G Frey

SU‐GG‐E‐02: Radiology Residents Performance on Physics Examinations

Purpose To quantify radiology resident performance on radiological physics examinations, and investigate how this performance varies temporally. Method and Materials We analyzed results of online physics examinations consisting of 120 multiple choice questions covering all of radiological physics. In 2007, results were obtained for 121 residents in the eight week period immediately prior to the written ABR Physics examination. In 2008, results were obtained for 145 residents in the two week period immediately prior to the ABR Physics examination. The scores are presented as the absolute number of correct answers out of the 120 questions, where one of the five options was correct. Results In 2007, the median score increased from 59 when the examinations were taken eight weeks prior to the ABR examination, to 81 when taken less than two weeks prior to the ABR examination. The 15th/85th percentile values showed similar increases from 41/69 at “eight weeks” to 67/94 at less than “two weeks”. In 2008, the median score for all residents was 81. Corresponding scores for selected percentiles were 58 (10th percentile), 74 (30th percentile), 88 (70th percentile) and 96 (90th percentile). Conclusion Radiology resident scores on Physics Examinations increase dramatically (i.e., > 50%) over a two month period immediately prior the ABR Physics examination. The median score on a Physics Examination for residents taking the ABR examination is about 65%. Historical data suggest that the bottom 15% of Radiology Residents fail their written ABR Physics examination, implying a score greater than 55% to pass.

MO‐D‐137‐01: ABR Update

This session will present a review of the ABR requirements and policies for the initial certification of medical physicists. Changes in the program that have occurred in the last several years will be discussed. The requirements for certification for 2014 and beyond will be reviewed. Changes in the oral exam and the board eligibility policy will be presented he MOC program will also be reviewed. The changes that occurred in 2013 will be emphasized. These include the change to continuous MOC, easy public access to certification status and the new ABR My ABR website. There will be adequate time for questions and group discussion. LEARNING OBJECTIVES 1. The participant will understand the role of the ABR in the certification of medical physicists. 2. The participant will understand the ABR requirements for Medical Physics Certification. 3. he participant will understand the requirements for participation the ABRs Maintenance of Certification process.

TU‐C‐116‐01: The Elements of a Highly Effective Educational Session

The class or conference room is the common setting for educational sessions in both academic institutions and continuing education conferences and programs such as those sponsored by the AAPM. A major value of a class/conference room program is one of efficiency by bringing a group of learners together to share in a common learning experience under the guidance of one or more learning facilitators (lecturers or presenters). The challenge is providing truly effective learning, especially in the field of medical physics. An effective learning activity is one which enables an individual to perform specific functions or tasks. The design of an educational activity needs to take into consideration the desired outcomes with respect to what the learners should be able to do. The distinction is that of being able to apply the knowledge to perform specific physics functions rather than just knowing and being able to recall facts, and perhaps do well on written examinations. These are two different types of knowledge structures within the human brain and distinctly different learning activities to develop each. Much of medical physics education, especially at the postgraduate and continuing education level, is for the purpose of enhancing the ability of physicists and other related professionals to perform applied procedures and tasks. An example we will use in this session is optimizing CT image quality and dose. The knowledge structure for this is best developed by observing and interacting with the physics activities that are being studied by working directly in the laboratory, clinic, or other real‐world environment under the direction of a knowable leader.The major limitation of the class/conference room is its physical separation from the applied physics activities taking place elsewhere and the limitation on one‐to‐one or small group activities. In this session we will focus on five initiatives that will consider these limitations and contribute to more effective class/conference room activities. They are:• Effective representations of the physics reality in the classroom • Development of useful knowledge structures in the human brain• Efficient utilization of class/conference room time and resources• Guided interactions, feedback, and real time assessment• Testing and verification of achievement. The function of the human brain will be considered with respect to learning experiences that contribute to effective medical physics knowledge structures. The characteristics of various types of educational activities will be compared with respect to their effectiveness for producing desired outcomes along with their limitations. The design of highly‐effective classroom/conference presentations and activities will be demonstrated with an emphasis of using technology to enhance human performance of both learners and the learning facilitators. The value and process of assessment for both the learners and facilitators/instructors during class activities will be described along with techniques to improve the use of audience response systems. There are many issues associated with the design of effective testing and question writing. This session will discuss effective test design which includes determining the best form of testing to use. Forms of testing will be discussed. Planning tests to assure reliability and effectiveness will be considered. Item writing requires knowledge of effective techniques to make sure questions are clear and unambiguous. Learning Objectives: 1. Develop and provide highly effective medical physics educational sessions. 2. Use technology to enhance human performance in the educational process. 3. Integrate audience response systems into their presentations. 4. Understand various types of testing and determine which should be used in various circumstances 5. Write questions that are clear and effective

