple calculations and very few calculations at all. It is not similar to the Part or Part e aminations.

Scoring the Exam

The benchmark used to set the passing score is the perceived performance of the minimally competent medical physicist. The e am is not designed to determine the star performers, nor is it designed to rank the participants. A panel of AB volunteers analyzes each uestion on the e am. ike the committees that design the e ams, these committees are composed of both MS and Ph physicists and those in private practice, consulting, and academic physics. ach uestion is evaluated as to the likely performance of the minimally competent medical physicist. This practice, called the Angoff procedure, is used to set the passing score for each e am. The same techni ue is used for all AB e aminations. There are no scoring curves, and each candidate may pass or fail the e amination.

There is also no arbitrary number of candidates that must pass or fail.

The Performance of the Exam

The M C e am has been given since , so the AB now has sufficient data on the e am to draw some conclusions. The number of candidates is shown in the figure below. As e pected, the number of M C e am takers increases as the number of participants reaching the end of their first year cycle increases. e e pect this number to continue to increase for several decades.

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ABR News, cont.

A statistical procedure used to evaluate e ams is called the e am reliability. This measure determines how likely it is that a candidate taking a similar e am would have the same result. Based on the therapeutic medical physics e am, the reliability of the M C e am is e cellent. The most recent value for the therapeutic medical physics e am was . . The values for the diagnostic medical physics and nuclear medical physics e ams have not been determined because of the small number of test takers, but from analysis of the individual items on these e ams, we are confident that the e am is of e cellent uality. The development, assembly, and vetting of e am items for the diagnostic medical physics and nuclear medical physics e ams are identical to those for the therapeutic medical physics e am. te

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The M C e am is a criterion based e am. The criterion is that a minimally competent medical physicist would pass the e amination, which is not designed to rank the participants. n such an e am, uestions that are very easy more than percent of the participants get the uestion correct) or too difficult less than percent of the participants get the uestion right) are of little value since they don’t help determine if an individual meets the standard. A uestion that about percent of the candidates get right works well. Some participants find this unsettling since they are used to doing well on e ams. The difficulty of the items on the M C e ams is shown in the figure below.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

ABR News, cont.

Because the uestions are designed so that roughly percent of the test takers will answer them correctly, it is common to receive complaints that the test is too difficult. It is important to realize that the e am is designed to discriminate well by avoiding uestions that are too easy or too difficult. The passing score is not directly related to how difficult each uestion is.

Results The combined pass rates for first time takers are shown in the graphs below. The overall weighted pass rate for the si years of the e am has been percent.

The overall pass rate and the pass rate for first time takers also are shown in the graphs.

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ABR News, cont.

It is worth noting that there were low numbers of takers in and , as shown in the graph above. It is important to remember that the e am can be taken more than one time, so a diplomate who fails the e am on the first attempt can have additional opportunities to succeed. e have now completed the year M C cycle for three separate diplomate cohorts those certified in , , and ). or those three years, . percent of the individuals at the end of a year cycle had met all the re uirements of M C. In the same group, . percent of the diplomates had not met several re uirements and entered the Certified, Not Meeting M C e uirements group. They then had one year to remove the deficiencies. inally, . percent had met all the re uirements e cept passing the cognitive e am. They also entered the Certified, Not Meeting M C e uirements group. The following pie chart shows this graphically. Note again that the latter two groups would have one year to make up any deficiencies before they become uncertified.

verall, just a small percentage of diplomates have failed to meet all M C re uirements only because of the cognitive e am. iplomates who become uncertified can regain certification by completing all re uisite re uirements within a chosen calendar year.

Plans for the Future The medical physics trustees are working on ways to improve the e amination and make it more useful to the diplomates. It is our hope that we will soon be able to provide robust feedback to all the e aminees. This will allow diplomates to determine their strengths and weaknesses and to design educational programs, Self irected ducational Projects S Ps), and Practice uality Improvement P I) projects that meet their individual needs.

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The medical physics trustees are always happy to receive comments about the M C e am and to answer any uestions. Please feel free to contact us by email or call the M C elp esk at ) .

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R • Special 3-Day Program on Ultrasound – This track highlights recent advances in ultrasound for diagnostic imaging, ultrasound for guidance and control of radiation therapy, and therapeutic ultrasound such as MR guided HIFU. Each daily track begins with an Educational Session related to the subse uent scientific sessions a hands on ultrasound workshop to highlight US imaging and therapy systems; a primer on Image-guided High-Intensity Ultrasound (HIFU) therapies; and a primer on QA for diagnostic ultrasound.

NEW! erti cate f leti n r gra in Magnetic Resonance Guided Radiation Therapy – e erti cate f leti n r gra is a new offering from AAPM which provides an in-depth review of a particular topic with verification of learning ob ectives through online homework.

