AAPM Newsletter September/October 2016 Vol. 41 No. 5

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

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

IN THIS ISSUE: ▶ President Elect’s Report ▶ 2016 Women Physicist Luncheon ▶ 2016 Summer School & MPLA Launch

▶ Imaging Practice Accreditation Subcommittee Report ▶ AAPM Professional Services ▶ DICOM Working Group 7 Report

▶ MPLA Working Group Report ▶ Medical Physics 3.0 Committee Report and more...

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

2016Award Winners •

The John R. Cameron Young Investigators Symposium A competition for new investigators within a special symposium in honor of Dr. John Cameron.

Congratulations go to: 1st Place: James Scheuermann, Stony Brook University for his abstract entitled: Low Dose Imaging with Avalanche Amorphous Selenium Flat Panel Imager 2nd Place: Brandon J. Walker, University of Wisconsin Madison for his abstract entitled: A Modular Multi-Source X-Ray Tube for Novel Computed Tomography Applications 3rd Place: Matthew Scarpelli, University of Wisconsin-Madison for his abstract entitled: Dynamic FLT PET for Investigating Potential Synergistic Therapeutic Targets During Anti-Angiogenic Treatment

•

Award for Excellence in Educational Innovation The Education Council of the AAPM sponsors a session during the Annual Meeting to honor and publicize Innovation in Medical Physics Education. The abstracts can be scientific research, novel teaching strategies – team teaching or adult learning efforts, novel educational materials – lectures, websites, or other innovations.

Congratulations goes to: Marco Carlone, Princess Margaret Hospital SIMAC: A Simulation Tool for Teaching Linear Accelerator Physics

ARTICLES IN THIS ISSUE 5 7 11 12 13 15 19 25 29 31 32 34 36 38 41 42 43 44 51 53 54

President Elect’s Report Executive Director’s Column Treasurer’s Report Professional Council Report Science Council Report Education Council Report ABR News Health Policy & Economic Issues ACR Accreditation IROC Report 2016 Women Physicist Luncheon MPLA Working Group Report 2016 Summer School and MPLA Launch Medical Physics 3.0 Committee Report Imaging Practice Accreditation Subcommittee Report AAPM Professional Services Image Wisely 2016 William D. Coolidge Gold Medal Person in the News DICOM Working Group 7 Report International Workshop: Update on AAPM Clinical Radiotherapy

EVENTS/ANNOUNCEMENTS 2 4 6 9 10 10 18 40 50

2016 Award Winners AAPM DREAM Program AAPM Awards — Call for Nominations Condolences ­— AAPM Deceased Members AAPM 2017 Spring Clinical Meeting AAPM 2016 Donors’ Lounge AAPM SUFP AAPM Career Services RSNA 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

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

PUBLISHING SCHEDULE The AAPM Newsletter is produced bi-monthly.

Next issue: November/December Submission Deadline: October 7, 2016 Posted Online: Week of November 1, 2016

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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.

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CONTENTS

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

DREAM

Diversity Recruitment through Education And Mentoring

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

ELIGIBILITY •

Undergraduate Juniors and Seniors majoring in Physics, Engineering, or other science degrees

•

U.S. Citizens, Canadian Citizens, or Permanent Citizens of the U.S.

HOW TO APPLY •

Complete application

•

Official transcript

•

2 Letters of recommendation

•

Self statement

FOR MORE DETAILS, VISIT: gaf.aapm.org/

PROGRAM CONTACT: Jacqueline Ogburn, jackie@aapm.org or 571-298-1228 AD: Sponsored by the AAPM Education Council through the AAPM Education and Research Fund

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

AAPM PRESIDENT-ELECT’S REPORT Melissa Martin, Gardena, CA

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e have just finished a very successful Annual Meeting in Washington, DC where there were a record number of scientific registrants and exhibitors.

The Meeting Coordination Committee chaired by Chris Serago, the program chairpersons of Kristi Brock, Scientific Program Director, Robin Stern, Education Program Director, and Ingrid Reiser, Professional Track Director, Jean Moran, Young Investigators Symposium, Norman Brown, Technical Exhibits Chairman, Nicholas Koch, Analysis and Evaluation Chairman, and Michael Yester, MOC Chairman, and all of the terrific Headquarters staff.

The countless hours spent in getting this meeting organized and completed is appreciated by all of those who attend. A very special last-minute addition to the planned program was the presentation by Dr. Douglas Lowy, NIH Acting Director, on the “National Cancer Moonshot Initiative” on Wednesday afternoon. Our appreciation for Dr. Lowy’s presentation goes to Matt Reiter, our lobbyist and to Lynne Fairobent, our Government Relations Manager.

The Presidential Symposium: “Inspiring Leadership” moderated by President Bruce Curran included Ron Arenson, MD, RSNA President, David Beyer, MD, ASTRO President, Bennett Greenspan, MD, SMMI President and AAPM Member, and Kolleen Kennedy, MS, Varian Medical Systems President, followed up on the 2016 Summer School on Leadership Development held in May. One of the primary goals of the AAPM leadership is to develop several pathways for our members to grow and develop their own leadership abilities. Throughout this year and the coming year, you will be presented with several opportunities to participate in this development program.

At the Town Hall and Business Meeting on Wednesday evening, President Bruce Curran presented an update on the progress of the Ad Hoc Committee on Governance Assessment (AHCGA) to those in attendance. Discussion was held on the upcoming By-Laws amendments that will be coming to the membership for a vote this fall. Two of the topics generating discussion were the proposed amendment on a name change to AAPM and changes in the composition of the Nominating Committee. Please read these proposed amendments carefully before voting to ensure that you cast your preference on moving forward with these proposed changes. Many more changes will be needed to implement the proposed Governance changes in the near future. These changes will be brought to the membership at the 2017 Town Hall and for a vote in the fall of 2017 for implementation in 2018 at the earliest. Several presentations at chapter meetings will be made over the next year to discuss these proposed changes in the Governance Structure with the membership. Please make your voices and preferences heard. The changes in the Governance Structure of AAPM to be proposed are the most significant changes in the past twenty years.

On Thursday evening following the Board of Directors meeting in Washington, DC, approximately 50 members of the Board and their companions were bused over to the new AAPM Headquarters in Alexandria to allow the board members to see the new offices and facilities. Thanks are expressed to the staff for going over to the office after a long week at the Annual Meeting to play hosts for the board members and companions. Anytime anyone is in town, please come by the new office to see our new headquarters. Use of the building is increasing as most committee meetings are now held at Headquarters.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

President-Elect, cont.

One of the activities of the President-Elect during the year is to attend many chapter meetings. It has been a pleasure to meet with several chapters across the country already and I look forward to the several more that are planned for the fall. Please plan to attend your chapter meeting when either Bruce or I are attending to express your opinions on the proposed governance changes and provide us with more input on your thoughts to better align priorities of AAPM leadership with our members. Being discussed and prioritized at this time are the number of councils needed, length of terms of office, election of council chairs, and how to ensure appropriate representation of the leadership for all members of our society.

The primary activity of Committee and Council Chairs at this time is the development of budget requests for 2017. All budget requests are due by August 30th so many of us are very busy at this time. Appreciation goes to the Staff Liaisons who are coordinating all of these budget requests prior to their submittal to the Finance Committee which will meet in October at Headquarters.

I look forward to hearing from many of you in the upcoming months at your chapter meetings.

We value your input. Any questions are welcome. n

Call for Nominations Nominations are now being accepted for the following AAPM Awards: • •

• William D. Coolidge Gold Medal Award Marvin M.D. Williams Professional Achievement Award • Edith H. Quimby Lifetime Achievement Award John S. Laughlin Young Scientist Award • AAPM Fellows

All nominations are due by September 15, 2016 and are to be done through the online nomination system. Applicants will be notified of decisions by March, 2017. Recipients will be honored at the AAPM Awards and Honors Ceremony and Reception during the 59th Annual Meeting & Exhibition in Denver, CO in the year 2017.

awards.aapm.org

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

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

1631 Prince Street — Your New AAPM Headquarters Two events were held at the new AAPM HQ during the recent Annual Meeting.

Approximately 15 members made the trip to Alexandria for an Open House on Saturday evening prior to the official start of the show. Members of the HQ team were on hand to show off our new home! It was very rewarding to see several Past AAPM Presidents and their guests. I was encouraged to see their excitement and pride in their organization. Then, after the Board meeting at the end of the week, members of the Board of Directors visited HQ, many for the first time. Everyone seemed excited about the new opportunities afforded to AAPM through the decision to purchase the building. If you are ever in the area, please do stop by for a tour! Someone asked me, “So, you bought the building?” My response was, “No, you did!”

4th International Day of Medical Physics on November 7 The International Organization of Medical Physics (IOMP) is once again promoting activities to raise awareness about the role of medical physicists through the International Day of Medical Physics (IDMP). The 2016 IDMP is scheduled for November 7, the birthdate in 1867 of Marie Sklodowska-Curie. The theme of IDMP 2016 is “Education in Medical Physics: The Key to Success.” This is an excellent opportunity to promote the role of medical physicists. Visit the IOMP website for more information and promotional resources.

InternationalDayofMedicalPhysics

@IntDayofMedPhys

ICRU Publications I am pleased to report that AAPM and ICRU have extended through 2018 the agreement that allows AAPM members access to their publications.

Shop Amazon Smile = Donation Made to AAPM‘s Education & Research Fund Contribute to the AAPM’s Education & Research Fund while you shop on Amazon. With a simple action and at no cost to you, AmazonSmile will donate to AAPM’s Education & Research Fund.

What is AmazonSmile? When first visiting AmazonSmile, customers are prompted to select a charitable organization from almost one million eligible organizations. For eligible purchases at AmazonSmile, The AmazonSmile Foundation will donate 0.5% of the purchase price to the customer’s selected charitable organization. This AAPM opportunity was launched in late May, and in the first few weeks, AAPM’s Education and Research Fund received $23.50 based on accumulated purchases.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Executive Director, cont.

How To Get Started To select AAPM’s Education & Research Fund as your charity: 1. Go to this link.

2. Log in using your Amazon account. Your shopping cart, Wish List, wedding or baby registry, and other account settings are also the same.

3. Now every eligible purchase you make at smile.amazon.com will result in a donation to AAPM’s Education & Research Fund.

For more information about the AmazonSmile program, go here.

Reminders Make sure to register for RSNA 2016 by November 4 to receive the complimentary registration provided to all AAPM members. AAPM’s Headquarters Hotel is The Hyatt Regency Chicago, 151 E. Upper Wacker Drive. AAPM meetings and annual reception will be held at the Hyatt Regency Chicago. The AAPM Reception will be held on Tuesday, November 29 from 6:00 pm – 8:00 pm.

Mark your calendars for the 2017 AAPM Spring Clinical Meeting to be held March 18 – 21 in New Orleans, Louisiana.

Denver, Colorado is the host of the 2017 AAPM Annual Meeting scheduled for July 30 – August 3.

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

Members will find: • • • • • • •

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

Should you ever have any questions, please do not hesitate to contact me.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Executive Director, cont.

2017 AAPM Dues Renewals Dues renewal notices for the 2017-year will be sent out in early October. I encourage you to pay your dues via the AAPM website. Remember, many of the regional chapters are partnering with HQ on the dues process, so make sure to check the invoice to see if you can pay your national and chapter dues with one transaction. Be mindful, though, that some chapters have a membership application process. Please only remit dues for chapters of which you are an official member.

Staff News

Tanvir Chowdhury is the newest member of the AAPM team. He started in mid-July as the Staff Accountant working with the other members of the Finance Team. Specifically, Tanvir is working on the monthly closing of the books of record, account reconciliation, and journal entry adjustments.

