Index of content:
Volume 35, Issue 6, June 2008
- Professional Course Series: Room 350
- Civil Law, Ethics and the Medical Physicist
35(2008); http://dx.doi.org/10.1118/1.2962568View Description Hide Description
The practice of Medical Physics requires adherence to both ethical conduct and legal rules when dealing with issues arising in one's professional life. The purpose of this lecture is to discuss and distinguish the fine line between what is considered ethical as opposed to legal. Examples of ethical conduct and legal actions are provided and the ramification of the lack of distinction between the two is discussed. Emphasis is placed on the ethical and legal responsibilities of the medical physicists in delivering health care.
35(2008); http://dx.doi.org/10.1118/1.2962569View Description Hide Description
Ethics Case Reports.
Questionable ethical behavior may or may not also entail questionable lawful behavior. Several case reports are presented to differentiate legal and ethical issues. There is often an overlap of ethical and legal boundaries; so many situations may have both legal and ethical implications. The ramifications of legal vs. ethical violations are obviously different. Hypothetical case reports will include: hostile work environment, sexual harassment, graduate student progress impediments, substance abuse, and questionable practice.
- Clinical Practice and Professional Services Activities
35(2008); http://dx.doi.org/10.1118/1.2962429View Description Hide Description
This review task was initiated under the direction of the Clinical Practice Committee of the Professional Council of the AAPM. Some of the Task Group (TG) reports published by the AAPM present a wide range of comprehensive performance tests or QA processes for a particular radiological modality or procedure. Limited by available resources and given the range of clinical uses, full‐time clinical physicists of many medium and small centers often find it difficult to determine the minimum subset of a complete TG report to follow to ensure consistent high quality of patient care and procedure maintenance. Furthermore, state regulators have, in some instances, unfortunately adopted entire sections of TG reports as regulatory requirements despite the clarification in all TG reports that such use would be inappropriate. Therefore, Minimum Practice Recommendations (MPR) should be established and be charged by the new Practice Guideline Subcommittee. The MPRs are intended to provide the AAPM members with a set of requirements for a basic standard of medical physics practice that AAPM would consider necessary in all sizes of clinical practice sites. These MPRs are not designed to replace extensive clinical practice guidelines, TG reports or review articles, but rather to describe minimum common standards. The establishment of MPRs is an important expression of AAPM's mission to disseminate knowledge, in order to maintain a high common standard in medical physics practice. The Subcommittee is charged with reviewing TG reports prior to publication, and determining which reports would benefit from an accompanying Implementation Guideline.
1. Understand the benefits of reviewing TG reports by the Professional Council.
2. Understand the concept of Minimum Practice Recommendation (MPR).
3. Understand the guidelines and issues related to the establishment of MPR.
35(2008); http://dx.doi.org/10.1118/1.2962430View Description Hide Description
The Professional Services Committee (PROFS) is a relatively new node in the AAPM's Committee Tree, created by gathering together some previously free‐floating entities that all have in common that they represent services to the membership in nominal support of professional practice. These include the newsletter, insurance, the Placement Service, and the Professional (salary) Survey. In addition, PROFS also serves as a home for some critical infrastructure including subcommittees charged with gathering workforce statistics and with validating the results of the Professional Survey.
PROFS is the right platform for addition of new member‐directed services to the membership in support of professional practice. The last three bullets in the current Rules describing the charge of PROFS are.
• Create and operate a career services booth at the Association annual meeting.
• Educate the membership on issues related to practice development and business management support.
• Offer programs and services of value to the membership that support the careers of medical physicists, such as malpractice insurance, legal and contractual guidance, business education, employment counseling, marketing techniques and compensation negotiation.
We're currently underachieving at most of this, and both Vice Chair Mark Davidson and I are anxious to try to fill some of the void with your help. In this presentation I'll briefly review the structure of PROFS and the work of the current subcommittees. But I'll move pretty quickly to the question of what PROFS can be and what our priorities ought to be in the coming year, and will solicit audience feedback about that.
