Index of content:
Volume 36, Issue 6, June 2009
- Professional Symposium: Room 211A
- Economics Update
36(2009); http://dx.doi.org/10.1118/1.3182653View Description Hide Description
As health care costs continue to escalate and reimbursements rates tighten, medical physicists must be prepared to demonstrate their economic value as well as their clinical value. This talk will review the major reimbursement processes that exist and the fundamental differences in how payment rates are established for hospital outpatient departments, free standing facilities and physicians. The CPT® coding system will be reviewed with special emphasis on the Continuing Medical Physics Consultation code 77336 and the Special Medical Radiation Physics Consultation code 77370. Proper reporting documentation will be discussed. Sources of information on reimbursement and coding will be identified. Finally, current activities of the AAPM Professional Economic Committee will be highlighted.
1. To understand the major reimbursement systems and how payment rates are established
2. To understand the CPT® coding system and the need for proper documentation in the clinic
3. To identify authoritative sources of reimbursement and coding information
4. To learn about AAPM PEC activities and how they benefit the membership
36(2009); http://dx.doi.org/10.1118/1.3182654View Description Hide Description
In the last year or two, new procedures in radiationoncology have become more common and issues surrounding their reimbursement have surfaced at the same time. The procedures of Stereotactic RadioSurgery(SRS) and Stereotactic Body Radiation Therapy(SBRT) have now been recognized by most carriers as bonafide procedures to treat some cancers for their beneficiaries. With IMRT, these new procedures make liberal use of Image Guided Radiation Therapy (IGRT) to insure that the target tumors at the focus of these procedures are being treated precisely and accurately.
Because these new procedures involve planning and delivering large doses in a few fractions (hypofractionation), it is imperative that the radiationoncologist and medical physicist are “present” at each treatment fraction. The increase in complexity and treatment times for these procedures further insist on these presence requirements. Frequent imaging before and during treatment delivery require feedback from the radiationoncologist and medical physicist for accurate localization of the targets. Patients have the potential of injury if they are not supervised in the treatment delivery and there is greater onus on the treatingRadiation Therapist to understand all of the mechanisms involved in these more complex delivery schemes. Unlike the presence requirements for HDR procedures which are rooted in a regulatory requirement (NRC and State agencies), the presence requirements for SRS/SBRT are rooted in the reimbursement values for these procedures with professional and technical times for the radiationoncologist and medical physicist.
Another area that has surfaced recently for activities of the medical physicist is in the fusion of image data sets to the base CT planning images used for treatment planning — not only for SRS/SBRT, but for IMRT and Conventional 3D where these image sets are utilized. Magnetic Resonance Imaging (MRI) is the most common image set one thinks of in fusing to the CT planning data set and has been used historically in cranial target RT. Other “foreign” image sets are coming to the fore also. These are PET and PET/CT data sets as well as Ultrasound and even, arteriograms. If these are DICOM compatible, most can be fused with the primary CT data set if the planning software is set up to accept these image sets. CPT 77370, Special Physics Consult is the primary CPT code used to cover this work, as the medical physicist (or dosimetrist under the supervision of the medical physicist) is primarily responsible for evaluating the goodness of anatomic fusion of these image sets to the primary CT data set. As with any work performed under CPT 77370, the request for fusion must come from the radiationoncologist in a signed/dated requisition and the medical physicist will generate a report back to the radiationoncologist referring to the congruence between the two image sets for a particular patient study. The report is signed/dated by the medical physicist, again, as with any
- New Member Symposium/Meet the Experts
36(2009); http://dx.doi.org/10.1118/1.3182403View Description Hide Description
No matter how well you've done in school and training getting your first job will be a job unto itself. Most young applicants mistakenly believe that job applications and interviews are for their own benefit. Not true! Applying for a job is about what you can do for me, not what I can do for you. Your goals are to make me like you, convince me that you're competent and hard working, and that hiring you will be good for me and the company that I work for. Thus, your goals ‘to get lots of clinical experience and pass your boards’ doesn't help me. If I hire you then I'm goi>g to pay you a salary, not vice versa, so make me want to hire you.
