AAPM Newsletter May/June 2015 Vol. 40 No. 3

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

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

“EFFICIENT OPERATION OF AAPM IS JUST ONE OF MANY ELEMENTS WITHIN THE AAPM STRATEGIC PLAN.” John E. Bayouth AAPM Chair of the Board

IN THIS ISSUE:

The Science of Safety in Medical Physics

▶ MedPhys Match 2015:

A Resounding Success ▶ New Federal X-Ray Guidelines Published

▶ Working Group on Student and

Trainee Research ▶ DICOM Standards

and more...

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▶ Research Spotlight:

NEW AND EXCITING FEATURES THIS YEAR… • President’s Symposium: Revitalizing Scientific Excellence: Turning Research into Clinical Reality through Translational Research.

NEW! 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 subsequent 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.

• Carson-Zagzebski Distinguished Lectureship on Medical Ultrasound: Dr. Mickael Tanter, PhD, from the Institut Langevin, École Supérieure de Physiqueet de Chimie Industrielles de la Ville de Paris, will provide an overview regarding ultrafast ultrasound imagingcurrent applications and changes to the future paradigm of diagnostic imaging and therapeutic monitoring.

NEW! Certificate of Completion Program in Magnetic Resonance Guided Radiation Therapy – The Certificate of Completion Program is a new offering from AAPM which provides an in-depth review of a particular topic with verification of learning achieved through an on-line examination. Sessions are available to all meeting registrants, but those who enroll in the program for an additional fee are entitled to dedicated seating in the mini-track sessions as well as additional online materials. Following the meeting, certificate program participants will be required to take an on-

line examination, which covers the material presented throughout the day-long mini-track. Enrollees who demonstrate satisfactory attendance at the course and successful completion of the on-line examination (available after the meeting) will receive a framed certificate of completion for this course.

NEW! Coordinated Educational/Scientific Sessions Invited sessions which provide both educational and scientific content from leaders in the field. Come 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 knowledge-based automatic treatment planning, quality assurance and safety research, and CT lung cancer screening.

NEW! Electronic Poster Theater • Reinvigorating scientific presentations through electronic poster sessions lead by a Campus Provost, Monday and Tuesday afternoons in the exhibit hall.

• Best in Physics – the top 5 abstracts in each track, Imaging, Joint – Imaging and Therapy, and Therapy, will be highlighted on Sunday afternoon in an electronic poster theater in the exhibit hall.

• In addition to Symposia and regular Sessions, Keynote Sessions on topics of special interest.

• Joint scientific symposium with the World Molecular Imaging Society – Linking Pre-Clinical and Clinical Trials: Co-Clinical Trials.

• Joint scientific symposium with ESTRO – Imaging Markers for Assessment of Treatment Response.

ARTICLES IN THIS ISSUE 3 7 11 13 15 17 20 24 31 33 37 41 45 49 51 52 53

Chair of the Board’s Report Executive Director’s Column Editor’s Column Science Council Report Professional Council Report Education Council Report MedPhys Match 2015 ABR News Legislative & Regulatory Affairs Report Website Editor’s Report ACR Accreditation FAQs Health Policy & Economic Issues Research Spotlight New Federal X-Ray Guidelines Published Person in the News Working Group on Student & Trainee Research DICOM Standards

EVENTS/ANNOUNCEMENTS 2 6 9 10 12 16 19 30 34 43 44

AAPM 2015 Award Recipients AAPM Headquarters Hotel at RSNA 2015 AAPM 2015 Elections AAPM Certificate Program New Member Benefit: NCRP Publications “The Interview” Webinar AAPM Expanding Horizons Travel Grant SRT/SBRT: Safe and Accurate Delivery of Hypofractionated Radiation Therapy 2015 AAPM Summer School 2016 AAPM Spring Clinical Meeting AAPM 57th Annual Meeting & Exhibition Deceased Members 57th Annual Meeting & Exhibition Dates to Remember

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

EDITORIAL BOARD Editor Mahadevappa Mahesh, MS, PhD Johns Hopkins University E-mail: mmahesh@jhmi.edu Phone: 410-955-5115 John M. Boone, PhD Robert Jeraj, PhD George C. Kagadis, PhD E. Ishmael Parsai, PhD Charles R. Wilson, PhD SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: E-mail: nvazquez@aapm.org AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse College Park, MD 20740 Phone: (301) 209-3390

NAVIGATION HELP

PUBLISHING SCHEDULE The AAPM Newsletter is produced bi-monthly.

Next issue: July/August Submission Deadline: June 12, 2015 Posted Online: Week of July 1, 2015

Previous/Next Article

Tap the arrows at the bottom of the page to go to the next or previous page.

EDITOR’S NOTE I welcome all readers to send me any suggestions or comments on any of the articles or new features to make this a more effective and engaging publication and to enhance the overall readership experience. Thank you.

www.aapm.org

CONNECT WITH US!

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CONTENTS

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Congratulations

to the Recipients of the Following Awards, Achievements & Honors in 2015!

WILLIAM D. COOLIDGE AWARD Maryellen Giger, Ph.D. EDITH QUIMBY LIFETIME ACHIEVEMENT AWARD Larry DeWerd, Ph.D. Kunio Doi, Ph.D. Melissa Martin, M.S. MARVIN M.D. WILLIAMS AWARD Christopher Marshall, Ph.D. Jean St. Germain, M.S. HONORARY MEMBERSHIP Marilyn Goske, M.D. Roderick Pettigrew, M.D. JOHN S. LAUGHLIN YOUNG SCIENTIST AWARD Katia Parodi, Ph.D. FELLOW NOMINATIONS Stephen Avery, Ph.D. Kristy Brock, Ph.D. Gene Cardarelli, Ph.D. Steven de Boer, M.Sc. Sonja Dieterich, Ph.D. Warren D’Souza, Ph.D. Martin Fraser, M.S. Eric Ford, Ph.D. David Hintenlang, Ph.D. Rebecca Howell, Ph.D. Kwok Leung Lam, Ph.D. Lijun Ma, Ph.D. Patrick McDermott, Ph.D. Malcolm McEwen, Ph.D. Michael Mitch, Ph.D. Eduardo Moros, Ph.D. Baldev Patyal, Ph.D. Stephen Riederer, Ph.D. Vythialingam Sathiaseelan, Ph.D. Charles Shang, M.Sc. Michael Sharpe, Ph.D. Russell Tarver, M.S. Georgia Tourassi, Ph.D. Ching-Chong Jack Yang, Ph.D.

MOSES AND SYLVIA GREENFIELD PAPER AWARD (NON-DOSIMETRY) “Interstitial rotating shield brachytherapy for prostate cancer,”

by Quentin Adams, Jingzhu Xu, Elizabeth Kaye Breitbach, Xing Li, Shirin Enger, William Rockey, Yusung Kim, Xiaodong Wu and Ryan Thomas Flynn – Medical Physics 41, 051703 (2014).

FARRINGTON DANIELS PAPER AWARD “Dosimetric characterization and output verification for conical brachytherapy surface applicators (Part 1: electronic brachytherapy source),” by Regina Fulkerson, John Micka and Larry DeWerd – Med. Phys.

41, 022103 (2014).

JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS PAPER AWARDS Editor-in-Chief Award “Measurement and Monte Carlo simulation for energy- and intensitymodulated electron radiotherapy delivered by a computer-controlled electron multileaf collimator,” by Lihui Jin, Ahmed Eldib, Jinsheng Li, Ismail Emam, Jiajin Fan, Lu Wang and Chang Ming Charlie Ma – Journal of Applied Clinical Medical Physics, 15, 1 (2014).

Medical Imaging Physics Award “FDG PET/CT for rectal carcinoma radiotherapy treatment planning: comparison of functional volume delineation algorithms and clinical challenges,” by Nadia Withofs, Claire Bernard, Catherine van der Rest, Philippe Martinive, Mathieu Hatt, Sebastien Jodogne, Dimitris Visvikis, John A. Lee, Philippe A. Coucke and Roland Hustinx – Journal of Applied Clinical Medical Physics, 15, 5 (2014).

Radiation Oncology Physics Award “Performance of dose calculation algorithms from three generations in lung SBRT: comparison with full Monte Carlo-based dose distributions,” Jarkko J. Ojala, Mika K. Kapanen, Simo J. Hyödynmaa, Tuija K. Wigren and Maunu A. Pitkänen – Journal of Applied Clinical Medical Physics, 15, 2 (2014).

Radiation Measurements Award “Low-cost flexible thin-film detector for medical dosimetry,” by Piotr Zygmanski, Ciamak Abkai, Zhaohui Han, Yury Shulevich, David Menichelli and Jurgen Hesser – Journal of Applied Clinical Medical Physics, 15, 2 (2014).

All of the award, achievement and honor recipients will be recognized during the 2015 AAPM Annual Meeting in Anaheim, California at the Awards and Honors Ceremony and Reception.

Please join us in congratulating all of the recipients:

DATE: Monday, July 13, 2015 TIME: 6:30 PM PLACE: Platinum Ballroom, Anaheim Marriott

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

CHAIR OF THE BOARD’S REPORT John E. Bayouth, Madison, WI Strategic Progress — Purchasing a New Building is Just One Example

I

n my third year of service within the AAPM Presidential chain I am now responsible for chairing the Strategic Planning Committee of the Board (SPC), which is a committee of the Board of Directors (BOD) responsible for monitoring our progress on long-term goals of the organization.

AAPM governance can quickly loose focus, making long-term projects difficult to execute; a byproduct of electing 1/3 of the board members anew each year. By establishing a Strategic Plan and monitoring our progress towards those goals we have accomplished significant goals.

AAPM is working on thinking big and identifying things we can do that will have a major impact on our field and organization. A recent example is our decision to purchase a building in Alexandria, Virginia, to serve as the new location of our Headquarters operations. This decision is strategic for many reasons. First, the cost of our mortgage payments is slightly less than our current lease payments, and allows us to build equity and diversify our financial portfolio. Second, the building’s location is in an affluent area near our nation’s capital, conveniently located two stops away from DCA airport AAPM’s Purchase of Headquarters Building in Alexandria, on the subway. Both the proximity to the airport and VA. John Bayouth, Chair of the Board; John Boone, the dozen hotels and scores of restaurants in the area President; Angela Keyser, Executive Director; Michael Woodward, Deputy Executive Director; John Hazle, Past make our new home an ideal location for hosting President; Robert McKoy, Controller meetings. This should enable AAPM to leverage our Headquarters location to better execute the mission of the organization, not simply be an expense in our budget. Third, the area is home to over 200 not-for-profit organizations, rich in resources and trained personnel to enhance services provided to our membership. I am grateful to the members who spent the last couple of years evaluating our options for (re)locating headquarters operations, and converged on a solution that aims to impact our organization for years to come.

Efficient operation of AAPM is just one of many elements within the AAPM Strategic Plan. The May 2011 version of the Strategic Plan was extensive and granular, so in March 2012 it was consolidated into a version identifying the most immediate items for the BOD to monitor. The charge of the SPC provides oversight of the AAPM’s progress towards achieving our long-term goals.

The goals of the AAPM Strategic Plan identified to carry out our mission are: 1. Promote the highest quality medical physics services for patients.

2. Encourage research and development to advance the discipline.

3. Disseminate scientific and technical information in the discipline.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Chair of the Board, cont.

4. Foster the education and professional development of medical physicists.

5. Support the medical physics education of physicians and other medical professionals.

6. Promote guidance for the practice of medical physics.

7. Govern and manage the Association in an effective, efficient, and fiscally responsible manner.

In the last 4 years we have made significant progress on each of these goals, by identifying specific objectives for each goal, strategies to achieve those objectives, and deliverables for each strategy that were assigned to specific groups within each Council. Again, these types of projects require a long-term commitment of effort and funding to be successful. Allow me to share one example from each goal, keeping in mind there are several examples for each.

Goal 1: Promote the highest quality medical physics services for patients. Strategy 3 of Objective 3 for this goal is to create a central event reporting system in cooperation with other groups. Since 2011 we have worked with ASTRO to create the Radiation Oncology – Incident Learning System (RO-ILS). Much of the work required to build this system was produced by the Work Group on the Prevention of Errors (within Science Council), a multi-year effort. Additionally, AAPM leveraged a multi-year financial commitment with ASTRO, resulting in ASTRO doubling the investment made by AAPM. Within its first year of operation the RO-ILS system has enrolled over 40 institutions, a number that is expected to double in the coming months.

Goal 2: Encourage research and development to advance the discipline. Strategy 3 of Objective 1 for this goal is “…encouraging external research funding (e.g. NIH funding for technical comparative effectiveness) as well as persistent operational revenue streams.” As reimbursement is moving in the direction of requiring demonstration of the value added by technologies and procedures, it is critical for AAPM to perform the research needed to demonstrate the comparative effectiveness of our work.

As a product of seed-grant funding provided by AAPM three years ago, Dr. Maryellen Giger recently submitted a grant proposal to the NIH on behalf of AAPM. Goal 3: Disseminate scientific and technical information in the discipline. Objective 3 for this goal is to develop a communication infrastructure for dissemination of information outside AAPM. After identifying a host of target audiences and messages to communicate, AAPM has hired Public Communications Inc. to help us develop our communication goals, strategies to achieve those goals, and the specific tactics to support those strategies. Our primary goal is to inform key audiences about the value medical physicists bring to their institutions and the healthcare community. We should be the scientists funding agencies look towards for imaging and radiation therapy proposals, that physicians look towards to implement technologies that can improve their practice of medicine, and hospital administrators look towards to identify and implement the appropriate technologies in a competitive healthcare environment.

Goal 4: Foster the education and professional development of medical physicists. Objective 1 for this goal is to lead medical physics graduate and residency program development. Since 2011, we have increased the number of residency programs to a level that for the first time meets the number of clinical positions within the job market. Of particular challenge was in the area of Imaging Physics; AAPM worked with leadership from RSNA to create a grant mechanism to establish new clinical

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Chair of the Board, cont. residency programs in Imaging Physics. The three year project combined AAPM investment with matched funds from RSNA and a doubling of those dollars by the participating programs, leading to a substantial increase in the number of imaging residencies. A similar model is now under consideration for Nuclear Medical Physics, in collaboration with the Society of Nuclear Molecular Medical Imaging.