• NEW! Coordinated Educational/ Scientific Sessions – Invited sessions which provide both educational and scientific content fro leaders in the field o e to the first session to learn all all the background information; stay for the second session to see the latest scientific developments on that same topic. Topics for coordinated sessions include knowledgebased automatic treatment planning, quality assurance and safet research and T lung cancer screening.

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NEW! ars n ag e s i isting is ed ect res i n edical ltras nd Dr. Mickael Tanter, PhD, from the Institut Langevin, École Supérieure de Physiqueet de hi ie ndustrielles de la ille de aris will provide an overview regarding ultrafast ultrasound imaging-current applications and changes to the future paradigm of diagnostic imaging and real time guidance of therapy/ intervention.

The cience ouncil ession Imaging Genomics.

Radiomics/

• In addition to Symposia and regular Sessions, Keynote Sessions on topics of special interest. oint scientific s posiu ith the orld Molecular Imaging Society – Linking Pre-Clinical and Clinical Trials: Co-Clinical Trials oint scientific s posiu ith T Imaging Markers for Assessment of Treatment Response a or e pansion of A s offerings in ducation rofessional ractical and cientific rogra s • Dedicated time in the meeting program for Visit the Vendors.

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erti cate f advanced training in agnetic res nance ided Radiati n era n ednesda ul at the Annual eeting of the AA a ini Track on Magnetic Resonance guided Radiation Therapy will be open to meeting registrants. This track will consist of 5 sessions (2 educational sessions, 2 symposia and proffered paper session focused on advancing the knowledge of medical physicists related to understanding and opti izing use of in adiation Therap treatment. Basic education as well as emerging and advanced concepts will be covered in this one-day mini-track. All those who register for the AAPM meeting (weekly or ednesda dail ill have access to these sessions as usual. In addition, an inaugural certi cate f c leti n r gra will be rolled out in con unction ith this course attendees

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ill be able to enroll in the certificate program for an additional fee. Enrollment in the certificate progra entitles participants dedicated seating in the mini-track sessions as well as some presentation materials. Following the eeting certificate progra participants ill be able ta e an online e a ination hich covers the material presented throughout the day-long mini-track. The test will be available on the AAPM website by August 3, nrollees ho de onstrate satisfactor attendance at the course and successful co pletion of the online e a ination ill receive a fra ed certificate of co pletion for this course b ail The certificate of completion document demonstrates that the recipient has received advanced training in MRI-guided radiation therapy, and that he or she has demonstrated comprehension of these concepts through e a ination

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Deadline for receipt of w rd a stracts and supporting data.

This deadline recognizes other conference schedules There ill be . Authors must submit their abstracts by this time to be considered for review.

Meeting Housing and Registration available online.

Authors notified of presentation disposition Annual

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

EDUCATION COUNCIL REPORT George Starkschall, Houston, TX Education Council 101

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lthough you are probably reading this report in March, it was actually the first report that I am writing in , so I thought that with the start of a new year, and the beginning of the tenure of several new members on ducation Council, I would use this article to introduce readers to ducation Council, its members, and the various committees that make up the ducation Council.

The ducation Council is identified in Article III, Section of the AAPM By aws. As you can see from the By aws, the charge to the ducation Council is somewhat vague. The charge reads, The ducation Council shall act as a clearinghouse for educational in uiries addressed to the Corporation by members or outside groups and shall route in uiries to the appropriate categorical ducational Committees. The ducation Council shall consider and make recommendations of educational policy to the Board. It shall formulate specific charges for the guidance and direction of the categorical ducational Committees. As is so often the case with such general statements, those sentences tell everything about what the ducation Council does, and nothing about what the ducation Council does. or a much more detailed description of ducation Council and its activities, you will need to go to the Rules of the AAPM and look at ule . . ho are the individuals who comprise the ducation Council ou can find a roster of ducation Council members here. Most members of the ducation Council are ex o ficio members by virtue of being chairs of the standing committees that make up the ducation Council. ther ex o ficio members are the individuals in the Presidential succession chain, or the chairs of other councils. ducation Council also includes several at large members as well as AAPM ead uarters Staff members, who assist the Council in carrying out its tasks. ho are the individuals who comprise the ducation Council ou can find a roster of ducation Council members here. Most members of the ducation Council are e officio members by virtue of being chairs of the standing committees that make up the ducation Council. ther e officio members are the individuals in the Presidential succession chain, or the chairs of other councils. ducation Council also includes several at large members as well as AAPM ead uarters Staff members, who assist the Council in carrying out its tasks.

