AAPM Newsletter November/December 2007 Vol. 32 No. 6

Newsletter

A M ERIC A N ASSOCIATION OF PHY SICIST S IN ME D I CI NE VOLUME 32 NO. 6

NOVEMBER/DECEMBER 2007

AAPM President’s Column time this newsletter is published in November, but I thought it important that this summary is documented in the newsletter archives for retrieval in the near and distant future.

Mary K. Martel UT MD Anderson Cancer Center ABR 2012 he three American Board of Radiology Physics trustees (Don Frey, Geoff Ibbott, Rick Morin) and associate executive director (AED), Steve Thomas, called a summit meeting with CAMPEP, medical physics society leaders and program directors to discuss new requirements for eligibility to take the ABR physics board exam. This meeting took place in Dallas in August 2007 the day before another ABR summit meeting on Maintenance of Certification.

The leadership of the AAPM wishes to thank the ABR trustees and AED for calling this meeting to solicit our advice.

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A summary of the meeting is given following these brief introductory paragraphs.

I felt this was a sufficiently important topic that it should be featured on the front page of this newsletter. This information will also go out electronically by the

The word “important” used above to describe the eligibility issue is an understatement. The advice given at the end of the meeting was to require a CAMPEP accredited residency program (as opposed to a CAMPEP accredited residency or graduate program) after the year 2012 (exact dates to be worked out at the ABR). This is a fundamental change to the way that medical physicists have been trained for clinic duties, which for the majority has been on-the-job training. You have probably heard all the pros and cons to how best to train medical physicists, and I will not repeat them here. Other columns in this newsletter issue (and in the past) offer more detailed arguments (for example, Dr. Podgorsak’s column), and there are many good points on all sides of the issue.

However, the AAPM Board of Directors (myself included) felt very strongly that a CAMPEP accredited residency should ultimately be the crucial element to determine eligibility to sit for the ABR physics boards.

The Board passed a resolution to that effect in its March board meeting.

And now there must be a concerted effort to establish medical physics residencies for both therapeutic and diagnostic specialties. It is likely that distributed residencies will be the

key to having an adequate number of trainees to fill job openings.

The ABR trustees mentioned that approximately 250 physicists sit for the boards every year and this would be a minimum number of residency graduates to shoot for.

The ABR trustees will bring a policy to the full ABR Board in October. We wait for the final policy statement.

ABR Summit on CAMPEP Requirements for Board Certification in Radiologic Physics (summary statement provided by ABR Trustees and AED - G. Donald Frey, Geoffrey S. Ibbott, Richard L. Morin and Stephen R. Thomas (AED)) In 2002, the ABR announced a policy whereby a prerequisite for certification in radiologic physics after 2012 would be completion of TABLE OF CONTENTS Chairman of the Board Column Executive Director’s Column Editor’s Column Education Council Report Science Council Report Professional Council Report Leg. & Reg. Affairs ACR Accreditation FAQS Education & Training Health Policy/Economics AAPM Travel Grant Report Website Editor Report 2007 Summer School Report AAPM-IPEM Travel Grant Report

p. 3 p. 5 p. 7 p. 8 p. 9 p. 11 p. 12 p. 15 p. 17 p. 21 p. 23 p. 25 p. 27 p. 29

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a CAMPEP accredited educational program. In recognition of the fact that half of this lead-in time had now passed, the ABR convened a Summit meeting for the purpose of obtaining the perspective and opinions of associated organizations and stakeholders concerning options for transition from the current eligibility requirements. The Summit, held on August 17, 2007, was attended by leaders from the AAPM, CAMPEP, ACR, ACMP, CCPM, the ABR and directors of CAMPEP accredited programs (both medical physics graduate programs and residencies).

The Summit format included a series of introductory presentations followed by general discussion with the objective of reaching a consensus position. First, the background and history of the ABR initiative to revise the eligibility requirements for certification in radiologic physics starting in 2012 was reviewed by Richard Morin, Ph.D. (ABR Trustee in Diagnostic Radiologic Physics) who served also as the moderator of the Summit. A principal factor leading to the 2002 policy statement was concern among the ABR trustees and exam committee chairs regarding the level of knowledge of candidates applying for certification who come from non-structured medical physics graduate programs. Another point now coming to the forefront is the fact that the ABR certification process for radiologic physics is one of only two within the 24 boards of the American Board of Medical Specialties (ABMS) that does not require a formal residency.

The second speaker, John Hazle, Ph.D. (President, CAMPEP) presented an overview of the activities of CAMPEP and a perspective of the current operational status. The challenges ahead were clear with regard to establishing the operational capacity to review the increase in applications expected in response to

the 2012 timeline. He reported that the CAMPEP guidelines for residency accreditation had been revised in 2006 to facilitate program review.

As a bottom line, he was confident that CAMPEP could develop the capability to serve as the accrediting body for medical physics educational programs and accommodate any increase in demand that may arise leading up to the 2012 transition.

.doc). His presentation reflected the theme of TG Report 133 that patient care is paramount in the practice of medical physics and that properly trained medical physicists are essential to ensuring that high quality medical care is provided. Confidence was expressed that both the number of required residencies and the funding to support those residencies could be in place to meet a 2012 timeline.

The perspective of the director of a CAMPEP accredited graduate program was presented by Charles Coffey, II, Ph.D. He pointed out that many graduate program directors had introduced adjustments in response to the original ABR policy statement that the eligibility requirement involved completion of a CAMPEP accredited educational program and not the more stringent condition of an accredited medical physics residency as recommended by the recent AAPM Board resolutions.

The importance of estimating medical physics manpower needs and production was emphasized.

Another issue brought forward was the potential impact that the newly evolving doctorate of medical physics (DMP) might have on MS programs, the economics of the DMP, and the overall timetable for certification for candidates holding a DMP. A number of critical questions were put on the table with personal answers offered for some, ending with the expressed willingness to roll up the sleeves and engage in the work ahead.

At the request of the moderator, the perspective of a medical physics residency director was presented by Eric Klein, Ph.D. He described the strengths of residency programs from the viewpoint of his institution and emphasized the critical importance of the clinical experience in preparing the candidate for board certification as well as for a successful career in medical physics.

The final formal talk was given by Michael Herman, Ph.D. (Chair, AAPM TG 133) and addressed current AAPM TG 133 activities in defining alternate pathways for clinical medical physics residency (including affiliated residencies). The draft report has been posted on the AAPM website and is available for member review (http://www.aapm. org/org/committees/TG133/ reports/report_draft_ v4.1_7_13_07

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The ensuing discussion touched on many issues associated with the ABR policy transition in 2012. The original policy statement as enunciated by the Board specified that as of 2012 and thereafter certification in radiologic physics would require that the candidate had successfully completed a CAMPEP accredited educational program that could have included either a graduate degree (MS or PhD) or a residency. In response to the TG 133 report, pros and cons of requiring a residency were expressed. A general consensus evolved that the new policy should state that an accredited medical physics residency (clinical, 2 years) is required. This reflected the AAPM Board resolution passed in March 2007 and reconfirmed in July 2007 that completion of a CAMPEP accredited residency should be required. The impact that this revised policy might have on existing graduate programs was discussed. There appeared to be unanimous agreement that the quality of clinical training leading to eligibility for the ABR Board examinations would be elevated by requiring a CAMPEP accredited residency.

AAPM Newsletter The imperative to ensure that an adequate number of residencies were in place was underscored. A major issue centered on the economics and the requirement that sufficient funding be available. Options for securing that funding were discussed.

Organizations (AAPM) expressed a commitment to working toward the goal of ensuring availability of adequate residency opportunities by the 2012 target date. The critical aspect of supporting CAMPEP as an effective accrediting organization was emphasized.

The importance of providing clear communication to the candidates with regard to time lines was stressed.

It was agreed that the action date should remain as 2012. Safeguards would be in place for candidates who are already in the pipeline; namely, those candidates whose application for certification had been accepted prior to 2012 would be subject to the rules in effect before the new policy.

Viewpoints were expressed on a number of other related issues.

There was a general feeling that the preferred pathway on the medical physics track would be progression through a CAMPEP accredited graduate program followed by the accredited residency (in parallel with an accredited medical school followed by a residency for physicians). It was considered important that the CAMPEP accredited graduate programs continue to be acknowledged as having a clear advantage with regard to eligibility status. The consensus was to underscore the value of being in a CAMPEP accredited graduate program.

However, there was concern that this would preclude the traditional nonmedical physics degree candidate from entering the discipline individuals whose contributions have enriched the field of medical physics. An option discussed here was that those candidates with

November/December 2007 an acceptable “outside” doctorate degree wishing to pursue a career in medical physics would be required to enter an extended residency designed to provide an appropriate didactic component as well as the clinical training. It was recognized that defining pathways such as these fell under the purview of CAMPEP and presented opportunities for evaluation by that organization.

In summary, the general consensus of the Summit was that the ABR policy should require a clinical residency for candidates applying for certification after 2012. However, it was recognized by the attendees that this consensus was not binding on the ABR. The Physics Trustees would take these decisions under advisement as they formulate a final policy to be presented to the full ABR Board of Trustees for approval. It is expected that an official policy statement on this topic will be issued by the ABR by the end of October 2007.

Chairman of the Board’s Column

E. Russell Ritenour Minneapolis, MN

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e could certainly slow the aging process down if it had to work its way through Congress. - Will Rogers

So, our Board of Directors isn’t congress. We move a little faster.

Many things happened at the Board of Directors meeting at the Annual meeting of the AAPM in Minneapolis this past summer. In our Executive Director’s report we learned that more and more chapters are taking advantage of using the national organization to collect their chapter dues. This is a service that is provided for free to the chapters. We also learned that attendance at the Annual Meeting has risen fairly steadily since 2001.

In 2001 the attendance was 2,723.

In 2006 it was 3,851. Preregistration for the summer meeting was already a record breaking 3,902 and the 50th anniversary Annual Meeting next year in Houston is likely to continue

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the trend. Membership has also grown, with a total of 6,185 members at the beginning of 2007.

As Stephen Wright once said “When everything is coming your way, you’re in the wrong lane.” Not everyone got their way at the Board meeting. There was some discussion of another resolution to change the structure of the Board. Some Board members were passionate about it. However, the resolution failed. At this time, it seems clear to me that the majority of the Board members just want to make the present Board work as efficiently as it can. With increased use of the BBS and electronic voting, the Board is functioning well and is doing its business throughout the year. I personally think that it is time to let the issue of restructuring the

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Board sit on the shelf for awhile.

To paraphrase the famous quote from Shakespeare’s Julius Caesar, “There is a tide in the affairs of the Association”. My own feeling is that this one has gone out – at least for now.

