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Nuclear Decontamination Evolution and Revolution - 20349

Decontamination, one of the oldest practices in the nuclear industry, is about to change. While no single approach to decontamination is appropriate in all situations, decontamination of highly contaminated surfaces is historically viewed as difficult and/or marginally effective and fixatives and strippable coatings are often called on to manage time sensitive contamination control issues. The deferral of proper decontamination can lead to accumulated concentrations of radioactive material increasing the risk of cross-contamination of workers and equipment while also increasing radiation levels, which further discourages decontamination. The results of the subject testing demonstrate that superior decontamination factors are readily achievable and the ALARA benefit of decontamination is viable through advanced decontamination technologies in conjunction with innovative application techniques. The collateral benefits will save countless radiological man-hours and personnel radiological exposure. The appropriate use of radiological decontamination techniques can prevent or limit the adverse effects of highly radioactive contamination in the work area. High levels of radiological contamination are typically associated with some of the most physically demanding work in the nuclear industry. Additionally, working in highly contaminated environments increases the risk of exposure to elevated levels of airborne radioactivity and radiation from the source term of the contamination, particularly in hard to reach areas or complex equipment. Veolia's Alaron Nuclear Services (Alaron), a fully integrated nuclear facility, has provided the nuclear industry waste treatment, consolidation, repackaging, and broad decontamination services for almost 35 years. In looking at solutions for its customers, as well as for their own facility, Alaron has recently collaborated with Environmental Alternatives, Inc. (EAI), which has provided innovative solutions addressing difficult nuclear decontamination and industrial cleaning challenges since 1989. This broad range of experience along with the products to support the work created an ideal partner for Alaron's needs at their facility. The benefits of collaboration were immediately recognizable to the management of both companies although the decontamination challenge was significant. Due to the nature of the services offered, contamination at the Alaron facility is routine. The recent decontamination experience at Alaron utilized an innovative surfactant process that quickly produces remarkably higher decontamination factors for both removable surface contamination and fixed contamination. Considering the time to decontaminate areas historically designated for high radiological hazard work, the results from this decontamination effort not only reduced contamination levels but also significantly lowered exposure rates in the working environment. The relative ease with which the surfactant is applied, combined with extraordinary decontamination test results, indicates the potential to alter current radiological work processes in a way that improves worker comfort, and removes radiological engineering barriers, allowing Alaron to complete complex radiological tasks more efficiently and effectively. In a series of two simple applications of the decontamination agent to contaminated high bay vertical surfaces, as well as a variety of horizontal and vertical surfaces with variable porousness and surface sealants, there was an overall reduction in removable contamination of approximately 73% with a reduction in area dose of approximately 93%. The results indicate additional reduction in fixed contamination with application of the surfactant. These values are much higher than experienced with more traditional decontamination agents. In conjunction with demonstrating EAI's surfactant on room surfaces, additional studies were conducted on complex geometry equipment including waste processing equipment, tools, and heavily contaminated parts normally handled from Alaron's customers. Evaluations were made with straight application of EAI's surfactant as well as adding additional techniques to the treatment which afforded revolutionary improvements in the levels of contamination removed. Successful decontamination with up to 95% reduction in removable contamination with just one application were demonstrated in several of the trials. This paper outlines the planned approach to use this technology, the variety of surfaces and equipment treated, and the results of the decontamination efforts. Furthermore, this paper discusses options for pretreatment of certain heavily contaminated equipment prior to employees handling and/or working with the equipment. The potential for dose saving and the reduced risk of cross-contamination with the added benefit of lower PPE requirements, produces an enormous potential for cost and time savings. Attendees will benefit from Alaron's experiences and more fully understand the capabilities of EAI's decontamination process. With the variety of contamination agents, forms and surfaces on which the technology was demonstrated, the information will be valuable to a broad cross-section of industry users. The significance of this report demonstrates superior decontamination factors are achievable utilizing the next evolution of decontamination technology and that the ALARA benefits of decontamination are available through advanced and modern decontamination efforts. The collateral benefits will save countless radiological man-hours and valuable personnel radiological exposure. (authors)

12 MANAGEMENT OF RADIOACTIVE AND NON-RADIOACTIVE W↗

Radiologist Digital Workspace Use and Preference: a Survey-Based Study

Literature regarding the heterogeneity of and preferences for radiology workstation design—and, in particular, the digital workspace of the radiology workstation—is scant. The purpose of this study was to determine the nature of the digital environments across the specialty and the degree of satisfaction users associated with the particular facets of those environments. A survey was sent to the membership of the Association of University Radiologists in February 2015. The survey comprised 10 questions establishing demographics, current typical workstation setup, perceived satisfaction with that setup, and preferences for potential altered setups. A total of 336 radiologists responded, with a cross-section similar to that described in the 2015 ACR annual workforce survey (1). Although there was a rough split in the number of radiologists using one or two non-diagnostic monitors (46 vs. 51%, respectively), the strong majority (75%) of radiologists use two diagnostic monitors. Users of two non-diagnostic monitors were more likely to keep open the case info (87 vs. 68%) and EMR (84 vs 68%). More senior radiologists tended to find the current setup easy more frequent than younger radiologists, and the latter group was more likely to believe additional monitors would be helpful. Although many radiologists are comfortable with their computing workflows, a significant number indicate dissatisfaction and may be interested in being able to specify the amount of monitor space with which they can work. Additional monitors may promote improved quality in addition to any potential productivity gains.

