Volume 34, Issue 6, June 2007
Index of content:
- Professional Symposium: Ballroom B
- Establishing Clinical Procedures
34(2007); http://dx.doi.org/10.1118/1.2761230View Description Hide Description
The AAPM has for many years developed guidelines and recommendations, in the form of task group reports and other publications, for performing many of the technical aspects of medical physics practice. Notable examples include the TG‐51 calibration protocol and the TG‐40 recommendations for quality assurance in radiation therapy. These publications and many others state specifically that they are intended as advice, and are not to be followed “slavishly” or used for accreditation or regulation without consideration of other related activities conducted by an institution. Despite these statements, some AAPM recommendations have been adopted in their entirety by regulatory agencies. In other cases, language that should arguably be incorporated into regulation cannot, because of the way in which it is published.
The AAPM should instead develop mechanisms to create, adopt, and promulgate technical standards of practice, in a format that can be adopted by regulatory agencies. The mechanisms must include ways of adopting standards developed by other organizations, and ways of developing standards in concert with these organizations, to make sure we don't duplicate each other's work.
An ideal method for technical standards development is for the AAPM to become a standards developer of the American National Standards Institute (ANSI). Standards developed through the ANSI mechanism would have the recognition of the standards and regulatory industries, and could be adopted by regulators simply by reference. Thus, the AAPM could determine which requirements belonged in a standard and which were suitable for recommendations. This would reduce the risk that AAPM recommendations were incorporated into standards, but could increase the likelihood that provisions believed by the AAPM to be crucial to safe and effective practice would be incorporated into regulation.
For the AAPM to develop ANSI standards, it must first become an ANSI “organizational” member. This is the mechanism chosen by the Health Physics Society, which currently develops ANSI standards “pertaining to products and equipment for non‐medical scientific, industrial, and educational uses”. The AAPM should then consider becoming the secretariat for the ANSI N44 committee on medical applications. Once membership is obtained, the AAPM should develop:
1. A template for AAPM standards, and boilerplate language. 2. A “roadmap” by which standards developed internally would be reviewed, approved, and published. 3. A similar roadmap by which standards developed and published by other organizations would be reviewed and adopted. 4. Mechanisms (if necessary) for ensuring collaboration on the development of new standards. 5. A list of topics for which AAPM standards of practice should be considered.
Recommendations for each of these steps will be enumerated and discussed.
1. Understand the current situation in which AAPM publications can be inappropriately turned into regulations.
2. Become familiar with the methods of standards development through ANSI.
3. Learn of the possible benefits of the AAPM becoming an ANSI standards developer.
4. Review and contribute to a list of possible future AAPM/ANSI standards.
34(2007); http://dx.doi.org/10.1118/1.2761231View Description Hide Description
Implementing new technologies into the clinic is challenging on many levels. Besides the obvious manpower issues, physicists are challenged with; unreasonable timelines driven by market competition, technical staff acceptance, incompatibilities of devices provided by multiple vendors, and the lack of opportunities for proper education. Vendors have capitalized on the open purse‐strings hospitals provide due to the healthy reimbursement for IMRT and IGRT (daily localization). Physicist must use tools such as the Abt studies to negotiate proper staffing before the technologies arrive. During this talk we will review some simple methods to justify staffing. Physicists should set realistic timelines that depend on the agreed on staffing levels including IT assistance, and on compatibility of all systems involved. We will review timelines that have been suggested for given technologies, along with time efforts from Washington University, including, MLC‐IMRT, Tomotherapy, OBI, CBCT, video surface imaging, gating, US localization, etc. Physicists must be the key decision makers in choosing a team of technical staff personal to be the initial implementers. We have found the initiation of a new technology is smoothest if the dosimetrists and therapists first involved are pro‐active and capable of implementing a new technology. Procedure writing should be a team effort to ensure there is ownership. Ongoing continuing education and scheduled migration of other support staff to operating the new technology should be the responsibility of the physicist in charge of the device or technique. This includes re‐education of all involved for new software releases or new processes. As daily localization empowers therapists to make decisions on shifting patients, physicists should work with clinicians to decide; what is the minimum shift required for a shift to take place, when is the shift too much, and whether re‐evaluation is required. Our protocols will be discussed. And finally, physicists should ensure they receive proper training beyond what the vendor provides. This may be in the form of legitimate courses and workshops, or visits to institutions using the new technology. To this end, the physics and radiotherapy community should address how new physicists (residencies), dosimetrists (MDCB), and therapists (testing out) are being trained and evaluated, and how experienced personal are being re‐trained for our new environments.
