AAPM Newsletter March/April 2003 Vol. 28 No. 2

Newsletter

American Association Of Physicists In Medicine VOLUME 28 NO. 2

MARCH/APRIL 2003

AAPM President’s Column Martin S. Weinhous Cleveland, Ohio

Progress Several issues were mentioned in my last column as works in progress for 2003. The Association continues its efforts on these items.

Better coordination of the works of the AAPM and ACMP is evolving via the contributions of a joint Ad Hoc Committee, our Professional Council, and our Journal Business Management Committee. Some items under consideration include a common Scope of Practice statement, and co-ownership of JACMP. John Horton (as ACMP chairman) and I will make a joint presentation describing these and other

efforts at the ACMP Annual Meeting in Lake George, New York in May. As part of the Association’s continuing efforts to strengthen imaging science within the AAPM, we cosponsored the Biomedical Imaging Research Opportunities Workshop, www.birow.org, in Bethesda in late January. According to AAPM representative Paul Carson, the workshop was a significant success.

As I prepare this column in mid-February, I am in the process of forming a multi-society ad hoc committee to study non-occupational radiation exposure recommendations. This committee is expected to use the best available science to make independent non-occupational exposure recommendations.

Other issues mentioned in my last column are AAPM’s endorsement of outside position papers, studying and perhaps modifying our organization and governance, and the recruitment of physicists and others into the profession. Progress has been made in all these areas. As the overseeing bodies move toward consensus, the ideas will be published.

(See Weinhous - p. 2)

AAPM Awards, Honors and Grants Congratulations to the recipients of the following honorable awards and achievements for 2003: The William D. Coolidge Award is presented to Kenneth Hogstrom, Ph.D.

The Achievement in Medical Physics Award is presented to Stewart Bushong, Ph.D. and Radhe Mohan, Ph.D. (See Awards - p. 3)

TABLE OF CONTENTS President-elect Report p 3 Exec. Dir’s. Column p 5 Gov’t. Affairs Column p 6 Announcements pp 7/16 Call for Travel Grants p 8 Call for Nominations p 9 Prostate Cancer . . . p 10 AAPM in the News p 15 Mammography FAQ’s p 18 Let’s to the Editor pp 21-3

AAPM NEWSLETTER

MARCH/APRIL 2003

Weinhous (from p. 1) New Issues and Activities The History Committee has been asked to begin producing Web pages to describe the AAPM’s founding and evolution.

Further, to enhance its activities, the History Committee’s position in our organizational structure will be shifted from the administrative committees area to within the Education Council.

Past-president Charlie Coffey has suggested that it is time for the AAPM to push for routine use of lung inhomogeneity corrections in treatment plan-

ning. This suggestion is strongly supported by ExCom and has been referred to the Radiation Therapy Committee for action.

An Ad Hoc Committee on AAPM/ASTRO Relations is very likely to be formed to create a procedural understanding between the two organizations for more effective collaborations.

A Placement Service Management Committee will be created to support Bob Rice and to manage that service.

Plans

tion Therapy to be held June 2226, in Colorado Springs, CO. Likewise, it is also time to make your plans to attend our Annual Meeting to be held August 10 - 14, in San Diego, CA. Further information about these and other AAPM activities can be found at www.aapm.org.

As always, the Association’s officers and staff are available to the members to correspond on any issue as we all work together to improve the Association. ‘Til next time…

■

Please make your plans to attend the AAPM Summer School on Intensity Modulated Radia-

2003 RDCE

Need Continuing Education Credits?

Earn your medical physics continuing education credits online through the

AAPM Remotely Directed Continuing Education Program Answering 8 of the 10 questions will provide you with one Medical Physics Continuing Education Credit (MPCEC). The results of your passing scores will be forwarded to the Commission on Accreditation of Medical Physics Education Programs (CAMPEP). You will receive a summary of your MPCEC’s earned through the RDCE program at the end of the year from CAMPEP. Questions set categories: - CT - PACS, DICOM, and Monitors - Diagnostic - Radiation Protection - Mammography - Radiation Oncology

- Ultrasound - Nuclear Medicine - MRI

Question sets based on: - AAPM Virtual Library presentations - Medical Physics articles - Other easily accessible publications such as AAPM Task Group or NCRP Reports Member Registration Fee: $25

www.aapm.org/educ/rdce.asp 2

AAPM NEWSLETTER

Awards (from

MARCH/APRIL 2003

2003 AAPM Fellows

p. 1)

The following are named as Fellows in 2003 for their distinguished contributions: A Special Award for Outstanding Service to AAPM is presented to Salvatore Trofi, Jr., MBA

Suresh Brahmavar, Ph.D. Libby Brateman, Ph.D. Sherry Connors, M.Sc. George David, M.S. Nicholas Detorie, Ph.D. Aaron Fenster, Ph.D. Ellen Grein, Ph.D. John Hazle, Ph.D. Michael Herman, Ph.D. Gary Luxton, Ph.D. Mark Madsen, Ph.D. Robert Nishikawa, Ph.D. Charles Pelizzari, Ph.D. Terrence Peters, Ph.D. Chester Reft, Ph.D. Timothy Schultheiss, Ph.D. Ralph Shuping, Sc.D. Marc Sontag, Ph.D. Robert Zamenhof, Ph.D.

The AAPM-IPEM Travel Grant for 2003 is awarded to Paul Keall, Ph.D.

The AAPM Medical Physics Travel Grant for 2003 is awarded to Nesrin Dogan, Ph.D.

President-elect Report Don Frey Charleston, SC One of the great strengths of the AAPM is our large and varied committee structure. There are councils, committees, subcommittees, ad hoc committees and task groups that serve our organizational needs. In 2003, 621 (17%) of our 3667 members have appointments to these committees. One of the most important activities of the presidentelect is to recommend to the board of directors new appointments to these committees. You probably have seen the annual “call for volunteers.” I would like

you to think about how you can serve the AAPM. The biggest difficulty associated with the appointments is knowing which members are interested in serving and knowing their qualifications. When the presi-

dent-elect is not aware of an individual who wants to serve in a particular committee, he runs down a mental list of candidates he can recruit. This sometimes leads to the assertion by some members that the appointment process is an “old boys club,” and to the feeling by the presidentelect that there are not enough members interested in serving.

Therefore I am encouraging more of you to make your interests known so that the AAPM can benefit from a broader base of volunteers and so that the more active members don’t burn out and become lost from the volunteer pool.

(See Frey - p. 4)

3

AAPM NEWSLETTER

Frey (from p. 3) Some of the details of the process are important to matching members with areas where they can be active. Task groups are usually formed to accomplish some specific task, and frequently to publish a report that is useful to the membership. The AAPM councils or committees officially appoint task group members.

However, the best way to obtain an appointment is to ask the task group chair to appoint you. It is often the case that there are AAPM members who have extensive knowledge and experience who are unknown to the chair and members of the task group. This is especially true because task groups often deal with matters of importance to the working physicist and need individuals who have a practical knowledge. I urge everyone to take a couple of minutes to read the list of task groups. If you feel you can contribute, send an email to the chair of the task group. Task groups are in various stages of work from collecting data to crafting, reviewing and publishing their reports. Depending upon where they are in the cycle, they need various talents.