Who does what on the AAPM HQ Team? See a list with contact information and brief descriptions of responsibilities here. An Organization Chart is also provided. n

Our Condolences Patrick Booten — Gibson, GA Michael Goitein — Windisch, Switzerland Allen F. Hrejsa — Downers Grove, IL

Our deepest sympathies go out to their families. We will all feel the loss in the medical physics community.

If you have information on the passing of members, please inform HQ ASAP so that these members can be remembered appropriately. 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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SAVE THE DATE! MARCH 18–21, 2017 Hilton New Orleans Riverside New Orleans, LA

AAPM E&R FUND DONORS’ LOUNGE AT AAPM 2016 the trip home, charge up their electronic devices, and charge up themselves for the rest of a busy day.

Please give serious consideration to making a donation to this Fund, which supports the development of our great profession via the provision of seed money for research, fellowships for PhD students, and support for clinical residencies. To learn more or to make a contribution, please visit: www.aapm.org/education/edfundintro.asp

AAPM members who have generously donated to our Education & Research Fund relaxed and caught up with colleagues in the Donors‘ Lounge at this year’s Annual Meeting.

Open to members who have contributed $100 or more, access to the Lounge allowed them enjoy light refreshments while conversing with friends and colleagues, print out boarding passes for

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

TREASURER’S REPORT Mahadevappa Mahesh, PhD, Baltimore, MD

I

am writing this column after attending the AAPM Annual Meeting in Washington DC. The meeting was well attended including a higher than expected number of attendees and vendor participation than previous years. I wanted to share in this column the financial report I gave to the AAPM Board.

Fiscally, AAPM continues to perform well despite having a small deficit at the end of last year.

The Association realized a deficit from operations in 2015 of approximately $260,000 (Figure 1). What does this mean? AAPM budgeted for a deficit of approximately $1.24M, at the end of fiscal year 2015. This is done to account for anticipated underspending which I will discuss more fully in a future column.

Even though we had deficit budget of $1.24M, at the end of the year we ended up with a deficit of only $260K. This was due to a favorable variance of just under $982,000. The largest single driver contributing to this favorable variance was the underspending by councils and committees. In fact, the Association revenue in this category was nearly $191,000 better than budget while underspending accounted for a $740,000 favorable variance creating a total favorable variance of $931,000.

Regarding the reserve funds (restricted and non-restricted), due to the financial markets fluctuations during the course of 2015, we had an unrealized loss on investments of approximately $335,000. Hence at year-end in 2015, the reserve fund balance stood at nearly $12.9 million. However, I am happy to report that the reserve funds have made up most of the losses due to favorable market gains in the first two quarters of this year ($13.3M).

The deficit from operations kept AAPM from complying with the Debt Service Coverage Ratio (DSC) of 1.2 to 1 covenant stipulation (discussed this in my Mar-April 2016 column). Even though in 2015 the year-end result was 0.72 to 1, TD Bank (Mortgage Lender) approved a waiver of the covenant violation due to strong AAPM reserve funds.

The 2016 budget has an approved deficit from operations of ($1.38M). This budget was prepared utilizing a revised statistical model, using historical budgets and operating results as a guide. The model assumes that the Association will breakeven for the year given the budgeted deficit. Currently until October, various councils and committees are invited to prepare their respective budget for next year, and in mid-October the FINCOM will be meeting to approve the 2017 budget. n

Figure 2: AAPM Historical Reserves (Restricted & Unrestricted funds)

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Figure 1: AAPM Income and Expenses for year 2015.

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

PROFESSIONAL COUNCIL REPORT Dan Pavord, Poughkeepsie, NY

I

returned from the Annual Meeting both exhausted and invigorated at the same time. The exchange of ideas and interaction with colleagues is always an energizing experience. The pace of the meeting however leaves little time for rest. This reminds me of all of the hard work done by the volunteers and staff to make the meeting a success. I would like to thank all of the members of Professional Council, the committees, subcommittees, and our staff liaisons for everything that they do to advance our profession.

As we collectively work to advance our profession, we continue our work on the new scope of practice for clinical medical physics. There was a very productive face-to-face meeting and we will have a draft for review in time for the RSNA SUGGESTION BOX meeting. We have decided to have a short policy that refers to a more comprehensive document that will ultimately be a Medical Physics Practice Guideline (MPPG). We did this in the anticipation that other entities may reference our scope of practice and a MPPG will likely have more acceptance than an internal policy. The other important result of this being a MPPG is that it will be open for membership comment before being adopted. This is an important document for the future of our profession and I encourage you to read it carefully and offer thoughtful comments.

The proposed 2017 rules for Medicare reimbursement were released in July and are being carefully reviewed by the Professional Economics Subcommittee. See the two Newsletter articles by Wendy Smith Fuss in this edition.

We had a very successful Summer School as the kick off for the Medical Physics Leadership Academy to further individual member development beyond technical expertise. Please see the related articles in this edition of the newsletter.

The topic of the PC Symposium at the Annual Meeting was the Medical Physics Value Proposition. After an introduction to frame the issue by George Sherouse, we had presentations by a medical physicist (Gerald White), a physician (Dr. Stuart Burri from Charlotte, NC), and an administrator (Don McNary from Allegheny Health Network) followed by a panel discussion with John Hazle, Jessica Clements, Per Halvorsen, Virgil Willcut, and myself. There were many viewpoints represented and some common themes emerged regarding the value of a medical physicist.

•

Gate keeper of safety/insurance policy

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Must be willing to say NO

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Must be present/seen in the clinic and at the table

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Know your stuff/be an expert

•

Be the objective evaluator of new technology

•

Communication within and outside department

•

Be a leader

The communication piece is a key. In a changing healthcare environment we must be able to communicate our value. I will close with that comment and note that change has been a common theme to my columns this year and look forward to AAPM playing an important role in that change.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

SCIENCE COUNCIL REPORT Cynthia McCollough, PhD, Rochester, MN

T

he charge of AAPM’s Science Council is to advance the science of medical physics, address pressing scientific questions, and collate and assess scientific data. All three of these objectives were met in the recent Low Dose CT Grand Challenge, which was sponsored by Science Council and the CT Subcommittee, in cooperation with the National Institute of Biomedical Imaging and Bioengineering and the Mayo Clinic.

SUGGESTION BOX

Announced at the 2015 Annual Meeting of the RSNA, the Low Dose CT Grand Challenge invited image reconstruction and denoising experts from around the globe to test their algorithms against others in the field using real patient image and projection data. Within 3 weeks of the RSNA meeting, 103 participants had registered to compete in the challenge, representing 26 countries. Facilitating these types of scientific activities reflects well upon AAPM, and demonstrates its leadership role at the international level in the development and translation of new medical technology.

The specific objective for this challenge was to reduce image noise using either image-domain or projection-domain techniques in order to maximize detectability of liver metastases in low-dose patient CT datasets. The resultant noisereduced images were read in a blinded and randomized manner at Mayo Clinic, the host institution, and the winners were announced at the 2016 AAPM Awards Ceremony. The 3rd place winner of the Low Dose CT Grand Challenge was Dr. Larry Zeng, who is a Professor of Engineering at Weber State University in Ogden, Utah. The 2nd place winner of the Low Dose CT Grand Challenge was Eunhee Kang, who is a PhD student at the Korea Advanced Institute of Science and Technology in South Korea, her colleague, Junhong Min, and her advisor, Dr. Jong Chul Ye. The 1st place winner of the Low Dose CT Grand Challenge was Dr. Kyungsang Kim, who is a post-doctoral research fellow at Massachusetts General Hospital in Boston, Massachusetts, and his advisor, Dr. Quanzheng Li.

Low Dose CT Grand Challenge 2nd Place Winner: Kyungsang Kim

Low Dose CT Grand Challenge 3rd Place Winner: Dr. Larry Zeng

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Low Dose CT Grand Challenge 1st Place Winner: Dr. Eunhee Kang

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Science Council, cont.

This challenge was scientifically and clinically significant, as participants were asked to restore the clinical image quality — as measured by radiologist performance of a detection and characterization task — of patients images that used only 25% of typical clinical doses. This type of aggressive dose reduction, accompanied by successful noise reduction, is required to bring the effective doses from body CT exams to background levels (a few mSv). This is the vision of the submSv CT initiative of the National Institute of Biomedical Imaging and Bioengineering, which funded the development of a patient CT data library for just these types of evaluative studies.

The patient data library contains images and projection data of patients at full and 25% dose levels. The projection data are stored in a vendor-neutral, DICOM-like format, which contains all the information needed to accurately reconstruct images from the provided projection data1. These data are available for academic research. Interested parties should contact me directly.

Training data was shared with the 77 sites that completed the necessary data sharing agreements. The 10 training cases — which included the full and quarter dose data — consisted of 1 and 3 mm images reconstructed with medium and sharp kernels, as well as the projection data. Subsequently, 41 sites downloaded the 20 test cases, which included only the 25% dose data. Sites were allowed to select from projection data, thin or thick image, and medium or sharp kernels, according to their preference and the details of their algorithm. In the end, 22 sites submitted their results for evaluation in a human observer study design, although one site provided binary images which were excluded from reader review.

The range of quality of these 21 remaining sites’ images is exemplified below.

Several sites performed very well, approaching the reader performance of the 100% dose data set. However, even in those sites, a number of false positive lesions where found to be present. Thus, this difficult task is far from solved. Future work of the Mayo Clinic team will be to further interrogate the data from trends relating to algorithm features and to repeat the reader study user more readers in order to confirm the initial results. The AAPM membership should be exceptionally proud to be part of an organization that is actively working to develop and evaluate new approaches to CT dose reduction. Without the sponsorship of the Science Council, the CT subcommittee, and the expert support of AAPM’s webmistress Farhana Khan and the team at Mayo Clinic, this Grand Challenge could not have happened. Based on the number of people expressing interest in participating “next year,” I’d say that this effort was a huge success, and I look forward to AAPM continuing to facilitate these types of Grand Challenges. n

Chen et al., “Development and validation of an open data format for CT projection data” Med Phys. 42, 6964 (2015).

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

EDUCATION COUNCIL REPORT John Antolak, PhD, Rochester, MN, Chair of the Subcommittee on the Oversight of MedPhys Match (SCOMM)

MedPhys Match Update Last year, we reported on the success of the inaugural MedPhys Match.1 That article was focused on matching statistics, comparing various applicant subgroups that participated in the MedPhys Match. An important finding was that if you only consider applicants that were ranked by participating programs, the match rate was approximately the same (55-60%) for all subgroups of applicants. This year, the number of applicants participating in the MedPhys Match was down from 280 to 209.2 The number of participating applicants that were ranked by programs also was down from 178 to 143. The number SUGGESTION BOX of applicants that were matched was almost unchanged, 108 in 2015 and 106 in 2016, so the drop in applicants ranked by programs means that the overall match rate increased from 61% to 74%. This data can be compared to the NRMP Match data3 where there were 223 applicants for 167 matched PGY-2 Radiation Oncology positions, which gives a match rate of 75%. For Diagnostic Radiology PGY-2 positions, the match rate was only 70%, and the match rate over all specialties was 76%.4 If we look at the various subgroups in the 2016 MedPhys Match, the match rate was 83% for participating female applicants (52% in 2015) versus 72% for male applicants (65% in 2015). The percentage of female applicants that were ranked by programs was 78% (74% in 2015) versus 76% for male applicants (64% in 2015). For MS and PhD applicants (including certificate graduates), the percentage of applicants that were ranked by programs was the same (76%). In 2015, CAMPEP reported that there were 99 PhD graduates, 25 certificate graduates, and 202 MS graduates.5 Of the 202 MS graduates, 51 went on to further graduate studies, and another 50 were able to find some sort of employment in clinical, industry, or government. The data do not allow us to determine how many of those seeking further graduate studies did so because they were unable to find a residency position.

