Volume 36, Issue 6, June 2009
Index of content:
- Professional Session: Room 211A
- Professional Proffered
36(2009); http://dx.doi.org/10.1118/1.3182505View Description Hide Description
Purpose: Significant controversy surrounds the 2012 / 2014 decision announced by the Trustees of the American Board of Radiology in October of 2007. According to the ABR, only medical physicists that are graduates of a CAMPEP‐accredited academic or residency program will be admitted for examination in the years 2012 and 2013. Only graduates of a CAMPEP —accredited residency program will be admitted for examination beginning in the year 2014. Method and Materials: An essential question facing the medical physics community is an estimation of supply and demand for medical physicists through the year 2020. To that end, a Supply/Demand model was created on STELLA software. Inputs into the model include the a) projected new cancer incidence 1990 – 2020, AAPM member ages and retirement projections 1990 – 2020, Number of ABR physics diplomates 1990 – 2008, Number of patients per Qualified Medical Physicist from Abt Reports I (1995), II (2002) and III (2008), non‐CAMPEP physicists trained 1990 – 2008 and projected through 2014, CAMPEP physicists trained 1993 – 2008, and working Qualified Medical Physicists in radiation oncology in the United States (1990 – 2007). Results: The model indicates that the number of qualified medical physicists working in radiation oncology required to meet demand in 2020 will be 200 per year. Because there is some elasticity in the workforce, some of the work effort might be assumed by practicing medical physicists. However the minimum number of new radiation oncologyphysicists required for the health of the profession is estimated to be 125 per year. Conclusion: The AAPM should plan to support a more rigorous supply/demand model and to build residency programs to support these numbers for the future of the profession.
36(2009); http://dx.doi.org/10.1118/1.3182506View Description Hide Description
Purpose: To evaluate use of Petri nets industrial system modeling tool for error pathway analysis and error prevention in radiation therapy (RT). Materials and Methods: Petri nets are a common and easily accessible tool for modeling state and event based systems. A Petri net includes “state‐like” objects and “event‐like” objects and the dependencies between the objects. The complete system is represented as a graph consisting of places (states) and transitions (state changes due to occurring events) that are connected by directed arcs. The places on the net can contain any number of mobile elements of the system, referred to as tokens. These tokens are moved from place to place by the “firing” of the transition representing an event in the system. A transition does not have to fire immediately when a token is added to an input place. It may instead have a deterministic or stochastic time delay. Petri nets with randomness in the transitions are called Stochastic Petri Nets. This representation would allow thorough analysis of the system activities. We designed a Petri net representation of our clinical workflow and represented events as transitions and cause for the events as the states. We have collected more than 1000 events through our electronic error reporting software and used Petri Nets to analyze the data. Results: We could identify the fault events and their propagation through the system. We could estimate the corresponding failure probabilities at different stages and their impact on the treatment process. In addition, we can investigate the effects of workflow alteration and patient load on the system performance, and identify optimal system design schemes. Conclusions: The proposed Petri Net approach can achieve early failure detection as well as facilitate event quantification. This can be used for the improvement of patient care and processes in RT.
36(2009); http://dx.doi.org/10.1118/1.3182507View Description Hide Description
Each year, Congress creates the federal budget, establishing the funding of the NIH and all other granting agencies. The federal budget works at a much finer degree of detail than most appreciate, regularly creating, resizing, and eliminating research grant programs of all sizes, such as specific NIH funding mechanisms. Congress also considers many non‐budgetary changes to medical and science policy throughout the year. Despite the importance of their work, Congress has little in‐house expertise in most areas. Therefore, for all aspects of federal policy and budgeting, Congress knowingly depends on the proactive and reactive involvement of its expert constituents.
This presentation will review the structure and realities of Congress from the perspective of a medical physicist who spent the last two years in physics policyfellowships on the Hill. Examples of recent years' continuing resolutions, omnibus budgets, emergency supplemental budgets, and policy changes will be used to illustrate how science has fared and why. Strategies medical physicists can use to help inform policy making will be presented. A full spectrum of opportunities for involvement will be discussed; that is, everything from sending an email to serving on a committee, from spending a few months in a policyfellowship to making a career change into policy or politics.
Historically, vocal individuals and small groups have had a great deal of success in informing and influencing Congress. Accordingly, the goal of this presentation is to inform medical physicists of the many ways they can advocate for the profession and the services it provides.
WE‐D‐211A‐04: About the Implementation of a Paperless Patient Chart System in Private and Hospital Based Radiation Medicine Departments36(2009); http://dx.doi.org/10.1118/1.3182508View Description Hide Description
Introdution: Many hospitals have made it one of their main goals to become paperless within the next couple of years. However, we are facing unique challenges in radiation medicine. Typical EMR systems are not suited as verify&record systems. In addition, most EMR systems are built with nurses and physicians in mind. However, in radiation medicine other healthcare professionals like radiation therapists, dosimetrists and physicists are also key players. As a result, a change management team at the department level needs to implement the paperless process in radiation medicine departments. I want to share the experience we gained during the process of doing so. Methods & Materials: Implementation of a paperless system requires good technical understanding and training. In addition, it requires a good understanding of workflow. The latter is also critical for the implementation of a quality management program. The paperless process was implemented in several phases. Initially, the change management team was small and consisted only of the chief therapist and physicist. Others were consulted and a dry run was started in treatment planning and with only a few patients. Workflow was closely monitored and then fine‐tuned. Training needs were identified and eventually the change management team involved all key players and the paperless process was fully implemented. Workflow for the entire department was mapped out in flowcharts. Results: Change needs to be implemented in phases, but going back to the “old” system must not be an option. Phasing in new processes will temporarily create certain disconnects and the change management team needs to address resulting problems immediately. Most departments will typically end‐up being “paperlight” initially. However, the advantages of transparent workflow and QA procedures result in self‐motivation, until the point is reached where the change management team can retire and the department owns the new processes.
