AAPM Newsletter May/June 2016 Vol. 41 No. 3 by AAPM Docs

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

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

IN THIS ISSUE: ▶ Chair of the Board’s Report

▶ Professional Council Report

▶ Treasurer’s Report

▶ Research Spotlight

▶ Report from the AAPM Practice Accreditation Subcommittee and more...

ADAPT AND SUCCEED.

“What if we don’t change at all...and something magical just happens.”

Medical Physics Leadership Academy June 12 –16, 2016 | Chantilly, VA This is a 4.5 day program with lectures/exercises in these key areas suitable for all career stages: •

Leadership in Visioning

•

Leadership in Communication

•

Leadership with People

•

Leadership in a Constrained Environment

•

Leadership in Practice

Leadership in Projects • Leadership in Finance •

This program has been planned by AAPM members, drawing from their broad experience. For added specialized expertise in Leadership Development training, Impact International has been engaged to help participants manage and master the processes of awareness, decision-making and action.

www.aapm.org/meetings/2016SS/

CONTENTS ARTICLES IN THIS ISSUE 5 7 11 19 23 25 29 31 35 36 39

Chair of the Board’s Report Executive Director’s Column Treasurer’s Report Professional Council Report Administrative Council Report ABR News ACR Accreditation: FAQs For Medical Physicists Research Spotlight Legislative & Regulatory Affairs Report In Memoriam — Donald E. Herbert, Jr., PhD, FAAPM Practice Accreditation Subcommittee

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

AAPM NEWSLETTER The AAPM NEWSLETTER is published by the American Association of Physicists in Medicine on a bi-monthly schedule. AAPM is located at 1631 Prince Street, Alexandria, VA 22314-2818

EVENTS/ANNOUNCEMENTS 2 4 14 20 21 22 22 30 41 42 43

AAPM Summer School 2016 AAPM 58th Annual Meeting & Exhibition Student & Trainee Activities AAPM 58th Annual Meeting & Exhibition AAPM 2017 Spring Clinical Meeting AAPM 2016 Elections AAPM 2016 Certificate Course AAPM 58th Annual Meeting & Exhibition Keynote Speaker Condolences — AAPM Deceased Members 2016 Awards, Achievements & Honors Recipients RSNA 2016 AAPM 2016 Expanding Horizons Travel Grant

EDITORIAL BOARD Editor Jessica B Clements, MS Kaiser Permanente E-mail: JessicaClements@gmail.com Phone: 818-502-5180 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 1631 Prince Street Alexandria, VA 22314 Phone: (571) 298-1300

NAVIGATION HELP Previous/Next Article Tap the arrows at the bottom of the page to go to the next or previous page.

PUBLISHING SCHEDULE The AAPM Newsletter is produced bi-monthly. Next issue: July/August Submission Deadline: June 10, 2016 Posted Online: Week of July 4, 2016

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.

CONNECT WITH US!

www.aapm.org

www.aapm.org/ meetings/2016AM/ AssociationMtgs.asp

STUDENT AND TRAINEE EVENTS Please join us for the first ever Student and Trainee Day on Sunday July 31

ANNUAL STUDENT MEETING: THE MANY PATHS OF MEDICAL PHYSICS

AAPM STUDENTS AND TRAINEES NIGHT OUT: ALL-INCLUSIVE EXPERIENCE AT THE DC UNITED SOCCER GAME!

9:30 – 11:00 am | Ballroom C, Level Three, Convention Center

6:00 – 8:30pm | RFK Stadium | Tickets: $35/person (space is limited) | Registration Deadline: June 30

This year’s Annual Student Meeting consists of a panel of professionals who have pursued an education in medical physics and have since filled a variety of jobs ranging from chief medical physicist, small business founder, NIST scientist, company R&D scientist, and an academic researcher.

WGSTR STUDENT AND TRAINEE LUNCH: CORE ASPECTS OF A MEDICAL PHYSICS EDUCATION 11:30 am – 1:00 pm | Ballroom C, Level Three, Convention Center | Tickets: $10/person (space is limited) Registration Deadline: July 6 The Working Group on Student and Trainee Research and the AAPM Students and Trainees Subcommittee (STSC) are hosting this lunch to foster a discussion on Core Aspects of a Medical Physics Education as they pertain to research in our field.

RESIDENCY FAIR 1:00 – 3:00 pm | Ballroom Foyer, Level Three, Convention Center Programs: reserve your table here | Students/Attendees: RSVP here The STSC, in collaboration with SDAMPP, is hosting a Residency Fair to provide students with an opportunity to learn more about individual residency programs and how they are structured.

CAREER EXPO 4:00 – 6:00 pm | Ballroom Foyer, Level Three, Convention Center The STSC is holding the first non-clinical Career Expo at the Annual Meeting to allow students, trainees, and young professionals to talk to physicists currently working in a variety of roles at companies, government agencies and labs, and academic research. This is not meant to be a job fair, but rather a place to facilitate discussions about future career paths and roles that medical physicists fill outside of the clinic. Company/Gov’t Agency Reps: RSVP here Students/Attendees: RSVP here

Join us for our Annual Students and Trainees Night Out sponsored by the STSC! This event provides attendees the opportunity to network with fellow students, residents, and post-docs. This year we have partnered with DC’s professional soccer team, DC United. We will attend the game and have exclusive access to the team’s Capitol View Club where they will provide buffet-style food options, beer, wine, as well as non-alcoholic beverages.

ADDITIONALLY, THE FOLLOWING ACTIVITIES WILL BE TAKING PLACE DURING THE ANNUAL MEETING: Interview Workshop 10:15 – 11:00 am (Academic/Research/Clinical Careers) 11:15 am – Noon (Regulatory and Industry Careers) Wednesday, August 3 | Partners in Solutions Room, Exhibit Hall The STSC would like to invite students, trainees, and young professionals to attend an interview workshop to practice their interviewing skills and receive feedback from real interviewers. The first workshop is designed for those seeking careers in academic, research, or clinical environments. The second workshop is geared towards those seeking careers in regulatory or industry positions.

Partners for the Future | More information coming soon! In an effort to open the dialogue between our corporate partners and those individuals training to become medical physicists, participating corporate partners will be conducting demonstrations designed specifically for trainees.

Symposium: Fostering a Successful Career in Research Wednesday, August 3 | 1:45-2:45 | Room 204 Interested in pursuing a career in research? Come hear from leaders in the field who have found success in academic and industry research careers.

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

CHAIR OF THE BOARD’S REPORT John M. Boone, Sacramento, CA

nder the energetic leadership of AAPM president Bruce Curran, our organization has been engaged in a broad discussion of mission, vision, and organizational structure. To aid in the discussion of where AAPM might be headed, with the enormous help of AAPM staff I put together the timeline shown below. The vertical dimension of the background’s blue “horn” is proportional to the membership of AAPM. From this chart, it is apparent that we started as a sleepy discipline that was focused mostly on science, and pursued that trend for over two decades. The Annual Meeting had a science track (1961), Science Council was formed in 1972, and the Medical Physics journal was started in 1974. Education and Professional Councils were also formed in the mid-1970s. Fast forward to the last decade; we see that membership has grown substantially. We also see that most of the new activities in AAPM are focused on professional matters — including the addition of the Professional Track at the annual summer meeting, expenditure on licensure, genesis of the Spring Clinical Meeting, and subsuming JACMP. Note that the Spring Clinical Meeting and Journal of Applied Clinical Medical Physics (formerly Journal of the American College of Medical Physics) were transferred from the American College of Medical Physics in an agreement which terminated the ACMP. The chart suggests that we transitioned from primarily a science (and education) organization to what appears to be primarily a professional (and education) organization. This doesn’t mean that science has vanished, it just means that AAPM’s focus on the profession of medical physics has been able to expand as our membership has grown. What isn’t clear to me is whether this redirection in the AAPM mission occurred organically or by design. Probably a bit of both.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Chair of the Board, cont.

The chart gives us a brief view of who we were when we started, and where we are at the present. As we address the issue of modernizing the AAPM governance structure, however, we have to think about who we will become in the future. So, here are some of the questions we need to consider: •

Will we embrace a “big tent” strategy for AAPM, so that we can grow our membership? For example, should we have a strategy that will allow medical physicist assistants (MPAs) to become (associate) members of AAPM, as some have advocated?

•

Will the future leaders of AAPM continue to embrace the practice of science in our organization, or will the current inertia of AAPM towards a professional society lead to the atrophy of research science in our organization? If researchers gradually leave AAPM, will they continue to publish in the Medical Physics journal (which provides considerable revenue to the organization)?

•

The majority of AAPM members (80%) are engaged in radiation oncology. Will AAPM continue to be a home for diagnostic medical physicists in the future, or will we see this component of our organization gradually slip away? Diagnostic medical physicists who work primarily in MRI and ultrasound imaging already have much larger organizations which nurture their scientific interests.

•

There is a lot of current discussion and debate about the future role of medical physicists with MS degrees versus those with PhDs. Currently, 39% of diagnostic medical physicists and 49% of therapy physicists hold MS degrees, making for an organization in which 47% of our full members are MS medical physicists. Will the residency selection process gradually lead to fewer MS medical physicists in the ranks of AAPM in 2036?

•

Will board certification become a de facto requirement for AAPM membership? For AAPM leadership? In the past 20 years, 18 of 20 presidents (90%) have been board certified, even though <60% of our full members are boardcertified.

•

If you are not a QMP but practice clinical medical physics, does that mean in effect that you are an MPA?

•

For physicists with a lifetime credential who do not engage in maintenance of certification, will health care providers continue to employ and payers continue to pay?

•

Will the dual requirements of a CAMPEP graduate program and a CAMPEP residency mean that AAPM will be effectively closed to scientists working in other fields such as high energy physics or astrophysics? Is this a good thing or a bad thing? Have we narrowed the selection pool so much that we will lose scientific curiosity and diversity?