So, do not be discouraged if you are not needed for a particular task group. I encourage you to keep trying. One advantage of task group work is that much of it is done away from formal meetings so members who cannot attend the meetings can still frequently contribute to the task group.

Committee chairs also appoint subcommittee members. Sub-

MARCH/APRIL 2003

committees exist to carry out longer-range activities. Again, I suggest that if you have an interest in a particular activity, you should first contact the subcommittee chair and make your interest known. Some subcommittees need individuals to review materials, an activity that does not require attendance at meetings.

“Participation in the AAPM committees is a wonderful way to get to know other members, expand your knowledge of medical physics and the AAPM, and to contribute to the AAPM and to the profession.”

The Board, on recommendation by the president-elect, appoints committee members. The president-elect makes the recommendations by consulting with the committee and council chairs.

There are several routes to service on a committee. Members that are active on task groups and subcommittees often move to the parent committee. Another way to get to know the activities of the committee is by attending the committee meetings at AAPM, ASTRO or RSNA. If you like what you see at a committee meeting, introduce yourself to the chair and discuss committee membership. When you talk to 4

the chair discuss what you can do to help the committee with its tasks. You may use the form on the AAPM Web site to submit your name to the president-elect.

Participation in the AAPM committees is a wonderful way to get to know other members, expand your knowledge of medical physics and the AAPM, and to contribute to the AAPM and to the profession. I encourage each of you who has not participated to find ways of helping your organization by active committee ser■ vice.

AAPM NEWSLETTER

MARCH/APRIL 2003

Executive Director’s Column Sal Trofi College Park, MD

2003 Summer School

2003 AAPM Annual Meeting The 45th AAPM Annual Meeting will take place August 10–14, 2003 at the San Diego Convention Center. Sessions, exhibits, registration and the Welcome Center will be at the center. The Headquarters hotel is the San Diego Marriott and Marina. The Headquarters office, all committee meetings and the Awards and Honors Ceremony and Reception will be held in the Marriott.

The overflow hotels are the Manchester Grand Hyatt and the Clarion Bayview. The online registration system opened in midMarch. The deadline for discounted registration is June 18.

Advance registration closes on July 23. The deadline to make hotel reservations is July 7.

Remember, scientific sessions and exhibits now begin on Sunday, August 10, so make plans to arrive in time to participate in the Sunday events.

Steve Goetsch and the San Diego Local Arrangements Committee have a wonderful Night Out planned for Tuesday, August 12. The Night Out will be a private party at the Embarcadero Park – a jetty of land right on the bay, just a few minutes walk from each of the hotels.

New in 2003: Student meeting – Sunday, Au-

gust 10 from 9:30–11 AM, just prior to the Young Investigators Symposium. Students from MD Anderson are working with Bhudatt Paliwal, as chair of the Education and Training of Medical Physicists Committee, to arrange the program.

Diagnostic Imaging Symposium – a special symposium scheduled for Sunday and Monday. You must register for the Imaging Symposium in addition to the Annual Meeting, but you will receive a discount if you register for both.

Welcome Center – There will not be a Companions’ Hospitality Suite at the San Diego meeting.

Instead, scientific attendees and companions alike are encouraged to take advantage of the Welcome Center, located in the registration area of the Convention Center. At the Welcome Center you will find Internet access, tour information and information on the San Diego area. A Starbucks is conveniently located right next to the Welcome Center.

For the most up-to-date information, go to: http:// www.aapm.org/meetings/ 03AM/.

5

The 2003 Summer School will be held June 22–26, 2003 at Colorado College in Colorado Springs. The topic is “Intensity Modulated Radiation Therapy – The State of the Art.” The program directors are Jatinder Palta and Rock Mackie. Jerry White, Chris Dennett and Robin Miller head up the Local Arrangements Committee.

New this year! Registration will be available via the Web ONLY. Make sure to register before April 30 to take advantage of discounted registration fees. Housing reservations must be made directly with Colorado College by June 6. Registration closes on May 30.

The entire Summer School program is available on the Web at: http://www.aapm.org/meetings/ 03SS/.

Membership Directory If you have not already received your paper version of the AAPM Membership Directory, you will soon. We try to eliminate the incidences of abuse of the information contained in the directory.

The main abuse is when individuals use the membership contact information, without authorization, for commercial purposes.

The directory contains a statement of proper use: “this directory is intended for the convenience of AAPM Members.” It (See Trofi - p. 6)

AAPM NEWSLETTER

Trofi (from p. 5) also has a statement of improper use: “use of this directory for business solicitation, commercial mailings or other advertising purposes is prohibited.”

We work with companies who have a message for the membership by selling contact information after we review the content to be delivered to make sure it is of interest to medical physicists.

This is an important source of revenue that helps defray the cost of delivering services to the membership. It has come to our attention that some medical physics sites have been contacted by individuals soliciting names and addresses of medical physicists at their site. The callers indicate that they are calling on behalf of or at the request of the AAPM. AAPM would not grant or sanction this type of solicitation. If you receive such a call and have doubts, please call AAPM Headquarters at 301-209-3350.

Staff News AAPM’s database administrator, Sean Benedict and his wife, Amanda, welcomed their first child on January 6. Sophie Alicia Benedict was born at 6:56 AM, weighing 6 lb, 12.6 oz and was 19.5 inches long. Dad, Mom and Sophie seem to be adjusting well to family life.

■

MARCH/APRIL 2003

Government Affairs Column Angela L. Lee College Park, MD I have prepared a document on CAMPEP Residency Program Funding. The document is a summary of the Medicare Program Payment for Nursing and Allied Education Final Rule which appeared in the January 12, 2001 Federal Register.

This document is located on http:/ /www.campep.org/, under Residency Education Programs.

I attended the Biomedical Imaging Research Opportunities Workshop (BIROW) in Bethesda, MD on January 31 and February 1, 2003. The BIROW meeting was sponsored by the AAPM, the Academy of Radiology Research, the Biomedical Engineering Society and the Radiological Society of North America. The meeting drew 174 attendees, many from the federal government (mostly NIH agencies) and offered four plenary sessions relating to issues facing biomedical imaging. Attendees had the opportunity to participate in one of four breakout groups that corresponded with the plenary sessions. Interestingly, after the attendees evaluated and prioritized the significant issues and challenges facing the biomedical imaging community, the individual groups came up with similar issues and challenges, regardless of the subject matter. A white paper based on the breakout sessions will be published.

6

Government representatives from the Department of Energy, Department of Defense, the National Cancer Institute (NCI), and the National Institute of Biomedical Imaging and Bioengineering (NIBIB) attended the BIROW meeting. Dr. Elias A. Zerhouni, secretary of the NIH, was the dinner speaker. He gave a compelling and provocative speech on the challenges facing biomedical imaging and research. Among the people playing integral roles in the program were Dr. Roderic Pettigrew, director of the NIBIB; Dr. Donna Dean, assistant director of the NIBIB, several other staff members from the NIBIB, as well as Dr. Dan Sullivan, director of the NCI, and others from the NCI. Everyone was very knowledgeable and conveyed their information in a clear way. For more information on the BIROW, go to: http:// www.birow.org/.