The job market is tight, and you'll have competition, so don't begin the process by wasting my time. Don't call me on the phone unless the advertisement clearly invites it. Don't ‘pad’ your resume or cover letter with irrelevent material making it hard for me to read. Prepare them both carefully. Include all the basic information I need but little more. Account for all time since high school and leave no gaps. Include you citizenship and visa information, plus list of references and publications. If I have trouble deciphering your resume then you've made extra work for me before before I've even hired you! Poorly organized resumes and cover letters containing spelling and gramatical errors immediate raise doubts about how carefully you can do your job. Similarly, letters addressed ‘Dear Sir’, ‘To Whom it may concern’, or with my name spelled incorrectly belie a degree of carelessness that prejudices your application.
Use Google, Pubmed, etc. to learn as much as you can about the people and institution you're applying to. Indicate that you know something about who and what you're applying to. If you're invited for an interview show up on time, well prepared, neatly and conservatively dressed. Don't express radical political opinions or tell me why your current boss, teacher, or school, is unbearable. Nobody wants to hire a chronic malcontent! Anticipate and be prepared to answer tough questions. If you're asked to give a seminar practice your delivery and seek advice first from your mentors. Be truthful in your correspondence and during your interview. Medical Physics is a small community. People interviewing you will likely know your references and things you write or say are easily checked, so don't get caught in a lie.
When you're lucky enough to get that first job, unless there are unusually horrific circumstances stay there for at least 3 years . As hard as it is to get that first job, it will be even more difficult to find a job later in your career if you've made a reputation for yourself as a frequent job changer or trouble maker.
1. Applicants will learn strategies for preparing an effective resume and job application
2. Applicants will learn strategies for preparing for an interview and seminar
36(2009); http://dx.doi.org/10.1118/1.3182404View Description Hide Description
A time of challenges is a time of opportunities, especially for young people in a discipline. Never have there been more opportunities for young medical physicists. The technologies of imaging, intervention and treatment are expanding at an unprecedented rate. The same technologies are being targeted as examples of technology overutilization and excessive costs in the healthcare system. Scientists are encouraged to be more entrepreneurial in their research so that the economic competitiveness of the nation is enhanced. Physicians are demanding that medical physicists be better teachers, and graduate students are looking for mentors in medical physics. Young medical physicists have the potential to address all of these opportunities, but first they have to identify their own particular interests, talents and needs as medical physicists.
1. Appreciate the challenges of technology evolution in health care.
2. Understand how these challenges present opportunities for medical physicists.
3. Identify the knowledge and skills that enable medical physicists to respond to technology opportunities.
4. Project how these knowledge and skills can support career development of medical physicists.
36(2009); http://dx.doi.org/10.1118/1.3182405View Description Hide Description
Medical imaging is big business — a multibillion dollar business, both for the manufacturers of medical imaging equipment and for health care providers. 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.
36(2009); http://dx.doi.org/10.1118/1.3182406View 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 scopes of such grants 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 and Dr. James Deye, Ph.D. of the National Institutes of Health.
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 four additional R01s and an R21 and has coauthored more than 125 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.
Dr. Deye is a program director in the National Cancer Institute of the National Institutes of Health. Dr. Deye is responsible for developing funding priorities for the NCI as well as directing and overseeing major NCI grant initiatives. Dr. Deye will bring his extensive expertise in grant development and management as well as advice on the directions and changes in the NIH peer review process and scientific emphasis.
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
36(2009); http://dx.doi.org/10.1118/1.3182407View 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 former Chair of AAPM's Professional Economics Committee and most recent clinical interest is in developing the CyberKnife SBRT treatment modality for cancer therapy. He holds a basic patent in this technology.