There are many more questions to ponder as AAPM faces the future. If you have comments or questions, I would love to hear about them. In closing, it is important to recognize that AAPM got where it is today, and will get to wherever it is headed, through the actions, decisions and engagement of its members. In my term of AAPM leadership, I have heard from many medical physicists who are troubled with various trends in our field, and wonder why we can’t “fix them.” It is important to note, however, that AAPM is just one player in the field of Medical Physics. We have zero authority over organizations who accredit educational programs, or over boards that certify medical physicists, or over universities which train our members — who all have graduate degrees. We are in a dynamic equilibrium with all of these other players, and that equilibrium was profoundly perturbed when residencies became required for board certification. We will see how long the ripples from this perturbation continue… n

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

EXECUTIVE DIRECTOR’S REPORT Angela R. Keyser, Alexandria, VA

1631 Prince Street — Your New AAPM Headquarters

Make plans to Visit AAPM’s HQ During the 2016 Annual Meeting AAPM Open House, Saturday, July 30, 5:00 PM – 7:00 PM

With the Annual Meeting in our neighborhood, we hope you will find time to visit the new AAPM HQ located at 1631 Prince Street in Alexandria, Virginia. Please consider this when you are making your travel and hotel plans. The new AAPM HQ is nine Metro subway stops away from the Washington Convention Center on the Yellow Line (King Street Station). Transportation to the Open House will not be arranged, but Metro information will be provided. Register for the Tour.

AIP Gifts AAPM with Picture of Roslyn Yalow The American Institute of Physics (AIP) gifted AAPM with a commemorative photograph for display in the new HQ offices. The picture is of Dr. Rosalyn Yalow posing with her Nobel Prize next to the bust of Alfred Nobel. Catherine O’Riordan, AIP’s Chief Operating Officer and Liz Dart Caron, AIP Senior Director, Member Society Relations, delivered the gift during a recent visit to the new AAPM HQ in Alexandria, Virginia. I’m confident that this notable gift will be enjoyed by the visitors to AAPM HQ for many years to come!

AAPM HQ — Great Location for Group Meetings One of the many benefits to AAPM of the new HQ building is the ability to host meetings in-house, avoiding hotel pricing for technology and catering services. The HQ meeting space offers the latest in technology, including a dedicated wireless network for in-house meetings with speeds of 75 Mbps down/15 Mbps up. The Large Conference Room has four 90” screens driven by a Crestron system that allows you to connect to one or more screens by HDMI, VGA, or AirMedia Wireless connection. There is also an Apple computer with wireless keyboard and trackpad. The room is equipped with ceiling-mounted speakers and mics and conference calls can be

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•

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Executive Director, cont.

MEETING Mid-Atlantic Chapter Leadership

December 10, 2015

Strategic Planning Committee and Ad Hoc Committee on Governance Assessment

January 15–17, 2016

TG 278 -- Task Group on Combined Residency and Research Training in Medical Physics (TG-Hybrid Training)

January 19, 2016

Ad Hoc Committee on Unifying Publication Platforms

January 20, 2016

Professional Council Retreat

April 8–10, 2016

TAG IEC SC 62C

May 12, 2016

CAMPEP Board of Directors

May 20–21, 2016

Executive Committee to include a meeting with ASTRO leadership

June 9–11, 2016

Audit Committee

June 9, 2016

Public Education Committee

September 16–17, 2016

made using either these or the in-room computer via services like GotoMeeting. There is a printer just outside of the Large Conference Room accessible from the AAPM Guest network. •

The Executive Conference Room has one 80” screen driven by a Crestron system that allows you to connect via HDMI, VGA, or AirMedia Wireless connection. The room also has an Apple computer with wireless keyboard and trackpad. The room is equipped with ceiling mounted speakers.

•

There is a wireless-only 60” screen located in the AAPM Café and several 60” screen monitors located in various Teaming Rooms throughout the space that allow you to connect via HDMI or VGA as well.

•

All of the screens at AAPM feature AirMedia Wireless connections that allow you to connect your computer to display wirelessly.

A number of successful meetings have already occurred, with several more scheduled in the near future.

Election Process — Online Only! Elections for the 2017 Officers and Board Members-At-Large will open on June 21 and will run through July 12. 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.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Executive Director, cont.

Your Online Member Profile This is a reminder to keep your AAPM Membership Profile information up-to-date by going to the AAPM Member Profile Page and making any changes necessary. Please upload your picture if you have not already done so. Remember to review the “Conflict of Interest” area of the Member Profile to self-report conflicts per the AAPM Conflict of Interest Policy. AAPM 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 2016 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.

Education and Research Fund Update Are you a “Platinum, Gold, Silver, or Copper” level contributor to the AAPM Education and 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 an Education and 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 and 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. AAPM 2016 Summer School Medical Physics Leadership Academy June 12–16, 2016 Westfields Marriott Conference Center, Chantilly, Virginia View program and register now! AAPM offers scholarships for AAPM Members who are early in their careers in the form of a full waiver of Summer School tuition fees. Congratulations to the 2016 recipients: • •

Elizabeth Boehnke Corey Clift Dominic DiCostanzo

• • •

Leland Page Marija Popovik Vrinda Narayana

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•

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Executive Director, cont.

AAPM 58th Annual Meeting & Exhibition July 31 – August 4, 2016 Washington, DC This year’s program focusing on “Communicating Our Value—Improving Our Future” will be held in the Walter E. Washington Convention Center. •

•

Don’t delay in making housing arrangements; deadline is July 6. AAPM’s Headquarters Hotel is the Marriott Marquis, and there are eight other hotels offering discounted rates to AAPM attendees.

•

Don’t forget that the AAPM Committee Schedule changes frequently.

•

The meeting program will be available online by May 10.

New plans for the AAPM Night Out at the Newseum — The 2016 Night Out will not be a dinner event. Instead, you are encouraged to meet your colleagues at the venue for limited light snacks and then make your way to one of the many restaurants in the area for dinner. Or, dine first and make your way to the event for a bite of something sweet at the end of the evening! This change has been made in an effort to contain costs, but still provide an opportunity for attendees to socialize with colleagues and see a bit of Washington, DC. Each adult Night Out ticket will include one drink ticket, good for beer or a glass of wine. Again, you will be disappointed if you come to the Night Out expecting a meal. Please make your plans in advance and dine at a restaurant of your choice and favorite cuisine! We have compiled a list of restaurants located between the Convention Center and The Newseum, and encourage you to either make reservations on your own, or with help from the restaurant desk at the Convention Center. View restaurant list » RSNA 2016 Beyond Imaging is the theme of the 102nd Scientific Assembly and Annual Meeting, November 27 – December 2. 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 27th. n

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNEL 2016

TREASURER’S REPORT Mahadevappa Mahesh, Baltimore, MD

Loan Covenants Last year, April 2015, AAPM purchased a Headquarters building in Alexandria, Virginia. The acquisition and renovation was financed through Industrial Revenue Bonds issued by the City of Alexandria and purchased by TD Bank. As a part of this deal, AAPM negotiated certain loan covenants with TD Bank. Now that AAPM is a property owner and has borrowed a considerable amount to acquire the building, I would like to discuss the topic of “Loan Covenants” since it is timely and appropriate for us to understand why it is important for AAPM to meet all the requirements of loan covenants.

What is a Loan Covenant? A loan covenant is a condition in a commercial loan or bond issue that requires the borrower to fulfill certain conditions which forbid the borrower from undertaking certain actions, or which possibly restrict certain activities to circumstances when other conditions are met. Typically, violation of a covenant may result in a default on the loan being declared, penalties being applied, or the loan being called. In our case, TD Bank is the bond issuer and AAPM is the borrower. Traditionally, banks (such as TD Bank) include loan covenants in their loan agreements to improve the likelihood that the loan will be repaid by the borrower (such as AAPM) on time and in full and to preserve their position as the lender. Bank loan agreements may include three types of loan covenants: •

•

Affirmative Loan Covenants — Require the borrower to take certain actions during the course of the loan to protect the bank’s interests and communicate information or preserve the assets of the borrower. Examples of affirmative loan covenants include submitting financial statements to the bank at certain intervals, maintaining adequate insurance to protect the borrowers’ assets, and paying business and payroll related taxes. Negative Loan Covenants — Preclude a borrower from taking certain actions during the course of the loan. Examples of negative loan covenants include limiting the amount of debt the organization can assume with another borrower, preventing mergers or acquisitions, or selling a significant portion of organization assets without the bank’s permission. Financial Loan Covenants — Financial loan covenants are used to measure how closely the business performs against the financial projections provided (i.e., the budget). Certain financial covenants can restrict the amount of debt a borrower can borrow against a revolving credit line. Examples of financial loan covenants include a requirement to maintain a certain ratio of current assets versus current liabilities, maintaining a certain net worth, or achieving a certain level of profitability.

If a borrower violates its loan covenants, lenders have multiple remedies at their disposal and can generally choose from them as they see fit, depending upon the nature and severity of the default. If the borrower commits a minor default such as failing to submit its audited report by the deadline, the bank can simply extend the deadline. However, if a borrower commits a more serious violation such as taking out an additional material loan or selling off a division of its business without getting the bank’s permission, the bank can call the loan, halt any additional borrowings, exercise its right to seize assets, or initiate legal action against the borrower to recover its money.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Treasurer, cont.

AAPM’s agreement with TD Bank contains the following covenant requirements: Affirmative Covenants — Among the many requirements, the most critical ones are: •

To maintain unencumbered cash and investment balances of not less than six months operating expenses.

•

To maintain a Cash Flow Coverage Ratio (CFCR) of 1.2 to 1 as of June 30th and December 31st of each year.

•

To provide copy of AAPM’s annual budget by January 31st of the new fiscal year.

•

Maintain adequate insurance.

•

For other requirements please view the Supplemental Information Sheet.

Negative Covenants — Among the many requirements, the most critical ones are: •

AAPM will not incur or assume any third party debt greater than $500,000.

•

AAPM will not enter into any mergers, acquisitions, or sale of a significant part of its assets.

•

AAPM will not enter into any lease arrangements worth greater than $500,000.

•

AAPM will not create any subsidiaries.

•

AAPM will notify TD Bank about any changes in its executive management.

•

For other requirements please view the Supplemental Information Sheet.

The three most critical covenants are: 1. Achieve as of June 30th and December 31st a Cash Flow Coverage Ratio of 1.2 to 1. 2. Maintain unencumbered cash and investment balances of not less than six month operating expenses. 3. AAPM will not incur or assume any third party debt greater than $500,000. These are the three items which AAPM must report to the bank on a semi-annual covenant compliance checklist.