36(2009); http://dx.doi.org/10.1118/1.3182509View Description Hide Description
Purpose: Workflow in the treatment planning section consists of repeat consults and updates between the CT‐Sim technologists, radiation oncologists,medical physicists,medicaldosimetrists, radiation therapists and scheduling personnel on the status of patients undergoing treatment planning. For a center with a number of medicaldosimetrists, radiation oncologists, and medical physicists, all have other responsibilities the interactions can be very chaotic. The eManagement is used to inform patient status so that untimely queries are reduced and only relevant personnel needed are informed to create efficient workflow. Methods and Materials: The eManagement is a task‐orient software capable of updating with categories of (a) open, (b) in‐progress, (c) completed, and (d) cancel tasks. Scripts are written to define tasks associated with the treatment planning workflow. For example, an open task on “MD clinical intent” means that the attending physician is required to provide the dose directives and prescription. Once the attending physician completes the prescription in the ARIA/Eclipse database, the task is changed to complete informing the medicaldosimetrist of the status on this particular patient allowing him/her to proceed with the next task. An advantage of eManagement is the attending physician can complete this task in any place without physically going to the treatment planning section. A few scripts being implemented are “CT image dataset for TPS”, “MD clinical intent”, “MD contours”, “IMRT QA Measurements”, and “Post Chart after IMRT QA”. Results: The outcome will be (a) reduction of untimely queries, (b) only relevant personnel needs to respond for timely processing, (c) completion of task can be perform in any place within the department, (d) time reduction in creating individualized treatment plans. Conclusion: The implementation of the eManagement software should improve workflow in the treatment planning section reducing patient simulation time resulting in quicker initiation of patient treatment.
36(2009); http://dx.doi.org/10.1118/1.3182510View Description Hide Description
Purpose: The purpose of this study is to examine the trends of radiation exposure among medical professionals in Canada, and identify professional groups where radiation protection measures need to be enhanced. Method and Materials: The Canadian National Dose Registry contains dose records of people who are monitored for occupational exposures to ionizing radiation. In the Registry, the medicine job sector is further divided into 18 professional categories. The average annual doses by job category were calculated for 12 years from 1994 to 2005. Trends of average annual doses for each of these 18 categories in the medical sector were studied. Results: The average annual dose for the medical sector has remained almost unchanged during the 12 year period, 0.09 ± 0.02 mSv. However, among the 18 job categories, average annual doses decreased for some professional groups and increased for others. Significant increases in annual radiationdose were observed for dental therapists, medical laboratory technicians, radiologists and nuclear medical technologists. Conclusion: The average annual radiationdoses for medical professionals in certain job categories have increased significantly from 1994 to 2005, while the doses for radiation workers in nuclear power industries and underground mines have decreased significantly. Therefore occupational radiation protection in the medical sector should be considered as an important area for potential improvement.
36(2009); http://dx.doi.org/10.1118/1.3182511View Description Hide Description
The American College of Medical Physics and the AAPM recently co‐sponsored an all day workshop on Response to Radiation Incidents. The talks included information on the federal response framework as well as how medical physicists could become involved through organizations such as the Medical Reserve Corps (MRC). Within the Florida MRC, a section known as the Radiation Response Volunteer Corps (RRVC) was formed. The Florida AAPM and FL Health Physics Society chapters participated in training in June 2008. The RRVC was designed specifically for medical and health physicists.Information on the MRC and RRVC were presented at the workshop. In the afternoon, staff from the Radiation Emergency Assistance Center and Training Site (REAC/TS) conducted a realistic demonstration of patient decontamination procedures. All participants received a toolkit with valuable training tools.
36(2009); http://dx.doi.org/10.1118/1.3182512View Description Hide Description
In December 2007, the International Commission on Radiological Protection (ICRP) published revised and updated recommendations for radiation protection as ICRP Publication 103. The Nuclear Regulatory Commission (NRC) staff engaged in a comparative review of the NRC Standards for Protection Against Ionizing Radiation, 10 CFR Part 20, and other NRC regulations, with ICRP Publication 103, and provided the Commission with recommendations for next steps in December, 2008. The Commission has approved the staff recommendation to seek early engagement with stakeholders and interested parties on the technical and regulatory issues and options for potential changes to the agency's radiation protection regulations, to achieve greater alignment between the regulations and ICRP Publication 103. The NRC staff is particularly interested in understanding the perspectives of different organizations and groups on the benefits, burdens, and impacts of possible options for change. The NRC staff has not made any decisions on particular positions or changes at this time. This presentation provides background on the current regulatory framework, the contents of the 2007 ICRP recommendations, the status of international standards updates, and describes issues identified by NRC staff as initial key topics for discussion with stakeholders on options and necessary technical information for possible future rulemaking. These issues include the occupational dose limits, the application of constraints to the optimization process, and updates of the scientific information and models supporting dose assessment and compliance.
36(2009); http://dx.doi.org/10.1118/1.3182513View Description Hide Description
Efforts to better define the occupational risks associated with working in a fluoroscopic laboratory led to the formation of the Multi‐Specialty Occupational Health Group (MSOHG). The main goal of this group is to clarify the magnitude and impact of the occupational health concerns of the cardiologists, radiologists, and surgeons working with fluoroscopy; pain management specialists performing nonvascular fluoroscopic procedures; and the many support personnel working in interventional laboratory work environment. This paper will briefly review the physical stresses inherent in this career choice appear to be associated with a predisposition to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight and design of personal protective apparel worn to reduce radiation risk, and to the poor ergonomic design of interventional suites.