For MedPhys Match, 187 of the 209 participating applicants were also registered in MP-RAP,6 which means we have some additional demographic information, such as their educational background. For the 2016 MedPhys Match, 109 applicants had a PhD degree and were either CAMPEP PhD or certificate graduates, and 78 applicants had an MS degree. As stated above, about half of MS graduates go on to further graduate studies or employment, so the number of MedPhys Match applicants at the MS and PhD levels is reasonably consistent with CAMPEP statistics.

Changes for 2017 By the time you read this, the 2017 MedPhys Match will be underway. As noted previously, the AAPM/SDAMPP subsidy towards the cost of the MedPhys Match drops to approximately 50% this year, and the remainder will come from user fees. Residency Programs will be asked to pay $175 USD, and applicants will pay $55 USD to participate in this year’s MedPhys Match. The fee level should stay approximately the same for the next two years, and will double after that.

The vast majority of the applications submitted for MedPhys Match positions are submitted through the AAPM MP-RAP application system.7 Residency Programs pay a $200 USD fee to post a position in MP-RAP, and applicants pay a $150 USD fee to use the system to submit applications. The applicant fee covers the first 10 applications, and subsequent

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Education Council, cont.

applications cost $150 USD for 10 applications, or $20 USD for a single application. The latter option is new for this recruiting season, and is only available if the applicant has already paid the initial $150 USD fee. The Work Group on Coordination of Medical Physics Residency Programs8 is sensitive to the effect that the MP-RAP cost has on applicants, but also wants to encourage applicants to carefully consider which programs they submit applications to. Because MPRAP makes submitting more applications very easy, some programs find that they have to wade through a very large number of submissions from applicants that are not necessarily very interested in their program.

One of the applicant complaints from last year was that while most residency programs listed their openings on the NMS website by the beginning of October, the openings in MP-RAP were sometimes delayed to December or later. Because of the fee structure for applicants, some applicants would use up their application credits, and then another desirable opening would be posted in MP-RAP. In MP-RAP, the application deadline can be up to 4 months after the opening date, so openings that start in mid-October can have an application deadline up to mid-February. There is really no excuse to delay posting the opening in MP-RAP once you are certain it is available (e.g., residency funding has been secured).

Therefore, we would like to encourage all residency programs participating in the MedPhys Match to post their opening in MP-RAP as soon as practicable.

Why should my program participate?

While most residency programs do participate in the MedPhys Match, there are a few that do not. In some cases, the residency program might have an internal pipeline, perhaps a graduate program or postdoctoral research program that supplies internal candidates for residency positions. A typical comment from the program might be something like “We offer residency positions to our top students. We know that they would rather not compete in the MedPhys Match and want to be in our residency program, because that’s what they tell us”. I would argue that the residency program director is possibly taking advantage of their position, and are not really getting an honest opinion from the student. The graduate program director should generally advocate for the student’s best interest, and pushing the student to take the internal residency position is arguable in conflict with that goal.

A recent trend in residency programs is the emergence of so-called hybrid residency programs, which combine research and clinical training. These programs are touted as an ideal way to provide clinical training for those desiring an academic career. The research portion is often funded using soft funds that would usually fund postdoctoral researchers, and similar research productivity is expected for the portion funded by the research advisor. While these programs can be accredited the same as traditional residency programs, some of them want to be considered outside of the regular matching process. However, these programs can participate and arguably should participate in the MedPhys Match. For residency programs with a standard and hybrid track, there are going to be applicants that would like to be considered for both positions. The residency program can have separate rank lists for each track, so only those applicants that a research advisor considers to be acceptable would be ranked in the hybrid track. If the program says that they should be able to offer the hybrid position to whomever they want outside of the MedPhys Match, then they are possibly ignoring the preferences of the applicant. I would argue that they are using their position of power to apply undue influence on the applicant to accept something that may not be in the applicant’s best interest. Another potential issue for those residency programs with multiple tracks is that the MedPhys Match Rules require that all positions being filled in a given year be offered in the MedPhys Match.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Education Council, cont.

There are likely to be other arguments against participation in the MedPhys Match, but I would encourage everyone to consider that the matching algorithm has been shown to be fair to applicants and residency programs. One common misconception among programs is that the quality of a program can be measured by how high they match on their list. If a program wants to have a better chance to land their top-ranking applicant, they should rank less-competitive applicants higher on their list. However, but doing so, they are giving up on the possibility that a more competitive and desirable applicant might actually have been matched to their program. The program should create their rank list in their true preference order, ignoring their perception of the probability of ranking to the particular individual. Similarly, applicants should also create their rank lists in true preference order to maximize their chances of a best match. Doing anything else could deliver a sub-optimal result.

Who administers MedPhys Match?

The MedPhys Match is currently administered by the Subcommittee on the Oversight of MedPhys Match,9 which is chaired by the author of this article. The two charges for the Subcommittee are to interface with NMS to establish MedPhys Match policies, and to review any potential violations of the MedPhys Match Rules of Participation.10 As with any other AAPM committee, minutes are available to AAPM members on the subcommittee website. The Subcommittee is grateful for the cooperation of participating programs, and welcomes constructive criticism regarding any aspect of the program.

John A. Antolak, PhD Chair, Subcommittee on the Oversight of MedPhys Match (SCOMM) Chair, Medical Physics Residency Training and Promotion Subcommittee (MPRTP) n

AAPM Newsletter, Vol 40, No. 3, pages 20-23, accessed Aug 17, 2016

1

MedPhys Match Statistics, accessed Aug 17, 2016

2

NRMP Results and Data 2016, Table 1, accessed Aug 17, 2016

3

NRMP 2016 Match Infographic, accessed Aug 17, 2016

4

CAMPEP 2015 Annual Graduate Report, accessed Aug 17, 2016

5

All matched positions were for applicants registered in MP-RAP, and only 2 applicants that did not participate in MP-RAP were ranked by programs.

6

AAPM MP-RAP Applicant Home Page, accessed Aug 17, 2016

7

AAPM WGCMPR Committee Page, accessed Aug 17, 2016

8

AAPM SCOMM Committee Page, accessed Aug 17, 2016

9

2017 MedPhys Match Rules of Participation, accessed Aug 17, 2016

10

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AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE Interested in applying your physics or engineering knowledge in medicine?

Want to make a clinical impact this summer?

Then the SUMMER UNDERGRADUATE FELLOWSHIP PROGRAM is for you!

We provide opportunities for excellent undergraduates to gain experience in medical physics at leading clinical and research institutions. A large menu of mentordefined projects is available and Fellows select their mentor according to their mutual interests.

Fellowships are offered for 10 weeks during the summer (May through September) and available to students not in their final year.

For more details, visit: gaf.aapm.org

Sponsored by the AAPM Educational Council through the AAPM Education and Research Fund PROGRAM CONTACT: Jacqueline Ogburn, jackie@aapm.org or 571-298-1228

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

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

New Exam Item Types for the American Board of Radiology Examinations in Medical Physics The multiple-choice question format — with a stem (background information and question), several distractors (incorrect options), and a single key (correct option) — has been the model for a majority of the American Board of Radiology (ABR) exam items in Diagnostic Radiology, Radiation Oncology, and Medical Physics over the past 20-plus years. Within the past five years, “R-type” items, consisting of a long list of options that are shared by two or more “stems,” have been introduced, as well as “point-and-click” items that contain images, illustrations, or figures and require the examinee to identify the location of the information requested in the stem by using the computer mouse to point and click on the area. Each of these exam item types accounts for one “scorable unit” if the correct answer or correct area is selected. In addition, unique to Medical Physics in the Part 1 and Part 2 certification exams, is the historical “complex” multiple-choice item that typically requires several steps of calculation or reasoning to determine the answer and accounts for three “scorable units” when the correct answer is selected. There is no partial credit for complex items.

In an effort to add more flexibility to the assessment of knowledge derived from exam items on the Medical Physics Part 1 and Part 2 certification exams, the ABR has approved three new item types for introduction as pilot items beginning with 2017 Medical Physics Part 1 and Part 2 certification exams. These include case-based, multiple-select, and fill-inthe-blank, as described with examples that follow. An example of the existing point-and-click item type is also shown at the end of this article.

Case-based items consist of two or more (typically three) sequentially related questions on a single topic. These are targeted to eventually replace the “complex” question type described above. Each question in a case-based item is a single-answer multiple-choice question and makes up a single scorable unit. The questions are linked in a one-way direction that does not allow revisiting the previous question or changing an answer after moving to the next question.

Often, the key to the previous question will be part of the next question, giving an opportunity for testing knowledge with more granularity. So, instead of the possibility of zero or three scorable units for a complex item, there is an opportunity to receive credit for zero, one, two, or three scorable units for a case-based item. Case-based items will be clearly identified for the examinee, with instructions and warnings stating that once the item is started, each question must be completed and that there are no opportunities to change a response once recorded. The implementation plan is to gradually replace the 25 complex questions now in the Part I and Part 2 discipline certification exams with case-based items having a similar number of scorable units. The following is an example of a complex question changed to a casebased item: MRI resonance frequency and chemical shift concepts, complex question (3 scorable units) An MR image is acquired with a gradient strength of 2.5 mT/m over a field of view of 25 cm and 128 frequency-encoding samples. If fat and water are shifted in an MR image by exactly 1 pixel, what is the main magnetic field strength? (Assume that the chemical shift of fat to water is 3 ppm.)

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

ABR, cont.

A. B. C. D. E.

0.8 T 1.0 T 1.3 T 1.6 T 3.0 T

Key: D (follow the case-based questions below to arrive at the answer) Case-based question group revised from the complex question: MRI resonance frequency and chemical shift concepts (3 parts, single scorable unit per question) Part 1. An MR image is acquired with a gradient strength of 2.5 mT/m over a field of view of 25 cm during the Frequency Encode Gradient readout. What is the bandwidth of the echo?

A. B. C. D. E.

62.5 kHz 48.8 kHz 31.3 kHz 26.6 kHz 14.7 kHz

Key: D 2.5 mT/m*0.25m = 0.625 mT; BW = 0.625 mT/1000 mT/T * 42.58 MHz/T = 0.0266 MHz = 26.6 kHz BLOCK Part 2. If the 26.6 kHz bandwidth echo is acquired with 128 samples in the frequency-encoding direction of the k-space matrix, what is the bandwidth across each pixel?

208 Hz 230 Hz 381 Hz 416 Hz 652 Hz

A. B. C. D. E. Key: A

BW across each pixel is 26.6 kHz / 128 samples = 208 Hz BLOCK Part 3. If fat and water are shifted in the MR image by exactly 1 pixel, what is the main magnetic field strength? (Assume the chemical shift of fat to water is 3 ppm.)

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0.3 T 0.6 T

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A. B.

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

ABR, cont.

C. D. E.

1.3 T 1.6 T 3.0 T

Key: D Chemical shift = 208 Hz, which is 3 ppm of the resonance frequency of the main magnet. Use this information to get the estimated field strength: 208 Hz / 3 × 10-6 = 69.3 MHz Magnet strength = 69.3 MHz / 42.58 MHz/T = 1.62 T ALL SUBSEQUENT INTERACTIONS WITH THESE ITEMS ARE BLOCKED WITHIN THE EXAM. Multiple-select items are a variant of multiple-choice questions with a single best answer. They have multiple keys (typically two or three) and multiple distractors for a single scorable unit. These items specifically state in the stem the exact number of responses required to identify the correct keys. In order to receive credit for a single scorable unit for the item, an exact match of the responses with the correct keys is necessary. Choosing an incorrect option will result in no credit. In addition, failure to provide the exact number of required correct responses results in no credit for the item. Multiple-select items add flexibility to assess knowledge when there is more than one good option and can largely replace items that use negative stems (e.g., “Which of the following is NOT,” “All of the following are correct outcomes EXCEPT”), which are less desirable from an exam psychometrics perspective.