Goal 5: Support the medical physics education of physicians and other medical professionals.

Objective 1 for this goal is to develop online education modules. The physics modules developed for radiology residents have been widely successful in its creation and utilization. Moving forward we will be challenged to maintain the content, as well as expand this effort for other groups including radiation oncologists, dosimetrists, radiologic technologists, physician assistants, and radiology assistants.

Goal 6: Promote guidance for the practice of medical physics. Strategy 3 of Objective 2 for this goal is to develop a consensus on medical physics minimum practice guidelines based on existing AAPM documents and reports. As practice accreditation becomes more broadly available we want to assure the minimum practice expected in the clinical setting is guided by consensus statements from AAPM, not the whim of a single reviewer from ACR, ASTRO, or JCAHO. Consequently, AAPM has set out on an ambitious effort to establish Medical Physics Practice Guidelines (MPPGs). In just four years we have executed the infrastructure that was established in the first year, to yield multiple guidelines with 2-3 new guidelines expected to be produced in subsequent years. These guidelines will be excellent resources for regulators as an alternative to expecting clinical medical physicists to execute all activities considered in existing task group reports.

Goal 7: Govern and manage the Association in an effective, efficient, and fiscally responsible manner. Strategy 5 of Objective 1 for this goal is to monitor and enhance online educational materials. Sometimes you have to spend money to make money. Two years ago the AAPM Headquarters team was expanded to bring in-house expertise to manage video content captured at our various meetings. Although the salary for this position was less than what we had been paying an outside contractor to do this work for our annual meeting, the in-house staff has increased the quantity and quality of our Virtual Library. Now members have access to a great set of content from our Annual Meetings, Spring Clinical Meetings, and specialty meetings. In the future, we expect to make some of this content available to non-members for a fee, which will both increase the impact of our work and establish a source of non-dues revenue for the organization.

In March of 2015 the Strategic Planning Committee met to engage in blue sky discussions on missed opportunities for the organization, receive proposals on additions to the Strategic Plan, and consider AAPM’s resource allocation with regards to strategic goals of the organization. As we are nearing the five-year anniversary of the existing Strategic Plan, I anticipate in the coming months we will assess the changes in our environment to identify the next set of strategic issues that face AAPM and should receive a focused effort with a long-term commitment. Please feel free to contact me or any other member of the SPC regarding what you feel are the most important things AAPM could accomplish to improve the medical physics profession over the next decade.

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PLANNING TO ATTEND

RSNA 2015?

Be Sure to Book Your Room at the AAPM Headquarters Hotel:

The Hyatt Regency Chicago 151 E. Wacker Drive AAPM Meetings and Annual Reception will be held at the Hyatt Regency Chicago RSNA 101 Scientific Assembly and Annual Meeting November 29 – December 4, 2015 Chicago, IL st

April 29: Member Registration and Housing Opens, 10:30 AM CT June 3: General Registration and Housing Opens, 10:30 AM CT

AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE | WWW.AAPM.ORG

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

EXECUTIVE DIRECTOR’S COLUMN Angela Keyser, College Park, MD Election Process Online Only!

Elections for the 2016 Officers and Board Members-At-Large will open on June 3 and will run through June 24. Again this year AAPM will use the Bulletin Board System (BBS) during the election process to allow members to discuss issues of concern with the candidates and the election in general. The election process will be online only so be alert for email announcements.

AAPM Adds Value to Your Membership with NCRP Partnership AAPM has entered into an organizational subscription agreement with the National Council on Radiation Protection (NCRP) to provide online NCRP reports to AAPM members at no cost to the member. This agreement extends to all digitally available NCRP reports in the past (going to back to 1971), and includes NCRP reports that will be produced in the future. You may now access the NCRP reports from the AAPM website (after login).

Your Online Member Profile This is a reminder to keep your AAPM Membership Profile information up to date and make any changes necessary. Please upload your picture if you have not already done so.

Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy.

AAPM recognizes that not everyone is interested in every topic that we communicate to our membership, so we are now organizing our e-mail communications into “campaigns” that are typically time and event based. The first time you receive an email about a particular event, you may opt-out of receiving future emails on this topic at the bottom where it says, “To inhibit future messages of this kind, click here.” For example, if you know you aren’t able to go to the 2015 Annual Meeting and don’t want communications about the meeting, you may opt-out from any email in the campaign, or from the e-preferences screen in your member profile.

“Summer School will provide collecive knowlege in the form of lectures from some of the best experts in the world. Deadline to register with discounted registration fee and reserve on campus housing is May 6.”

IMPORTANT LINKS AAPM 57th Annual Meeting & Exhibition Register Here

AAPM 2015 Summer School Register Here

SRT/SBRT: Safe and Accurate Delivery of Hypofractionated Radiation Therapy More Information

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AAPM Meetings More Information

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Executive Director, cont.

Education & Research Fund Update Are you a “Platinum, Gold, Silver, or Copper” level contributor to the AAPM Education & Research Fund? This information is displayed on the AAPM website to assist you in keeping track of your total to the fund. If you are logged in, you will see a message in the upper right-hand side of the page that shows your cumulative contributions with an indication of the additional donations required to elevate your contribution to the next “level.”

There will once again be and Education & Research Fund Donors’ Lounge at the Annual Meeting.

Individuals who have made a cumulative lifetime donation of $100 or more will have access to the Lounge. Comfortable seating, beverages and electronic charging stations will be available.

Consider donating to the Education & Research Fund today.

Upcoming AAPM Meetings Looking for a way to engage with medical physicists in your local area? Consider attending a local chapter meeting. Many chapter meetings offer MPCECs for participating. For a list of meetings, go here.

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 6. 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 e-book) to include every aspect of proton beam therapy.

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. Register now!

Items of note: • The

AAPM Committee Schedule is available now online.

•

The full meeting program will be available by May 12.

•

The 2015 Night Out will be held a few steps out the door of the meeting hotels! Join your colleagues under the palm trees on the Grand Plaza, between the Marriott and Hilton, Tuesday, July 14 from 6:30 PM – 10:00 PM. Taste the local flavor from food trucks parked along the plaza.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Executive Director, cont.

•

Sun Nuclear is the new sponsor of the Dr. Charles Lescrenier Annual 5K Run/Walk to be held on Tuesday, July 14 at 6:00 AM. There is a $20 fee, which is a tax-deductible donation (receipt will be provided) to the AAPM Education & Research Fund. Deadline to register is June 17. There is no on-site registration for this event.

•

NEW! A Residency Fair is planned for Wednesday, July 15 from 11:00 AM – 12:15 PM in the Platinum Ballroom 6 in the Anaheim Marriott

Make sure you check out the helpful Anaheim information — Things To Do in the Anaheim Resort.

More information on the 57th AAPM Annual Meeting is available online.

SRT/SBRT: Safe and Accurate Delivery of Hypofractionated Radiation Therapy September 18–20, 2015 in Detroit, Michigan

This comprehensive course is aimed specifically for clinical physicists and will address the many aspects of SRS/SBRT in a single format. This program has applied for approval of 8.50 SAMs credits.

Registrants will receive a hardcover copy of Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy.

DATES TO REMEMBER May 27 – Registration and housing available online.

August 6 – Deadline to receive early registration fees.

August 24 – Last day to make hotel reservations at the group rate.

RSNA 2015 RSNA celebrates the 100th anniversary of its founding in 1915 and RSNA 2015 will mark the 101st Scientific Assembly and Annual Meeting. Reminder — AAPM’s Headquarters Hotel is the Hyatt Regency Chicago located at 151 E. Wacker Drive. AAPM and RSNA Member Registration & Housing opened on April 29th.

AAPM 2015 ELECTIONS The 2015 AAPM elections will open for online voting on June 3, 2015.

Deadline to submit your vote electronically: June 24, 2015

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MRI is Coming to Rad Onc. ARE YOU READY?

Register for the Certificate Program HERE. John M. Boone, AAPM President James Balter, 2015 Certificate Program Coordinator

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Better Hardware.

Better Data.

Phantoms

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launch at the 2015 Annual Meeting to provide documented advanced training in subspecialty areas of medical physics.

The focus of the 2015 Certificate Program is MRI-guided Radiation Therapy. For an additional fee, registrants are eligible to receive the certificate of completion for the course based on attendance and comprehensive on-line examination. Upon passing the exam, registrants will receive a framed certificate issued by the AAPM to demonstrate successful completion of the training program.

If MRI isn’t already in your practice, it soon will be. We encourage medical physicists in any stage of his or her career to take advantage of the Certificate Program, solidify knowledge, hone skills, and demonstrate training and expertise on this vital emerging topic via the Certificate of Completion.

DoseView™ 3D

THE AAPM CERTIFICATE PROGRAM will

Through innovative, easy-to-use design, the DoseView 3D provides accurate data

1374-20, 02/15

by focusing on the details

www.standardimaging.com

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

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

W

elcome to the 3rd issue of the 2015 AAPM Newsletter. This issue contains several interesting and timely articles on the various activities of our organization. As we approach the Annual Meeting, program highlights are featured throughout the Newsletter. In addition to the regular columns, I would like to draw your attention to the articles on the Residency Matching Program for medical physics residents, ABR News on the design and delivery of future oral exams, including categories for all three specialties, and the ACR Accreditation FAQs regarding Digital Breast Tomosynthesis. I would also like to highlight a new column facilitated by the Science Council that started with the last issue, titled “Research Spotlight.” In this issue, the Research Spotlight addresses the science of safety in medical physics.

I want to applaud the AAPM leadership for facilitating free online access to all NCRP reports. As many of us constantly refer to NCRP reports, I consider this a great membership benefit and it is justly demonstrated by the high number of downloads (more than 7000 as listed in the website editor’s column) during the first week of this development.

On topics that impact the Newsletter, I would like to inform the membership about the changes regarding Newsletter production. For the past two years, an outside consulting group was used to produce the Newsletter in tablet and PDF format. Due to a number of issues that included a delay in Newsletter production, increased demand of AAPM staff time and less than 1% APP downloads in the past year, the decision has been made to bring the production of the Newsletter back in house and provide it in PDF format only from this point forward. This decision was made after the Newsletter Editorial Board gave careful consideration of the issues at hand and approval was given to sever ties with the consulting group (saving both time and money). I certainly do apologize for any inconvenience this may cause and hope that this a short-term set back for the AAPM Newsletter.

Finally, I would like to congratulate all of the recipients of the 2015 AAPM Awards and Honors. I am looking forward to the Awards Ceremony and Reception in Los Angeles, California this summer.

One Question Survey Results Diagnostic Radiology

(Members only. Login required.)

Radiation Oncology Nuclear Medicine Magnetic Resonance Rad Safety/Health Physics Engineering Ultrasound Other 0

10

20

30

40

50

60

70

80

WHAT IS YOUR SPECIALTY? (by percent).

Members reporting - 809 % Highcharts.com

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If you haven’t already done so, please be sure to complete our Specialty Survey, accessible from the AAPM Homepage.

DID YOU CATCH OUR WEBINAR ON “THE INTERVIEW”?

Don’t worry, you can watch the recorded version anytime! www.aapm.org/careers/ jobseekers/resources/ webinars/the-interview.asp Learn how to convert conversations and networking into interviews and interviews into job offers. Discover what you need to know and do throughout the interview process to demonstrate your value to the institution and land the job.

After watching the webinar, be sure to browse the moderator’s extensive post-event Q&A for even more advice on this valuable topic:

www.aapm.org/careers/jobseekers/resources/levine/your-questionsanswered-about-job-interviews-part-1.asp

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

SCIENCE COUNCIL REPORT Jeffrey H. Siewerdsen, Baltimore, MD AAPM Science — in the Interest of Future Medical Physics Researchers

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esearch performed by AAPM members in the early stages of their career has played an enormous role in advancing the state of the art in radiology and radiation oncology and expanding the role of medical physics in areas beyond conventional boundaries. For example, a review of the last decade’s finalists from the Annual Meeting’s Young Investigator Symposium as well as the Research Seed Funding Award shows the depth of expertise of earlycareer AAPM members in topics at the cutting edge of medical physics research. It also suggests a bright future for AAPM science if our Association can provide the resources and vibrant culture to cultivate such immense talent as the researchers of tomorrow. This year, AAPM is advancing several new initiatives to engage early-career members within the AAPM scientific enterprise and expand and strengthen the role of medical physicists in research.

Science Council Associates Program. Benjamin Franklin reminds us: “Tell me and I forget, teach me and I may remember, involve me and I learn.” A new program announced in April aims to involve young researchers directly in scientific activities of AAPM through mentorship with members of the Science Council, Research Committee, Imaging Physics Committee, Therapy Physics Committee, and Technology Assessment Committee. The program includes 8 student or junior member Associates selected via competitive review to shadow AAPM leadership in selected meetings of the Mentor’s Committee, engage in Task Group activity therein, and participate in both committee and conference activities at two consecutive Annual Meetings. Such experience will expose researchers to AAPM science at an early stage of their career, promote involvement, and contribute to a vibrant culture of researchers in future AAPM leadership. The call for applications was announced in April, and finalists will be announced at the Annual Meeting in Anaheim. Thanks to Rebecca Fahrig and the Research Committee for leading the creation of this new program.

Expansion of the Research Seed Funding Initiative. Each year, the Joint Working Group for Research Seed Funding receives innovative grant proposals from AAPM junior investigators taking their first steps toward independent research. This year, the number of seed funding grants will increase from two to three, recognizing both the strength of ideas among applicants and the commitment of AAPM toward their success as researchers. This year’s applications are under review, with awardees announced soon, and new projects starting July 1. The Scientific Program Directors for the Annual Meeting also look to each year’s Research Seed Funding winners for consideration of “Feature Presentations” — a special extended format oral presentation giving young researchers the spotlight to report their work arising from the Seed Funding project and identify future directions of research.

