AAPM Newsletter January/February 2017 Vol. 42 No. 1

AMERICAN ASSOCIATION of PHYSICISTS IN MEDICINE

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

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

IN THIS ISSUE: ▶ President’s Report ▶ Education Council Report ▶ Work Group on IMRT Report

▶ Meetings Coordination Committee Report ▶ Imaging Practice Accreditation Subcommittee Report ▶ IROC Report

▶ Bangladesh Medical Physics Society ▶ ISEP/AAPM/IOMP Radiation Therapy Physics 2016 and more...

JUL 30–AUG 3

AAPM 2017 DATES TO REMEMBER January 18

Website activated to receive electronic abstract submissions.

March 9 at 8PM Eastern, 5PM Pacific Time

Deadline for receipt of 300-word abstracts and supporting data.

This deadline recognizes other conference schedules. There will be NO EXTENSION OF THIS DEADLINE. Authors must submit their abstracts by this time to be considered for review.

March 22

Meeting Housing and Registration available online.

By April 18

Authors notified of presentation disposition.

By May 9

Annual Meeting Program available online.

June 21

Deadline to receive Discounted Registration Fees.

For the most up-to-date meeting and abstract submission information, visit www.aapm.org/meetings/2017AM/

CONTENTS ARTICLES IN THIS ISSUE 5 11 15 19 21 25 29 31 33 35 39 41

President’s Report Executive Director’s Report Treasurer’s Report Education Council Report ABR News Health Policy & Economic Issues ACR Accreditation Report Work Group on IMRT Report Meetings Coordination Committee Report Imaging Practice Accreditation Subcommittee Report Bangladesh Medical Physics Society ISEP/AAPM/IOMP Radiation Therapy Physics 2016

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

AAPM NEWSLETTER The AAPM NEWSLETTER is published by the American Association of Physicists in Medicine on a bi-monthly schedule.

AAPM is located at 1631 Prince Street, Alexandria, VA 22314-2818

EVENTS/ANNOUNCEMENTS 2 AAPM 2017 Annual Meeting & Exhibition Important Dates 4 AAPM 2017 Spring Clinical Meeting 4 AAPM 2017 Summer School 7 AAPM 2017 Annual Meeting & Exhibition Program Information 13 Condolences ­— AAPM Deceased Members 20 DREAM 28 AAPM 2017 Funding Opportunities 30 SCAMP 38 SUFP 40 Wiley Publishing

EDITORIAL BOARD Editor Jessica B. Clements, MS Kaiser Permanente E-mail: JessicaClements@gmail.com Phone: 818-502-5180 John M. Boone, PhD Robert Jeraj, PhD George C. Kagadis, PhD E. Ishmael Parsai, PhD Charles R. Wilson, PhD SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: E-mail: nvazquez@aapm.org AAPM Headquarters Attn: Nancy Vazquez 1631 Prince Street Alexandria, VA 22314 Phone: (571) 298-1300

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

PUBLISHING SCHEDULE The AAPM Newsletter is produced bi-monthly.

Next issue: March/April Submission Deadline: February 10, 2017 Posted Online: Week of March 5, 2017

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

CONNECT WITH US!

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Deadline to Receive Discounted Registration Fee: February 8th www.aapm.org/meetings/2017SCM/

SAVE THE DATE! MARCH 18–21, 2017 Hilton New Orleans Riverside New Orleans, LA

Registration and Housing Available Online: February 15

In conjunction with the American Brachytherapy Society The course will provide an intense experience to cover the state-of-the-art for clinical brachytherapy physics. Presentations will include the experiences from experts as well as discussion and dialog with course attendees. Workshops will provide practical hands-on opportunities for attendees to gain experience on nine key aspects of clinical brachytherapy physics, with

opportunities for feedback from the faculty. The course textbook will archive the contents of the presentations and workshops, provide example forms and workflows, and include practical problems and explanative solutions. Course attendees will learn up-to-date methods for the responsibilities associated with clinical brachytherapy physics. *This event is not endorsed or sponsored by Lewis & Clark

www.aapm.org/meetings/2017SS/

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

AAPM PRESIDENT’S REPORT Melissa C. Martin, MS, Gardena, CA

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t is my pleasure to write this first article for the Newsletter as your AAPM President. I look forward to a rewarding and exciting year with all of the planned activities for the organization. Bruce Curran is continuing with the possible updated governance project which is the most significant and time consuming activity that has been undertaken in a while. We have just completed the Board of Directors’ meeting at the RSNA meeting in Chicago where a more detailed explanation of this proposal was given to the members of the Board. You can contact your chapter representative for more details or wait until they are presented in an upcoming article from Bruce and at the Annual Meeting. Some of the proposed changes include a restructured set of Councils with elected Council Chairpersons, a Nominations Committee (elected), a Governance Committee, and Operations and Strategic Planning Committees of the Board along with a much smaller Board of Directors. Plans are in place for presentations to be given to each chapter prior to the Annual Meeting with details of the proposed reorganization. Please plan to attend your chapter meeting when this presentation is made to get details and voice your opinion.

The project that I am undertaking, that may or may not be successful, is to attempt to work with our AAPM Educational Program directors and leaders, along with the American Board of Radiology Trustees, Chair Valerie Jackson, MD, and the American Board of Medical Physics representative, to meet in mid-January at AAPM Headquarters to address the problems with getting enough Qualified Medical Physicists into the workforce, particularly in imaging. Now that we have had the residency requirement in place for a couple of years, there is a growing mismatch between the number of candidates completing residencies in imaging (diagnostic and nuclear medicine) and the increasing demand by accreditation bodies and regulatory requirements for QMPs in the clinical practice areas. When we have no way for a significant percentage of our Medical Physics graduates to even enter the process to become a QMP, an increasing divergence between the supply of physicists and the number of candidates eligible to enter the certifying process develops. It is recognized and documented that those candidates who complete residencies do better on the ABR certification exams. Therefore, we want to maintain those imaging residencies that are in existence whenever possible.

We are very aware though, that the funding of these programs is tenuous at best and may not continue in the future.

Therefore, we feel that we need to look at some alternate pathway for diagnostic imaging and nuclear medicine physicists to become qualified to enter the ABR Certification process.

Other projects that are moving along very well include Medical Physics 3.0 under the direction of Ehsan Samei. Some very interesting and informative videos about medical physicists and their stories, as well as the field of medical physics, are in production and should be available soon. Regarding international activities projects: there are currently many ongoing activities. I am writing this article on the long flight to Bangkok, Thailand to attend the International Congress of Medical Physics along with Alan Wilkerson and Yakov Pipman as IOMP delegates. Other speakers from AAPM at this meeting include Tony Seibert, Ehsan Samei, and Cari Boras.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

President, cont.

The planning for the upcoming Spring Clinical Meeting is solidly underway under the direction of Jessica Clements and her team including Chris Serago, Jean Moran, Annie Hsu, and other great program directors. The meeting will be held just after St. Patrick’s Day in New Orleans so if you have never attended a Spring Clinical Meeting, this one may be the one to start with: great program, great location, and great time of year in New Orleans. In addition, there will be a oneday course on implementing TG100 preceding the Spring Clinical Meeting.

Planning is also well underway for the 2017 Annual Meeting in the Mile High City of Denver. Another terrific job will, no doubt, be performed by the team at Headquarters this year regarding logistics. And once again, a fantastic scientific, professional, and educational program has been assembled. Please plan to attend one of these meetings, if not both, to keep up your required continuing education credits as well as learn the latest scientific developments.

As you can see, we have an exciting and busy year ahead of us and those of us in leadership really do appreciate the opportunity to work with all of you. Together we are a much stronger organization and community of medical physicists. n

Quality, Safety and TG100 MARCH 17, 2017 | HILTON NEW ORLEANS RIVERSIDE | NEW ORLEANS, LA

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n March 17, just prior to the Spring Clinical Meeting, plan to attend this full day interactive workshop to develop competence with the tools of TG 100, a structured systematic risk-based approach to quality management in radiation therapy.

WHO SHOULD ATTEND: Multidisciplinary participation is encouraged. The registration fee is the same for Medical Physicists, Dosimetrists, Therapists, Regulators and Administrators.

REGISTRATION NOW OPEN: Early Registration Deadline is February 8.

To allow full and active participation by all participants, no lecture is longer than 15 minutes. Participants will work on exercises in multidisciplinary groups of 4-8. Faculty will provide mentorship during the exercise sessions.

www.aapm.org/meetings/2017TG100/

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he theme for AAPM's 2017 Annual Meeting is “Connecting Our Pathways. Unifying Our Profession.” As many of us have observed in recent times, our profession of Medical Physics that had been functioning in fairly discrete segments not that long ago is now moving together at a rapid pace: Imaging with dual mode capabilities such as PET/CT or PET/MR and Therapeutic Modalities incorporating MR or X-ray localization immediately prior to energizing the treatment beam to ensure accurate placement of the treatment dose. Imaging is now an integral part of a Radiation Oncology Department to the extent that Radiation Oncology Physicists must be thoroughly familiar with all types of imaging modalities. The accuracy of treatment planning is totally dependent on the accuracy of the imaging information available for the patient. How we integrate the training of each of the current disciplines in Medical Physics is crucial to the success of our field in the future.

THIS YEAR… • Special 3-Day Program on Ultrasound

(Monday–Wednesday, July 31–August 2, 2017).

• The Science Council Session — Big Data, Deep Learning,

and AI in Imaging and Radiation Oncology (see below).

• SPS Undergraduate Research & Outreach — The Society of

Physics Students (SPS) Undergraduate Research & Outreach poster session highlights the work of undergraduate students with an interest in medical physics. The first author (and presenter) of all posters in this session must be an undergraduate at the time of submission. Posters should reflect either research related to medical physics or outreach to promote the importance of and relationship between physics in medicine. All undergraduate members are invited to submit.

• 2017 Certificate Course — A day-long track on Advanced

Imaging for Clinical Trials and Advanced Practice (see below) • Joint Scientific Symposium with the World Molecular Imaging

Society — Imaging Hypoxia • Joint Scientific Symposium with ESTRO – AAPM Symposium:

From Bench to Bedside via Veterinary Radiation Oncology • Distinguished Lectureships: • The Carson/Zagzebski Distinguished Lecture on Medical

Ultrasound — This speaker will highlight a specific advancement in the area of ultrasound imaging that

The Presidential Symposium this year will feature leading physicians speaking on the integration of each of the three branches of Medical Physics: Diagnostic Imaging Physics, Nuclear Medical Physics and Radiation Oncology Physics, into their practice. Their outlook concerning future developments that may be occurring as we speak with other modalities, particularly with the incorporation of the immunological therapy agents and genomic sequencing, will provide us valuable insights into our potential future work. The Radiology Profession has already incorporated Imaging 3.0 into their practice as we incorporate Medical Physics 3.0 into ours.

This year’s Annual Meeting in the Mile-High City of Denver will provide the perfect opportunity to showcase the highlights of our profession, which requires that all of us work together to bring into the clinic those exciting and significant developments being made by our researchers. Only when we utilize all of the talents of our multi-faceted profession will true success be obtained in providing the best possible diagnosis and treatment of our patients. Our Annual Meeting provides unique opportunities for you to share your scientific and clinical knowledge and skills. Ensure your professional development for the sake of our future in the field of Medical Physics by attending this year’s Annual Meeting in the Mile-High City.

—Melissa C. Martin, 2017 AAPM President

will be relevant to the medical physics community. This presentation will be held during the diagnostic ultrasound imaging sessions within the Special 3-day Ultrasound Track.

• The Anne and Donald Herbert Distinguished Lectureship

in Modern Statistical Modeling — Daniel Krewski, PhD, MHA, Natural Sciences and Engineering Research Council of Canada Chair in Risk Science, Professor and Director, McLaughlin Centre for Population Health Risk Assessment, University of Ottawa will discuss the statistical modeling involved in making conclusions from analysis of accumulated data on the effects of radiation at low doses.