Non-physics example of a multiple-select item Which three of the following cities are state capitals? (Please select 3 options.)

A. Columbus B. Lexington C. Minneapolis D. New York City E. Sacramento F. St. Louis G. Tallahassee Keys: A, E, and G--to receive credit, these keys must be selected exactly.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

ABR, cont.

Diagnostic Medical Physics example of a multiple-select item During a fluoroscopy procedure with automatic exposure rate control (AERC), an additional 0.1-mm Cu filter is added to the inherent filtration. Select the three changes that occur to the kV, mA, and patient air-kerma rate when the AERC stabilizes. (Please select 3 options.)

A. B. C. D. E. F.

kV increases kV decreases mA increases mA decreases Air kerma rate increases Air kerma rate decreases

Keys: A, C, and F--to get credit, these keys must be selected exactly. In this item, note that there are three separate comparisons (kV, mA, and air kerma rate).

Nuclear Medical Physics example of a multiple-select item Which three of the following affect parallel-hole collimator resolution? (Please select 3 options.)

A. B. C. D. E. F.

Hole length Hole diameter Field of view Source distance Focal length Pinhole diameter

Keys: A, B, and D--to receive credit, these keys must be selected exactly.

Therapeutic Medical Physics example of a multiple-select item For an electron beam, as the field size decreases, which three of the following occur? (Please select three options.)

A. B. C. D. E. F.

The depth of Dmax decreases.

The depth of Dmax increases.

Surface dose increases.

Average energy increases.

Practical range decreases.

For field size > Rp, the PDD remains unchanged.

Answer – A, C, and F--to receive credit, these keys must be selected exactly.

Fill-in-the-blank items require the candidate to answer a quantitative problem within a prescribed range of values that are deemed to be within acceptable limits for the calculation. This type of item is a single scorable unit.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

ABR, cont.

Example of a fill-in-the-blank item A PMMA phantom, 20 cm thick, is exposed to an x-ray beam with an effective linear attenuation coefficient of 0.19 cm-1.

The fraction of the beam attenuated is _______. (Enter a fractional number between 0 and 1, with three significant digits.)

Answer: 1 – e-(20*.19) = 0.978. Accepted values are 0.975 to 0.981 Point-andclick items require the candidate to identify the region in an image, illustration, or figure that matches the requested information by using the computer mouse to point and click on the area. The last click recorded is the one submitted for evaluation, and when the click is within the predetermined acceptable area, 1 scorable unit is achieved.

In the image below, identify the region where slice thickness accuracy can be evaluated. Use the mouse pointer and click with the left mouse button.

Answer: The red oval (image on right) indicates the acceptable area for the candidate to identify in order to achieve 1 scorable unit.

Summary New item types for the ABR examination, now under development, are expected to add flexibility to assessing the knowledge of candidates seeking and maintaining certification. Beginning with the 2017 exams, new item types will appear incrementally, and they will be evaluated by psychometric analysis to validate appropriate performance and other important exam criteria. Example questions for each item type are being produced, and volunteer item writers on the many ABR exam committees are currently being trained. To ensure a fair and equitable exam process, adjustments and fine-tuning of exam parameters (e.g., time allotted for different item types) will be ongoing. The majority of all exam content will continue to be the multiple-choice item with a single best answer, with a small fraction of each new item type being present in future exams. n

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International Organization for Medical Physics (IOMP) Information for those willing to be involved with IOMP About IOMP IOMP represents about 24,000 medical physicists worldwide and over 80 adhering national member organizations.

The mission of IOMP is to advance medical physics practice worldwide by disseminating scientific and technical information, fostering the educational and professional development of medical physicists, and promoting the highest quality medical services for patients. For more information, please visit www.iomp.org IOMP is a society of societies, an association of associations. Medical physics societies/associations of countries are encouraged to seek affiliation with IOMP and once affiliated and in good standing, all members of the national society are automatically members of IOMP. Thus you do not need to be individually seeking membership of IOMP.

How you can interact with IOMP Become a member of any of the Committees of IOMP, usually at start of the term every 3 years and through Chair of one of the Committees.

Get elected to management team of IOMP. Next election is at the end 2017 for the term 2018-2021.

Be aware about IOMP awards (Marie Sklodowska-Curie Award, Harold Johns Medal, John Mallard Award, IDMP Award, IUPAP Young Scientist Award in Medical Physics)

Submit a manuscript to the Medical Physics International (MPI) journal

Implement actions in member countries through existing committees

Avail travel support for participation in WCs and ICMPs.

Contribute articles to eMPW on topics of wider interest

www.iomp.org EDUCATION IN MEDICAL PHYSICS

THE KEY TO SUCCESS

NOVEMBER 7, 2016 International Day of Medical Physics

Organize or join an event to celebrate the International Day of Medical Physics on November 7 www.iomp.org/idmp

Promote your products in medical physics field through IOMP website and publications and become corporate member of IOMP* *Against payment of fee

Contribute to the IOMP Women Subcommittee

Take advantage of sponsorship/funding for organizing scientific, educational and professional meetings

Participate in World Congresses (WCs) held every 3 years and International Conference on Medical Physics (ICMPs) in between two WCs.

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

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

2017 Proposed Rule Has Minimal Impact on Payments to Physicians and Freestanding Cancer Centers The Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Medicare Physician Fee Schedule (MPFS) proposed rule. The final rule will be published by November 1, with an effective date of January 1, 2017 and the AAPM will submit comments to CMS by the September 6th deadline. The MPFS specifies payment rates to physicians and other providers, including freestanding cancer centers. It does not apply to hospital-based facilities. Facility payment to hospital outpatient departments is covered under a separate rule and those changes are described in a separate article below.

CMS identified 3 treatment device codes (CPT 77332, 77333, 77334) as being “potentially misvalued” under the high expenditure services review screen. The RUC had recommended no change from the current work relative value units (RVUs) for these codes. CMS believes, however, that the recommended work RVUs overstate the work involved in furnishing these services. CMS is proposing reduced work RVUs of 0.45, 0.75 and 1.15 for CPT codes 77332, 77333 and 777334, respectively, which will reduce payment.

CMS is providing values for the new moderate sedation codes and proposing a uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure. Specifically, CMS proposes to reduce the work RVU for radiation oncology procedures 77371, 77600, 77605, 77610 and 77615 by 0.25 RVUs. The reduction in work RVUs will be offset by the physician work of the new moderate sedation codes, when it is provided.

Other 2017 proposals that impact radiology and radiation oncology payment include: •

Add a professional PACS workstation to many diagnostic radiology codes that use the current less expensive technical PACS workstation. CMS proposes a price of $14,617, which increases practice expense RVUs for these codes.

•

Reduce the technical component payment by 20 percent for x-ray imaging services that use film.

•

The Protecting Access to Medicare Act of 2014 establishes a program to promote the use of appropriate use criteria (AUC) for advanced diagnostic imaging services. The 2017 proposed rule focuses on the next component of the Medicare AUC program and includes proposals for priority clinical areas, clinical decision support mechanism (CDSM) requirements, the CDSM application process, and exceptions for ordering professionals for whom consultation with AUC would pose a significant hardship.

•

Revise the geographic practice cost indices (GPCIs) using updated data to be phased in over 2017 and 2018.

As proposed, the rule would minimally impact payment to radiation oncologists, radiologists and freestanding cancer centers.

Read a complete summary of the proposed rule and review impact tables here.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Health Policy, cont.

CMS Proposes Expansion of Comprehensive APCs The Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. AAPM will submit comments to CMS by the September 6th deadline. The final rule will be published by November 1, with an effective date of January 1, 2017.

CMS proposes to reduce the number of ambulatory payment classifications (APCs) for Therapeutic Radiation Treatment Preparation from 4 to 3 levels by consolidating Level 1 and Level 2 Treatment Prep codes into Level 1 payment. Three reassigned codes have a significant payment decrease of 30%, including the special medical physics consultation (CPT 77370). Proposed 2017 payments and impacts are noted in the table below.

CMS is also proposing to make further changes to the structure of diagnostic imaging APCs by consolidating the imaging APCs from 17 clinical APCs in 2016 to 8 APCs in 2017.

In addition, CMS proposes to create 25 new Comprehensive APCs. Many brachytherapy catheter/needle insertion codes (20555, 41019, and 55920) and other related brachytherapy procedures such as insert tandem and/or ovoids (57155) and insert Heyman capsules (58346) would be converted from a clinical APC to a Comprehensive APC in 2017. This may have implications for brachytherapy treatment delivery since Comprehensive APCs make a single payment, bundling all costs on the same claim.

The 2017 HOPPS payment rule also proposes to: •

Implement section 603 of the Bipartisan Budget Act of 2015, which requires that certain items and services furnished in certain off-campus provider-based departments will not be covered outpatient department services for purposes of HOPPS payment and those items and services will instead be paid “under the applicable payment system” beginning January 1, 2017. CMS is proposing that the Medicare Physician Fee Schedule will be the “applicable payment system” for the majority of the items and services furnished by off-campus provider-based departments.

•

The Consolidated Appropriations Act of 2016 provides that, effective January 1, 2017 and subsequent years, the payment under the HOPPS for x-ray imaging services that use film (including the X-ray component of a packaged service) will be reduced by 20 percent. CMS is proposing that hospitals would be required to use a modifier on claims for X-rays that are taken using film.

A complete summary of the proposed rule and impact tables is on the AAPM website. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Health Policy, cont.

Summary of Proposed 2017 Radiation Oncology HOPPS Payments 2016 Payment

2017 Proposed Payment

Percentage Change 2016-2017

19298 & other breast surgery codes

$7,557.75

$4,394.99

-41.8%

Level 3 Breast/ Lymphatic Surgery and Related Procedures

19296, 77424, 77425 & other breast surgery codes

$7,557.75

$6,696.89

-11.4%

5611

Level 1 Therapeutic Radiation Treatment Preparation

77280, 77299, 77300, 77316, 77331, 77332, 77333, 77336, 77370, 77399

$107.40

$116.52

8.5%

5612

Level 2 Therapeutic Radiation Treatment Preparation

77285, 77290, 77306, 77307, 77317, 77318, 77321, 77334, 77338

$291.77

$307.74

5.5%

5613

Level 3 Therapeutic Radiation Treatment Preparation

32553, 49411, 55876, 77295, 77301, C9728

$1,026.81

$1,058.79

3.1%

5621

Level 1 Radiation Therapy

77401, 77402, 77407, 77789, 77799

$110.34

$111.05

0.6%

5622

Level 2 Radiation Therapy

77412, 77600, 77750, 77767, 77768, 0394T

$194.35

$201.90

3.9%

5623

Level 3 Radiation Therapy

77385, 77386, 77422, 77423, 77470, 77520, 77610, 77615, 77620, 77761, 77762

$505.51

$492.89

-2.5%

5624

Level 4 Radiation Therapy

77605, 77763, 77770, 77771, 77772, 77778, 0395T

$696.21

$731.39

5.1%

5625

Level 5 Radiation Therapy

77522, 77523, 77525

$1,150.69

$1,115.64

-3.0%

5626

Level 6 Radiation Therapy

77373

$1,671.91

$1,663.52

-0.5%

5627*

Level 7 Radiation Therapy

77371, 77372

$7,300.24

$7,552.92

3.5%

8001

LDR Prostate Brachytherapy Composite

55875 and 77778 on the same day

$3,385.44

$3,426.25

1.2%

APC

Description

CPT Codes

5092*

Level 2 Breast/ Lymphatic Surgery and Related Procedures

5093*

APC reassignments for 2017 are highlighted in bold *Comprehensive APC in 2017

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

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

D

oes your facility need help on applying for accreditation? In each issue of this newsletter, I’ll present frequently asked questions (FAQs) of particular importance for medical physicists. You may also check out the ACR’s accreditation website portal (click “Accreditation”) for more FAQs, accreditation application information 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 mammography accreditation.