Learning Objectives: From this lecture, the physicists will learn how to:
1) estimate manpower needs,
2) formulate implementation timelines and tasks,
3) obtain the education necessary for the new technology.
- The Road to (Training and Practice of) the Medical Physicist of the Future
34(2007); http://dx.doi.org/10.1118/1.2761379View Description Hide Description
There are a number of changes pending that will impact the practice of medical physics and those who are called “medical physicist.” Recent changes in the U.S. Nuclear Regulatory Commission (NRC) regulations have impacted the training and experience requirements for medical physicists to practice in programs licensed by the NRC and Agreement States. The pending CARE Act legislation in Congress will require that Providers utilize individuals, who meet Federal education and credentialing standards, to perform the technical components of medical imaging and radiation therapy in order to participate in federal health programs such as Medicare, Medicaid and other programs administered by the Department of Health and Human Services. These minimum standards may be met by states requiring licensure. After 2012, the American Board of Radiology (ABR) goal for eligibility for certification will require graduation from a CAMPEP‐accredited medical physics training program. All of these will impact how one qualifies to be a medical physicist and how they practice. This session will address these issues.
Jeffrey Masten, JD: Update and impact of the CARE Act.
Jeffrey Limmer, MS Ed, MSc, DABR, — Past methods used to promote licensure in the existing states and the differences and similarities in these regulations.
Debbie Gilley, — Review and Impact of Existing State Licensure and Differences in NRC and Agreement State Training and Experience Requirements.
Mike Herman, Ph.D. — Future certification and credentialing in the post‐CARE ra and post‐2012 ABR (activities of MPRTP and TG133).
- New Member Symposium/Meet the Experts
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The New Members Symposium will provide an introduction to the AAPM, our current officers, council chairs and operations. This will be followed by a brief review of how to apply for a job by past president Howard Amols. AAPM leaders will remain at the symposium to continue informal discussions following the brief opening presentations.
The New Members Symposium is followed directly by the Meet the Experts sessions in the same room. Bill Hendee, Gary Barnes, Dan Low and Jim Hevezi, all individuals with many years of experience will address current issues and lead discussions on many medical physics aspects of Imaging Research, Imaging Clinical, Therapy Research and Therapy clinical.
1. To introduce new members to the AAPM leadership and operations.
2. To provide discussions with experts in medical physics.
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Research, be it radiation therapy or imaging, requires manpower. In the past, clinical resources were relatively generous and significant research could be conducted using clinical funds. Decreased clinical resources means that research groups will need to develop funding strategies that involve extramural funding,generally divided in to corporate, foundation, and governmental funding.
Corporate funding can provide significant resources for research. The scope of such grants will span fundamental research to product development and evaluation. In most cases, corporate grants are closely tied to the company's profit goals and a good fit is essential to securing and maintaining funding. There is often a “marketing” component to the grant, in that the company benefits by keeping the grantee happy. However, this should not be construed as a rationale for the grant, nor should it be considered when determining the scope of work. Only the highest quality research and development will lead to a long‐term grant relationship. Unlike governmental grants, a good personal relationship between the researchers and the company representatives is essential. Effective and regular communication will keep the projects on track and flexibility will often be required as technology develops and the company strategy changes. Corporate funding also tends to be less stable than governmental funding, first because it relies heavily on personal relationships, and second because the corporate environment can change rapidly. While it is less stable than governmental funding, it is often much easier to acquire. Corporate applications are typically much shorter than for governmental grants and a rigorous scientific approach and stellar scientific track record are not as important as for governmental grants.
Governmental grants, including from the National Institutes of Health, the National Science Foundation, and the Department of Defense, can provide a stable source of research support, but they typically require long, detailed applications as well as the development of a team of experts to meet the specific aims. These grants are very competitive and are peer‐reviewed, so obtaining one of these grants is very valuable to a CV, and many universities have written or unwritten tenure guidelines that require the faculty member to be the principal investigator on a major government grant. While there are many sources of governmental funding, I will concentrate on the National Institutes of Health. The major investigator‐initiated grant is called the R01, which has no specific limit on funding per year (although the rules change as the amounts increase), but typically has a maximum funding period of 5 years (with a 1‐year extension if some funds remain uncommitted). The methods for submission, review, and funding of an R01 will be presented. Guidance for developing a plan to successfully submit a major grant, such as an R01 will be described.