SU‐E‐I‐78: CT Usage in Adult Patients at An Academic Medical Center: A Snapshot

Purpose: To document the use of CTimaging in adult patients for a typical day in the Radiology department at the Medical University of South Carolina, and estimate the corresponding patient effective doses and use of iodinated contrast. Method: We reviewed the dose summary sheets of all adult patients who underwent CT examinations on six scanners installed at MUSC on one day (13 September 2010). We obtained the total Dose Length Product (DLP), and computed the corresponding DLP weighted average CTDIvol. Dosimetry data for head and neck CT scans pertain to a 16 cm dosimetry phantom and for body scans pertain to a 32 cm dosimetry phantom. Estimates of the effective doses (E) based on ICRP 103 weighting factors were obtained using nominal E/DLP conversion factors (∼ 3 μSv/mGy‐cm in head/neck; ∼ 18 μSv/mGy‐cm in body). Also recorded was whether iodinated contrast was used each patient examination. Results: A total of 120 adult patients underwent CT examinations with a mean age of 51± 17 years. Overall, 30% of the patient examinations involved the head and neck, with a mean CTDIvol of 62 ± 33 mGy and a mean DLP of 1490 ± 1000 mGy‐cm. The remaining 70% were body examinations with a mean CTDIvol 19 ± 11 mGy and a mean DLP of 990 ± 710 mGy‐cm. A total of 46% of patients were scanned with no iodinated contrast, 33% had contrast, and the remaining 21% had scans performed both with and without contrast. Conclusions: Adult patients undergoing CT examinations have effective doses of the order of 4 mSv for head and neck CT examinations, and of the order of 15 mSv for body examinations, and with slightly more than half receiving iodinated contrast.

SU‐GG‐I‐52: Kerma Area Product and Energy Incident on Patients in X‐Ray Imaging

Purpose: To quantify the total x‐ray energy incident on a patient undergoing an x‐ray exposure using the Kerma Area Product. Method and Materials: Knowledge of the x‐ray beam spectrum permits the total energy in the x‐ray beam (mJ) and the corresponding Kerma Area Product (KAP, unit: Gy‐cm2) to be determined. For each x‐ray beam spectrum, conversion factors between the total energy incident on the patient and the KAP were determined (mJ/Gy‐cm2). We investigated mono‐energetic x‐ray beams and x‐ray spectra of interest in diagnostic x‐ray imaging. For the latter, we determined the importance of x‐ray tube voltage (kV), x‐ray beam filtration (mm Al), x‐ray tube anode angle (°), and voltage ripple (%). Results: Energy incident per unit KAP increases from 6.71 mJ per Gy‐cm2 for 30 keV photons to 43.5 mJ per Gy‐cm2 for 100 keV photons. For 3 mm Al filtration beams, increasing the x‐ray tube voltage from 50 kV to 100 kV increased the energy incident per unit KAP from 7.0 mJ per Gy‐cm2 18.5 mJ per Gy‐cm2. At 80 kV, increasing the x‐ray tube filtration from 1 to 5 mm Al increased the energy incident per unit KAP from 9.0 mJ per Gy‐cm2 17 mJ per Gy‐cm2. The x‐ray tube anode angle and voltage ripple had very little effect (< 20%) on energy incident per unit KAP conversion coefficients. Conclusion: Energy incident on the patient, determined from the Kerma Area Product, can be combined with absorbed fraction values to quantify energy imparted to patients.

