The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education, and professional practice of medical physics. The AAPM has more than 8000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. While must is the term to be used in the guidelines, if an entity that adopts the guideline has shall as the preferred term, the AAPM considers that must and shall have the same meaning.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

PreambleThe American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: (1) Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. (2) Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Radiography remains the most widely used imaging modality throughout the world. Additionally, while it has been demonstrated that a quality control (QC) program, especially in mammography, improves image quality, weekly technologist QC testing might be lacking even where there is clinical qualified medical physicist (CQMP) support. Therefore, the International Atomic Energy Agency (IAEA) developed simple QC phantoms that can easily be used on a regular basis (daily/weekly) for radiography and mammography. These are simple in design and use materials that are easily accessible in most parts of the world. A software application is also developed that automatically analyzes images and Digital Imaging and Communications in Medicine (DICOM) header information. It exports data to a comma-separated values (CSV) file that is read by a Microsoft Excel® spreadsheet for documentation and graphical analysis. The phantom and the software were tested in four institutions (in Costa Rica and the United States of America) both on computed radiography and direct digital mammography and radiography systems. Data were collected over a 3-year period. No corrective actions were taken on the data, but service was performed on two of the units. Results demonstrated noise that could be attributed to suboptimal placement of the phantom and incorrect data being put into the DICOM header. Preliminary evaluation of the IAEA methodology has demonstrated that it can provide meaningful QC data that are sensitive to changes in the imaging systems. Care must be taken at implementation to properly train personnel and ensure that the image data, including the DICOM header, are being correctly transmitted. The methodology gives the opportunity for a single CQMP to provide QC services even to remote sites where travel is prohibitive, and it is feasible and easy to implement.

Medical PhysicsVolume 47, Issue 7 p. 3256-3257 Book Review FRCR Physics MCQs in Clinical Radiology. Shuaib, IL, Zin, HM, Aziz, MZA, Osman, ND, Zainon, R, Authors. Springer Nature Singapore Pte Ltd. 2019. Hardcover 203 pp. Price: $99.99. ISBN: 978-981-13-0910-6 Douglas Pfeiffer MS, DABR, FAAPM, FACR, orcid.org/0000-0003-4915-0790 Search for more papers by this author Douglas Pfeiffer MS, DABR, FAAPM, FACR, orcid.org/0000-0003-4915-0790 Search for more papers by this author First published: 18 April 2020 https://doi.org/10.1002/mp.14188Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume47, Issue7July 2020Pages 3256-3257 RelatedInformation

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances. Approved by AAPM's Executive Committee May 28, 2019.

Nuclear cardiac imaging began in the 1950s with potassium and rubidium and has been central to the practice since the 1960s. Positron emission tomography (PET) imaging is often considered to be a relatively late development in nuclear imaging. Because PET imaging depends on the detection of coincident photons, the decay time of the detector crystal is very important for accurate determination of coincidence events. It is becoming increasingly difficult to purchase a general-purpose nuclear imaging system that is not a hybrid with another modality, particularly computed tomography (CT). CT yields vital attenuation correction information and provides anatomical information that is not present in nuclear studies. Nuclear medicine is the most highly regulated modality in medical imaging, and few individuals are as intimately familiar with regulations as a medical physicist. The transition to Medical Physics 3.0 should be somewhat easier in nuclear imaging facilities, as physicists supporting them are familiar with involvement beyond just equipment evaluations.

Quality control (QC) in medical imaging is an ongoing process and not just a series of infrequent evaluations of medical imaging equipment. The QC process involves designing and implementing a QC program, collecting and analyzing data, investigating results that are outside the acceptance levels for the QC program, and taking corrective action to bring these results back to an acceptable level. The QC process involves key personnel in the imaging department, including the radiologist, radiologic technologist, and the qualified medical physicist (QMP). The QMP performs detailed equipment evaluations and helps with oversight of the QC program, the radiologic technologist is responsible for the day-to-day operation of the QC program. The continued need for ongoing QC in digital radiography has been highlighted in the scientific literature. The charge of this task group was to recommend consistency tests designed to be performed by a medical physicist or a radiologic technologist under the direction of a medical physicist to identify problems with an imaging system that need further evaluation by a medical physicist, including a fault tree to define actions that need to be taken when certain fault conditions are identified. The focus of this final report is the ongoing QC process, including rejected image analysis, exposure analysis, and artifact identification. These QC tasks are vital for the optimal operation of a department performing digital radiography.