New WG Focuses on Student / Trainee Research. A new Working Group on Student and Trainee Research was formed in April, charged to enhance and broaden research initiatives benefiting predoctoral students and postdoctoral fellows. High on the agenda for the new WG is creation of a new student travel grant program, hosting symposium panels on building a successful scientific

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Science Council Report, cont. career, and providing recommendations for medical physics educational standards that foster the development of research scientists. The WG will work closely with other AAPM committees and the Students and Trainees Subcommittee (STSC) to enhance research-oriented education and training resources and prepare a more comprehensive strategy to promote medical physics research to undergraduates. Thanks to Robert Jeraj, the Research Committee, and the Education Council for their support and championship of this initiative.

The Expanding Horizons Travel Grant. A new travel grant program will award up to 20 awards (each $1000) to cover travel expenses for scientific conferences on topics beyond the conventional boundaries of medical physics research. As detailed in this month’s newsletter article, the Expanding Horizons grants broaden the scope of scientific meetings attended by AAPM student / junior members to engage in research topics relevant to medical physics and likely to be incorporated in future research that will advance our field in new directions. Thanks to Robert Jeraj and the Working Group on Student and Trainee Research for helping to establish this bold initiative.

When Do We Eat? At the Research Student Luncheon, of Course. A student luncheon will be held at the Annual Meeting in Anaheim to foster discussion of the future of research in the field of medical physics, including several AAPM representatives leading such research initiatives. Panelists at the luncheon will discuss new and ongoing initiatives to enhance and promote student research. The luncheon is jointly hosted by the Science and Education Councils, the FUTURE Working Group, the WG on Student and Trainee Research, and the Students and Trainees Subcommittee. The luncheon will be held on July 15 at 12:15 pm, immediately following the Residency Fair in Platinum Ballroom 6 of the Anaheim Marriott.

The Road Ahead. A research enterprise that is built to last requires getting great people on the bus (via the initiatives described above, for example), fueling the tank (nurturing their success), and making sure the bus is going in the right direction. The crossroads of science, education, professional practice, and the future of our field have been a prominent theme of discussion since the turning of the millennium, and there is certainly no lack of vision for how our field can continue to grow, strengthen, and provide an essential contribution to medicine and healthcare. In addition to the areas of emerging science and technology highlighted in the last newsletter, the new frontiers of medical physics research are ever within the sights of AAPM researchers. A review of topics presented each year in the Science Council Session at the AAPM Annual Meeting gives a clue to such promising areas: multimodality imaging and registration; the fundamental nature of cancer progression and treatment response; quantitative imaging and radiogenomics; molecular imaging and therapeutics; and new imaging methods in support of high-precision therapies. Seeing that vision further, the FUTURE Working Group is planning a Grand Challenges Workshop to be held in late 2015 including clinicians and scientists from within and beyond conventional domains of medical physics research.

Topics include medical physics in relation to biology, genomics, applied mathematics, and operational research. Thanks to Robert Jeraj and Thomas Bortfeld for spearheading the initiative.

Our Association could have no greater investment than to ensure a vibrant future for its student and junior members. Thanks to the time and energy of AAPM volunteers and the bold initiatives arising from their work as summarized above — along with countless others underway within the ~140 task groups, working groups, committees, and subcommittees within Science Council — such a future will be secured, if hard earned.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

PROFESSIONAL COUNCIL REPORT Douglas E. Pfeiffer, Boulder, CO

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n a recent article in the Journal of Applied Clinical Medical Physics, Per Halvorsen discusses some of the challenges and opportunities facing clinical medical physics. I will not repeat those challenges here, so suffice it to say that the way we practice clinical medical physics will look very different in ten years from the way it does now. As research funding continues to be pressured by Congress, competition for limited funds will grow. Research is also becoming more interdisciplinary, with medical physicists interacting with other researchers from many different aspects of medicine, analytics, and imaging science. As with clinical medical physics, research medical physics will also likely look much different in ten years.

As Per suggests in his article, we must change our approach to medical physics, whatever our specialty. We must transition from being behind the scene to being prominent in our facilities, and in the public eye. This requires medical physicists to take leadership roles where perhaps we might have stayed quiet in the past. We have to take on responsibilities in our facilities that might seem to be beyond the realm of traditional medical physics duties. We must make ourselves invaluable to our institutions, lest we become a commodity easily replaced by the lowest cost option.

Radiologists recognized this several years ago, starting their Radiology 3.0 initiative, and, perhaps more importantly, the Radiology Leadership Institute (RLI), which is intended to give radiologists the tools they need to survive and thrive in the changing environment. For several years, medical physicists have been able to earn RLI credits at our two main meetings, thanks largely to the efforts of Jessica Clements.

Leadership means more than running a department or managing a consulting business. Leadership in a broader sense means effectiveness, influence, and stewardship. These and many other features enable one to be prominent in an organization, respected and depended upon. This is what we must strive for as the face of medical physics changes.

As important as the RLI, and our involvement with it, is, we recognize that we also need a program to prepare medical physicists for the future. Many aspects of the RLI are generally applicable leadership principles and are valuable to both radiologists and medical physicists. The applications of those principles are what we need to be applicable to the medical physics context. Therefore, as part of the AAPM Strategic Plan, we are undertaking a new initiative, the Medical Physics Leadership Academy (MPLA). This academy will provide the tools necessary to excel in the changing medical physics environment.

The MPLA is still in its infancy. We are in the process of forming a working group under Professional Council, with Jessica Clements as chair and Jennifer Johnson as vice chair. The leadership and visionaries of this academy are Jessica, Jennifer, Ehsan Samei, Per Halvorsen, and Jerry White. It is staffed by Lynne Fairobent, who also brings valuable insights to the table.

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Professional Council Report, cont.

The specifics of what the MPLA will look like are still being developed. It will likely be structured to include a number of topical umbrellas under which the applications of general leadership tools will reside. These include, for example, management, research, clinical, and education. The concept is to provide both the tools to excel under these umbrellas and also additional tools to bring others to excellence. Again, this is all in a developmental state of flux and so may end up looking different, but this captures the initial concept.

These are all topics that are not taught in typical undergraduate or graduate physics or engineering programs, and they are not part of the CAMPEP curricula for graduate programs and residencies.

They are not skills that are necessarily innate to we who are driven to the sciences. But they are vital for our survival as individuals and as a profession.

A sample of the MPLA will be presented at the 2016 Summer School. A subset of these topics will be presented and attendees will start learning some of the underlying principles. It promises to be an important step in the development of the MPLA. Medical physics is changing due to pressures outside of our control. We must evolve under these pressures, using our strengths as medical physicists to become an essential part of our practice environments, outside of our offices, labs, and vaults. The Medical Physics Leadership Academy is one way that AAPM is helping us through these changes.

Travel Grants for Expanding Medical Physics Research Horizons

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he medical physics field has thrived under the culture of bringing innovative ideas together across science, medicine, and engineering disciplines. To continue the expansion of transformative ideas in research, we are excited to announce a new travel grant fund has been allocated to provide support for student and trainee travel to conferences that are not specifically geared toward medical physics.

The AAPM Expanding Horizons Travel Grant supports up to twenty $1000 scholarships for students each year, aiming to provide an opportunity to broaden the scope of scientific meetings attended in order to introduce students and trainees to new topics which may be of relevance to medical physics research. It is our hope that the scientific impact of these travel awards will motivate the younger generation of scientists to think ahead to future research and progress the field in new directions.

In an effort to diversify research in our field, conferences directly related to AAPM, RSNA, or major imaging meetings are discouraged. There will be two calls for applications per year, beginning with the first call deadline in June 2015. Special highlights of the awards and the inaugural recipients will be announced at AAPM’s Annual Meeting in Anaheim. Full details are available on the AAPM Grants & Fellowships webpage, including a list of ineligible conferences. Check back for more information on application requirements and deadlines!

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

EDUCATION COUNCIL REPORT George Starkschall, Houston, TX James T. Dobbins III, Durham, NC

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ne of the major areas of concern in education today is the role of online education. About two years ago, the AAPM Education Council constituted a Task Group, TG-250, chaired by Jim Dobbins, to assess how AAPM should address this issue. The Task Group recently reported to the Education Council with a series of recommendations. I have asked Jim to write this month’s Education Council Report on the activities of TG-250 and online education. Thanks go to Jim and his Task Group.

George Starkschall, PhD Chair, AAPM Education Council Online Education in Medical Physics: A Report of TG-250 There are many exciting changes underway in how we provide education in medical physics. These changes include new pedagogical approaches, such as team-based learning, project-based learning, and the “flipped classroom,” but also incorporate evolving technological innovations such as online education. The use of electronic resources of content opens the door for more expansive and consistent educational opportunities for our learners but also presents challenges due to issues of scope and scale and questions about who oversees or maintains such resources. Furthermore, there are questions about exactly what should be considered “online education,” since most teaching today includes some electronic content. In order to address the multiple facets of online education in medical physics, the AAPM Education Council established TG-250 two years ago to look into this topic and to provide recommendations for its effective use in our educational efforts.

TG-250 structured its activities around three basic questions: (1) What online education material in medical physics is currently available? (2) What additional resources would be useful, and who should be responsible for developing them? (3) Should there be any organizational restructuring of the Education Council’s efforts in the area of online education? This brief report will highlight the answers to these three questions and approaches being taken to address them.

As part of the answer to these questions, the Education Council hosted a symposium on Online Education in Medical Physics at the 2014 Annual Meeting. This symposium included reports on available resources, technologies for producing online content, and the potential for novel online content such as Massively Open Online Courses (MOOCs) in medical physics.

In regard to the currently available resources, the Task Group identified a number of materials available, both through information from individual TG members and from an extensive list of such resources in an article by Joann Prisciandaro (JACMP 14:368-387, 2013). One of the outcomes of the TG efforts will be a publicly hosted list of available resources that can be updated continually by the community. After a suitable host for this location is established, its location will be publicized to the community. It is our hope that this will provide a valuable resource to both educators and students, and will also serve to identify areas in which individual AAPM members can contribute additional content.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Education Council Report, cont.

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The Task Group looked carefully at what additional resources might be beneficial and identified nine constituent categories of learners to whom online content might be targeted. It is important to note that this Task Group focused mainly on learners as the target audience for content, in order to not overlap with efforts underway in the committee overseeing medical physicists as educators; that committee focuses on the teacher as the target audience. Thus, the efforts of these two groups are complementary, although there will be some inevitable overlap in certain areas.

The nine categories of learners addressed by our Task Group are (1) medical physics graduate students, (2) medical physics residents, (3) Qualified Medical Physicists (QMPs) needing Maintenance of Certification (MOC) credits, (4) physicians in training (radiology and radiation oncology residents and medical students), (5) physicians needing MOC credits, (6) physicians seeking different certification (e.g., specialized training in fluoroscopy), (7) the general public, (8) allied health professionals, and (9) legislators and regulators.

Detailed recommendations were made for each of these categories, and space does not permit a full description of those recommendations here. However, several major recommendations can be summarized. First, it was recommended that a repository of donated slides (and similar materials) be hosted for educating graduate students, which would contain high-quality educational content developed by individual faculty members who were willing to share those with colleagues elsewhere.

End users of materials donated to this repository would be required to retain notice of authorship of the contributors on the materials and would be required to agree to certain restrictions on use.

Similar materials for medical physics residents would be hosted in a repository that would also include instructional videos on topics of clinical importance. For QMPs seeking MOC credit, the AAPM Virtual Library of content and quizzes would continue to be the main resource. For physicians in training, we recommend the ongoing updating of the RSNA / AAPM online modules in diagnostic physics as well as the development of analogous online modules in the area of radiation oncology physics. For allied health professionals, the Education Council is looking at ways in which the Virtual Library resources could be made available for a fee to these different groups. Online content for the general public would continue to be developed by the Public Education Committee under the Education Council, which would include resources of commonly asked questions about radiation, health, and medical procedures. And last, for the category of legislators and regulators, it was not felt that developing

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Education Council Report, cont. specific resources was feasible at the current time beyond that provided by the Public Education Committee or our contacts in government relations.

The Task Group felt that the best way to oversee online educational content was to continue using an “organic” approach whereby various committees and subcommittees would oversee their own online content rather than trying to impose a central committee overseeing all online education. Thus, the Task Group did not recommend any specific reorganization of Education Council efforts around the topic of online education.

The Task Group will continue working this year on implementation strategies for each of the above recommendations, and will publicize to our community of educators and learners the locations of the various resources produced. We encourage the membership of AAPM to take an active role in producing and using these resources. If you have specific content that you would like to contribute to the publicly accessible repositories, please contact me or the Education Council through the AAPM Suggestion Box. You will find a link to the Suggestion Box on AAPM’s homepage. Also, we would welcome your suggestions for other ways in which online content could be useful in educational efforts.

James T. Dobbins III Vice Chair, AAPM Educational Council

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Registration Opens on May 27th.

formed at major academic centers to a widely accepted treatment regimen adopted by a majority of Radiation Oncology Clinics. The technology has undergone major developments from frame-based to frameless implementations as a result of the advances of high-precision IGRT tools. Delivery devices have also technically diversified, ranging from dedicated machines such as the Gamma Knife all the way to all-purpose linacs to protons. Respiratory motion management techniques have allowed treatments to expand into lung and GI; radiobiological arguments increasingly support hypofractionation for GU applications.

www.aapm.org/meetings/2015SBRT/

SRS/SBRT treatment techniques tie together technological advancements of the last decade into a high-precision, hypofractionated course of treatment while minimizing treatment uncertainties.

Most physicists have gained SRS/SBRT skills and knowledge through attending educational offerings at AAPM, ASTRO and RSS; this comprehensive course is aimed specifically for clinical physicists and will address the many aspects of SRS/SBRT in a single format.

