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The radiation oncology workforce: A focus on medical dosimetry

The 2012 Radiation Oncology Workforce survey was conducted to assess the current state of the entire workforce, predict its future needs and concerns, and evaluate quality improvement and safety within the field. This article describes the dosimetrist segment results. The American Society for Radiation Oncology (ASTRO) Workforce Subcommittee, in conjunction with other specialty societies, conducted an online survey targeting all segments of the radiation oncology treatment team. The data from the dosimetrist respondents are presented in this article. Of the 2573 dosimetrists who were surveyed, 890 responded, which resulted in a 35% segment response rate. Most respondents were women (67%), whereas only a third were men (33%). More than half of the medical dosimetrists were older than 45 years (69.2%), whereas the 45 to 54 years age group represented the highest percentage of respondents (37%). Most medical dosimetrists stated that their workload was appropriate (52%), with respondents working a reported average of 41.7 ± 4 hours per week. Overall, 86% of medical dosimetrists indicated that they were satisfied with their career, and 69% were satisfied in their current position. Overall, 61% of respondents felt that there was an oversupply of medical dosimetrists in the field, 14% reported that supply and demand was balanced, and the remaining 25% felt that there was an undersupply. The medical dosimetrists' greatest concerns included documentation/paperwork (78%), uninsured patients (80%), and insufficient reimbursement rates (87%). This survey provided an insight into the dosimetrist perspective of the radiation oncology workforce. Though an overwhelming majority has conveyed satisfaction concerning their career, the study allowed a spotlight to be placed on the profession's current concerns, such as insufficient reimbursement rates and possible oversupply of dosimetrists within the field.

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SU-B-213-01: Introduction

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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SU-B-213-00: Education Council Symposium: Accreditation and Certification: Establishing Educational Standards and Evaluating Candidates Based on these Standards

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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SU-B-213-02: Development of CAMPEP Standards

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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SU-B-213-05: Development of ABR Certification Standards

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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SU-B-213-06: Development of ABR Examination Questions

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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SU-B-213-07: Panel Discussion

The North American medical physics community validates the education received by medical physicists and the clinical qualifications for medical physicists through accreditation of educational programs and certification of medical physicists. Medical physics educational programs (graduate education and residency education) are accredited by the Commission on Accreditation of Medical Physics Education Programs (CAMPEP), whereas medical physicists are certified by several organizations, the most familiar of which is the American Board of Radiology (ABR). In order for an educational program to become accredited or a medical physicist to become certified, the applicant must meet certain specified standards set by the appropriate organization. In this Symposium, representatives from both CAMPEP and the ABR will describe the process by which standards are established as well as the process by which qualifications of candidates for accreditation or certification are shown to be compliant with these standards. The Symposium will conclude with a panel discussion. Learning Objectives: Recognize the difference between accreditation of an educational program and certification of an individual Identify the two organizations primarily responsible for these tasks Describe the development of educational standards Describe the process by which examination questions are developed GS is Executive Secretary of CAMPEP.

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MO-AB-201-01: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223

The role of the Radiation Safety Officer at a medical facility can be complicated. The complexity of the position is based on the breadth of services provided at the institution and the nature of the radioactive materials license. Medical practices are constantly changing and the use of ionizing radiation continues to rise in this area. Some of the newer medical applications involving radiation have unique regulatory and safety issues that must be addressed. Oversight of the uses of radiation start at the local level (radiation safety officer, radiation safety committee) and are heavily impacted by outside agencies (i.e. Nuclear Regulatory Commission, State Radiologic Health, The Joint Commission (TJC), etc). This session will provide both an overview of regulatory oversight and essential compliance practices as well as practical ways to assess and introduce some of the new applications utilizing radioactive materials into your medical facility. Learning Objectives: Regulatory Compliance and Safety with New Radiotherapies: Spheres and Ra-223 (Lance Phillips) Understand the radioactive materials license amendment process to add new radiotherapies (i.e., SIR-Spheres, Therasphere, Xofigo). Understand the AU approval process for microspheres and Xofigo. Examine the training and handling requirements for new procedures. Understand the process involved with protocol development, SOP in order to define roles and responsibilities. The RSO and The RSC: Challenges and Opportunities (Colin Dimock) Understand how to form an effective Committee. Examine what the Committee does for the Program and the RSO. Understand the importance of Committee engagement. Discuss the balance of the complimentary roles of the RSO and the Committee. The Alphabet Soup of Regulatory Compliance: Being Prepared for Inspections (Linda Kroger) Recognize the various regulatory bodies and organizations with oversight or impact in Nuclear Medicine, Radiology and Radiation Oncology. Examine 10CFR35 requirements as they relate to the everyday practice of Nuclear Medicine and Radiation Oncology. Understand the nature of available guidance documents (e.g., NUREG 1556). Examine the commonalities between TJC and CMS preparedness.