Cash Flow Coverage Ratio (CFCR) Also known as the Debt Service Coverage Ratio (DSCR), CFCR is the measure of cash flow available to pay current debt obligations. This covenant requires AAPM to generate a certain level of surplus from operations. It is calculated as follows:

DSCR =

CashFlow

DebtService

where, Cash Flow = [Change in Unrestricted Net Assets + Depreciation + Interest Exp. – Unrealized Gains] Debt Service = [Current Portion of Long Term Debt Payments + Interest Expense]

For the first reporting period June 30, 2015, AAPM achieved a ratio of 77.4 to 1, well exceeding the required 1.2 to 1. This was achieved as a result of the nature of cash flow at AAPM. Most of the revenue generated from Membership Dues and the Annual Meeting is received during the first two quarters of the year. This was a major factor in our ability to surpass the required ratio. Currently, 2015 year-end figures are being compiled as we are preparing for our year-end audit, but it is anticipated that while the gap will close, AAPM should once again achieve this certification requirement.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Treasurer, cont.

Liquidity This covenant requires that AAPM maintain cash and investment balances greater than six months of operating expenses. This ratio is calculated as follows:

(

AnnualOperatingExpenses – Depreciation 365days

)

*180days

For the reporting period June 30, 2015, AAPM was required to have on hand $5,181,484 in cash and investments. Actual cash and investments on hand as of June 30, 2015 were $17,638,402. Once again, AAPM far exceeded the targeted performance during the mid-year compliance reporting.

Third Party Loans This ratio is fairly simple: AAPM cannot assume any third party debt in excess of $500,000. For the reporting period June 30, 2015, AAPM had a total of $15,268 of third-party debt which was a capital lease on a copier. As AAPM’s Treasurer I want our members to be aware of these covenant requirements and to outline our plan should AAPM violate one of the covenants in the future, especially one of the three required during the compliance certificate reporting. First, it is important to understand that in most lending situations the borrower lacks the financial resources to acquire the asset without financing. When AAPM purchased the new Headquarters building, the organization held investments three times greater than the amount borrowed. Leadership elected to finance the purchase instead of spending down AAPM reserves because the organization was able to borrow the money at very favorable interest rates. AAPM financed the building purchase with a portion financed at a fixed interest rate and a portion variable. The fixed interest rate is 2.425% and the variable (at the time of borrowing) was 1.173%. Since 2001, AAPM has achieved a return on investments in excess of 5%. Therefore, it was a sound business decision to utilize a third party’s cash to acquire the building. However, the concern remains as to what remedies the bank would take if AAPM were to violate one of the covenants, especially the certificate reporting requirements. From the bank’s perspective, as AAPM has liquidity levels exceeding three times the required levels, the risk of AAPM being unable to repay the loan is very low. Therefore, a covenant violation in the words of the lending officer “isn’t a big deal.” As a result of the low risk that AAPM represents to the bank, if a covenant violation were to occur, the bank would meet with executive management to understand the cause of the violation and likely issue a waiver. In other words, managing the process is about the relationship between AAPM and TD Bank and our Executive Director and Controller manage that relationship to ensure effective communication regarding operations. If any potential violations were to occur, management would communicate this information early in the process to prevent surprises to the lender. [I would like to thank Robert A. McKoy, AAPM Controller for his subject matter contributing to this column.] n

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he theme for 2016 and the AAPM Annual Meeting is “Communicating our Value. Improving our Future.” I have observed over recent years that the importance of the Medical Physicist to both the imaging and treatment processes has lessened in many institutions. We are losing/have lost our place as key players on the diagnosis and treatment teams, often relegated to the role of technicians in the eyes of our colleagues and administrators. This is true in academic/research arenas as well, where grant opportunities for improvements in technology and process, areas in which we are major players, have been on the decline. We need to reverse these trends in order to survive and thrive. AAPM can help medical physicists achieve better recognition by providing tools and guidance in promoting our value to our institutions and colleagues. Medical Physics 3.0, the Medical Physics Leadership Academy and the 2016 Summer School on Leadership are all venues that have this goal (among others). Our Annual Meeting provides opportunities for sharing/improving your scientific knowledge, clinical skills, and professional leadership. Involvement in AAPM committees and task groups enables you to help shape our future, clinically, scientifically, and professionally. These opportunities, however, are only of value if you take advantage of them and work to incorporate them into your research, clinical practice, or interactions with your colleagues. I echo John Boone’s words from 2015; “I invite you — indeed I challenge you — to take advantage of the outstanding opportunities offered at this summer’s meeting to reinvigorate your professional, [clinical, and scientific] excellence.” —Bruce H. Curran, AAPM President

NEW AND EXCITING FEATURES THIS YEAR…. • PRESIDENTIAL DEBATE (Monday, August 1, 4:30 – 6:00 pm)

In the spirit of the meeting being held in Washington, DC during an election year, the AAPM will host its own Presidential Debate! Since AAPM is currently not close to an election, we will bring back a panel of past presidents to have a lively debate about issues facing the administrative, professional, educational, and scientific aspects of physics in medicine. Make sure to come and cast your vote! • Special 2-Day Program on Radiomics (Monday, August 1 –

Tuesday, August 2) • Distinguished Lectureships:

 Carson-Zagzebski Distinguished Lectureship — In the spirit of education and science, this year’s session will feature an overview of new and innovative noninvasive use of ultrasound in the treatment of disease presented by Kullervo Hynynen, PhD.  The Anne and Donald Herbert Distinguished Lectureship in Modern Statistical Modeling — his session will feature an overview of statistical modeling techniques used for analyzing the many types of research data and an exploration of recent advances in new statistical modeling methodologies.

• TG100 Certificate of Completion Course: Application of Risk

Analysis Methods to Radiotherapy Quality Management — See below for further details. • Joint scientific symposium with the World Molecular Imaging

Society — Metabolic Imaging of Cancer • Joint scientific symposium with ESTRO — Advances in

Experimental Medical Physics • NEW Exhibit Hall Guided Tour: Join a guided tour of vendors

offering either microdosimeters for therapy applications or dosimeters for diagnostic imaging quality control. Tours will be led by AAPM members and will include a short introduction. SAMS credit will be offered. Pre-registration required.

AAPM 2016 DATES TO REMEMBER • BY MAY 10: Annual Meeting Program available

online. • JUNE 22: Deadline to receive discounted registration

fees.

All sessions and technical exhibits will take place in the Walter E. Washington Convention Center, 801 Mt Vernon Pl NW, Washington, DC. The education program and professional program will offer a significant opportunity to gain practical knowledge on emerging technical and professional issues. This year, the scientific program will also offer a special twoday track on Radiomics.

TG100 Certificate of Completion Course: Application of Risk Analysis Methods to Radiotherapy Quality Management The course will consist of an all-day program on Wednesday followed by a workshop on Thursday, which provides further hands-on experience with tools of risk analysis and safety improvement. The course will run in Ballroom C concurrently with other AAPM program content. Upon fulfilling the requirements, participants will receive a certificate of completion. This mini-track, open to all registrants, will focus on describing a structured methodology of TG100 for analyzing clinical processes and for developing clinic - and site - specific quality management programs that more effectively and efficiently address work practices in individual clinics. The mini-track will consist of 6 sessions (including educational and scientific sessions, and proffered papers) which provide basic education as well as a survey of emerging and advanced concepts. The topics will be of interest to those working in diagnostic radiology as well as therapy physics.

The mini-track will also serve as the certificate course at this year’s meeting, which provides an in-depth review of a particular topic with verification of learning objectives through online homework. Attendees may enroll in the certificate program for an additional fee. Enrollment in the program entitles participants 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 online 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 online examination (available after the meeting) will receive a framed certificate of completion for this course.

SCIENTIFIC PROGRAM Therapy Track

Imaging Track

Symposia • The Joint AAPM-ESTRO Symposium: Advances in Experimental Medical Physics • Radiation and Immunotherapy: How to Ignite Long Term Anti-Cancer Response • Radiation Countermeasures Research and Development • Session in Memory of Robert J. Shalek: High Resolution Dosimetry from 2D to 3D to Real-time 3D • Motion Management in Proton Therapy • Connecting Radiation Physics with Computational Biology • The Challenges of Predicting RBE Effects in Particle Therapy and Opportunities for Improving Cancer Therapy • Research Opportunities with Digital Linear Accelerators

Symposia • Radiation and Cancer: Reality, Extrapolations, Myths & Practice • Model Observer Design and its Validation for Task-based Evaluation of Digital Breast Tomosynthesis • Quantitative Assessment of CT Systems with Iterative Image Reconstruction Algorithms • Joint Imaging-Radiomics Symposium: Low-dose CT Grand Challenge • Advances in Image-guided Neurointerventions — Clinical Pull and Technology Push • Advances in Dedicated Breast CT • Advances in Preclinical Imaging

www.aapm.org/meetings/2016AM

SCIENTIFIC PROGRAM (CONTINUED) Joint Imaging/Therapy Track

Radiomics (Special 2-Day Program)

Symposia • Session in Memory of Jean Pouliot: Next-Generation Deformable Image Registration • HHigh Impact Technologies for Low Resource Environments • CT Ventilation Imaging: The New Clinical Reality of Functional Avoidance and Response Assessment in Lung Cancer Radiation Therapy • Image-Guided Interventions: Advances in Intraoperative Imaging, Guidance, and an Emerging Role for Medical Physics in Surgery • Dual Energy CT in Radiation Therapy • The EPID Strikes Back • Advances and Innovations in Image Guided Brachytherapy • RIP ITV • The Joint WMIS-AAPM Symposium: Metabolic Imaging of Cancer

Symposia • Radiomics: Segmentation & Feature Extraction Techniques (Educational Course) • Harmonization & Robustness in Radiomics (Educational Course) • State-of-the-Art in Radiomics in Radiology and Radiation Oncology • Imaging Genomics Associations and Biological correlates of Radiomics (Educational Course) • Challenges in Radiomics and Big Data (Educational Course) • Moving Radiomics Forward: Funding, Regulatory Issues, and Clinical Translation