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines: Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline. Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Medical Physics is an attractive career choice for many young scientists, offering opportunities in both research and clinical activities. Very often, clinical medical physics is broadly divided into two categories: we are either therapy physicists or diagnostic physicists. Such a bifurcation, while capturing much of what we have historically done, does not reflect the breadth of the applications of physics in medicine. Further, the second bifurcation - that between research and clinical medical physics - also does not reflect the breadth of professional opportunities. As health care changes and more bright candidates enter the field, recognizing the broader opportunities for medical physicists is becoming increasingly important. This symposium will explore just two aspects of non-traditional medical physics careers. The first speaker will first focus on the enormous opportunities in quantitative imaging in cancer care, which is linked with treatment response assessment, Response Evaluation Criteria in Solid Tumors (RECIST), and advanced image analysis. Second, biological data analysis, including analysis of big data in images and other biomarkers will be discussed. Finally, opportunities for physicists in the pharmaceutical industry, such as in pharmacokinetics and modeling) will be presented. The second speaker will discuss some of the many opportunities for medical physicists in imaging and therapeutic equipment industry. Both large corporations and small companies offer alternative career paths for physicists outside of the typical research and clinical realms. Research and clinical medical physics are still vital in these companies, but are implemented differently. Learning Objectives: 1. Become familiar with career opportunities in quantitative imaging, biological data analysis, pharmaceutical industry, and equipment industry. 2. Learn the activities associated with these opportunities 3. Learn the education and experience expected to be successful in these realms.

Health Physics and Radiological Health, 4th Edition. Johnson Thomas E., Birky Brian K., Lippincott Williams & Wilkins, a Walter Kluwer business, Baltimore, Maryland, 2012, $205.99. ISBN: 9781609134198, 1288 pp. (hardcover)