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SU-B-BRA-02: The Medical Physics Value Proposition for Tomorrow and Today

In the current rapidly changing Healthcare environment, many groups are competing for limited resources. How can medical physicists position themselves to be a relevant stakeholder in the discussion of how those resources are allocated Our value goes beyond what can be shown in a business plan and is heavily involved with safety and quality. Three areas will be explored: What is our value? Who needs to receive that message? How do we communicate that message? To help frame the discussion in terms of how other stakeholders may view the value of medical physicists, a physician and an administrator will present their perspective. Lastly, a multidisciplinary panel will present real life examples of strategies that can be utilized today to establish the value of medical physicists. The presentation of these examples will lead into an interactive question and answer time. V. Willcut, I work for Elekta. There was no research associated with this talk.

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SU-F-T-250: What Does It Take to Correctly Assess the High Failure Modes of an Advanced Radiotherapy Procedure Such as Stereotactic Body Radiation Therapy?

Purpose: Assess the correct implementation of risk-based methodology of TG 100 to optimize quality management and patient safety procedures for Stereotactic Body Radiation Therapy. Methods: A detailed process map of SBRT treatment procedure was generated by a team of three physicists with varying clinical experience at our institution to assess the potential high-risk failure modes. The probabilities of occurrence (O), severity (S) and detectability (D) for potential failure mode in each step of the process map were assigned by these individuals independently on the scale from1 to 10. The risk priority numbers (RPN) were computed and analyzed. The highest 30 potential modes from each physicist’s analysis were then compared. Results: The RPN values assessed by the three physicists ranged from 30 to 300. The magnitudes of the RPN values from each physicist were different, and there was no concordance in the highest RPN values recorded by three physicists independently. The 10 highest RPN values belonged to sub steps of CT simulation, contouring and delivery in the SBRT process map. For these 10 highest RPN values, at least two physicists, irrespective of their length of experience had concordance but no general conclusions emerged. Conclusion: This study clearly shows that the risk-based assessment of a clinical process map requires great deal of preparation, group discussions, and participation by all stakeholders. One group albeit physicists cannot effectively implement risk-based methodology proposed by TG100. It should be a team effort in which the physicists can certainly play the leading role. This also corroborates TG100 recommendation that risk-based assessment of clinical processes is a multidisciplinary team effort.

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MO-DE-BRA-03: The Ottawa Medical Physics Institute (OMPI): A Practical Model for Academic Program Collaboration in a Multi-Centre City

Purpose: To build a world-class medical physics educational program that capitalizes on expertise distributed over several clinical, government, and academic centres. Few if any of these centres would have the critical mass to solely resource a program. Methods: In order to enable an academic program, stakeholders from five institutions made a proposal to Carleton University for a) a research network with defined membership requirements and a process for accepting new members, and b) a graduate specialization (MSc and PhD) in medical physics. Both proposals were accepted and the program has grown steadily. Our courses are taught by medical physicists from across the collaboration. Our students have access to physicists in: clinical radiotherapy (the Ottawa Cancer Centre treats 4500 new patients/y), radiology, cardiology and nuclear medicine, Canada’s primary standards dosimetry laboratory, radiobiology, and university-based medical physics research. Our graduate courses emphasize the foundational physics plus applied aspects of imaging, radiotherapy, and radiobiology. Active researchers in the city-wide volunteer-run network are appointed as adjunct professors by Physics, giving them access to national funding competitions and partial student funding through teaching assistantships while opening up facilities in their institutions for student thesis research. Results: The medical physics network has grown to ∼40 members from eight institutions and includes five full-time faculty in Physics and 17 adjunct research professors. The graduate student population is ∼20. Our graduates have proceeded to a spectrum of careers. Our alumni list includes a CCPM Past-President, the current COMP President, many clinical physicists, and the heads of at least three major clinical medical physics departments. Our PhD was Ontario’s first CAMPEP-accredited program. Conclusion: A self-governing volunteer network is the foundational element that enables an MSc/PhD medical physics program in a city with multiple physicist employers. It enriches graduate education with an unusually broad range of expertise.