SU‐GG‐I‐89: Absorbed Dose to the Conceptus and Patient Size in X‐Ray Projection Imaging

Purpose To investigate how absorbed doses to the conceptus vary with patient size in projection radiography.Method and Materials Absorbed doses to the uterus (i.e., conceptus) were obtained using a commercial patient dosimetry software package (PCXMC 2.0.1). Pelvic x‐ray images were simulated for a range of projections (Anteroposterior to Posteroanterior), and x‐ray beam qualities were varied by making adjustments to the x‐ray tube voltage (50 to 120 kV). Calculations were performed on patients whose weights ranged from 50 to 120 kg. For a given projection and beam quality, normalized uterus doses were obtained by dividing the uterus dose by the free‐in‐air kerma incident on the patient (i.e. mGy per mGy). Results For AP projections performed at 50 kV, increasing the patient size from 50 to 120 kg reduced the normalized uterus dose from 0.24 to 0.097 mGy per mGy; at 120 kV, the corresponding normalized uterus dose was reduced from 0.71 to 0.40 mGy per mGy. At 80 kV, increasing patient size from 50 to 120 kg reduced the normalized uterus dose from 0.28 to 0.11 for PA projections, and from 0.061 to 0.0085 for lateral projections. Conclusion Increasing patient size from 50 to 120 kg changes normalized uterus doses by about a factor of 2.0 for AP projections, a factor of 2.5 for PA projections, and a factor of 7 for lateral projections.

TH‐D‐203‐01: Enhancing the Medical Physicist — Patient Relationship

Patients today are increasingly aware of the importance of medical physicists in the safe and effective use of radiation for diagnosis and treatment. As a Medical Specialist practicing in a clinical department the medical physicists duties include direct interaction with patients and their families answering questions and providing assurance to the patient that the procedures they are about to undergo will be performed appropriately. However many currently practicing medical physicists lack the formal training from which their physician colleagues gain skills and confidence for interacting with patients. In radiationoncology simulation the physicist‐patient consult can occur for many different reasons but usually it involves helping the physician determine the best treatment options for a patient. At the time of simulation it is important for the physicist to be able to assist the therapist and dosimetrist in understanding and optimally implementing the treatment goals for a given patient for instance by participating in the design and fabrication of appropriate patient‐specific devices to meet these goals. In brachytherapy the medical physicist can be present in a number of roles; collaborating with physician colleagues during planning and delivery of the implant performing radiation surveys and instructing patients on safe practices for the duration of their irradiation. In diagnostic situations the medical physicist is often called upon to explain the radiation risks of a specific procedure. This has always involved sensitive issues such as pregnancy and concern for children and recent newspaper articles about radiation risk have raised more anxiety in the general population. Physicists also have to be able to educate and counsel individuals who have personal concerns about radiation radiation exposures and contamination. In this session speakers will discuss the importance of the medical physicists direct patient interactions in the above situations and will offer some advice regarding how best to present such issues. They will illustrate effective methods for such interactions including the use of anecdotal cases. The goal of the session is to provide medical physicists with ideas for improving their patient interactions; helping the patient to understand the procedures they are undergoing and thus enhancing the stature of the medical physicist.

WE‐C‐211A‐01: Requirements and Opportunities for Maintenance of Certification

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. Learning Objectives: 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.

WE‐D‐350‐01: MOC: The ABR Perspective

This course will review that status of the various aspects of accreditation by the American Board of Radiology. There have been a number of important changes in the process. Among the topics covered will be: 1) Changes in the requirements for the primary certificate for medical physicists. This section will discuss the changes that will require training in a CAMPEP approved program in 2012 and a residency by 2014; 2) Status of MOC. This section will review the current status of the MOC program and requirements; 3) Changes in the physics requirements for radiation oncologists and radiologists. There are significant changes in examination process for radiation oncologists and radiologists. This will require changes in the physics education of these groups. Radiation oncologists and radiologists in the MOC process will be tested on physics; 4) A report on the activities of TG 127: MOC will be presented.

WE‐C‐BRB‐01: Practice Performance Improvement Introduction for Medical Physicists

Practice Performance Improvement is a key component for analyzing and improving the practice of medical physics. It is also an important component of the maintenance of Certification Process for physicists certified by the American Board of Radiology. In order to use Practice Performance Improvement effectively physicists should have training in the techniques available. This session will provide the necessary training. The session is structured as follows: Introduction Practice Performance Improvement — Techniques and Methods. Application of Practice Performance Improvement in Radiotherapy. Examples of Practice Performance Improvement Projects from Diagnostic Radiology, Nuclear Medicine and Radiation Therapy.