The American Association of Physicists in Medicine (AAPM) advocates licensure of medical physicists in order to assure that only qualified individuals practice the profession. For well over ten years, the AAPM has provided financial, staff, and member support for the establishment of licensure in several states yet, so far, only four states have enacted licensure laws. Consequently, it has been suggested that maybe registration of medical physicists rather than licensure might be a more efficient way of assuring appropriate qualification of medical physicists, at least in some states, and this is the premise debated in this month's Point/Counterpoint. Certification by an appropriate certification board, Scope of practice, Continuing education, Adherence to practice standards, both ethical and behavioral, and Due process for revocation of the credential. A comprehensive regulatory approach to medical physicist credentialing can provide many of the benefits of licensure without the cost and complexity associated with legislating professional licensure. Currently, 30 states have some form of registration of medical physicists.1 Where registration exists, the path is direct with the cooperation of the State Regulatory Authorities. For example, in Colorado, a very direct statement was adopted that specific tasks in radiation therapy shall be performed by a registered medical physicist, where the term “registered” is equivalent to the term “qualified” as used by AAPM and ACMP in the definition of a qualified medical physicist (QMP). This simple approach established acceptable credentials and scope of practice. Regulations can be written to provide audits for QMPs to ensure continued competency, as has been accomplished in Colorado. It can be specified that any decisions to deny or revoke registration are to be performed by a selection of peers. It is already common to require continuing education within a regulatory framework. The path to regulatory changes can be much more direct and less expensive than the legislative approach, depending on the wording of the enabling act. The governing radiation control office is often given broad authority to regulate the use of radiation within the state. This usually includes rules for the training and experience of radiation workers, including medical physicists. Rather than money, the capital required is an excellent working relationship between the regulatory authority and the medical physicists of the state. No lobbyists are required, no time vying for the attention of busy legislators, trying to convince them that medical physicists exist. Instead, regulators and physicists work together toward a common goal. It is also important to remember that a “suggested” national regulatory structure already exists through the Conference of Radiation Control Program Directors (CRCPD) and their suggested state regulations.2 Many states have it in their authorizing legislation that they must adopt the SSRs in whole or with some exceptions. The CRCPD is currently close to adopting language regarding the qualifications of medical physicists; efforts can then move to trying to get the organization to adopt other features as discussed above. In short, almost any line item of a licensure act can be incorporated into a regulatory structure. It is most often less expensive and less difficult to achieve regulatory changes than to establish new legislation and a new recognized license. The AAPM must look at a regulatory approach as an adjunct to achieving the goals of medical physicist licensure. The rather tangled legal status of the clinical practice of medical physics in the United States was highlighted recently by our AAPM President, Dr. Herman, in his remarks before the House Subcommittee on Health when he pointed out that “Medical physicists are licensed in four states (TX, NY, FL, and HI) and regulated at widely varying levels in the other 46 states.”3 The fact that a congressional committee convened a hearing, prompted by a series of articles in The New York Times detailing radiation therapy accidents across the country, means that the discussion in our profession of licensing and regulation is no longer an academic pursuit; there will be consequences, both sooner and later. For that reason we need to clearly understand what licensing is, what it is not, and what alternatives may exist. Stated most broadly, a license is a form of permission granted by some competent authority which awards the holder with the privilege to do some act that is otherwise proscribed by law. Although there are forms of licenses that are private or that involve copyright or patents, we will focus on government licenses in this discussion. Through the grant or denial of a license, a government is able to regulate many different areas of human endeavor. A number of consequences flow immediately from the definition of a license. One way to view a requirement for a license to undertake an activity is that it is in fact the grant of a monopoly to an individual, or a group, in exchange for certain obligations. Stated another way, the holder of a license to practice medicine, for example, can practice medicine as it is defined in the statutes, and no one else can. Governments (local, state, and federal) have seen fit to create this type of restriction particularly in areas thought to pose significant risks to members of the public. Medicine, law, accounting, engineering, and insurance are just a few examples. There is the suggestion that the goal of restricting the practice of medical physics to competent individuals can be more easily achieved by a simple registration process with some well-defined education and training criteria. My objection to this approach is that it is essentially “license-lite” and ultimately fails to achieve the goal of effective regulation of the practice of clinical medical physics. Note that both law and medicine have specific education and training requirements as a part of the licensing (and registration) process. If one did not look any further than the possession of a degree from an accredited school and the appropriate postgraduate training, there is no difference between a law/medical license and “registration.” What is different is that both professions possess specific Codes of Ethics which govern how the professions are practiced, and are enforceable within the membership. Both types of professional licenses similarly have specific legal rights, both statutory and constitutional, that are granted to the license holders to protect them from arbitrary action terminating or suspending their license. A simple registration requirement does not offer that protection. For me, the concept of a formal license is preferable because it fuses the idea of enforceable ethical practice with training and education, and further offers protection from arbitrary adverse action to the holder of that license. Registration might restrict the field to qualified individuals in the sense of training and education, but not much past that. In an ideal world, universal licensure of medical physicists could ensure all of the goals that both my worthy colleague and I agree are important to achieve. We live in a less than an ideal world, however. Four states currently require licensure of medical physicists: New York, Texas, Hawaii, and Florida. Of these four, only Florida requires certification by a nationally recognized board.4 New York does not require certification; licensees must only pass ABR Parts I and II.5 Texas does not require certification at all, just their own exam.6,7 It is the stated policy of the AAPM that a qualified medical physicist is certified by an appropriate certification board.8 Practical and political realities reduce ideal licensure language to something palatable by the given state legislature. My colleague in this discussion has identified one of the most challenging aspects of registration, that of assuring adherence to ethical standards. I cannot argue that this is not difficult to achieve. However, the number of recorded instances of ethical misconduct in those states currently having licensure is small, as is the number of cases that have come before the Ethics Committee of the AAPM. Thankfully, this appears to be the least of our concerns compared to ensuring that qualified individuals are doing the work. Just as licensure cannot ensure complete adoption of our goals, neither can registration. We must recognize that there are some states in which licensure is not practicable. Prime examples reside in the Mountain West. These states are sparsely populated and will never have enough physicists to sustain the expense of a licensure program. Other states are simply not proponents of creating additional professional licensures. What is the answer in such states? Registration allows medical physicists to obtain some of their clinical practice goals, if imperfectly. The AAPM should work to make the registration regulations as strong and comprehensive as possible in parallel with efforts to achieve licensure. There is a very significant flaw in the suggestion that any line item of a licensure act can be incorporated into a regulatory structure. That might be true in principle, but it is not correct in fact. A regulatory agency can only do those things which are within the scope of its grant of authority. This is a fundamental principle of administrative law. Any proposed new regulation needs to withstand not only review by the legislative committees charged with supervision of agencies in the jurisdiction, but also review by the courts. The first place the challenge will focus on is the scope of the original grant when that regulatory body was created. The second challenge faced by any attempt to extend the jurisdiction of a regulatory agency is financial. Who is going to pay for this registration? If the taxpayers foot the bill through agency expenditures, that requires the approval of the legislature and its appropriations committees. If the physicists have to cover that bill, it may be just this side of oppressive in a state such as South Dakota, with fewer than a dozen physicists to pick up the expense. The credentialing requirements offered in my opponent's Opening Statement fit exactly into the definition of a license. It excludes all except a certain class of individuals from doing a particular set of activities backed by a penalty enforced by the state. A license by any other name is still a license.