On completing the session on Meet the Experts, The Practice of Clinical Therapy Medical Physics, the attendee will:
1. Be able to identify the procedures in Clinical Therapy Medical Physics that are germane to the Practice
2. Be able to describe the interactions between the Medical Physicist and the Radiation Oncology team members
3. Be versed in the method of reimbursement currently available for the Medical Physicist in Clinical Therapy Medical Physics
4. Be able to identify the specific quality assurance procedures that the Medical Physicist must know in the Practice of Clinical Therapy Medical Physics
5. Be able to identify the spectrum of activities the Clinical Therapy Medical Physicist may be called on to perform in the Radiation Oncology Department
- Professional Doctor of Medical Physics
36(2009); http://dx.doi.org/10.1118/1.3182246View Description Hide Description
There has been and continues to be a dynamic dialogue concerning the establishment of a professional doctorate in medical physics (DMP). The AAPM created a working group in the spring of 2008 tasked with assessing the impact of a DMP degree on the education, research, and clinical practice of medical physics. This working group submitted their report to the AAPM Board of Directors the summer of 2008 outlining many of the potential ramifications the DMP may have on the profession of medical physics. Among the implications to be considered if the DMP degree becomes a reality are: impact on existing Masters medical physics programs; impact on Ph.D. medical physics programs; impact on post‐doctoral programs; impact on the quality of patient care; impact on medical physics residency programs; and the impact on the professional standing of medical physics. Since 2008 some academic institutions have or are in the process of creating DMP graduate programs. This potential new pathway toward a career in medical physics will also impact credentialing organizations such as CAMPEP (Commission of Accreditation of Medical PhysicsEducation Programs) and the ABR (American Board of Radiology).
- Recap the 2008 Physics Teachers Workshop
36(2009); http://dx.doi.org/10.1118/1.3182318View Description Hide Description
Every medical physicist is a teacher, either formally in the classroom or informally in the clinic. Some physicists skillfully fulfill their educational obligations, while others struggle with their teaching responsibilities. However, everyone can be a good teacher — what are required are determination, dedication and diligence. This objective was the focus of a 3‐day AAPM Educational Summit held immediately after the 2008 AAPM annual meeting in Houston. It will also be the goal of a second Educational Summit scheduled to follow the 2010 annual meeting in Philadelphia. Discussion of the outcomes of the 2008 Educational Summit, and plans for the 2010 Summit, are the topics of this educational session scheduled for the 2009 annual meeting. This session will include solicitation of suggestions from the audience for the 2010 Educational Summit.
- Regulatory Update
36(2009); http://dx.doi.org/10.1118/1.3182364View Description Hide Description
As the lead U.S. regulatory agency for civilian uses of radioactive material, the United States Nuclear Regulatory Commission (USNRC) plays a key role in domestic and international security activities. The events of September 11, 2001 highlighted the need to enhance security to address potential terrorist threats. The USNRC took numerous immediate actions to enhance materials security and also initiated broader programs, designed to improve security in a comprehensive manner over the long‐term.
As with its other regulatory programs, USNRC utilized a risk‐informed, graded approach to enhance security. Consistent with the risk‐informed approach, it was necessary to categorize radioactive sources and materials according to risk. USNRC cooperated with other domestic organizations and the International Atomic Energy Agency (IAEA) in revising and adopting the security principles and source categories in the IAEA Code of Conduct. The highest risk sources were designated as Category 1 and 2. Based on these categories, USNRC then developed and issued enhanced security requirements to the U.S. licensees who possess Category 1 and 2 radioactive sources.