• MR-in-RT mini-series: MR-in-RT is a multi-part course on

the role of MRI in radiation therapy, intended to offer comprehensive and focused education to both imaging and therapy physicists, including those who may have missed the MRgRT certificate course offered previously.

Coordinated sessions will be held in the Imaging Education, Therapy Education, Professional, and Practical programs.

• SAMs offerings in Education, Professional, Practical, and

Scientific Programs.

• Dedicated time in the meeting program for Visit the

Vendors.

• Guided Tours on the Exhibit Floor. SAM credit will be offered.

See below.

• Partners in Solutions — an exciting venue on the exhibit floor

(see below).

All sessions and technical exhibits will take place in the Colorado Convention Center, 700 14th St, Denver, CO. The education program and professional program will offer a significant opportunity to gain practical knowledge on emerging technical and professional issues. This year, the scientific program will also offer a special three-day track on Ultrasound.

CERTIFICATE COURSE — Beyond Clinical Imaging: The Role of the Medical Physicist in Clinical Trials and Response Assessment This year’s Certificate Course will be on Wednesday of the meeting (August 2) on the topic of “Beyond Clinical Imaging: The Role of the Medical Physicist in Clinical Trials and Response Assessment.” This course will be open to all registrants and will focus on the important roles that medical physicists — both diagnostic and therapeutic — play in clinical trials and in clinical practice where the assessment of patient response to treatment is being evaluated. This course will consist of 4 sessions: (a) an education session that will focus on clinical trials — both those using radiation therapy and those that involve diagnostic imaging — and on the roles that medical physicists may play in each; (b) an education session on advanced technologies such as MR-PET and MR/RT that are being used for trials and response assessment; (c) a scientific session with proffered talks on these topics and (d) a session that will describe several active clinical trial settings and the roles that medical physicists are playing now and in the future. All sessions aim to be relevant to both diagnostic and therapeutic medical physicists, will seek to identify the unique requirements

of trials compared to clinical practice and seeks to increase the communication between physicists in these important activities. All those who register for the AAPM meeting (weekly or Wednesday daily) will have access to these sessions as usual.

The mini-track will also serve as the certificate course at this year’s meeting, which provides an in-depth review of a particular topic with verification of learning objectives through online homework. Attendees may enroll in the certificate program for an additional fee. Enrollment in the program entitles participants to dedicated seating in the mini-track sessions as well as additional online materials. Following the meeting, certificate program participants will be required to take an online examination which covers the material presented throughout the day-long mini-track. Enrollees who demonstrate satisfactory attendance at the course and successful completion of the online examination (available after the meeting) will receive a framed certificate of completion for this course.

SCIENTIFIC PROGRAM Joint Imaging-Therapy Track

Therapy Track

The 2017 Joint Imaging-Therapy Track will feature exciting topics highlighting the latest science incorporating imaging for improving therapeutic interventions. In addition to over 30 hours of proffered sessions, this track will include invited symposia covering many exciting topics. For example, the topics on Automated segmentation, in vivo dose verification, optical image-guided surgery, MR guided radiation therapy, nanoparticles, machine learning in radiomics, functional and quantitative MRI, and research funding symposium from NIH. This year, the goal is to offer all of the symposia for SAM credits for those participating in the ABR’s MOC program who don’t want to miss out on hearing the latest science in imaging and therapy. Where possible we are coordinating sequential sessions from different tracks. For example, we will have sessions on machine learning from the Education Program, followed by symposia on new advancements and applications organized by the Imaging and Joint Imaging-Therapy Tracks.

The 2017 Therapy Track will showcase several current hot topics in therapy physics including emerging fields that present unique opportunities: The role of physics in epidemiology, normal tissue dose-volume effects for SBRT, advances in brachytherapy, radiomics for lung cancer, Microscopic Monte Carlo simulations for radiobiology modeling, and emerging QA techniques for modern rad therapy. This year's Joint Symposium of AAPM and ESTRO is titled ‘From Bench to Bedside via Veterinary Radiation Oncology.’ As with other tracks, we are aiming to offer SAM credits for all symposia.

Imaging Track The 2017 Imaging Track highlights ongoing research and advances in imaging in medical physics. In addition to proffered sessions, this track will include scientific symposia on photon counting detector and applications in CT, mammography, and phase contrast imaging, digital PET to

www.aapm.org/meetings/2017AM

Scientific Program (continued) update the most recent advances in PET and PET/CT, deep learning in medical imaging, novel x-ray source for new applications, status of sub-mSv CT imaging, and hypoxia imaging in partnering with the World Molecular Imaging Society. Similar to other tracks, the goal is to offer SAM credits for all symposia for those participating in the ABR’s MOC program to keep up with the state-of-the-art in imaging science and technology. The scientific symposia and the proffered scientific sessions will explore the state of the art and also new frontiers in imaging.

theranostics, and includes the Carson-Zagzebski Distinguished Lectureship on Medical Ultrasound. A selection of proffered abstracts ise incorporated within these sessions, and within a SNAP oral session. Each daily track begins with an Educational Session related to the subsequent scientific sessions: a twohour hands-on ultrasound workshop to highlight US imaging and therapy systems; a primer on the biological and clinical rationale for ultrasound energy combined with radiation therapy/chemotherapy/immunotherapy; and a primer on QA for diagnostic ultrasound.

Ultrasound Track (Special 3 Day Program)

Science Council Session: Big Data, Deep Learning, and AI in Imaging and Radiation Oncology

This track highlights recent advances in ultrasound for diagnostic imaging, ultrasound for guidance and control of radiation therapy, and therapeutic ultrasound such as MR guided HIFU and hyperthermia. These ultrasound symposia and scientific sessions have been allocated as a three day track. Day 1 will highlight advances of ultrasound imaging technology applied to guiding and planning external beam radiation therapy and brachytherapy. Day 2 covers image guided therapeutic ultrasound, with clinical sessions covering HIFU in oncology and neurology, treatment planning, therapy monitoring, and innovative directions of therapeutic ultrasound for hyperthermia, thermal ablation, enhanced radiotherapy, targeted drug delivery, and immunotherapies.

Day 3 brings together advances in diagnostic imaging, innovations in liver ultrasound imaging, contrast agents and

The Science Council Session includes proffered abstracts on a topic at the cutting-edge of medical physics research, presented in a special, high-visibility proffered oral session.

For the 2017 Annual Meeting, the Scientific Program invites abstract submissions on “Big Data, Deep Learning, and AI in Imaging and Radiation Oncology,” emphasizing research on physics contributions to artificial intelligence and the application of deep learning to find useful meaning to big data.

Criteria for abstract evaluation include the novelty of the research, the emphasis on innovation in the development and application of artificial intelligence and deep learning, and the potential impact/significance in diagnosis and therapeutic intervention.

EDUCATIONAL PROGRAM Educational Course Therapy Track The 2017 Therapy Education track will feature 32 hours of educational sessions designed to meet the diverse interests of our membership, with the majority of sessions being SAM sessions. The program will include topics in electron therapy, optimization, shielding, electronic charting, big data, MRI in RT, SRS/SBRT, IGRT, brachytherapy, intra-operative RT, proton therapy, machine learning, EPID-based machine QA and safety. New this year are joint Therapy & Imaging Education sessions (identified as cross-hatched on the program) focusing on radiation protection and shielding, and the concept of MedPhys 3.0. Core therapy physics topics highlighted in this year’s education program include electron dosimetry and calculation algorithms, TG-51 and ICRU-90 updates, and radiation protection and shielding.

Educational Course Imaging Track The 2017 Imaging Education Track will feature a total of sixteen educational sessions, including 25 hours of CME and 18 hours

of SAM sessions. General education sessions will cover CT, Nuclear Medicine, MRI, Mammography, Radiography, and Fluoroscopy. New this year are focused sessions on 4D imaging, stereotactic breast biopsy, and quantitative dual energy CT. Special attention was given to coordinating content between the imaging and therapy tracks in order to fulfill this year’s theme of “Connecting Our Pathways. Unifying Our Profession.”

Two mini- courses will bridge imaging and therapy physics on the topics of MR in Radiation Therapy and Medical Physics 3.0.

Practical Medical Physics Track The Practical Medical Physics Track features presentations designed for practicing, clinical medical physicists. For 2017, the practical medical physics track will feature a variety of expert speakers who will focus on topics you can implement immediately into your practice. Sessions will be offered that focus on both Therapy and Imaging, so there’s something for everyone within the Practical track.

www.aapm.org/meetings/2017AM

PARTNERS IN SOLUTIONS Partners in Solutions continues to offer a unique way for physicists to interact with and learn from our vendors, with vendors providing physics-level applications training classes in a special-purpose lecture room located on the exhibit floor.

These are not sales pitches, but practical information for the clinical physicist from the people who know their systems in depth. Topics for this year are: • Imaging: Metal Artifact Reduction. Metallic implants in

a patient undergoing CT produce artifacts in the image set which can mask the anatomy and interfere with the accurate interpretation of the images. Learn about techniques and algorithms that vendors have introduced to minimize these artifacts.

• Therapy: Patient Treatment Delivery Verification. A variety

of methods are now available for clinical verification of radiation treatment delivery, particularly for IMRT/VMAT treatments but also applicable to static fields. Vendors

will present their solutions, describing how they work, how to interpret the results, and the pros and cons. A better understanding of the available options will help the clinical physicist choose the best solution for his or her clinic.

Look for the Partners in Solutions sessions on the meeting program. CE credit will be offered. Come learn with us!

Exhibit Hall Guided Tours Come visit our vendors as part of a guided tour. Tourists will first hear a short introduction on the selected topic by one of the leaders in the field, then follow their AAPM-member Tour Guide to the vendor booths to hear about their related products.

SAM credit available. Topics for this year are: • Imaging: Phantoms • Therapy: Dose Calculation Check Programs

PROFESSIONAL PROGRAM Professional Track

Key sessions or tracks:

The Professional Track will be offering sessions designed to keep our imaging, research, and therapy members abreast of the latest profession-related developments. Topics this year include a point-counterpoint discussion on medical physics assistants, a medical physics leadership academy session, updates on upcoming Medical Physics Practice guidelines, international, ethics, diversity, and other relevant aspects of our profession.

SAMs sessions will be offered.

• Economics and Legal • Workforce Reports • MPPG and TG Updates • Leadership Topics • New Member Symposium • Question Writing Workshop • ABR: Prep, Therapy and Diagnostic and MOC Update

www.aapm.org/meetings/2017AM

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

EXECUTIVE DIRECTOR’S REPORT Angela R. Keyser, Alexandria, VA This is the first in a series of articles designed to acquaint you with your AAPM HQ Team and give you an idea of the responsibilities for each member of the team.

Jennifer Hudson began her career with AAPM in April 2001 as the Receptionist and was promoted to Membership Services Coordinator in 2004 and Membership Manager in 2012. In 2006, the membership process was moved to the IS team in recognition that the AAPM database and website are an integral part of the membership process. Jennifer is AAPM’s only one-person department! She currently holds the title of Membership Manager.

What does a Membership Manager do? Jennifer is the first staff person most AAPM members interact with, shepherding members through the application process. She works very closely with AAPM’s Membership Committee. As an expert on the various qualifications required for each membership type, she fields calls and email questions from applicants and the Membership Committee about the rules of membership.

An application is required both to join AAPM, and to change from one category of membership to another.

From 2007–2015, Jennifer handled an average of 915 applications per year. Many people do not realize that about 40% of the applications AAPM process are for current AAPM members wishing to change their status. Each application is reviewed for completeness and appropriate responses to the form before being assigned to a panel for review. When the Committee completes their process, Jennifer puts each applicant into the category that was assigned and generates invoices for the new members.

