news STRO - American Society for Radiation Oncology · 2011. 10. 27. · and Dr. Brady and Carlos...

SPRING 2011STROnews

Anthony Zietman, M.D.,

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S P R I N G 2 0 1 1Inside

Features14 New Red Journal editor selected Meet the new Red Journal editor, Anthony Zietman, M.D.

16 Survivor Circle grant updates Th e 2009 Survivor Circle grant awardees provide a one-year progress report on how they spent the grant funds.

19 Accrediting medical physicists ASTRO member calls for continued growth of accredited medical physicist training programs.

20 Member survey Find out how you view your ASTRO membership with the results of the annual member survey.

24 Cancer care cost projections Learn how NIH’s 2020 cost projections will impact cancer care.

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AMERICAN SOCIETY FOR RADIATION ONCOLOGY

SENIOR EDITOR: Thomas Eichler, M.D.PUBLISHER Laura I. Thevenot

EDITORIAL DIRECTOR: Beth BukataMANAGING EDITOR: Nicole Napoli

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news

VOLUME 14 • NUMBER 1

STRO

DepartmentsEditor’s Notes 4

Chair’s Update 5

Guest Column 7

Society News 8

Cancer Imaging Symposium 8

Corporate Advisory Council 10

Ambassador Recognition 10

IHE-RO 11

In Memoriam 11

Career Center 12

3B Forum 13

PQRS 25

Biology Bytes 27

At the Agencies 31

Upcoming Society Events 32

7

11

ASTRO’s Advocacy Day is March 27-29, 2011. Check the ASTROgram and

ASTRO homepage in the weeks

after the meeting ends for a

link to a special online only

edition of ASTROnews covering

radiation oncology’s premiere

advocacy event.

we believe in a better way

We believe it should be easier to achieve the results you desire.

www.TomoTherapy.com


EDITOR’Snotes THOMAS EICHLER, M.D.

CONTINUITY A HOMERUN FOR RED JOURNAL

WALTER ALSTON, THE ICONIC HALL OF FAME MANAGER of the Brooklyn and

Los Angeles Dodgers, is perhaps best

remembered for having signed 23

consecutive one-year contracts before

retiring from baseball in 1976.

He was succeeded by the loquacious

Tommy Lasorda, who went on to manage

the Dodgers for the next 20 years and is

likewise enshrined in the Baseball Hall

of Fame. Forty-three years. Two manag-

ers. Combined records: 3,639 wins, 3,052

losses, 11 National League pennants and

six World Series titles. Th ere is something

to be said for continuity.

ASTRO has had its own version of

Alston and Lasorda over the past three

and a half decades. Remarkably, our own

Red Journal has had only two editors in

36 years: Philip Rubin, M.D., FASTRO,

and James Cox, M.D., FASTRO. In

January 2011, Anthony Zietman, M.D.,

was named the third editor of what

has grown to become one of the most

respected cancer publications in the

world. How did we get here?

In December 1958, the American

Club of Th erapeutic Radiologists was

founded in Chicago under the leader-

ship of Juan del Regato, M.D. Fifty-four

members signed that original founders’

document, boldly seeking to diff erentiate

themselves from the RSNA, the ACR

and the ARRS.

By 1962, the membership had grown

to 252 at which time the offi cial name

was changed to the American Society

for Th erapeutic Radiologists (ASTR).

A decade later, the journal Cancer was

chosen as its authorized periodical, but

in 1975, the Society felt strongly

about establishing its own journal

and sponsored a new publication,

the International Journal of Radiation

Oncology•Biology•Physics (IJROBP).

In 1983, the expansive scope of the

organization was recognized by another

name change to the American Society

for Th erapeutic Radiology and Oncol-

ogy, and in 1984, the “Red Journal”, as it

quickly became known, was designated

as the offi cial publication of ASTRO.

Before the Red Journal actually made

it to the drawing board, however, some

decisions had to be made. Dr. Rubin

and Luther Brady, M.D., FASTRO, met

with the John Wiley publishing company

in 1973 to discuss the need for a jour-

nal devoted to the specialty, as well as a

textbook in radiation oncology.

As Dr. Brady tells it, “Th e decision as

to who would do what was determined

by the fl ipping of an Eisenhower dol-

lar. Heads did the journal, tails did the

book.” And thus did Dr. Rubin become

the founding editor of the Red Journal

and Dr. Brady and Carlos Perez, M.D.,

FASTRO, become the editors of the

Principles and Practice of Radiation

Oncology. (Continued on Page 6)

Dr. Rubin nurtured the new journal

with a paternal instinct, establishing

editorial guidelines to ensure quality

and integrity in the selection of scientifi c

studies for publication. Th e senior

editor was none other Dr. Brady, with

an Editorial Board that included such

legendary fi gures such as Th eodore

Phillips, M.D., FASTRO, and Eric

Hall, D.Sc., FASTRO. Advisory editors

included Dr. del Regato, Henry Kaplan,

M.D., and Vincent DeVita Jr., M.D.