A comprehensive Code of Ethics for the members of the American Association of Physicists in Medicine (AAPM) is presented as the report of Task Group 109 which consolidates previous AAPM ethics policies into a unified document. The membership of the AAPM is increasingly diverse. Prior existing AAPM ethics polices were applicable specifically to medical physicists, and did not encompass other types of members such as health physicists, regulators, corporate affiliates, physicians, scientists, engineers, those in training, or other health care professionals. Prior AAPM ethics policies did not specifically address research, education, or business ethics. The Ethics Guidelines of this new Code of Ethics have four major sections: professional conduct, research ethics, education ethics, and business ethics. Some elements of each major section may be duplicated in other sections, so that readers interested in a particular aspect of the code do not need to read the entire document for all relevant information. The prior Complaint Procedure has also been incorporated into this Code of Ethics. This Code of Ethics (PP 24-A) replaces the following AAPM policies: Ethical Guidelines for Vacating a Position (PP 4-B); Ethical Guidelines for Reviewing the Work of Another Physicist (PP 5-C); Guidelines for Ethical Practice for Medical Physicists (PP 8-D); and Ethics Complaint Procedure (PP 21-A). The AAPM Board of Directors approved this Code or Ethics on July 31, 2008.

While ultrasound guided prostate brachytherapy has gained wide acceptance as a primary treatment tool for prostate cancer, quality assurance of the ultrasound guidance system has received very little attention. Task Group 128 of the American Association of Physicists in Medicine was created to address quality assurance requirements specific to transrectal ultrasound used for guidance of prostate brachytherapy. Accurate imaging guidance and dosimetry calculation depend upon the quality and accuracy of the ultrasound image. Therefore, a robust quality assurance program for the ultrasound system is essential. A brief review of prostate brachytherapy and ultrasound physics is provided, followed by a recommendation for elements to be included in a comprehensive test phantom. Specific test recommendations are presented, covering grayscale visibility, depth of penetration, axial and lateral resolution, distance measurement, area measurement, volume measurement, needle template/electronic grid alignment, and geometric consistency with the treatment planning computer.