It should be no surprise that an overarching theme of my presentation will be that if you want help from the AAPM, you've got to volunteer to be part of the effort. Requests from members for new services from subcommittees or task groups in PROFS are always welcome, and the potential for funding of new projects is high, but a suggestion is way more likely to be implemented if the request is accompanied by a draft charge and a list of 6 willing and enthusiastic volunteer members.
35(2008); http://dx.doi.org/10.1118/1.2962431View Description Hide Description
To ensure that qualified individuals perform the job of clinical Medical Physics as outlined in the AAPM/ACMP Scope of practice. This is seen as important with or without the passage of the CARE Bill. The existence of the CARE Bill gives us the impetus to do this work. If we do not help the legislators define who is qualified to do our jobs, someone else will.
In this session the activities of the Joint Medical Physics Licensure Subcommittee will be discussed. Topics will range from the rationale for the effort, the new full time position at HQ to help with the effort, the status of licensure efforts, and future goals and plans. In addition, the implications for the clinical practice of medical physics if it became law in more states will be explored.
1. Be exposed to the rationale behind the effort for professional licensure.
2. Understand what has been accomplished related to this effort.
3. Hear what the near and long term goals are for the effort.
35(2008); http://dx.doi.org/10.1118/1.2962432View Description Hide Description
The Consistency, Accuracy, Responsibility, and Excellence in Medical Imaging and Radiation Therapy (CARE bill) was first introduced in the 106th Congress on September 26, 2000. Since that time, it has been introduced in all subsequent Congressional sessions including the current 110th Congress. The bills are now co‐sponsored by 122 US Representatives and 22 US Senators. The CARE bill directs the Secretary of Health and Human Services to establish education and credentialing standards for all persons performing medical imaging, planning, and deliveringradiation therapy. Each individual State will be responsible for developing procedures to insure compliance with the federal regulations. The origin, history, and importance of the CARE bills will be discussed as well as AAPM's involvement with the Alliance in this legislative effort. Political realities that have been encountered during this process will be reviewed and suggested actions that members can take to help the CARE bill become law will be presented. Additional effort by the AAPM, the Alliance, and individual members after the CARE bill passage will be also be identified and discussed.
1. Understand basic differences between certification, credentialing, registration, and licensure.
2. Understand the CARE bill and its importance to medical physicists.
3. Understand the current status of the CARE bill and actions that can be taken to help passage by Congress.
4. Understand the subsequent actions by members that will be required on a State government level.
- Current Issues in Economics
35(2008); http://dx.doi.org/10.1118/1.2962377View Description Hide Description
Most new technology is launched without dedicated codes, coverage, or payment. It takes time, data, and a significant effort to garner new codes, influence coverage policies and drive appropriate payment. The talk will focus on new technology coding, coverage and payment through the Medicare Fee Schedule and the Hospital Outpatient Prospective Payment System. It will discuss the process for CPT application, how codes are valued by the Relative Value Update Committee (RUC) for physician work and non‐physician clinical labor (including physics and dosimetry work) and equipment. The talk will also touch upon supervision requirements for SBRT and IGRT.
1. Understand the process for CPT applications.
2. Introduction to how new codes are valued.
3. Work and supervision requirements for SBRT and IGRT.
35(2008); http://dx.doi.org/10.1118/1.2962378View Description Hide Description
In October 2005, the Board of the Directors of the American Society for Therapeutic Radiology and Oncology (ASTRO) acted to create an Emerging Technology Committee (ETC). The mission of the Committee is:
To provide a proactive resource for all stakeholders: ASTRO members and staff, industry, commercial payers, healthcare organizations, and government, in the application and integration of new and emerging technologies into the practice of radiation oncology.
The Committee was formed in clear recognition of the critical role played by new and emerging technologies and procedures in the practice of Radiation Oncology, the responsibility of the Society in development of clinically and evidence‐based policy regarding those technologies and procedures, and a determination that the four ASTRO Councils should have a more clear and coherent roadmap regarding new technologies and procedures for their individual policy decision‐making and programming.