EDUCATIONAL PROGRAM Therapy Track • • • • • • • • • • • • • • • • • • • • • • • • • •

SBRT Workflow Overview Panel Discussion: SBRT/SRS Case Studies — Lung Panel Discussion: SBRT/SRS Case Studies — Liver Panel Discussion: SBRT/SRS Case Studies — Brain and Spine SRS Efficiency: Multi-Met & New Methods Image Guidance Technologies and Management Strategies TG180: Imaging Dose During RT In Memoriam of Jan van de Geijn: Knowledge-based Planning Basics of Proton Therapy Educational Point Counter/Point: Has Photon RT Hit the Limits? Opportunities for Big Data in Radiation Oncology How to Identify and Resolve Potential Clinical Errors Before They Impact Patients Treatment: Less Learned MRgRT Online Adaptive Radiotherapy — Considerations for Practical Clinical Implementation AAPM-AMPR-SEFM Joint Course on Challenges and Advantages of Small Field Radiation Treatment Techniques Prostate HDR Treatment Planning — Considering Different Imaging Modalities Three Dimensional Dosimetry Key Dosimetry Data — Impact of New ICRU Recommendations New Task Groups for External Beam QA: An Overview TG167 — Clinical Recommendations for Innovative Brachytherapy Devices and Applicators TG-191: Clinical Use of Luminescent Dosimeters Implanted Markers for Radiation Therapy and TG 199 Update Statistical Failings That Keep Us All In The Dark Anne and Donald Herbert Distinguished Lectureship on Modern Statistical Modeling MRI for Radiation Therapy PET for Radiation Therapy

Imaging Track • Nuclear Medicine Physics and Testing • DBT Physics Basic to Advanced • Recent Advances in Virtual Tools for Validation of 3D/4D • • • • • • • • • • •

Breast Imaging Systems (TG234) CT Systems Course Body Tomosynthesis Imaging Informatics Diagnostic QA/QC Hands-on Workshop MRI Physics Carson/Zagzebski Distinguished Lectureship: Image Guided Ultrasound Therapy Challenges and Opportunities for Nuclear Medicine Theranostics Shear-wave Imaging and a QIBA US Biomarker Update Pediatric Image Quality Optimization Radiation Dose Monitoring and Protocol Management Pitfalls: Reliability and Performance of Diagnostic X-Ray Sources

Practical Medical Physics • Overcoming the Challenges of Motion Management in

Current Lung SBRT Practice • Practical Implementation of Deep Inspiration Breath Hold • • • • • • • • •

Techniques for Breast Radiation Therapy Planning and Delivering HDR Savi APBI Treatments Treatment Planning System Commissioning and QA Practical Statistics for Medical Physicists Open Source Hardware in Medical Physics and its Potential to Accelerate Innovation An Introduction to Research and Clinical Development Using Treatment Planning System APIs A Cliff’s Notes Version of Proton Therapy Optimizing the Treatment Planning Process A Practical Guide to Radiation Safety Surveys Identifying Image Artifacts, Their Causes, and How to Fix Them

PROFESSIONAL PROGRAM Therapy Track Symposia • New Member Symposium • Medical Physics Leadership Academy • International Symposium: Patient Dose Reduction in Diagnostic Radiology • Opportunities for Medical Physicists In Developing Countries • Diversity and Inclusion in Medical Physics • Ethics Symposium: Do the Right Thing • The Gadget: Making of the Atomic Bomb • Compliance with the AAPM CT Clinical Practice and Joint Commission Guidelines • Work of ICRP, NCRP and Others and How They Impact on Medical Physicists • CDRH/FDA Regulatory Processes and Device Science Activities • Certificate Extension Process for DBT and the Medical Physicist’s Role [DBT #1] • MERCER Liability & Insurance • Interoperability in Radiation Oncology: IHE-RO Committee Update • The Pursuit of Radiation Oncology Performance Excellence

• Session in Memory of Franca Kuchnir: Excellence in Medical

Physics Residency Education • Teaching Radiology Residents: What, How, and Expectation • Writing Good Multiple Choice Questions • Fostering a Successful Career in Research • Post-graduate Training of the Next Generation of Academic

Medical Physicists • To Which Journal Shall I Submit My Manuscript • Medical Physics Workshop • Financial Perspectives on Scientific Publishing • Preparing for the ABR Diagnostic and Nuclear Medical

Physics Exams • Preparing for Parts 2 and 3 of the ABR Therapy Medical

Physics Exam • The American Board of Radiology Maintenance of

Certification Process • 4-hour HAZMAT Training for the Medical Physicist. Required

training for individuals performing hazmat duties. Instructor: Roy Parker, PhD, Radiation Physics Consultant to FedEx Express. Pre-registration required.

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: Digital Breast Tomosynthesis. The three PinS sessions

will cover the manufacturer- and model-specific features and requirements of the DBT systems currently approved by FDA. Together with other sessions offered during the Annual Meeting program, these will allow attendees to meet the FDA initial training requirements for DBT (8 hours of training including manufacturer-specific features of each approved system).

• Therapy: MR Simulation. MRI techniques are becoming

increasingly used in treatment planning, image-guided radiation therapy, and treatment evaluation, and it is important that medical physicists understand the underlying processes of the systems they are using. Presentations from three manufacturers will feature details of their fast MR imaging techniques, functional MR imaging techniques, and MRI distortion correction and quality assurance techniques, including their pros and cons. An increased awareness of how MRI simulation tools work will allow attendees to better understand and apply their results.

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Online Medical Radiation Safety Officer TG-100 Workshops & Training Medical Internal Radiation Dosimetry traininginfo@dmhg.net

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Offering Medical Physics and Radiation Safety Consulting Services

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

PROFESSIONAL COUNCIL REPORT Dan Pavord, Poughkeepsie, NY

am writing this article as I take the train home from our Professional Council retreat that was held at AAPM’s HQ in Alexandria April 9-10. The new HQ facility is well designed to host these meetings and our retreat was ably facilitated by the excellent HQ staff. The new facility is a great reminder of our success as an organization and a tangible symbol of our need to continue to meet the needs of our members. The retreat was a great time to recalibrate our priorities and to map out action plans to achieve them. Many priorities were discussed but several were clearly of a higher importance. First among them is a need to ensure that the stewardship of the profession is well-managed. The leadership of AAPM has a fiduciary imperative to SUGGESTION protect the profession of medical physics and to ensure that our value to the healthcare enterprise is recognized. To that end, the value proposition of medical physics will be the focus of the Professional Council Symposium at this year’s Annual Meeting. The idea of stewardship will also be the topic of a future Newsletter article.

BOX

The impact of medical physicist assistants (MPAs) was also discussed in great detail. This is the topic of a Medical Physics Practice Guideline that should be out for member comment by the time you read this. AAPM’s relationship to MPAs is a controversial subject. Please take the time to read the draft MPPG and provide thoughtful feedback. AAPM Professional Policy 17 on the Scope of Practice of Medical Physicists is due to sunset on December 31, 2016 and is currently under review by the Clinical Practice Committee. This is directly related to the idea of MPAs and will be reviewed with careful attention to ensuring that Medical Physics activities are provided by qualified individuals. AAPM PP 1 on the definition of a Qualified Medical Physicist is also due for review. These two policies are the key to protecting the profession and ensuring that patient care has the highest quality and safety. It is an expressed goal of AAPM to have these policies referenced by regulatory and accrediting organizations. Professional Council has made it a strategic goal to work to make this happen. There has been a lot of discussion recently regarding the 2014 ABR initiative and the resulting changes to our education and training pipeline. There were definitely some bumps in the road but overall the changes have successfully protected Medical Physics as a profession. There will definitely need to be some adjustments to the process but being able to clearly define the most basic educational requirements for entry into Medical Physics is a key element in the definition of the profession and is what differentiates Medical Physics as a profession as opposed to a trade. Professional Council will continue to work to ensure that the process is working and to work on improvements. As I mentioned in the last issue, the healthcare environment is rapidly changing. This is particularly true for healthcare economics. Professional Council will devote considerable time and resources to understanding how these changes affect Medical Physics and how we can ensure the continued recognition of the profession in the reimbursement stream. If you feel there are other priorities that we should address, please let me know. We are always happy to receive input. I would also like to thank the dedicated members of Professional Council who devote many hours to the protection and improvement of the profession of Medical Physics. n

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2016-04-07 20:52

TG100, Application of Risk Analysis Methods to Radiotherapy Quality Management

uring the Annual Meeting AAPM offers a daylong Certificate Course on a topic of current interest. The topic this year will be patient safety and quality improvement. With the release of AAPM Task Group 100, this topic becomes increasingly important and relevant to the practicing medical physicist and trainee. Upon fulfilling the requirements of the course, participants will receive a formal certificate of completion as recognition of their mastery of the material. The course runs all day Wednesday and consists of 6 sessions, including educational and scientific sessions, and proffered papers. These sessions which provide basic education as well as a survey of emerging and advanced concepts. Participants

must enroll in advance. In addition to the Wednesday course there is an optional workshop component on Thursday which provides 3-hours of hands-on experience with risk analysis methods.

A highlight of this course is the special guest keynote speaker, Leilani Schweitzer, sharing her story of medical error and the lessons that have emerged from it. Registration for the Certificate Course is now open as part of the Annual Meeting registration. We hope to see you there!

Eric Ford, PhD and Jatinder Palta, PhD Course Organizers

Special Guest Keynote Speaker: Leilani Schweitzer Learning From Medical Errors: A Partnership for Progress Open to all attendees of AAPM 2016 Wednesday, August 3 | 1:45-2:45 PM | Ballroom C Leilani Schweitzer understands medical error as few others do: through the death of her child. Faced with this profound loss, she has made a choice. Instead of pursing action through the courts she has begun working together with the healthcare community to ask why mistakes happen and what can be done to respond to them in a meaningful way. In this keynote address, Leilani will share her story and the lessons that have emerged. She will highlight the importance of investigating and understanding errors and the advances that she has made in partnership with the healthcare community. Her experience is a powerful reminder of the accidents that no one wants to happen and what can be done to stop them.