The ducation Council acts as a forum for the activities of the various Committees that comprise the ducation Council, and provides guidance to these Committees. The real work, however, is done in the Committees, Subcommittees, Task roups, and orking roups. The ducation Council typically meets three times a year, at the AAPM Annual Meeting, at the SNA Meeting, and at a . day retreat, typically held in March. ere is brief overview of the Committees that make up the ducation Council The Continuing Professional evelopment Committee, chaired by William Parker, handles most of the continuing

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Education Council Report, cont. education activities of the AAPM, including the Summer School, the irtual ibrary, and the physics tracks in the SNA refresher courses. The ducation and Training of Medical Physicists Committee, chaired by Joann Prisciandaro, develops and reviews curricula for graduate and residency programs, promotes and supports the establishment of medical physics residencies, awards various fellowships such as the Summer ndergraduate ellowship Program S P) and the iversity ecruitment through ducation and Mentoring Program AM), provides educational resources for medical physicists involved in education, and provides resources for students and trainees. The International ducational Activities Committee, chaired by Yakov Pipman, coordinates the International Scientific change Program IS P) and implements cooperative agreements between the AAPM and other medical physics organizations. The Public ducation Committee, chaired by George Sandison, promotes public education in matters pertaining to medical physics, the Medical Physics ducation of Physicians Committee, chaired by Thad Wilson, develops resources for medical physics education primarily of radiology and radiation oncology residents, and organizes tutorials on e uipment selection and physics in radiology at SNA meeting. inally the Medical Physics ducation of Allied ealth Professionals Committee, chaired by Steve de Boer, provides liaisons to many of the e am committees for allied health professionals. In addition, the ducation Council works closely with the ducation Page Coordinator, Perry Sprawls, to develop an online ducator’s esource uide. inally, ducation Council has a Task roup, T , chaired by Jim Dobbins, charged with assessing AAPM’s online educational presence. More will be presented on the Task roup in a later Newsletter article. ducation Council is always eager to involve AAPM volunteers. Although at the Council or even the Committee level, it may be difficult for a new member to become involved, Subcommittees and orking roups are continually seeking new members who are willing to dirty their hands and become involved in the work of the organization. If you are interested in making your voice heard, make sure a Subcommittee Chair hears your voice and let them know of your interest. Attend a Council, Committee, Subcommittee, orking roup, or Task roup meeting most are open to AAPM members, introduce yourself to the Chair, and ask to be placed on the mailing list as a uest. Soon it is likely you will be invited to participate. ou, too, can play a role in guiding the educational activities of our organization.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

TG 109 UPDATE Christina Skourou, TG 109 Chair, Dublin, Ireland Code of Ethics: Tell us what you think!

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ask Group 109 was reinstated in January for the purpose of reviewing the existing Code of Ethics and making suggestions for change if such change is deemed necessary. As the Chair of the Task Group, I am inviting AAPM members to share with us their feedback and suggestions early in the process to ensure that the review reflects the opinion of all the members of the Association. Beginning at the end of March, a feedback form will be available on the AAPM homepage. I enjoin all members to communicate their thoughts and concerns through this pathway. The following few paragraphs aim to provide the background of the review and emphasize why the involvement of all members in this process is of critical importance.

The AAPM Ethics Committee was formed to act as a policy maker and regulator of the professional conduct of AAPM members. In , the first Code of thics PP A) was drafted to replace the following AAPM policies thical uidelines for acating a Position PP B) thical uidelines for eviewing the ork of Another Physicist PP C) uidelines for thical Practice for Medical Physicists PP ) and thics Complaint Procedure PP A). The AAPM Board of irectors approved PP A Code or thics on uly , . The full te t of the current revision of the Code of thics PP C) can be accessed via the AAPM website.

The Code communicates the Association’s ethics and compliance standards and sets out the principles and values on which good practice is founded. Professionalism requires more than just complying with the law, and so the Code contains standards of behavior that go beyond what the law requires. It is each member’s responsibility to be familiar with the AAPM Code of Ethics and to follow the guidance it contains.

The current Code of thics is structured as a set of core principles, followed by specific though not e haustive) guidelines as to the members’ practice in four domains

Professional Conduct addresses the maintenance of knowledge and skills it admonishes the members to act in a manner where potential harm to others is minimized and high quality care is provided to the patient. In the same domain, honesty and respect are defined as the standards for the uality of communication and partnership between physicists and with other collaborating professionals.

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Research Ethics: these clauses promote the aims of research, such as knowledge, truth and the avoidance of error, and the values that are essential to collaborative work, such as authorship, peer review and management of conflicts of interest.

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Education Ethics: this domain differentiates between the ethics governing teachers and those governing students. Members acting in the teacher’s capacity have an obligation to promote the success of every student by acting with integrity, fairness, and respect.

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TG 109 update, cont.

Members who are students are considered vulnerable and as such the code aims to ensure their protection. Student status does not absolve members from the obligation to act with integrity and honesty.

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“Business/Government Ethics: the last domain sets the standards for the business interactions of members and covers areas such as sponsorship and employment.

All AAPM members agree to be compliant with the Code of Ethics at the time of initiation or renewal of their membership. While the guidance contained in the Code aims to be consistent with the law across the USA, it does not supersede the laws and codes of practice that apply where members work – it is therefore important that members keep up to date with, and comply with, the local legislature.