AAPM has various programs (financial assistance, Developing Country Educational Associates) available to applicants outside the US where English may not be the applicant’s first language. For these applicants, Jennifer gives extra attention to ensure the applicant understands what is needed through the process. The Partners in Physics program currently has 195 participants, each of which are sent a form yearly to be completed and returned. Jennifer then assembles them for the International Affairs Committee and ultimately updates each record with the decision to renew financial assistance.

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Executive Director, cont.

Jennifer also works with RSNA on the logistics to afford AAPM members with free RSNA meeting registration. In addition, she also coordinates with the Canadian Organization of Medical Physicists (COMP) to administer the reduced dues agreement between the two organizations. Furthermore, Jennifer takes the lead in the yearly dues renewal process and provides monthly membership trend reports and forecasts. In additional to AAPM members, Jennifer coordinates the onboarding for new AAPM Corporate Affiliates and interacts with them to maintain contact information and generating yearly billing.

Ever have a question about “who does what” at AAPM HQ? See a list with contact information and brief descriptions of responsibilities online. An Organization Chart is also provided. Of course, do not ever hesitate to contact me if you need assistance!

AAPM to Assume Program Management of IHE-RO ASTRO initially convened the Integrating the Healthcare Enterprise for Radiation Oncology (IHE-RO) in 2005 to identify and improve issues of interoperability of healthcare information and treatment systems in Radiation Oncology. While AAPM and ASTRO leaders continue to believe that physicians are critical in identifying and prioritizing the possible issues to address, they agree that medical physicists are best suited to engage with engineers to develop solutions. With the strength of the medical physicists in mind, AAPM and ASTRO agreed that AAPM will assume program management in January 2017. This means that AAPM will take over leadership and management of IHE-RO including staffing and organizing the Technical Committee and Planning Committee, as well as the workgroups on the testing profiles, and organizing and hosting the Connectathons, among other activities needed to maintain the IHE-RO. Carla Hull joined the AAPM HQ team in November as the Programs Manager providing support to the IHE-RO program.

2017 Funding Opportunities

The Research Seed Funding Grant (Application Deadline: April 5, 2017)

Three $25,000 grants will be awarded to provide funds to develop exciting investigator- initiated concepts, which will hopefully lead to successful longer-term project funding from the NIH or equivalent funding sources.

Funding for grant recipients will begin on July 1st of the award year. Research results will be submitted for presentation at future AAPM meetings.

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

View additional information and access the online application

AAPM Fellowship for the Training of a Doctoral Candidate in the Field of Medical Physics (Application Deadline: April 28, 2017)

The AAPM Fellowship for the training of a doctoral candidate in the field of Medical Physics is awarded for first two years of graduate study leading to a doctoral degree in Medical Physics. Both BSc and MS holders are eligible to apply. A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year will be assigned to the recipient.

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Executive Director, cont.

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

View additional information and access the online application

Summer Undergraduate Fellowship Program (Application Deadline: February 2, 2017)

The Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility.

In this program, AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many of whom are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a $5,000 stipend from AAPM. View additional information and access the online application

Diversity Recruitment through Education and Mentoring Program (DREAM) (Application Deadline: February 7, 2017) The American Association of Physicists in Medicine Diversity Recruitment through Education and Mentoring Program (DREAM) 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. Students participating in the program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be a DREAM fellow. Each DREAM fellow receives a $5,000 stipend from AAPM. View additional information and access the online application n

Our Condolences William S. Kubricht, MMSc • Darrell O. Poole • John “Jack” F. Fowler, DSc • James S. Sample, MS

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: 2017.aapm@aapm.org Please include supporting information so that we can take appropriate steps.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

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

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would like to start the new year with pleasant news about the AAPM finances.

It has been a year since I became the AAPM Treasurer. Throughout the past year, I have utilized this platform to keep you informed about the various fiscal issues and plan to continue with this practice in 2017. It has been quite exhilarating for me to learn a lot about financial topics including reviewing financial statements, audit reports, developing budgets, and tackling several budgetary items to ensure our association’s finances are in a secure position.

The AAPM Finance Committee and Board of Directors met in Chicago in December, reviewing the Association’s current financial position, as well as approving the budget for 2017. I am happy to report that 2016 was a successful

financial year for our association.

Financial Position and Estimates for 2016 As of mid-December, I am pleased to report that AAPM will finish the year with a surplus from operations. While conservative reports provided to the Board in November indicated that we would complete the year with a modest surplus from operations, when factoring in a reduced spending pattern within the Councils and Committees through the end of the year and historical spending in the last two months of the year, it is now estimated that, due to recent market gains, the association will see a healthy surplus from operations as well as an increase in reserves.

The 2016 budget, as approved by the Board of Directors, was developed using a statistical model to project revenue and expenses based on historical spending trends. As you will see in the accompanying reports (as of October 31), revenue and expenses are estimated at $11.21 million and $11.19 million respectively, compared to approved budgeted revenue of $9.57 million and expenses of $10.95 million.

AAPM experienced a better-than-anticipated revenue gain from the Placement Services, the Annual Meeting, and the Medical Physical Journal, contributing to the better-than-anticipated revenue in 2016. On the expense side, while current expenses presented are pacing ahead of budget, it is expected that final expenses will come in below budget (partially due to historical underspending by the councils).

Currently, AAPM’s investment portfolio saw substantial gains during 2016, recording more than $800,000 of unrealized gains in the first ten months of the year. Even after transferring out $1.2M to operations to replenish funds spent out of operations to acquire the Headquarters building, the reserve fund exceeds $12.3M as of October 31, 2016.

2017 Budget I would once again like to thank the Council and Committee Chairs, along with their liaisons, who worked extremely hard in developing their budgets. As reported in my previous column (Nov–Dec 2016), in a change from previous years, the entire Finance Committee reviewed the 2017 budget with the Council Chairs while keeping the goals and objectives of AAPM’s strategic plan in the forefront.

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Treasurer, cont.

Revised Summary of 2016 Year with Estimates and Variances as of October 31, 2016 A

B

C

D

1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65

E

F

G

H

I

Revenue Difference from Budget (Col. E - Col. F)

Actual Revenue Difference from Prior Year (Col. C - Col. B)

J

K

L

M

N

O

P

Q

R

Revenue and Expenses vs. Budget As of October 31, 2016

2

Actual 10/31/2015 Membership Dues Dues (Net of Journal) Applications & Reinstatements Renewal Notices

REVENUE Total 2016 Estimate to Actual & Approved 12/31/2016 Estimate Budget (Numbers in brackets are negative)

Actual 10/31/2016

Sub-total

2,172,265 17,775 9,100 $2,199,140

2,727,942 18,500 6,650 $2,753,092

0 0 0 $0

Sub-total

302 $302

100 $100

400 $400

500 $500

500 $500

Sub-total

28,000 234,120 280,276 33,570 0 0 $575,966

39,800 246,130 362,434 33,300 0 0 $681,664

10,200 30,525 131,251 1,000 0 0 $172,976

50,000 276,655 493,685 34,300 0 0 $854,640

50,000 266,500 315,700 33,500 0 0 $665,700

Sub-total

3,013,870 213,645 6,000 216,882 56,215 143,805 0 $3,650,417

3,203,711 136,825 3,000 247,820 0 0 0 $3,591,356

Sub-total

2,589,096 20,000 $2,609,096

3,056,994 41,553 $3,098,547

645,739 43,497 $689,236

Other Income & Expense Computers in Physics, Royalties AAPM Mailing Lists Membership Certificates RSEA Interest Income from Operations CAMPEP (Other organizations SDAMPP, COMP etc) Meeting evaluation system Web hosting Programming services Contributions and Donations Dues and other payments Miscellaneous Sub-total

0 16,661 200 4,239 5,789 89,215 3,000 4,000 1,600 0 0 0 0 $124,704

0 7,943 25 3,765 1,055 91,890 7,720 1,500 1,600 0 0 0 0 $115,498

0 102,407 225 0 6,445 0 0 0 400 225 0 0 100 $109,802

Governance & Administrative Services Governance Administration Councils , Committees, and Liaisons Administrative Education Professional Science Committees Reporting to Board Liaisons/Individual Appts Education & Professional Development Annual Meeting Summer School RSNA Spring Clinical Meeting ILS Meeting ABS/SBRT Safety Meeting Specialty Meetings Publications Medical Physics Journal JACMP

Overhead

$0 TOTALS from Operations

$0

$9,159,625

$10,240,257

$1,223,492

$1,458,945

0 0 0 0 0 0 0 $0

$0 $972,414

2,727,942 2,697,329 18,500 16,000 6,650 8,500 2,753,092 $2,721,829

3,203,711 2,857,740 136,825 147,014 3,000 2,000 247,820 242,036 0 0 0 0 0 101,353 $3,591,356 $3,350,143 3,702,733 2,476,798 85,050 133,000 $3,787,783 $2,609,798 0 110,350 250 3,765 7,500 91,890 7,720 1,500 2,000 225 0 0 100 $225,300 $0

0 110,350 250 0 7,500 91,890 7,720 1,500 2,000 225 0 0 100 $221,535 $0

$11,212,671 $9,569,505

30,613 2,500 (1,850) $31,263

EXPENSE Total 2016 Actual Actual Estimate to Actual & Approved 10/31/2015 10/31/2016 12/31/2016 Estimate Budget (Numbers in brackets are negative)

Expenses Expenses Difference Difference from Budget Prior Year (Col. N - Col. M) (Col. J - Col. K)

Total Difference from Approved 2016 Budget

555,677 $725 (2,450) $553,952

0 0 8,128 $8,128

0 8,100 9,601 $17,701

0 0 1,210 $1,210

0 8,100 10,811 $18,911

0 0 8,200 $8,200

0 (8,100) (2,611) ($10,711)

0 (8,100) (1,473) ($9,573)

30,613 (5,600) (4,461) $20,552

0 $0

(202) ($202)

216,219 265,314 $481,533

146,971 303,064 $450,035

57,209 9,350 $66,559

204,180 312,414 $516,594

172,095 291,325 $463,420

(32,085) (21,089) (53,174)

69,248 (37,750) 31,498

(32,085) (21,089) ($53,174)

0 10,155 177,985 800 0 0 $188,940

11,800 12,010 82,158 (270) 0 0 $105,698

322,505 334,173 424,367 403,342 194,155 282,317 372,572 434,243 100,307 226,563 1,160 710 $1,415,066 $1,681,348

221,805 160,480 74,614 262,366 12,826 250 $732,341

555,978 563,822 356,931 696,609 239,389 960 $2,413,689

583,694 547,240 421,070 708,945 202,780 1,025 $2,464,754

$27,716 (16,582) 64,139 12,336 (36,609) 65 $51,065

(11,668) 21,025 (88,162) (61,671) (126,256) 450 ($266,282)

$27,716 (6,427) 242,124 13,136 (36,609) 65 $240,005

345,971 (10,189) 1,000 5,784 0 0 (101,353) $241,213

189,841 (76,820) (3,000) 30,938 (56,215) (143,805) 0 ($59,061)

1,636,787 1,670,732 $168,625 91,004 9,155 4,672 165,843 143,328 28,549 0 120,444 0 0 0 $2,129,403 $1,909,736

20,408 1,192 102,878 0 0 0 0 $124,478

1,691,140 92,196 107,550 143,328 0 0 0 $2,034,214

1,750,866 92,809 107,550 168,375 0 0 0 $2,119,600

59,726 613 0 25,047 0 0 0 $85,386

(33,945) 77,621 4,483 22,515 28,549 120,444 0 $219,667

405,697 (9,576) 1,000 $30,831 0 0 (101,353) $326,599

467,898 21,553 $489,451

1,061,585 1,186,646 153,331 193,497 $1,214,916 $1,380,143

540,995 27,101 $568,096

1,727,641 220,598 $1,948,239

1,534,289 201,794 $1,736,083

(193,352) (18,804) ($212,156)