Volume 1, number 1-2 appeared in

October 1975 and was scheduled to be

a monthly periodical. Th e price for

members of the ASTR was a cool $40.

Th e lead article in that inaugural edition

was titled “Management of presump-

tive or proven Hodgkin’s disease of the

liver: A new radiotherapy technique,” by

Schultz, Glatstein and Kaplan.

Th e new journal was so successful

that in 1984, the IJROBP supplanted

Cancer as the singular offi cial scientifi c

journal of ASTRO. Dr. Rubin remained

at the helm through 1996 when he

retired from clinical practice.

Th e ensuing search for the next editor

ended in Houston with the election of

Dr. Cox as the new editor-in-chief. His

fi rst issue in November 1997 paid tribute

to Dr. Rubin with a festschrift—a series

of scholarly articles by his colleagues “in

celebration of his professional contribu-

tions.”

Many of the preeminent radiation

oncologists, physicists and biologists

from around the world contributed to

Volume 39, number 4, including an

update on bladder cancer by Shipley

et al, whose authors included a junior

faculty member at Mass General by the

name of Dr. Anthony Zietmen.

5A S T R O N E W S | S P R I N G | 2 0 1 1

CHAIR’Supdate A N T H O N Y L . Z I E T M A N , M . D. , C H A I R M A N , B O A R D O F D I R E C TO R S

RIDING A SHINING WAVE: THE NEW GENERATION OF RESIDENTS AND THE FUTURE OF OUR SPECIALTY

ON JANUARY 25, PRESIDENT OBAMA

gave his State of the Union address and

talked about the value of education as

an investment in the future. Th at set

me thinking about our own educational

investment, our residents.

Who they are and how they

are trained will determine who they

become. In the short-term the health of

our specialty can be infl uenced by payer

policy decisions or by ASTRO’s strategy

on Capitol Hill. In the long-term, how-

ever, it is the quality of our “seed corn”

that will determine the strength and

vibrancy of the specialty.

As an associate residency program

director, I, like many of you, have

noticed a progressive rise in the quality

of applicants to our residency programs

over the last six to eight years. I knew

that radiation oncology was becoming

popular as a specialty that off ered real

patient care, high-technology solutions,

a rich research tradition and, let’s not

forget, sociable hours and generous

reimbursement.

I was not aware, however, just how

popular. I felt that better candidates

than ever had been applying to radiation

oncology but did not have the ability

to judge how good they were relative

to other fi elds in medicine. Statistics

published last year by the National

Residency Match Program (NRMP)

reveal the thrilling truth.

Th e NRMP reported the details of

the 2009 match and told us about the

class that will be entering our residency

programs this summer. Th ey published

fascinating data on 20 diff erent specialty

residencies. Let’s look at some of the

parameters they reported.

It is worth reminding ourselves that

we are a small specialty with a class of

only 159 selected in 2009. Th is makes

us much closer in size to neurosurgery,

ENT and plastics than to the mega-

residencies of medicine, surgery,

anesthesiology and radiology.

Our applicants did extremely well

in terms of USMLE step 1 and 2 scores

coming in a close third behind plastics

and dermatology. Our median scores

were 238 and 245, theirs 248/248 and

229/251, respectively.

Family medicine, physical medicine

and psychiatry represent the “tail” with

median scores around 205. Fifty-four

percent of our residents attended one

of the “Top 40” U.S. medical schools

defi ned by National Institutes of Health

(NIH) funding.

Th is put radiation oncology on top

of the chart with plastics (52 percent),

neurosurgery (50 percent) and derma-

tology (47 percent) following behind.

Again, we were in the top four for

proportion of residents who were Alpha

Omega Alpha at 35 percent. Derma-

tology ranked fi rst at 51 percent with

the other “usual suspects,” plastics and

neurosurgery, in between.

Striking as these numbers appear,

perhaps the most compelling data comes

when one looks at preresidency research

experience. Radiation oncology residents

had an average of eight abstracts, pre-

sentations and publications, second only

to plastics. At the opposite end of the (Continued on Page 6)

It is worth reminding ourselves that we are a small specialty with a class of only 159 selected in 2009.


scale several residencies have a class with

an average of less than two such experi-

ences.

Th is may refl ect the signifi cant

proportion of radiation oncology residents

with higher degrees and the research

opportunities they would have off ered.

Th irty two percent of our residents had

higher degrees with 22 percent Ph.D.s

and 10 percent master’s.

Th e only specialties to come close

were pathology at 16 percent and 9 per-

cent, neurosurgery at 12 percent and

14 percent, and dermatology at 11 percent

and 10 percent, respectively. Many spe-

cialties have fewer than 2 percent Ph.D.s.