We also held a Town Hall Meeting on Wednesday of the AAPM meeting. It started out with sparse attendance, but the large ballroom was full by the end of the meeting. This was an opportunity for members to address the Board of Directors directly and voice any concerns they may have.

The entire Board was seated on stools at the front of the room. One issue that came up was the position statement that was passed by the Board at its March meeting. The statement was that it was the position of the AAPM that, at some point in the future, to be determined jointly with certifying boards, all those eligible to take board exams should be required to have completed a residency. This caused some concern for students just entering medical physics programs and from program directors because it is clear that there are not enough residency slots to meet the needs of the field. At the meeting, we were able to clarify that we expect that, again, at some point in the future, graduate programs and residency programs will make use of “distributed” residencies, programs that will farm out students to private practice medical physics groups to obtain clinical experience under the supervision of the regional academic center. Compensation plans are being discussed as of this writing and the Board hopes that a full blown guideline to such programs will be published soon. However, at present, there is no dictate that requires a residency to be completed in order to sit for any of the boards at present. The policy was put forth as a way to encourage a movement in this direction and to support the concept of “distributed”

residencies. It appears that this movement will occur. The Medical Physics Residency Training and Promotion Subcommittee, chaired

by Mike Herman, conducted a survey of training programs. The survey indicated that more than 70% of the programs would take advantage of a well defined alternate clinical pathway, such as defined in Task Group Report No. 133 (a draft of which can be seen at http:// www.aapm.org/org/committees/ TG133/reports/report_draft_ v4.1_7_13_07 .doc.) Figures from the survey indicate that use of such a program would almost double the number of individuals who would receive clinical training.

On August 17, leaders from the AAPM, CAMPEP, ACR, ACMP, CCPM, the ABR and directors of CAMPEP accredited programs (both medical physics graduate programs and residencies) met at a Summit Meeting on CAMPEP Requirements for Board Certification in Radiologic Physics. After presentations from representatives of CAMPEP, the AAPM, and

the ABR and ample discussion the general consensus of the Summit was that the ABR should require a clinical residency for candidates applying for certification after 2012. The Summit’s conclusions are not binding upon the ABR, but it is expected that an official policy statement on this topic will be issued by the ABR by the end of October 2007.

Extracurricular activities of the Board I want to thank the Board Members who joined me at the Night Out for a round of log rolling – Jerry White and Per Halvorsen. I believe that the vast majority of the membership would enjoy seeing as many Board Members as possible fall into a tank of water. The limited sample of the membership who were in the stands at that time certainly seemed to. A lumberjack and general pioneer theme fit well with Minnesota’s roots. But, for next year’s meeting in Houston, surely there will be some provision for bull riding. I’m just sorry I’ll be off the Board by then.

The American Association of Physicists in Medicine cordially invites you to attend the AAPM Tuesday Evening Reception during the 2007 AAPM / RSNA Meeting Sponsored in part by Advanced Radiation Measurements, Inc. Landauer, Inc. Tuesday, November 27, 2007 6:00 pm - 8:00 pm Waldorf Room, Chicago Hilton Chicago, Illinois light hors d’oeuvres

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AAPM Newsletter

November/December 2007

AAPM Executive Director’s Column convenience of paying your national and chapter dues at one time!

AAPM Reception during RSNA meeting Reminder! Make plans to join your colleagues on Tuesday, November 27, 2007 for the AAPM Reception during RSNA at the Chicago Hilton.

Thanks to Advanced Radiation Measurements, Inc. and Landauer, Inc. for their financial contributions to offset the costs for this event.

Angela R. Keyser College Park, MD Biomedical Imaging Research Opportunities Workshop APM is once again partnering with the Academy of Radiology Research (ARR), the American Institute for Medical and Biological Engineering (AIMBE), the International Society of Analytical Cytology (ISAC), and the Radiological Society of North America (RSNA) to sponsor the 5th Annual Biomedical Imaging Research Opportunities Workshop (BIROW 5). The workshop is supported in part by a grant from the National Institute of Biomedical Imaging and Bioengineering (NIBIB). Many other leading societies in medical imaging are also participating in this event.

BIROW 5 will take place January 17-19, 2008 at the Bethesda North Convention Center I Rockville, MD. AAPM staff members are providing the meetings management services.

For program and registration information, go to: www.birow.org

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2008 AAPM Dues Renewals A reminder that 2008 dues renewal notices were distributed in October.

Sixteen AAPM Chapters have elected to have HQ collect their chapter dues. Make sure to check to see if your chapter is participating. If it is, we hope that you will appreciate the

Headquarters News New phones were installed in the American Center for Physics in late August. My apologies to any frustrated members who were inconvenienced during the time of transition.

AAPM has entered into an agreement with the American College of Medical Physics (ACMP) to provide staff support to ACMP effective January 1, 2008. AAPM is recruiting a Meetings and Programs Manager to serve as ACMP Executive Secretary as well as manage other AAPM conferences that are on the horizon. This move further strengthens the relationship between the AAPM and the ACMP. AAPM has joined the Convene Green Alliance (www.convenegreen. com), a grass-roots meetings industry initiative that seeks to affect positive environmental practices

in the association community and meetings industry through outreach and education. This alliance will serve as a valuable resource as AAPM strives to put in place environmentally-friendly policies for the organization’s meetings.

Laurie Hayden has been promoted to Programs Assistant. In this newly created staff position, she will provide support to the program directors for the Annual Meeting and other association conferences.

Part of the success of AAPM HQ operations is our ability to attract and retain an excellent team of highperforming association management professionals. The AAPM team members listed below have celebrated an AAPM anniversary in the last half of 2007. I want to publicly thank them and acknowledge their efforts.

I joined the AAPM HQ team on November 1, 1993. I have found the past 14 years very rewarding and I thank the AAPM membership for your continued support and for the confidence that you place in me as your Executive Director.

The AAPM Headquarters office will be closed Thursday, November 22 – Friday, November 23, Monday, December 24 – Tuesday, December 25 and Monday, December 31 – Tuesday, January 1. I wish you and your loved ones a happy and healthy holiday season.

AAPM STAFF ANNIVERSARIES

Lisa Rose Sullivan Penny Slattery Michael Woodward Farhana Khan Peggy Compton Noel Crisman-Fillhart Yan-Hong Xing 5

14 years of service 11 years of service 11 years of service 9 years of service 3 years of service 2 years of service 1 year of service

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2008 AAPM Meeting Information 2008 AAPM Summer School June 25-29, 2008 University of Houston • Houston, Texas The Physics and Applications of PET/CT Imaging with separate, limited registration for Hands-on Sessions Covering Scanner Testing, Accreditation and Shielding Calculations to be held at MD Anderson Cancer Center February 13 Meeting Registration and Housing available on-line February 20 Deadline to submit scholarship application http://www.aapm.org/meetings/08SS/

2008 AAPM Annual Meeting July 27 - 31, 2008 George R. Brown Convetion Center • Houston, Texas December 2007

2008 Annual Meeting website activated. View the site for the most up to date meeting and abstract submission information.

January 7

Web site activated to receive electronic abstract submissions.

March 2

Deadline for receipt of 300 word abstracts and supporting data.

March 19

Meeting Housing and Registration available on-line.

By April 22

Authors notified of presentation disposition.

By May 14

Annual Meeting Scientific Program available on-line.

June 11

Deadline to receive Discounted Registration Fees. http://www.aapm.org/meetings/08AM/ 2008 AAPM Physics Education Workshop August 1-3, 2008 • League City, Texas Medical Physics: What Do I Need to Know and How Should I Teach It? http://www.aapm.org/meetings/08workshop/default.asp 6

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Editor’s Column

Mahadevappa Mahesh Johns Hopkins University

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his is the 6th and final issue for the 2007 year. I cannot believe this year has gone by so fast that before I realized, we have already started working on the January/February 2008 issue. When I first took this position as Editor I was a bit nervous, but as the year has progressed, I have become more comfortable with the task of editing the newsletter. I have gradually implemented certain policies throughout the year such as word/page limitations for regular columns and printing schedule changes that make the content of the Newsletter reach the membership in a more timely fashion. I would like to thank all of the contributors for their cooperation as this change was made. Please know that I also have appreciated receiving various articles from the general membership and look forward to receiving even more articles in the new year.

You may recall, half way through this past year a survey about the newsletter was conducted.

Even though approximately only one-third of the membership participated in the survey, I was quite encouraged by the overall response and the number of comments received. Among the comments was one regarding the cost of printing and mailing the newsletter.

In order to decrease the mailing cost by nearly 50%, I have decided to mail the newsletter standard mail rather than first class beginning with the January/February 2008 issue. Generally speaking, first class mail takes 3-5 business days, while standard mail takes 5-10 business days. In order for the membership to continue to receive the newsletter in a timely fashion, it is possible that the deadline for submission will have to be moved up. Therefore, I would like to request that all who contribute information to the newsletter, do so within the production schedule dates for each issue.

Another topic that I would like to cover in this column is teaching to residents and students and the search for good teaching materials.

A 3-day long workshop addressing this issue is being organized to be held immediately following the AAPM Annual Meeting in Houston next year. Another rich source of materials readily available and free for AAPM members are physics tutorials published in RadioGraphics.

The AAPM/RSNA Physics Tutorial subcommittee has worked with RadioGraphics to have all AAPM Physics tutorials published in RadioGraphics.

These tutorials are available on-line free to AAPM members and can be accessed via the following link: (http://www.rsna. org/Education/archive/aapm.cfm).

I recently received an email about a fraud and perjury case where a physicist providing radiation health physics services was convicted by the United States attorney for falsifying and is now facing jail term. At first, I thought this was the case I had heard about last year but was surprised to learn this was a second case involving someone of our profession. This

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situation highlights the importance of setting high professional standards and boosts the case for licensing and credentialing (details of this case can be found on the AAPM website).

I often hear from younger colleagues about their disappointment for not being able to gain membership on AAPM committees or councils. Please do not get discouraged if you initially do not get assigned to the committee of your top choice. My advice is to continue expressing your interest and communicate directly with the chair of the respective committees or councils you wish to be part of. Another insight I wish to share with those who are just getting started with AAPM is to increase your activity with local chapters. Often times local chapters are desperate for good volunteers; In fact, my participation with the local chapter of the AAPM is what jump started the various capacities in which I am involved with AAPM now.

As the last 2007 issue of the newsletter reaches AAPM members, I’d like to thank the AAPM staff. Particularly, I wish to thank Ms. Nancy Vazquez who has been my administrative partner for production of the newsletter.

We communicate almost on a daily basis. Also, I would like to thank Ms. Farhana Khan for her help in establishing a presence on the AAPM website. I would like to express my sincere thanks to Angela Keyser and her staff, the Newsletter Editorial Board and the Executive Committee for their help and advice. Finally, I would also like to thank my wife and kids for their cooperation in this task.