(125,061) (40,166) ($165,227)

1,032,583 (66,754) $965,829

0 0 50 0 0 250 0 0 0 0 0 11,077 150 $11,527

0 0 50 5,791 0 250 0 0 0 0 8,000 83,000 150 $97,241

0 0 50 0 0 250 0 0 0 0 8,000 83,000 150 $91,450

0 0 0 (5,791) 0 0 0 0 0 0 $0 0 0 ($5,791)

0 0 0 (1,553) 0 0 0 0 0 0 (3,000) (11,000) 0 ($15,553)

0 0 0 (2,026) $0 0 0 0 $0 0 $0 0 0 ($2,026)

4,160,261

$4,070,394

($89,867)

($639,709)

($89,867)

($235,248)

($845,179)

$1,407,918

($15,319) $0 ($3,965) (19,284)

($241,220) $0 ($9,871) (251,091)

$76,407 $800,166 $12,890 889,463

1,225,935 (47,950) $1,177,985 0 0 0 3,765 $0 0 0 0 $0 0 $0 0 $0 $3,765 $0 $1,643,166

0 (8,718) (175) (474) (4,734) 2,675 4,720 (2,500) 0 0 0 0 0 ($9,206) $0 $1,080,632

0 0 0 4,238 0 0 0 0 0 0 5,000 60,923 0 $70,161

0 0 0 5,791 0 0 0 0 0 0 8,000 71,923 0 $85,714

$2,616,926 $3,256,635 $7,936,133 $8,781,312

$903,626 $2,407,837

$11,189,149 $10,953,901

66 67 68 69 70 Budgeted Net Loss from Operations 71 72

Actual Income (Loss) from Operations

($1,384,396)

$23,522

73 74 75 76 77 78 79 80 81 82 83

Adjustments: AAPM Education & Research Fund Unrealized Gains/(Losses) on Investments Investment Income from LT Investments Total Adjustments

Net Income All Sources

$609,609 (25,545) 160,853 $744,917

279,482 800,166 146,855 $1,226,503

$1,941,766

$2,407,714

302,444 0 10,000 $312,444

581,926 800,166 156,855 $1,538,947

490,200 0 140,000 $630,200

91,726 800,166 16,855 $908,747

(330,127) 825,711 (13,998) $481,586

7,049 0 19,594 26,643

248,269 0 29,465 277,734

277,800 0 4,500 282,300

526,069 0 33,965 560,034

510,750 0 30,000 540,750

$1,002,435

84 85

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

Treasurer, cont.

The 2017 budget summary is included with this report. Revenue projections total $9.5 million and expenses total $10.7 million, with a budgeted deficit of $1,201,961. The statistical model predicted a deficit of $1,010,347 which is based upon AAPM complying with the financial covenants established by TD Bank, the mortgage holder for the new HQ building. Given our normal under-spending patterns, the Finance Committee felt that the approved deficit would allow for AAPM to operate, still meet the bank covenants and operate at or near break-even from the operations’ budget.

AAPM’s Finance Committee, Strategic Planning Committee, and the Board feel that this conservative budget allows for AAPM to achieve its strategic initiatives and yet meet its fiscal responsibilities to the bank at the same time.

Included you will find a graphical presentation of the 2017 budgeted revenues and expenses by category (including which programs are included in the various categories).

In closing, I would like to thank Robert McKoy for all his help during this past year, especially in making the budgeting process and the job of Treasurer manageable. Please feel free to reach out to me by email or call me at 410-955-5115 or tweet me at @mmahesh1 if you have any questions concerning this report. n

AAPM Total Revenue and Expenses from Operations 12,000,000

10,000,000

8,000,000

6,000,000

4,000,000

2,000,000

-

2011

2012 Budget Revenue

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2013 Actual Revenue

2014 Budget Expenses

2015 Actual Expenses

2016 est.

2017 Budget Approved By Board Revenue

First Draft 2017 Oct 2016 Membership Dues Dues

Expenses

Direct

Subtotal

2,834,007 6,350 15,000 $2,855,357

Overhead

Net

$19,100

106,707 0 0 $106,707

125,807 0 0 $125,807

2,708,200 6,350 15,000 $2,729,550

Subtotal

0 0 0 $0

0 0 0 $0

99,984 640 586,979 $687,603

99,984 640 586,979 $687,603

(99,984) (640) (586,979) ($687,603)

Subtotal

0 0 $0

186,570 15,000 $201,570

177,083 0 $177,083

363,653 15,000 $378,653

(363,653) (15,000) ($378,653)

Subtotal

50,000 243,000 397,800 311,800 0 0 $1,002,600

593,151 500,335 416,095 974,761 259,792 1,425 $2,745,559

361,740 98,938 122,141 165,636 75,155 0 $823,610

954,891 599,273 538,236 1,140,397 334,947 1,425 $3,569,169

(904,891) (356,273) (140,436) (828,597) (334,947) (1,425) ($2,566,569)

1,974,727 178,857 199,407 122,000

Subtotal

3,242,175 258,095 245,597 2,000 40,000 $3,787,867

$2,474,991

634,420 45,960 66,195 83,087 18,860 $848,522

2,609,147 224,817 265,602 205,087 18,860 $3,323,513

633,028 33,278 (20,005) (203,087) 21,140 $464,354

Subtotal

1,736,560 0 0 0 $1,736,560

495,500 0 0 0 $495,500

80,523 0 0 0 $80,523

576,023 0 0 0 $576,023

1,160,537 0 0 0 $1,160,537

Subtotal

500 0 0 $500

206,000 0 141,875 $347,875

101,330 38,850 1,474,237 $1,614,417

307,330 38,850 1,616,112 $1,962,292

(306,830) (38,850) (1,616,112) ($1,961,792)

0 0 0 0 0 8,000 93,000 0 $101,000

0 1,937 0 0 26,159 0 2,654 0 0 0 $30,750

0 1,937 0 0 26,159 0 2,654 8,000 93,000 0 $131,750

0 18,413 150 7,500 104,986 0 8,166 (8,000) (93,000) 0 $38,215

$9,552,849 $6,385,595 $4,369,215

$10,754,810

($1,201,961)

Reinstatement Fees Applications Fees

Membership Services

Member Inquiries/Services Membership Directory AAPM Web Site

Organizational Governance

Governance - Contingency

Councils and Committees Administrative Council Education Council Professional Council Science Council Committees Reporting to the Board Liaisons with other Organizations

Education & Professional Development Annual Meeting

Summer School Spring Clinical Meeting RSNA Specialty Meetings

Publications Journals

Medical Physics Journal JACMP Other Publications

Administrative Services

Administration/Prof Services/AIP Prince St. General Operations

Other Income & Expense

Computers in Physics, Royalties

0 20,350 150 7,500 131,145 0 10,820 0

AAPM Mailing Lists Membership Certificates Investment Earnings & Fees CAMPEP RSEA Services to other organizations (COMP, SDAMPP, etc.)

Contributions and Donations Dues and other payments/AIP Miscellaneous Subtotal

TOTAL FROM OPERATIONS AAPM Education & Research Fund Investment Income

Grand Total

0 $169,965

19,100 0

Total

419,525 140,000

434,835 40,000

3,526 0

438,361 40,000

(18,836) 100,000

$10,112,374

$6,860,430

$4,372,741

$11,233,171

($1,120,797)

2017 Model to Break-Even 2017 Model Debt Service 2017 Debt Service Loss

($943,758) ($1,010,347) ($109,592)

2017 AAPM Budgeted Revenue Other Income $169,965 2%

Administrative Services $500 < 0.1% Publications $1,736,560 18%

Membership Services $2,855,357 30%

Committee Projects $1,002,600 10% Education/Professional Development $3,790,524 40%

2017 AAPM Budget Expenses (Overhead Unallocated) Membership Services $19,100 < 0.1%

Governance & Administrative Services $549,445 5%

Committee Projects $2,745,559 25%

Overhead $4,369,215 41%

Other Income $101,000 1%

Publications $495,500 5%

Education/Professional Development $2,437,355 23%

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

EDUCATION COUNCIL REPORT Vic Montemayor, PhD, Fort Washington, PA

Summary of the 2016 Education Council Symposium

O

n Sunday morning, July 31, 2016, the Medical Physicists as Educators Committee (MPESC) hosted the annual Education Council Symposium during the national AAPM Annual Meeting in Washington, DC. The symposium was entitled, “Revitalizing Your Medical Physics Classroom: Some Examples and Thoughts from the Trenches.” MPESC chair, Vic Montemayor, served as moderator for the symposium.

Vic opened the symposium with a brief history of the push for reform in the teaching of medical physics within the AAPM, starting with the 2008 AAPM Workshop on Becoming a Better Teacher of Medical Physics, which was organized by Bill Hendee. Vic’s discussion covered the formation and evolution of MPESC, and the Innovation in Medical Physics Education Session that is run

by MPESC and held each year at the AAPM Annual Meeting.

SUGGESTION BOX

Vic’s introduction was followed by Rebecca Howell speaking on “Making the Most of a One Hour Lecture with Alternative Teaching Methodologies: Implementing Project-based and Flipped Learning.” In particular, Rebecca’s presentation focused on two teaching methodologies: project-based learning and flipped learning. She also spoke about her experience in trying to implement these alternative teaching methodologies and how she overcame obstacles to implementation.

Shahid Naqvi then spoke about “Creative Simulation: A Flexible Hands-on Approach to Building a Deeper Understanding of Critical Concepts in Radiation Physics.” More specifically, Shahid discussed the Monte Carlo code that he designed to help elucidate concepts in radiological dosimetry for medical physics students. He explained how he uses color-coded particle tracks from his code overlaid with dose distributions to help the students see, for example, the elusive connections between dose, kerma and electronic disequilibrium.

Finally, Jay Burmeister spoke on “Incorporating Active Learning into Medical Physics Education.” Jay persuasively pulled together thoughts on why changing one’s approach to the teaching of medical physics is worth serious consideration, and shared his experiences experimenting with active learning in his medical physics classrooms. Jay also discussed the student feedback that he received after the incorporation of active learning into his classroom, indicating that these course changes improved the students’ abilities to actively assimilate the course content.

The symposium ended with a question/answer period, during which some productive discussion took place. The symposium was well attended and seemed to be well received by the participants.

A Request For Your Input The Education Council has asked the Medical Physicists as Educators Committee (MPESC) to organize and run a 1.5-day workshop on Becoming a Better Teacher of Medical Physics, much in the spirit of the original workshop put together

by Bill Hendee back in 2008. This workshop is to take place immediately following the conclusion of the 2018 Annual Meeting in Nashville, TN. MPESC has begun the planning of the workshop, and would be very interested in receiving your thoughts on what should be covered in the workshop. If you have any suggestions for topics that you would like to see covered, please send your suggestions to Vic Montemayor. All suggestions will be considered for inclusion by the Committee. Thank you! n

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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

AWARD DURATION: MAY 1, 2017 – SEPTEMBER 1, 2017 • APPLICATION DEADLINE: FEBRUARY 9, 2017 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 42 No. 1 JANUARY | FEBRUARY 2017

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

Improving the ABR Maintenance of Certification Process Introduction

T

he medical certification process arose from the desire of medical specialties to improve patient care and protect the public by ensuring a body of competent practitioners. The key was the identification of these competent practitioners.

This point is tied to the mission of the American Board of Radiology (ABR). The emphasis of board certification has never been on identifying stars, or even top-level practitioners, so boards have never provided gradations of diplomate performance. Rather, the goal is for all diplomates to meet a level of competence that ensures quality care.

The ABR is a member board of the American Board of Medical Specialties (ABMS). Most of the 24 ABMS member boards were organized in the 1930s and 1940s. Certification of medical physicists dates from the same era, with the task first being accomplished by the Radiological Society of North America (RSNA) and then, beginning in 1947, by the ABR. Next year will mark the 70th anniversary of ABR certification of medical physicists.