A significant amount of time and effort was spent in development of policies and procedures necessary to enable smooth and consistent function of the new Committee and that would, to the greatest extent possible, avoid conflict and risk to the Society from Committee actions.
Since its implementation, the Committee has initiated six projects for technology and/or procedure evaluation. These projects are:
• Dose escalation and normal tissue protection in prostate cancer.
• Electronic brachytherapy.
• Interactive localization and tracking devices.
• Proton beam radiation therapy.
• Stereotactic body radiation therapy for prostate cancer.
• Stereotactic body radiation therapy for non‐small cell lungcancer.
The status and results of these projects will be presented in detail, as will an overview of Committee procedures.
35(2008); http://dx.doi.org/10.1118/1.2962379View Description Hide Description
The Abt study of medical physicist work values for radiationoncology physics services, Round III is completed and was published in May of 2008. It supersedes the Abt II study of 2003. The 2008 Abt study measured qualified medical physicist (QMP) work associated with routine radiationoncology procedures as well as some special procedures. In the intervening years between Abt II and Abt III, medical physics practice has changed. Image‐guidedradiation therapy and image‐guidedstereotactic radiosurgery along with respiratory gating are emerging radiationoncology technologies. High dose rate afterloading brachytherapy is an important special procedure with a significant component of medical physicist work. These procedures emphasized the need for an updated work and staffing study for qualified medical physicists. As before, a work model was created to allow the medical physicist to defend QMP work based on both routine and special procedures service mix. The work model can be used to develop a cost justification report for setting charges for radiationoncology physics services. Additionally, staffing patterns were surveyed and reported for a variety of practice settings. The work and cost justification models may in turn be used to defend medical physicist staffing and compensation. The Abt study round III was designed to empower the medical physicist to negotiate a service or employment contract with providers based on measured national QMP work force and staffing data.
1. Understand the information documented in the Abt studies.
2. Understand what new information was provided in the Abt III study.
3. Understand how to use the Abt studies to justify medical physicist work and staffing
- MOC: The ABR Perspective
35(2008); http://dx.doi.org/10.1118/1.2962729View Description Hide Description
This course will review that status of the various aspects of accreditation by the American Board of Radiology. There have been a number of important changes in the process. Among the topics covered will be: 1) Changes in the requirements for the primary certificate for medical physicists. This section will discuss the changes that will require training in a CAMPEP approved program in 2012 and a residency by 2014; 2) Status of MOC. This section will review the current status of the MOC program and requirements; 3) Changes in the physics requirements for radiation oncologists and radiologists. There are significant changes in examination process for radiation oncologists and radiologists. This will require changes in the physics education of these groups. Radiation oncologists and radiologists in the MOC process will be tested on physics; 4) A report on the activities of TG 127: MOC will be presented.
- New Member Symposium/Meet the Experts
35(2008); http://dx.doi.org/10.1118/1.2962629View Description Hide Description
The New Members Symposium will provide an introduction to the AAPM, our current officers, council chairs and operations. 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
35(2008); http://dx.doi.org/10.1118/1.2962630View Description Hide Description
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.
35(2008); http://dx.doi.org/10.1118/1.2962631View Description Hide Description
It is a privilege to be a medical physicist. Few professions can match medical physics in the depth of intellectual challenge, the opportunity for technology development, and the prerogative of improving the care of patients singly and collectively through applications of physics. To exercise this privilege while making a decent living is a personal benefit that we all share. But with it comes a responsibility to advance the state of knowledge in medical physics, nurture young physicists entering the field, engage in clinical practice with the patients' welfare foremost in mind, and relate to physicists, other healthcare providers, patients and the public with forthrightness and integrity.