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

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p

SRS/SBRT has progressed from a specialty procedure only per-

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

MEDPHYS MATCH 2015: A RESOUNDING SUCCESS John A. Antolak, Rochester, MN John P. Gibbons Jr., New Orleans, LA J. Daniel Bourland, Winston-Salem, NC MedPhys Match Steering Committee

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t this time last year, we described progress being made towards a matching program for medical physics residents1, similar to the current matching programs for medical residents. With generous financial support from AAPM and SDAMPP and a lot of hard work on the part of National Matching Services, Inc. (NMS) and others, the MedPhys Match2 was ready for this year’s resident recruitment.

Thanks to program directors in both Canada and the USA, we were able to exceed our participation goals by a large margin. About one week before the Match deadline, we reported at the Spring Clinical Meeting of AAPM that the program participation rate in the USA was 92%.3 There was some participation by programs in Canada, but it was limited.

Some basic statistics about this year’s MedPhys Match were posted to the NMS website on the same day the Match results were announced (Mar 27, 2015).4 Of the 402 applicants in the MedPhys Match system, 122 withdrew from the Match or did not submit a rank list. Applicants that officially withdraw or do not submit rank lists do not get included in the list of unmatched applicants posted after the Match results are announced. If we only consider applicants that submitted a rank list and didn’t withdraw, there were 280 applicants competing for 112 total positions offered by 77 residency programs.

There were 108 positions (96%) filled by the matching algorithm, which is an outstanding result. Figure 1 shows a breakdown of applicant placement by both applicant and program rank order list. For applicants, 55% of matched applicants were matched to their top choice, and 86% were matched to one of their top three programs. This compares very favorably to the latest results of the NRMP Match, where 75% of applicants were matched to one of their top three programs.5 For programs, the numbers are a little lower, but still very good. A “standardized rank” is used Figure 1. Percentage of matched applicants at each rank position on the applicant’s rank list (blue) and the program standardized rank list in Figure 1 to include programs that had more (orange). Standardized rank positions are program ranks normalized than one position (e.g., if a program had three to the number of offered positions. positions, the first three applicants on their list were considered to be “first choice” and given a standardized rank of 1; the next three were given a standardized rank of 2, and so on). Overall, 37% of matched applicants were ranked #1 by programs, and 80% of matched applicants were ranked in the top three by programs.

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MedPhys Match, cont.

For applicants, the success rate quoted on the NMS website is 39%; 108 of 280 applicants were matched to a residency position. However, many of these applicants may not have met the minimum qualifications required by the programs they applied to. If we restrict these data to those applicants that were ranked by at least one program, then the applicant match rate goes up to 58% (108 of 185 ranked applicants). To avoid potential confusion, we will use success rate when considering all applicants that submitted a rank list, and match rate when considering only those applicants that were ranked by programs.

All of the programs participating in the MedPhys Match this year6 indicated that they were using the Medical Physics Residency Application Program (MP-RAP)7 to collect applications. Of the 402 applicants in the MedPhys Match, there were 83 applicants that did not use MP-RAP. There were a total of 10,190 applications submitted through the MP-RAP system. This was a substantial increase from previous years, likely due to fact that application fees were waived this year for MedPhys Match participants. There were an average of 129 applications submitted to each program, with 31 programs receiving 150 or more applications.

Figure 2 shows the success and match rates as a function of the number of applications submitted, with “none” being those applicants that were in MedPhys Match but not MP-RAP. If we look at the applicants that did not use MP-RAP (“none” in the figure), there is a large difference between the number of applicants that submitted a rank list (21) and the number that were ranked by programs (4), which is the reason for the large difference between the success rate and match rate. If we look at the match rates (data relative to the number of applicants ranked by programs), it is relatively constant as you might expect. The success rates (data relative to the number of applicants that Figure 2. Success and match rate relative to the number of applications submitted a rank list) are a reflection of the fact submitted to MP-RAP. Success rate considers all applicants submitting that submitting more applications gives you a rank lists, and match rate considers only those applicants that were ranked by programs. better chance of getting an interview and hence being included on at least one program rank list.

In fact, for the 18 applicants that submitted more than 70 applications and did not withdraw from the Match, all of them were on at least one program rank list. It makes sense that applicants need to get interviews (and hence get on program rank lists) in order to be matched to a position.

As mentioned before, applicants were allowed to rank any program they desired, even if they didn’t interview with them. Therefore, the length of the applicant rank lists is not very meaningful. However, if we look at the number of times a given applicant is included on a program’s rank list, we get a proxy for the number of interviews for the applicant, and this is shown in Figure 3. As might be expected, a lot of applicants are only on a few program rank lists, and there are a few applicants that are on a lot of rank lists. In this case, there were 43 applicants that were on only one program’s rank list, while there were only 21 applicants that were on 10 or more program rank lists. Figure 3 also shows how many applicants matched, did not match, or withdrew. There were a few applicants that were on a program rank list that withdrew from the Match, but all applicants that were on four or more program rank lists submitted rank lists. It can be seen that applicants that get ranked on more program rank lists tend to

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MedPhys Match, cont. have a better chance of being matched, although there were a few unmatched applicants that were on 7-10 program rank lists; this demonstrates how competitive it was for applicants to get a position. The numbers are small, but all applicants that were on 11 or more program rank lists were matched to residency positions.

Figure 4 shows the distribution of rank list length for all programs, with imaging programs being shown in gray. The median length of the program rank list was 10 applicants, but lengths ranged from 2-20. There were only two programs that Figure 3. Number of applicants versus the number of programs ranking the applicant.

didn’t match all of their positions and two programs did not submit rank lists. These programs and others (who filled with applicants close to the end of their list) may decide to interview more applicants in future years to have a longer rank list (and hence a better chance of having all positions filled).

Figures 5 and 6 show the Match results for several subsets of applicants. The first three columns are for CAMPEP-certificate, MS and PhD applicants. The next two columns break Figure 4. Histogram of program rank list length. out the data versus gender, and the next two columns show the data for CAMPEP applicants versus non-CAMPEP applicants. The next to last column shows data for CAMPEP applicants that identified 2015 as their graduation year, and the last column shows the total data. For applicants that did not apply through MP-RAP (approximately 20% of applicants), we are not able to classify them as anything other than CAMPEP or non-CAMPEP, so the accuracy of the data is limited. For each applicant, they are classified as matched, non-matched (but ranked by at least one program), not-ranked (but submitted a rank list), or withdrew or no rank. In Figure 6, applicants that withdrew or did not submit a rank list were not considered.

The data in Figure 5 show that more applicants with CAMPEP MS degrees matched (40) than either the certificate (13), PhD (37), or non-CAMPEP (15) applicants. Referring to Figure 6, both the certificate and PhD candidates had a slightly higher success rate (50% and 49%, respectively) than the MS applicants (42%). Match rates were also slightly higher (65% and 60% versus 58%). This is contrary to the perception (among some in the community) that residency programs favor either PhDs, or those coming from outside the field. It is also interesting that among those applying to residency programs, the number of PhD holders is only about 25% fewer than the number of MS holders.

Comparing by gender, fewer female applicants withdraw from the Match (9% versus 22%). It also appears that female applicants are able to get interviews more often than male applicants (74% versus

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MedPhys Match, cont.

64%, percent ranked in Figure 6). However, male applicants had a higher match rate (65%) compared to female applicants (52%).

As a result, male applicants had a slightly higher success rate (41%) compared to female applicants (39%).

The next two columns compare the result for CAMPEP versus non-CAMPEP graduates. In this case, we were able to use NMS data so we have results for all 402 applicants. It is readily apparent that the proportion of non-CAMPEP graduates that are able to obtain an interview (percent ranked) is much smaller than that for CAMPEP graduates. Relative to all nonCAMPEP applicants, 39% of them withdrew or submitted no rank list, and 42% were not ranked by any program.

Figure 5. Match statistics for various subsets of applicants. The size of each colored region indicates the proportion of that class of applicant in that category.

The next to last column looks at CAMPEP graduates with 2015 listed as the graduation year. It appears that recent graduates are slightly favored (more interviews, better success rate) compared to the overall CAMPEP population, with the overall distribution comparable to CAMPEP PhD or certificate holders. In Figure 6, recent graduates had the highest percent ranked (88%) and success rate (57%).

One interesting observation about Figure 6 is that the match rate is approximately the same (55-60%) for all subsets of applicants. Other than what was already mentioned above, this figure underscores the difficulty that non-CAMPEP graduates encounter when trying to get into a residency program. Both the percent ranked (30%) and success rate (20%) for non-CAMPEP graduates were much smaller than those of CAMPEP graduates (76% and 46%, respectively).

Figure 6. Percent ranked and match rate for various subsets of applicants. Percent ranked is defined as the number of applicants ranked at least once by programs relative to the number of applicants submitting rank lists. The match rate is defined as the number of applicants matched relative to the number of ranked applicants.

We would like to thank Jonah Peranson at National Matching Services for providing some of the data shown here and helping to clarify the interpretation of the data. We would like to close by thanking applicants and program directors for their patience as we put this new process in place. We welcome your constructive feedback about the process and appreciate your support.

http://www.aapm.org/pubs/protected_files/newsletter/3903-aapmnews.pdf (pages 23-25), accessed Apr 10, 2015 2 https://natmatch.com/medphys/, accessed Apr 10, 2015 3 http://amos3.aapm.org/abstracts/pdf/97-25902-353470-110052-1445577423.pdf, accessed Apr 10, 2015 4 https://natmatch.com/medphys/aboutstats.html, accessed Apr 10, 2015 5 http://www.nrmp.org/wp-content/uploads/2015/03/ADT2015_final.pdf, accessed Apr 10, 2015 6 https://natmatch.com/medphys/instdirp/aboutproglist.html, accessed Apr 10, 2015 7 http://www.aapm.org/CAP/ and http://www.aapm.org/CAP/institution/, accessed Apr 10, 2015 1

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ABR NEWS Jerry D. Allison, Geoffrey S. Ibbott and J. Anthony Seibert ABR Physics Trustees The Purpose and Scope of the ABR Oral Exam

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he Oral Exam in Medical Physics is designed to test the clinical skills of the candidate and assess the candidate’s readiness to practice medical physics independently. The exam includes a broad range of topics that provide the candidate an opportunity to:

• • • • •

demonstrate that he or she understands how common medical physics equipment performance evaluations are conducted, analyze the results of medical physics evaluations and make appropriate recommendations, explain how the performance of clinical equipment may affect patient care, analyze uncommon situations and explain how he or she would approach them, and communicate the results of medical physics evaluations.

The focus of the oral exam is on clinical competence, which is a factor distinguishing it from the Part 1 and Part 2 exams that focus on the fundamental concepts of medical physics and include detailed calculations.

The Design and Delivery of the Oral Exam The oral exam consists of 25 questions in five categories. Each candidate is examined by five examiners, each of whom asks one question in each of the five categories.

Examiner 1

Examiner 2

Examiner 3

Examiner 4

Examiner 5

Category 1

Cat 1 – Q 1

Cat 1 – Q 2

Cat 1 – Q 3

Cat 1 – Q 4

Cat 1 – Q 5

Category 2

Cat 2 – Q 1

Cat 2 – Q 2

Cat 2 – Q 3

Cat 2– Q 4

Cat 2 – Q 5

Category 3

Cat 3 – Q 1

Cat 3 – Q 2

Cat 3 – Q 3

Cat 3 – Q 4

Cat 3 – Q 5

Category 4

Cat 4 – Q 1

Cat 4 – Q 2

Cat 4 – Q 3

Cat 4 – Q 4

Cat 4 – Q 5

Category 5

Cat 5 – Q 1

Cat 5 – Q 2

Cat 5 – Q 3

Cat 5 – Q 4

Cat 5 – Q 5

This arrangement ensures that the candidate’s score in each category is the average of the scores on five questions evaluated by five different examiners.

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ABR News, cont.

The oral examiners are selected from experienced medical physicists who have either MS. or PhD degrees. The pool of examiners contains physicists from private practice and from academic departments. Examiners must be at least five years post initial certification and must have previous experience on an ABR question-writing committee. All new examiners must be enrolled in Maintenance of Certification (MOC), and beginning with the 2016 exam, all examiners, as well as all other ABR volunteers, must be enrolled in MOC. Each year the examiners receive training on the oral exam and its content, and new examiners have additional training. The examiners are organized into panels, and the panel chairs have further training on ABR procedures and scoring. Following the final evaluation of the candidate by a panel, the scores and decision of the panel are reviewed by the associate executive director (AED) for medical physics and a medical physics trustee to verify that there were no errors in the process.

To ensure each question is asked in the same way by each examiner, all examiners who will be asking a particular question meet together to discuss each of the questions. During the course of the exam, the examiners are observed at least twice by either a trustee or the AED for medical physics.

The Categories for 2015 and Future Years The oral exam categories used in all three physics disciplines were identical for many years. These categories remain very relevant for Therapeutic Medical Physics, but an analysis by the oral exam committees suggested that the congruence between the categories and clinical practice could be improved for Diagnostic Medical Physics and Nuclear Medical Physics. Thus, new categories were developed for those two specialties. The current categories are:

Category Description

Radiography, Mammography, Fluoroscopy, and Interventional Imaging

X-ray production, beam characteristics, interactions, and image-formation principles; types and characteristics of image detectors; clinical protocols for common imaging exams; fluoroscopy and interventional procedures, including acquisition parameters and dose-reduction strategies; image noise assessment and dose metrics for all projection imaging modalities; common artifacts, quality assurance, quality control, mammography accreditation, and MQSA standards

Computed Tomography

CT system design and principles of operation; image- acquisition protocols, including helical acquisition and tube; current modulation techniques; cone beam geometry; post-processing protocols, multi-planar and volumetric reconstruction; quantitative CT; image noise assessment, statistics, dose metrics (CTDI, DLP, SSDE), and effective dose estimation; common CT artifacts, quality assurance, and CT accreditation program

MRI and Ultrasound

MR equipment, principles of magnetization, resonance, and excitation; MR pulse sequences, localization, acquisition, and processing; ultrasound (US) principles, beam properties, acquisition methods, signal processing, and image display; Doppler US and color flow imaging principles and operation; common artifacts for MRI and US, siting requirements for MRI, quality assurance, and accreditation for MRI and US

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DMP

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ABR News, cont.