Q. When was the new ACR Digital Mammography QC Manual published?

A. The new ACR Digital Mammography QC Manual was published on July 29, 2016. A link to download the new manual at no charge was emailed on August 1, 2016 to the Facility Contact (the person with the ACR Mammography Accreditation log-in information) and technologist Contact at all ACR-accredited mammography facilities. They were instructed to share this link with their colleagues at the facility, including their medical physicists.

Q. I am the medical physicist for several ACR-accredit mammography facilities. How should I obtain the new QC manual?

A. A link to download the new manual at no charge was emailed to the Facility Contact (the person with the ACR Mammography Accreditation log-in information) and technologist Contact at all ACR-accredited mammography facilities. They were instructed to share this link with their medical physicists. Contact your mammography facility and ask them to send you the link.

Q. I am not affiliated with an ACR-accredited facility. How may I obtain a copy of the new manual?

A. Individuals not associated with ACR-accredited facilities may purchase the manual from the ACR catalog.

Q. I am on the faculty at an educational institution. Is there volume discount pricing to obtain the new QC manual?

A. Yes. Please contact Wil Creech for volume discount pricing.

Q. Is the new QC manual available in hard copy?

A. No. The new manual is only available as an electronic file (PDF). If you would like a hard copy, you may print the PDF file. You may wish to use a commercial office printing company to print the manual double-sided and in color. n

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Exclusive offer for AAPM members.

AAPM members get 10% off all survey meters when purchasing one or more phantoms.

Contact us to learn more!

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

IROC REPORT David Followill, PhD, Houston, TX

O

ne of the most important job functions of a medical physicist is the measurement and calculation of the clinical reference dosimetry of high energy photon and electron beams. Seventeen years after the publication of the Task Group 51 Report, the percentage of institutions monitored by the IROC Houston QA Center in North America that use the TG-51 protocol to calibrate their megavoltage beams is finally 100%. In 2014, McEwen et al published an addendum to the TG-51 report updating the sections pertinent to photon beams. However, there has not been any electron beam calibration addendum published, yet there are some known issues with the electron beam calibration portion of the TG-51 protocol that need to be updated. While most senior medical physicists are aware of these issues with electron beam calibration, it became obvious to us after David Followill’s talks at the 2016 Annaul Meeting identifying common errors identified by IROC Houston audits, that there were many junior medical physicists who were not aware of the TG-51 electron calibration issues.

This article focuses on one of the problems encountered calibrating electron beams with TG-51 using a parallel plate ion chamber and its ADCL determined ND,w calibration factor. The problem with this method is that the kecal values in TG-51 for some of the parallel plate chambers are incorrect and their use may lead to up to a 2-2½ % error in the electron beam calibration. If you use a parallel plate chamber, the recommended procedure by the AAPM Therapy Physics Committee, as published in the January/February 2000 AAPM Newsletter, is to assign an (ND,w)(kecal) product based on a cross calibration with an ADCL calibrated cylindrical chamber in a high energy electron beam [see TG-39 report (Med. Phys.

21: 1251-1260, 1994)] using worksheet C in the back of the TG-51 protocol. An analysis of this problem was presented at the 2001 AAPM meeting and can be found on the IROC Houston website. n

Table 1: Ratios of kecalND,w values determined from ADCL calibration and TG-51 tabular kecal values to those determined by cross calibration.

The top row is an average over all data, the second row is averages of the means for each energy which over represents some data points on energies that have a limited number of data points. The third and fourth rows represent the ratios for two possible energies.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

LEADERSHIP INTO ACTION: A REPORT FROM THE WPSC 2016 AAPM LUNCHEON Ashley Cetnar, MS, Columbus, OH

T

his year’s annual Women Physicist Luncheon took place in Washington DC at the AAPM Annual Meeting. This sold out event was attended by a variety of professionals at various stages in their careers with different backgrounds.

All came together to share their time, perspectives, and a meal in a unique interactive setting at the nation’s capital.

The meeting was kicked off by Nicole Ranger, Chair of the AAPM Women Professional Subcommittee, who discussed what leadership means to her. She also described existing and future WPSC projects including the WPSC newsletter (edited by Jennifer Pursley) and newly proposed working groups, including one focused on outreach initiatives. Her introduction was followed by an address by Bruce Curran, President of AAPM, who explained the benefits of gender diversity in his research team and acknowledged women serving in leadership roles within AAPM present at the luncheon. Laura Cerviño, Luncheon Chair, then provided a warm welcome and instructions to attendees prior to the moderated session.

The table discussions started by giving each attendee an opportunity to share their accomplishments and their goals.

Our association is filled with successful and ambitious women. Some of the accomplishments shared include becoming fellows, organizing national and local meetings, implementing clinical changes, publishing manuscripts, obtaining R01 grants, being invited lecturers, completing academic and residency programs, promotions in the workplace, founding start-ups, and balancing work and family responsibilities.

Attendees of the 2016 Luncheon.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

WPSC, cont.

The conversation was then guided by table moderators to a discussion on this year’s theme of “Leadership in Action.”

Attendees were asked to define leadership and discuss opportunities for leadership in their own sphere of influence.

Below is a word cloud based on the feedback from women during the session on what leadership means to them.

The word cloud highlights themes that developed during the table discussions. The size font is proportional to the frequency of keywords that appear in the notes from each table. You will notice the emphasis of working together as a team since leadership cannot take place in a vacuum. Great leaders inspire others. They have vision and insight and are able to leverage the effort of individuals and groups to solve problems. A common observation was that you don’t have to be the oldest or most experienced to be a leader.

As a first time attendee, I was impressed with the number of women participating in the luncheon and the rich discussion during the wonderful meal. This was an opportunity to meet fantastic colleagues and was moderated in a way that everyone could participate and grow through the conversation. This was a highlight of the Annual Meeting and is a mustattend event. Please make sure to reserve your ticket early for next year in Denver, because this is a unique experience that you do not want to miss.

The success of this event is due to the stewardship of Laura Cerviño (Luncheon Chair), Jaclyn Marcel (fund-raiser), many senior women mentors who served as discussion moderators, the tireless work of our AAPM staff, and the generous sponsorship of the following companies/organizations: Elekta, Landauer, Nelco, Philips, MD Anderson Cancer Center, PTW, Radcal, ABMP, ACR, CivaTech Oncology, LAP Laser, Modus QA, RIT, Sun Nuclear Corporation, and WePassed. n

Word cloud showing themes from leadership discussion.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

MEDICAL PHYSICS LEADERSHIP ACADEMY WORKING GROUP REPORT Jessica Clements, MS, Chair, on behalf of the Medical Physics Leadership Academy Working Group, Los Angeles, CA

Introduction to the Medical Physics Leadership Academy and Emotional Intelligence Health care is changing rapidly. Expectations are higher and we face new and more complex reimbursement models. While medical physicists have technical skills, we must develop effective leadership and management skills in order to play a meaningful role in our practice environments, whether clinical, research, industrial or regulatory. The Medical Physics Leadership Academy (MPLA) was created to help AAPM members become more effective in this aspect of our professional practice. The Medical Physics Leadership Academy (MPLA) was created to help AAPM members become more effective in this aspect of our professional practice. MPLAWG members include: Marco Corlone, James Goodwin, Per Halvorsen, Michael Herman, Jennifer Johnson (vice-chair), Robin Miller, Dan Pavord, Russell Ritenour, Ehsan Samei and Gerald White.

How did the MPLA come into existence? For the past several years, there has been much discussion within various AAPM groups about how to provide leadership and management training to members with the intent to continue to advance the practice of medical physics. My first involvement in these discussions was at the Professional Council meeting at the 2011 AAPM Annual Meeting in Vancouver. Bill Hendee shared news about other related professional organizations building leadership programs and had in hand a copy of Daniel Goleman’s book, Emotional Intelligence. Charles Coffey expressed interest in providing leadership training to graduate students and residents and was hopeful that resources could be developed by AAPM. In the months after that meeting, several options were explored. The American College of Radiology’s Radiology Leadership Institute (RLI) was scheduled to launch the following summer. John Hazle and I spent time evaluating the program and working out an affiliation between AAPM and the RLI. AAPM was in fact the first formal affiliate and was finalized just before the launch of the RLI program. This partnership was a great first step because it allowed AAPM members to register for RLI events at discounted affiliate rates even if they weren’t ACR members. Realizing that these meetings were very expensive and how difficult it can be for medical physicists to attend meetings, I made arrangements with AAPM and ACR staff to have our annual and spring meeting professional program abstracts and learning objectives sent to the RLI to be mapped to the program so that AAPM members could obtain RLI credits at existing AAPM meetings. Several sessions at Annual Meetings have awarded RLI credits. While the AAPM continues to support the RLI as an affiliate organization, the AAPM has moved forward with development of our own leadership and management resources.

At the end of 2014, Jennifer Johnson submitted a Summer School request for proposal for a “mini-MBA” concept and Ehsan Samei submitted for a Medical Physics 2.0/3.0 concept. The Summer School committee combined the two ideas into one for the 2016 summer school which was ultimately named after our workgroup: Medical Physics Leadership Academy. See more details about the 2016 summer school here.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

MPLA, cont.

In the early planning phases of the MPLA summer school, the MPLAWG along with PC leadership and AAPM staff, formulated a request for proposal to several groups that offer leadership training services. On one of our first calls with Impact International, we were really excited about an idea to use an instrument called an Emotional Competency Inventory (ECI). The ECI is a research-based 360-degree feedback tool designed to provide a precise look at individual Emotional Intelligence (EI) strengths and challenges. Based on feedback from yourself, your manager, your peers, and others, the ECI indicates the specific emotional competencies where development is needed to enhance emotional intelligence and build capacity for further effective leadership. Approximately 30 individuals chosen from the four AAPM councils, MPLAWG members and summer school faculty completed the 360 in early 2016. According to several published studies, emotional competencies can be learned and can contribute to effective performance at work. There are combinations of competencies that can be more effective for you, depending on your situation. You also don’t have to master each competency to be successful. Impact International provided an aggregate report from the initial ECIs. As a group, we have the greatest opportunities with two of the six essential competencies: empathy and emotional selfawareness. We also have opportunities with auxiliary competencies of conflict management, initiative, adaptability and service orientation. The working group chose to initially focus on the two core competencies with a presentation in the professional track at the 2016 Annual Meeting.

The MPLAWG continues to analyze feedback from the summer school. When we met at the annual meeting, a few key projects quickly emerged. We will be forming at least three task groups to work on these projects: 1) Survey the Society of Directors of Academic Medical Physics Programs (SDAMPP) about developing resources to help them provide leadership training as required by the ethics and professional curriculum. (Section 8.6 of residency standards) 2) Development of a MPLA website with resources. This may also include a mechanism for AAPM members to order a 360 ECI. 3) Coordination of additional training. This may be at existing AAPM meetings, through online seminars, or through specialty meetings.