The Ethics Committee assumes responsibility for the facilitation of the Code of Ethics and for ensuring compliance with its clauses. The Association is self regulated and its integrity relies on the honesty and transparency of its members, as well as their capacity to act in a protective role to the profession.

The last section of the Code of Ethics details a procedure by which any member of the Association can bring an issue or incidence contrary to the Code of thics to the attention of the Committee due process can be assured in the dispensation of such complaints. Authority for investigation of specific circumstances and dispensation of disciplinary action remains with the Professional Council to ensure that fairness and impartiality in the process is not compromised.

While the fundamental principles of ethical conduct remain intact in a realm of changing technology and innovation, the professional roles and responsibilities of AAPM members change and the Code may re uire updating to reflect these new challenges and realities. Therefore, further to the ongoing facilitation of the Code of thics, the thics Committee assumes the task of the continuing definition of the organization’s ethics and compliance standards, as well as that of recommendation of where revisions need to be made to the Code itself.

The Ethics Committee reinstated Task Group 109 in January to review the current Code of Ethics and evaluate its efficacy in guiding today’s practicing professional in acting according to the principles and values of the Association. While our task is to critique, evaluate, and examine the existing Code of thics, it is important to remember that the current version of the Code has played a significant role in the introduction of ethics and professionalism instruction in the workplace and in medical physics educational and training programs. It is understood that the guidance was not, and cannot be, all encompassing. It does however aim to serve as an ethical framework providing the principles which a medical physicist can apply to the situations they most commonly face in their daily practice.

The Task Group review therefore is focusing on areas in the Code that have either caused confusion to the members, have failed to provide adequate guidance, or have lead to inconsistent guidance in essentially similar scenarios. The Task Group aims to identify and rewrite these sections in a manner that ensures clarity and applicability and to reduce the probability that similar aberrations or misinterpretations would recur. The Task Group must complete its work of review and revision in time for full review and approval by the Board to occur before the ecember sunset date. ue

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TG 109 update, cont. to the complexity and importance of the material, the Group is starting this year to engage with the members our first aim is to gather feedback we can use to focus our endeavors to the areas of most concern to AAPM members.

As the Chair of Task Group 109, I extend a personal invitation to all members to participate in the online survey that will become available on the AAPM Homepage by the end of March, which has been put in place to facilitate communication between the Task Group and AAPM members. You will need your AAPM username and password to complete the survey as proof of membership. I assure you that your responses and any personal information shared will be treated with utmost confidentiality. our response to this survey is critical in the accumulation of necessary information to formulate useful and appropriate revisions of the Code of Ethics thus ensuring the true representation of the members’ practices and needs.

Thank you all very much for your participation in this important survey and for your help in steering our review of the Code of Ethics. I wish you all safe and successful practice.

SAVE THE DATE!

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

SCIENCE COUNCIL REPORT Jeffrey H. Siewerdsen, Baltimore, MD

Emerging Science Comes to Light: AAPM Researchers Look to Burgeoning Technologies and Clinical Applications

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015 is the International Year of Light, a global initiative adopted by the United Nations to promote and raise awareness on the role of optical technologies in answering major challenges in communication, education, and health. Among the founding partners of the initiative are AIP, IOP, SPIE, OSA, and other groups with which AAPM and its members are deeply involved. With optics providing just one of the many tools in the medical physics arsenal, the AAPM Science Council is helping to bring emerging technologies “to light.”

Such activities include imaging methods that bridge physical scales from molecules to whole organs and treatment approaches that unleash the full spectrum of imaging modalities for high-precision therapies – from photons to phonons.

A few of the areas to watch for emerging AAPM science are summarized in this update, including: • The 2015 AAPM Annual Meeting (July 12–16, Anaheim CA); • Activities underway in the Research Committee and Technology Assessment Committee; and • The new Research Spotlight article, the inaugural of which is in this newsletter.

What better location to bring emerging science to light than sunny southern California?

The AAPM 57th Annual Meeting & Exhibition in Ana ei inclu e an e tra r inar cienti c program that not only presents the latest breakthroughs in imaging, image-guided procedures, and radiation therapy physics but also features numerous areas of emerging science that are shaping the future of medical physics.

For example, an invited symposium entitled “Bridging the Scales from Molecules and Cells to Clinical Applications” organized by Robert Jeraj (University of Wisconsin) features invited presentations by Amy Rowat (UCLA) on fundamental understanding of cancer gained from imaging of the cell nucleus, Enrico Gratton C Irvine) on fluorescence spectroscopy and near infrared imaging in application to breast cancer, and Brian Pogue (Dartmouth University), whose research has opened countless applications of photonics in medicine, including near-infrared imaging, photodynamic therapy, and fluorescence guided neurosurgery.