DMP

Category Description

Informatics, Image Display, and Image Fundamentals

Informatics infrastructure, standards, and patient security; PACS-modality connectivity, workflow, display, and archive functions; image display requirements, characteristics, and calibration procedures; image-processing techniques and qualitative data extraction; image fundamentals, sampling theory, and ROC analysis

Radiation, Dosimetry, Protection, and Safety

Radiation biology, radiation effects, and age/gender-specific risks; radiation protection principles, guidelines, and regulations; radiation dosimetry, detectors, standards, and units; radiation-shielding design factors, barrier requirements, surveys, and reports; patient safety and error-prevention issues, including dose reduction, sentinel events, and MR- and US-specific safety issues

NMP

Category Description

Radiation protection

Internal dosimetry, including MIRD; fetal dose units; personnel safety, including facility surveys and occupational dose limits; radiation protection principles; patient safety, including breastfeeding and pregnancy; shielding, including facility and personnel protection; regulations and regulatory bodies, including shipping and waste disposal; ALARA; time, distance, and shielding; and radiation surveys

PET and hybrids

Radionuclide production, assay, and characteristics; QC procedures, including ACR and acceptance testing; artifacts; system principles; image fusion; quantitative PET; image reconstruction, including attenuation correction, random coincidences, scattered radiation, dead time, and 2D versus 3D

Radiation Measurements

Radioactivity measurement, including dose calibrators and well counters; statistics, including minimum detectable activity; radiation detectors, including survey meters, personnel monitoring, and dead time; quantitative measurements, including calibration; and QC procedures

Clinical Procedures

Radionuclide therapy, including facilities, dosimetry, radiation protection, and release criteria; PET and hybrids; SPECT and hybrids, including gamma cameras; radiation dose, including risk; radiopharmaceutical usage; thyroid imaging/ uptake; informatics and display performance; misc.

Radiation Protection and Patient Safety

External beam shielding: shielding design and regulations, shielding calculations, protection survey, and ALARA for shielding. Brachytherapy shielding: shielding design, regulations, shielding calculations, protection survey, and ALARA for shielding. ALARA and radiation biology: regulations, reporting, postings, and limits. Assuring patient safety: error prevention, identification, and reporting; chart rounds, chart checks, safety environment, procedural pauses, integrated staff training, and introduction of new technologies. Clinical radiation biology: compromise among tumor/normal tissue dose, out-of-field dose, fetal dose, and pacemaker doses; risk of second malignancies; chart checks, peer review (chart rounds, tumor boards), and error reporting

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ABR News, cont.

Category Description

Patient-Related Measurements

External beam planning and simulation: representative clinical treatment plans, plan quality and improvement, use of wedges and other modifiers, identification of target volumes and organs at risk, commissioning of CT for RT planning, use of DVHs and other metrics, and tolerance doses. Photon beam algorithms and dose calculations: photon beam characteristics and modeling, calculation algorithms, heterogeneity corrections (historical and contemporary), methods for separating primary and scatter, and MU calculations. Electron beam treatments: electron beam characteristics and modeling, calculation algorithms, heterogeneity corrections (historical and contemporary), gap and VSD calculations, and MU calculations. Brachytherapy treatments: representative clinical plans, source characteristics, treatment applicators, calculation methods (historical and contemporary), and tolerance doses; special procedures

Image Acquisition Processing and Display

Reference images (DRR, etc.): identification of modalities, understanding of influence of imaging parameters, and understanding of DRRs, EPIDs, etc.

Image fusion: image registration and fusion, use, pitfalls, and errors. Organ/ target segmentation: definitions of GTV, CTV, PTV, OAR, etc.; identification of structures and methods of segmenting. Verification and localization images: characterization of images, influence of imaging parameters, equipment for imaging, and purposes of different image types. Basic imaging and physics: function of imaging systems, use of nuclides, and physics of imaging for different systems.

Calibration, Quality Control, and Quality Assurance

Absolute calibration protocols: external beam and details of TG-51 calibration protocols. Quality assurance: QA procedures for mechanical and radiological alignment, beam QA, equipment for QA, recommendations, and requirements.

Acceptance testing and commissioning: performance specifications, commissioning equipment, commissioning of accelerator, IMRT, VMAT, wedges, etc. Brachytherapy calibration and QA: LDR and HDR commissioning, calibration, QA procedures, and equipment needed. Photon beam characteristics: isodose distributions, surface dose, beam parameters, kerma versus dose, electronic equilibrium and dose buildup, definition of flatness and symmetry, relationships among depth dose, field size, SSD, etc.

Equipment

Linac treatment head components and function: monitor chamber, bending magnet, wedges, collimators, wedges and independent jaws, target, flattening filter, and leakage characteristics. Ion chamber design, characteristics, and function: temperature and pressure effects, stem effect, effect of volume, recombination, polarity effect, and comparison with other instruments. Other detectors: TLD, OSLD, diodes, radiographic, and radiochromic film. Linac acceleration systemwaveguide and power components: design and operation of klystron, magnetron electron gun, energy switch, accelerator guide, and electron acceleration. Miscellaneous equipment: electrometers, water/tissue substitute materials and appropriate use, phantoms, beam-scanning systems, CT and MR simulators, test/QA equipment for imaging systems, equipment for SRS QA, and equipment for 4D CT.

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TMP

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ABR News, cont.

Question Development Oral exam questions are divided into the five main categories and a number of subcategories. Each medical physics specialty has a committee to manage its questions. These committees consist of MS and PhD physicists from private and academic practice. The committees are chaired by the trustee in that specialty. As part of the annual question-writing cycle, each committee addresses the following tasks: •

Reviews existing questions in the pool to determine their current relevance and correctness.

•

Determines which categories and subcategories need to be refreshed.

•

Writes new questions as needed.

•

Reviews the key concepts being tested by each new question and recommends changes for clarity and content.

•

Reviews the expected answer(s) and suggests follow-up questions.

•

Checks the accuracy of the expected answer(s) against an indicated reference.

•

Determines if the new question should be submitted to the pool.

•

The chair selects questions from the pool for use in an oral examination according to the category designations for the discipline.

•

The committee gives each question a final review for accuracy.

•

The committee also checks that the questions span the domain of medical physics and that no two questions are too similar.

THE STRUCTURE OF AN ORAL EXAM QUESTION • One or More

Illustrations.

• A Written Question of

One or More Parts.

• Additional Material

for the Examiner. o

A discussion of the question with suggested answers.

o

Suggestions for follow-up question.

o

A reference to the medical physics literature.

Final Remarks The ABR makes great efforts to ensure that the oral examination reflects the clinical practice of medical physics. This requires selecting committees that span the pool of practicing medical physics, training committee members, and conducting an extensive review to be sure the process works correctly. The ABR strives to ensure that every candidate is treated fairly.

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AAPM Newsletter โ ข Volume 40 No. 3 MAY | JUNE 2015

ABR News, cont.

ABR Medical Physics Volunteer Awards 2014 The ABR is pleased to announce that the following physicists have received ABR Volunteer service awards. The ABR recognizes that without physicist volunteers it would not be able to conduct its certification programs in medical physics, diagnostic radiology, radiation oncology, and interventional radiology. The honorees have made outstanding contributions to the ABR and the profession of medical physics.

Mary Martel

S. Cheenu Kappadath

Melissa Martin

Vythialingam Sathiaseelan

Phillip Berry

Horacio Patrocinio

Lawrence Sweeney

Jon Kruse

Caridad Borrรกs

Donald Peck

Michael S. Taylor

Katja Langen

J. Daniel Bourland

Robert Pooley

Louis Wagner

Bruce Libby

Geoffrey Clarke

Ronald Price

Thomas Wagner

Richard Massoth

Charles Coffey

Robert Sanford

Ning Yue

Charles Mayo

Indra Das

Wolfgang Tome

Beth Harkness

Fang-Fang Yin

Philip Heintz

3-Year Volunteer Awards

6-Year Volunteer Awards

Frank Ascoli

Hania Al-Hallaq

Jagdish Bhatnagar

Peter Balter

Tewfik Bichay

John Bayouth

Stefan Both

William Breeden

Jessica Clements

Jay Burmeister

Nicholas Detorie

Indrin Chetty

Sonja Dieterich

10-Year Volunteer Awards

Frank Goodin

Nesrin Dogan

Leena Hamberg

Sean Dresser

John Antolak

X. Allen Li

Dennis Duggan

Peter Biggs

Lijun Ma

Fredric Edwards

Rosemary Gallagher

Marlene McKetty

Stephanie Franz

Linda Hong

Tariq Mian

David Gauntt

Andrew Karellas

Moyed Miften

Michael Gillin

Eric Klein

Madeline Palisca

Eric Gingold

Mahadevappa Mahesh

Mohammad Salehpour

Mary Jafari

Kathryn Held Shirish Jani Sanford Meeks Jatinder Palta Perry Sprawls Robert Stanton Marcia Urie

Stephen Balter

Michelle Kritzman

Kiaran McGee Kent Ogden Thomas Oshiro Baldev Patyal David Pickens Susan Richardson Lynn Rill Bill Salter Stephen Sapareto Mehrad Sarfaraz Steven Sutlief Jason Tavel Sameer Tipnis Martin Weinhous Raymond Wu Ying Xiao Albert Zacarias

Ashok N. Jain

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Lifetime Volunteer Awards

EARLY REGISTRATION DEADLINE: MAY 6

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.

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

SAVE THE DATE!

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

LEGISLATIVE & REGULATORY AFFAIRS REPORT Lynne Fairobent, College Park, MD NRC Extends Comment Period for ANPR for 10 CFR Part 20 Standards for Protection Against Radiation Once Again There is still time to weigh in on the proposed changes on Part 20 being considered by the NRC as NRC extended the public comment period again to June 22, 2015.

On November 20, 2014, NRC published in the Federal Register, an extension for the comment period for advance notice of the 10 CFR Part 20 proposed rulemaking by 120 days. Comments should be filed no later than June 22, 2015 (80 FR 14033).

The comment period in the notice published on July 25, 2014 (79 FR 43284) is extended.

NRC issued the Advance Notice for Proposed Rulemaking (ANPR) for 10 CFR Part 20 Standards for Protection Against Radiation was published in the Federal Register on July 25, 2014 (79 FR 43284). In addition to the ANPR, NRC also published six Issue Papers as well. This information is contained on the NRC website: •

Advance Notice of Proposed Rulemaking: Potential Changes to Radiation Protection Regulations

•

Issue Paper 1: Update 10 CFR Part 20 to Align with International Commission on Radiological Protection Publication 103 Methodology and Terminology

•

Issue Paper 2: Occupational Dose Limit for the Lens of the Eye

•

Issue Paper 3: Dose Limit for the Embryo/Fetus of a Declared Pregnant Occupational Worker.

•

Issue Paper 4: Individual Protection – ALARA Planning

•

Issue Paper 5: Metrication – Units of Radiation Exposure and Dose

•

Issue Paper 6: Reporting of Occupational Exposure

I look forward to hearing from all of you about this very important topic that will affect your Radiation Protection Programs in the years to come and I thank you in advance for your assistance!

Please send any comments for AAPM’s consideration to Lynne Fairobent, Senior Manager for Government Relations.

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SRS

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• Verify patient positioning using frame or frameless systems, head and shoulder masks or other patient fixation devices • Verify patient treatment plan in critical regions • Perform QA of OBI systems • Assess image fusion, image transfer QA, accuracy verification and TPS testing with multi- modality imaging capabilities (CT, MRI and PET) • Perform geometric machine QA including Winston-Lutz isocenter verification and localization/ repositioning with couch shift

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

WEBSITE EDITOR’S REPORT George C. Kagadis, Rion, Greece

I

will complete my second year as Website Editor at the end of this month. I would like to thank AAPM for their trust and acknowledge the great work accomplished by AAPM IS personnel: Ms. Farhana Khan, Mr. Michael Woodward and Ms. Abby Pardes. They are continuously working for the improvement of our Social Media presence. Together with me they receive hundreds of emails every day for many issues that are of interest to the membership. Often times I must say ‘no’ to a new initiative, to a new email that asks for a new Facebook or LinkedIn page, etc. and usually the reason is that we try to be as good as possible on maintaining, running and keeping everything up-to-date on AAPM’s social media pages. On the other hand, we are trying to avoid redundancies. Speaking about redundant information, I have recently come across a few pages that contain obsolete information. We will be reaching out to the people in charge of maintaining the content of these pages to request that the content be updated or archived should no new information be available.

In the meantime, we are all getting prepared for the AAPM Annual Meeting in Anaheim, CA, July 12–16. The majority of our Association’s Committees, Subcommittees, Task Groups, and Working Groups will meet during the Annual Meeting and will work together for the advancement of their groups. This year, as during every Annual Meeting, two optional lunchtime orientation talks will be offered to new Chairs, or those who want a refresher on the capabilities of AAPM’s Information Services. The first is a General Chair Orientation and the second one addresses AAPM Committee Wikis. I would like to invite every Chair who is willing to see the advanced options available to maintain their group’s web presence to participate in these informative talks. After those talks I am sure you will be ready to take advantage of the great opportunities the AAPM website can offer to your groups.

With regards to our social media presence, I am pleased to report that as of April 10, 2015 we have 37,928 images posted to AAPM’s Flickr, 3,073 likes on Facebook, 7,653 members on LinkedIn and 3,671 followers on Twitter.

Last but not least, one major development: AAPM has contracted with NCRP and all online NCRP publications are now freely available to the AAPM membership. This feature debuted on April 6 and as of April 10, the membership had downloaded more than 7,400 online NCRP publications.

We hope that you enjoy this added value to your membership as much as we do.

I hope you find the AAPM website useful, visit it often and send me your feedback.