This year the AAPM, along with other scientists, engineers, researchers and educators, will go to Capitol Hill to visit their representatives and senators in or-

AAPM NEWSLETTER

der to discuss issues that affect the scientific community. The Science-Engineering-Technology (SET) Work Group, of which the AAPM is a member, is sponsoring a two-day (April 2-3) Capitol Hill meeting. The SET Work Group’s objective is “to under score the long-term importance of science, engineering and technology to the nation” through visits with lawmakers. This year’s core message is “federally funded research is the nation’s foundation for the future.” The meeting consists of one day of briefings and a reception that honors two members of congress who have been supporters of mathematics, science, and research policy. The AAPM plans to send several medical physicists to Capitol Hill to meet with lawmakers and discuss bills related to radiation and health care issues. For more information on the SET Congres-

sional Visits Day, go to: http:// www.agiweb.org/cvd/.

In legislative news, developments on Capitol Hill are moving slowly. The omnibus bill, which contains the remaining 11 Appropriations bills, passed the House and Senate on February 13, 2003. I will have a budget breakdown in my next column.

In regulatory news, the Nuclear Regulatory Commission (NRC) has approved the Advisory Committee on the Medical Use of Isotope’s (ACMUI) recommendations on Training and Experience requirements (http:// www.nrc.gov/what-we-do/ regulatory/advisory/ te080102.pdf) with a slight modification. This recommendation will be published in the form of a Proposed Rule. Here is a quote from a NRC memo dated February 12, 2003:

MARCH/APRIL 2003

The Commission has approved the proposal that all boards that meet the criteria for recognition by the NRC will be listed on the NRC website rather than in [10 CFR 35 Medical Use of Byproduct Material]. In addition, the preceptor statement should remain as written in the final Part 35 rule.

The staff should clarify that the preceptor language does not require an attestation of general clinical competency, but does require sufficient attestation to demonstrate that the candidate has the knowledge to fulfill the duties of the position for which certification is sought. This form of attestation should be preserved for both pathways of certification (i.e., through board certification or through training and ■ experience).

Announcement National Science Foundation Scholar-in-Residence Program at FDA The NSF has just released Program Solicitation NSF 03525 for the NSF/FDA Scholarin-Residence at FDA program.

The announcement is available at the NSF Web site at: http:// www.nsf.gov/pubs/2003/ nsf03525/nsf03525.htm.

This is a newly established program that comprises an interagency partnership for the investigation of scientific and engineering issues concerning

emerging trends in medical device technology. This partnership is designed to enable investigators in science, engineering, and mathematics to develop research collaborations within the intramural research environment at the FDA’s Center for Devices and Radiological Health. The solicitation features four flexible mechanisms for support of research at the FDA: 1) Faculty at FDA;

7

2) Graduate Student Fellowships; 3) Postdoctoral Fellowships; and 4) Undergraduate Student Research Experiences.

Undergraduate student participants supported with NSF funds must be citizens or permanent residents of the United States.

Further information and details regarding application procedures are found on the aformentioned Web site.

AAPM NEWSLETTER

MARCH/APRIL 2003

AAPM Awards and Honors Committee Call for Competitive Applications for 2004 Travel Grants Deadline*All applications must be received by October 15, 2003. Address Travel Grant applications to: AAPM Awards and Honors Committee One Physics Ellipse College Park MD 20740-3846 Applicants will be notified of decisions by June 15, 2004. Recipients will be honored at the AAPM Awards and Honors Ceremony and Reception during the 46th Annual Meeting in Pittsburgh, Pennsylvania.

AAPM-IPEM Medical Physics Travel Grant This grant is made annually to a U.S. AAPM member who shows evidence of an active scientific career in medical physics. The purpose of this grant is to promote communications and professional partnerships between U.S. AAPM members and IPEM members from the United Kingdom.

Primary Criteria •Practicing medical physics for at least five years.

•Travel to United Kingdom for 14 to 21 days between July, 2004 and July, 2005.

•Submit report suitable for publication in AAPM Newsletter and appropriate receipts for reimbursement.

Application Procedure •Applicant should send curriculum vitae and letter detailing anticipated professional development as a result of this travel, and five suggested topics for lectures to be presented during their visit to the U.K., to the AAPM Awards and Honors Committee (address above) along with a list of proposed facilities to be visited and professional contacts at those facilities.

This grant is supported by a donation from Charles Lescrenier of up to $1,500. In addition, this grant will include £400 from the Institute of Physics and Engineering in Medicine and $1,250 from AAPM towards expenses incurred in the U.K.

AAPM Medical Physics Travel Grant This grant is made annually to a U.S. AAPM member to travel to a foreign country of the recipient’s choice. The purpose of this grant is to assist in the career development of the recipient and to promote communications in medical physics between nations.

Primary Criteria •Completed graduate training within the past 10 years.

•Not be able to accomplish this travel without financial assistance.

•Travel for 14 to 21 days to a foreign country between July, 2004 and July, 2005.

•Submit report suitable for publication in AAPM Newsletter, and appropriate receipts, for reimbursement.

Application Procedure •Applicant should send curriculum vitae and letter detailing anticipated professional development as a result of this travel, and five suggested topics for lectures to be presented during his/her travel, to the AAPM Awards and Honors Committee (address above) along with a list of proposed facilities to be visited and professional contacts at those facilities.

This grant is supported by a donation not to exceed $1,500 from Charles Lescrenier.

8

AAPM NEWSLETTER

MARCH/APRIL 2003

AAPM Awards and Honors Committee Call for Nominations *Deadline - All nominations must be received by October 15, 2003. *Awardees will be honored at the AAPM Awards and Honors Ceremony and Reception during the 46th Annual Meeting in Pittsburgh, Pennsylvania in the year 2004. *Please call Mary K. Martel, Ph.D., chair of the Awards and Honors Committee, at 773-702-6884 if you wish to submit a nomination.

William D. Coolidge Award This award recognizes an AAPM member for an eminent career in medical physics.

Primary Criteria •Significant impact upon the scientific practice of medical physics, and •Significant influence on the professional development of the careers of other medical physicists, and •Demonstrated leadership in national and/or international organizations, with specific emphasis on AAPM activities.

Nomination Procedure •Submission of nomination letter and curriculum vitae.

•Letters of support from three (or more) other AAPM members.

AAPM Award for Achievement in Medical Physics This award recognizes AAPM members whose careers have been notable based on their outstanding achievements.

Primary Criteria •Outstanding career achievements in medical physics science, or education, or organizational/professional activities.

Nomination Procedure •Submission of nomination including supporting evidence of outstanding achievement in one of the three areas of medical physics.

•Letters of support from three (or more) other AAPM members.

AAPM Fellows ON-LINE SUBMISSION PROCESS ONLY!! — http://www.aapm.org/memb/nominate/ The category of Fellow is established to honor members who have made significant contributions through one or more of the following: a) Service to the AAPM. b) The advancement of medical physics knowledge based upon independent original research or development. c) Medical physics educational activities, especially in regard to the education and training of medical physicists, medical students, medical residents and allied health personnel . d) Leadership in the medical physics community.

Nomination Requirements •Nominated by either an AAPM chapter, with endorsement by two Fellows, or by two AAPM Fellows.

•Minimum of 10 years as Full Member of AAPM.