The task of a board in Initial Certification is to ensure minimal competence of its candidates. Certification processes should be rigorous but not too onerous, and the tradeoff between rigor and difficulty is always a challenge to a board. If the requirements are too onerous, candidates will not be able to achieve them in a practical way; however, if requirements are too simple, the certification will not ensure competency and will not be accepted by the public.

In 1999, the Institute of Medicine published To Err Is Human: Building a Safer Health System. This report on the weaknesses in the U.S. healthcare system was a major driver for recertification and then MOC, as the following gaps in traditional certification became clear: • • •

Certification was for a lifetime, but a diplomate’s skills might vary over time.

A diplomate’s continuing education efforts might not be well aligned with the diplomate’s needs.

The public expects ongoing evidence of competence.

Transition to Maintenance of Certification (MOC) Because of these limitations, the ABMS boards began issuing time-limited certificates and also initiated processes for Maintenance of Certification (MOC).

The ABR began implementing its MOC program in 2007.

MISSION OF THE ABR

MOC has four components: • • • •

To certify that our diplomates demonstrate the requisite knowledge, skill, and understanding of their disciplines to the benefit of patients.

Part 1: Professional Standing (licensure and/or attestation) Part 2: Lifelong Learning and Self-Assessment (continuing education) Part 3: Cognitive Expertise (MOC Exam) Part 4: Practice Quality Improvement (PQI) projects and quality and safety activities

In the nine years that have passed, the MOC process has evolved substantially.

This expected evolution has resulted in increased relevance and decreased burden on diplomates. Recent major ABR MOC initiatives are described below.

Increasing the Relevance and Availability of Continuing Education Efforts have expanded the range of self-assessment continuing education (SA-CE) beyond the initial self-assessment

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

ABR, cont. modules (SAM) program. The possibilities now include all “enduring” CE, such as continuing education based on journal articles with embedded questions, the AAPM virtual library, and for medical physicists, self-directed educational projects (SDEPs). Medical physicists can obtain all their required SA-CE credits from these sources and thus do not have to depend entirely on meetings where SAM are offered.

Introducing Simplified Attestation for Parts 1, 2, and 4 All ABR diplomates, including those certified in medical physics, are required to attest annually in myABR to their participation in MOC Parts 1, 2, and 4. However, the data do not need to be sent to the ABR unless the diplomate is selected for an audit. For non-licensure states, the Part 1 process has been simplified to require only one attester, reducing the effort involved. In addition, attestation for Part 1 is only required if the diplomate is audited.

Expanding the Range of Part 4 (PQI) Ooptions The possibilities for meeting Part 4 requirements have been expanded by creating Participatory Quality Improvement Activities, which include many quality and safety activities that medical physicists often do as part of their usual workday.

These can demonstrate the medical physicist’s role in quality and safety, while reducing extra Part 4 effort.

Replacing the Decennial Exam with ABR Online Assessment (ABR OLA) The episodic nature of the 10-year MOC exam has an intrinsic limitation in light of the intent to achieve a continuous and more relevant Part 3 assessment. The new ABR OLA method, currently being designed, will be more flexible and more continuous, with real-time feedback provided to the diplomate after each question is answered online. Thus, ABR OLA will combine assessment with feedback. The feedback from the OLA questions can be used as a basis for learning by the diplomate.

Each diplomate will be offered 104 question opportunities per calendar year and will be required to respond to 52 of these opportunities. This feature will give diplomates exceptional flexibility in how frequently they participate.

An initial assessment will occur after a diplomate has responded to 200 calibrated question opportunities, or after five years, whichever comes first. After the 200-question threshold is reached, a rolling summative decision will be made, using the most recent 200 questions.

After reaching the 200-item threshold, a diplomate must achieve a passing summative decision at the March 2nd annual review in order to continue meeting MOC Part 3 requirements. If not, the diplomate will be publicly reported as “not meeting the requirements of MOC” until he or she achieves a passing summative decision prior to the next year’s annual review.

Again, the diplomate will have continuous feedback with ample opportunities to correct deficiencies.

ABR Connections Center The ABR has adopted a program to track diplomate questions and concerns by e-mail, phone, or fax to ensure that a response is provided in a timely manner. The ABR Connections Center is staffed by a knowledgeable team that can answer most questions and routes more complicated queries to an appropriate subject matter expert.

Summary and Conclusions While Initial Certification and MOC require effort to achieve the rigor the process demands, without that rigor, ABR certification would not be respected within the medical physics community and the wider community of radiology and radiation oncology. The level of rigor is noticed by the public, policymakers, and regulators, and it provides strong evidence that medical physicists can regulate their own profession. Without a rigorous process, medical physicists would be vulnerable to requirements imposed by outside groups who would not have a sufficient understanding of the profession. The ABR process is continually evolving to maintain that rigor while, at the same time, the ABR continually attempts to reduce the burden on its diplomates. n

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ABR, cont.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

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

2017 Medicare Rule Has Minimal Impact on Payments to Physicians and Freestanding Cancer Centers

T

he Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Medicare Physician Fee Schedule (MPFS) final rule. All policies and payments are effective on January 1, 2017. The MPFS specifies payment rates to physicians and other providers, as well as technical payments for freestanding cancer centers. It does not apply to hospital outpatient departments, which is covered under a separate rule whose changes are described in a separate article below.

CMS identified several radiation oncology codes as being “potentially misvalued”. These codes were revalued by the AMA Relative Value Scale Update Committee (RUC) and payment will be reduced in 2017. Impacted codes include 2 for treatment device (77332, 77334), the special treatment procedure (77470) and 4 for hyperthermia treatment (77600, 77605, 77610, 77615). The technical and global payment for the intermediate treatment device (77333) code will increase in 2017. The AAPM successfully persuaded CMS to increase the physician work value for complex interstitial brachytherapy (77778) from 8.00 to 8.78 relative value units (RVUs).

CMS’s new rule establishes values for new moderate sedation codes and implements a uniform method for valuing codes for procedures that currently include moderate sedation. Specifically, CMS reduces 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: •

Adds the cost of $14,617 for a professional PACS workstation to many diagnostic radiology codes, increasing the practice expense RVUs for these codes.

•

Reduces by 20 percent the technical component payment for x-ray imaging using film.

•

The Protecting Access to Medicare Act of 2014 created 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. It includes proposals for priority clinical areas, clinical decision support mechanism (CDSM) requirements, the CDSM application process, and exceptions for cases when consultation with AUC would pose a significant hardship.

•

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

Overall, the final rule has minimal impact on payments to radiation oncologists, radiologists, and freestanding cancer centers.

To read a complete summary of the final rule and to review impact tables go to the AAPM website.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

Health Policy, cont.

CMS Expands Comprehensive APCs Without Addressing Data Concerns The Centers for Medicare and Medicaid Services (CMS) recently released the 2017 Hospital Outpatient Prospective Payment System (HOPPS) final rule with an effective date of January 1, 2017.

CMS reduced the number of ambulatory payment classifications (APCs) for Therapeutic Radiation Treatment Preparation from 4 to 3 levels. Three reassigned codes, including the special medical physics consultation code (77370), have a significant payment decrease of 30%. Final 2017 payments and impacts for radiation oncology procedures are in the table below.

CMS finalized their proposal to create 25 new Comprehensive APCs, many which include brachytherapy related surgical procedures (20555, 41019, 55920, 57155, 58346), which are 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 for the primary surgical procedure and bundle all other costs, including radiation treatment planning and delivery codes, on the same claim.

AAPM did an economic analysis of the new Comprehensive APC claims data and determined that some costs of associated radiation therapy services, including brachytherapy treatment delivery, were not captured in the bundled payment. CMS replied that they rely on hospitals to bill all codes accurately in accordance with their code descriptors and CPT and CMS instructions, as applicable, and to report charges on claims and charges and costs on their Medicare hospital cost reports appropriately. Moreover, CMS stated that they do not remove claims from the claims accounting when stakeholders believe that hospitals included incorrect information on some claims. CMS may examine the claims for these brachytherapy insertion codes and determine if any future adjustment to the methodology (or possibly code edits) would be appropriate.

Other 2017 HOPPS policies include: •

Implementing site-neutral payments as required under the Bipartisan Budget Act of 2015, which requires that items and services furnished in certain off-campus provider-based departments not be covered or paid under the HOPPS. Those items and services will instead be paid “under the applicable payment system” beginning January 1, 2017, which CMS designates as the Medicare Physician Fee Schedule. CMS reports that payment to these affected offcampus, provider-based departments will be approximately 50 percent of the HOPPS payment.

•

CMS consolidated the diagnostic imaging APCs from 17 clinical APCs in 2016 to 8 APCs in 2017.

•

X-ray imaging with film (including the x-ray component of a packaged service) will be reduced by 20 percent.

Hospitals will be required to use a modifier on claims for x-ray images that are made using film.

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

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

Health Policy, cont.

2017 RADIATION ONCOLOGY HOPPS PAYMENTS 2016 Payment

2017 Payment

Percentage Change 2016–2017

19298 & other breast surgery codes

$7,557.75

$4,417.60

-41.5%

Level 3 Breast/ Lymphatic Surgery and Related Procedures

19296 & other breast surgery codes

$7,557.75

$6,483.61

-14.2%

5611

Level 1 Therapeutic Radiation Treatment Preparation

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

$107.40

$117.53

9.4%

5612

Level 2 Therapeutic Radiation Treatment Preparation

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

$291.77

$311.43

6.7%

5613

Level 3 Therapeutic Radiation Treatment Preparation

32553, 49411, 55876, 77295, 77301, C9728

$1,026.81

$1,065.79

3.8%

5621

Level 1 Radiation Therapy

77401, 77402, 77407, 77789, 77799

$110.34

$114.30

3.6%

5622

Level 2 Radiation Therapy

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

$194.35

$204.42

5.2%

5623

Level 3 Radiation Therapy

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

$505.51

$494.42

-2.2%

5624

Level 4 Radiation Therapy

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

$696.21

$738.32

6.0%

5625

Level 5 Radiation Therapy

77522, 77523, 77525

$1,150.69

$993.70

-13.6%

5626

Level 6 Radiation Therapy

77373

$1,671.91

$1,650.59

-1.3%

5627*

Level 7 Radiation Therapy

77371, 77372, 77424, 77425

$7,300.24

$7,452.84

2.1%

8001

LDR Prostate Brachytherapy Composite

55875 and 77778 on the same day

$3,385.44

$3,498.77

3.3%

APC

Description

5092*

Level 2 Breast/ Lymphatic Surgery and Related Procedures

5093*

CPT Codes

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

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AMERICAN ASSOCIATION OF PHYSICISTS IN MEDICINE

2017 AAPM FUNDING OPPORTUNITIES

FELLOWSHIPS AAPM Fellowship for the Training of a Doctoral Candidate in the Field of Medical Physics The AAPM Fellowship for the training of a doctoral candidate in the field of Medical Physics is awarded for first two years of graduate study leading to a doctoral degree in Medical Physics. Both BSc. and MS holders are eligible to apply. A stipend of $13,000 per year, plus tuition support not exceeding $5,000 per year will be assigned to the recipient.

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

Deadline: April 28, 2017

Summer Undergraduate Fellowship Program The American Association of Physicists in Medicine Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain experience in medical physics by in a medical physics laboratory or assisting with clinical service at a clinical facility.

In this program, AAPM serves as a clearinghouse to match exceptional students with exceptional medical physicists, many who are faculty at leading research centers. Students participating in the program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be an AAPM summer fellow. Each summer fellow receives a $5,000 stipend from AAPM. Deadline: February 2, 2017

GRANTS The Research Seed Funding Grant Three $25,000 grants will be awarded to provide funds to develop exciting investigator- initiated concepts, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources.

Funding for grant recipients will begin on July 1 of the award year. Research results will be submitted for presentation at future AAPM meetings.