As this issue arrives at your desk, we are entering the holiday season and I wish you and your family a very happy holidays.

AAPM Newsletter

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Education Council Report

Herb Mower Education Council Chair

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s you read this, many of you will be preparing to head off to the RSNA meeting in Chicago. Don’t forget the many exciting medical physics opportunities available at the meeting including the new and popular therapy session on Monday afternoon. Bruce Curran is putting together a program on organ motion and image guided radiation therapy based on some of the presentations at the 2006 summer school.

Speaking of Summer Schools, we have some exciting opportunities coming up in 2008. The regular summer school will be in Houston in June. It will be on PET CT with both a didactic portion (at the University of Houston) and a practical laboratory component (at MD Anderson). Be sure to watch for the registration materials and the laboratory portion can only accommodate 96 conferees.

The other exciting educational opportunity in 2008 will be the Workshop on Teaching Physics which will immediately follow the Annual Meeting. It will be South Shore Harbour Resort and Conference Center in League City, close to Houston. Registration and the first session will be Thursday evening July 31st, right after the Annual Meeting.

The Workshop will conclude about 12:30 PM on Sunday August 3rd,

allowing plenty of travel time for people to return home. Bill Hendee and Ervin Podgorsak have been spearheading the effort on this project. The Workshop is designed for those teaching in medical physics or MD residency programs.

The preliminary schedule identifies several areas of interest and concern including: how people learn, differences in learning between physicists and physicians, understanding your audience, assessing the assimilation of knowledge, knowing what to teach (curriculum) and resources, tag-team teaching concepts. There is a lot of interest in this Workshop so I would encourage everyone interested to enroll as soon as the registration material is available.

By the time you read this, we will have held our second Educators’

Day at the ASTRO meeting. We anticipate that, as in 2006, this will be a very successful event. If so, the Public Relations committee will be looking into continuing this effort in the future.

As you prepare for your trip to Chicago, be sure to check the AAPM web-site for the committee meeting schedule. With the move of the Board meeting from Wednesday to Saturday, there have been several changes in the committee meeting times. As of this writing most meetings are on Sunday November 25th with some on Monday the 26th. I am sure that this will be updated as we get closer to the actual meeting time.

I look forward to seeing you at one of the Education Council activities in Chicago or at the Physics Reception on Tuesday evening November 27th.

NCRP Releases Report No. 155, Management of Radionuclide Therapy Patients NCRP Report No. 155, Management of Radionuclide Therapy Patients, is intended for use by a wide readership including physicians, medical physicists, health physicists, administrators, nurses, other professional and medical staff, and patients. This Report makes recommendations on explaining risks from therapeutic procedures and obtaining adequate, informed patient consent; dose limits for members of the patient’s family; patient confinement in a hospital or skilled-care facility; and patient records including the radionuclide and activity used, the treating physician, and contact information.

Sections 1 and 2 deal with the basic principles of radiopharmaceutical therapy and brachytherapy, and basic radiation safety principles in a medical facility.

Section 3 addresses radiopharmaceutical therapy, and appendices A and B expand on the patient release criteria. Section 4 deals with brachytherapy including techniques, termi¬nology, and a brief discussion of applicable dosimetry.

Sections 5 and 6 include facility design and changes in patients’ status. Appendix C presents a discussion of quality-assurance requirements for high dose rate afterloading which is an increasingly useful modality. Appendix D outlines shielding requirements for high dose rate brachytherapy installations.

NCRP Report No. 155 can be purchased online at http://NCRPpublications. org. A 20 % discount is available to AAPM members by entering the code aapm37155 at checkout. For additional information contact David A. Schauer, ScD, CHP at schauer@NCRPonline.org.

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AAPM Newsletter

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Science Council Report tomography (CT), positron emission tomography (PET), single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) simply didn’t exist.

These modern tomographic imaging techniques are responsible for most cancer detection, diagnoses and staging in North America today.

what medical physicists do, because it factors out childhood diseases and therefore emphasizes cancer diagnosis and treatment more.

We have come a long way, and hopefully in the next 50 years the contributions of medical physicists will be even more revolutionary, and have an even greater impact on the

John M. Boone Science Council Chair

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he AAPM turns 50 in 2008, and the annual meeting in Houston will feature a number of historical events in recognition of this hallmark.

Scientifically, the field of Medical Physics in the United States has not just advanced over this period, it has been defined. Part of the reason for this incredible change has been due to technology advancements outside medical physics, most notably in computers, but in other areas as well (waveguides, transistor-based electronics, detectors, etc.). During the past 50 years, modern radiation therapy systems have advanced from systems representative of pre-war physics laboratories (e.g. the Van de Graaf generator) and the early atomic age (e.g. cobalt systems) to the remarkably complex radiation delivery systems of today (linear accelerators, multi-leaf collimators, IMRT, advanced brachytherapy systems, etc.). Dosimetry methods in radiation oncology have advanced from experimentally-based estimates such as Patterson-Parker methods to image guided Monte Carlo dosimetry methods, capitalizing on the fast computers of today. In imaging, the radiology department is completely different today than in 1958. While film-based radiography enjoyed widespread use in 1958, computed

Figure 1: Life expectancy for newborns (solid symbols, top curve) and for 50 year olds (open circles, bottom curve), for the year of achieving that age.

The advancements in Medical Physics have tangible consequences to Americans. In 1958, a newborn had a lifespan of 69.5 years, a baby born in 2008 will have an average lifespan of 78.6 years, a difference of 9.1 years (a 13% extension of life)1.

A small part of this increase is due, in a very literal sense, to what we do as medical physicists – imaging has led to early and better detection of disease, and advancements in radiation oncology have led to cancer treatments which in many cases significantly extend both quality and length of life. Closer to home for me personally, a 50 year old can expect to live another 31.1 years in 2008, whereas a 50 year old in 1958 lived on average another 25.1 years, a difference of 6 years - a 24% extension of life.

This later statistic is more related to

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average person. The medical physicists of today have our elder colleagues (living and dead) to thank, the founding fathers of medical physics, for leaving us in good stead such that we have the opportunity to make an impact today and to make the future better. While the AAPM is the vessel which serves our community (well), we AAPM members are the contents of that vessel which need to nourish our field. I hope that we currently practicing medical physicists will leave the future just as bright to the next generation of medical physicists, as our forefathers have for us. lifespan statistics are averaged over gender and racial background 1

National Vital Statistics Reports, 51(2), (2002), 2008 data extrapolated per Fig 1 2

AAPM Newsletter November/December 2007 !!0- .EWSLETTER !D PDF 0-

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AAPM Newsletter

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Professional Council Report meaningful mission statement that reflects who we are and what we do. Further, a second document on the important role that medical physicists play in patient care is undergoing similar feedback and revision. This document would be a basis for general education on medical physicist’s position in the patient care environment.

Michael Herman Professional Council Chair

Professional Program Annual Meeting he Professional Program at the 2007 meeting focused on all the factors and facets that contribute to how and why we do what we do in support of the best medical procedures and patient care. From the quality chasm to the nuts and bolts of technology implementation and the myriad of regulatory structure, Bruce Gerbi led an excellent program. The Professional Program will be led

by Chris Serago for 2008 and we will be tapping each of the council committees for current program material on items such as the AAPM mission, ethics, professional communication, economic reality and others. If you have thoughts or ideas for the program for 2008, please let Chris or me know.

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Structure and Mission The internal structure of PC relative to TG, WG, SC etc. was modified based on the extensive review at our Spring retreat. This is now posted on the AAPM committee tree. A revised draft AAPM mission statement has received Board feedback and is undergoing another revision. The intent is to develop a concise and

Volunteer Recruiting “Yellow Book” The concept of a “yellow book” to be used by councils, committees etc, to solicit volunteer AAPM members has been under development and by the time this newsletter hits the web, it should be in use. This first iteration is a simple modified version of the Blue Book, to allow quick access to the tool. Getting the membership informed and able to apply for open and needed volunteer committee positions is paramount to a successful AAPM. Legislation and regulation The CARE bill has 121 sponsors in the House and 21 sponsors in the Senate and we continue to expect that it will pass this year.

Once this becomes law, a much needed, organized grass roots effort by and for medical physics will be necessary. To that end, the Join Medical Physics Licensure Sub Committee has been at task, developing strategies to carry the law in a consistent and direct manner to each state. The budget to accomplish this in non-trivial and is a major focus of discussion at the Fall EXCOM/Council Chair and Budget committee meetings. AAPM is committed to providing the necessary tools and resources to facilitate effective communication for

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implementation of this essential legislation. Much more detail on current legislative and regulatory affairs is in Lynne’s column.

Working Group on Medical Response to Radiation Incidents A new working group on the response to radiation incidents, chaired by Eric Hendee, has been approved. The WG within CPC has the charge of coordinating and collating essential educational information and making it readily available should we need to respond to a large scale radiation emergency.

Economics Professional Economics remains very active with a focus in Wendy’s column this month on recently proposed federal rules on reimbursement and specifically on AAPM comments to CMS. At the summer meeting, a pilot project to conduct an Abt type work values study for imaging physics was budgeted. This effort will help establish benchmark work values for the essential effort that medical physicists devote to imaging procedures in support of patient care. If you would like to contribute to this effort, please contact Mike Mills.

The Commission on Accreditation of Medical Physics Educational Programs (CAMPEP) now has a new telephone number: 301-209-3346

AAPM Newsletter

November/December 2007

Legislative and Regulatory Affairs Column

Lynne Fairobent College Park, MD EDWARD McGaffigan Jr., Longest-Serving NRC Commissioner, Dies

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dward McGaffigan Jr., the longest serving member of the U.S. Nuclear Regulatory Commission (NRC) and a public servant for more than 31 years, died today at Capital Hospice in Arlington, Va., after a long battle with melanoma. A Boston native and self-described John Kennedy Democrat, McGaffigan was appointed to the Commission

by President Clinton in 1996 and 2000, and by President Bush in 2005. In October 2005, he began an unprecedented third term on the commission that regulates the safety and security of nuclear materials and nuclear power plants. On Nov. 3, 2006, he became the panel’s longest serving member. Then, on Dec. 8, 2006, he marked 10 years of service to the NRC. His death followed the 11 anniversary of his first swearing-in by a matter of days .In his tenure at the agency he focused on improving the effectiveness and efficiency of agency processes dealing with reactor oversight and reactor license renewals, and since Sept. 11, 2001, he helped design an enhanced security posture at the

nation’s 104 commercial nuclear power reactors and other NRC licensees. He took great pride in the fact that the agency, beginning in the late 1990s, became a more disciplined, higher achieving organization, and also took pride in the stability having a full slate of five members gave the agency’s efforts after Sept. 11. Currently the Commission is at three members awaiting nominations by the President and Senate confirmation to fill Commissioners McGaffigan and Merrifield’s positions.