9

AAPM NEWSLETTER

MARCH/APRIL 2003

Prostate Cancer for Physicists R. J. Schulz Johnson, Vermont schulz@pshift.com There have been some truly remarkable technical developments in radiation oncology over the past decade, some of which make it possible to shape dose distributions to the perceived tumor volume as precisely as it may ever be possible using high-energy X-ray beams. Because precisely defined dose distributions are usually more critical when targeting small organs that are in close proximity to sensitive normal tissues, the prostate has become a cause celebre for the promoters of this technology. Indeed, if men had evolved without prostates, it is questionable whether these technical developments would have progressed as far as they have.

Since retirement, and with a great deal of support from a medical colleague, I’ve had the time to learn far more about prostate cancer than I ever knew while professionally active. I’ve also been able to put this disease into perspective regarding what can be reasonably expected from radiation therapy whether it be intensity modulated or a conventional four-field box. The following is intended to give physicists the rudiments of how this disease is currently diagnosed and treated so that they may make more rational decisions about the role of new treatment modalities.

Let me begin by stating unequivocally that there is no one generally accepted treatment for prostate cancer. Surgery, radiation, hormonal or watchful waiting may be used singly or in various combinations. Each has its share of risks and complications but, interestingly, survival rates are remarkably similar. Which treatment is given depends to a great extent upon physician referral patterns, surgery or implants being more common when patients live long distances from treatment centers. This said, consider the following and draw your own conclusions about the potential for surgery or radiation to further enhance current survival rates.

Before delving into the complexities of prostate cancer, it is important to understand the various ways in which survival from this and other diseases are frequently expressed. The fraction of deaths from all causes in a specific group of patients, the “test group,” graphed as a function of time yields a “crude” survival curve. A similar graph for a

10

group from the general population, and age-matched to the test group, yields an “expected” survival curve. Dividing points on the crude survival curve for the test group by similar points from the expected survival curve yields the “relative” or “disease-specific” survival curve. For example, if the five-year crude survival for a test group is 40% and the expected survival is 80%, the disease-specific survival of the test group is 50%. Disease-specific survival curves are useful for comparing the efficacy of one type of treatment with another, however, they tend to overlook the fact that patients are subject to causes of death other than the one under consideration. For example, the disease-specific 10-year survival for men with early-stage prostate cancer is about 90%. However, Albertsen et al (1), who studied 451 men with clinically localized disease and whose mean age was 70.9 years, found that after a mean follow-up of 15.5 years, 9% were still alive, 34% had died of prostate cancer, whereas 57% had died of other causes.

The ACS estimates that there were 30,200 deaths from prostate cancer in year 2002 compared with 154,900 from lung cancer, 48,100 from colon cancer and only slightly fewer from lymphomas and pancreatic cancer. Prostate cancer is a disease of older men; the incidence for men aged 70 – 80 being almost seven times that for men aged

AAPM NEWSLETTER

50 – 60. Prostate cancer accounts for 5.4% of all cancer deaths, and although the annual number has increased by about 5,000 since 1980, mortality (deaths per 100,000) has actually decreased about 10%. This apparent anomaly is due mainly to an increasingly larger older population and to some extent to screening programs that uncover earlier-stage disease. Based upon reports from selected tumor registries, the NCI estimates that the current prevalence of prostate cancer is 1.5 million, however, based upon autopsy data for men who died of other causes (2), the actual prevalence is more likely to be on the order of 20 million.

Five-year survivals are commonly employed to describe post-diagnosis life expectancy.

For a virulent disease such as small-cell lung cancer, the fiveyear survival for all stages has increased from only 4% to 6% over the past three decades, and it is clear that little progress has been made in its treatment. The mortality of prostate cancer today is also about the same as it was three decades ago, which suggests that little progress has been made in its treatment. However, the disease-specific fiveyear survival of prostate cancer has increased from about 70% in 1970 to a current level of slightly better than 90%. The reason for this increase is earlier detection.

For example, 30 years ago and before the PSA test, a man’s cancer would likely progress much further before detection than today. Back then he may have been diagnosed at age 65 and suc-

cumbed at 75. Today, this same man’s cancer is more likely to be detected at age 55 but, as mortality hasn’t changed, he might still succumb at age 75. Earlier detection of any disease without a concomitant decrease in mortality tends to increase five-year survival.

The first steps in the diagnosis of prostate cancer are measurement of serum prostate-specific antigen (PSA) and digital rectal examination (DRE). Should PSA exceed the generally accepted cutoff level of 4 ng/ml, and palpation of the gland be suspicious, the next step is a series of needle biopsies and the determination of a Gleason score by two pathologists, with each grading from 1 to 5, a sum of 2-4 being favorable (low-grade) and 7-10 being highly unfavorable (highgrade). Aggressive treatment such as prostatectomy, external-beam irradiation or radioactive-seed implants, is usually prescribed for patients with high Gleason scores regardless of age whereas the patient’s age becomes an important consideration when the scores are low. It has been reported (3) that, for men in their 70’s with low Gleason scores, watchful waiting may be the preferred prescription.

Prostate cancer screening programs based upon PSA have about as many proponents as opponents: the ACS recommends annual testing, the AMA policy is that mass screening is premature. Benign prostate hyperplasia (BPH) results in false positives, i. e., PSA levels higher than 4 ng/ml, in about 65% of 11

MARCH/APRIL 2003

men so tested. Similarly, about 20% of prostate cancers produce PSA’s lower than 4 ng/ml, and these false negatives may result in the disease going unrecognized unless a nodule is detected by DRE or there are symptoms of obstruction which warrant further diagnostic workup. Over-diagnosis, “the detection of prostate cancer through PSA testing that otherwise would not have been diagnosed within the patient’s lifetime,” is reported by Etzioni et al (4) as approximately 29% for whites and 44% for blacks.

Although PSA screening alone has these wide uncertainties, after a diagnosis has been made, serum PSA’s play an important role in the choice of subsequent treatment and as a predictor of outcome.

The term “biochemical no evidence of diseases” (bNED) is applied to patients whose posttreatment levels of PSA have fallen below pretreatment levels and remain so indefinitely. Following prostatectomy, PSA’s become undetectable and remain so unless there is recurrence. Following radiation therapy, PSA’s of 1 –2 ng/ml, and sometimes as high as 3 ng/ml are common because some non-malignant cells survive. The consensus of an ASTRO conference is that three consecutive rises over a period of two years is indicative of biochemical failure. Regardless of the type of treatment, low and consistent levels of PSA are widely accepted as a surrogate for cure, and rising levels are taken as evidence of recurrence. However, (See Schulz - p. 13)

AAPM NEWSLETTER

MARCH/APRIL 2003

“The Clinical Advantage”

Dose Calibrators & Thyroid Uptake Systems, designed to fit your needs and budget... from Biodex

BIODEX www.biodex.com

1-800-224-6339 In New York and Int’l, call 631-924-9000

20 Ramsay Road, Shirley, New York, 11967-0702, Tel: 800-224-6339 (In NY and Int’l, call 631-924-9000), Fax: 631-924-9241, Email: sales@biodex.com, www.biodex.com FN: 03-012

12

AAPM NEWSLETTER

MARCH/APRIL 2003

Schulz (from p. 11) biochemical failure has not been associated with increased mortality for up to 10 years after initial therapy (5). The complexities and uncertainties of PSA as a diagnostic and prognostic tool are clearly presented by Brawer (6).