Ongoing collaboration with the World Molecular Imaging Society points to the expanding horizons of medical imaging physics as evidenced in the second annual joint AAPM-WMIS Symposium to be held at the Annual Meeting in Anaheim. Organized by Jason Lewis (MSKCC) and Yue Cao (University of Michigan), the symposium addresses breakthrough methods that link pre-clinical research with clinical trials via “Co-Clinical Trials.” Invited speakers include John Hazle (UT MD Anderson) on pre-clinical imaging in co-clinical trials, Kayvan Rahimi (MSKCC) on molecular imaging and nano-medicine, Henry

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Science Council Report, cont.

Manning (Vanderbilt) on molecular imaging of cancer therapy response, and Larry Clarke (NCI) on how co-clinical trials can synergize with priority research areas at the NCI. inally, though this only scratches the surface of a deep scientific program at the Annual Meeting, Chris Diederich (UCSF) and Mark Holland (Indiana University) have organized a dedicated 2–3 day track on Ultrasound Physics, including both imaging and therapeutic applications. Topics include emerging ultrasound technologies for diagnostic imaging as well as invited presentations by Dimitre Hristov (Stanford University) on USgRT, Kai Ding (Johns Hopkins University) on ultrasound imaging for intrafraction soft-tissue monitoring, and X. Allen Li (Medical College of Wisconsin) on ultrasound-MRIguided radiotherapy of the pancreas. Furthermore, a full day of symposia and sessions are dedicated to the topic of HIFU as an emerging area of medical physics research and clinical application.

Highlights include presentations on MR-guided HIFU tumor ablation and targeted hyperthermia

by Pejman Ghanouni (Stanford University) and Chrit Moonen (University Medical Center, Utrecht), respectively. Additional sessions cover topics in advanced devices, image guidance techniques, and treatment delivery strategies and include Kathy Ferrara (UC Davis) presenting the role of HIFU for drug delivery and immunotherapy, Rajiv Chopra T Southwestern) on image guidance specific to hyperthermia applications, and Elisa Konofago (Columbia University) on harmonic motion imaging.

Advances in HIFU treatment planning will be presented by Doug Christensen (University of Utah) and Tobias Preusser (Fraunhofer MEVIS).

The 2015 Annual Meeting also marks the inaugural symposium for the Carson-Zagzebski Distinguished Lectureship on Medical Ultrasound, featuring Mickael Tanter (Institut Langevin, École Supérieure de Physique et de Chimie Industrielles de la Ville de Paris), who will present the latest advances in ultrafast ultrasound imaging, new applications, and emerging paradigms for ultrasound imaging and therapy guidance.

Identifying the means by which to advance the science of medical physics is foremost to the charge of the AAPM Science Council, and activities underway in the Imaging Physics Committee, Therapy Physics Committee, Research Committee, and Technology Assessment Committee - fueled by the commitment, vision, and expertise of volunteers – are critical to that mission. In addition to new and ongoing work in the IPC (including, for example, TG 234 on Virtual Tools for Evaluation of New 3D/4D Breast Imaging Systems, TG 246 on Patient Dose from Diagnostic Radiation, and the Working Group on Quantitative MRI) and TPC (for example, the forthcoming work of TG 100 on new paradigms for safety and QA in radiation therapy, TG 256 on Proton Therapy RBE, and the Working Group on Emerging Therapy Technologies), a few new initiatives from the RC and TAC warrant a highlight with respect to their impact on AAPM science, emerging research, and new frontiers for medical physics.

Among the new initiatives of the Research Committee is a new Travel Grant mechanism available to AAPM member graduate students, postdoctoral fellows, and residents with the aim to diversify the scope of research interests within the medical physics community. Specifically, the travel grant e pected to launch in will facilitate travel of such AAPM members to scientific meetings

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Science Council Report, cont. outside the conventional scope of medical physics research – for example, conferences on molecular medicine, genomics, photonics, robotics, and big data – with the aim of expanding the horizons of medical research and synergizing such activity with our own expertise and capability for clinical translational research. In addition to attending the meeting, awardees will be expected to report their experience and connections to future areas of medical physics research in both a summary and poster presentation, thereby e panding the content of our own scientific meeting and providing e posure and feedback to the AAPM membership in these diverse areas of research.

Also noteworthy among such initiatives is the ongoing work of the FUTURE Working Group on Future Research and Academic Medical Physics, chaired by Thomas Bortfeld (Massachusetts General Hospital) and Robert Jeraj (University of Wisconsin). Following from the 2014 Science Council Session on “The Physics of Cancer” at the Annual Meeting in Austin TX, the 2015 meeting will feature a symposium on “Modeling Cancer Complexity,” chaired by Robert Jeraj (University of Wisconsin) and Mariam Eljanne (NCI) with talks by Robert Austin (Princeton) , Eugene Koay (UT MD Anderson), and Raul Rabadan (Columbia University). Finally, the FUTURE Working Group is looking ahead to a Grand Challenges workshop bringing together AAPM scientists as well as non-AAPM experts from areas beyond Radiology and Radiation Oncology – for example, biology, mathematics, biostatistics, and operational research – to identify priority areas for the expanding horizons of medical physics research.