For the past 30 years, medical imaging has been experiencing a massive expansion in technology and applications. This expansion is continuing, with new horizons to conquer such as molecular imaging, quantitative imaging,imaging in multiple dimensions (4D, 5D, etc), image‐guided adaptive therapy, multi‐modality imaging platforms, and many others. This expansion is a major opportunity for medical physicists, whose many roles include ensuring that what is presented in images reflects conditions in the patient and not in the imaging system. To respond to this opportunity, medical physicists always must remain open to new knowledge and new ways of thinking, and must commit to a lifetime of study and learning that will keep them productively engaged in the discipline and its contributions to advancing knowledge, mentoring students, and caring for patients.
Usually financial support is needed to conduct research in medical physics. There are several possible sources of support, including institutional funds, industry contracts and government grants. Each of these sources has benefits and limitations, which will be discussed in this session. To facilitate this discussion, copies of a recent publication will be provided (A. Wolbarst and W. Hendee, The National Institute of Biomedical Imaging and Bioengineering and NIH Grant Process: An Overview: Radiology 2007; 242: 32–55). This publication is intended as guidance for the young investigator submitting a first application to one of the institutes of the National Institutes of Health.
This session will encourage questions and discussion among participants, and will be led by William Hendee. Dr. Hendee has over 40 years of experience in medical physics, including Professor and Director of the Division of Radiological Sciences of the University of Colorado Department of Radiology; Professor and Chair of the Department of Radiology at the University of Colorado; Vice President of the American Medical Association and Executive Secretary of the AMA Council of Scientific Affairs; and Professor and Vice Chair of Radiology, Dean of the Graduate School of Biomedical Sciences, Senior Associate Dean for Research, Acting Dean of the Medical School, and President of the Research Foundation at the Medical College of Wisconsin. Currently Dr. Hendee is Distinguished Professor of Radiology, Radiation Oncology,Biophysics, and Community and Public Health at the Medical College of Wisconsin, Professor of Biomedical Engineering at Marquette University, Adjunct Professor of Electrical Engineering at the University of Wisconsin‐Milwaukee, and Clinical Professor of Radiology at the University of New Mexico. Dr Hendee serves as editor of Medical Physics.
35(2008); http://dx.doi.org/10.1118/1.2962632View Description Hide Description
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 currently serves as Lead CyberKnife Physicist with the South Texas RadioSurgery Associantion 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.
35(2008); http://dx.doi.org/10.1118/1.2962633View Description Hide Description
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 the discussion 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 requested budget increases), but typically has a maximum funding period of 5 years (with a 1–2 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 implementation 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.
- Professional Comportment: Professional Is As Professional Does
35(2008); http://dx.doi.org/10.1118/1.2962338View Description Hide Description
Medical Physics is an odd specialty in the constellation of healthcare providers and allied health professionals. We hold the distinction of being the only exclusively non‐physician specialty that is certified by a Medical Specialty Board in the US, consistent with our unique role as independent thinkers in the clinical decision‐making and provision of care. At the same time, there has been more of an ingathering than a pathway for those entering the field, and our education and training has been, to be kind, systematically ad hoc. Many if not most of us spend our education and training years communing closely with machinery into the wee hours and spend precious little business‐hour time in a clinic learning under the wing of professional role models how to act, and how to interact in the healthcare workplace. We largely enter practice with nowhere near adequate preparation or “people skills” to take on the leadership role that our work demands.
Sometimes we act badly.
In this session we will explore several aspects of what it means to comport oneself professionally. Certainly it means to do one's technical work independently with a degree of craftsmanship and skill, cognizant of the impact that each decision has on patients who rely on our services. It means treating our colleagues and co‐workers with respect, no doubt. But beyond that, the perception of an individual as a professional — and by extension, of Medical Physics as a profession rather than a trade — hinges on those nebulous‐seeming skills of leadership and sagacity that seem to be the very antithesis of the analytic skills we learned in school.
Respect in the workplace as a professional is not an object that comes wrapped in a diploma or certificate, nor is it the least bit determined by Medicare reimbursement policy. Professional stature is something that we each build or fail to build for ourselves every day by the way we act toward other people. Professionalism is political, not analytical.