With his PSA, DRE, Gleason score and other clinical findings in place, the patient may then be clinically staged at anything between T1a (microscopic tumor confined to the prostate) through T4 (invading adjacent structures). Patients staged T1a through T2c are more likely to receive aggressive treatment in the U.S., whereas greater consideration is given to watchful waiting (WW) in Europe. In a randomized-prospective trial of prostatectomy versus WW in patients staged as T1b, T1c and T2, Holmberg et al (7) found that although twice as many in the WW group died of cancer, there was no significant difference in crude survival between the two groups. Whether irradiation versus WW would yield similar results has yet to be demonstrated.

As to the results achieved by current treatment techniques, the reader should appreciate that, because of the relatively high fiveand 10-year survivals, assessment of a new treatment modality is a long-term proposition, and that large numbers of patients in both the control and test arms of the trial are required if statistically significant results are to be obtained. There are numerous reports on survival following surgery or conventional irradiation but I have listed the 10-year dis-

Stage T1 T2

Prostatectomy (8) 95% 89%

ease-specific survivals from just two which are typical of what is generally achieved (see chart).

The advantage of surgery over irradiation is to some extent an artifact of the staging process.

Whereas radiation therapy patients are clinically staged (PSA, DRE, Gleason score), surgical patients are pathologically staged, i.e., the stage is determined by direct examination of the prostate and suspect surrounding tissue samples by the pathologist. A radiation oncologist may have treated patients clinically staged as T2b, which in reality were T3, and thereby report a lower survival for T2b’s than would a surgeon treating the same group of patients. However, this so-called “understaging” cannot account for all of these differences, and leaves some (10) to proclaim prostatectomy as the “gold standard” for the treatment of prostate cancer. As mentioned above, when looking at diseasespecific survival the reader should bear in mind that deaths from other causes may be far more significant.

There is some degree of morbidity (impotence, incontinence, rectal bleeding) associated with both surgery and irradiation, and its severity depends to a great extent upon the skill of the surgeon, or that of the radiation therapy team. Impotence ranges between 30% and 100% for ei13

Irradiation (9) 79% 66%

ther treatment, whereas incontinence, 2-15%, is more common to surgery, and rectal bleeding, 2-10%, is more common to irradiation. Incontinence following surgery may require the use of absorbent pads and decreased fluid intake in the evening. Similar gastrointestinal morbidity has been reported following radiation therapy. The effect of dose escalation on the urethra and the urethral sphincter is yet to be discovered. Surgery has the advantage of providing immediate pathological staging, three to four days of hospitalization, and a relatively rapid recovery, but the disadvantage of operative trauma and not insignificant operative mortality. The advantages of irradiation are moderate debilitation which builds during the course of treatment and the absence of operative trauma but the disadvantages are six to eight weeks of daily treatments and the absence of a pathologically based prognosis.

As our understanding of biology improves, the ways in which we prognosticate and treat cancer will change. For example, the activity levels of as many as 70 genes in breast tumors have been found to be a better predictor of mortality than the tumor’s size or stage at the time of resection (11).

If such “genetic signatures” were (See Schulz - p. 14)

AAPM NEWSLETTER

Schulz (from

p. 13)

to be established for prostate cancer, a new and very important parameter would be added to those currently employed to establish a clinical stage, and decisions about whether to treat aggressively or to adopt watchful waiting would be put on a more rational basis.

The dilemma faced by many physicians as well as physicists is how to justify the acquisition of complex and costly new technologies when there is a dearth of clinical trials that show improved outcomes or, for the prostate, the very limited benefits predicted by the most optimistic scenarios. Based upon sketchy dose-response data, they might conclude that, with exceedingly careful application of preciselydefined dose distributions, moderate dose escalation could reduce but not close the present gap between radiation and surgery while maintaining acceptable levels of morbidity. The proof of this assessment would require carefully controlled, randomized/ prospective clinical trials involving many hundreds of patients, lasting many years, in order to show stage-by-stage improvements in 10-year survival. In our market-driven economy, it is unlikely that such trials will ever be undertaken. Physicists must bear in mind that, regardless of how elegant, technical achievements do not necessarily translate to improved clinical outcomes, and that they, too will have to face up to the restrictions imposed by cost/benefit ratios.

MARCH/APRIL 2003

1. Albertsen PC, Fryback DG, Storer BE, et al. 1996. The impact of comorbidity on life expectancy among men with localized prostate cancer. J Urol 156:127-132.

2. Schulz, R J and Kagan, A Robert. Prostate Cancer: prevalence and frequency of treatment.

Submitted to The Lancet, December 2002.

3. Albertsen PC, Fryback DG, Storer BE, Kolon TF and Fine J. 1995. Long-term survival among men with conservatively treated localized prostate cancer.

JAMA 274:626-3.

4. Etzioni R, Penson DF, Legler JM, DiTommaso D, Boer R, Gann PH and Feuer EJ. 2002.

Overdiagnosis due to prostatespecific antigen screening: lessons from U.S. prostate cancer incidence trends. J Natl Cancer Inst 94:981-90.

5. Kupelian PA, Bucksbaum JC, Patel C, Elshaikh M, Reddy CA, Zippe C and Klein EA. 2002. Impact of biochemical failure on overall survival after radiation therapy for localized prostate cancer in the PSA era.

Int J Radiat Oncol Biol Phys 52:704-11.

6. Brawer, Michael K., ed.

2001. Prostate Specific Antigen.

New York: Marcel Dekker, Inc. 7. Holmberg L, Bill-Axelson A, Helgesen F, et al. 2002. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.

N Eng J Med 347:781-89.

8. Zincke H, Oesterling JE, Blute ML, Bergstralh EJ, Myers RP and Barrett DM. 1994.

Long-term (15 years) results af14

ter radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer. J Urol 152:1850-57.

9. Duncan W, Warde P, Catton CN, Munro AJ, Lakier R, Gadalla T and Gospodarowicz MK. 1993. Carcinoma of the prostate: results of radical radiotherapy (1970 – 1985). Int J Radiat Oncol Biol Phys 26:203 10.

10. Garnick MB and Fair WR. 1998. Combating prostate cancer. Sci Am 279:75-83.

11. Kolata G. 2002. Breast cancer: genes are tied to death rates.

N Y Times, 19 Dec. â–

AAPM NEWSLETTER

MARCH/APRIL 2003

AAPM in the News The following excerpts were reprinted from the December 25, 2002 edition of the Wyoming TribuneEagle with permission of Cheyenne Newspapers, Inc., Copyright 2002. All rights reserved.

“PROACTIVE HEALTH? FULL-BODY SCANS MAY BE HARMING THE PREVENTION-MINDED”

By Allison Fashek CHEYENNE — Oprah Winfrey endorsed them on her show, and businesses offering them in shopping malls and parking lots in at least five states are thriving.

Full-body exams, also known as computed tomography or CT scans, have long been ordered by physicians for trauma patients or patients with suspected conditions.

But more and more the exams are being advertised directly to the public as a quick, safe and easy way to detect diseases at their earliest, otherwise unnoticeable, stages.

As a result, a number of physicians and experts are concerned that the tests will alert people to abnormalities that do not need treatment and, more important, expose people to significant doses of radiation. ...