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2009 Canadian Radiation Oncology Resident Survey

Purpose: Statistics from the Canadian post-MD education registry show that numbers of Canadian radiation oncology (RO) trainees have risen from 62 in 1999 to approximately 150 per year between 2003 and 2009, contributing to the current perceived downturn in employment opportunities for radiation oncologists in Canada. When last surveyed in 2003, Canadian RO residents identified job availability as their main concern. Our objective was to survey current Canadian RO residents on their training and career plans. Methods and Materials: Trainees from the 13 Canadian residency programs using the national matching service were sought. Potential respondents were identified through individual program directors or chief resident and were e-mailed a secure link to an online survey. Descriptive statistics were used to report responses. Results: The eligible response rate was 53% (83/156). Similar to the 2003 survey, respondents generally expressed high satisfaction with their programs and specialty. The most frequently expressed perceived weakness in their training differed from 2003, with 46.5% of current respondents feeling unprepared to enter the job market. 72% plan on pursuing a postresidency fellowship. Most respondents intend to practice in Canada. Fewer than 20% of respondents believe that there is a strong demand for radiation oncologists in Canada. Conclusions: Respondents to the current survey expressed significant satisfaction with their career choice and training program. However, differences exist compared with the 2003 survey, including the current perceived lack of demand for radiation oncologists in Canada.

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SU-E-E-07: When the Old Ways Are the Best Ways: In Defense of Didactic Training

Purpose: Physics education for residents has taken on a more prominent role due to the new ABR examination format. We present a curriculum for a new radiology residency entering its second year. This curriculum favors an extensive traditional didactic teaching approach. The curriculum is designed to minimize the amount of independent learning that is necessary outside the classroom Methods and Materials: idactic training repeats yearly for all four years of residency and consists of two 1-hour lectures per week and several in-class tests. The impact of physics on clinical practice is introduced gradually throughout the residency using specific clinical cases. The extensive time spent with the residents allows lectures to be taught at a deep (almost physicist) level and reduces the necessity of learning base concepts outside of lecture. This frees the resident to use resources (e.g., AAPM/RSNA physics modules) to cement concepts through repetition or to learn a slightly confusing concept from a different teaching perspective. Consistent testing reduces the traditional resident studying technique of physics “cramming.” Results: On average, the first year residents scored in the 98th percentile on the American College of Radiology Diagnostic Radiology In-Service Training Exam (ACR DXIT). Feedback from the new first year residents was very positive and suggestions are constantly solicited and incorporated. For example, based on resident feedback, short-format quizzes each lecture were eliminated and replaced interactive questions during lecture. Residents felt they have advanced rapidly and have a better understanding of radiologic physics, though they have expressed concern that the 1-hour lecture block may not be optimal for learning physics. Conclusion: An extensive, physicist-led series of didactic lectures is effective in the teaching of physics to residents.

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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-213-03: Evaluation of Graduate Programs

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-213-04: Evaluation of Residency Programs

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-F-201-00: PANEL DISCUSSION: Preparing for Parts 2 and 3 of the ABR Therapy Medical Physics Exam

The goal of this session is to provide guidance to medical physicists undergoing the American Board of Radiology certification process in therapeutic medical physics. This panel discussion will focus on parts 2 (computer-based) and 3 (oral) of the examination. Unlike the latter portions of the exam which are specialty-driven, part 1 is universal for all medical physics fields and will not be addressed. This session is structured into different topics that aim to guide the participants on how to successfully prepare for the board exams. The subjects of discussion will include timing and strategies for exam preparation, crucial differences in preparing for the clinical computer-based exam versus the oral exam, what study tools are currently available for each, etc. The panel discussion format will allow the speakers to collectively present their experience and advice relating to each topic and foment audience participation. Learning Objectives: Know the main differences between what is expected for parts 2 and 3 Know different resources for test preparation Know how to formulate a plan to best study for each part based on the specific skill set the two parts require Know how to best present his/her answers during the oral examination – demeanor, answer structure, etc.