Please feel free to contact the MPLAWG if you have any suggestions or interest in these projects — we have so much work to do! n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

STANDING OVATION FOR THE 2016 AAPM SUMMER SCHOOL AND THE LAUNCH OF THE AAPM MEDICAL PHYSICS LEADERSHIP ACADEMY Jennifer L. Johnson, MS, Houston, TX and Robert Pizzutiello, MS, Victor, NY, Course Directors

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ne hundred eighty attendees arrived at the Westfields Marriott in Chantilly, Virginia, uncertain what to expect. It was being held in a conference center, an unusual venue choice for an AAPM Summer School. The traditional classroom seating was replaced by 24 large round tables with a Summer School faculty member at each table to promote group interaction. Finally, the topic was certainly different: leadership and business skill development designed to be applied in any imaging or therapy practice environment, be it a community hospital, an academic center, a vendor, or a private practice setting. Each session included practical didactic information, blended with exercises and interactions specifically designed to make learning more effective and address the practical challenges of leadership and management.

Impact International faculty with leadership and organizational development expertise and medical physicists with leadership experience set the tone for the summer school. Over the course of five days attendees delved into various leadership and management skills and insights. They learned ways to recognize emotions and their effect on work, establish rapport, lead through action, strengthen team discussions, interview better, plan and justify projects and staffing, grasp accounting and financial concepts, define the medical physicist’s value, communicate better, market themselves, cope with upcoming healthcare economic changes, and tie everything together into different practice settings.

Perhaps most importantly, attendees bonded from sharing experiences with different groups while attending different sessions, and enjoying delicious meals, longer coffee breaks, and refreshments on the patio at the end of each day.

They participated in an icebreaker, scavenger hunt, museum excursion, a group bike ride, and poolside chats. They experienced firsthand that leadership is not achieved in isolation or only in a conference room.

Instead, successful leadership greatly depends upon building relationships and consistently practicing newly developed skills in any environment. Their willingness to experience the unexpected will shape their own future, and the AAPM Medical Physics Leadership Academy hopes to shape other physicists’ futures as well. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

MEDICAL PHYSICS 3.0 COMMITTEE REPORT Ehsan Samei, PhD, Durham, NC

Introducing Medical Physics 3.0: What is it, and why you should care?

Redefining and reinvigorating the role of physics in modern medicine

Medical Physics is at a crossroads. Broad and profound changes in the delivery of healthcare are underway and accelerating, and it is urgent for our profession to address these changes head-on. We are faced with new mandates to deliver value-based, personalized, and evidence-based medicine. Reimbursements are diminishing at the same time. These realities necessitate medical physics to change. In any progression of this nature, it is crucial to understand the goals and proactively set a standard that can clarify, unify, and motivate the advancement.

Medical Physics 3.0 (MP3.0) is an initiative to define and practice sustainable excellence in medical physics. MP3.0 is re-visiting our roots and re-envisioning our desired contributions to quality healthcare. It asks the question of whether we are fulfilling our potential, and if we are not, how we can do so. MP3.0 is based on the core premise that medical physicists have a unique calling and expertise to be scientific agents of precision and innovation in the development and practice of medicine. MP3.0 aims to foster a culture within medical physics of seizing such opportunities, engaging proactively and meaningfully in patient care, and growing and building upon the unique skills of medical physicists. Towards this goal, the MP3.0 initiative is devising the following road map: 1. Competence •

Delineating the global definitions of excellence for medical physics: scholarship, innovation, patient care, and context-awareness

•

Clinical: Advancing medical physicists beyond the conformance-based technology-care provider to the scientific, quality-bound healthcare provider

•

Administrative: Modeling leadership and management skills and attributes for confident and effective practice (in collaboration with the Medical Physics Leadership Academy)

•

Scientific: Setting the models of scientific excellence and innovation in all domains of medical physics in recognition of its interplay with associated disciplines (e.g., engineering, biomedicine, informatics)

•

Educational: Encouraging updated and enhanced teaching skills to empower and to improve human health around the world

2. Visibility

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Developing targeted marketing, advocacy, and communication tools to effectively articulate value-based medical physics

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Med Phys 3.0, cont.

3. Sustainability •

Modeling MP3.0 practices that can be achieved and sustained

•

Encouraging pragmatic resources for MP3.0 practice

4. Expansion •

Clinical: Identifying and encouraging areas of clinical growth where care can be enhanced with new physics contributions including robust pathways for translation of science to practice

•

Scientific: Encouraging opportunities and claiming roles for meaningful engagement of physics in all areas of medicine, including domains beyond radiation medicine

•

Educational: Devising and encouraging enhanced educational opportunities to position the physicist to have the competence and the confidence to fulfill his/her unique role as a scientist and as a practitioner along the MP3.0 objectives.

MP3.0 currently has a number of projects underway including the production of a video series designed to express the value of medical physics to patients, administrators, and physicians, educational offerings at the upcoming RSNA and AAPM meetings, a webpage with examples of “MP3.0 in practice”, and white papers to delineate how physicists can enact, express, and enhance the full value of physics towards human health.

AAPM launched the MP3.0 initiative through an Ad Hoc Committee in 2016. MP3.0 expands upon a three-year pilot trial of the concept (under the brand name Medical Physics 2.0) which contributed to a multi-year series of advanced, imaging–focused refresher courses at the RSNA, the formation of Medical Physics Leadership Academy, and the 2016 Summer School. The rebranding to 3.0 aimed to encompass a broader scope including therapy physics and all the subdomains of practice including clinical, research, education, and administration.

The membership of the MP3.0 committee includes Dan Bourland, Shiva Das, Mary Fox, Jay Freedman, Nick Hangiandreou, David Jordan, Melissa Martin, Robin Miller, Bill Pavlicek, Dan Pavord, Todd Pawlicki (Vice-Chair), and Ehsan Samei (Chair). I encourage you to contact any of us with ideas and suggestions. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

REPORT FROM THE IMAGING PRACTICE ACCREDITATION SUBCOMMITTEE David Jordan, PhD, Cleveland, OH

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he Working Group on Magnetic Resonance Testing and Quality Assurance has been working to compile detailed tips and step-by-step instructions for carrying out MRI performance tests to help medical physicists perform the tests required by the 2015 ACR MRI Quality Control Manual (and, previously, the 2004 edition). Many AAPM members who perform these tests have different degrees of experience and comfort with some aspects of the testing that are specific to individual scanner makes and models.

The Working Group has posted an initial document with vendor-specific tips for measurement of magnetic field homogeneity (B0) using the different methods described in the ACR manual. The document provides detailed, step by step instructions on how to setup, acquire, and analyze the data for Siemens, GE, Hitachi, Toshiba, and Philips MR systems. The PDF document can be downloaded from the Working Group wiki page for offline use.

We need your help! Please download the document, try it, and send us your feedback as we intend to revise and add to this document on a regular basis. We would like to capture your best tips and suggestions, both for making this a more useful field reference guide and for adding things that are not yet included.

Over the coming months, the Working Group will be working on additions and revisions to the homogeneity testing guide — based on your feedback — and drafting similar guides for RF coil testing. Your suggestions and contributions are welcome, whether you wish to join the WG or just submit a comment or favorite tip. Stay tuned for further announcements when we post revisions, updates, and new guides. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

AAPM PROFESSIONAL SERVICES Robin Miller, MS, Vice Chair Professionals Services Lynnwood, WA and Russ Tarver, MS, Chair, Professionals Services, Fort Worth, TX

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APM wants you to volunteer. Consider that the AAPM membership is, in fact, comprised entirely of volunteers.

Given the current environment of doing more with less, of working more hours with diminishing resources, what is the benefit? What do you get for your efforts?

1. You build your network Being on a committee or any of its variants (subcommittees, task groups, working groups, etc) is an easy way to meet a variety of physicists. It can be overwhelming to meet new people at the Annual Meeting where the attendance is in the thousands. All committee meetings are open to members unless in executive session. Growing your personal network can be instrumental for future job searches, pesky clinical or research questions and finding a great mentor.

It’s also an opportunity to personally meet our great AAPM staff. Each committee has a staff liaison assigned to it.

2. You learn new skills Committees have a general structure: there is a chair and a vice chair — a chain of command. There is a charge or mission, a work product or goal to accomplish. You may not be chief of a department, but you could demonstrate leadership by becoming the chair. You can define your management style and finesse diplomatic and negotiating skills.

3. You give back By participating you can gain insight into the internal and external forces that will impact your career. You can have an active role in the future of your chosen profession. You can contribute to the protocols and guidelines that affect the way you work.

How do you know what committee might be a good fit? Browse the committee’s webpages to see the roster, minutes and general activities. Look for committees whose charge interests you, or needs specific skills you have.

How do you actually volunteer?

• • • •

Check the committee classifieds (aka yellow pages) for open positions.

Show up to a committee meeting and participate.

E-mail the committee chair and ask to be a guest. This allows inclusion on the committee alias and emails but not a vote.

Do you have a good idea? Suggest a TG.

Things to be aware of: •

As mentioned, AAPM is a volunteer organization… and chairs/vice-chairs have fulltime jobs and lives. Sometimes — sometimes more than other times — it may take a while to hear back from a chair or committee on a request to be involved or added to the guest list. Do not accept silence as a denial. Be politely persistent until you do get an answer. If that answer is no, do not take it personally; there are likely many individuals doing exactly what you’re trying to do, which is getting involved.

•

Consider the commitment. Once you “break the glass,” be careful about overextending your personal resources. If offered a position, ask the Chair about realistic commitments. Some committees function primarily through telecom and email. Some however, meet several times a year face-to-face. You want your experience on a committee to be positive, so be aware of the commitment you’re giving when asked. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

IMAGE WISELY UPDATE Eric Gingold, PhD, Philadelphia, PA AAPM Representative on Image Wisely Executive Committee

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mage Wisely is an initiative supported by the ACR, RSNA, AAPM and ASRT to raise awareness and provide educational resources for radiology professionals and referring clinicians regarding the use of ionizing radiation in adult medical imaging examinations. The goals of the program are to optimize radiation techniques, and to encourage monitoring of dose indices for continuous quality improvement.

The Image Wisely website contains a wealth of practical information for the diagnostic imaging physicist, such as regulations and standards news, educational review articles, selected RSNA educational exhibits, and “Radiation Safety Cases” which provide free CAMPEP credits. Stay updated about new content on the website by following @imagewisely on Twitter. The Image Wisely website received over 86,000 visits during Jan-June 2016, a 30% increase vs 2015.

AAPM members are encouraged to take the Image Wisely Pledge to optimize the use of radiation in imaging, which now must be reaffirmed each calendar year.

Image Wisely is actively soliciting new Radiation Safety Cases for its website. If you have a topic that could be presented as a “case” with images and a narrative that illustrates dose optimization in imaging, please contact me. The Radiation Safety Cases have become one of the most popular features of Image Wisely, with 18,500 total enrollments to date. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

WILLIAM D. COOLIDGE GOLD MEDAL Introduction of Paul M DeLuca, Jr. by colleague and friend Rock Mackie

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am delighted to be introducing Paul M. DeLuca Jr., a giant of medical physics. Paul grew up in Upstate New York as the oldest son of a neurosurgeon, who was also the son of a general surgeon. Wanting to do something more challenging than being a brain surgeon, he received his bachelor’s degree in physics and math from LeMoyne College in Syracuse New York in 1966. He then attended University of Notre Dame where he attained a PhD in nuclear physics in 1971. His love of Notre Dame Fighting Irish is only challenged by his love of the University of Wisconsin (UW) Badgers. He came to the UW in 1971 and never left. He rose from post-doctoral fellow in the Department of Physics to the position of Provost and Vice Chancellor.