A Growing Trend ... “It’s gone from being a very exotic piece of equipment to a mainstay in how we treat people,” said Steve Nowak, director of radiology, radiation therapy and endoscopy at United Medical Center in Cheyenne. “The demand for CT has grown significantly in the past five years.” ...

In response, the American As-

sociation of Physicists in Medicine has released a statement saying there is no demonstrable benefit of taking the exam as preventative medicine and receiving the amount of radiation involved. ...

According to the AAPM, the whole-body CT scan also delivers significantly higher radiation doses than other x-ray procedures. A standard chest x-ray just takes one snapshot of a targeted region of the body, while the fullbody CT scan takes multiple shots as it circles the length of the patient’s body.

Overall, a typical full-body CT scan delivers about 250 times the radiation dose that a patient receives through a chest x-ray.

Dr. Joseph Mercola of the Optimal Wellness Center in Illinois put the dose level into context in one of his weekly health newsletters last year.

While the average full-body CT scan delivers between .2 and 2 rads of radiation, depending on a patient’s body size, studies of Japanese survivors of the U.S. atomic attacks on Hiroshima and Nagasaki during World War II link an increased risk of cancer to lifetime cumulative exposures of 5 to 20 rads, Mercola said. ...

But despite the abundance of warnings, people tend to want the tests anyway.

15

“Sure, it’s called preventive medicine,” said Jean Burton of Cheyenne when asked if she would be willing to take a fullbody CT scan. “Doctors do a bunch of individual tests for every little thing. They could just do this one test and figure out what’s wrong with you. I think it would save money.”

Burton was not worried about the possible radiation risks.

“We have radiation everywhere,” she said, “why not get something good in return?”

Betty Schrader of Cheyenne also said she would take the test.

“I’m not concerned about radiation,” Schrader said. “I’d rather get (the test) and know for sure.” ...

“The most significant diagnostic tool to this day is the conversations between a patient and physician,” Nowak said. “I would rather have a physician know me as opposed to having all of the technology in the world.”

Allison Fashek is the Wyoming Tribune-Eagle’s health and environment reporter. A copy of this article in its entirety may be acquired directly from the Wyoming Tribune-Eagle at 307/6333161.

AAPM NEWSLETTER

MARCH/APRIL 2003

Announcements BECON 2003 Symposium to Focus on Team Science The Bioengineering Consortium (BECON) of the National Institutes of Health (NIH) has scheduled its sixth annual Symposium for June 23-24, 2003 at the Natcher Conference Center on the main campus of the NIH in Bethesda, Maryland. The Symposium, entitled “Catalyzing Team Science,” is aimed at examining the forces that encourage and discourage team approaches to biomedical research, and exploring ways in which the NIH, academia, and others can stimulate and reward team efforts.

Amid growing concerns that the paradigm of individual principal investigators working in isolation is not well suited to many areas of contemporary biomedical research, the BECON Symposium will look at the fundamental shift

in the conduct of science towards transdisciplinary teams. The complexity of modern biomedical research increasingly requires effective collaborative efforts to realize the potential benefits promised from advances in science and technology. Encouraging and rewarding participation or productivity in team environments is critical to advancing discovery and development in the field of bioengineering. The BECON is well situated to address these concerns as one of the few organizational units at the NIH whose mission and functions crosscut all the institutes and centers.

This year’s symposium chairs are Dr. Janie Fouke, dean of Engineering of Michigan State University, and Dr. Keith Brodie, president emeritus of Duke Uni-

versity. Dr. Daniel Sullivan of the National Cancer Institute chairs the BECON planning group.

The symposium is structured to draw leaders and critical thinkers such as investigators, university administrators responsible for formulating and overseeing academic policies, managers of information dissemination, and funding agencies.

A preliminary agenda, along with program and registration information, are available on the BECON Web site at: <http:// w w w. b e c o n . n i h . g o v / symposium2003.htm>.

The Bioengineering Consortium is administered by the National Institute of Biomedical Imaging and Bioengineering.

■

NATO Science Program Radiation Safety Problems in the Caspian Region “Radiation Safety Problems in the Caspian Region” will be held in Baku, Azerbaijan September 11-14, 2003. The objective of this advanced research workshop is to exchange information and experience in the field of securing the radiation safety of the biosphere, and development of international cooperation for solving regional radiological problems. The main topics will be Radiation Environmental Monitoring, Natural and Artif icial

Sources of Radioactivity in the Caspian Region, Radiotherapy and Radiodiagnostics, Radiation Safety Problems in the Oil Industry, Problems of Burial of Radioactive Wastes in the Caspian Countries, New Methods and Technics of Dosimetry of Ionizing Radiation, Environmental Impact of Electromagnetic Field, Radar Stations, and NGO Movement for Radiation Safety of the Caspian Region. The participation is mainly by invitation.

16

I am co-director for this workshop and my host director is Dr. Islam Mustafaev from the Azerbaijan National Academy of Sciences. The deadline for abstract submission (up to 250 words) is March 31, 2003. If you are interested or have worked on any of these topics and want to share your knowledge, please contact: Mohammed K. Zaidi at 208-526-2132 or by e-mail at: <zaidimk@id.doe.gov>.

■

AAPM NEWSLETTER

17

MARCH/APRIL 2003

AAPM NEWSLETTER

MARCH/APRIL 2003

ACR Mammography Accreditation Frequently Asked Questions for Medical Physicists Priscilla F. Butler Sen. Dir., ACR Breast Imaging Accreditation Programs Does your facility need help applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? Check out the ACR’s web site at www.acr.org; click “Mammography” and then “Frequently Asked Questions.” You can also call the Mammography Accreditation Information Line at (800) 227-6440. In each issue of this newsletter, I’ll present questions of particular importance for medical physicists.

Important!

New ACR Accreditation Process for Mammography Facilities Installing New Mammography Units The Food and Drug Administration (FDA) requires a mammography facility to have their medical physicist perform an Equipment Evaluation when a new unit is installed.

This applies to both screen-film and full-field digital (GE Senographe 2000D) mammography units and includes previously owned units, accredited units moved from one site to another site and new units replacing previously accredited units. This Equipment Evaluation must determine whether the new unit meets the MQSA requirements for mammography equipment [section 900.12(b) of the FDA regulations] in addition to the quality assurance requirements [section 900.12(e)]. All prob-

lems must be corrected before the facility may apply for accreditation of the unit and before the new unit is put into service for mammography. In the past, the ACR Mammography Accreditation Program simply asked facilities applying for accreditation of their new units for the date of the medical physicist’s Equipment Evaluation indicating that all required tests had passed.

The FDA regulates accrediting bodies as well as mammography facilities. Since 1994, the ACR must comply with FDA regulations and undergo periodic review by the FDA for this compliance. During the last review period, the FDA notified the ACR that the above-described facility attestation for Equipment Evaluations is “not consistent with FDA’s MQSA final regulations (Section 900.4(e)),” which require facilities to submit a copy of the new unit’s Equipment Evaluation as part of the initial accreditation application of a mammography unit. Effective February 15, 2003, all new mammography facilities and all ACR-accredited facilities installing new mammography units must submit a copy of their medical physicist’s Equipment Evaluation results with their initial accreditation application and

18

fee to the ACR before the units may be used to examine patients.