New and ongoing activity underway in the Technology Assessment Committee also helps to identify areas of emerging research and technology and expand the role of medical physicists therein. Among the five orking roups underway in the TAC is work in computer aided diagnosis, CT standardization, optimization of medical imaging systems, model QA programs, and imageguided interventions. The last deserves some attention - the Working Group on the Assessment of Technologies for Image-Guided Interventions, chaired by Keyvan Farahani (NCI) - as it tackles numerous areas of emerging technology relevant to the future of medical physics. Within the charge of this Working Group are task groups addressing topics of 3D C-arm imaging, robotics-assisted interventions, ultrasound-guided surgery, and MR-guided focused ultrasound (MRgFUS). Each of these areas suggests an expanding role for medical physics research and clinical practice immediately beyond conventional boundaries.

Taking MRgFUS, for example, I spoke with Dr. Farahani about activity underway in TG 241 on MRgFUS, chaired by, Rajiv Chopra (UT Southwestern) and R. Jason Stafford (UT MD Anderson).

He explained that research in MRgFUS is generally focused on component imaging, therapy technologies, or the hybridization of image-guided therapy and methods to monitor and control therapy. On the clinical side, medical physicists can also play a crucial role in: • assuring the safety and accuracy of procedures; • development and application of robust dosimetry and QA methods; and • educating and assisting clinicians in proper use of the technology.

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Science Council Report, cont.

Farahani went on to e plain that although there are several scientific and professional societies interested in HIFU, few (or perhaps none) are formally addressing QA, an area that is crucial to successful widespread clinical translation of this promising technology - and a strength of the AAPM. Task Group 241 tackles this directly through the assessment of current clinical MR-guided HIFU systems and identification of uantitative metrics and training issues for the medical physicists. The TG includes members from academic, industry, and government agencies (including the NCI and FDA). They have also formed a sub-group charged with the development and assessment of a platform-independent QA phantom for image-guided therapy applications.

This update provided just a glimmering peek at how AAPM scientists are helping to bring emerging technologies to light. Building from the strength of its volunteers and the unique capacity of medical physicists to translate breakthrough technologies to clinical application, AAPM eyes a horizon beset by challenges and ripe with opportunities, with rewards paid in proportion to the strength of our vision, persistence, and expertise, and with no less than the c ntinue i rance ur el at ta e With that in closing, it is a pleasure to introduce the inaugural Research Spotlight article to be featured regularly in future AAPM website and newsletter communications. The goal of the Research Spotlight is to highlight areas at the cutting edge of medical physics research, including the projects and people at work in such emerging areas and spanning the full spectrum of medical physics research from fundamental physics and biology to research translating technology to first clinical application as well as the novel ways that clinical physicists are improving the safety and performance of medical technologies and practice. Future articles will include cutting edge research and clinical translation on topics of: • Deformable image registration - in theory and practice; • Quantitative imaging and radiomics in imaging and therapy; • The science of safety in medical physics; • Breakthroughs and challenges in computed tomography; and • Particle therapy realities, hype, economics, and new science. and our inaugural article on MRI in Radiation Therapy, including insight and perspectives from James Balter (University of Michigan) and other experts on the expanding role of this powerful imaging modality for treatment planning, guidance, and therapy assessment.

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AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

MRI: A GROWING MODALITY IN RADIATION THERAPY

Research Spotlight

Highlights From Today’s Cutting Edge Medical Physics Research

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n recent years, we’ve made great strides in optimizing the integration of M I in adiation ncology. In fact, it’s not difficult to imagine a day when MRI becomes the primary method of therapy planning simulation and image guidance for a variety of treatment indications.

While CT has long been the preferred modality for radiation therapy due to its geometric reliability and easy conversion to representation of electron density in support of dose calculations, M I has been a useful adjunct because of its improved ability to discern soft tissue anatomy. M I is now recommended for volumetric treatment planning in cervical cancer brachytherapy,1 and CT M I fusion is now standard practice in radiation therapy. The application of M I in radiation oncology is not without its challenges, however. In this inaugural issue of the AAPM Research Spotlight, James Balter offers his perspectives on the growing use of M I for therapy planning, guidance, and assessment treatment response as well as major areas of research and new opportunities provided by AAPM for its members to improve understanding and utilization of M I in radiation oncology.