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ADMINISTRATIVE COUNCIL REPORT Jatinder Palta, Richmond, VA

t is an honor, a privilege, and a pleasure for me to give my first report to you as Administrative Council (AC) Chair. First of all, I would like to express my most sincere appreciation for Melissa Martin who served as the founding Chair of this Council. Melissa has moved on to bigger and better things within AAPM but I take solace in knowing that she is around to ensure that I do not falter. I have come to quickly realize that AC is the glue that keeps everything together within AAPM. It has a potpourri of committees with the following purposes and value: •

Serve as a conduit for communicating administrative information to the Board.

•

Oversee the main mechanisms for communication with members.

•

Develop and maintain a vehicle for long-range financial planning by projecting revenue streams and by considering options to grow revenue for the association.

•

Maintain and grow the society’s investment portfolio.

•

Provide binding operational controls considered necessary as a supplement to or as an amplification of the AAPM ByLaws and Rules.

•

Identify distinguished members for awards and honors.

•

Provide general oversight over the information technology activities and infrastructure of the association.

•

Advise on legislative and regulatory issues that affect medical physicists or the practice of medical physics.

•

Ensure that the history of medical physics and that of the association is preserved and disseminated.

•

Coordinate global medical physics activities with other international medical physics organizations.

•

Coordinate the scientific, educational, and technical exhibits at the association’s meetings

•

Review and make determination on all applications for association membership.

•

Foster communication among regional chapters and between the chapters and the Board of Directors.

SUGGESTION BOX

The Council committees continue to do an outstanding job of accomplishing their goals and visions. However, we will in addition be focusing on a few new priority items that I would like to share with you. 1. Develop an innovative corporate partnership program to strengthen corporate outreach and increase engagement between the industry and medical physicists. The caveat is that AAPM relies heavily on the revenue streams from corporate sponsors, especially the exhibits program and journal advertising. These programs have grown in scope and number in a very piece-meal fashion with little attention given to organization, efficiencies, and how the corporate sponsors would prefer to do business with AAPM. We plan to have an open dialogue with a core group of corporate partners comprised of senior-level executives who are representative of large and small companies and various disciplines and modalities to work with the AAPM leaders and staff to strengthen corporate relations.

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AAPM Newsletter â&#x20AC;˘ Volume 41 No. 3 MAY | JUNE 2016

Administrative Council, cont.

2. The AAPM TG100 report on the application of risk analysis methods to radiotherapy quality management will be published by this summer. The AC has been charged to develop a comprehensive plan for broader dissemination of information on structured methodology of TG100 for analyzing clinical processes and for developing clinic- and site-specific quality management programs that more effectively and efficiently address work practices in individual clinics. It is anticipated that in the future, process mapping, failure modes and effects analysis, and fault tree analysis will assume more central roles in work flow design as we strive for greater safety and enhanced quality through the optimization of clinical processes. A Working Group under the direction of Peter Dunscombe and Saiful Huq will develop strategies for promoting and implementing TG 100 methodology in a multidisciplinary radiotherapy environment. 3. AAPM is the largest and most effective professional organization for medical physicists in the world. I would like to see us play a much broader role in combating the global health issues relating to cancer diagnosis and treatment. We will explore opportunities to work with organizations such as International Atomic Energy Agency, the World Health Organization, and the Union for International Cancer Control to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the world health and development agenda. I would like to invite you to share your questions or thoughts on any task under the purview of the AC Council. Please email me or the chair of the relevant AC committee. I would also like to take this opportunity to express my most sincere appreciation to the members of our committees and subcommittees for their continued commitment to the AAPM vision and mission. You will be hearing from them in future editions of the Newsletter. n

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ABR NEWS Geoffrey Ibbott, ABR Board of Governors and Jerry Allison, J. Anthony Seibert and Michael Herman, ABR Trustees

The Self Directed Educational Project Medical physicists often face the challenge of learning a new skill for clinical practice, teaching, or administration. The self-directed educational project (SDEP) is a tool developed by the American Board of Radiology to make that task more organized and productive. SDEPs are opportunities available only to ABR-certified medical physicists and are approved by the American Board of Medical Specialties (ABMS) for Maintenance of Certification (MOC) credit. An SDEP helps the physicist organize the assimilation of new knowledge so the process is more efficient, thorough, and useful. SDEPs are not required but may be counted for either Continuing Education (CE) or Self-Assessment-CE credit. A maximum of one SDEP may be recorded yearly. Fifteen CE credits are given for each completed SDEP. SDEPs can be used to improve one’s knowledge in a wide variety of areas. Some examples of SDEPs include the following: •

Quality improvement

•

Research projects that have a self-educational component

•

Publication of original research that has a self-educational component

•

New lecture development

•

Regulatory issue review

•

Educational topics

•

Technology updates

•

New protocol implementation

These are just a few examples; almost any topic relevant to education in an individual’s area of practice is acceptable. To be efficient, an SDEP must be formulated before an individual begins the project.

How is an SDEP structured? The elements of an SDEP are as follows: •

Significance: a statement of the educational need

•

Approach: a list of activities designated to address the need

•

Evaluation of achievement, with an initial prospective statement and a summary statement at the time of completion

•

Impact on practice/outcome statement, with an initial prospective statement and a summary statement at the time of completion

To begin an SDEP, one needs to consider what knowledge is needed and why one needs it. The “why” is important because by considering “why,” one may modify the structure of the necessary information.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ABR, cont.

Significance: We are installing our first PET-CT scanner, and I need to improve my knowledge of PET shielding and the testing of PET shielding so I can efficiently and effectively design and test the shielding.

Once an individual decides on the required elements of the SDEP, he or she should make a list of the resources proposed for use. These can include: •

AAPM reports

•

Virtual Library presentations

•

Journal articles

•

Discussion with other physicists

•

Online materials

Individuals may worry excessively about details because they fear that an ABR audit will be hypercritical. That is not the case as the ABR assumes that someone conducting an SDEP does so in good faith. Approach: Initially, I will use the following resources. Others will be added as necessary. • AAPM Report 108 • PET/CT Facility Design – ACMP 2010 • AAPM 2007 Summer School resources • Discussions with XX, YY, and ZZ • Internet search for PET/CT shielding resources • AAPM Virtual Library resources

Following the design of the educational project, an individual works with the resources to acquire the appropriate knowledge and then puts it into practice. When the individual is satisfied that he or she has completed the project, there are two final steps. The first is an evaluation of the achievement, which has two distinct parts. Part 1 is a prospective written as part of the initiation of the SDEP, and Part 2 is a retrospective evaluation of the project as it was done. Evaluation of the Project Prospective — I will evaluate the project by determining that the radiation exposures in the facility meet both my expectations and regulatory requirements. Retrospective — I designed the facility using the techniques I learned from my resources. I paid particular attention to areas that would be exposed from multiple parts of the facility. After the shielding was in place, I measured the exposure rates in all the appropriate areas and determined that they were below my design values and the regulatory limits.

The last element in the SDEP is the impact on practice/outcome, which also has prospective and retrospective parts. This section is the most confusing to many individuals who are contemplating an SDEP. The key concept is to consider how the project is important to the medical physics practice where it is conducted. Many times, this is very simple. For example, if a shielding design is not done correctly, the practice has a major problem. Other impacts are a bit more

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ABR, cont.

subtle. If the goal of an SDEP is to improve an individual’s teaching skills, it may be more difficult to determine the benefit. Again, the ABR will not evaluate the details and will accept that the SDEP was done with honest intentions. Impact on Practice Prospective — I expect that this project will allow me to design the shielding more effectively, which will save time. Well-designed shielding can also save money, especially for PET scanners, and will make testing more efficient. Retrospective — I learned a number of important points from the educational materials that made the design easier and improved the overall shielding. The testing went quickly. The good design and testing kept the project on schedule and probably saved money.

SDEPs and MOC Part4 An important component of the ABR MOC process is Practice Quality Improvement (PQI). In 2015, the ABR made a major change to Part 4–PQI by adding the category of Participatory Quality Improvement Activities to satisfy Part 4 requirements. It is important for physicists to be aware that SDEPs relating to quality and safety can be counted as Part 4 projects and thus meet the physicist’s requirement for a triennial PQI project. Thus, an SDEP related to quality and safety can be counted as contributing to both Part 2 and Part 4.

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Final Thoughts The ABR medical physics trustees believe that SDEPs are underused in the medical physics community. SDEPs can make the incorporation of new knowledge into a medical physicist’s practice more efficient, serve as a source of self-directed educational credits, and, if quality and safety related, they can meet a medical physicist’s MOC Part 4–PQI requirements. n

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NEW!

Introduction to Academic Radiology for Scientists [ITARSc] ®

The Radiological Society of North America (RSNA ) is expanding the Introduction to Academic Radiology (ITAR) program to include PhD postdoctoral fellows in the Imaging Sciences or Biomedical Engineering.

Eligibility: Postdoctoral fellows in the Imaging Sciences or Biomedical Engineering, no more than six years since award of their doctorate, are invited to apply for this unique opportunity to participate in a dynamic program held during the RSNA Annual Meeting in Chicago. NOVEMBER 27-DECEMBER 1, 2016.

Program objectives: Introduce participants to the scope of research in the imaging sciences • Highlight the important role of PhDs in the imaging sciences • Identify keys to success for PhD scientists in imaging research • Introduce participants to successful radiological researchers that may serve as future mentors •

The program will consist of a combination of dedicated programming for ITARSc participants, and shared sessions with participants of the ITAR program.