Q. How should the medical physicist summarize the results of the Equipment Evaluation?

A. In order to expedite the application review process for a new unit, the ACR is requiring the medical physicist to complete and the facility to submit only the following two short forms: 1. MQSA Requirements for Mammography Equipment (the medical physicist should complete all applicable sections of the checklist, indicating “Not Applicable” where appropriate), AND 2. Medical Physicist’s Mammography QC Test Summary for screen-film or full-field digital mammography as applicable.

Because an Equipment Evaluation is performed before a mammography unit is used clinically, a medical physicist is not required to complete the “Evaluation of Site’s Technologist QC Program” section of the form at this time. Your medical physicist will need to evaluate your facility’s QC program and complete this section of the QC Test Summary as part of the new unit’s Annual Survey report submitted to the ACR with the full application and/or testing materials (see below).

AAPM NEWSLETTER

The ACR provides these forms with each new facility or new unit application. They can also be downloaded from the ACR Web site at www.acr.org by clicking on “Mammography.” It is important to note that summaries submitted in different formats will delay the ACR’s review even if they contain all of the required information.

The medical physicist should provide these summaries to the facility as soon as possible for inclusion with your application to the ACR. (Handwritten or faxed summaries are acceptable.) You do not need to submit the entire Equipment Evaluation report at this time, only the summaries described above. Also, be sure that all requirements pass before submitting the application.

Q. Who reviews the Equipment Evaluations and what is evaluated?

A. ACR staff, who are experienced mammography technologists with advanced registries in mammography, review the medical physicist’s pass/fail Equipment Evaluation summary. They check to ensure that the Equipment Evaluation was performed no earlier than six months before the date of application, that the medical physicist has evaluated each applicable FDA-required item and that each item passes. If the medical physicist fails an item, ACR staff will check that the facility has provided appropriate documentation of corrective action (e.g., the medical physicist’s

re-evaluation, a service ticket, etc.). If the required item was not evaluated by the medical physicist or if the item failed and no corrective action was provided, ACR staff will call and/or contact the facility in writing for the missing information. The application will not be processed until all information is complete.

Q. When can my facility start using the new unit to examine patients?

A. A facility with a current MQSA certificate may begin examining patients with the new unit ONLY AFTER the medical physicist indicates that the Equipment Evaluation has passed AND the facility has sent the complete new unit application (with the Equipment Evaluation results) to the ACR. Once approved, the ACR will notify the FDA (or the state certifying body) within two business days that an accreditation application has been accepted for the new unit. These facilities are not required to wait for a response from the ACR to begin clinical use of the new unit since they are operating with a current MQSA certificate.

A new mammography facility may perform mammography on patients ONLY AFTER receiving a valid provisional MQSA certificate. The FDA (or state certifying body) will send the facility a six-month provisional MQSA certificate within two business days of receiving the 19

MARCH/APRIL 2003

ACR notification. Hence, a total of four business days may elapse from the time a facility submits all required documentation to the ACR and when they receive the provisional MQSA certificate.

When scheduling your medical physicist’s Equipment Evaluation for your new unit, be sure to allow enough time for any possible corrective action and the accreditation application process described above. The ACR typically recommends scheduling an Equipment Evaluation at least one week prior to performing mammography on patients. You cannot use the unit to examine patients even during “applications” training until you meet the above conditions.

Q. FDA regulations require an Equipment Evaluation after a new processor is installed and before it is used to process patient films.

Must the facility also submit the results of this Equipment Evaluation to the ACR anytime a new processor is installed and before using it for mammography?

A. No. Although an Equipment Evaluation must be performed and all items must pass before a new processor is used to develop patient films, a facility does not need to notify the ACR or submit this information for a new or replacement film processor.

Q. What medical physicist QC documentation is required when a facility submits the full application or testing materials of a new unit to the ACR? (See Mammography - p. 20)

AAPM NEWSLETTER

Mammography (from p. 19) A. Within 45 days after submitting the initial application for the new unit, the facility must submit the full application and/or testing materials to the ACR. In addition, the facility must submit the entire, most recent medical physicist’s Annual Survey report.

Because this is a new unit, this Annual Survey report will generally include the Equipment Evaluation report. To summarize the results, the following two forms must be completed by the medical physicist and included with the full report: 1. MQSA Requirements for Mammography Equipment, AND

MARCH/APRIL 2003

2. Medical Physicist’s Mammography QC Test Summary for screen-film or full-field digital mammography, as applicable. It is important to note that the medical physicist must now complete the “Evaluation of Site’s Technologist QC Program” section of this form.

The medical physicist should check that all required QC tests are done by the QC technologist initially and then at the FDA-mandated frequencies. The ACR does not require the medical physicist to evaluate a certain number of days of QC. The ACR recognizes that, for this first Annual Survey, the medical physicist can only evaluate the number of tests that have been per-

formed since the unit was installed. In addition, the medical physicist need not evaluate the technologist’s QC program in person. Review of the facility’s QC program may also be done ■ remotely by mail or fax.

Report on the National Cancer Institute and National Science Foundation Workshop James Deye Program Director, NCI The National Cancer Institute and the National Science Foundation sponsored a two-day workshop on “Operations Research Applied to Radiation Therapy” (ORART) held at the Hyatt Dulles at the Washington Dulles International Airport in Herndon, VA on February 7-9, 2002. Approximately 30 experts from the radiation oncology, medical physics and operations research communities came together to address fundamental problems associated with treatment planning optimization in radiation oncology. With the advancement of intensity modulated radiation therapy and the associated high level of complexity involved in designing treatment plans, it is crucial that an interdisciplinary effort be made to integrate sophisticated optimization techniques into the treatment planning process, and to explore cutting edge methods of optimizing the clinical outcome of radiotherapy.

The presentations that were made can be found on the Web at: http://www.isye.gatech.edu/ncinsf.orart.2002/, while the summary report along with recommendations for future research development efforts has been submitted for publication.

20

AAPM NEWSLETTER

MARCH/APRIL 2003

Letter to the Editor Licensing Medical Physicists: Why? Howard Amols New York, NY amolsh@mskcc.org After the expenditure of many dollars by both AAPM and RAMPS, and many years of political lobbying, New York State has ‘successfully’ become the third state to enact legislation requiring licensure for medical physicists. I have placed the word ‘successfully’ in quotation marks because I am not quite sure what great victory we have won, and at the risk of offending my many respected colleagues who have selfishly labored for this cause, I think it is appropriate to ask why we wanted it in the first place. So far, for a physicist practicing in New York State (plus Texas and Florida, which have had licensing laws for several years), the only ramifications apparent to me resulting from the new licensing law are that I now have the opportunity to shell out $450 of my hard-earned greenbacks to obtain a license, I get to spend several hours filling out forms and trying to obtain college transcripts from 30 years ago, plus letters of recommendation (particularly difficult when you are as ornery as I am), or face the possibility of being prosecuted as a felon for practicing medical physics without a license.