Must be a member of AAPM at time of application (any membership category). Pending membership status not accepted. **No Exceptions** Deadline: April 5, 2017

Diversity Recruitment through Education and Mentoring Program (DREAM) The American Association of Physicists in Medicine Diversity Recruitment through Education and Mentoring Program (DREAM) 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. Students participating in the program are placed into summer positions that are consistent with their interest.

Students are selected for the program on a competitive basis to be a DREAM fellow. Each DREAM fellow receives a $5,000 stipend from AAPM. Deadline: February 7, 2017

APPLY: gaf.aapm.org

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

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 web site portal for more FAQs, accreditation application information, and QC forms.

The following questions are for the ACR Computed Tomography Accreditation Program. Please feel free to contact us if you have questions about CT accreditation.

Q. The ACR now requests that facilities provide their Dose Notification values (mGy), as described by MITA Standard XR-25 (and included in XR-29), on the CT Phantom Site Scanning Data Form. Is this required for CT accreditation?

A. No, completion of Dose Notification values is not required for ACR CT Accreditation. The new Dose Notification values described by MITA XR-25 (and included in XR-29) are now requested in the phantom site scanning data form for informational purposes only and is intended to raise your facility’s awareness and understanding of this feature as it may apply to your scanner and protocol. XR-29 compliance is not a requirement of CT Accreditation. Therefore, this field is optional. Please visit the ACR NEMA XR-29 (MITA Smart Dose) Standard Frequently Asked Questions for further information on XR-29 and the CMS rule.

Q. The adult head, adult abdomen, pediatric head and pediatric abdomen dose calculation forms now include a field to enter the CTDIvol reported by the scanner (mGy) for the protocol entered into the phantom site scanning data form. Is this required? How do I obtain this value?

A. This is an optional field. When prescribing the phantom scans using the adult head, adult abdomen, pediatric head and pediatric abdomen protocols for ACR CT accreditation phantom testing, the scanner will report the expected CTDIvol for the respective protocol. This data may be entered into the dose calculation form and the database will calculate the percent difference between the calculated CTDIvol and the CTDIvol reported by the scanner. While this value is not scored as a part of accreditation, the percent difference should be less than 20%. Measured values not within 20% of the values reported by the scanner should be investigated. We recommend contacting your Qualified Medical Physicist (QMP) for assistance if needed. The CTDIvol reported by the scanner (mGy) and the percent difference between the calculated CTDIvol and the CTDIvol reported by the scanner are for informational purposes only, will not be evaluated by the reviewers and will not contribute to deficiencies at this time.

Q. The adult abdomen and pediatric abdomen dose calculation forms now include an SSDE for 35 and 18.5 cm water equivalent diameter (mGy). What is the purpose of this new calculation and how is it scored for accreditation?

A. Size specific dose estimate (SSDE) is a calculation that allows an estimation of patient dose based on CTDIvol and patient size. This value is for informational purposes only and will not be scored as a part of accreditation at this time. For more information on CT dose and SSDE, please visit the Alliance for Quality Computed Tomography Education Slides. Your Qualified Medical Physicist (QMP) may also refer to AAPM Reports 204 and 220.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

ACR, cont.

Q. The pediatric abdomen (40-50 lb) dose calculation for accreditation submission now provides a choice of a 16 or 32 cm phantom. How do I know which one is required for my scanner and how does this affect the CTDIvol reference values and pass/fail criteria for the pediatric abdomen protocol?

A. For pediatric abdomen (40-50 lb.) protocols, some CT scanners report CTDIvol using the 16 cm phantom, while others use the 32 cm phantom. The medical physicist should select the phantom (16 or 32 cm) that is used by the scanner to report CTDIvol. For accreditation, the adjusted reference values and pass/fail criteria are as follows: Reference Levels CTDIvol (mGy

Pass/Fail Criteria CTDIvol (mGy)

Pediatric Abdomen (40-50 lb) – 16 cm phantom (existing)

15

20

Pediatric Abdomen (40-50 lb) – 32 cm phantom

7.5

10

Q. My scanner reports the pediatric abdomen protocol with a 32 cm phantom but my Qualified Medical Physicist (QMP) has already tested with a 16 cm phantom. Does my QMP need to rescan the pediatric abdomen dose phantom using a 32 cm phantom?

A. No. If the QMP scanned the 16 cm phantom, then ensure that the 16 cm phantom is selected in the pediatric abdomen dose calculation form. The phantom selected in the pediatric abdomen dose calculation form must match the scanned phantom pediatric abdomen dose images and resultant dose measurements. n

THE AAPM SCIENCE COUNCIL ASSOCIATES MENTORSHIP PROGRAM This program has been established to recognize and cultivate outstanding researchers at an early stage in their careers, with the goal of promoting a long-term commitment to science within AAPM. TThe program will include eight Associates, each assigned to shadow one member from the AAPM Science Council, Research Committee, Therapy Physics Committee, Imaging Physics Committee, or Technology Assessment Committee.

APPLY AT: gaf.aapm.org DIRECT INQUIRIES: scamp@aapm.org

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SC Associates will participate in the program for one year, and would be funded for up to $4000 per Associate (to cover travel costs including flight, hotel, and meeting registration) to attend two consecutive AAPM Annual Meetings, including the pre-meeting activities associated with each Committee.

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

WORK GROUP ON IMRT REPORT Written by the WGIMRT

Article Watch 2016 Planning

Ahanj et al. created a planning technique that boosts the superior/inferior edges of a lung tumor to account for respiratory-induced target motion. The edge-enhancing boost was found to reduce lung dose compared to the ITV treatment of moving lung targets. However, their technique was more sensitive to changes in tumor size and fluctuations in the patient’s respiratory motion.

Ziegenhein et al. presented a new planning model called interactive dose shaping (IDS) that uses user-requested dose modifications instead of a traditional optimization cost function. The algorithm works in two phases: 1) first, it adapts the plan to conform to the requested modification, 2) next it attempts to recover undesired disturbances of the dose pattern caused by the modification. The IDS optimization has been combined with an “ultra-fast” dose update calculation method to form a new planning system Dynaplan. The fast dose calculation and modification nature of optimization are ideal for adaptive planning for changing patient anatomies.

Irene Hazell et al. reported a significant clinical study result stating that Philips Pinnacle TPS’s Auto-Planning module can automatically generate clinical acceptable IMRT plans for virtually all cases in their study. They included a total of 26 head and neck IMRT cases in their comparison — to compare automatically generated plans from Pinnacle auto-planning module, and dosimetrist-optimized plans on the same patients. A blind plan quality clinical review is conducted as well as direct DVH comparisons. Each plan is given a score between 1 and 6. They reported that for 94% of cases, auto-planning was able to generate IMRT plans having at least as high as a score as the manually optimized IMRT plans from dosimetry.

This is certainly promising news for one direction in IMRT treatment planning – that is automation and class solutions.

Kamran et al. studied the potential benefit of using multi-criteria optimization (MCO) for planning non-small cell lung IMRT cases. RayStation’s MCO algorithm was used, which allows the planner to vary OAR/target criteria interactively, to see how improving one criterion worsens another. 5-field IMRT plans were created in RayStation using MCO and nonMCO planning techniques. Planning time was capped at 4 hours. MCO plans required less planning time and resulted in improved OAR sparing, while maintaining target coverage.

Dosimetry Bailey et al. reported on the use of a measurement uncertainty correction function when calculating gamma pass rates for IMRT QA using MapCHECK. The use of the correction function—enabled by default—was found to have a noticeable effect upon QA results. The magnitude of the effect was both plan type and technique dependent with a maximum change in pass rate of 8.7% for a single field when 3%/3mm criteria were used. The authors conclude that the use of this uncertainty function should be specified in reports of MapCHECK-based QA results in the literature.

Chuter et al. demonstrated the ability to use EPID-based in vivo portal dosimetry in FFF radiotherapy. It was noted that while the Elekta iView EPID saturated at a dose rate of 800 MU/min — below the maximum FFF dose rate for the linac — FFF beams limited to this dose rate were successfully modelled using the procedures developed for flattened beams despite the differing spectra of their FFF counterparts. It was concluded that in vivo portal dosimetry in its current iteration was viable for FFF treatments limited to lower dose rates.

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

IMRT, cont.

Kim et al. reported the results of a multi-institutional IMRT QA study. The goal was to evaluate confidence limits for both point dose and planar QA in the style of TG-119, and to determine if the confidence limit concept was appropriate for the data. Across all plans they report confidence limits of 2.7% for point doses in high dose regions, 6.2% for point doses in low dose regions, and 93.7% pass rate on for single field planar gamma analysis (3%/3mm). However they conclude that the concept of confidence limits was appropriate only for point dose measurements due to the lack of normality in the distribution of planar QA results.

Steers and Fraass presented a study of the sensitivity of gamma analysis in detecting delivery errors as a function of DTA, % dose error, and threshold %. Intentional errors are introduced to IMRT plans and several combinations of gamma criterion are evaluated. The authors promote the concept of an “error curve” which is stated to represent the sensitivity of each gamma criterion to a particular induced error. From the evaluation of these error curves the authors determine that the typical 3%/3mm/10%TH gamma criterion could allow clinically meaningful errors to go unnoticed at a 90% pass rate cutoff. Instead it is suggested that 3%/2mm/50%TH or 2%/3mm/50% with 90% to 95% pass rate cutoff would be more clinically valuable.

Ricketts et al. reported on their experience using EPID-based transit dosimetry and their efforts to create dose-deviation action limits. The authors evaluated reconstructed point doses in 58 patients using this transit dosimetry system, including breast, prostate and head and neck cases. The authors conclude that, for their particular system, the reconstructed point doses for IMRT treatments were consistently lower than the planned values, and that asymmetric action levels were required as a result of this. Action levels were set at -6% ± 7% for their system.

Pérez et al. attempted to mitigate lateral artifacts in EBT3 dosimetry by using an additional thin linear polarized film during the initial EBT3 scanning process. A thorough description of the typical optical scanning system is presented, and the effects on the response of the system of the inherent polarization of the light transmitted through an EBT3 film are analyzed. These polarization effects are shown to be counteracted by using a polarized light source for transmission scanning. This can be done by placing a thin, linearly polarized sheet of film on top of the EBT3 during scanning.

Knill et al. presented an investigation of ion recombination effects in a liquid-filled ion chamber array designed for SRS and SBRT dosimetry. The relationship between collection efficiency and dose per pulse, pulse frequency, and energy are studied for VMAT SBRT plans using both 6MV and 10FFF beams. It is concluded that ion recombination effects are negligible for 6MV, but the increased dose per pulse for the unflattened beam could result in up to a 4.8% difference in measured 2%/2mm gamma pass rates with and without corrections for the ion recombination effects.

Palma et al. performed a planning study comparing “conventional” VMAT versus theoretical very high-energy electron (VHEE) treatments. BEAMnrc/EGSnrc was used to create the initial phase space files for VHEE that were imported into RayStation. Optimization was done using RayStation’s proton pencil beam scanning optimization algorithm. VHEE treatments consisted of sixteen to thirty–two 100MeV electron beams delivered using pencil beam scanning in a fixedgantry coplanar technique. VHEE treatments produced comparable coverage and better OAR sparing, especially for centrally located tumors >4cm. The authors hope the advantages of VHEE will motivate the design of a VHEE treatment machine.

MacFarlane et al. compared unified intensity-modulated arc therapy (UIMAT), a technique involving both static-gantry IMRT and VMAT, to IMRT and VMAT alone. UIMAT begins with the optimization of multiple static beams distributed along an arc range. Beams with fewer segments are converted into VMAT phases while beams with more segments are converted into IMRT phases. The IMRT/VMAT phases are optimized simultaneously and finally merged into a single plan.