As a professor, Paul was prodigious. He taught UW MP 569 Health Physics for 35 years. It was universally accepted as the toughest course in our curriculum. Over the years he taught at least 700 medical physics or nuclear engineering students.

He financially supported and supervised 49 graduate students and was the PI on at least one grant throughout his entire career in which he had 129 peer-reviewed publications. Including AAPM, he was a member of 10 scientific societies. I am not sure how he afforded the dues for ten organizations. In addition to dozens of AAPM volunteer assignments, Paul has served as many years as the Chair or Vice-Chair of the main commission of the International Commission on Radiation Units and Measurements.

Paul was both a nuclear physicist and a medical physicist.

Combining these disciplines, he was one of the world’s experts in neutron dosimetry. One of his greatest achievements was as director and innovator of the Wisconsin Gas Target Neutron Source, which was one of the brightest neutron sources on the planet. This system used a deuteron accelerator coupled to a tritium gas target. The system had no vacuum window between the accelerator

Paul, the oldest, with five of his siblings.

Paul is on the right.

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Paul, wearing a suit is standing above his father and surrounded by his siblings.

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Coolidge Introduction, cont.

and the target but relied on multi-chambered differential pumping to achieve a gas density gradient of 7 or 8 orders of magnitude. Forty years later his innovation is being used as the neutron source for a sub-critical assembly for the production of fission-based nuclear isotopes to be soon constructed in Janesville, WI.

Clockwise from top left: Figure of the gas-target system. Paul characteristically hands on. Modern gas-target system to be used as the neutron source for a sub-critical assembly system from the production of medical isotopes.

Succeeding Medical Physics Department founder John Cameron and Herb Attix , both former Coolidge Awardees, Paul DeLuca was the department Chairman from 1987 to 1998. His time as Chairman corresponded to the years of the greatest growth of our department. In 1999 he was asked to become the Associate Dean for Research in the UW Medical School and by 2002 he was also serving as the Vice Dean of the newly renamed UW School of Medicine and Public Health. During his tenure in the Dean’s Office, Paul was the leading force for the greatest medical research facilities campaign in UW’s history. He personally oversaw hundreds of millions of dollars of new building and lab construction. The Medical Physics Department did very well by occupying the basement and ground floors of the first research tower abutting the hospital and the medical school and in direct access to both radiation oncology and radiology resources. This gave our department the largest and best space and equipment in the world and for the first time housed the majority of the students and faculty in one location. In 2009 an open nation-wide search picked him to be the UW Provost and Vice Chancellor, the highest academic ranking achieved by a medical physicist in an American university. Paul once again was focused on facilities and achieved, during his time as the second-highest UW official, an unprecedented updating of the scientific research enterprise on campus and making it one of the largest biosciences universities in the world and consistently ranking in the top three recipients of NIH funding.

In addition to the William D. Coolidge award that he is being honored with tonight, Paul is a Fellow of AAPM, the 2005 UW Medical School Folkert O. Belzer Lifetime Achievement Award recipient as well as the 2007 UW Rennebohm Research Professor. Paul would consider though that the greatest honor was to be able to be of service to students, his colleagues in the Medical Physics Department and the UW.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Coolidge Introduction, cont.

Besides his intelligence, Paul’s greatest virtue is his sense of duty. He is selfless but that doesn’t mean he is a push over.

He is tough when he needs to be but always clear-minded and calm. He works hard but enjoys life, friends, travel, and family. He and his wife Florence have been blessed with wonderful kids, Paul DeLuca (the Third) and Kelly, who are also at the awards ceremony with Paul and Florence’s grandchildren.

Finally, I would like to thank AAPM for giving me the chance to introduce Professor Emeritus Paul M. DeLuca, Jr., the 2016 AAPM William D. Coolidge Awardee.

Clockwise from top left: Paul is an experienced Italian chef (Graduate student Angela Perez-Andujar is next to him). With his wife Florence at a Badger football game. With his staff in the Provost’s office at Christmas (his long-time secretary Colleen Schutz is on the left). Paul and Florence with their children Kelly and Paul and their grandchildren.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

WILLIAM D. COOLIDGE GOLD MEDAL ACCEPTANCE SPEECH Paul M. DeLuca, Jr., Madison, WI

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hocked, amazed, humbled, …. what can one say that encompasses this honor?! Certainly not expectation.

Before the ceremony this evening, the ever-meticulous Nancy Vazquez stressed the need to report on-time to a specific room. Upon arriving I realized this room was set aside for meditation and prayer — logically I assumed AAPM had changed their mind about the award!

There are many to thank for this wonderful decision. Geoff Ibbott and the AAPM Awards and Honors Committee are certainly at the forefront. I am sure there are many deserving of this honor. The AAPM Executive Committee and Board for endorsing the Awards and Honors recommendation. Rock Mackie, who just provided the outstanding introduction this evening, for shepherding the nomination and being such a colleague, friend and confidant these many years. Scientists like Rock are the backbone of creativity for medical physics.

Such a recognition is really a reflection of decades of effort, collaboration, and pursuit of the discovery process by many individuals. First amongst these are the compelling mentors I enjoyed. These include John R. Cameron, often thought of as the father of medical physics, but assuredly a founding member of medical physics. John, the first chairman of our department, knew where we needed to go and expended exceptional energy getting there. Herb Attix — his insight into experiments and their results defined ingenious. Herb epitomized the philosophy that less is more! Heinz Barschall — an experimental nuclear physicist of unparalleled accomplishment. Heinz’s iconic career is almost unequalled. We spent countless hours planning and executing and analyzing data from experiments at facilities world-wide. He was my closest friend and colleague. Chuck Kelsey led the way for University of Notre Dame graduates in nuclear physics to the field of medical physics at the University of Wisconsin – Madison. He was a model for employing physics solutions to creative medical applications. Chuck brought me to UW and was in a leadership role for developing the Gas Target Neutron Source (GTNS). The aforementioned individuals were far more than mentors and served to form my career in medical physics. A luxury few enjoy.

Speaking of the GTNS, which served as a platform for two decades of research and many graduate theses, the initial design and development was made possible by a tiger team of colleagues. These included Gary Chenevert (USDOE), Nick Detorie (Johns Hopkins), Joe Tesmer (LANL/LAMPF) and Dick Tortie (MIT). All PhD nuclear accelerator physicists who went on to enjoy exceptional careers, shown parenthetically. The GTNS eventually reached an intensity only exceeded by RTNS II at LLNL, and serves as the design basis for a unique facility to produce the nation’s supply of Tc — the SHINE program at Wisconsin.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Coolidge Acceptance, cont.

Students! None of this would have been possible without the exceptional students I had the pleasure of serving as their major professor. Spanning four decades of research these students created a fabric of knowledge surrounding fast neutron interactions. This included establishing the technique for determination of elemental neutron kerma coefficients by microdosimetric measurements. Using pulse beam neutron time-of-flight techniques these students covered the energy range from 10 to 100 MeV. Other measurements determined cell death from photons less than 1000 eV where controlled portions of the cell nucleus were radiated. In short, the body of work and creativity of these exceptional young scientists forever changed our knowledge base. I contributed, but they carried the bulk of the science. I am forever grateful to them for these accomplishments.

While important, no individuals compare to the support of my family. My wife Florence and two children, Paul and Kelly, their spouses Kerry and Jason, and certainly our six grandchildren, Patrick, Ryan, Molly, Thomas, Colleen and Ben provided a compelling reason to work as hard as possible. Florence has been my wife, my friend, my collaborator, and the mother to this brood in an unparalleled manner for several decades. Nothing would have happened without her love and support and perhaps forgiveness for the innumerable missed dinners, trips, holidays, etc.

Let me now turn briefly to AAPM and the field of Medical Physics from a somewhat historical point of view. The slightly modified cartoon adopted from Larson sets the stage for the early years. Certainly in the late 60’s and early 70’s, when compared to other basic medical sciences, medical physics was a small emergent discipline. Few NIH Study Sections were populated by medical physicists. There was no institute aligned with medical physics research. What was increasingly clear was that the NCI/NIH budget was going to grow dramatically over the next decade. Unfortunately, not being strongly a part of the research fabric of leading research-one institutions, federal funding of medical physics science was going to be a challenge. Moreover, medical physics suffered from a multiple personality syndrome — were we clinical or were we basic? This latter point was a major source of debate amongst the AAPM membership.

From the present meeting alone, we can now clearly say that AAPM enjoys enormously firm footing amongst our clinical brethren as well as our basic science and engineering colleagues. AAPM leadership deserves our strongest appreciation for the many accomplishments that have led to this result!

Returning to the early years, the “Larson conundrum” also presented a unique and exceptional opportunity for medical physics. Advances academically and scientifically were greatly needed, but the opportunity to make them was finally there. In pursuit of this, I spent the next 15 years establishing the strongest academic department of medical physics possible in a large research-oriented medical school at a research one institution — University of Wisconsin. Success required AAPM to establish CAMPEP and to implement a formal accreditation process similar to other science and engineering disciplines, yet to retain the “professional” credentialing essential for our field. CAMPEP has been instrumental to this process. This has all come to pass.

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

Coolidge Award Acceptance, cont.

THERE ARE SO MANY INTEGRATING POTENTIAL HOLES IN PATIENT SAFETY THE PROCESS FOR IN RADIATION RADIOTHERAPY ONCOLOGY QA...

One of the

By Integrating Patient Safety in primary weaknesses of the traditional pointbased MU verification approach is that there can be one Radiation Oncology™, SunCHECK™ or multiple significant dose discrepancies elsewhere in the field(s), beyond the regions that directly impact the connects the dots between potential chosen point(s). In IMRT and VMAT, complex intensity errors and real possibilities for distributions exist within each field and contribute to improved care — across optimized the dose distributions in the full patient geometry that cannot be adequately verified by simple numerical QA workflow.

The next and necessary evolution of the secondary dose calculation process will require verification of all patient dose distribution points (i.e., the full patient dose volume) to adequately account for the myriad variations inside the treatment fields as generated for IMRT, VMAT, and other complex modern treatment techniques.

The method utilized to perform this verification involves a secondary calculation of the full patient dose volume using a robust, modern dose calculation engine (e.g., Superposition/ Convolution). The input for this process is the field intensities as a function of time, most often captured by the DICOM RT

In closing, I cannot easily express the breadth and depth of my appreciation for this honor. Thank you. n

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© 2016 Sun Nuclear Corporation. All rights reserved.

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The foregoing discussion is founded in a core discipline, medical physics, that works on the “edge” of several related disciplines.

From this frictional heat arises a spectrum of creative discoveries and advances otherwise unidentified or appreciated. Moreover, what is true for medical physics is also true for other areas of science and engineering.

Exercising this option consumed the next 12 years of my career! Pursuing these opportunities nationally is now changing the core beliefs of major science and educational entities — translational multifocused research is important. However, fundamental science is not going away!

Working along the overlapping disciplines is expanding the already strong base of fundamental science! During my five years as Provost, I enjoyed a unique opportunity to play a small role in this strong revolution of science and discovery.

PLANNING TO ATTEND

RSNA 2016?

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

The Hyatt Regency Chicago 151 E. Wacker Drive AAPM Meetings and Annual Reception will be held at the Hyatt Regency Chicago RSNA 102nd Scientific Assembly and Annual Meeting November 27 – December 2, 2016 Chicago, IL Final Housing and Discounted Registration Deadline:

November 4

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

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

PERSON IN THE NEWS Mark T. Madsen, PhD, Iowa City, IA

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he Society of Nuclear Medicine and Molecular Imaging (SNMMI), an international scientific and medical organization, recognized contributions to the field of nuclear medicine and molecular imaging during its 2016 Annual Meeting in San Diego, CA in June. Several awards ceremonies were held to recognize the valuable role SNMMI members play in advancing the diagnosis and treatment of heart disease, cancer and neurological conditions.