Commissioner Merrifield’s term was up on June 30, 2007.

Regulatory Issues Summaries (RIS): The following RIS were recently issued by the NRC and can be found at: http://www.nrc. gov/reading-rm/doc-collections/ gen-comm/reg-issues/2007/.

The following contains a brief summary of the RIS, however, it is recommended that the full RIS be reviewed.

1) NRC Regulatory Issue Summary 2007-18 Data for Updating the Interim Inventory of Radioactive Sources issued September 7, 2007. This RIS applies to Part 40, Part 50, Part 70, Part 72, and Part 76 licensees and certificate holders who are authorized to possess sources of radioactive material at the Category “3.5” (as defined below) activity or higher. It is a voluntary reporting however, is indicative of the type of information likely to be asked of Part 35 licensees in the future.

The reasons for maintaining the inventory are: a) To maintain an inventory of the sources at or above the Category2 threshold and feed these data to the NSTS in 2008;

12

b) To maintain or establish contact with the licensees that will participate in the system; c) To provide specific information on the number, types, general uses, and geographic locations of sources in use; d) To plan for the possible expansion of the NSTS, to include Category 3 sources; and e) To evaluate the effect of limiting generally licensed devices to a maximum activity of Category “3.5”.

2) NRC Regulatory Issue Summary 2007-13 Verification of the Authenticity of Materials Possession Licenses issued August 31, 2007. This RIS applies to all U.S. Nuclear Regulatory Commission (NRC) materials licensees. All Agreement State Radiation Control Program Directors and State Liaison Officers.

NRC is issuing this regulatory issue summary (RIS) to emphasize the importance of licensees maintaining situational awareness before and during all transfers of radioactive material. This RIS requires no action, or written response. In May 2007, the U.S. Government Accountability Office (GAO) Forensic Audits and Special Investigations team fraudulently obtained a license from the NRC authorizing the use of six portable moisture density gauges. Using commercially available software, GAO altered the license to increase the maximum possession limits and obtain quotes for the purchase of a total of 45 portable moisture density gauges from two companies. GAO concluded that individuals seeking to use the material for malevolent activities could have completed the purchases and obtained the gauges.

AAPM Newsletter

As a result of the GAO activities, NRC staff promptly issued internal guidance that requires either on-site inspections or in-office meetings for many new materials license applicants. For your information, GAO report can be found at: http://www.gao.gov/new.items/ d071038t.pdf.

3) NRC Regulatory Issue Summary 2007-15 Unescorted Access to Materials for NonManufacturer and Distributor Service Providers issued June 5, 2007. This RIS applies to all U.S. Nuclear Regulatory Commission (NRC) licensees that are nonmanufacturer and distributor (non-M&D) service providers. All Agreement State Radiation Control Program Directors and State Liaison Officers. In 2005, NRC and the Agreement States issued Increased Control (IC) Orders or other legally binding requirements to licensees to control access to licensed radioactive materials to protect the public health and safety.

IC requirement 1.c. requires that service providers be escorted unless determined to be trustworthy and reliable pursuant to a background investigation as an employee of an M&D licensee. As a result, currently only M&D service providers may be granted unescorted access to risk significant sources even though non-M&D service providers provide similar services and have the same intimate knowledge of risk significant sources and devices as M&D service providers. On March 12, 2007, the Commission directed staff to issue, upon request, trustworthy and reliability and fingerprinting requirements to non-M&D service providers that may want unescorted access at a customer’s facility. To maintain appropriate access control to radioactive materials and address any inequity between M&D and

non-M&D service providers’ ability to access a customer’s facility, NRC will issue Orders to non-M&D service providers upon request. This will allow non-M&D service providers unescorted access to radioactive material quantities of concern while performing service at a site for a licensee that is implementing the IC requirements. The Order to non-M&D service providers will impose trustworthy and reliability and fingerprinting requirements that are equivalent to the requirements for M&D service providers, who perform services requiring unescorted access to material. NRC will issue this Order to non-M&D service providers that specifically request that NRC issue it to them. The Agreement States will issue similar requirements through Orders or other legally binding requirements to Agreement State licensees who specifically request them. The Order will contain requirements similar to IC 1, and IC 5, and will require individuals granted unescorted access to be fingerprinted and have a Federal Bureau of Investigation (FBI) identification and criminal history records check.

4) N R C R e g u l a t o r y Issue Summary 2007-14 Fingerprinting Requirements for Licensees Implementing the Increased Control Order issued June 5, 2007. This RIS applies to all U.S. Nuclear Regulatory Commission (NRC) licensees that have received the Increased Controls (IC) requirements.

All Agreement State Radiation Control Program Directors and State Liaison Officers. The NRC is issuing this regulatory issue summary (RIS) to inform addressees that in fall 2007, the NRC will issue additional Orders

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November/December 2007

to licensees that have received the IC requirements. The Orders will require fingerprinting and a Federal Bureau of Investigation (FBI) identification and criminal history records check for individuals that have or will have unescorted access to radioactive material in quantities of concern. No specific action or written response is required at this time. Agreement States will be taking similar actions through the issuance of Orders or other legally binding requirements to their IC licensees.

In accordance with Section 149 of the AEA, as amended by the EPAct, the NRC and Agreement States will impose additional requirements for unescorted access to material in quantities of concern, so that affected licensees can obtain and grant unescorted access to radioactive materials. Orders or other legally binding requirements will be issued in the near future requiring that the results of an FBI criminal history records check, based on fingerprints, are used in conjunction with IC trustworthy and reliability criteria to make determinations for individuals granted unescorted access to radioactive materials in quantities of concern. All NRC and Agreement State licensees that are required to implement the IC requirements will be required to fingerprint and make a trustworthiness and reliability determination for individuals granted unescorted access to radioactive material in quantities of concern.

SCATR: The Conference of Radiation Control Program Directors (CRCPD) and the Department of Energy have initiated a rare opportunity for radioactive material licensees to have financial assistance in properly disposing of unwanted sealed sources. The program is entitled “Source Collection and Threat

AAPM Newsletter

November/December 2007

Reduction” or “SCATR.” The AAPM endorses the SCATR program and encourages AAPM members to have their licensees register and take advantage of this opportunity.

The Department of Energy recognizes that the availability of disposal of such sources is limited and expensive. The radioactive sources do not need to meet any activity threshold to be registered for disposal. Examples of therapy or nuclear medicine sealed sources that would be eligible for the SCATR program include medical brachytherapy sources (cesium 137 and radium 226), eye applicators, low activity sources that exceed the NRC 120-day half-life limit for decay-in-storage, long half-life industrial sources and calibration sources.

With the closure of the Barnwell, low-level radioactive waste disposal site, scheduled for next June, disposal options may be limited in the future.

To participate in this program, the licensees will need to register the unused sources with the Department of Energy Offsite Source Recovery Project at http://osrp.lanl.gov/ CRCPDSCATR.shtml by October 20 2007. Registration is an absolute requirement to have this opportunity.

Once the inventory of sources has been identified, the CRCPD will coordinate for a collection site and transferal of ownership for the purposes of disposal.

The licensee will be required to package and arrange transportation to the collection site. If DOT transportation containers are needed they can be provided to the licensee. Information on this will be provided when you are notified of the collection time.

Mail Fraud and Perjury Case US Attorney office have announced the conviction of Mr. Fenton of Nellysford, VA for mail fraud and one count of perjury. He was convicted for providing radiological health physics services with falsified degree and license certificates. He is now facing 54 months in prison and $400,000 in restitution fines. This is the second case of this type.

In 2005, there was another case of conviction on a radiological physicist for fabricating academic and professional credentials and falsifying calibration data regarding mammography machines. More details on these cases can be found in the AAPM website at: http://www.aapm. org/pubs/newsletter/references/UnqualifiedMedPhys.asp

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AAPM Newsletter

November/December 2007

ACR Accreditation physicist still required to test it during Mammography Equipment Evaluations and Annual Surveys of our facility’s unit? Does the facility still need to submit QC results on that workstation to the ACR during accreditation?

ACR Mammography Accreditation: Frequently Asked Questions for Medical Physicists

Does your facility need help on applying for mammography accreditation? Do you have a question about the ACR Mammography QC Manual? 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 (www.acr.org; click “Accreditation,” then “Mammography”) for more FAQs, accreditation applications and QC forms or call the Mammography Accreditation Information Line at (800) 227-6440.

Full-Field Digital Mammography: Monitors and Workstations Q. Does my facility have to use an FDA-approved review workstation to interpret digital mammograms?

A. No. However, the FDA recommends that only monitors specifically cleared for full-field digital mammography (FFDM) use by FDA’s Office of Device Evaluation (ODE) be used. (See FDA’s Modifications and Additions to Policy Guidance Help System #9.)

Q. We just installed our first FFDM unit. Does our medical physicist also have to test the review workstation along with the new FFDM unit as part of the Mammography Equipment Evaluation? Do we have to submit the review workstation test results for accreditation?

Priscilla F. Butler, M.S. Senior Director - ACR Breast Imaging Accreditation Programs A. Yes and yes.

Q. We have just added a second FFDM unit. Images from this unit are interpreted on our current review workstation. This review workstation was evaluated during the medical physicist’s Annual Survey of our old FFDM unit.

Does our medical physicist have to retest that review workstation along with the new FFDM unit as part of the Mammography Equipment Evaluation? Do we have to submit the review workstation test results for accreditation?

A. No and yes. If the review workstation was tested previously with another FFDM unit at that site during its Mammography Equipment Evaluation or Annual Survey, the medical physicist does not have to retest the workstation. However, the medical physicist should indicate on the Mammography Equipment Evaluation summary forms sent with the accreditation application when the workstation was tested and the results.

Q. The physician’s review workstation is not at the same physical location as the FFDM unit (it is off site). Is the medical

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A. Possibly and yes. There are at least two possible scenarios if the review workstation is not located at the facility where the FFDM unit is located: • If the workstation was tested previously with another FFDM unit (either at the location of the workstation or a sister site), the medical physicist does not have to retest the workstation. However, the medical physicist should indicate on the Mammography Equipment Evaluation summary forms the MAP ID # of the facility where the workstation is located, when the workstation was tested and the results.

• If the workstation is located off-site in an office with no FFDM units and was not tested previously, the medical physicist must include the review workstation in the FFDM unit’s Mammography Equipment Evaluation.

In either case, the review workstation testing results must be included in the accreditation application to the ACR. Q. Our facility uses a thirdparty review workstation for interpreting our FFDM images (it was not provided by the FFDM unit manufacturer). May I follow the review workstation’s QC manual when performing the Mammography Equipment Evaluation tests or QC on the workstation?