This forum will allow aspiring researchers the ability to discuss these issues with Dr. Daniel Low, Director of Medical Physics and a Professor in the Department of Radiation Oncology at Washington University.
Dr. Low earned his Ph.D. in 1988 in the field of experimental Nuclear Physics from Indiana University and spent two years as a postdoctoral fellow at M.D. Anderson Cancer Center. In 1991, Dr. Low joined the faculty at Washington University in radiation oncology physics at what was then the Mallinckrodt Institute of Radiology. Dr. Low spent the next 10 years developing his medical physics research skills before getting his first NIH R01. Since then, Dr. Low has been the PI on two additional R01s and an R21 and has coauthored more than 90 peer‐reviewed publications. Dr. Low was instrumental in the clinical development of IMRT and is now engaged in research into modeling human breathing motion for purposes of radiation therapytreatment planning,imaging, and delivery, and the development of a small‐animal experimental conformal irradiator, called microRT. Dr. Low is a member and fellow of the AAPM.
1. Understand corporate grants, including pros and cons of corporate funding.
2. Understand governmental grant submission, review, and funding processes.
3. Be able to generate a plan for developing a funded research program.
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Clinical Therapy Physics is the real “practice” of Medical Physics. Therapy Medical Physics is reimbursed explicitly and implicitly as having direct contribution to specific patient care — the only Medical Physics sub‐field with this advantage. Whether it is in establishing External Beam, IMRT,SRS or SBRT programs with IGRT or providing Brachytherapy (HDR & LDR) programs for cancer therapy, the Clinical Therapy Medical Physicist works in partnership with the Radiation Oncologist to provide quality services in cancer care. Supervision of dosimetrists and therapists, the other members of the radiation oncology team is an important part played by us.
Dr. Hevezi was Director of Medical Physics at the Cancer Therapy & Research Center for 15 years and built an important clinical therapy physics program there.A broad range of clinical services there included not only the above mentioned procedures, but procedures like Total Body Photon Therapy, COMS Eye Plaque therapy, and others. He is currently the lead Medical Physicist at the Methodist CyberKnife Center in San Antonio and directs Medical Physics graduate students in the University of Texas Health Science Center at San Antonio. Dr. Hevezi has been recently elected to the Board of Chancellors of the American College of Radiology where he serves as Chair of the Medical Physics Commission. He is current Chair of AAPM's Professional Economics Committee and most recent clinical interest is in developing the CyberKnife SBRT treatment modality for cancer therapy.
1. To understand the clinical practice of Therapy Medical Physics.
2. To become familiar with some of the new technologies in Radiation Oncology.
34(2007); http://dx.doi.org/10.1118/1.2761432View Description Hide Description
No field in research is evolving more rapidly than biomedical imaging. Advances such as functional magnetic resonance,computed tomography and digital radiography with 2D detector arrays, flow ultrasonography and computer‐enhanced displays are enhancing the sensitivity and specificity of imaging for detection and diagnosis of human disease and disability. Biomedical imaging to guide therapeutic interventions in cancer and cardiovascular disease, and to identify new, more effective treatments for chronic and neurodegenerative diseases, is yielding longer and more productive lives for millions of individuals. Imaging techniques are opening windows into genetic and cellular mechanisms underlying biological structure and function, leading to new knowledge about human health and disease. Even the concept of an image is changing, as multidimensional databases of genetic and patient information are expressed as progressions of color‐coded displays in order to facilitate their interpretation in response to questions about genetic variability and predictions of patient response to specific medications.Biomedicalimaging is one of the most dynamic and exciting fields of medical science, and is attracting some of the brightest and most creative scientists into its research laboratories in the United States and around the world.
A young scientist aspiring to a career in biomedical imaging is well advised to map out a career‐development lattice that will support both vertical and lateral growth as opportunities for advancement in knowledge and research arise. Individuals experienced in biomedical imaging and career development can be helpful in structuring this career lattice for the young scientist, and he/she should seek advice wherever it can be found. One opportunity for advice is the Meet the Expert” session on Imaging Physics Research presented at the 2006 Annual Meeting of the AAPM. This session will be orchestrated by Bill Hendee PhD, Distinguished Professor of Radiology, Radiation Oncology, Biophysics and Bioethics at the Medical College of Wisconsin in Milwaukee. Dr. Hendee earned the PhD in physics in 1962 from the University of Texas, and has held the following positions during his career in medical physics: Professor and Chair of Physics and Astronomy, Millsaps College; Director of the Division of Radiological Sciences and Professor and Chair of Radiology, University of Colorado; Vice President for Science, Technology and Public Health, American Medical Association; and Senior Associate Dean for Research, Dean of the Graduate School of Biomedical Sciences, and President of the MCW Research Foundation, Medical College of Wisconsin. Dr. Hendee is past‐president of the AAPM, Society of Nuclear Medicine, American Institute of Medical and Biological Engineers, and American Board of Radiology. He is editor of Medical Physics, and has published more than 350 peer‐reviewed articles.