If the seed corn is of the highest

quality, what of the ground into which

it is planted? I believe our residency

programs are better organized and off er

better educational opportunities than

ever before.

Th is comes, in part, in response

to the ACGME strengthening the

educational component of all residency

programs, but it is also an inevitable con-

sequence of radiation oncology programs

competing for the superstar candidates.

It is also worth noting that a unique

training opportunity was created 10 years

ago by the American Board of Radiol-

ogy for radiation oncology and

diagnostic radiology residents and

championed by, then trustee, Jay Harris,

M.D., FASTRO.

It was a training track for the

most academically and clinically gifted

residents and named the Leonard

Holman Pathway after the great

Brigham radiologist of that name. Th is

unique and selective program abbrevi-

ates the clinical training from 36 to 27

months and lengthens the research time

from 12 to 21 months.

It allows graduating residents with a

strong research inclination to undertake

more lengthy and substantial projects

and puts them in an excellent position to

apply for major NIH grants early in their

days on faculty.

To date nearly 100 residents have

availed themselves of this opportunity,

a staggering 80 percent of them coming

from radiation oncology (and remember

diagnostic radiology is eight times our

size!). During this 10th anniversary year

the outcome of the program is being

evaluated with surveys of graduates and

program directors.

Early numbers strongly suggest that

the vast majority of graduates did

exactly what was anticipated; they

EDITOR’Snote(Continued from Page 4)

CHAIR’Supdate(Continued from Page 5)

Dr. Cox presided over a period that

successfully ushered the Red Journal

into the digital age with the advent of

an electronic manuscript submission and

review system that nearly doubled the

number of submissions between 2004

and 2010. Th e impact factor (the average

number of journal article citations in a

particular year) jumped dramatically dur-

ing Dr. Cox’s tenure, from 2.367 in 1996

to 4.592 in 2009, the last year for which

such data is available.

And now, after 36 years, ASTRO not

only celebrates the selection of Dr. Ziet-

man as the new editor of the Red Journal

entered research careers, obtained major

awards and are on their way to being

future leaders in oncology.

What can we take from all this? I

believe the data show that the strong

intellectual appeal of radiation oncol-

ogy together with its heavy emphasis on

patient care and its relatively tolerable

lifestyle have combined to make it the

most attractive specialty in the United

States for the smartest, most caring

and most research-oriented medical

students.

Th is augurs very well for our

specialty as this generation will be more

than capable of absorbing, even leading,

the molecular revolution in oncology.

Radiation oncology has always been a

Cinderella specialty next to its bigger

and more assertive sisters in surgery and

medical oncology.

Its value has never been assumed,

and since the days of del Regato, it has

had to argue its case from evidence. If

life is a long relay race, we are passing our

torch on to the fastest and fi ttest genera-

tion of new residents in our history.

Dr. Zietman is a radiation oncologist at

Massachusetts General Hospital in Boston.

He welcomes comments on his editorial at

[email protected].

but also proudly announces the birth of a

new quarterly publication, Practical

Radiation Oncology, destined to be

known simply as PRO.

Th is journal will focus more on

the everyday management of cancer

patients using the various radiotherapeu-

tic modalities at our disposal and provide

a forum for exploring treatment conun-

drums and exchanging information.

W. Robert Lee, M.D., a respected

clinician, researcher and colleague from

Duke University, will edit PRO. Like its

predecessor, PRO is expected to eventu-

ally morph into a bimonthly or monthly

publication and to serve as a pragmatic

complement to the IJROBP. Th e fi rst

issue was mailed in late January.

Continuity. It’s worked for both the

Dodgers and for the Red Journal, and

even though the latter have had their

problems of late, the proud tradition of

ASTRO publications suggests nothing

less than unqualifi ed success. If the Red

Journal is considered the MVP (Most

Valuable Publication), then PRO should

be a shoo-in for Rookie of the Year. Stay

tuned.

“Be well. Do good work. Keep in

Touch.” (Garrison Keillor)

Dr. Eichler is the medical director of

radiation oncology at the Th omas Johns

Cancer Hospital in Richmond, Va. He

welcomes comments on his editorial at

[email protected].


GUESTcolumn MATTHEW KATZ, M.D. | ASTRO COMMUNICATIONS COMMITTEE CHAIRMAN

RADIATION ONCOLOGY: A STORY THAT NEEDS TO BE TOLD

THE ARTICLES ABOUT RADIATION SAFETY from Th e New York Times keep

reminding me of something I learned my

fi rst year of residency: radiation oncology

is one of the most opaque specialties in

medicine. And it’s hurting our ability to

help our patients.

During one of my fi rst rotations at

Memorial Sloan-Kettering Cancer

Center, I spent time following a

renowned medical oncologist around in

clinic. One of his patients needed radia-

tion therapy. “Just buzz him,” he said.

Further discussion made it clear: he had

no sense of how the radiation was done,

and he had not seen a linear accelerator

in two decades in oncology.