AAPM Newsletter

November/December 2007

A. Possibly. The FDA requires that facilities with FFDM systems comply with a QC program that is substantially the same as that recommended by the image receptor manufacturer (i.e., GE, Fischer, Lorad, Siemens, Fuji). This requirement also applies to review workstations (monitors). However, the FDA allows some flexibility for workstation QC depending on the device’s clearance from the FDA’s ODE for FFDM use. You should check with the workstation manufacturer for their device’s FDA clearance status.

• Workstations approved by the FDA's ODE for FFDM - FDA considers the workstation’s QC manual to be “substantially the same” as that of the image receptor manufacturer and the facility may follow it for QC • Workstations not approved by the FDA’s ODE for FFDM - the facility must follow the QC manual provided by the image receptor manufacturer (check with the image receptor manufacturer for their required tests)

Q. We just installed a new review workstation. (We have had our FFDM unit for several years.)

Does our medical physicist have to conduct a Mammography Equipment Evaluation of this workstation? Do we have to submit the results of this test to the ACR? A. Yes and no. It is important that your medical physicist conduct a Mammography Equipment

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Q. All clinical images at our new FFDM facility will be printed and interpreted on hardcopy. There is no review workstation for the physician. Do we need to have access to a review workstation and submit the results of its Mammography Equipment Evaluation and QC testing for accreditation?

A. No. However, since this is an unusual situation (most facilities interpret from the softcopy), you must provide a letter signed by your lead interpreting physician stating that all interpretations will be done from hardcopy. Also, please note that any testing required by the manufacturer for the FFDM unit’s display is still required since the technologist clinically uses this display when performing the examination.

Evaluation of your new workstation (and document his results in a report) to ensure that it is operating properly for image interpretation. However, you do not need to send this to the ACR at this time. We will request the results of the entire system’s Annual Survey (which must include the review workstation tests) during accreditation renewal.

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AAPM Newsletter

November/December 2007

Education and Training

Ervin B. Podgorsak McGill University, Montreal The looming crisis in medical physics education and training

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uring the past two decades significant advances in medical physics teaching, training, and research have resulted in general acceptance of medical physics as a profession and scientific discipline.

Medical physics organizations are strong, steadily growing and run by medical physicists. Standards for medical physics education programs are set and controlled by a professional commission (CAMPEP) run by medical physicists. Medical physicists are making invaluable contributions to clinical imaging and radiotherapy services and most modern university physics departments regard medical physics as an important and relevant branch of physics. Yet, there is a crisis looming on the education horizon, a crisis that is to a degree self-inflicted by medical physicists but may seriously affect the credibility and the seemingly bright future of the medical physics profession.

Medical physics is not only a scientific discipline, it is also a medical subspecialty regulated by professional certification exams. In the U.S., the medical physics certification exams are conducted by the American Board of Radiology (ABR) which is

one of 24 specialty boards under the umbrella of the American Board of Medical Specialties (ABMS).

The vast majority of the ABMS affiliated boards require that their certification exam candidates have completed their specialty education and training in accredited programs.

A notable exception to the link of certification with education and training program accreditation is the ABR certification exam in medical physics, despite the significant pressure the ABMS has been exerting on the ABR to fall in line with other certifying boards and make eligibility for writing the medical physics certification exam more stringent.

In 2002, partly in response to pressure exerted on the ABR by the ABMS and partly in response to concerns over a relatively poor ABR certification exam performance of medical physics candidates coming from non-accredited medical physics programs, the ABR physics trustees passed a resolution which, as condition for admission to the ABR board exam, will require exam candidates to have completed either a CAMPEP-accredited graduate study or a CAMPEPaccredited residency in medical physics, or both. The resolution was to become effective in 2012 and, with a 10-year lead period, was to meet, at least partially, the ABMS program accreditation requirement and improve the medical physics exam results without undue inconvenience and hardship for potential candidates. The AAPM Board of Directors initially agreed with the ABR resolution but in 2007 strengthened it significantly by stipulating that starting in 2012 only candidates who have completed a CAMPEP-accredited medical

17

physics residency program should be admitted to the ABR certification exam.

The AAPM recommendation for 2012 poses two problems: (1) the current number of available CAMPEP-accredited residency positions meets only about 15% of actual needs and (2) the new AAPM position distances the AAPM from its 20-year history of support and encouragement of CAMPEP accreditation of graduate medical physics degree programs and conveys a message that the accreditation of graduate medical physics programs is not important.

The CAMPEP-accredited graduate programs in medical physics are in excellent shape after 20 years of steady growth and improvement and, moreover, they produce close to the required annual number of new didactically educated medical physicists. It is thus unfortunate that the AAPM would take a stand that is impractical and as well may put into doubt the importance of the CAMPEP accreditation of graduate programs in comparison with CAMPEP-accredited residency programs.

The current confusion around the CAMPEP accreditation requirement, combined with lack of clear understanding of what the 2012 deadline actually means, is causing great consternation among potential candidates for the ABR exam: medical physics graduate students, residents in medical physics, and junior medical physicists. The current conventional wisdom is that candidates who apply to start the ABR examination process before October 2011 will follow the rules in effect today. These rules require that the candidate hold a bachelor’s

AAPM Newsletter

November/December 2007

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Today’s rules require neither residency nor CAMPEP accreditation; however, they stipulate that a candidate registered in a CAMPEP-accredited medical physics graduate program may start the board examination process prior to receiving the graduate degree. This effectively means that graduate students entering CAMPEP-accredited graduate programs for the next four years and applying for admission to the ABR examination before October 2011 will not be affected by the 2012 rule. On the other hand, if the AAPM 2012 recommendation prevails, candidates signing up for the ABR exam after October 1, 2011 will need a diploma from a CAMPEP-accredited 2-year residency program.

Clearly, the long-term goal should be that all ABR physics exam candidates possess a graduate degree (master’s or doctoral) in medical physics from an accredited institution as well as a diploma from an accredited 2-year residency program in medical physics.

However, we are not there yet. While the current output of accredited graduate programs almost satisfies the graduate degree component of this goal, the current output of accredited residency programs is much too low to satisfy the residency component of the goal.

In North America, the number of CAMPEP-accredited graduate programs and the number of CAMPEPaccredited residency programs currently each stand at around 15.

However, the number of students per graduate program significantly exceeds (by a typical ratio of 6 to 1) the number of residents per residency program.

The reasons for this are in funding and staffing requirements. In comparison

with graduate students, medical physics residents not only get better remuneration and thus “cost more”, they also require from staff a heavier teaching effort, more individual attention, and closer supervision. In comparison with standard medical residencies, funding for medical physics residencies is haphazard and poorly regulated.

The obvious solution to these problems is to encourage accreditation of new and reaccreditation of existing graduate programs, and, more importantly, to increase significantly the number of CAMPEP-accredited residency positions. The AAPM has been addressing the residency issue for the past several years, starting with an ad-hoc committee on alternate pathways to residency that was set up in 2004 by President Howard Amols and chaired by Lawrence Reinstein.

The ad-hoc committee work evolved into Task Group 133 chaired by Michael Herman under the auspices of the AAPM Education and Training of Medical Physicists committee.

The TG 133 report will be released soon and its main innovation will be a proposal for CAMPEP residency accreditation through a program of affiliated residencies between a primary CAMPEP-accredited program and a satellite (affiliate) institution. This approach is a step in right direction and holds a promise to increase significantly the number of accredited residency positions across North America.

Another proposal purported to hold promise to alleviate the shortage of residency positions is the introduction of professional programs leading to a doctorate in medical physics (DMP).

The DMP program would essentially merge the current 2-year master’s degree program in medical physics with a 2-year residency program in medical physics into a 4- to 5-year doctoral program and completely dispense with all research training

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November/December 2007 that forms a standard component of graduate studies in sciences.

The DMP option enjoys significant support among medical physicists because it would confer a doctoral title to medical physicists who, for having essentially the same didactic and clinical credentials, currently receive a master’s degree title and a residency diploma. Yet, in the Ph.D. degree, medical physicists already have a well-established pathway to a doctoral title. Do we really need to add a diluted degree to get access to another doctoral title?

Supporters of the DMP program believe that funding for DMP studies will be easier to obtain from universities than is the case with the current master’s and residency programs. This may be true, however, a closer look at the DMP proposal reveals many disadvantages that will likely outweigh any potential advantages. For example, while the DMP programs for the foreseeable future cannot increase the number of clinical training positions, they will have an immediate deleterious effect on the current master’s and Ph.D. programs in medical physics. Why would students register into a master’s program and subsequent residency when, for the same didactic and clinical effort, they can obtain a doctoral degree?

Furthermore, a doctoral degree in science implies research training, and medical physics is a scientific discipline which has achieved its position among other scientific disciplines through imaginative research work carried out by our professional grandfathers.

DMP programs will not promote this tradition and we will lose the credibility we enjoy now with other physics specialties, credibility that took many years to establish.

Another argument used in support of the DMP idea is that M.Sc. and Ph.D. medical physicists who devote their professional life to clinical work have effectively wasted their research efforts when working on the research

AAPM Newsletter

November/December 2007

component of their graduate degrees in medical physics. Not so: it is the research training that makes an indelible mark on the performance of clinical physicists, on their interaction with medical colleagues and patients, and on their problem solving skills. Can we imagine AAPM meetings with research not playing a primary role?

A medical physicist, M.Sc. or Ph.D., is not a glorified technician but a scientist who, in addition to clinical training, has some research training, who understands the importance of applied research, and who, through translational research, advances the science of medical physics and its rapid translation into clinical practice. DMP programs will not only redirect medical physics from these basic attributes that define our profession, they will also create confusion between a Ph.D. degree in medical physics and a DMP degree. Moreover, to the detriment of

the medical physics profession, they will almost certainly siphon excellent candidates from Ph.D. studies in medical physics.

step toward this goal, the DMP idea, on the other hand, seems to be an unnecessary solution looking for a problem.

The requirement for a degree (master’s or Ph.D.) from an accredited medical physics graduate program combined with a requirement for a diploma from an accredited medical physics residency program is the best guarantee for improved performance in ABR medical physics board exam which, in turn, will improve the professional standards in medical physics in general. To achieve this goal the medical physics organizations (AAPM, ACMP, COMP, CCPM) as well as relevant medical organizations (ACR, ASTRO, CARO, RSNA) should do their utmost to stimulate an increase in the number of accredited medical physics residency positions; the TG 133 recommendation on affiliated residencies is an important

Since by 2012 the number of accredited medical physics graduate positions are likely to meet the needs, in contrast to accredited medical physics residency positions which will not, it would seem prudent to follow the 2012 resolution proposed in 2002 by the ABR physics trustees (requirement for either accredited graduate degree or accredited residency diploma) and postpone the mandatory accredited residency diploma requirement until the number of available accredited residency positions meets the demand.