ITARSc Topics include: Faculty tracks for imaging scientists • Building and organizing a laboratory • Commercial partnerships, intellectual property, and technology transfer • Importance and development of clinical collaborations •

Selected participants will receive a $1000 stipend to offset travel and hotel costs as well as free registration for the RSNA Annual Meeting. Application forms will be available by March 1, 2016 at www.rsna.org/ITARSc APPLICATION DEADLINE: JULY 1, 2016

Questions: Please contact Dept. of Research Staff at dor@rsna.org

REF177

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ACR ACCREDITATION: FAQS FOR MEDICAL PHYSICISTS Priscilla F. Butler, MS, Senior Director and Medical Physicist ACR Quality and Safety

oes your facility need help with 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 (click “Accreditation”) for more FAQs, accreditation applications, and QC forms. The following questions are for the new ACR Digital Mammography Quality Control Manual. Please feel free to contact us if you have questions about radiation oncology accreditation. Q. When was the ACR Digital Mammography Quality Control Manual approved by the FDA? A. The Food and Drug Administration (FDA) approved the American College of Radiology’s (ACR) alternative standard request to allow mammography facilities to use the ACR’s new Digital Mammography Quality Control (QC) Manual and Digital Mammography QC Phantom in routine QC of digital equipment. The FDA requires digital mammography facilities to perform QC for approved imaging systems, according to their respective manufacturers’ quality control manuals. Approval of this alternative standard will enable mammography QC technologists and medical physicists to use the new ACR manual in lieu of manufacturers’ quality control manuals when it becomes available. The FDA alternative standard specifies that the new manual may be used only for full-field digital mammography systems without advanced imaging capabilities (e.g., tomosynthesis and contrast enhancement).

Q. When will the new ACR Digital Mammography QC Manual be available? A. The manual will be available in late spring of 2016. Q. How will the new ACR Digital Mammography QC Manual be distributed? A. The manual will be provided, at no charge, to all ACR-accredited mammography facilities (and to those applying for accreditation) in a PDF format. Medical physicists associated with ACR-accredited facilities will also be allowed to download the manual at no charge. All others may purchase the manual PDF from the ACR catalog. Hard copies will not be available. Q. May I obtain a pre-publication version of the manual to review? A. No. Unfortunately, we cannot release non-finalized versions to anyone prior to publication. Q. Does the new ACR Digital Mammography QC Manual contain QC instructions for tomosynthesis or contrastenhanced imaging? A. No, the new manual only includes QC instructions for 2D digital mammography. Q. Our facility has a digital mammography unit that only performs 2D imaging. Will we be allowed to use the new ACR Digital Mammography QC Manual instead of our manufacturer’s QC manual for QC on this unit? A. Yes.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ACR Accreditation, cont.

Q. Our facility has a mammography unit that performs 2D imaging using computed radiography (CR). Will we be allowed to use the new ACR Digital Mammography QC Manual instead of our CR manufacturer’s QC manual for QC on this unit? A. Yes. Q. Our facility has a digital mammography unit that performs both 2D imaging and tomosynthesis. Will we be allowed to use the new ACR Digital Mammography QC Manual instead of our manufacturer’s manual for QC of the 2D applications of our digital mammography unit and then follow our manufacturer’s QC manual for tomosynthesis? A. No. Since the manufacturer’s QC of tomosynthesis is typically built on their 2D digital mammography QC, in order to ensure that no gaps in testing occur, facilities with these systems must follow all of the manufacturer’s quality control procedures for both 2D and tomosynthesis imaging. Q. Our facility has a digital mammography unit that performs both 2D imaging and contrast enhancement (imaging of an iodinated contrast agent using mammography equipment). Will we be allowed to use the new ACR Digital Mammography QC Manual instead of our manufacturer’s manual for QC of the 2D applications of our digital mammography unit and then follow our manufacturer’s QC manual for contrast enhancement? A. No. Since the manufacturer’s QC of contrast enhancement is typically built on their 2D digital mammography QC, in order to ensure that no gaps in testing occur, facilities with these systems must follow all of the manufacturer’s quality control procedures for both 2D and contrast enhancement imaging. n

Our Condolences Donald E. Herbert, PhD — Mobile, AL Robert W. Luthmann, PhD — Mechanicsburg, PA Adrian U. Markus, MS — Inverness, FL Carmen F. Mesina, MS — Philadelphia, PA Mary Jean Scott, PhD —Waverley, South Africa Donald F. Simon, MS — Fort Lee, NJ Robert J. Slayton, MS — Parrish, FL David A. Weber, PhD —Victor, NY

Ann E. Wright, PhD — Spring, TX Laurence P. Clarke, PhD — Bethesda, MD William B. Harms, BS — Saint Charles, MO Lech S. Papiez, PhD — Mooresville, IN Donald F. Simon, MS —Fort Lee, NJ Robert J. Slayton, MS — Parrish, FL Thomas G. Stinchcomb, PhD — Chicago, IL Alexander P. Turner, PhD — Breckenridge, CO

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: 2016.aapm@aapm.org Please include supporting information so that we can take appropriate steps.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

ADVANCES IN NANOPARTICLE IMAGING AND RADIOTHERAPY Highlights From Today’s Cutting Edge Medical Physics Research

The Importance of Correct Coding and an Up-To-Date Charge Master The next big thing in radiation physics may actually be quite small. Within the next decade, the use of nanoparticles (NPs) could lead to substantial improvements in both clinical imaging and radiation therapy. “Nanoparticles have the potential to improve not only tumor localization and radiation treatment planning, but also radiation therapy,” notes Wilfred Ngwa, PhD (Department of Radiation Oncology, Brigham and Women’s Hospital, DanaFarber Cancer Institute, Harvard Medical School).

Research Spotlight

Recent technological advances and research have led to enormous promise in the use of NPs in the areas of: •

Imaging — serving as contrast, localization, and targeting agents

•

Radiation Therapy — functioning as radiosensitizers, therapeutic targeting agents, tumor vascular-disrupting agents, and in situ dose-painters

Role of Nanoparticles in Radiation Physics Nanomedicine is the medically-related study and manipulation of NPs, structures that measure in the range of 1-100 nm. Biological NPs can be prepared from a variety of materials, the choice of which is guided by several factors including: (1) size and morphology; (2) surface charge and permeability; (3) degree of biodegradability, biocompatibility, and cytotoxicity; and (4) loading and release profiles.1 In radiation physics, most of the research has focused on heavy metal NPs. Dr. Ngwa explains that the interdisciplinary area of research involving heavy metal NPs and radiation physics is relatively new, and he notes that the field really took off after the pioneering in vivo work on gold nanoparticle-aided radiotherapy in mouse tumors published by Hainfeld and associates in 2004.2 Historically, gold nanoparticles (GNPs) have been favored over other heavy metal NPs for radiation-related use because of their biocompatibility, high x-ray attenuation, ease of synthesis, facile surface functionalization, and limited toxicity.3 Early observations about these theoretical benefits of GNPs, notes Ngwa, have subsequently been supported by extensive experimental in vitro and in vivo validation, establishing the potential clinical efficacy of GNPs as both contrast agents and tumor radiosensitizers.

Evolution of Nanoimaging – Improving on Current Techniques Traditional iodine-based contrast for medical imaging has been limited by the risk of renal toxicity, restricted imaging time, and suboptimal resolution in larger patients. It appears that GNPs may be superior contrast agents. Researchers have found that injectable GNP solutions have lower viscosity, higher absorption coefficients, lower bone-tissue interference, longer serum and tissue half-lives, and improved resolution even at low doses, when compared to standard contrast agents.4 Furthermore, GNPs are capable of actually being directed to the site of interest, including to blood pools, tumors, and microcalcifications. Investigators have shown that this can be accomplished using strategic control of GNP structural

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Research Spotlight, cont.

characteristics (such as their size, shape, composition, mass concentration, and surface functionalization).3 For example, the conjugation of antibodies, peptides, or other ligands onto GNP surfaces has allowed the active targeting of contrast agents, resulting in their selective accumulation in specific cells or tissues. Similarly, molecularly-targeted GNPs may be combined with CT imaging, endowing it with functional- and molecular-based capabilities that previously only existed with MRI and PET scanning.5

Nanoparticles in Radiotherapy — Refining the Therapeutic Ratio The potential benefits of NPs may, however, be greatest in the therapeutic realm. Targeted radiotherapy with GNPs (so-called GNRT) is being actively investigated in preclinical studies as a means to further increase the therapeutic ratio of radiotherapy, creating greater efficacy, fewer side effects, and reduced time under treatment. Indeed, substantial progress has been made with the use of GNPs both in active targeting and as radiosensitizers.6 “There is now significant evidence supporting the use of GNPs for radiosensitization,” explains Ngwa. He goes on to describe how the process of NP radiosensitization works. First, tumor subvolumes are targeted with GNPs, using the enhanced permeability and retention (EPR) effect. This effect refers to the propensity of macromolecules or NPs to preferentially accumulate at sites of increased vascular permeability, common in solid tumors. Next, these GNPs are directly targeted with energy during radiotherapy. The prevailing hypothesis, he explains, is that the high atomic number (Z) of GNPs endows them with the ability to readily interact with kilovoltlevel radiation photons (better than with megavolt energy). This combination of photon energy and NPs results in substantial radiotherapy amplification due to the emission of additional photoelectrons (through a process known as the photoelectric effect) as well as Auger electrons (via the Auger effect).6

Figure. Three of the emerging approaches of gold nanoparticle-aided radiotherapy (GNRT).6 (A) Customizable radiotherapy enhancement with GNPs, (B) GNPs as vasculardisrupting agents and (C) radiotherapy application with in situ dose painting with GNPs. AMD: Age-related macular degeneration; GNP: Gold nanoparticle. Figure reproduced with permission from Nanomedicine as agreed by Future Medicine Ltd.6

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Investigators have also seized upon the fact that certain surface receptors are overexpressed on cancer cells, and they have used this insight to guide the creation of specific ligands that engage these receptors. These ligands can then be incorporated into injected GNPs, essentially targeting tumor cells, and ultimately resulting in direct GNP uptake into the cancer cells via receptor-

AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Research Spotlight, cont.

mediated endocytosis. In this way, cancer cells can be actively targeted with enhanced radiation, localized to the vicinity of the tumor but sparing the surrounding tissues.6 Using concepts like these, there are several related GNRT models that are currently being pursued in the medical physics research community and that have been outlined by Dr. Ngwa and colleagues in a recent review article (Figure)6: •

GNPs as tumor vascular-disrupting agents (VDAs). Given the unique features of and greater accessibility to tumor endothelium compared with healthy tissue endothelium, GNP active targeting strategies can be adapted during radiotherapy to create preferential accumulation of GNPs near the tumor vasculature, rather than uniformly within the tumor. “Radiotherapy along with VDAs targeting these dysmorphic endothelial cells can cause selective occlusion of the tumor vasculature, virtually strangling the tumor, leading to tumor cell death from ischemia and extensive hemorrhagic necrosis,” Ngwa notes in reference to findings from another publication he has co-authored.7

•

Radiotherapy Application with In situ dose-painting (RAID). Inert image-guided radiotherapy (IGRT) biomaterials, such as brachytherapy spacers and other fiducial markers, can be upgraded by loading them with radiosensitizing drugs which can be released in situ after implantation. This can provide subvolume radiation boosting, or so-called dosepainting, without an increase in normal tissue toxicity. In this scenario, high-risk tumor subvolumes, which can currently be identified by MRI or PET scanning, would be targeted with a high concentration of GNPs around the area where radiation boosting is most needed.