Balter explains that larger magnet bores and improved field homogeneity have supported the potential role of M I in treatment simulation. Numerous studies indicate that uantitative measurements of perfusion, diffusion, and spectroscopy from MR systems may serve as a biomarker for supporting personalized therapy, supporting assessment of treatment and, if necessary, adaptation mid-therapy course. arious efforts are underway to support M I in place Stereotactic treatment plan for an of CT capabilities by providing a synthetic model of the intrahepatic lesion shown on an axial patient that sufficiently represents radiation attenuation and post-contrast MR image through the 2 geometric configuration. endors are making M I compatible liver. Isodoses are shown in percent immobilization as well as laser-based positioning systems. They relative to the dose at the normalization are optimizing imaging se uences for the needs of radiation point of the plan (planning target oncology and improving the integration of imaging coils with volume center). immobilization systems. Most adaptations to MRI scanners to accommodate radiation therapy simulation primarily re uire software and ine pensive hardware modifications. As most radiation oncology clinics have access to M I outside of the department, enhancement of such systems is a cost effective means of supporting M I based simulation for smaller departments.

Not only is M I seeing increased use in treatment planning, e plained Balter, it is making its way

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Research Spotlight, cont. into the treatment room for guidance of therapy delivery. More than a decade ago, an agendijk and colleagues at the niversity Medical Center at trecht, Netherlands proposed using M I in conjunction with a linear accelerator for therapy guidance.3 Since then, development of M I guided treatment delivery systems (MRgRT) has led to exciting new approaches in treatment that have recently come online or will shortly, including

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A . Tesla system with three cobalt treatment heads that supports image guided positioning, tracking of patient anatomy during treatment and the ability to adapt plans during treatment iew ay). This system is being used to treat patients at ashington niversity, the niversity of California at os Angeles, the niversity of Miami and the niversity of isconsin.

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A linac integrated with a . Tesla M I system Philips, lekta) under development by agendijk and colleagues at trecht.3

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A linac integrated with a gantry mounted . . Tesla M I system in a rotating biplanar arrangement developed by Gino Fallone and colleagues at the Cross Cancer Institute in dmonton.4

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A three room suite with a mobile high field M I scanner, with a brachytherapy unit on one side and a linear accelerator on the other, providing the ability to perform scans of the patient on the treatment couch, which then can be turned around and used for patient treatment, under development by David Jaffray and colleagues at the Princess Margaret Cancer Centre, Toronto, Ontario.

urther integration of “MRI is seeing increased use in treatment planning, guidance of MRI in Radiation Oncology therapy delivery, and assessment of therapy response.” will re uire changes to education and practice, says Balter. Magnetic field safety and interference with other imaging and treatment systems need to be considered in design and installation of M I in adiation ncology departments. Along these lines, M I specific uality assurance , as well as modified treatment A for systems integrated with M I are areas that need to be considered, presenting an important area of research by AAPM physicists. Balter went on to e plain that the uantitative use of M I re uires special vigilance regarding imaging scan parameters and analysis methods, as well as development of additional measurements to ensure that the different needs of adiation ncology versus diagnostic radiology are met.6 As with any significant medical advance, there are concomitant demands and challenges, e plains Balter, and foremost is the need to educate medical physicists. To that end, AAPM is offering a new Certificate Course at its Annual Meeting dedicated to the topic of MRI in Radiation Therapy. The hibition Certificate Course will be held ednesday, uly , at the AAPM’s th Annual Meeting in Anaheim and will include five sessions two educational sessions, two symposia, and one proffered paper session. The symposia and sessions are open to all meeting registrants, with the certificate

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Research Spotlight, cont. component including online evaluations, etc.) available via additional registration. or more information, visit the Annual Meeting website.

1.

imopoulos , Petrow P, Tanderup , et al. ecommendations from ynaecological N) C ST orking roup I ) basic principles and parameters for M imaging within the frame of image based adaptive cervix cancer brachytherapy. Radiother oncol. ) .

2.

su S, Cao , uang , eng M and Balter . Investigation of a method for generating synthetic CT models from MRI scans of the head and neck for radiation therapy. Phys Med Biol. ) .

3.

agendijk , aaymakers B and van ulpen M. The magnetic resonance imaging linac system. Semin Radiat Oncol. ul ) .

4.

allone B , Murray B, athee S, et al. irst M images obtained during megavoltage photon irradiation from a prototype integrated linac-MR system. Med Phys ) .

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affray , Carlone M, Milosevic M, et al. A facility for magnetic resonance guided radiation therapy. Semin Radiat Oncol. ) .

6. Paulson , rickson B, Schultz C and i . Comprehensive M I simulation methodology using a dedicated M I scanner in radiation oncology for e ternal beam radiation treatment planning. Med Phys. ) .

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ILS WORKSHOP SUMMARY Jennifer Johnson, Houston, TX

Incident Learning Systems and Root Cause Analysis for Safer Radiation Oncology: A Hands-On Workshop Report Incidents Being Reported in San Diego. February 12 – 13, 2015.