From then on, requirement for an accreditation of both the graduate degree and the residency diploma would be fair and in the best interest of the medical physics profession and patients the profession serves.

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AAPM Newsletter

November/December 2007

Health Policy/Economic Issues Wendy Smith Fuss, M.P.H. AAPM Health Policy Consultant AAPM Submit Comments to Medicare Regarding 2008 Proposed Rules

T

he AAPM Professional Economics Committee (PEC) has had a very busy regulatory season reviewing multiple Medicare proposed rules and their impact on medical physics procedures and submitting comment letters, including recommendations to CMS that benefit the practice of medical physics. In the September/October 2007 issue of the AAPM Newsletter, we provided highlights of key issues contained in two Medicare proposed rules. In this issue, we summarize the key comments and recommendations made by AAPM in our formal written comments to CMS. Hospital Outpatient Prospective Payment System (HOPPS): In order to further efficiencies within the hospital outpatient payment structure, CMS proposes to extend the current packaging approach to additional services, so that these additional services would be paid through larger payment bundles. Effective January 1, 2008, CMS proposes to package payment for items and services in seven categories of supportive ancillary services (known as “dependent” procedures) into the payment for primary diagnostic or therapeutic modality (known as “independent” procedures) with which they are performed: Guidance services Image processing services Intraoperative services Imaging supervision and interpretation services Diagnostic radiopharmaceuticals Contrast agents Observation services

CMS proposes to package (also known as “bundling”) payment for “guidance” codes, specifically those codes that are reported for supportive guidance services, such as ultrasound, fluoroscopic and stereotactic navigation services, which aid in the performance of a primary procedure. CMS notes that hospitals have several options regarding the performance and type of guidance services they use.

Therefore, by proposing to package payment for all forms of guidance, CMS is specifically encouraging hospitals to utilize the most costeffective and clinically advantageous method of guidance that is appropriate in each situation by providing them with the maximum flexibility associated with a single payment for the independent procedure. Similarly, hospitals may appropriately not utilize guidance services in certain situations based on clinical conditions.

Based on the information in the proposed rule and lack of data available to the public, AAPM cited their concerns that the proposed reimbursement structure may create an incentive for hospitals to cut back their use of advanced technologies for daily patient localization used in radiation oncology treatment delivery in a way that could have a direct negative impact on the quality of patient care. AAPM believes that the use of state-of-theart radiation oncology treatment delivery modalities without the corresponding use of adequate daily target localization presents a serious safety risk to patients, and the current proposal seems to offer a financial incentive to those hospitals that choose to make little or no use of daily localization when providing radiation therapy.

21

On September 12, 2007, AAPM submitted comments to CMS regarding the 2008 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule. This payment system applies to technical component or facility payments to hospital outpatient departments.

AAPM made the following recommendations: 1. The AAPM believes that CMS should delay the 2008 packaging proposal until complete information is made available to the public on the CMS website and stakeholders have the opportunity to fully comment.

2. The AAPM requests that CMS make available to the public all data associated with the packaging proposal. Specifically, AAPM requests that CMS provide the data for all of the image guidance codes to include: The crosswalk of each dependent image guidance code to the independent primary service(s) with which they are performed.

The median costs of the independent APCs with the dependent image guidance codes packaged and without the packaging proposal.

The percentage of claims for each independent procedure with a packaged dependent procedure code.

3. The AAPM strongly supports the APC Advisory Panel’s September 6, 2007 recommendation that CMS exclude all image guidance codes used in conjunction with radiation oncology procedures from the 2008 proposal to package guidance services.

4. The AAPM supports the APC Advisory Panel’s September 6, 2007 recommendation that CMS provide in the 2008 HOPPS Final Rule the crosswalks and guidance for newly packaged codes as proposed for 2008

AAPM Newsletter

November/December 2007

(e.g. median costs of HCPCS codes with and without packaging).

CMS is proposing a significant change to the hospital outpatient payment system effective January 1, 2008. While the AAPM understands the rationale of packaging under a prospective payment system, we are concerned that the methodology to determine payment for packaged services is not transparent and may lead to inappropriate payment for image guidance services. AAPM believes that CMS has a duty to provide the relevant data to the public when making a proposal of this magnitude.

Only through such transparency can professional medical societies comment on how image guidance codes are packaged and the potential impact to cancer care. Both the agency and Medicare beneficiaries will be better served if this information is made available to the public.

Medicare Physician Fee Schedule: CMS will continue to implement the new “bottom-up” practice expense methodology. For 2008, the practice expense relative value units (RVUs) will be calculated on the basis of a blend of RVUs calculated using the new practice expense methodology weighted by 50% and 50% of the 2006 practice expense RVUs for each code.

The overall impact of the practice expense methodology to all radiation oncology payments in 2008 is zero percent, however, several radiation oncology codes continue to realize significant reductions under the new methodology, including the weekly continuing medical physics consult code (CPT 77336). Reductions in several medical physics codes were identified in 2007 under the new practice expense methodology and these reductions will continue in 2008, the second year of the fouryear transition period. The majority of radiation oncology codes increase under the new practice expense methodology and these procedures will receive additional increases in practice expense RVUs in 2008.

In addition, CMS makes assumptions regarding equipment usage (50%) and interest rates (11%) for medical imaging equipment when calculating the practice expense RVUs. Although CMS did not propose any changes to the current assumptions for 2008, it is likely that this issue will continue to be studied. Future changes would likely decrease medical imaging payments, especially for CT, MRI, PET and nuclear medicine studies.

On August 22, 2007, AAPM submitted comments to CMS regarding the 2008 Medicare Physician Fee Schedule proposed rule. This Physician Fee Schedule applies to global and technical component payments to freestanding radiation oncology centers, as well as physician reimbursement. AAPM made the following comments and recommendations: AAPM recommends that CMS review and refine the direct practice expense inputs for the Continuing Medical Physics Consult code 77336 so that accurate salary and time data for medical physicists can be assigned to these codes for 2008.

AAPM supports CMS’s decision to maintain the current imaging equipment usage assumption at 50% until sufficient empirical evidence justifies an alternative proposal.

AAPM supports CMS’s decision to retain the interest rate assumption used in the calculation of equipment costs at 11%.

CMS should replace the Sustainable Growth Rate in 2008 with an annual update system like those of other provider groups so that payment rates will better reflect actual increases in physician practice costs and take into account Medicare Part B savings associated with new technologies.

AAPM supports the use of the $1.35 billion Physician Assistance and Quality Initiative Fund to help offset the negative 9.9% annual update for 2008.

To access the complete AAPM comment letters, go to the AAPM website at http://www.aapm.org/ government_affairs/CMS/default. asp

AAPM 50th Anniversary T-shirt Slogan Contest

Would you like to win a complimentary registration to the 2008 AAPM Annual Meeting?

For rules and details, visit http://www.aapm.org/announcements/50thTshirtSlogan.asp

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AAPM Newsletter

November/December 2007

2005 AAPM Medical Physics Travel Grant Report AAPM Travel Grant – France Warren D. D’Souza

I

chose to visit 5 radiotherapy departments as part of my medical physics travel grant award.

Centre Alexis Vautrin - Nancy I arrived in Paris on March 22nd, 2006 with my family. My first stop was Nancy, which is about 150 km east of Paris. We took a day to enjoy the city of Nancy, observing locals taking an afternoon stroll, tourists awing at the stone buildings surrounding the plaza known as Place Stanislas. In Nancy, I had arranged to visit Centre Alexis Vautrin (CAV). My host was Dr. Didier Peiffert who is Chief of the Radiotherapie and Curietherapie Departments at CAV. He had invited my family for dinner where, other physicians and physicists including Dr. Alain Noel, head of the physics division joined us.

The following day, my visit began with me delivering a talk titled “Stereotactic Body Radiation Therapy: Consideration of Respiration-Induced Tumor Motion”.

My audience consisted of radiation oncologists, physicists, and medical physics students. As I learned during the day, CAV is one of the three centers in France that have been chosen by the French Health Ministry to receive a cyberknife unit. This is part of an undertaking by the French government to improve technology with the goal of delivering precise stereotactic treatments to patients.

Following my talk, I met with various physician and physics staff with whom I discussed topics ranging from MR-based treatment planning for gynecological brachytherapy to IMRT planning and delivery.

CAV has 4 linear accelerators. Dr. Peiffert had a clear interest in pulse-

dose brachytherapy (PDR) and informed me that some of the leading brachytherapy specialists from the US had spent time at CAV to learn about their experience. I met with 3 physicists, Dr. Noel, Dr. Pierre Aletti and Dr. Vincent Marchesi. They shared with me some of their ongoing research particularly in inter-fraction organ motion modeling using finiteelement analysis, a multi-institution Monte Carlo based dose calculation framework using a super-computer in collaboration with a technical university in Nancy and EPID dosimetry for IMRT. My day ended with a trip to a French market (with Dr. Aletti).

Centre Hospitalier Universitaire Bretonneau - Tours The following day, we departed Nancy to my second stop, Tours.

Tours is located approximately 100 km south west of Paris. We were met at the hotel by my host Dr. Helene Aget, chief of the physics division at Centre Hospitalier Universitaire (CHU) Bretonneau.

The following day, Dr. Aget and Dr. Olivier Le Floch, chief of the radiotherapie department at CHUBretonneau invited us to a picnic and wine tasting. We rounded out the day with a visit of the Le Cher river and the Chenonceau castle.

Dr. D’Souza on the banks of the Le Cher river with Dr. Helene Aget and Dr. Olivier Le Floch in Tours.

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My visit at CHU-Bretonneau began with a visit of the department.

CHU-Bretonneau is a general university hospital with radiotherapy being one of the departments. I was informed that unlike in the United States, French medical physicists at university hospitals are not offered faculty positions. The radiotherapy department has 3 linear accelerators with a BrainLab microMLC for intra-cranial stereotactic radiotherapy, HDR and LDR remote afterloaders. I learned about the a French treatment planning system (IsoGray), that is used both for 3D conformal and IMRT treatment planning. Dr. Aget had also arranged for me to visit the PET and MRI facilities with her colleagues. I learned that at many centers, French medical physicists provide radiation therapy, diagnostic radiology and nuclear medicine services and that medical physicists in France are certified in all 3 areas. The imaging facilities at CHU-Bretonneau were state-ofthe-art with a PET-CT scanner, 3T MR scanner and 40-slice CT scanner. I presented a talk titled “4D dose calculation: consideration of respiration-induced organ motion”.

My audience consisted of medical physicists, radiation oncologists, dosimetrists and clinical engineers.

Dr. Aget had invited medical physicists from other hospitals in the surrounding areas for the talk. At the conclusion of the talk there was a lively discussion of the technical aspects of my research as well as the practicality of implementation of some of the more resource intensive techniques I had presented.