•

Customizable radiation therapy enhancement of wet age-related macular degeneration (AMD): The rationale for this radiotherapy approach to AMD is based on evidence that the rapidly proliferating neovascular endothelial cells that drive its development are relatively more radiosensitive than quiescent or less actively dividing cells. Dr. Ngwa and his colleagues have proposed and demonstrated in a theoretical study a process by which GNPs could be used to significantly enhance kilovolt stereotactic radiosurgery for neovascular AMD.8

Alternative Directions In addition to these areas of research, Dr. Ngwa is optimistic about other efforts, including the application of platinumcoated GNPs to obtain a localized Cisplatin-like effect in tumors9 (which could ultimately lead to an enhanced chemoradiation strategy) and the combination of GNPs with immunotherapy to allow dose-painting (which could eventually translate to the treatment of metastatic cancers). He also notes that some investigators have begun to study the use of NPs with other forms of radiotherapy such as electron beam therapy and proton therapy, while others have been pursuing work with heavy metal NPs other than gold, including platinum, gadolinium, and hafnium, as well as with alternative methods of NP delivery, such as via inhalation.

Nanotechnology at the Cutting Edge of Medical Physics While the use of NPs for imaging and radiotherapy is showing great promise at this stage, Dr. Ngwa notes that a significant body of work remains to be performed before this technology can be fully translated into the clinical arena. However, he expects that it should be possible within the next five years to advance some of these emerging modalities to clinical trials and towards their establishment as more effective imaging and radiotherapy options for patients with cancer and other diseases. Indeed, the accelerated pace of this work certainly signals that nanotechnology will be found at the cutting edge of medical physics research during the next few years. The Research Spotlight highlights projects, people, and emerging science in medical physics. The article is arranged and edited by Dr. Taly Gilat Schmidt on behalf of the AAPM Research Committee.

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Research Spotlight, cont.

References 1. Sundar S, Kundu J, Kundu SC. Topical Review: Biopolymeric nanoparticles. Sci Technol Adv Mater. 2010;11:1-13. 2. Hainfeld JF, Slatkin DN, Smilowitz HM. The use of gold nanoparticles to enhance radiotherapy in mice. Phys Med Biol. 2004;49(18):N309-N315. 3. Cole LE, Ross RD, Tilley JMR, Vargo-Gogola T, Roeder RK. Source Review: Gold nanoparticles as contrast agents in x-ray imaging and computed tomography. Nanomedicine. 2015;10(2):321-341. 4. Sungsook A, Jung SY, Lee SJ. Gold nanoparticle contrast agents in advanced x-ray imaging technologies. Molecules. 2013;18(5):5858-5890. 5. McQuaid HN, Muir MF, Taggart LE, et al. Imaging and radiation effects of gold nanoparticles in tumour cells. Nature Scientific Reports. Published January 20, 2016. Accessed March 25, 2016. 6. Ngwa W, Kumar R, Sridhar S, et al. Targeted radiotherapy with gold nanoparticles: current status and future perspectives. Nanomedicine. 2014;9(7):1063-1082. 7. Ngwa W, Makrigiorgos GM, Berbeco RI. Applying gold nanoparticles as tumor-vascular disrupting agents during brachytherapy: estimation of endothelial dose enhancement. Phys Med Biol. 2010;55(21):6533-6548. 8. Ngwa W, Makrigiorgos GM, Berbeco RI. Gold nanoparticle enhancement of stereotactic radiosurgery for neovascular age-related macular degeneration. Phys Med Biol. 2012;57(20):6371-6380. 9. Dhar S, Daniel WL, Giljohann DA, Mirkin CA, Lippard SJ. Polyvalent oligonucleotide gold nanoparticle conjugates as delivery vehicles for platinum (IV) warheads. J Am Chem Soc. 2009;131(41):14652–14653.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

LEGISLATIVE & REGULATORY AFFAIRS REPORT Richard Martin, Alexandria, VA

Launch of HIPPA Phase 2 Audit Program Heralds Expanded Enforcement

n March 21, 2016, the Department of Health and Human Services’ (DHHS) Office for Civil Rights (“OCR”) announced the launch of Phase 2 of the Health Insurance Portability and Accountability Act (HIPAA) Audit Program. The HIPAA Privacy Rule established standards for disclosing individuals’ protected health information. Phase 2 will assess covered entities’ and business associates’ compliance with HIPAA’s privacy, security and breach notification requirements. This new round of audits follows on a September 2015 report of the DHHS Office of Inspector General (OIG), which was critical of OCR’s oversight of covered entities’ compliance, as well as a number of notable HIPAA settlements in March 2016. In one case, North Memorial Health Care of Minnesota agreed to pay $1.55 million to settle allegations that it failed to make a business associate agreement with a contractor and did not conduct a risk analysis to address security of patient data. In addition, the Feinstein Institute for Medical Research in Manhasset, New York, agreed to pay $3.9 million to settle claims stemming from OCR’s investigation of a breach report over a stolen laptop that contained electronic protected health information of approximately 13,000 patients. Phase 2 will begin with desk audits requiring participants to submit documentation online. After the desk audits have been completed, some participants may be selected for more extensive onsite audits. We anticipate that Phase 2 will result in more enforcement actions and urge medical physicists with access to HIPAAcovered patient records to be mindful of compliance requirements and exercise caution in using protected health information. n

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

IN MEMORIAM Obituary for Donald E. Herbert, Jr., PhD, FAAPM

t is with sadness that we announce the passing on March 4th of long-time member Donald E. Herbert, Jr., recipient of the AAPM Edith H. Quimby Lifetime Achievement Award in 2004. Dr. Herbert was a renowned expert in statistics and biological effects of radiation and chaired several related AAPM Committees and Task Groups. Starting while he was Chair of the Biological Effects Committee and of the Task Group on Quality Assessment and Improvement of Dose Response Models in the mid-1980s, he helped organize, and co-edited the Proceedings of, many of the series of Dose, Time, and Fractionation in Radiation Oncology Conferences held every four years in Madison, Wisconsin. He also served as AAPM Representative to the AIP Statistics Advisory Committee. His understanding of advanced statistical methods led to his being appointed a member of the US National Academy of Sciences/National Research Council Biological Effects of Ionizing Radiation Committee, and he was a co-author of their 1990 BEIR V Report. Prior to this, he had served as an expert consultant on statistics on contract to the US Nuclear Regulatory Commission to evaluate the previous (1980) biological effects report BEIR III, of which he had been highly critical. Dr. Herbert was first introduced to medical physics while he was an assistant professor in the Physics Department of Colorado College in Colorado Springs from 1961-1964. While teaching there he became interested in biophysics and was introduced to Dr. Juan del Regato, Director of the Penrose Cancer Hospital, who offered him the opportunity to teach physics to his residents. He soon realized that it was medical physics, not biophysics, that excited him most, and he decided to seek support to do medical physics research. He was awarded a US National Cancer Institute Special Research Fellowship in 1964 to do research at the Medical College of St. Bartholomew’s Hospital, London University, England with Professor Joseph Rotblat (later to become Professor Sir Joseph Rotblat and to be awarded the Nobel Peace Prize in 1995). Prof. Rotblat soon offered him the opportunity to pursue a PhD under his direction and this was when he developed his lifelong interest in statistics. The research project he had selected involved the application of a new electron spin resonance (esr) spectrometer and multi-channel analyzer at St. Bart’s to study irradiated frozen tissue samples as part of the work being done in the Department at that time to understand the early chemical events that occur subsequent to ionization in biological systems. Knowing that very little research had been done in this field before and that esr spectra of biological specimens were extremely noisy, needing considerable processing, he realized that advanced statistical methods were required in order to determine the significance of his data, so he decided that he would have to become an expert in both esr and statistics. At that time I also was a PhD student in the department and my office was directly opposite his lab. I frequently peeked into his lab to ask how his experiments were going only to discover him behind an enormous pile of textbooks, which he insisted he needed to read and understand before turning on the equipment. Don was always a perfectionist and one of his favorite mottos (he was always ready to provide famous quotations) was that it was most important to “know what you don’t know.” Upon graduation in 1967, he rejoined Dr. del Regato at the Penrose Cancer Hospital as the physicist and statistician (for clinical trials), where he stayed for the next eight years before moving to the Medical College at the University of South Alabama, Mobile, where he practiced for the rest of his career as Professor of Radiology and Head of the Division of Physics and Statistics. It was there that he served as the first Director of the College of Medicine Bio-Statistics Epidemiology Core Unit.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Donald E. Herbert, Jr., PhD, FAAPM, cont.

Dr. Herbert is survived by his two daughters Hillary and Emily, and his son John Geary who, with Don, funded “The Anne and Donald Herbert Distinguished Lectureship in Modern Statistical Modeling” as a lasting memorial to Don’s wife, Anne, of 46 years, who was John’s mother, to be held annually at an AAPM meeting, the first of which will be at the Annual Meeting in Washington, DC, this coming August. This year’s lecture entitled “Some Perspectives and Insights from Modern Statistical Modeling” will be delivered by Andrzej Niemierko, Ph.D. and will be preceded by a brief review of Dr. Herbert’s many contributions to AAPM and to science in general. n — Colin G. Orton, PhD, FAAPM

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

REPORT FROM THE AAPM PRACTICE ACCREDITATION SUBCOMMITTEE Tyler Fisher, Costa Mesa, CA

uring the recent Spring Clinical Meeting in Salt Lake City, we were fortunate enough to have a presentation by Dr. Andrea Browne, a medical physicist in the Standards Interpretation Group at The Joint Commission. Her talk focused on the new Diagnostic Imaging Standards and best practices to satisfy them. She also included some information on the first six months of findings, or scores, from Joint Commission inspections. Below are some key takeaways from her presentation: •

The Code for each Element of Performance begins with either an “A” or a “C”. An “A” represents an ‘All or Nothing’ evaluation, where the facility strictly does or does not meet the Element of Performance, whereas a “C” represents an Element of Performance which could have multiple findings without the evaluation resulting in a score. The number and severity of these findings required for a score is decided by the inspector.