UIMAT was tested for 30 head and neck cases and was found to produce better target coverage with increased OAR sparing. n

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

MEETINGS COORDINATION COMMITTEE REPORT Christopher F. Serago, PhD, Jacksonville, FL

Please Book “Within the Block” at AAPM Meetings

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hen you stay at a hotel while attending an AAPM meeting, there are benefits to you and to AAPM if you book a room “within the block” of hotels contracted by AAPM for the meeting.

Benefits to you: •

This year, every registrant who books a stay through the contracted housing management site for the AAPM Annual or Spring Clinical Meeting will be entered in a drawing for a complimentary registration at the 2017 Annual or Spring Clinical Meeting. (One winner will be selected at random and the winner’s registration fee will be refunded after the drawing.)

•

Guest room Wi-Fi is included in your room rate. While some hotel brands already include Wi-Fi as part of the room rate, other hotels charge as much as $12.95 per day.

•

When you reserve a hotel room in the meeting contracted block, you will be the last to be ‘walked’ or relocated in an oversell situation. You may save a few dollars when reserving hotel rooms through bargain websites, but they will not protect you in an oversell situation.

•

Our hotels tend to be the closest to the convention center at discounted rates.

Benefits to AAPM: •

Our room block history (rooms booked and attributed to AAPM) is shared when contracting future venues. The better our room block history, the better leverage we have for lower room rates and fewer contracted penalties in the future.

•

Our room block history impacts the amount of meeting space a city or venue is willing to hold as well as the cost.

An excellent pick up history results in better leverage when negotiating with both hotels and convention centers for meeting space.

We know there are often attractive alternative hotels or reward programs that provide incentives. Please think twice before booking “outside the block” and we will continue to negotiate the best conventions centers and the best hotels at the best rates for future AAPM meetings. You can help us. n

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The Radiation Protection of Patients Unit, Radiation Safety Section, Nuclear Safety, Waste and Transport Division is pleased to announce the availability of the E-learning on Safety and Quality in Radiotherapy.

The e-learning is designed to improve the studentsâ&#x20AC;&#x2122; understanding on how they can improve safety in radiotherapy.

Students will gain knowledge and skills on strengthening safety culture, performing risk analysis, performing retrospective studies after a medical error and the value of learning from incidents through many of the tools provided in the 12 modules.

Students can complete the modules over time by completing each module and passing the quiz at one time. The system will record the completion of that module. Students can go back and review any module if they wish to refresh their understanding of how certain tools can be used in the clinic.

At the completion of all 12 modules the students will receive a certificate of completion of the course.

Please contact us if you have any questions.

If you have not previously accessed the IAEA e-learning platform, please follow these steps: 1. Register with NUCLEUS. 2. Confirm the email link received after your registration.

IAEA E-LEARNING IN SAFETY AND QUALITY IN RADIOTHERAPY

http://elearning.iaea.org/m2/course/view.php?id=392

What do we offer?

The International Atomic Energy Agency has prepared e-learning programme offering participants to improve their understanding of safety in radiotherapy, learn techniques to reduce and avoid radiotherapy incidents and understand the value and use of incident learning systems. The e-learning consists of 12 modules: Module 1: Introduction Module 2: Major Incidents in Radiotherapy Module 3: Learning From Incidents Module 4: Process Maps, Severity Metrics, Basic Causes & Safety Barriers Module 5: Reporting Incidents Using Safron Module 6: Root Cause Analysis 1. Human Factors & Basic Causes Module 7: Root Cause Analysis 2. Safety Barriers & Preventive Actions Module 8: Failure Modes and Effects Analysis Module 9: Fault Tree Analysis Module 10: Safety Culture Module 11: Useful Resources Module 12: And Now What? Enhancing Quality and Safety in Your Clinic The e-learning is available on the IAEA internet platform accessible to everyone. After the completion of the course, the participants can receive a certificate of completion.

How do I access the e-learning programme?

Create an account with Cyber Learning Platform for Network Education and Training (CLP4NET) (http:// elearning.iaea.org/m2/) and access Radiation Protection of Patients Category (http://elearning.iaea.org/m2/ course/view.php?id=392).

Would you like to receive more information?

For more information, please write to: SAFRON.Contact-Point@iaea.org

3. Once your IAEA NUCLEUS account is activated, click here.

4. Enroll yourself in the course.

AAPM Newsletter â&#x20AC;˘ Volume 42 No. 1 JANUARY | FEBRUARY 2017

IMAGING PRACTICE ACCREDITATION SUBCOMMITTEE REPORT Tyler Fisher, Costa Mesa, CA

Comparison of the Medical Physics Testing Requirements for MRI between the Four CMSApproved Accreditation Bodies

C

urrently there are four accreditation bodies approved to provide advanced diagnostic imaging accreditation as required under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). These include the American College of Radiology (ACR), the Joint Commission (JC), the Intersocietal Accreditation Commission (IAC), and RadSite. Accreditation bodies are unique, each bringing a slightly different philosophy to the market. Common areas required for accreditation include quality control of equipment, policies and procedures, personnel qualifications, MRI safety evaluations and phantom images. All accreditation bodies require some form of quality control evaluation of equipment but the number, scope and passing criteria of these tests can vary between organizations. The table below lists the various tests that are discussed within the MRI accreditation programs for each organization.

ACR accreditation testing focuses on phantom image review and evaluation of the technologist QC program. For accreditation submission, phantom images (acquired within the previous six months), using a specific accreditation phantom must be submitted. There are 5 imaging series that must be submitted for accreditation: an ACR-specific Sagittal localizer, ACR-specific T1 & T2 weighted protocols, and site-specific T1 & T2 weighted protocols. The ACR clearly defines the steps for acquiring these images, how to evaluate the images, and what acceptable criteria to use in the 2015 MRI QC Manual. Additional resources on performing many of these tests can be found on the AAPM website from the Working Group on Magnetic Resonance Testing & Quality Control. Information about ACR Accreditation can be found here.

The Joint Commission requirements for equipment quality control closely mirror the ACR requirements. The JC standards allow significant discretion to the physicist in determining how to perform the listed tests and what Pass/Fail standard to use. While the ACR-specified phantom can be used for testing, the Joint Commission does not require it to be used.

There is currently no phantom image quality review with the JC. Physics reports are reviewed during the normal course of a JC onsite inspection. Currently, the Joint Commission does not require a qualified medical physicist or MR Scientist to perform these evaluations. Information about JC Accreditation can be found here.

The IAC MRI accreditation program differs from the ACR and Joint Commission programs. IAC requires the submission of phantom images to verify completion of daily QC. The IAC allows the use of any acceptable image quality phantom and, like the Joint Commission, does not require a qualified medical physicist or MR Scientist to perform annual evaluations.

Some equipment parameters must be checked and documented as part of preventative maintenance. Information about IAC Accreditation can be found here.

RadSite, approved as an accreditation body in 2013, includes MRI accreditation within their MAP accreditation program.

Radsite provides acceptable criteria for their required imaging tests based on the field strength of the MRI. While no specific MRI phantom is required, the phantom must be capable of performing all the required tests and meeting all the pass/fail criteria specified in RadSite standards. Information about RadSite Accreditation can be found here.

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AAPM Newsletter â&#x20AC;˘ Volume 42 No. 1 JANUARY | FEBRUARY 2017

Imaging Practice Accreditation Subcommittee, cont.

All of the accreditation programs include MRI safety as a significant issue that should be evaluated during routine quality control. For example, the ACR has very specific policies and procedures that must be in place regarding patient safety.

The Joint Commission includes standards dealing with access, screening, and ferro-magnetic objects being near the entry to the MRI scan room. As physicists, it should be our standard practice to include an evaluation of MRI safety and make strong recommendations to our facilities when deficiencies are found. While there is still much to be determined about the effects of low levels of radiation from medical imaging, there are significant patient injuries and deaths that occur every year within the MRI scan room that we must all be vigilant to prevent. n

ACR

Joint Commission

IAC

Alignment Light Accuracy

x

x

x

Artifact Evaluation

x

x

x

Standard

RadSite x

Center Frequency

x

x

Film Printer QC

x

x

Geometric or Distance Accuracy

x

x

x

x

High-Contrast Resolution

x

x

x

x

Image Unformity

x

x

x

x

Low-Contrast Resolution

x

x

Magnetic Field Homogeneity

x

x

x

x

Slice Position Accuracy (Setup and Table Accuracy)

x

x

x

x

Slice Thickness Accuracy

x

x

x

x

Soft-Copy Monitor QC

x

x

x

Transmitter Gain or Attenuation

x

Visual Checklist

x

x

x

Coil Checks of All Clinically Used Coils x

x

Signal-to-Noise Ratio

x

x

Percent Signal Ghosting

x

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x x

x x

AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

IROC REPORT Paige Taylor, MS, IROC Houston QA Center

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roton therapy practices are growing and evolving. There are over 20 proton therapy centers treating patients in the USA, many of which are contributing to NCI-funded clinical trials. IROC Houston monitors proton centers that wish to participate in such protocols. To this end, we perform phantom audits and on-site dosimetry audits to ensure comparable dose across proton centers. One area of interest is the margins used by proton centers to cover target volumes. These parameters, both lateral and range margins, are collected from the institutions through our electronic proton facility questionnaire.

The typical lateral margins added to the CTV were collected for several anatomical disease sites from 24 proton centers. The median and range for the lateral margins are shown in Table 1. For brain targets, there was a 3-mm difference between the smallest and largest standard lateral margins. For thoracic targets, up to a 12-mm difference in standard lateral margins was reported. Overall, depending on the treatment site, the proton lateral margins varied from 2 mm to 15 mm.

The range margins added to the CTV were reported as either a percentage of the planned beam range, or a percentage of the planned beam range plus a fixed value. For example, a 1.5% margin for a beam with a range of 28 cm would be 4.2 mm water equivalent depth. The proton therapy centers’ range margins varied widely, from a variable 1% of the range + an additional 1 mm, to a variable 3.5% of the range + 3 mm. Table 2 shows the calculation of the median depth margin for a proton beam with an initial range of 12 cm (lung) and 28 cm (prostate). For these examples, the depth margins used by the centers varied by 5 mm between institutions for the lung, and 10 mm for the prostate.

We might expect small variation in margins between institutions based on their image guidance or beam delivery system, but most of the centers in this study were using the same orthogonal kV method for patient setup, thus the variation in lateral and depth margins across centers was not expected. In addition, many of the centers share similar proton delivery systems, and even these facilities did not all use the same margins.

This difference in treatment margins is particularly important to the cooperative groups when designing clinical trials and combining patient treatment data from multiple proton therapy centers. If a trial group designs a multi-institutional clinical trial to include proton therapy for the prostate, it will be valuable to know that unless penetration uncertainty margins are specified in the protocol, institutions’ depth margins may vary by as much as 10 mm. This means that institutions would be treating different target volumes, and this variation might result in very different normal tissue outcomes.

Thought should be given to which margins best suit each institution’s proton therapy equipment capabilities, but also the specifications of the trials. Several new proton centers have implemented variable range margins based on anatomical target location, changes of the pencil beam spot size with energy and air gap, or robustness evaluations of target coverage. Similarly, the increased use of CBCT or CT-on-rails systems may improve patient setup accuracy and reduce the necessary target margins. In the future, clinicians and physicists can work together to develop consensus values for clinical proton margins for treatment consistency across proton therapy centers. n

Anatomical Site-Specific Lateral Margins [mm] Median [range]

Brain

H&N

Thorax

Abdomen

Pelvis

3 [2-5]

3 [2-7]

5 [3-15]

5 [4-10]

5 [2-10]

Table 1. Lateral margins for proton therapy treatment of various anatomical disease sites.

Median [range]

Total Depth Margin for Lung [mm

Total Depth Margin for Prostate [mm]

5 [2-7]

10 [4-14]

Table 2. Total additional range margin for proton therapy treatment of lung and prostate.

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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.