I’m well aware of the arguments that have been made in favor of

licensing. They include the claim that licensing will somehow enhance our status as professionals (after all, acupuncturists, athletic trainers, interior designers, massage therapists, etc. are all licensed professionals also), will keep unqualified individuals from passing themselves off as physicists, and will enable physicists to directly bill for professional services. Let us examine each of these claims. As far as enhancing our professional status, quite frankly, I just don’t get it! I’ve never been ashamed of being an unlicensed physicist, nor have I ever been in awe of my colleagues who are licensed (physicians, nurses, therapists, etc.). To the best of my knowledge no other subfield of physics (such as solid state, particle, nuclear, low temperature, etc.) or member society of AIP has felt the need to seek licensure, and I don’t understand why some medical physicists feel that we have special needs in this regard vis-a-vis other physicists. I suspect it may be related to the old argument over whether we are physicists or medical specialists, but please don’t get me started on that again!

For the record, I consider myself to be a physicist, NOT a medical specialist, and suffice it to say, AAPM is a member society of the AIP and NOT the AMA (QED!).

Moving right along, what about the argument that licensing will keep unqualified people out of the field. Well and good as far as in21

tent, but isn’t that what board certification was supposed to have accomplished? And if that is not working, perhaps we should examine why instead of seeking licensure, not to mention that all three states that have licensing permitted ‘grandfathering’ during an initial phasing-in period for many of these same individuals. How about a real acid test on this issue; can anyone demonstrate that the quality of medical care has improved in Texas or Florida since the initiation of licensing, or is it still just as easy to get a lousy mammogram and shoddy radiotherapy in those states as it is in the other 48 states that don’t have licensing? As the quality of medical care is undoubtedly difficult to quantify, I present only for informational purposes the observation that according to US News and World Report, only four of the 50 top-rated cancer hospitals in the United States (i.e., 8%) are located in Texas and Florida, despite the fact that these two (See Amols - p. 22)

AAPM NEWSLETTER

Amols (from

MARCH/APRIL 2003

p. 21)

states comprise 13% of the US population and nearly 100% of all licensed medical physicists.

As far as licensed physicists directly billing for professional services, I predict that, however desirable this may be, it will happen only when pigs fly! In support of this opinion, I most humbly ask that any physicist from Texas or Florida who has successfully billed and collected so much as one thin dime to please step forward and prove me wrong.

As I sit here filling out my license application and writing checks for mucho dollars, I can only think of the old adage: ‘be careful what you ask for, because you just might get it.’

■

Letter to the Editor The Future of Medical Physics is in Our Own Hands Ivan A. Brezovich John Pacyniak Mark C. Bruels The editorial (Jan/Feb 2003 AAPM Newsletter, p. 20) was square on the mark. Medical physicists are expected to work longer hours than anyone else, and at low pay. I believe that we got into this predicament in the 1980’s and 90’s when HCFA (now CMS) started to distinguish between “professional” and “technical” services. Interestingly, the distinction is based on the person who does the work, not the type of work. Calibration of cobalt machines and generation of treatment plans was “professional” when it was done by radiologists, but is “technical” when done by medical physicists.

Reimbursement for professional services goes directly to the radiation oncologist, whereas pay for technical services goes to the employer of the physicist. The employer decides how much of the money collected for our services to pass along. Federal labor laws limiting working hours do not apply to highly educated, monthly paid employees. Having no control over the revenue we generate, we have little control over our pay or working hours. Medical physicists unwilling to work under these conditions are refusing to enter the field, 22

or even are leaving the field, which are the root causes of the current “shortage.”

We are in this unique position because of our unique failure to agree on a realistic course of action, and to implement it through the proven path of political lobbying. “Professionals” who get paid directly for their services, including nurse anesthetists and social workers, are following the well-established methods of survival. Medical physicists who feel that the situation needs change should voice their opinion to AAPM or ACMP. If you feel that a grass-roots effort would be more effective, please contact me so that we can present a coherent plan of action to our professional organizations.

—Ivan A. Brezovich: 205/9341758 or <ibrezovich@uabmc.

■ edu>.

AAPM NEWSLETTER

MARCH/APRIL 2003

Letter to the Editor Extra Hours The following is in response to the “Letter from the Editor” from the January/February AAPM Newsletter, p. 20.

Chuck Smith Port Huron, MI RadPhysChuck@comcast.net This is a very important issue. I nearly left the field altogether a decade ago because of the horrendous hours I was working (at one point I worked 10+ hours for 21 consecutive days). When I moved to a new job, I made it clear that I was willing to do “a little” extra, but there was a limit, especially since salaries here are lower than national, or even regional, averages.

My current situation (only Phys at institution, two linacs, LDR brachy, IMRT soon, Rad Safety Officer, some NM and X-ray duties - farmed out most X-ray and NM) is that I work, including time at home for data analysis, etc., about 8.7 hours per day, NOT including lunch. The ‘standard’ would be 7.5 hours, as we get one half hour for lunch and two breaks. So I am averaging 1.2 extra hours per day. OK. But, any weekend day comes with a comp day. I work at least one Saturday each month for linac and TPC QA. The next weekend is a three-day weekend. If I am there on Sunday, I take a fourday weekend or two three-day weekends, etc. In addition,

weekend days rarely are eighthour days. They are more likely to be 10-12-hour days, often even 16 hours. But I only claim one comp day. The point being that I am still only doing more than a standard work week. The way I see it, I am obligated for “80” hours per pay period. There is NOTHING in my contract that says those hours must be M-F, 8-5pm.

When I schedule my time, I do make my plans known so, say a prostate implant can be sched-

uled on a day when I am here, and so on. But I am taking that comp time somewhere.

Perhaps, no probably, I am lucky that my institution is so flexible on this. I am not sure what would happen if a harder line was taken. But it would not likely be a good situation. Most likely, I would look for another job, and try to write in some such language to my contract.

An AAPM stance on this would be very helpful in that re■ gard.

AAPM Virtual Library Corporate Affiliate Presentations We are pleased to announce the inclusion of AAPM Corporate Affiliates - Vendor Presentations in the AAPM Virtual Library AAPM recognizes the significant contributions to the field of medical physics our Corporate Affiliates provide.

We welcome their inclusion in the AAPM Virtual Library and hope members will find these presentations a resource for learning about products, techniques, and company activities.

AAPM Corporate Affiliates Presentations currently posted include

Impac Medical Systems, Inc. Varian Medical Systems We encourage you to view the presentations and learn more about our Corporate Affiliates

AAPM Virtual Library • www.aapm.org

23

AAPM NEWSLETTER

MARCH/APRIL 2003

AAPM NEWSLETTER

Editor Allan F. deGuzman Managing Editor Susan deGuzman

Please send submissions (with pictures when possible) to the editors at: e-mail: deguzman@wfubmc.edu (336)773-0537 Phone (336)716-7837 Fax 2340 Westover Drive, Winston-Salem, NC 27103 The AAPM Newsletter is printed bi-monthly.

Next Issue: May/June 2003 Postmark Date: May 15 Deadline: April 15, 2003

Editorial Board Arthur Boyer Nicholas Detorie Kenneth Ekstrand Geoffrey Ibbott C. Clifton Ling Richard Morin AMERICAN ASSOCIATES OF PHYSICISTS IN MEDICINE

One Physics Ellipse College Park, Maryland 20740-3846 (301)209-3350 Phone (301)209-0862 Fax e-mail: aapm@aapm.org http://www.aapm.org

24 1