In the decade since that conversation,

I’ve continually been impressed by the

degree of fear and misinformation

surrounding radiation oncology. As a

volunteer with ASTRO, I’ve been

fortunate to see some improvement

related to public policy.

But given the number of challenges

we currently face as a specialty, I believe

we need to focus more eff ort on eff ec-

tively communicating what we do. And

I fear unless we dedicate ourselves to

telling our stories, Th e New York Times

and others will do it for us.

To some extent, radiation oncology is

a victim of its own successes. Technical

and scientifi c advances have been excit-

ing and benefi cial to our patients. Often,

the overt emphasis in training is on

technology, expertise and specialization.

Interpersonal skills are valued but not

often cultivated or taught. Unless we

want to be technicians, we must use the

humanistic aspects of our training more

rigorously. Despite the rigor we instill

into our work, ultimately medicine is a

social science.

Doctor means teacher in Latin.

Whether it’s your breast cancer patient

afraid that radiation will make her lose

her hair or the congressional aide who

thinks you are a radiologist, you can

share your knowledge and stories to help

educate them.

Better communication can also help

inform the nurses, therapists, dosime-

trists, physicists, administrative assistants

and other health professionals we depend

upon so that we provide better, safer

treatment. Communicating is a learned

skill, so we need to work at it. But that’s

why it’s called medical practice, after all.

If we hone our skills in storytelling

and putting a human face on the fi eld,

radiation oncology will be better able to

provide a clear, cogent narrative on many

important issues:

• How radiation can cure and alleviate

suff ering.

• Our commitment to our patients.

• How we coordinate many health

professionals to off er radiation

treatment safely and eff ectively.

• Why self-referral threatens the quality

and cost of cancer care.

• Th e need to invest in cancer research.

Th ese issues are up at the top of my list,

and I’m sure you have others to share. By

sharing our stories, we can learn together

more eff ective ways to educate and to

demonstrate how valuable our work is

on all levels: personal, professional and

societal.

You can help improve how we com-

municate today. ASTRO is currently

planning to update its brochures and the

RT Answers website. We already have

several ASTRO members helping on

the Communications Committee, but

you can give us advice. What works in

your conversations with prostate cancer

patients? What questions do you want to

see in the brochure and on the website?

You can share other stories that you

think will help ASTRO humanize the

work we do. Keep it HIPAA compliant,

but sharing what inspires or concerns

you helps ASTRO understand how to

better represent you and patients. What

really matters to you? Share your

stories about radiation oncology at

[email protected].

Dr. Katz is a radiation oncologist at

Radiation Oncology Associates in

Andover, Mass.


SOCIETYnews

CANCER IMAGING SYMPOSIUM TO PROMOTE MULTIDISCIPLINARY LEARNING

AS THE LARGE SPECIALTY SOCIETY annual meetings, such as ASTRO,

American Society of Clinical Oncology

(ASCO) and the Radiological Society

of North America (RSNA), have now

grown to enormous size, there is the risk

that they become impersonal and that

major research fi ndings or key presenta-

tions can get swamped in the noise.

What is more, as cancer care becomes

truly multidisciplinary, the specialty

meetings don’t have suffi cient balance to

refl ect this. As a result, the last eight years

have seen the growth of smaller multidis-

ciplinary site-specifi c cancer meetings.

In each case, one of the cancer societ-

ies takes the lead on organization but

with co-sponsorship by the other relevant

societies who have seats on the steering

and program committees. All participants

are together in the same room the entire

time and there is no fragmentation like

with the society annual meetings.

Everyone hears the same presentations

at the same time, which is tremendous

for discussion in the evenings and for

esprit generally. Th e results have been

wildly successful with the GI, GU and

breast meetings drawing between 1,000

and 2,000 participants and the thoracic

and head and neck meetings between

500 and 1,000. Th e major research

fi ndings are now frequently and prefer-

ably presented at these meetings fi rst.

One clinical group has, however,

always been underrepresented and never

co-chaired a multidisciplinary cancer

meeting—the diagnostic radiologists.

When one considers their contribution

to cancer care, regardless of site, it is

clear that radiologists have much to learn

from their colleagues in therapy about

our specifi c needs and how we translate

their fi ndings into action.

Equally, we in radiation oncology

have become more of an image-based

specialty and have so much to learn from

them. Our residents often complain

about their lack of radiologic training,

and this is indeed an area where the

syllabus lags practice.

To my delight Sarah Donaldson,

M.D., FASTRO, now RSNA chair-

man of the board of directors, suggested

a few years back that ASTRO and the

RSNA come together to collaborate on a

single meeting on the subject of imaging

in oncology emphasizing the two-way

interaction between our specialties.

When one thinks about it, there is no

point in the course of a patient’s cancer,

from diagnosis to death, where images

do not play a role in decision-making

and therapy. It starts with screening

and cancer detection and moves on to

staging and prognostic determinations.