Henry N. Wagner, Jr., MD, Best Paper Award Mark T. Madsen, PhD, Professor of Radiology in the Department of Nuclear Medicine at the University of Iowa in Iowa City, Iowa, received the Henry N. Wagner, Jr., MD, Best Paper Award for “Personalized kidney dosimetry for Y-90 DOTATOC radionuclide therapy.” n

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Learn more about Adaptivo at: www.standardimaging.com/adaptivo

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CARS Newsletter Fall 2016 Learning from Small Incidents

We have recently seen several minor incidents at an institution, none of which had any consequences for patients. The incidents occurred at various stages in the radiotherapy process.

When taken as a whole, they pointed to two problems across the facility: lack of a cohesive communication pattern and a scheduling problem.

The same information in the facility sometimes would be communicated through notes in a chart and other times through checks on a form, sometimes written and sometimes verbally. The solution would best come from establishing a working group with representatives from each of the disciplines involved, including the physicians, clericals, therapists, dosimetrists, nurses, physicists and any others. The group discussion should consider what formats would best suit each type of information and who provides the information to whom. Diagrams of the flow of information usually highlight issues and help streamline communication patterns.

The scheduling problem produced days with too many patients interspersed with very slow days. Most of the incidents occurred on the very busy days and those involved commented on not having time to take great care with their work. Again, the problem should be address by a group with representatives of all those involved walking though the processes and finding why the schedules become erratic and how to even the work flow.

While each incident was minor, as Frank Rath says, many small incidents indicate a process out of control and that can lead to major events.

Bruce Thomadsen Director, CARS Radiotherapy Incident Reporting and Analysis System CARS is a 501(c)(3) non-profit Patient Safety Organization listed with the Agency for Healthcare Research and Quality

CARS -PSO brthomad@cars-pso.org

4913 Waukesha Street, Madison, WI 53705

608-345-5795

AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

REPORT FROM DICOM WORKING GROUP 7 (RT EXTENSIONS TO DICOM) Bruce Curran, MEng, AAPM WG-07 Liaison, Richmond, VA

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ICOM Working Group 7 (WG-07) met on Wednesday, August 3 – Saturday, August 6, 2016 at the AAPM Annual Meeting. During that meeting considerable time was spent discussing the DICOM supplements that comprise Radiation Oncology 2nd Generation DICOM. These supplements will significantly update and upgrade radiotherapy support for DICOM as they are released.

Supplement 147 (S147), the farthest along of the 2nd Gen supplements adds significant capabilities for RT Prescriptions and Segment Annotation. It provides structures capable of handling today’s complex IMRT, SBRT, and IGRT prescriptions, with capabilities for DVHbased prescription descriptions as well as physician intents. Complementing this are conceptual objects, recognizing that targets and organs-at-risk can have multiple representations depending upon imaging modality, temporal differences (4D, adaptive planning), and individual user differences. S147 provides data structures to convey such target / organ relationships along with appropriate prescription parameters. Physician intent and prescription parameters are now contained in their own object, allowing a simpler and more powerful representation that can be used to describe a set of plans rather than requiring a separate prescription with each DICOM plan object. Segments will now be able to be represented by DICOM Segmentations, which allow surface representations of targets and structures and improved facilities for multiple image dataset visualizations. The supplement is nearing completion after several rounds of review

by DICOM subject matter experts.

Following Supplement 147 are five additional releases currently in development by WG-07. A brief description of the supplements is as follows: Supplement 175: provides a new object for describing beams created by conventional (C-arm) linear accelerators Supplement 176: describes new objects for describing beams created by robotic delivery devices, gamma stereo delivery devices, and other non-conventional radiation delivery devices Supplement 177: augments the descriptions of delivery dose (RT Dose Objects) to allow better representation and comparison of treatment and algorithm differences Supplement 178: describes a formalism for workflow management during the treatment planning and delivery process Supplement 179: adds descriptive material to DICOM Part 17 to assist developers in writing code to create or interpret 2nd generation DICOM objects In addition to the 2nd generation work, WG-07 continues to make progress on new brachytherapy workflow and object definitions, ion therapy object definitions, treatment and positioning workflow, and templates for treatment machine and target/OAR definitions.

As the first of the supplements, S147 is anticipated to be elevated to Trial Implementation status in early 2017. The Trial Phase will allow manufacturers and users to begin testing its data structures and capabilities. n

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

INTERNATIONAL WORKSHOP: UPDATES ON CLINICAL RADIOTHERAPY MAY 24 – 27, 2016, CHENNAI, INDIA Dr. Kuppusamy Thayalan, Chennai, India and Cheng B Saw, PhD, Dunmore, PA

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n International Workshop: Updates on Clinical Radiotherapy (IWRT) hosted jointly by Dr. Kamakshi Institute of Medical Sciences and Research (A unit of Dr. Kamakshi Memorial Hospital pvt Ltd) and the Department of Medical Physics, Anna University was held at Chennai, India on May 24 – 27, 2016. This workshop was a 4-day workshop, conducted at the Tag Auditorium, Anna University, Chennai, India. The workshop was organized by Kuppusamy Thayalan, PhD in collaboration with Cheng B Saw, PhD with the mission of immediate transfer of the latest technology in cancer management to the participants, for safe and precise radiation treatments in this part of the world. About 160 delegates attended the workshop which included radiation oncologists, medical physicists, and radiotherapy technologists from India and other neighboring countries.

This workshop activity has been endorsed by the International Organization for Medical Physics (IOMP), The American Association of Physicists in Medicine (AAPM), Asia-Oceania Federation of Organizations for Medical Physics (AFOMP), Association of Medical Physicists of India (AMPI), and College of Medical Physics in India (CMPI). Medical Dosimetrist Certification Board (MDCB) and Commission on Accreditation of Medical Physics Education Programs (CAMPEP) have given 22 credit points by each organization. The Tamil Nadu MGR Medical University has also given 30 credit points for this activity. This is the first workshop with these credits in India, offering 74 credit points to each participant, and also attracted all the members of cancer management team (RO, MP, and RT) on the same platform. Furthermore this workshop exhibited the collaborations of volunteered efforts of active members of international societies of AMPI and AAPM. On May 25, the workshop was inaugurated by Dr. T. S. Swaminathan, former director of the Barnard Institute of Radiology and Oncology, Madras Medical College, Present Head of Radiology and Imaging, Dr. Kamakshi Memorial Hospital pvt Ltd. The welcoming address was delivered by Dr. K. Thayalan, Head Medical Physics Division, Dr. Kamakshi Memorial Hospital pvt Ltd. Dr. Cheng B. Saw, Director - Medical Physics, Northeast Radiation Oncology Centers, USA, briefed about the workshop. Dr. T.G. Sivaranjani, Director - Finance and Operation, Dr. Kamakshi Memorial Hospital pvt Ltd, released the e-souvenir, which was received by Dr. P. Aruna, Head, Department of Medical Physics, Anna University and the faculties among which are active AAPM members, Dr. Cheng B Saw (Northeast Radiation Oncology Centers, PA, USA), Dr. Ching-Chong (Jack) Yang (Monmouth Medical Center, NJ, USA), Dr. Eugene Lief (White Plains Hospitals, NY, USA), Dr. Weining (Khen) Zhen, (The University of Nebraska Medical Center, NE, USA), and Dr. B. Paul Ravindran (Christian Medical College, Vellore, India). The vendors, M/s Varian Medical Systems, M/s Elekta, M/s PTW, M/s Linatech, M/s Scandidos, M/s IBA, M/s Standard Imaging, M/s TeamBest Theratronics and M/s Meditronicx Co-operation were also honored for their support and participation. Finally Dr. A. Murugan, Chief Medical Physicist, Dr. Kamakshi Memorial Hospital pvt Ltd, delivered the vote of thanks.

In the morning sessions, there were seven theory lectures followed by the practical sessions in the afternoon. The morning session covered updates in (a) in-vivo dosimetry, (b) 3D brachytherapy planning and quality assurance, (c)

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AAPM Newsletter • Volume 41 No. 5 SEPTEMBER | OCTOBER 2016

International Workshop, cont.

EMR/EHR, (d) treatment planning strategies 3DCRT, IMRT, and VMAT, (e) patient specific QA, (f) IGRT and motion management, and (g) MRI linac. In addition, special emphasis was made on the use of SRS technique in the treatment of intracranial lesions and SBRT technique for the treatment of lung lesions with clinical examples. For the practical sessions the participants were divided into three groups in different rooms with audio-visual facility. M/s.Varian Medical Solution, M/s PTW and M/s Linatech have demonstrated their products and software with a hands-on session. This was mostly an intensive way of teaching and training. Similarly, lectures and practical sessions were conducted on May 26 and 27; the participants were rotated during the practical sessions in each room. Overall 22 lectures were delivered which included 17 faculty lectures and five technology updates by the vendors.

The workshop came to an end with a valedictory function. The delegates acknowledged the organizers for organizing a wonderful workshop. They wanted to repeat the same in the very near future. Feedback from the participants was obtained. Comments from the delegates included the statements that the workshop provided (a) invaluable hands-on experience on commercial treatment planning systems, and commercial QA products, (b) the seamless integration of linac from different vendors into a modern treatment planning system (c) awareness of up-to-date modern radiotherapy worldwide, and (d) the opportunity to meet local colleagues in the field. All the participants were given a certificate of participation, with endorsement and accreditation organizations’ logos and credit points, signed by Dr. Cheng B Saw (International Organizer) and Dr. K. Thayalan (Host Organizer). All the participants were also given a copy of e-souvenir, compiled by Mr. A. N. Muralidharan, which consisted of all the lectures and vendors’ advertisement and product specifications.

The Indian hospitality for the faculty included a visit to Dr. Kamakshi Memorial Hospital and a meeting with the management staff and a tour of the radiotherapy facility. The faculty also had a sightseeing tour of Mamallaprum, a UNESCO designated world heritage site of the city. A faculty dinner was arranged for that evening. n

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Upcoming Courses

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MIRD

MRSO

October 11-12th, 2016 8:30 AM to 5:00 PM

The popular Medical Radiation Safety Officer course is now virtual!

Current Issues in Clinical Radiation Safety 10 CFR 35 Regulatory Requirements Fundamentals of Radiopharmaceutical Internal Dosimetry Special Requirements for High-Dose Radionuclide Therapy Compliance with Patient-Release Criteria Radiation Instruments and Contamination Control Radioactive Material Security Radioactive Waste Management Managing Safety Culture Preparing for Audits and Inspections Dade Moeller Training Center Las Vegas, Nevada

Follow the link to register online: https://access.versantphysics.com/register/onsite

♦ Current Regulatory Requirements for both X-Ray Generating Equipment and Radioactive Materials ♦ Requirements of Materials Licensing ♦ Safety Culture and Radiation Safety ♦ Radiation Detector Understanding and Use ♦ Radioactive Waste Management ♦ Radiation Biology ♦ Managing a Personal Monitoring Program Inspections and Audits ♦ Training Program Development ♦ Sealed and Unsealed Sources ♦ Hospital Emergency Response

Online Registration: https://access.versantphysics.com/education/courses/register

Take a course online, attend a live session or both!

WWW.VERSANTPHYSICS.COM ♦ INFO@VERSANTPHYSICS.COM ♦ 888­316­3644

UPCOMING AAPM MEETINGS: March 18–21, 2017 AAPM 2017 Spring Clinical Meeting New Orleans, LA July 30–August 3, 2017 AAPM 59th Annual Meeting & Exhibition Denver, CO

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