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APM hosted a specialty meeting on Incident Learning Systems (ILS) and Root Cause Analysis (RCA) for Safer Radiation Oncology: A Hands-On Workshop. Eighty-six attendees escaped winter weather throughout the United States to enjoy sunny San Diego on February 12-13 at the University of California, San Diego Moores Cancer Center in La Jolla, CA. Arno Mundt, MD, UCSD Chairman of Radiation Oncology, welcomed the group along with Program Directors Jennifer Johnson, Derek Brown, Grace Gwe-Ya Kim and Lawrence Marks, MD. Invited faculty included present and past members of AAPM’s Working Group on Prevention of Errors, Radiation Oncology Healthcare Advisory Council (RO-HAC), and ASTRO’s Multidisciplinary Quality Assurance Subcommittee.

Attendees had lots of discussion during the sessions and mingled during coffee breaks at the Incident Learning Systems (ILS) and Root Cause Analysis (RCA) for Safer Radiation Oncology Workshop.

Sue Evans, MD, kicked off the meeting Thursday afternoon with a talk about safety culture and how incidents are used to learn and improve the radiation oncology delivery system.

Peter Dunscombe gave an overview of how the workshop topics match with the general anatomy of an incident learning system as well as comparisons of IL systems. Jennifer Johnson discussed the benefits of learning from potential incidents (sometimes called near misses or good catches) while Kathy Lash discussed the pros and cons to anonymous vs. confidential reporting. Anne Greener introduced process mapping, and attendees broke out into small groups of around six to create their own process maps.

Early Friday morning Grace Kim taught us the four steps in RCA by using a Chipmunks™ example to identify what happened, why it happened, make recommendations, and then implement and monitor. Gary Ezell shared examples and related issues of severity metrics. Luis Fong de los Santos made learning about human and design errors fun. After discussing just culture, reporting culture and biases, Todd Pawlicki used a video and a faculty skit to demonstrate how to do an RCA or causal

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ILS Workshop Summary, cont. analysis. Attendees then were shown another video to use for their small group RCA hands-on exercise.

Friday after lunch, Larry Marks, MD, also gave practical suggestions for fostering a safety culture, such as using a good catch program, team huddles, and data to improve engagement. Steven Sutlief shared typical causes and typical interventions, and suggested a “5-5-5” timeframe for corrective actions. A third video and a fourth incident were presented for the small groups to use in their handson corrective actions. Derek Brown used a baseball analogy for feedback and learning, while Kathy Lash returned to discuss the organization’s past, present and future for patient safety, with a Lucille Ball example to demonstrate a point. Gary Ezell explained in detail ASTRO and AAPM’s Radiation Oncology Incident Learning System (RO-ILS) initiative and shared Mayo Clinic Arizona’s experience. or the final hands on e ercise, the attendees individually entered the three video incidents into ILS for practice.

Attendees had lots of discussion during the sessions and mingled during coffee breaks, Thursday evening reception, and Friday lunch due to the generosity of sponsorship by Landauer, LAP Laser, and Mobius Medical Systems and support by ASTRO.

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POSITRON EMISSION TOMOGRAPHY Andrew Joseph Boria Oh great P.E.T. Edwards/Chapman’s invention.

Born nineteen fifties. ses fine tracers. . . . is the choice norm, A kind of sugar.

P T is uite famous, It uses antimatter.

Emits positrons...

Travel short distance, ose kinetic energy, ntil huge event...

They meet electrons, Meet with a wondrous fate.

ANNIHILATION!!!! nergy produced. etect with scintillators... vents’ localized Cool phenomenon. nergy peak not at edge, ess harm to body...

Integrated now, Works with C.T./M.R.I. Much info gathered...

Oh great P.E.T...

So great for diagnosing, as saved many lives.

Oh great P.E.T...

The topic of great teachers. reat subject of all Always reat, Cool Cheers!!!

And-rew Jos-eph Bor-i-a; 2-8 Jan ‘1-5

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www.aapm.org |55

AAPM Newsletter • Volume 40 No. 2 MARCH | APRIL 2015

AAPM HQ TEAM…AT YOUR SERVICE! Angela Keyser, College Park, MD

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APM’s interactions within the science and science policy communities continue to increase. The organization has a great HQ team hard at work alongside numerous AAPM volunteers to represent AAPM and the medical physics profession.

Lynne Fairobent joined the AAPM team in 2004 as Manager, Legislative and Regulatory Affairs and was promoted to Senior Manager for Government Relations in 2014. She works with AAPM volunteers in their interactions with Congress, federal agencies & other policy makers. Additionally, Lynne serves as the liaison to the Professional Council.

Richard Martin joined the AAPM team in January as the Government Relations Specialist. He has extensive experience with other health care organizations, including ASTRO, with his most recent position with the American Academy of Dermatology Association (AADA). In addition to working with Lynne in the national arena, Richard will be gathering and disseminating information on the activities of the state legislatures and state agencies on issues related to the medical physics profession.

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Lynne Fairobent with Richard Martin.

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