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SCIENTIFIC PROGRAM • The Science Council Session – Radiomics / Imaging Genomics.

THERAPY TRACK • In Memoriam of Warren Sinclair: Physics Applications for New Radiobiology • New Methods to Ensure Target Coverage • The Science of QA • Clinical Trials in Proton and Particle Therapy (SAM) • Modeling Cancer Complexity • New Developments in Knowledge-Based Treatment Planning and Automation • NIH-Funded Research: Instrumental in the Pursuit of Clinical Trials and Technological Innovations • Current Topics in SRS/SBRT (SAM) IMAGING TRACK • The Joint AAPM-WMIS Symposium: Linking PreClinical and Clinical Trials: Co-Clinical Trials • Advances in Cone-Beam CT and Emerging Applications • Technological Advances in PET/MR Imaging • Iterative Reconstruction in CT • CT Lung Cancer Screening and the Medical Physicist: Moving Forward (SAM) • Emerging Applications of X-Ray Imaging • Advances in Breast Imaging JOINT IMAGING/THERAPY TRACK • The Joint ESTRO-AAPM Symposium: Imaging Markers for Assessment of Treatment Response • MRgRT Mini-Track: New Developments in Hybrid MR-treatment: Technology (SAM) • MRgRT Mini-Track: New Developments in Hybrid MR-treatment: Applications (SAM) • Real-Time Imaging and Tracking Techniques for Intrafractional Motion Management (SAM)

• Bridging the Scales from Molecules and Cells to Clinical Applications • Radiomics: Advances in the Use of Quantitative Imaging used for Predictive Modeling • Nanotechnology for Imaging and Therapy • Computational Phantoms ULTRASOUND (SPECIAL 3 DAY PROGRAM) Diagnostic Ultrasound, Ultrasound Therapy and Image Guided Interventions • Diagnostic Ultrasound Imaging Quality Control and High Intensity Focused Ultrasound Therapy Hands-on Workshop • Ultrasound Guidance for RT Interventions • Ultrasound Guided Systems for Brachytherapy • HIFU Therapies: A Primer • MR-guided Focused Ultrasound Therapy in Oncology • Advanced Novel Technologies & Delivery Strategies • Therapeutic Strategies and Image Guidance • Treatment Planning Strategies, Modeling, Control • Educational: Diagnostic Ultrasound QA • Carson/Zagzebski Distinguished Lecture – Mickael Tanter, PhD “The Advent of Ultrafast Imaging in Biomedical Ultrasound” • Advances in Ultrasound Contrast Agents for Diagnosis &Therapy • Advances in Ultrasound Imaging Technology • Advances in Breast Ultrasound Imaging PROGRAM SPONSORS • Philips Healthcare – Ultrasound • Siemens Medical Solutions • The Focused Ultrasound Foundation

www.aapm.org/meetings/2015AM

EDUCATIONAL PROGRAM • Point/Counterpoint: Biological Dose Optimization • MRI for Radiation Oncology • Implementing SBRT Protocols (SAM) • Knowledge-Based Treatment Planning Automation (SAM) • Education Council Symposium: Accreditation • Outcomes of Hypofractionated Treatments – and Certification: Establishing Educational Results of the WGSBRT (SAM) Standards and Evaluating Candidates Based • Small Field Dosimetry: Overview of AAPM TG-155 on these Standards. and the IAEA-AAPM Code of Practice (SAM) • Proton Therapy (SAM) THERAPY TRACK • Spine SBRT (SAM) • Current Trends in Y90-Microsphere Therapy: • Optimization of CT Planning Imaging and Delivery and Dosimetry Techniques to Reduce Radiation Dose Resulting • Electronic Charting in EBRT and Brachytherapy from Daily Imaging Guidance Procedures (SAM) • Clinical Applications of 3D Printing • Real Time Imaging Verification and Tracking for • Optimizing the Treatment Planning Process Moving Targets • Electronic Brachytherapy (SAM) • Reference Dosimetry for Beam Modalities Other • Pediatric Radiation Therapy Planning, Treatment, Than MV Photons (SAM) and Late Effects (SAM) • Task Group 158: Measurement and Calculation • Breast Brachytherapy: The Phoenix of Radiation of Doses Outside the Treatment Volume from Therapy (SAM) External-Beam Radiation Therapy Treatment • Patient Specific Q/A: Pre-treatment, During- treatment, and Post-treatment (SAM) IMAGING TRACK • The Global Cancer Challenge: What Can We • ACR Update in MR, CT, Nuclear Medicine, and Do? (SAM) Mammography • Imaging, Treatment Planning, and QA for • A Review of Radiologic Anatomy (SAM) Stereotactic Body Radiation Therapy (SBRT) • Pediatric Imaging (SAM) (SAM) • CT Scanner Hardware and Image Quality • Task Group 100 (SAM) Assessment (SAM) • The Aftermath of TG-142 (SAM) • Digital Tomosynthesis (SAM) • Incident Learning/RO-ILS (SAM) • MR Basics I (SAM) • Deformable Image Registration: Is it Right for • MR Basics II (SAM) Your Clinic (SAM) • CT Lung Cancer Screening Part 1 (SAM) • MRI-Based Motion Management for RT (SAM) • Mobile Viewing Devices (SAM) • Stereotactic Radiosurgery (SAM) • MR Safety (SAM) • In Memoriam of Jacques Ovadia – • Nuclear Medicine 101 (SAM) Reinvigorating Scientific Excellence: Electron • Nuclear Medicine 102 (SAM) Beam Therapy – Past, Present and Future More than 50 hours of educational courses in medical imaging and radiation therapy physics will be offered. This will include SAMS courses for diagnostic, medical nuclear, and radiation therapy physicists.

www.aapm.org/meetings/2015AM

EDUCATIONAL PROGRAM (cont.)

PRACTICAL MEDICAL PHYSICS • Radiation Safety Officer Update • High-Impact Presentations • Clinical Implementation of HDR Brachytherapy (SAM) • Use of End-of-Life Brachytherapy Devices • Eye Lens Dosimetry for Patients and Staff (SAM) • Radiochromic Film Dosimetry Update (SAM) • Imaging Equipment Specification and Selection in Radiation Oncology Departments

• Treatment Planning System Commissioning and QA (SAM) • Practical Statistics for Medical Physicists (SAM) • Practical Guidelines for Commissioning Advanced Brachytherapy Dose Calculation Algorithms (SAM) • Software Libraries for your Research Projects – Don’t Start From Scratch • Clinical Networks: IT for Radiation Oncology

PROFESSIONAL PROGRAM • Professional Council Symposium: Alternative Career Opportunities for Medical Physicists • Economics Update • Session in Memory of Penny S. Slattery: Medical Physics Workshop – Update: Journal Improvement Activities and Guidance on Writing and Reviewing Papers • AAPM Professional Liability Insurance Update • Journal of Applied Clinical Medical Physics: Mission and Submission • Workforce Assessment Committee Update • Academic-Industrial Research and Development Partnerships – Nuts and Bolts, Pitfalls and Rewards • PQI • MBAs for Medical Physicists: Business School Basics

• MBAs for Medical Physicists: DABR-MBA Alumni Panel • Administrative Aspects of Medical Physics • Management Skills for Medical Physicists • The International Electrotechnical Commission (IEC): What is it and Why Should Medical Physicists Care? (SAM) • New Member Symposium • Developments in International Medical Physics Collaborations in Africa and Latin America • Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams • Building, Maintaining and Improving Physics Residency Programs • It Can’t Happen to Me! My Position Has Been Terminated, Now What?

www.aapm.org/meetings/2015AM

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ACR ACCREDITATION: FAQs FOR MEDICAL PHYSICISTS Priscilla F. Butler, M.S., Senior Director and Medical Physicist, ACR Quality and Safety Does your facility need help on applying for accreditation? In each issue of this newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR’s accreditation website portal for more FAQs, accreditation applications and QC forms.

Although the ACR does not accredit digital breast tomosynthesis (DBT), we have received a number of questions regarding the FDA MQSA requirements for initial training. The following FAQs are based on discussions with the FDA.

Q. I understand that the Food and Drug Administration’s MQSA regulations require mammography personnel to obtain 8 hours of initial training before working with new mammographic modalities. I just discovered as of March 2015, FDA considers each Digital Breast Tomosynthesis (DBT) manufacturer’s system to be a “new mammographic modality”, thus requiring personnel to have 8 hours of initial new-modality training on each manufacturer’s DBT system before they interpret/survey or operate. Is this correct?

A. Yes. See the FDA website. The following FAQs are based on discussions the ACR had with the FDA’s Division of Mammography Quality Standards (DMQS) to obtain clarification of these requirements.

Q. How does the FDA’s MQSA definition of a new mammographic modality apply to DBT? A. Due to the technological differences between DBT systems, and differences in their FDAapproved Indications for Use (IFU), the FDA’s Division of Mammography Quality Standards (DMQS) currently considers each manufacturer’s DBT system to be a new mammographic modality under the MQSA definition. Under MQSA, personnel need to receive eight hours of initial new-modality training prior to using any new mammographic modality. For clarification of eligible training, please see the questions below.

Q. Do personnel with eight hours of DBT training specific to one manufacturer’s system meet the requirements for the initial eight hours of DBT training for another manufacturer’s system?

A. No. However, the FDA’s Division of Mammography Quality Standards (DMQS) recognizes that there are many features which are common to different DBT systems, so: Personnel who have already received eight hours of general training in DBT need documentation of training in the features of the particular DBT system they will use that were not covered in generalized DBT training.

•

Personnel who have received eight hours of training on any one DBT unit also need documentation of training on the unique features of another DBT system prior to independently using that other system.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ACR FAQs, cont.

Q. How much training on the “unique features of the particular DBT system” is required?

A. Currently, the FDA’s Division of Mammography Quality Standards (DMQS) has not specified the number of hours of training needed on the “unique features of the particular DBT system.”

Q. Must the training be provided by the manufacturer?

A. No. Under MQSA, the new-modality training, including the training on the unique features (technological differences and Indications for Use) of a particular DBT system, does not need to be provided by the manufacturer. Each of the currently approved manufacturers, Hologic and GE, offers formal training on its own system; however, third-party training courses as well as informal training can also provide new mammographic modality training under MQSA. Residents and fellows may receive the training during their residency or fellowship. The individual providing the training must be a qualified instructor, defined as “an individual whose training and experience adequately prepare him or her to carry out specified training assignments.” For example, peer training by a qualified peer who has previously met the training requirement is permitted. The FDA’s Division of Mammography Quality Standards (DMQS) will accept signed attestation, using DMQS’s recommended form or a form with similar elements, to document that personnel received training in the new unique features of a particular manufacturer’s DBT system.

Q. What is the status of training received prior to this clarification?

A. Such training counts toward the eight hours of new-modality training for any approved DBT system, but personnel also need to document that they received training in the unique features of whichever DBT system they will use. For documentation of training in the unique features of a particular manufacturer’s DBT system, the FDA’s Division of Mammography Quality Standards (DMQS) will accept: •

A course certificate or letter that clearly indicates that the training included the unique features of a particular system, or

•

A signed attestation, using DMQS’s recommended form or a form with similar elements, to document training in the unique features.

If the eight hours of new modality training in DBT were obtained between February 18, 2011 and August 26, 2014, when Hologic was the only DBT system approved for marketing in the US, DMQS will accept that such training included the unique features of the Hologic system, even if that is not stated explicitly on the training certificate.

Q. What documentation will MQSA inspectors look for in order to determine that a facility is in compliance with new mammographic modality training?

A. Personnel need to have acceptable documentation of a total of eight hours of training in the new mammographic modality, defined as the specific manufacturer’s DBT system used by the personnel. The training in the unique features of the particular DBT system the personnel will use may be included in the eight hours of new-modality training, or this training in the unique features may be obtained separately. Thus, personnel may receive:

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ACR FAQs, cont.

•

Eight hours of training in general DBT topics, plus training in the unique features of the specific DBT system they will use; or

•

Eight hours of training in one specific DBT system they will use; or

•

Eight hours of training in one DBT system, plus training in the unique features of another DBT system prior to independent use of that other system.

Signed attestation is acceptable for documentation of the training in the unique features of a particular DBT system. Also, if 8 hours of new-modality training in DBT were obtained prior to August 26, 2014, when Hologic was the only DBT system approved for marketing in the United States, inspectors will accept that the training included the unique features of the Hologic system, even if that is not stated explicitly on the training certificate.

Q. A third party education provider held a DBT course in January 2014, before the GE DBT system was approved by the FDA. The identical course was repeated in September 2014, after GE DBT approval. If eight hours of new-modality training in DBT were obtained prior to August 26, 2014, when Hologic was the only DBT system approved for marketing in the United States, we understand that inspectors will accept that the training included the unique features of the Hologic system, even if that is not stated explicitly on the training certificate. This means the January 2014 course will be acceptable for Hologic training.

Will the September 2014 course be acceptable for Hologic training since it is the same course repeated? If so, how should this training be documented?

A. Yes. Complete and sign an attestation using DMQS’s recommended form or a form with similar elements, to document training in the unique features of the Hologic system.

Q. I am qualified to interpret DBT with only the Hologic system. We are employing a new radiologist who has had some general CME on DBT. The FDA guidance says that I can provide peer training to my radiologist colleague. How do I know which unique features of the Hologic system I should teach him or her?

A. The unique features of a specific DBT system will typically include its particular technological features of image acquisition, processing, and/or display, and its unique FDA-approved Indications for Use, such as the particular combination of views approved for screening mammography using that DBT system. You should emphasize to your physician colleague those unique features that fall into the interpreting physician’s area of responsibility.

Similarly, a medical physicist or a radiologic technologist providing peer training to a colleague should empha size those unique features that fall into the colleague’s respective area of responsibility.

Q. Do the above requirements apply to recently graduated radiology residents, fellows, radiologists providing locums services, consulting medical physicists and mammography technologists providing per diem services?

A. Yes.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

ACR FAQs, cont.