•

The Joint Commission survey process utilizes a tracer methodology. This process follows individual patients throughout their stay in an organization. If none of the tracer patients have imaging exams, it would be unlikely for The Joint Commission inspectors to visit radiology. In nearly all cases, Joint Commission inspectors are nurses who have limited knowledge of the details of a radiology department. They are trained to review the facility’s policies and judge compliance with the corresponding Element of Performance.

•

In general, all “A” Elements of Performance will be inspected using three key measures: does the facility have a written policy that addresses the Element of Performance, do the technologists know where to find the policy, and do the actions of the technologist follow the policy. With few exceptions, the facility is permitted to set a policy that meets the standard. This should be acceptable as long as the facility can speak to how the policy meets the standard.

•

The Joint Commission does not require four labeled MRI zones, but does require that the phrase “The Magnet is Always On” be posted at the entrance to the MRI room. Inspectors will likely review MRI access control and ferrous object screening protocols. An additional point of inspection will be looking for ferrous objects near the entrance to the MRI room. Two given examples were fire extinguisher safety pins and inspection certificate ties.

•

Physicist reports must include an assessment of displayed dose accuracy for four protocols and the accuracy must be within 20%. If a facility does not do pediatric exams, the physicist should measure and report for two other protocols.

•

The Joint Commission defines an annual inspection as 12 months +/- 30 days. This definition is not negotiable. An inspection that occurs prior to 12 months is acceptable.

•

Acquisition display workstation evaluation must include Luminance, Resolution, and Spatial Accuracy evaluations with measurements reported. The Joint Commission does not set acceptable limits, so Pass/Fail criteria are left to the physicist’s discretion. The standard that should be applied is “is the monitor acceptable for the clinical situation for this system.” Therefore, one could argue that an acceptable monitor for an ultrasound unit would not be an acceptable monitor for a CT unit.

•

For all replacement/new CT, Nuclear Medicine, or PET equipment installed after July 1, 2015, a shielding evaluation and safety survey must be available for review.

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AAPM Newsletter • Volume 41 No. 3 MAY | JUNE 2016

Practice Accreditation Subcommittee, cont.

•

Facilities are expected to have CT exam protocols in a hardcopy form and the protocols must include an expected dose range. This dose range must include at least a maximum CTDI or DLP value. Maximum values should be set at the discretion of the facility.

•

The Joint Commission requires that CT Doses be compared to external benchmarks. Any external benchmarks are acceptable: the ACR Dose Index Registry, AAPM published CT protocol guidelines, CRCPD achievable dose levels, etc.

Finally, Dr. Browne shared some of the findings from the first six months of inspections. There were 32 findings, 21 from MRI and 11 from CT. The most common finding was ferrous objects in or near the MRI room. An additional finding was a facility that let an inspector inside the MRI room without screening. In CT, a facility had specified in their policy that they would perform weekly technologist QC and one week was missing. While the Joint Commission does not require weekly QC, because it was the facility’s policy and they did not follow it, the facility was scored. Overall, the presentation from Dr. Browne was very informative and helpful. She clearly laid out strategies to meet the Joint Commission Standards. Ideally, your facility must have a written policy addressing each Element of Performance, staff must know where to find the policies, and staff must follow these policies. Many of the details of each policy are left up to the discretion of the facility and the physicist. For further information, I highly recommend accessing Dr. Browne’s presentation in the virtual library. n

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Congratulations

to the Recipients of the Following Awards, Achievements & Honors in 2016! WILLIAM D. COOLIDGE GOLD MEDAL Paul M. DeLuca, Ph.D.

EDITH QUIMBY LIFETIME ACHIEVEMENT AWARD Wendell R. Lutz, Ph.D. Robert J. Pizzutiello, M.S. Michael V. Yester, Ph.D.

MARVIN M.D. WILLIAMS AWARD Keith J. Strauss, M.Sc.

HONORARY MEMBERSHIP Wilfried De Neve, M.D., Ph.D. Anthony L. Zietman, M.D.

JOHN S. LAUGHLIN YOUNG SCIENTIST AWARD Arman Rahmim, Ph.D.

FELLOW NOMINATIONS Peter Balter, Ph.D. Evan Boote, Ph.D. Janice Campbell, Ph.D. Yue Cao, Ph.D. Robert Cormack, Ph.D. Magnus Dahlbom, Ph.D. Joseph Deasy, Ph.D. Larry John Filipow, DPhil Jeffrey Brian Fowlkes, Ph.D. Eric Gingold, Ph.D. Jiang Hsieh, Ph.D. David Jaffray, Ph.D. Robert Jeraj, Ph.D. Jennifer Johnson, M.S. Bruce Libby, Ph.D. Hsiao-Ming Lu, Ph.D. Zhengfeng Lu, Ph.D. Vrinda Narayana, Ph.D. Wayne Newhauser, Ph.D. Richard Popple, Ph.D. Frank Ranallo, Ph.D. Susan Richardson, Ph.D. Timothy Ritter, Ph.D.

Anil Sethi, Ph.D. Ke Sheng, Ph.D. Jason Sohn, Ph.D. Srinivasan Vedantham, Ph.D. Jihong Wang, Ph.D. Jacqueline Zoberi, Ph.D.

MOSES AND SYLVIA GREENFIELD PAPER AWARD (NON-DOSIMETRY) “Breast Dose in mammography is about 30% lower when realistic heterogeneous glandular distributions are considered,” by Andrew M. Hernandez, J. Anthony Seibert, John M. Boone – Medical Physics 42, 6337 (2015).

FARRINGTON DANIELS PAPER AWARD “Investigating the accuracy of microstereotactic-body-radiotherapy utilizing anatomically accurate 3D printed rodent-morphic dosimeters,” by Steven T. Bache, Titania Juang, Matthew D. Belley, Bridget F. Koontz, John Adamovics, Terry T. Yoshizumi, David G. Kirsch, Mark Oldham – Medical Physics. 42, 846 (2015).

JOURNAL OF APPLIED CLINICAL MEDICAL PHYSICS PAPER AWARDS Editor-in-Chief Award “Comparison of pediatric radiation dose and vessel visibility on angiographic systems using piglets as a surrogate: anti-scatter grid removal vs lower detector air kerma settings with a grid; a preclinical investigation,” by Keith J. Strauss, John M. Racadio, Todd A. Abruzzo, Neil D. Johnson, Manish N. Patel, Kamlesh U. Kukreja, Mark J.H. den Hartog, Bart P.A. Hoonaert, Rami A. Nachabe – Journal of Applied Clinical Medical Physics, 16(5) 2015.

Medical Imaging Physics Award “A measurement-based X-ray source model characterization for CT dosimetry computations,” by Mitchell Sommerville, Yannick Poirier, Mauro Tambasco – Journal of Applied Clinical Medical Physics, 16(6) (2015). Radiation Oncology Physics Award “Pion effects in flattening filter-free radiation beams,” by Robert A. Corns, Vicky W. Huang, Steven D. Thomas Mail – Journal of Applied Clinical Medical Physics, 16(6) (2015). Radiation Measurements Award “Percent depth-dose distribution discrepancies from very small volume ion chambers,” by Vikren Sarkar, Brian Wang, Hui Zhao, Bart Lynch, Joshua A. James, Kiernan T. McCullough, Bill J. Salter – Journal of Applied Clinical Medical Physics, 16(2) (2015).

All of the award, achievement and honor recipients will be recognized during the 2016 AAPM Annual Meeting in Washington, DC at the Awards and Honors Ceremony and Reception. Please join us in congratulating all of the recipients: DATE: Monday, August 1, 2016 TIME: 6:30 PM PLACE: Ballroom A, Level Three, Convention Center

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THE AAPM EXPANDING HORIZONS

Travel Grant

TYPE: Grant OPEN: 5/1/16 DEADLINE: 9/1/16 NOTIFICATION: 10/3/16 APPLICATION MATERIALS TO BE SUBMITTED • Personal statement describing long term career goals, motivation to attend the selected meeting, and expected scientific value of attendance on the applicant’s dissertation project or future research (2 pages maximum). •

Curriculum Vitae.

•

Letter of recommendation from the applicant’s supervisor or department head confirming that additional travel expenses will be covered.

•

Budget indicating expected expenses.

THE AAPM EXPANDING HORIZONS TRAVEL GRANT will award up to fifteen $1,000 travel grants per year for the purpose of providing additional support for student and trainee travel to conferences that are not specifically geared toward medical physics. The travel grant program is designed 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 and which may subsequently be incorporated into future research in order to progress the field in new directions. ELIGIBILITY CRITERIA • Must be a member of AAPM in good standing at the time of application •

Must be a current graduate student, post-doctoral candidate, or resident

•

Proposed meeting must not be specifically-related to medical physics

•

Examples of ineligible conferences include: • AAPM Annual Meeting • AAPM Spring Clinical Meeting • AAPM Chapter Meetings • American Society for Radiation Oncology (ASTRO) Annual Meeting • Radiological Society of North America (RSNA) Annual Meeting • Any meeting that the applicant’s group is regularly attending, this will be judged on a case-by-case basis.

•

Examples of eligible conferences include: • American Physical Society (APS) Annual Meeting • Biophysics Society (BPS) Annual Meeting • Physical Sciences in Oncology Centers (PSOC) Annual Meeting • Radiation Research Society (RRS) Annual Meeting • World Molecular Imaging Conference (WMIC)

APPLICATION PROCESS • APPLY AT: gaf.aapm.org • DIRECT INQUIRIES: exhg@aapm.org

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UPCOMING AAPM MEETINGS: June 12–16, 2016 AAPM Summer School Medical Physics Leadership Academy Chantilly, VA July 31–August 4, 2016 AAPM 58th Annual Meeting & Exhibition Washington, DC

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