Th en there is the role of imaging in

targeting therapy, assessing response and

ultimately detecting relapse.

I have, together with Suresh

Mukherji, M.D., professor of radiology

from the University of Michigan, been

given the task of heading up this joint

meeting—Th e Cancer Imaging and

Radiation Th erapy Symposium—in

Atlanta on April 29 - 30, 2011, and am

delighted to say that the program is

coming together superbly.

Over the two days we have four

morning sessions on new radiographic

techniques in oncology, matching

pathology with imaging, imaging and

outcome prediction, and image guided

therapy. Each session has speakers from

both disciplines.

In the afternoons we will take four

cancer sites, breast, prostate, lung and

CNS, and run from diagnosis through

therapy to relapse with multiple speak-

ers looking at the points of intersection

between the two specialties and learning

from one another as we go.

Th ere will also be two keynote

speakers, Brian Ross, Ph.D., will talk

about molecular imaging in oncology

and David Jaff ray, Ph.D., about image

guided cancer therapies.

While the meeting will concentrate

on the nuts and bolts of anatomic and

metabolic imaging in contemporary

cancer care and in radiation therapy, we

also plan to showcase research. We are

delighted to have nearly 150 submitted

research abstracts, a tremendous number

for a fi rst meeting and which bodes very

well for attendance and success.

Most of these will be displayed in

poster sessions but some will be

presented orally during the morning

sessions. As a “teaser” I have described

some of the more intriguing and high-

scoring abstracts below without revealing

their results to give you a sense of the

quality of the work and of its breadth

and relevance to our fi eld.

One study from Washington Univer-

ANTHONY ZIETMAN, M.D., SYMPOSIUM CO-CHAIRMAN

EDUCATION | MEE TINGS


sity looked at over 600 patients with head

and neck cancer who received IMRT

for their treatment. Th is study shows the

frequency with which local progression

is evident on the simulation scan, the

frequency with which it is picked up by

radiation oncologists at that time and

the frequency with which it is only seen

retrospectively by which time the conse-

quences for the patient may be grave.

Another study from St. Jude reminds

us how critical a dose-limiting organ the

brain stem is when in proximity to the

target volume for patients with tumors of

the head, neck and brain.

A Cancer Center of Irvine study looks

at the use of a gel-type tissue spacer,

injected through the perineum under

ultrasound guidance, to decrease the

rectal dose during intensity modulated

radiation therapy for prostate cancer.

Th ey took MRIs before and then seri-

ally throughout the course of treatment

and monitored changes in the spacer

compound over time and the degree of

separation it had created between

prostate and rectum.

Memorial Sloan-Kettering Cancer

Center researchers are presenting a

prospective study on lymphoma patients.

Th ey examined the FDG-PET CT

target volume defi nition and provoca-

tively compared the gross target volumes

drawn by radiation oncologists with

those that would have been drawn by

radiologists.

ASTRO and RSNA are proud to

be hosting this important multidisci-

plinary meeting. We anticipate a fi rst

class program and are looking for great

attendance.

Th e date is fi xed, the invitation is

open and every ASTRO member, be

they a radiation oncologist, physicist or

resident, is welcome. Let’s rub shoulders

with our colleagues in diagnostic radiol-

ogy, learn from one another and improve

the care of patients with cancer.

Dr. Zietman is a radiation oncologist at

Massachusetts General Hospital in Boston.


SOCIETYnews

BY LINDSAY HOFFMAN, DEVELOPMENT AND CORPORATE RELATIONS COORDINATOR, [email protected]

ASTRO’s Corporate Membership of nearly 100 companies has elected new Advisory Council representatives. There were three seats open for three-year terms. Council seats are comprised of small, medium and large size corporations based on their sales volume in radiation oncology, and seats represent a cross section of the radiation oncology industry. The election resulted in a tie in the small company category, with two newly elected Council members from D3 Radiation Oncology Solutions and WFR-Aquapast/Qfi x Systems. Council members from Brainlab

FOUR COMPANIES ELECTED TO CORPORATE ADVISORY COUNCIL

and Accuray were re-elected to their seats in the medium and large company categories, respectively. A complete Council listing with term expirations is as follows:

Calypso Medical (2011)Standard Imaging (2011)Varian Medical Systems (2011)Alliance Oncology (2012)Elekta (2012)Revenue Cycle Inc. (2012)D3 Radiation Oncology Solutions (2013)WFR-Aquaplast/Qfi x Systems (2013)Brainlab (2013)Accuray (2013)

The Council strives to fulfi ll its mis-sion to establish a synergistic relationship between ASTRO and the Corporate Mem-bers to focus on issues and initiatives of mutual concern, including increas-ing awareness of radiation therapy and advancing the science and practice of cancer treatment and patient care. The Council convenes quarterly with ASTRO leaders to discuss issues of mutual concern in the radiation oncology profession.