In parallel with these efforts, USNRC worked with other organizations to improve the overall nuclear security infrastructure. The U.S. Congress passed the Energy Policy Act of 2005, which created the Radiation Source Security and Protection Task Force. This Task Force is chaired by USNRC and is composed of representatives from 13 Federal agencies and 2 States. It is a primary vehicle for advancing source security issues across the U.S. government. This presentation describes an important element of the security infrastructure, the National SourceTracking System (NSTS). The system was launched in late 2008 after several years of development. The NSTS maintains an inventory of all Category 1 and 2 sources in the U.S. Licensees are required to maintain their inventory data and report transfers online. This enhances security by allowing close tracking of the locations of sources, and identifying possible unauthorized transfers. For the future, USNRC plans to integrate the NSTS into a broader electronic license verification system so that questions about sources and license authorization can be quickly resolved.
This presentation will focus on the following topics regarding tracking Category 1 and 2 sealed sources with the National SourceTracking System:
1. Deployment and Implementation of NSTS
2. Experience with NSTS
3. Credentialing Process for Access to NSTS
4. Potential Expansion of the System
5. User Feedback
36(2009); http://dx.doi.org/10.1118/1.3182365View Description Hide Description
Dynamic change is occurring at a rapid pace in both the medical and regulatory communities. Some of the impacts from these changes include new diagnostic and therapeutic modalities and increased attention to source security and the impact on the way medical physicists conduct their business in medical facilities across the nation. This presentation will address three pressing issues of interest to the medical physicists. The first is the attention to improving the security of radioactive material due to regulatory enhancement. Medical physicists will be informed about activities that are in progress to assist these facilities with improving the security of radioactive material used in medicine. The second topic will be the status of the suggested rule development process within CRCPD highlighting changes in regulations in Healing Arts, Radioisotopes in Medicine,Radiation Therapy and Credentialing of Qualified Medical Users. The last category is the progress made by the regulatory community to develop a standardized protocol for inspection CR/DR imaging equipment.
This is an informational sharing topic that will allow the attendee to understand the complexity and direction the regulatory community is taking to address these varied topics and understand the impact these regulatory decisions will have on their medical physics practice.
- Requirements and Opportunities for Maintenance of Certification
36(2009); http://dx.doi.org/10.1118/1.3182457View Description Hide Description
The ABR began issuing time‐limited certificates for physicists in 2002. As a result, many physicists are two‐thirds the way through their MOC cycles, and should have reached several milestones by now. This course will discuss the origins of the MOC program, the requirements for physicists, and some of the opportunities available for meeting the requirements. Specific information will be provided to help physicists understand how they can satisfy the requirements for professional standing, through licensure or attestation; life‐long learning and self assessment, through the accumulation of continuing education credits, self‐assessment modules (SAMs) and self‐directed educational projects (SDEPs); cognitive expertise, through participation in a cognitive exam; and assessment of performance in practice, through the conduct of a practice quality improvement (PQI) program. Examples of each aspect will be given. Use of the personal database (PDB) provided by the ABR for each diplomate to facilitate the MOC process will be described, and the opportunities for guidance in accomplishing SDEPs and PQI projects will be presented.
1. Understand the maintenance of certification program, its history and requirements.
2. Learn about opportunities for satisfying the MOC requirements.
3. Become familiar with sources of assistance from the ABR, including the personal database.
4. Identify opportunities for guidance from sources such as the AAPM.
- Women in the AAPM
36(2009); http://dx.doi.org/10.1118/1.3182205View Description Hide Description
This session focuses on professional development skills for women. The first speaker, Dr. Karen Garman, is President and Senior Learning Consultant for Healthcare Education, Leadership and Performance, Inc. or HELP Inc. Dr. Garman has over 25 years of experience as an expert in professional development. Dr. Garman will present on time management skills and on dealing with conflict in the workplace. The second speaker is Dr. Elizabeth Travis. Dr. Travis is a Professor in the Department of Experimental Radiation Oncology at MD Anderson Cancer Center and Associate Vice President for Women Faculty Programs. Dr. Travis is also the editor of a book on mentoring “Legends and Legacies: Personal journeys of women physicians and scientists at MD Anderson Cancer Center.” Dr. Travis will discuss the role of mentors as women build their careers.