Institut Curie - Paris My next stop was on the trip was Paris.

I had two days off in Paris in which we took in some of the sites including the Luxembourg Gardens, Notre Dame,

AAPM Newsletter

November/December 2007

Dr. D’Souza with his son, Caden in front of the Louvre in Paris.

the Eiffel Tower and the Pantheon.

On March 30th, I visited Institut Curie, which is located in the heart of Paris.

My host was Dr Jean-Claude Rosenwald who is the head of the physics division.

Institut Curie has 6 linear accelerators and treats approximately 250 patients a day. I was particularly impressed with the efficiency with which treatments were being delivered using breathholds and gating. I had the pleasure of meeting with 3 PhD graduate students who described their research on breathing adapted treatments, external surface contour matching for setup errors and EPID-based IMRT dosimetry, respectively. Following lunch with the physics staff, I was introduced to 3 medical physicists in the department Dr. Nathalie FournierBidoz, Dr. Genevieve Gaboriaud and Dr. Sofia Zefkili. I interacted with Dr. Fournier-Bidoz on a novel technology that uses the external surface contour matching to setup patients undergoing breast radiotherapy (Vision RT, UK), Dr. Gaboriaud on general treatment planning and Dr. Zefkili on IMRT planning and verification for head and neck tumors. Dr. Zefkili also described IMRT head and neck protocols in which Institut Curie was participating.

That concluded my visit to Institut Curie. To follow up on my visit to Institut Curie, Dr. Rosenwald invited my family and I to his house for dinner over the weekend.

Institut Gustave Roussy Villejuif The next stop on my itenary included a visit to Institut Gustave Roussy (IGR).

Villejuif is considered a suburb of Paris and is located about 20 km south from the city. My host at IGR was Dr. Dimitri Lefkopoulos (head of the medical physics division).

My visit started with a talk titled “Respiration Induced Tumor Motion Management for Radiotherapy” that was delivered to an audience consisting of medical physicists, graduate students and clinicians.

The talk was well received with an interesting discussion on currently implemented intra-fraction motion corrections methods. Following the talk, I was given a tour of the IGR clinic by Dr. Andre Bridier (the lead clinical physicist in the radiotherapy department at IGR). I was introduced to the ESTRO-QUALity assurance network (EQUAL), which is located at IGR and was set up by ESTRO (much akin to the RPC and ADCLs in the US). The department of radiotherapy at IGR consists of 7 linear accelerator vaults including a cobalt unit. During my visit, the department was in the process of undergoing equipment upgrades and Dr. Lefkopoulos was kind enough to share some of those plans with me.

I spent part of the day observing their 4D CT simulation process and gated radiation treatment. My visit coincided with a 2-day semi-annual workshop that included participants from IGR and the Karolinska Institute, Stockholm, Sweden. The workshop included interdisciplinary scientists and clinicians from both institutions. The medical physics sessions included discussions on Monte Carlo based dose calculations for various radiotherapy treatments.

I had lunch with participants from the workshop and was introduced to some of the physicists from Karolinska by Dr. Lefkopoulos. My visit ended with Dr. Lefkopoulos dropping me off at the train station for a 30-minute train ride back to Paris.

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Orsay The last stop on my itenary included a visit to the proton therapy center in Orsay. Centre de Protontherapie d’Orsay is one of two medical proton centers in France and uses a synchrocyclotron for beam generation.

Such equipment was formerly only available within centers studying particle physics, and in the case of the Orsay installation, the treatment machine was converted from particle research usage to medical usage in 1991 and has treated approximately 4000 patients. I was invited to watch the treatment for an ocular melanoma case. Patient positioning is of utmost importance particularly for proton therapy and I gained an appreciation for the utmost precision with which the patient was immobilized .

Following the treatment I met with Dr. Regis Ferrand, the director of proton center. The current facility has two treatment rooms. The proton center is currently initiating an expansion and modernization plan which in 2009 will give it the capacity to treat 650 patients per year with three treatment rooms.

Following the tour, Dr. Ferrand and I discussed mutual research interests over lunch. Upon completion of my trip I took the train back to Paris.

After a 2 week trip and a visit to 5 facilities, I departed France on April 5th. I am extremely grateful to the AAPM for awarding me the AAPM travel grant and giving me this unique opportunity. I am also extremely grateful to Charles Lescrenier whose generosity makes it possible for a medical physicist such as myself to have this enriching experience. I am also grateful to my colleagues at the University of Maryland for ensuring coverage of my clinical responsibilities during my absence. Finally, I am grateful for the wonderful hospitality extended to me by all my hosts during this visit.

AAPM Newsletter

November/December 2007

AAPM Website Editor Report

Christopher Marshall, Ph.D. NYU Medical Center

I

have the privilege of serving as the AAPM Website Editor – a position approved by the AAPM Board last year. In this report I will outline some of what I have learned, and what we have done and plan to do.

I have learned that the staff web-team are true professionals; if deadlines get tight the work gets done. They deserve most of the credit for what we are able to do. However, there are issues that the staff cannot (and should not) resolve alone; I find that I can usually resolve these issues quite rapidly. In doing so I may gain some other insight and improve the outcome.

I have become very aware that each member has a unique set of interests, and that my challenge is to provide each of you with the information that you need and to make this easy to find.

I have set a goal of “personalizing the Website” and we have made some progess. You are recognized at login with a personal greeting and periodically with personal messages.

In the “MY AAPM” section in the left menu you will find links to the committees that you belong to, and you can add more from the Committee Tree. Here you will find your past AAPM emails (including

your chapter email if it uses AAPM resources to send emails) and you can access and change your personal details or upload your picture. I encourage you to make suggestions for further customizations.

orphaned and growing stale. I am working to deal with this issue more systematically by tracking content and reaching out to the appropriate committees and individuals to try to keep things fresh.

We are coordinating the use of the Newsletter and Website for news delivery. News items can be posted almost instantly under “What’s New” on the Website, while the Newsletter takes time to assemble and distribute. However, you miss news on the Website unless you visit us, so we have plans to alert you to new Website content through the use of RSS feeds or other mechansims.

We will explain how to use new features as we roll them out.

We have taken steps to make the Website more visually appealing through the use of more color and icons, and plans are in the works for a “new look” to coincide with our golden anniversary. I hope you enjoy the changing Flickr images from past meetings – for which the staff get the credit.

I am aware that the Website is our interface with several potential audiences. These include, but are not limited to, the international community of medical physicists; potential new members of our community; other organizations; vendors; and those ubiquitous “members of the public” who on closer examination include those who employ us as well as those who may use our services. We can only address these audiences effectively if we shape and present our content appropriately. We attempt to group our content under menus that are associated with audiences, but we plan to target them more specifically as we move forward. Our primary constraint seems to be the time it now takes to generate new content through the committee process.

We have a systemic problem of aging content. This problem is compounded in an organization like ours because Committees and Task Groups produce content but then move on to new projects or go out of business, leaving their hard work

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I have proposed Rules changes to reflect my new role. If approved, I would formally absorb the detailed responsibility for Website content previously vested in the EMCC, while the the EMCC would formally assume responsiblity for broader oversight of our IT enterprise (which they now do by default). They would also review my activities and initiate the process for seeking my successor.

I would gain the authority to form an editorial board for the Website (subject to the approval of individual members by the EMCC). I regard this as a key step in addressing several of the concerns that I have outlined here and others that I may discuss in future reports. At the time of writing these changes have been submitted to the Rules Committee for review and will then need the approval of the Board, but I am initiating an editorial board on an ad-hoc basis in the meantime.

I hope that you find the Website useful, visit it often, and send me your feedback at http://www.

aapm.org/pubs/newsletter/ WebsiteEditor/3206.asp

AAPM Newsletter

November/December 2007

Bethesda North Convention Center January 17 - 19, 2008 IMAGING AND CHARACTERIZING STRUCTURE AND FUNCTION IN NATIVE AND ENGINEERED TISSUE Plenary Session 1:

Heterogeneous Single Cell Measurements and Their Integration into Tissue and Organism Models

Moderators:

Robert Murphy, PhD and Warren Grundfest, MD, PhD

Plenary Session II:

Functional Molecular and Structural Imaging of Engineered Tissue in vitro and in vivo.

Moderators:

Anne Meyer, PhD and Christine Kelley

Plenary Session III: New Technologies for Characterizing Cells and Tissues in situ Moderators:

Kevin Cleary, PhD, and Richard Ehman, MD

Plenary Session IV:

Imaging for Targeted Cell, Gene and Drug Delivery

Moderators:

Vladimir Torchlin, PhD and William Phillips, MD

• Discounted Registration Fee: $300.00 (Deadline is at 11:59 PM EST on December 20, 2007)

• Regular Registration Fee: $350.00 (Pre-registration for BIROW 5 will close at 11:59 PM EST on January 9, 2008)

www.birow.org

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AAPM Newsletter

November/December 2007

2007 AAPM Summer School Report AAPM at the Abbey 2007 Summer School Shielding Methods for Medical Facilities

T

Mary Fox, Local Arrangements Chair

ake a moment to imagine an Abbey Tower chiming the hours passing, monks walking in an arboretum setting, and monastic gardens surrounded by pristine lakes.

No, it’s not a medieval daydream, but the campus of St. John’s University in Collegeville, Minnesota, site of the 2007 AAPM Summer School.

2007 Summer School Program Directors, Melissa Martin and Pat McGinley, organized this year’s school, “Shielding Methods for Medical Facilities” which took place immediately following the AAPM annual meeting in Minneapolis.

Seventeen faculty presented topics on PET, CT, Neutron, Tomo, Cyberknife, R/F shielding, and Maze

design. Practical Solution Sessions on “Shielding Design Mistakes” were presented by industry representatives in the evenings.

A medieval dinner was held in the Great Hall, reminiscent of Hogwarts (see photo in center column). Other activities included canoeing, fishing, swimming and hiking. Almost three hundred participants enjoyed the escape, nourishing both mind and body in rural Minnesota.

CT Imaging” at the University of Houston, June 25-29. The Saturday, June 28 hands-on workshop component will be held separately at MD Anderson Cancer Center. This one-day workshop will cover scanner testing, accreditation and shielding calculations. Due to the nature of the one-day workshop, it will be offered as a separate ticket item, and will be open only to the first 92 registrants.

Details will be posted soon.