DEVELOPMENT AND CORPORATE RELATIONS

ASTRO proudly recognizes our 2011 Corporate Ambassadors

for their outstanding year-round leadership and support of radiation oncology.

AMBASSADORrecognition


ASTRO has recently learned that the following members have passed away. Our thoughts go out to their families and friends.

MELVIN GRIEM, M.D.HERBERT KERMAN, M.D., FASTRO

CHARLES W. KIMSEY, M.D.

The Radiation Oncology Institute (ROI) graciously accepts gifts in memory of or in tribute to individuals. For more information,

call 1-800-962-7876 or visit www.roinstitute.org.

In M emoriam

SOCIETYnews IHE-RO | RESEARCH | MEMORIAM

CONNECTION IS KEY TO SAFE, EFFECTIVE RADIATION THERAPYBY SIDRAH ABDUL, RESEARCH COORDINATOR, [email protected]

TREATING A PATIENT WITH RADIATION

requires the synchronization of a multi-

tude of people, processes and equipment.

For this reason, it is imperative that

the systems that are used to deliver this

treatment have a seamless connection

with one another. However, this is not

always the case. Clinicians experience

daily situations in which achieving a

connection between systems from

diff erent vendors poses obstacles.

Currently, the only formal way for

clinicians to communicate with various

health care vendors to establish solu-

tions for everyday connectivity problems

is through Integrating the Health Care

Enterprise-Radiation Oncology (IHE-

RO), a platform to which problems can

be brought and where potential solutions

for interoperability are sought.

IHE-RO has successfully solved

many connectivity issues related to

treatment planning and delivery systems

brought forth by clinicians, physicists

and others involved in radiation oncol-

ogy since ASTRO began sponsoring the

initiative in 2004.

By 2007, a common process for

image-based 3-D radiation therapy

treatment planning systems was devel-

oped. In 2008, the process of exchang-

ing and storing image registration, RT

structure sets, RT doses and related

spatial registration was released. Th e

Advanced Radiation Th erapy Objects

process was developed in 2009 to address

the exchange of data required to per-

form sophisticated treatment planning

for computer controlled accelerators in

external beam treatment delivery (i.e.,

IMRT, virtual wedge, VMAT, etc.).

IHE-RO is currently developing a

treatment delivery workfl ow process that

will clarify the departmental workfl ow,

decrease errors, create a more accurate

method for billing and off er a more

consistent way of scheduling.

IHE-RO is also a critical part of

Target Safely, ASTRO’s patient protec-

tion plan. Th e crucial need for seam-

less compatibility of radiation therapy

equipment from diff erent vendors was

demonstrated in a December 2010

Th e New York Times article. Th e article

brought to light a series of radiation

overdoses administered to patients in an

Illinois hospital, with the reason for the

overdose ultimately being pinned on the

diff erent machines not properly reading

each other.

ASTRO has been working since 2004

to solve interoperability problems and

while progress has been made, there is

still a lot of work to be done.

“It is time to take IHERO to a new

level. With six years of work behind

the scenes by vendors and volunteers,

we have the product that the radiation

oncologists, medical physicists and

administrators can use in their Request

For Proposals (RFP) for the new

software and hardware acquisition,”

Prabhakar Tripuraneni, M.D., FASTRO,

said.

IHE-RO is always looking for dedi-

cated volunteers to help further advance

the fi eld of radiation oncology in the

fi ght against cancer. For more informa-

tion on how you can help IHE-RO in

its mission to ensure compatibility

between radiation treatment machines

or how IHE-RO can help you solve

your interoperability problems, visit the

website at www.astro.org/IHERO.

For more information on Target

Safely, visit www.astro.org/TargetSafely.

DID YOU KNOW:ASTRO has been working

since 2004 to solve interoperability problems and while progress has

been made, there is still a lot of work to be done.


SOCIETYnews M E M B E R S H I P

BEATING THE COMPETITIONCareer center participants off er interview, job hunting tips for residentsBY LISA GIBSON, MEMBER RELATIONS AND COMMUNICATIONS ADMINISTRATIVE ASSISTANT, [email protected]

RADIATION ONCOLOGY IS A HIGHLY SPECIALIZED, yet growing, fi eld. More

and more residents are deciding to

venture into this part of cancer care, and

the competition can be fi erce. Residents

should be prepared when applying for

radiation oncologist positions and make

sure that they’ve done their homework

when committing to future employers.

One of the important elements in

researching a future employment

opportunity is studying the background

of the location. You should be looking at

the practice, the other physicians and the

community to make sure it is a good fi t

for you.

During this process, be honest with

yourself. An anonymous recruiter stresses

this and said, “making yourself into

something you are not will make you

unhappy in the job you get and will

make the employer unhappy as well.”