Q. Our GE DBT mammography equipment evaluation (MEE) was performed prior to the March 18, 2015 DMQS clarification issued inspectors. Must a MEE be done again after manufacturer-specific training is completed?

A. The FDA’s Division of Mammography Quality Standards (DMQS) has informed the ACR that MQSA-certified facilities which have already had their certificate extended to include the GE DBT system and whose MEE was performed prior to the March 18, 2015 DMQS clarification can continue using the equipment if they make arrangements to obtain training in the unique features of GE DBT as soon as possible.

Q. How is the ACR dealing with these requirements and their significant impact on the mammography community?

A. ACR has been in active discussion with the FDA’s Division of Mammography Quality Standards (DMQS), expressing our members’ significant concerns, as well as exploring ways to address these concerns. DMQS acknowledges that there are features which are common to more than one DBT system, such that personnel do not need to receive training twice on the common features in order to qualify to use two different DBT systems. ACR is also considering applying for an Alternative Standard for personnel training requirements under MQSA. This will take time to develop and submit for DMQS approval. We will update these FAQs as we obtain more information.

Q. I have additional questions on these requirements. Who should I contact?

A. Contact the FDA Mammography Facility Hotline at 1-800-838-7715 or via email.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

HEALTH POLICY & ECONOMIC ISSUES Blake Dirksen, Coralville, IA

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ne of the most common questions we receive at the Professional Economics Committee (PEC) is related to the difference between bundled and packaged codes in the hospital outpatient setting.

Packaging is different from bundling — bundling is a coding concept, whereas packaging is a payment concept. In this article we are going to explain the differences using image guided radiation therapy (IGRT) and dose calculations as examples.

A bundled service is one that is considered to be an inclusive component of another service from a coding perspective. With bundling, coders only report the most comprehensive or primary procedure code and don’t report the subsequent code(s) on separate lines of the claim.

The National Correct Coding Initiative (NCCI) code edits specify which codes are bundled codes, and under normal circumstances, coders should not separately report codes for these services. The charges for these services should be reported as part of the charge for the bundled code, or they may appear separately on an appropriate revenue code line without a HCPCS/CPT© code. If a code is bundled, it is improper to report it unless there is a clinical circumstance that justifies overriding the bundling rule.

An example is IGRT and the new IMRT treatment delivery codes (77385 and 77386). The work and code descriptions of these two treatment codes includes image guidance and therefore if it were reported along with the treatment, you would be charging Medicare twice for the IGRT work. Key point: do not report bundled codes with the code they are bundled into.

Packaging is a payment concept that indicates an item or service is not separately paid, but rather paid as part of another service. Medicare continues to package payment for items and services into the payment for the primary diagnostic or therapeutic modality to which these items and services are typically ancillary and supportive. Hospitals generally report the packaged services, but do not receive a separate payment for these services because they receive payment as part of other separately paid services reported on the same claim.

Under the Hospital Outpatient Prospective Payment System, Medicare specifies which codes are packaged in a composite APC and packages multiple procedures under the new comprehensive APCs. Unlike bundled items and services, packaged items and services may, and sometimes are required to, be reported separately on the claim with a HCPCS/CPT© code. You can, and should, bill separately for packaged services.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Health Policy, cont.

For example, IGRT is packaged into non-IMRT treatment delivery codes. It is important that packaged codes are still reported correctly as claims data is used to set payment rates for the codes they are packaged into. For example, if we stop billing the IGRT codes, which are packaged into treatment delivery codes in certain situations, reimbursement rates for treatments will go down. Key point: report packaged codes.

Keeping track of which codes are bundled and which codes are packaged can be very confusing.

IGRT Example For several years Medicare has packaged IGRT into the treatment delivery codes. Prior to 2015 multiple IGRT codes were used but many of the IGRT codes were deleted on January 1. Starting in 2015 this work is captured using the new guidance code (77387) and it should be billed even though it is packaged into most treatment delivery codes. The exceptions are the two new IMRT codes (77385 and 77386) and the single and multiple session stereotactic treatment codes (77371, 77372, and 77373). These treatments have the image guidance bundled into the treatment code description.

Therefore, you cannot bill the IGRT with these treatments.

Description

CPT© Codes

IGRT Packaged (report code)

External Beam Radiation Therapy Delivery

77401, 77402, 77407, 77412

IGRT Bundled (do NOT report code)

IMRT Treatment Delivery, SRS Treatment Delivery, SBRT Treatment Delivery

77385, 77386, 77371, 77372, 77373

Dose Calculations Example Dose calculations (77300) have also been bundled into many of the new treatment planning codes for 2015. This means that the work associated with a dose calculation has been included in the valuation of the new isodose planning codes and should not be reported separately. However, for 3D and IMRT plans the calculations can still be reported, as they are NOT bundled into those codes.

Description

CPT© Codes

Dose Calculation (report code)

3D Planning, IMRT Planning

77295, 77301

Dose Calculation Bundled into Planning Code (do NOT report code)

Isodose Planning Simple and Complex, Brachytherapy Isodose Planning

77306, 77307, 77316, 77317, 77318

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Health Policy, cont.

If the work of the dose calculation is for a treatment that does not involve an isodose plan then a dose calculation may be reported. An example of this is a twice daily high dose rate (HDR) brachytherapy treatment where the second treatment requires a decay calculation but an isodose plan is not generated.

Medicare sets the reimbursement value of a particular code by using the outpatient claims data. Since many codes are now bundled into either the treatment delivery or the planning codes it is important that hospitals adjust their chargemaster to reflect the increased work associated with treatment and planning. As an example, IMRT is typically delivered with IGRT but the IGRT is now bundled into the treatment delivery code. Your hospital should have included the cost of the IGRT into their 2015 chargemaster value for IMRT treatment delivery. If hospitals do not report codes correctly and update their chargemaster to account for bundled charges, radiation oncology reimbursement will decline.

This information is for CMS policy in 2015 and these policies change each year so stay tuned for updates. For more detailed information please refer to the 2015 ASTRO Radiation Oncology Coding Resource or the Government Affairs section of the AAPM website where information on 2015 CPT© code changes can be found. You may also reach out to the AAPM Professional Economics Committee.

Our condolences William Clayman – Stratford, CT Francis J. Connolly – Mobile, AL Ira J. Kalet – Kirkland, WA Vernon E. Leininger – West Jefferson, OH Hector Lopez – Bethesda, MD Frank Low – Chappaqua, NY Steven C. Luckstead – Walla Walla, WA Jacques Ovadia – Chicago, IL Richard W. Piontek – Randolph, VT Robert J. Shalek – Houston, TX Warren K. Sinclair – Escondido, CA Goran K. Svensson – Boston, MA Johannes van de Geijn – Pasadena, MD Lawrence E. Williams – Duarte, CA Our condolences are extended to their families. If you have information on the passing of members not listed above, please inform HQ ASAP so these members can be remembered during the Awards and Honors Ceremony at our upcoming Annual Meeting. We respectfully request the notification via e-mail to: 2015.aapm@aapm.org Please include supporting information so that we can take appropriate steps.

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PARTNERS IN SOLUTIONS Partners in Solutions returns again this year with vendors providing physics-level presentations on topics selected by AAPM in a special-purpose lecture room built on the exhibit floor. These sessions provide practical information for the clinical physicist from the people who know the systems in depth! CE credit is available. This year’s topics are: • Imaging: Tools for Collecting and Analyzing Patient Radiation Dose Index Information • Therapy: Deformable Image Registration, Contour Propagation, and Dose Mapping

AAPM 2015 DATES TO REMEMBER

BY MAY 12

Annual Meeting Scientific Program available online

MAY 27

Deadline to receive discounted registration fees • Housing Reservation deadline

JUNE 17

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

AUGUST 27

Credits released for meeting attendees

www.aapm.org/meetings/2015AM

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

THE SCIENCE OF SAFETY IN MEDICAL PHYSICS Highlights From Today’s Cutting Edge Medical Physics Research

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edical physicists need no convincing of the importance of quality and safety improvement — it’s in our DNA. The challenges lie in how to achieve quality improvements effectively, how to rigorously assess the effect changes in technology and process have on quality, and how to prove the value of improvements.

Research Spotlight

The growing appetite for safety research in medical physics, says Eric Ford, PhD, is evident in federal research grants awarded to medical physicists for research in quality and safety improvement in radiation therapy and diagnostic radiology.

“In recent years a number of quality-improvement tools have been developed, but the challenge is to effectively measure the impact these tools are having on patient care,” said Ford. “This is something that hasn’t been done in our field. We’ve traditionally been tool builders and know at an intuitive level that these tools should be beneficial, but we haven’t produced the data to back it up. But the field is evolving and recent work sets out to measure the impact of such tools through a variety of studies with various endpoints.”

Figure 1: An incorrectly planned treatment isocenter identified through the process of incident learning. Panel A shows the isocenter on the DRR as it should have been versus what emerged from planning (Panel B). In this hypofractionated lung case with small margins, the tumor would have been severely underdosed had the error not been identified (Panel C).

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Research Spotlight, cont.

Drawing a straight line from safety initiatives to improved care is key. Quality assurance research in radiation therapy, for example, has shown a clear link between quality metrics and improved outcomes for patients, notes Ford. This has been demonstrated in clinical trials from cooperative oncology groups.1 Such studies include review of hundreds of patient cases to provide statistical power demonstrating that patients with “high quality plans” have better outcomes, survive longer, experience better local control and benefit from lower toxicities.

But how does one guarantee a “high quality” plan for each patient? In clinical trials this often is accomplished by outside audits of the plan (sometimes in near real-time). This enables corrective actions. Extending this principle more broadly, the entire clinical process should be audited continuously. This is exactly the approach taken in “incident learning.” An example of how this works in practice is shown in Figure 1. In this case an incorrectly planned isocenter was identified (Panel A vs B), which would have had a significant impact on this patient’s treatment (Panel C). As with plan review in clinical trials, the process of incident learning identified this deficiency and corrected it. Experience at Washington University and other groups over the last decade has shown that such incident learning systems (ILS) are feasible even at high volume.2 Given the voluntary nature of reporting it is very encouraging to see that active engagement and high-volume reporting is possible, said Ford.

The movement toward organized incident learning received a boost with the June 2014 release of the Radiation Oncology Incident Learning System™ (RO-ILS), sponsored by ASTRO and AAPM. This system provides a nationwide network that is ready-made for radiation oncology and allows cross-institutional learning. RO-ILS operates under the umbrella of a federally protected patient safety organization (PSO), administered by AHRQ, providing a protective bubble that enables open discussion about how to improve quality.

Six months after the implementation of RO-ILS, some very valuable lessons are already emerging. For example, ensuring that the right patient is treated with the right plan underscores the importance of a checklist and a simple timeout prior to treatment.

“It’s still a work in progress, but we will likely continue to see higher level annual reports that boil down to valuable lessons learned,” said Ford.

Can we prove that engaging in ILS works? Institutions that have adopted ILS have begun to demonstrate its value. The group at the University of Washington, Seattle, demonstrated an improving culture of safety in which people across departments — from technicians to nurses, physicians and medical physicists — operate better in a non-punitive environment, reporting issues and concerns that reveal areas for improvement.3 Another study by investigators at The Ottawa Hospital and Tom Baker Cancer Center examined the benefits of incident learning over a five-year period in which the number of actual non-minor incidents measurably decreased.4 That study also discussed a “reporting index,” a ratio of potential incidents to non-minor actual incidents that appeared to increase over that same time period. That reflected the well-established trend that more reporting incidents and more engagement in incident learning actually reduces the rate of events that harm patients.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Research Spotlight, cont.

“While gold-standard metrics for ILS don’t yet exist, it’s clear that ILS prompts providers to engage and put increased thought behind the safe provision of treatment,” said Ford. “This awareness leads to fewer patient-harm events.”

As powerful as incident learning is, it must be recognized that it does not provide a complete assessment of risk in clinical processes. To address this gap, other quality improvement tools are now coming into wider use, namely process mapping, fault tree analysis, and failure mode and effects analysis (FMEA). The soon-to-be released TG100 Report describes these tools and will roll out a risk-based quality management program based on these tools. FMEA is a core component of this and has been employed effectively by NASA and the U.S. military. FMEA is complementary to ILS as it identifies failure modes — weak points — that typically are not detected through ILS because they are so rare, said Ford. FMEA and TG100 provide a method for judging and quantifying risk and a process for mitigating those risks. There are limitations — FMEA may not identify all possible failure modes.

Further, because the incidents are so rare, it is unclear how to quantify the benefits of resulting interventions.

Is FMEA practical to implement in a resource-limited clinic? To date, a number of studies of FMEA have been published in the radiation oncology literature, and several have demonstrated practical, easy-to-use implementations.5-13 A study from the Maastricht Radiation Oncology Clinic examined the effort involved in conducting an FMEA and concluded that it required approximately 19-35 l personhours in their hands.14 “Short of providing direct proof of improved patient care, FMEA is creating awareness and is being used to refine the design and implementation of quality improvement tools,” said Ford.

In diagnostic imaging, there are a number of initiatives focused on safety as well, using reduced dose as the main patient-safety improvement endpoint. The estimation and reduction of dose has been studied by investigators such as Michael McNitt-Gray and other researchers. Based on such work in the early 2000s, the Image Gently campaign was formed and can be credited with helping to significantly reduce the radiation dose in pediatric imaging scans. The tracking of dose continues to be an important aspect in CT scans and trials. Medicare will soon mandate the recording of CT doses for lung cancer screening, and dose data will be collected via a registry.

What does the future of hold for safety since in medical physics? The science is evolving, notes Ford, but safety research is gaining recognition as an important aspect of medical physics — and an expanded role for medical physicists in healthcare delivery.

“Most studies have focused on the operational aspects of safety and the use of quality assurance tools, while very little research has focused on how effective these tools are and whether they are actually helping patients,” said Ford. “We need to focus on identifying metrics and demonstrating meaningful outcomes. In other words, we need hard data. We’ve got our work cut out for us, but the impact is huge.”