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MO-F-201-01: Panel Member

The goal of this session is to provide guidance to medical physicists undergoing the American Board of Radiology certification process in therapeutic medical physics. This panel discussion will focus on parts 2 (computer-based) and 3 (oral) of the examination. Unlike the latter portions of the exam which are specialty-driven, part 1 is universal for all medical physics fields and will not be addressed. This session is structured into different topics that aim to guide the participants on how to successfully prepare for the board exams. The subjects of discussion will include timing and strategies for exam preparation, crucial differences in preparing for the clinical computer-based exam versus the oral exam, what study tools are currently available for each, etc. The panel discussion format will allow the speakers to collectively present their experience and advice relating to each topic and foment audience participation. Learning Objectives: Know the main differences between what is expected for parts 2 and 3 Know different resources for test preparation Know how to formulate a plan to best study for each part based on the specific skill set the two parts require Know how to best present his/her answers during the oral examination – demeanor, answer structure, etc.

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MO-F-201-02: Panel Member

The goal of this session is to provide guidance to medical physicists undergoing the American Board of Radiology certification process in therapeutic medical physics. This panel discussion will focus on parts 2 (computer-based) and 3 (oral) of the examination. Unlike the latter portions of the exam which are specialty-driven, part 1 is universal for all medical physics fields and will not be addressed. This session is structured into different topics that aim to guide the participants on how to successfully prepare for the board exams. The subjects of discussion will include timing and strategies for exam preparation, crucial differences in preparing for the clinical computer-based exam versus the oral exam, what study tools are currently available for each, etc. The panel discussion format will allow the speakers to collectively present their experience and advice relating to each topic and foment audience participation. Learning Objectives: Know the main differences between what is expected for parts 2 and 3 Know different resources for test preparation Know how to formulate a plan to best study for each part based on the specific skill set the two parts require Know how to best present his/her answers during the oral examination – demeanor, answer structure, etc.

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MO-F-201-03: Panel Member

The goal of this session is to provide guidance to medical physicists undergoing the American Board of Radiology certification process in therapeutic medical physics. This panel discussion will focus on parts 2 (computer-based) and 3 (oral) of the examination. Unlike the latter portions of the exam which are specialty-driven, part 1 is universal for all medical physics fields and will not be addressed. This session is structured into different topics that aim to guide the participants on how to successfully prepare for the board exams. The subjects of discussion will include timing and strategies for exam preparation, crucial differences in preparing for the clinical computer-based exam versus the oral exam, what study tools are currently available for each, etc. The panel discussion format will allow the speakers to collectively present their experience and advice relating to each topic and foment audience participation. Learning Objectives: Know the main differences between what is expected for parts 2 and 3 Know different resources for test preparation Know how to formulate a plan to best study for each part based on the specific skill set the two parts require Know how to best present his/her answers during the oral examination – demeanor, answer structure, etc.

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TU-D-201-01: 2016 Economics Update

The purpose of this session is to introduce attendees to the healthcare reimbursement system and how it applies to the clinical work of a medical physicist. This will include general information about the different categories of payers and payees, how work is described by CPT codes, and how various payers set values for this work in different clinical settings. 2016 is another year of significant changes to the payment system. This presentation will describe the work encompassed in these codes and will give attendees an overview of the changes for 2016 as they apply to radiation oncology. Finally, some insight into what can be expected during 2017 will be presented. This includes what information is typically released by the Centers for Medicaid and Medicare Services (CMS) during the year and how we as an organization respond. This will include ways members can interact with the AAPM professional economics committee and other resources members may find helpful. Learning objectives1) Basics of how Medicare is structured and how reimbursement rates are set.2) Basic understanding of proposed changes to the 2016 Medicare rules.3) Describe economics and policy resources that are available from the AAPM and how to interact with the professional economics committee.

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TU-D-201-02: Medical Physics Practices for Plan and Chart Review: Results of AAPM Task Group 275 Survey

Purpose: AAPM Task Group (TG) 275 is charged with developing riskbased guidelines for plan and chart review clinical processes. As part of this work an AAPM-wide survey was conducted to gauge current practices. Methods: The survey consisted of 103 multiple-choice questions covering the following review processes for external beam including protons: 1) Initial Plan Check, 2) On-Treatment and 3) End-of-Treatment Chart Check. The survey was designed and validated by TG members with the goal of providing an efficient and easy response process. The survey, developed and deployed with the support of AAPM headquarters, was released to all AAPM members who have self-reported as working in the radiation oncology field and it was kept open for 7 weeks. Results: There are an estimated 4700 eligible participants. At the time of writing, 962 completed surveys have been collected with an average completion time of 24 minutes. Participants are mainly from community hospitals (40%), academicaffiliated hospitals (31%) and free-standing clinics (18%). Among many other metrics covered on the survey, results so far indicate that manual review is an important component on the plan and chart review process (>90%) and that written procedures and checklists are widely used (>60%). However, the details of what is reviewed or checked are fairly heterogeneous among the sampled medical physics community. Conclusion: The data gathered from the survey gauging current practices will be used by TG 275 to develop benchmarks and recommendations for the type and extent of checks to perform effective physics plan and chart review processes.

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