Andy Trotti, M.D., a radiation

oncologist at Moffi tt Cancer Center and

an ASTRO Career Center participant,

suggests spending a week with your

future potential partner.

“Everyone is on good behavior in

one-hour interviews or at dinner. A week

inside the practice reveals much more,”

Trotti said.

As a resident, you will most likely be

applying to various cancer centers and

practices, which will result in multiple

interviews. Th ese facilities will have their

obvious similarities, but they will have

their diff erences as well. ASTRO

contacted several locations and found

one prominent desire for incoming

radiation oncologists: fl exibility.

Cancer care is an ever-changing fi eld

and the ability to modulate with that

change is the key to succeeding.

“We are seeing more and more

candidates who want to do things in a

very specifi c way, who aren’t willing to

cover other facilities and who are not

willing to compromise,” an ASTRO

Annual Meeting Career Fair participant

said. “In this ever-changing health care

environment, you have to be a chameleon

to survive and be successful.”

Joe Stork, chief development offi cer

for Oncure Medical Corporation and an

ASTRO Annual Meeting Career Fair

participant, also stresses the importance

of fl exibility.

“Most people do not really know

where they want to go or what kind of

work they will excel in even if they think

they do,” he said. “If they were fl exible to

consider other locations or types of jobs,

they would fi nd a whole spectrum of

opportunities they did not know existed

that would be very fulfi lling for them.”

Although residents may have

several priorities when searching for their

perfect position, the ultimate goal should

be providing the best possible treatment

for the cancer patients. In choosing

radiation oncology as a profession, the

fi ght against cancer should be your

guiding force in any job opportunity.

Th is goal should be shared by you and

your colleagues.

“Know the greatest and latest research

and treatment options for patients,”

John Sohrweid, offi ce supervisor and

personnel liaison for the University

of Colorado School of Medicine and

ASTRO Career Center participant, said.

“Develop good working relationships

with colleagues and staff since we all

work toward the same goal.”

Matthew Katz, M.D., of Radiation

Oncology Associates, P.A., agrees that

working collaboratively is ideal for

success in this fi eld.

“Success in radiation oncology hinges

on being an eff ective team leader, both

in clinic and in the community,” he said.

“Respect for all members of the team is

essential for providing good care.”

Keeping these tips in mind should

be helpful in your search for future

employment.

To assist you, please visit the ASTRO

Career Center at www.astro.org/

careercenter for current job opportunities

or visit the Career Fair at ASTRO’s 53rd

Annual Meeting in Miami Beach, Fla.,

October 2-6, 2011.

Cancer care is an ever-changing fi eld and the ability to fl uctuate with that change is the key to succeeding.


SOCIETYnews

ASTRO HOSTS NEW MEETING FOR TRANSLATIONAL RESEARCHERS BY JACQUELINE WILLIAMS, PH.D., FORUM CO-CHAIRMAN

IN THE LAST FEW DECADES, the biggest

advances in the discipline of radiation

oncology have been made in technology,

such as intensity modulated radiation

therapy and image-guided radiation

therapy.

Th ese are all advances that we know

allow radiation oncologists to more

defi nitively treat tumors and minimize

damage in the normal tissues, thus

improving patient treatment and safety.

It is no wonder that the Exhibit Hall at

the ASTRO Annual Meeting is packed

with bigger and better machines each

year.

Th e advances in the science of radia-

tion delivery have been less obvious but,

certainly, as signifi cant.

Enormous advances have been and are

being made in the molecular and genetic

areas, and it is imperative for radiation

therapy-related translational science

to be seen by the rest of the clinical

world as being science-driven and, more

importantly, as providing the momen-

tum that will move the fi eld of radiation

therapeutics forward in a scientifi cally-

justifi ed manner.

Th erefore, in line with ASTRO’s

mission to provide the membership

with information on the cutting edge

advances in the science, we are providing

a forum in which translational science is

the single focus of the meeting—the 3B

Research Forum: Benchtop to Bedside

and Back. Leaders from both the clinical

(bed) and basic (benchtop) sides of the

translational radiation fi eld have been

invited to provide information on the

cutting edge of science.

Th e format of the meeting is

focused on discussion between these

two important groups, with each session

being led by a scientist from both “sides.”

Th us, the meeting organizers have the

goals of not only providing our audience

with information and education about

cutting-edge research but also encourag-

ing dialogue between the participants

that will lead to deeper understandings

of issues and problems and to better

collaborations between the clinic and the

lab, enhancing ongoing research eff orts.

Finally, we hear almost on a daily

basis about the decline in the number of

young physicians and scientists entering

the fi eld of clinical cancer research; the

3B forum also aims at encouraging the

development of new work and provid-

ing converts to the world of clinical and

basic radiation science.

In this fi rst 3B forum, taking place

May 1-2, 2011, in Atlanta, we have

chosen the theme “Targeting.” When

you hear the word “targeting,” what do

you think of? Delivery of narrower, more

precise beams? Image-defi ned fi elds

helping to focus treatment on tumor

rather than normal tissue?