Application Deadline: February 2, 2017 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 42 No. 1 JANUARY | FEBRUARY 2017

BANGLADESH MEDICAL PHYSICS SOCIETY (BMPS) Celebration of the 4th International Day of Medical Physics (IDMP) 2016

I

nternational Day of Medical Physics is an initiative of the International Organization for Medical Physics (IOMP). This day is recognized every year to assist with improving the medical physics status worldwide. The theme of the International Day of Medical Physics in 2016 was ‘’Education in Medical Physics: The Key to Success.” It is true that without proper education and training, good medical physicists will not exist. In addition to a medical physicist’s clinical practice, active participation in education and training makes the medical physics world better.

The Bangladesh Medical Physics Society (BMPS) is a non-profit, non-trade organization primarily engaged in professional, educational and research activities throughout Bangladesh in the field of medical physics. Specific interests include biomedical engineering, focused on the application of physics in medical sciences. It represents the interests of medical physicists globally and creates education and training possibilities for the rising scientific generation.

The Department of Medical Physics and Biomedical Engineering (MPBME) at Gono University and BMPS together play a pioneer role, in Bangladesh, in promoting medical physics education. BMPS promoted the 4th International Day of Medical Physics (IDMP), November 7, 2016, by including activities of the BMPS, scientific articles and various events relating to IDMP in their newsletter, Voice of BMPS.

The day began at 9:30 AM at Gono Bishbidyalay (University), focused primarily on the importance of medical physics. Many BMPS members including the president, vice president, founding president, joint secretary, treasurer and executive members were in attendance for the celebration. Following the opening celebration, a seminar was held at the MPBME focused on the importance of this auspicious day. President of BMPS, Dr. Kumaresh Chandra Paul, delivered the opening speech and asked that the younger generation of medical physicists engage more in education so that they can use it practically for cancer patient care. Founding president of BMPS, Prof. Dr. Hasin Anupama Azhari, followed the theme for IDMP 2016, and discussed key points on how to be a successful medical physicist. Vice President Anwarul Islam, Joint Secretary Abu Kausar, and Treasurer Nupur Karmaker, also spoke about the IDMP and medical physics. n

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AAPM journals now

publishing with Wiley AVAILABLE ONLINE—See http://www.medphys.org

September 2016

Volume 43, Number 9

The International Journal of Medical Physics Research and Practice

Volume 17, Number 5

2D maps of a microdiamond (MD) dosimeter (PTW model 60019) response measured by scanning a 200 µm diameter soft x-ray microbeam over the 3 mm diameter active detector element. The left panel illustrates the response distribution (color wash) obtained by scanning (a) perpendicular to the diamond plate (dotted white lines) and (b) parallel to the detector axis where the solid white lines indicate the external surface of the MD dosimeter. The right panel shows normalized response maps of 10 different PTW MD detectors.

[Figures 3 and 6 from Marinelli, Prestopino, Verona, and Verona-Rinati, “Experimental determination of the PTW 60019 microDiamond dosimeter active area and volume,” Med. Phys. 43, 5205-5212 (2016)].

Published by the American Association of Physicists in Medicine (AAPM) with the association of the Canadian Organization of Medical Physicists (COMP), the Canadian College of Physicists in Medicine (CCPM), and the International Organization for Medical Physics (IOMP) through the AIP Publishing LLC. Medical Physics is an ofcial science journal of the AAPM and of the COMP/CCPM/IOMP. Medical Physics is a hybrid gold open-access journal.

We are delighted to announce that beginning in 2017 our prestigious journals, Medical Physics and Journal of Applied Clinical Medical Physics, will be published in partnership with Wiley.

For more information, please visit aapm.org

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AAPM Newsletter • Volume 42 No. 1 JANUARY | FEBRUARY 2017

ISEP/AAPM/IOMP RADIATION THERAPY PHYSICS 2016 Cheng B. Saw, PhD, Harrisonburg, PA

BAPETEN Educational and Training Center Jakarta, Indonesia • August 22– 26, 2016

A

five-day ISEP/AAPM/IOMP Radiation Therapy Physics 2016 course with the theme “Foundation on Theories, Development, and Practices” was held at the Indonesia Badan Pengawas Tenaga Nuklir – BAPETEN (Nuclear Energy Regulatory Agency of Indonesia) Educational and Training Center, Jakarta, Indonesia on August 22th–26th, 2016. This radiotherapy physics course was organized by the BAPETEN Educational and Training Center and University of Indonesia in collaboration with International Scientific Exchange Program (ISEP) of AAPM and International Organization for Medical Physics (IOMP).

The principal objective of this workshop was to improve the quality and knowledge of medical physicists and license evaluators in a radiotherapy facility through a strong medical physics foundation, understanding of the development of radiotherapy programs, and the clinical implementation processes. The radiotherapy physics course 2016 was separated into a radiotherapy physics session in the first four days and a shielding and barrier design session on the last day.

The organizers for this course were Cheng B Saw, PhD serving as Program Director on behalf of the ISEP/AAPM, Lukman Hakim, Ir, MAk, MEng from the Indonesia BAPETEN and Supriyanto A. Pawiro, PhD from University of Indonesia as Co-Host Directors. The faculty members from AAPM who volunteered their times and efforts were: • • • • •

Cheng Saw, PhD, Northeast Radiation Oncology Centers, Scranton, PA Arthur Boyer, PhD, AAPM, Benton, TX

Cesar Della Bianca, PhD, Memorial Sloan Kettering, New York, NY Sha Chang, PhD, University of North Carolina, Chapel Hill, NC

Geoffrey Ibbott, PhD, MD Anderson Cancer Center, Houston, TX

The opening ceremony for the radiotherapy physics session commenced on August 22, 2016 with the welcoming address delivered by Dr. Saw. He thanked the Host Directors, Mr. Hakim and Dr. Supriyanto for undertaking this project and conducting the course. Without their support and participation, this course would not be possible. Dr. Saw also thanked the faculty for traveling long distances to volunteer their efforts and times to participate in the project. Also, Dr. Saw indicated that without the participants who had taken their time off to attend, the course would not be possible.

The ceremonial process was conducted by Prof. Dr. Jazi Eko Istiyanto, Chairman of the Nuclear Energy Regulatory Agency. He described the current state and the increasing number of radiotherapy centers in Indonesia. He also assured that his agency, BAPETEN, has strongly supported medical physics programs as a regulator through the regulation and human resources development.

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AAPM Newsletter â&#x20AC;˘ Volume 42 No. 1 JANUARY | FEBRUARY 2017

ISEP/AAPM/IOMP

The day one presentations were given by Dr. Ibbott on advances in radiation therapy and in particular, the MRI-Linac.

Next, his lectures included discussions on acceptance testing and commissioning of medical linear accelerators. It was followed by reference dosimetry protocols and lastly on in-vivo dosimetry. The presentations on day two were given by Dr. Chang. He covered the in-house treatment planning system, PLUNC, followed by treatment planning strategies. Free copies of PLUNC software were distributed to meeting attendees and basic training was also provided. Compensatorbased IMRT, a low cost alternative IMRT approach may be relevant to developing countries, was also discussed. Next, Dr. Chang presented the basics of radiation biology. In the afternoon, Dr. Pawiro and his colleague presented medical linear accelerator quality assurance and patient specific quality assurance. In the morning of day three, Dr. Della Bianca presented 3D planning with HDR followed by brachytherapy quality assurance. Before lunch, Dr. Della Bianca presented advances in IGRT and quality assurance on imaging devices. Dr. Boyer presented the principles of stereotactic radiosurgery. This was followed by the principles of stereotactic body radiation therapy presented by Dr. Saw. The last lecture of the day was given by Dr. Saw on small field dosimetry. On the morning of day four, Dr. Saw presented the treatment planning of Tomotherapy. It was followed by Human Anatomy and then Motion Management by Dr. Boyer, who then continued with non-standard reference dosimetry and patient safety. After lunch, there were discussions on PLUNC software and the non-standard reference dosimetry and then a closing ceremony was held to close the radiotherapy physics session.

The opening ceremony for the shielding and barrier design symposium commenced on August 26, 2016 with the welcoming address delivered by Dr. Saw. Again, Dr. Saw emphasized the volunteer efforts of the Host Directors and the AAPM faculty to hold this course and symposium. In addition, he wanted to recognize the participants for taking time off to attend the radiotherapy physics session and shielding and barrier design symposium. The ceremonial process was conducted by Mr. Zainal Arifin, Director of BAPETEN Authorization for Radiation Safety and Radioactive Sources. He indicated the close collaboration between the regulators, the educators, and the medical physics society fosters faster advancements in the safe use of radiation in Indonesia.

This shielding and barrier design symposium was viewed as very important to BAPETEN Evaluators to further improve their skills and knowledge regarding how to conduct the evaluation of Safety Analysis Report Documents that are being submitted by licensees. It is the hope of the organizers that this symposium will provide insights and improve the quality services provided by BAPETEN. The first presentation was given by Dr. Boyer on the shielding design for low-dose rate and high-dose rate brachytherapy. He started by examining the shielding design for a patient room and the maximum permissible dose and then continued to the design of the HDR suite. Next, shielding design for medical linear accelerators was presented by Dr. Ibbott. He discussed the principles of shielding including primary beams, radiation leakage, and scattered radiation.

In addition, Dr. Ibbott addressed the issue of skyshine and also the presence of neutrons for higher energy machines.

The last presentation was given by Dr. Saw on Gamma Knife. Dr. Saw discussed the anisotropic nature of the radiation from the Gamma Knife. Unlike medical linear accelerators, the calculations of shielding barrier for Gamma Knife are done differently. The final hour was left for discussion followed by the closing ceremony. The closing ceremony was conducted

by Joni Kadir, from BAPETEN, acknowledging the unique opportunity of having this shielding and barrier symposium for the evaluators in Indonesia. The symposium and discussions during the presentations were invaluable to the audiences.

This ISEP/AAPM/IOMP Radiation Therapy Physics Course 2016, with emphasis on principles of medical physics and

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AAPM Newsletter â&#x20AC;˘ Volume 42 No. 1 JANUARY | FEBRUARY 2017

ISEP, AAPM, IOMP, cont.

shielding, was conducted under the BAPETEN guidelines. The medical physics course and shielding and barrier design symposium were held at the BAPETEN educational and training center which limited the participants to a maximum of 80. In this respect, the participation was at full capacity. In addition, the course was offered to local and international medical physicists without charging registration fees. Besides local medical physicists within Indonesia, the participants were from Singapore, Malaysia, and India. Being a small group, the fact that the sessions were very engaging can be attributed to the interest of the participants in principles of medical physics as applied in the clinics and shielding and barrier design concepts to the evaluators of the BAPETEN. On behalf of the faculty, the Program Director of ISEP/AAPM (Dr. Saw) wishes to thank the Host Directors, Dr. Hakim of BAPETEN and Dr. Pawiro of University of Indonesia for taking on this project and the hospitality extended to the AAPM faculty in Indonesia. The Host Directors also wish to thank the AAPM faculty for their willingness to travel to Indonesia to participate in this educational project.

Submitted By Cheng B Saw, PhD (Program Director of ISEP/AAPM) Mr. Lukman Hakim, Ir, M. Eng (BAPETEN) and Supriyanto Pawiro, PhD (University of Indonesia) n

Group Photo

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Opening Ceremony Presentation: [Left to Right: Supriyanto Pawiro, PhD, Cheng Saw, PhD, Prof Dr. Jazi Eko Istiyanto, and Joni Kadir, MSi

UPCOMING AAPM MEETINGS: March 17, 2017 Quality, Safety and TG100 New Orleans, LA March 18–21, 2017 AAPM 2017 Spring Clinical Meeting New Orleans, LA June 10–14, 2017 AAPM 2017 Summer School Clinical Brachytherapy Physics Portland, OR July 30–August 3, 2017 AAPM 59th Annual Meeting & Exhibition Denver, CO

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