APM AT THE

ABBEY

Shielding Methods for Medical Facilities St. John’s University • Collegeville, MN July 27-29, 2007

Next year, 2008 Program Directors, Dianna Cody and Osama Mahlawi, are organizing “The Physics and Applications of PET/

Program Directors, Local Arrangements, and HQ Staff Front row: King Pat McGinley Queen Melissa Martin, Lynne Fairobent (AAPM staff), Second row: Sherry Connors, Suzanne Yerich, Mary Fox (Local Arrangements Chair), Robin Miller, Lisa Siskind, Karen MacFarland (AAPM staff), Third Row: Jeff Richer, Paul Feller (Dumbledore), Will Parker and Igor Shishkov

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AAPM Newsletter

November/December 2007

Radiation Physics Residency Recipients Announced AAPM and ASTRO jointly sponsor Radiation Physics Residency grants to promote the development of radiation physics residency programs by providing assistance to newly established programs working toward accreditation. The 2007 Radiation Physics Residency grants were awarded to: Stefan Both, Ph.D. Todd Pawlicki, Ph.D. Kenneth N. Vanek, Ph.D. Fang-Fang Yin, Ph.D. Joann Prisciandaro, Ph.D. Arthur L. Boyer, Ph.D.

The Hospital of University of Pennsylvania University of California San Diego Medical University of South Carolina Duke University University of Michigan -- Division on Radiation Physics Scott and White Memorial Hospital

Fellowship available AAPM is accepting applications for a Fellowship for the training of a doctoral candidate in the field of Medical Physics. Awarded for the first two years of graduate study leading to a doctoral degree the Fellowship will be active from July 1, 2008 through June 30, 2010.

Application deadline: April 15, 2008

Research Seed Funding Initiative Two $25,000 grants are available to provide start-up funds for a research-orientated medical physicist. These one year awards are intended to provide funds to develop an exciting investigator-initiated concept, which will hopefully lead to successful longer term project funding from the NIH or equivalent funding sources.

Application deadline: February 15, 2008 For further information and application details, go to: www.aapm.org

Summer Undergraduate Fellowship Program The AAPM Summer Undergraduate Fellowship Program is designed to provide opportunities for undergraduate university students to gain exposure to and experience in medical physics by performing research in a medical physics laboratory or assisting with clinical service at a clinical facility. The program is aimed at junior and senior undergraduate students, particularly those that will become qualified for future graduate studies in medical physics. We expect there to be 14 summer undergraduate fellowships in 2008, each carrying a $4,000 stipend. The fellowship will be for a period of 10 weeks during the summer academic period (May 1 to September 30), which is mutually suitable to the mentor and fellow. The application receipt deadline for mentor and student applications are February 1, 2008. Information is available online at: http://www.aapm.org/education/sufp/

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AAPM Newsletter

November/December 2007

2006 AAPM-IPEM Medical Physics Travel Grant Report Re-warding Travel to the UK Mark Oldham “A traveller! By my faith, you have great reason to be sad: I fear you have sold your own lands to see other men’s; then, to have seen much and to have nothing, is to have rich eyes and poor hands.”

--William Shakespeare, As You Like It (1599), Act 4, Scene 1

H

ad I listened to these words 10 years ago I would perhaps never have left the UK to explore a career in medical physics in the US. But I did leave. Now, with 10 years of rich experience in American medical physics, and quite contrary to this gloomy perspective from Shakespeare, I felt truly enriched by the opportunity to return to the UK as the travelling AAPM-IPEM fellow, in May 2007. The aim was simple: to share visions of the eyes and improve the practice of the hands.

From left to right, the author, Roy Bentley, and Prof Steve Webb.

Sutton and London The Joint Department of Physics of RMH/ICR (Royal Marsden Hospital and the Institute of Cancer Research, Sutton, England) is a very special place for many reasons, just one being a top-flight tradition of academic and clinical excellence in radiation therapy. For me especially so, as this is where in 1992 I started my career in medical physics as a postdoctoral

researcher. I felt fortunate to be given this opportunity, having no prior experience in medical physics (my PhD being in non-Newtonian gravity), and an unusual story having just returned broke from 6 months living in a tent, working for a conservation organization in East Africa. My new boss, Professor Steve Webb, was unperturbed however, and immediately directed me to work on inverse planning algorithms for IMRT. I worked at RMH for over 5 fantastic years.

This was my first visit back, after 9 years experience in the US, and was needless to say a most poignant moment. The innovative quest continues at RMH/ICR, and I learned about ongoing research into the effects of motion on IMRT, image guidance, IMRT trials and multi-modal imaging, to name a few. Jim Warrington introduced me to the extensive new bunker facility at RMH Sutton, which will house 5 new state-of-the-art linear accelerators, and the TrackLeaf device which they were about to commission for real-time therapeutic tracking. I gave two lectures at RMH, one at each site (Sutton and Fulham Road respectively), and each conferenced live to the other site. The first on IMRT and IGRT at Duke, and the second on my recent research on optical tomographic imaging of tissue. Two true highlights (from many) were meeting Dr Roy Bently, co-inventor of the famous Rad-8 treatment planning system first used at RMH in 1971, and to spend an afternoon at Professor Webb’s home workshop, observing first hand the intricacies and art of live steam engineering. Professor Webb proved quite an authority on this subject.

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Guildford The next stop was the University of Surrey in Guidford, where a fortuitous set of coincidences had resulted in a mini-gathering of leading lights of optical-CT/3D-dosimetry. This was a great opportunity to review the state of the art, and engage in general brainstorming about the urgent need for realization of clinical 3D dosimetry systems. The visit included an introduction to Dr Doran’s latest scanning-laser opticalCT scanner, incorporating precise rotating mirror galvanometers. This device preserves high signal-tonoise of laser systems, with high speed, and represents a substantial innovation to the field.

From left to right, Dr Simon Doran and Dr Richard Krstajic of the University of Surrey, the author, Dr John Adamovics (Rider University,NJ), and Dr Kevin Jordan (London Regional Cancer Center, Canada) Bristol The first medical physicist I ever met was Dr Alan Mackenzie, Chief of Physics at Bristol Oncology Center, in 1991. I originally contacted Alan as preparation for the postdoctoral interview at RMH, because the BOC is only a 45 minute drive from where I grew up in South West England. Alan very kindly showed me around his dept one afternoon, and encouraged me to pursue the

AAPM Newsletter

November/December 2007

AAPM Virtual Library

Now online‌

Selected presentations given at the 2007 AAPM Annual Meeting Minneapolis, MN, July 22 – 26

2007 AAPM Summer School “Shielding Methods for Medical Facilities: Diagnostic Imaging, PET, and Radiation Therapy�

St. John’s University, Collegeville, MN, July 27 - 29

Presentations posted in the Virtual Library include‌ • • •

streaming audio of the speakers transcription of the audio presentations slides of the presentations

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AAPM Newsletter post-doctoral option at RMH. Dr McKenzie’s dept was just about to start commissioning an IMRT system, and so there was a great deal of interest to hear about our experiences in this area. It was a great moment to return to Bristol and feel able to give back in some manner to this dept where I gained first insights into the profession of radiation oncology physics. It was also interesting to learn about the novel imaging of cervical brachytherapy applicator placement in the new (2006) MRI scanner, an effort lead by Dr. Cornes.

Clatterbridge Leaving the delightful countryside of the west-country, I headed North to meet Professor Alan Nahum and Philip Mayles at the Clatterbridge Oncology Center. The CCO is unique in England, having a low energy proton facility, used primarily to treat occular melanomas. I had lots of questions for Dr Kacperek, especially regarding the nature of proton QA, who gave an exceptionally good guided tour of the facility. In the lunchtime seminar I reviewed some of the recent data from my collaborator Prof Geoffrey Ibbott (Director of the Radiologic Physics Center (RPC), Houston TX), which documents the alarmingly high failure rate of institutions in the US for the Head-and-neck IMRT credentialing test. This data prompted a lively debate about the challenges and non-triviality of implementing a high quality IMRT program. In the afternoon Dr Nahum drove me to the annual conference Medical Physics on Merseyside, where I gave the introductory lecture. The conference, organized by Dr Nahum, brought together researchers from all over Merseyside, and included a very interesting range of topics, from detectors to small field measurement.

It was a privilege to have the opportunity to give the opening lecture.

Hull England is really quite a small island. Traveling from Merseyside to the University of Hull involved driving right across England, from west-coast to east-coast, and an early start at 6am ensured arriving in time for breakfast at 9:15am! I had long been looking forward to visiting Hull. I’d known my host Prof Andy Beavis, since we did our Doctorates in the Dept of Physics at Newcastle University in 1990.

Andy also started in a non-medical field, and it is by coincidence that we both ended up in radiation oncology physics. Andy showed me around the very impressive new state-of-the-art 6-machine facility at Hull, which is nearing completion of construction. In the afternoon we visited his collaborative partners in the University of Hull Computer Science Dept. It is here that pioneering work is progressing to develop a life-size virtual-reality simulation that models linear accelerator based radiation therapy, complete with full linac control using a physical hand-pendant.

The utility of the tool, in first instance, is as a training aid for radiation therapists. Experiencing the inherent quality and flexibility of the virtual environment (digital linac/patient, set-up simulation, visualization of organ motion, fluence delivery etc) convinced me this approach has real potential in many areas of training, and will set the standard of the future.

Manchester The last stop on my travels was to the famous Christie Hospital in Manchester. The Christie is at the forefront of IGRT implementation in the UK, and I had a particularly informative and enjoyable time discussing and observing IGRT implementation with many staff there, including several outstanding

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November/December 2007 therapy staff. I was keen to also find out about current brachytherapy treatment approaches, and Mr. Simpson and Mrs. Julian obliged with a fascinating tour of the brachy suites. There is a wonderful old English pub called the Red Lion, next to the Christie Hospital, occasionally frequented by hospital staff. The end of my trip was rounded out by a pleasant couple of pints of local draught English ale, watching the local team play some lawn-bowls in the pub garden.

In summary, this was a fantastic trip on both a personal and professional level. It is difficult to place a value on the wealth of experience it provided.

I am very grateful to the AAPMIPEM travel award for enabling the trip. Also to the people who hosted my visits and provided such a wonderful stay, most especially to Professor Steve Webb, Dr Simon Doran, Dr Alan Mackenzie, Professor Alan Nahum, Professor Andy Beavis, and Dr. Ranald Mackay. Thank-you.

Editor

Mahadevappa Mahesh, MS, PhD Johns Hopkins University e-mail: mmahesh@jhmi.edu phone: 410-955-5115

Editorial Board Priscilla Butler, MS, Allan deGuzman, PhD, William Hendee, PhD, Chris Marshall, PhD (ex-officio) SUBMISSION INFORMATION Please send submissions (with pictures when possible) to: AAPM Headquarters Attn: Nancy Vazquez One Physics Ellipse, College Park, MD 20740 e-mail: nvazquez@aapm.org phone: (301) 209-3390

PRINT SCHEDULE • • • •

The AAPM Newsletter is printed bi-monthly.

Next issue: January/February Submission Deadline: November 15, 2007 Postmark Date: December 19, 2007

American Association of Physicists in Medicine One Physics Ellipse College Park, MD 20740-3846