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Medical imaging is big business — a multibillion dollar business, both for the manufacturers of medical imaging equipment and for health care providors. It plays an important role in diagnosis and in therapy. For these and other reasons medical imaging physics offers a number of highly satisfying career paths — clinical support in small to moderate sized medical centers, consulting clinical support, academic radiology positions, and positions in industry. For the past 30+ years, the career path an individual takes depends primarily on individual interest and capabilities and to a lesser extent on job availability. This session focuses on the responsibilities of the medical imagingphysicist in these different career paths. Presented are examples of different career paths. Discussed are the responsibilities that medical physicists typically have, minimum educational and experience requirements, and desirable skills and credentials.
This Meet the Expert Session will be moderated by Gary T. Barnes, Ph.D. Dr. Barnes has worked for more than thirty‐five years in medical imaging. His experience encompasses routine clinical support, radiology resident teaching, mentoring of young medical physicists, research, and prototype medical imaging equipment development. He is a Fellow of the AAPM, ACR and AIMBE, and is currently Professor Emeritus, Department of Radiology, UAB Medical Center, President of RAD Physics, Inc., a medical physics consulting company he founded in 1978, and President of X‐Ray Imaging Innovations, a technology development company he founded in 1998. For the fifteen years prior to his retirement from UAB and becoming Professor Emeritus, he was the Director of the Physics and Engineering Division of the Department of Radiology. The Division included medical physics faculty, medical imaging equipment service engineers, QC technologists and technicians, computer programmers, and other informatics specialists. At the time of his retirement the Division had twenty‐five members. Dr. Barnes is the author or coauthor of 100+ peer reviewed papers and has several issued U.S. patents.
- Practice Performance Improvement Introduction for Medical Physicists
34(2007); http://dx.doi.org/10.1118/1.2761507View Description Hide Description
Practice Performance Improvement is a key component for analyzing and improving the practice of medical physics. It is also an important component of the maintenance of Certification Process for physicists certified by the American Board of Radiology. In order to use Practice Performance Improvement effectively physicists should have training in the techniques available. This session will provide the necessary training. The session is structured as follows:
Practice Performance Improvement — Techniques and Methods.
Application of Practice Performance Improvement in Radiotherapy.
Examples of Practice Performance Improvement Projects from Diagnostic Radiology, Nuclear Medicine and Radiation Therapy.
- Support for Staffing and Assuring Quality in Radiation Oncology
34(2007); http://dx.doi.org/10.1118/1.2761553View Description Hide Description
Standards for commissioning and quality control of radiation therapy equipment have traditionally been established through the consensus of “experts”. The recently implemented Canadian approach to standards (medphys.ca) has broadened the expert panel to include the entire Canadian medical physics community through web‐based consultation. This process and the standards so developed will be discussed. A limitation is that while such standards developed to date in Canada and in many other jurisdictions undoubtedly have made major contributions to the safety and quality of radiation therapy, they could not be described as being evidence based. An approach to “evidence based” commissioning of a treatment planning system, in which the Equivalent Uniform Doses of targets and organs at risk are used as outcome surrogates, will be discussed. The resulting Quality Control Standards, whether using the novel Canadian approach or the more traditional AAPM Task Group approach, require a determinable amount of time that must be performed by medical physicists. Staffing at appropriate levels to accomplish these tasks is the focus of all activities in medical physics. Proper staffing is therefore crucial to patient care, and necessary to meet regulatory requirements. The results from the Abt study of medical physicist work values for radiationoncology physics services: round III may be used to justify personnel and defend staffing to administration for a number of venues of practice. A work model is created to allow the medical physicist to defend QMP work based on both routine and special procedures service mix. The model may be used to develop a cost‐justification report for setting charges for radiationoncology physics services.
1. Understand alternative options to develop Quality Control Standards for RadiationOncology Physics.
2. Understand what new information will be provided in the Abt III study.
3. Understand how to use the Abt studies to justify medical physicist work and staffing.