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Peripheral Blood Transcript Signatures after Internal 131 I-mIBG Therapy in Relapsed and Refractory Neuroblastoma Patients Identifies Early and Late Biomarkers of Internal 131 I Exposures

131 I-metaiodobenzylguanidine ( 131 I-mIBG) is a targeted radiation therapy developed for the treatment of advanced neuroblastoma. We have previously shown that this patient cohort can be used to predict absorbed dose associated with early 131 I exposure, 72 h after treatment. We now expand these studies to identify gene expression differences associated with 131 I-mIBG exposure 15 days after treatment. Total RNA from peripheral blood lymphocytes was isolated from 288 whole blood samples representing 59 relapsed or refractory neuroblastoma patients before and after 131 I-mIBG treatment. We found that several transcripts predictive of early exposure returned to baseline levels by day 15, however, selected transcripts did not return to baseline. At 72 h, all 17 selected pathway-specific transcripts were differentially expressed. Transcripts CDKN1A (P < 0.000001), FDXR (P < 0.000001), DDB2 (P < 0.000001), and BBC3 (P < 0.000001) showed the highest up-regulation at 72 h after 131 I-mIBG exposure, with mean log2 fold changes of 2.55, 2.93, 1.86 and 1.85, respectively. At day 15 after 131I-mIBG, 11 of the 17 selected transcripts were differentially expressed, with XPC, STAT5B, PRKDC, MDM2, POLH, IGF1R, and SGK1 displaying significant up-regulation at 72 h and significant down-regulation at day 15. Interestingly, transcripts FDXR (P = 0.01), DDB2 (P = 0.03), BCL2 (P = 0.003), and SESN1 (P < 0.0003) maintained differential expression 15 days after 131 I-mIBG treatment. These results suggest that transcript levels for DNA repair, apoptosis, and ionizing radiation-induced cellular stress are still changing by 15 days after 131 I-mIBG treatment. Our studies showcase the use of biodosimetry gene expression panels as predictive biomarkers following early (72 h) and late (15 days) internal 131 I exposure. Our findings also demonstrate the utility of our transcript panel to differentiate exposed from non-exposed individuals up to 15 days after exposure from internal 131 I.

63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTAN↗

Status of Cross-section Data Libraries for MCNP

The Data Team, part of the XCP-5 group at LANL, uses the NJOY code and other codes to prepare the cross-section data files used by the Monte Carlo codes MCNP5, MCNPX, and MCNP6. They perform extensive quality assurance checking of those data files. The cross-section data files are included with the releases of MCNP that are distributed by RSICC. MCNP5 is developed and supported by the Monte Carlo Codes group (XCP-3) at LANL. MCNPX is developed and supported by the NEN-5 group at LANL. MCNP6 is a merger of MCNP5 and MCNPX, with numerous additional features, and is jointly developed and supported by the XCP-3 and NEN-5 groups. MCNP5 and MCNPX are "frozen" codes, and all new development is being carried out only in the MCNP6 code. In the past, when new types of data or improved representations were developed, the Data Team would incorporate the changes into the cross-section data files, and the Monte Carlo groups would make corresponding changes to the MCNP codes to use the new data. At present, however, only MCNP6 is updated to handle new data representations; MCNP5/X are not.

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TA-55 Glovebox Safety Program

This Requirements Document (RD) outlines the requirements for managing health and safety concerns associated with gloveboxes and glovebox work.

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