We've assembled a distinguished panel to speak to the topic of professional comportment from a variety of perspectives and will be providing ample time for questions and comments from the audience.
James Purdy, PhD is Professor and Vice Chair in the Department of Radiation Oncology at the University of California, Davis Medical Center, where he has been since 2004. Prior to that he spent 31 years at Washington University School of Medicine in St. Louis where he rose to the rank of Professor and served as both Director of the Radiation Physics Division and Associate Director of the Mallinckrodt Institute of Radiology's Radiation Oncology Center. Dr. Purdy is a Fellow of the AAPM, ACMP, and ACR, and was one of the inaugural group selected to become an ASTRO Fellow in 2006. He was recipient of the 1996 ACMP Marvin M.D. Williams Professional Achievement Award and the 1997 AAPM William D. Coolidge Award. He was awarded the 2000 ASTRO GoldMedal and the 2002 ACR GoldMedal. He will share with us some about his long professional experience working effectively as a Medical Physicist within the medical establishment.
Peggy Landrum, PhD, RN is Associate Clinical Professor in College of Nursing at Texas Woman's University where she participates in the training of health care professionals. She is, among other distinctions, a trainer in a technique called “Motivational Interviewing” (MI) which is a formal approach to working with people to resolve their ambivalence about making behavioral changes that they know are good for them but they resist nonetheless. MI is a useful technique for providers in many healthcare settings such as psychotherapy, substance abuse therapy, medical management compliance, etc. and can also have a role in the workplace as a tool of change agency.
Sam Keen, PhD, ThM is a freelance thinker, lecturer, seminar leader, consultant, and author. His career has included decades in academia teaching Philosophy and Religion, as well as 20 years as a Contributing Editor of Psychology Today. He is distinguished by having been a sage of the “Men's Movement” who brought a great deal of value to that moment's zeitgeist without making it a career. His work is about asking the questions, and he is pleased to note that he has been an amateur at everything he has done professionally. He has taken some interest over time in the question of what it means to be “professional,” particularly in healthcare. That in addition to the constant question of what it means to live a human life fully.
George W. Sherouse, PhD, is President and Chief Medical Physicist of Sherouse Systems, Inc., a North Carolina based boutique Medical Physics service company. He is a popular lecturer and contributor to the public discourse, speaking frequently on the important distinction between “gadfly” and “curmudgeon.” He strives to comport himself professionally and has learned much from many failures.
- Quality in Radiation Therapy: What Is It and How Do You Achieve It?
35(2008); http://dx.doi.org/10.1118/1.2962683View Description Hide Description
The context for this symposium will be set by reviewing the definitions of the often confusing terminology used in the discussion of quality related issues. A brief overview of some of the modern approaches to quality improvement, such as Lean, 6σ, and total quality management will follow (TP). An obvious pre‐requisite of quality in any clinical program is safety. ROSIS (Radiation OncologySafety Information System) has been in existence for 5 years as a structured database tool for sharing information on clinical incidents and near misses. The development of the system, its current use and plans for expansion will be described (TK). For accreditation purposes, it is no longer sufficient to only have documentation that a quality clinical program is in place. It is clearly necessary to demonstrate quality through compliance with appropriate standards. The design and implementation of peer review quality audits will be discussed (PH). The relative importance of the different dimensions of quality depends on the perspective. A patient's assessment of the quality of a clinical program could be quite different from a physicist's assessment of the same program. A regulator's assessment may be different again. The important dimensions of quality from a regulator's view point will be presented (RZ). The essential clinical role of the medical physicist is to maintain and then to enhance quality. Fulfilling either role is particularly challenging in a technologically sophisticated and constantly changing clinical environment. The safe and effective implementation of Image Guided Radiation Therapy, as a quality improvement measure, will be described (J‐PB). The maintenance and enhancement of quality costs money — a commodity that, in most jurisdictions, is in short supply. Practicing evidence based medicine is the favoured medical approach to containing costs. The final presentation in the session will consider the possibility of evidence based quality assurance (PD). The symposium will include ample time for discussion.