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

Research Spotlight, cont.

1

FitzGerald T, Bishop-Jodoin M, Bosch W, et al. Future vision for the quality assurance of oncology clinical trials.

Front Oncol. 2013;Mar 15:3:31.

2

Mutic S, Brame R, Oddiraju S, et al. Event (error and near-miss) reporting and learning system for process improvement in radiation oncology. Med Phys. 2010;37(9):5027-5036.

3

Kusano A, Nyflot M, Zeng J, et al. Measurable improvement in patient safety culture: a departmental experience with incident learning. Pract Radiat Oncol. 2014;Oct 28 (epub ahead of print).

4

Clark B, Brown R, Ploquin J and Dunscombe P. Patient safety improvements in radiation treatment through 5 years of incident learning. Pract Radiat Oncol. 2013;Jul-Sep;3(3):157-63.

5

Ford E, Gaudette R, Myers L, et al. Evaluation of safety in a radiation oncology setting using failure mode and effects analysis. Intl J Radiat Oncol Biol Phys. 2009;74:852-858.

6

Scorsetti M., Signori C, Lattuada P, et al. Applying failure mode effects and criticality analysis in radiotherapy: Lessons learned and perspectives of enhancement. Radiother Onco. 2010;94:367-374.

7

Sawant A, Dieterich S, Svatos M and Keall P. Failure mode and effect analysis-based quality assurance for dynamic MLC tracking systems. Med Phys. 2010;37:6466-6479.

8

Perks J, Stanic S, Stern R, et al. Failure mode and effect analysis for delivery of lung stereotactic body radiation therapy.

Int J Radiat Oncol Biol Phys. 2012;83:1324-1329.

9

Ciocca M, Cantone M, Veronese I, et al. Application of failure mode and effects analysis to intraoperative radiation therapy using mobile electron linear accelerators. Int J Radiat Oncol Biol Phys. 2012;82:e305-e311.

Broggi S, Cantone M, Chiara A, et al. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy. J Appl Clin Med Phy. 2013;14:265-277.

10

Wilkinson D and Kolar M. Failure modes and effects analysis applied to high-dose-rate brachytherapy treatment planning. Brachytherapy. 2013;12:382-386.

11

Cantone M, Ciocca M, Dionisi F, et al. Application of failure mode and effects analysis to treatment planning in scanned proton beam radiotherapy. Radiat Oncol. 2013;8:127-136.

12

Ford E, Smith K, Terezakis S, et al. A streamlined failure mode and effects analysis. Med Phys. 2014;Jun 41(6):061709.

13

Vlayen A, Evaluation of time-and cost-saving modifications of HFMEA: An experimental approach in radiotherapy.

J Patient Safety. 2011;7:165-168.

14

“IN RECENT YEARS

A NUMBER OF QUALITY-IMPROVEMENT TOOLS HAVE BEEN DEVELOPED, BUT THE CHALLENGE IS TO EFFECTIVELY MEASURE THE IMPACT THESE TOOLS ARE HAVING ON PATIENT CARE.” Eric Ford, PhD

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

NEW FEDERAL X-RAY GUIDELINES PUBLISHED Mike Boyd, US EPA Sam Keith, US DHHS Donald Miller, MD, US FDA

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n January 15, 2015, US Environmental Protection Agency Administrator Gina McCarthy signed Federal Guidance Report No. 14: Radiation Protection Guidance for Diagnostic and Interventional X-Ray Procedures (FGR-14), finalizing a multiyear, interagency effort to update federal x-ray guidance. While not binding on any agency or facility, incorporating the best practices defined in this guidance will improve the safety of diagnostic and interventional imaging.

The new federal x-ray guidance updates the 1976 guidance in Federal Guidance Report No. 9 (FGR-9). Since 1976, two related trends in x-ray technology have emerged: 1) Digital technology has largely replaced x-ray film. With digital technology, overexposure does not degrade the image. This is different from film where an overexposure blackens the film, making the overexposure obvious as soon as the film is developed. 2) The availability and use of interventional fluoroscopy and computed tomography (CT) scanning have increased rapidly. Associated with this increase, there have been several reports of unnecessarily high radiation doses given to children because equipment exposure settings were not properly “dialed down” from adult settings.

Trends and reports from the National Council on Radiation Protection and Measurements show a sharp increase in imaging studies resulting in a doubling of the average annual radiation dose to the U.S. population from diagnostic and interventional x-ray procedures over the past 20 years. In response to these findings, the federal Interagency Steering Committee on Radiation Standards asked EPA to consider revising FGR-9. As a result, the Interagency Working Group on Medical Radiation was formed, which included medical and radiation protection professionals from the EPA, the Department of Health and Human Services, the Department of Veterans Affairs, the Department of Defense (Departments of the Army, Navy, and Air Force), the Occupational Safety and Health Administration and the Commonwealth of Pennsylvania.

The EPA’s Federal Guidance authority allows the Agency to provide advice to federal agencies with respect to radiation matters that directly or indirectly affect public health. While most of the recommendations in FGR-14 can be applied to any type of medical, dental or veterinary facility using radiological diagnostic and interventional imaging equipment, there are some considerations unique to certain federal facilities, such as military field hospitals.

FGR-14 includes facility guidance for each modality (radiography, CT, interventional fluoroscopy, and bone densitometry). The guidance covers a range of important matters, such as radiation shielding, training and credentialing, providing options for practitioners who refer patients and order studies, and managing informatics of patient records. Some of the key aspects of the update include:

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

New Federal X-ray Guidelines Published, cont.

•

Agencies should ensure that all radiation use in medical, dental, and veterinary imaging is justified and optimized.

•

Agencies should promote the development of national diagnostic reference levels for use as quality assurance and quality improvement tools in each type of examination.

•

Facilities should ensure that sufficient staffing is maintained and trained to appropriately address radiation safety issues.

•

Facilities should image only the area of anatomy in question, acquire only the necessary sequences, and select and adjust the protocol to ensure that the patient is examined using the appropriate techniques and dose.

•

Facilities should use the dose information from individual patient imaging procedures that is provided by imaging equipment as part of the quality assurance program for identifying opportunities to reduce dose.

•

Facilities should have adequate quality assurance and quality control programs for each of their modalities.

•

Facilities should ensure that advances in techniques and technology that reduce radiation dose are used, and used properly.

•

Facilities should establish infrastructure for collecting, storing, reporting, and analyzing dosimetry data from patient examinations.

Private health care facilities may already be familiar with the recommendations in this document.

Many of the recommendations have been identified as best practices by international and U.S. radiation protection organizations and professional medical organizations. This guidance should serve as a reminder to all medical professionals who use radiological diagnostic and interventional imaging equipment to keep patient doses as low as reasonably achievable without compromising patient care.

FGR-14 and supporting information are available here.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

PERSON IN THE NEWS Dr. William R. Hendee, Rochester, MN

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r. William R. Hendee has been named the International Organization for Medical Physics (IOMP) 2015 Harold Johns Medal recipient.

This award is given triennially at the IOMP World Congresses and will be presented during the World Congress on Medical Physics and Biomedical Engineering to be held in Toronto June 7–12, 2015. The award recognizes the major contributions Dr. Hendee has made to the field of medical physics and the international community through his contributions to international education.

Register today!

Congress highlights:





Over 1800 accepted abstracts 190 Scientific Program Sessions 133 Continuing Education Presentations in English, French and Spanish



Over 100 Exhibit booths



Plenary Speakers

Gordon McBean Jeff Immelt Mary Gospodarowicz Monique Frize & Londa Schiebinger Edward Shortliffe & Vimla Patel

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

AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

WORKING GROUP ON STUDENT AND TRAINEE RESEARCH Clemens Grassberger, Boston, MA Stephanie Harmon, Madison, WI and Christopher Peeler, Houston, TX, Working Group Co-Chairs Inaugural Initiatives of the Working Group on Student and Trainee Research

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ith many exciting student-based activities ahead for 2015, a new working group has been created to foster the development of student and trainee research. The primary focus of the Working Group on Student and Trainee Research (WGSTR) is to initiate or promote activities aimed at enhancing and broadening pre-doctoral research. It is also our intention to act as a platform to connect students and trainees that share interest in research-related topics in medical physics. To achieve this we are actively working to gather feedback from students and transmit that information to AAPM so that it may be used to better diversify research-oriented education and training in the field of medical physics.

In-line with these goals, we have organized two events at this year’s AAPM Annual Meeting to kickstart awareness and involvement. The first major action in this effort will be our hosting of a student luncheon. One of our ongoing efforts will be to encourage student dialogue regarding researchoriented education. The luncheon will be designed to highlight ongoing student efforts within AAPM as well as directly addressing efforts within AAPM at-large aimed at promoting student research interests. We aim to provide a setting where students with such similar interests may have a discussion and share ideas. It is our hope to make this a recurring event at the annual meeting! This event will be held on Wednesday July 15, please register by June 17. We have also co-organized a new symposium at the AAPM Annual Meeting at which scientists who have had successful careers focused on research describe how they got their start and how they built their career. This session will directly follow the long-standing and successful Grantsmanship and Funding symposium, ideally providing additional benefit and testimonial insight for students and trainees interested in building careers similarly focused on research. This will take place on Thursday July 16, additional symposium details can be found on the AAPM Meeting website.

Finally, our primary activity in 2015 has been focused on spearheading the creation of a new travel grant program: The AAPM Expanding Horizons Travel Grant. Designed to help fund student travel to meetings not associated with AAPM or even medical physics specifically, the objective of the grant is to provide opportunities to students that will serve to broaden the scientific approach in medical physics research. Hopefully, the advantage of such diversification will lie in the identification of new directions in which medical physics research may progress and will also improve the depth and robustness of our field. Read more about this exciting opportunity in the Travel Grants for Expanding Medical Physics Research Horizons feature, or by visiting the AAPM Grants & Fellowships webpage.

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

REQUEST FOR FEEDBACK ON PROPOSED DICOM STANDARDS

BY JUNE 1 Request of Feedback from AAPM Members on Proposed DICOM Standard Additions for Radiotherapy During the Forthcoming Public Comment Period

A

new DICOM Standard for radiotherapy is being developed that will enable departmental workflow, improve safety through tighter standard definition, improve interoperability, and open DICOM to new technologies and processes in RT. (2nd Generation of DICOM RT Standard.)

Radiotherapy has evolved since the introduction of Radiotherapy objects to DICOM in 1997 (“1st Generation”) with new treatment modalities, positioning techniques and more structured workflow.

This prompted WG-07 to undertake this multi-year effort to develop the new standard.

This major upgrade to the DICOM Standard consists of a set of Supplements to the existing Standard.

The following table contains the first set of these additions. Supplement 147 is already available for Public Comment. Others are in various stages of development.

AAPM members are invited to review and comment. We recommend that you start by browsing the relevant presentations to put the details of the supplements in perspective.

Title

Status

147

Second Generation Radiotherapy – Prescription and Segment Annotation

In Public Comment until June 1, 2015.

175

Second Generation Radiotherapy – C-Arm RT Treatment Modalities

Forthcoming for Public Comment.

176

Second Generation Radiotherapy – Additional RT Treatment Modalities

Forthcoming for Public Comment.

177

Second Generation Radiotherapy – Dose Objects

Forthcoming for Public Comment.

178

Second Generation Radiotherapy – RT Course

Forthcoming for Public Comment.

179

Second Generation Radiotherapy – RT Explanatory (Part 17)

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AAPM Newsletter • Volume 40 No. 3 MAY | JUNE 2015

DICOM, cont.

The first Supplement 147 “Second Generation Radiotherapy” proposes a comprehensive and extensible representation of Prescriptions to enable interoperable exchange between Radiotherapy applications.

WG-07 has a strong desire to receive feedback and is looking forward for any kind of input. We encourage you and your colleagues to review the supplement and provide comments on any part of the document.

The documents for review can be downloaded by anyone from these locations: MS Word Format: Digital Imaging and Communications in Medicine (DICOM) PDF Format: Digital Imaging and Communications in Medicine (DICOM) Note: Future documents will be posted in the following directory and will be identified with the Supplement numbers shown in the above table (175, 176, etc….) The dates cannot be predicted at this time; the best we know is that a couple more are expected this year. Additionally, persons that submit comments on Sup 147 will be added to an e-mail list for direct updates. Lastly, always feel free to contact the contacts listed below with any questions.

You may use any of the following approaches to provide comments: •

Use the form in this directory.

•

Mark up the MS Word format of the supplement itself using Track Changes.

•

Use free text in e-mails or attached documents or tables or other illustrations.

Please submit your comments to the DICOM Secretariat Office.

We hope that we have inspired your interest in the new generation of interoperability in Radiotherapy WG-07 is looking forward to your feedback.

With Best Regards, Stephen Vastagh General Secretary, DICOM On behalf of Ulrich Busch, Varian Medical Systems Chair, DICOM RT WG-07 Christof Schadt, Brainlab GmbH Vice Chair, DICOM RT WG-07

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focus on our future The AAPM Education & Research Fund supports the development of our great profession via the provision of seed money for research, Summer Undergraduate Fellowships, DREAM Program Fellowships, fellowships for PhD students and support for clinical residencies.

Without contributions from our generous members we would never have been able to provide the now over 100 grants, fellowships and residencies since the inception of the Fund 20 years ago.

All contributions are tax deductible. Larger donations may be designated for specific fellowships, residencies, travel awards, research or other suitable purposes.

GIVE TO THE AAPM EDUCATION & RESEARCH FUND DONATE NOW!

UPCOMING AAPM MEETINGS: June 14–18, 2015 AAPM Summer School Proton Therapy: Physical Principles and Practice Colorado Springs, CO July 12–16, 2015 AAPM 57th Annual Meeting & Exhibition Anaheim, CA September 18–20, 2015 SRT/SBRT: Safe and Accurate Delivery of Hypofractionated Radiation Therapy Detroit, MI March 5–8, 2016 AAPM Spring Clinical Meeting Salt Lake City, UT

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