Certainly those are accurate defi ni-

tions and ones that will be discussed in

full at the Cancer Imaging and Radia-

tion Th erapy Symposium, a meeting that

is taking place immediately prior to the

3B forum.

But the word “targeting” means much

more to the oncologic area as a whole—

it means genes, proteins, molecules,

pathways, etc. Th is meeting has been

designed to broaden the defi nition of

targeting to the radiation oncologist and

scientist and open up new frontiers for

exploration.

Th e opening session will begin by

taking a closer look at the word “target-

ing” and discussing it in the context of

research and in terms of clinical trials

and patient selection. From there, the

sessions will delve into how we can make

use of targets in treatment, looking at

such concepts as cell signaling, DNA

repair, hypoxia and microenvironment,

and stem cells.

In addition, there will be discussion

about the use of biomarkers in trials and

how “targeting” in all of its defi nitions

aff ects high dose fractionation schedul-

ing. Finally, a session will be led by two

accomplished translational scientists

who will provide aspiring (and current)

researchers with information on how to

survive as a translational researcher.

We are anticipating lively discussions

on subjects that should prove of interest

to all ASTRO members, whether you

are in the trenches of research yourself

or just want to know where the fi eld is

going. So “target” the beginning of May

as a time to come to Atlanta and see

where the fi eld of translational radiation

research is going, and I’ll see you all on

the way to the 3B Forum!

Dr. Williams is a radiation biologist at the

University of Rochester Medical Center in

Rochester, N.Y.

EDUCATION | MEE TINGS


ANTHONY ZIETMAN, M.D., an

endowed professor of radiation

oncology at Harvard Medical School in

Boston, has been named the new editor

of the International Journal of Radiation

Oncology•Biology•Physics, ASTRO’s

primary research journal also known as

the Red Journal.

After more than 14 years in dedi-

cated service to the Red Journal and

ASTRO, current editor-in-chief James

Cox, M.D., FASTRO, announced last

year that he would retire when his third

fi ve-year term ended at the close of 2011.

In June 2010, ASTRO’s Board of

Directors selected then immediate past

chairman Patricia Eifel, M.D., FASTRO,

to lead a search for a new editor with the

help of an 11-person task force made

up of radiation oncologists from private

and academic practice, a biologist and

a physicist. Th e task force also included

a representative from our international

counterpart, Radiotherapy and

Oncology, and ASTRO’s new practice

journal, Practical Radiation Oncology.

To begin the search last summer,

advertisements ran in the Red Journal

and other related journals, and

announcements were published in the

ASTROgram and the ASTROnews.

Applications complete with curriculum

vitae and a vision statement had to be

received at ASTRO headquarters by

October 1, 2010, with the goal of

holding in-person interviews during

the Annual Meeting in San Diego

beginning November 1, 2010.

“I am pleased to announce we

received eight very strong applications

and interviewed three candidates at the

Annual Meeting,” Dr. Eifel said. “After

several conference calls and lengthy

discussions, the task force selected

Anthony Zietman, M.D. He gave a

presentation at the ASTRO Board of

Directors meeting in January 2011 and

has been confi rmed. I am thrilled for

Anthony and excited for him to build

upon Jim’s excellent work and the tenure

of Phil Rubin before him.”

Dr. Zietman’s qualifi cations include

a long commitment to ASTRO through

the Scientifi c Program Committee, the

Board of Directors and the presidency.

He has a lengthy history of scientifi c

writing publishing original works, books,

chapters and reviews in both clinical

radiation oncology and radiobiology and

is one of the most highly cited authors in

radiation oncology.

He has had multifaceted training in

internal medicine, medical oncology

and radiation oncology in both Europe

and the U.S. and has had a career that

has incorporated a higher degree in

radiobiology.

He brings to the job a substantial

history of editorial writing on the

future and evolution of our specialty. In

addition, he has a history spanning more

than 20 years of reviewing for multiple

oncology journals.

“It is with great pleasure and after

considerable thought that I accept the

editorship of the International Journal of

Radiation Oncology•Biology•Physics,” Dr.

Zietman said. “Under Dr. Cox’s leader-

ship, the journal has grown greatly in

stature, and it is an honor to maintain

that momentum and advance his work.”

Dr. Zietman also sits on the editorial

board for Practical Radiation Oncology.

Both ASTRO journals are published by

Elsevier, which will ensure PRO and

the Red Journal continue to work well

together.

Anthony Zietman named new read journal editor

BY KATHERINE BENNETT, ASTRO STAFF, [email protected]

Redcap J

M.D

James Cox, M.D., FASTRO, (R) hands over

the reins of the Red Journal to Anthony

Zietman, M.D., (L) after over 14 years as

editor.


“My goal for the journal is to

continue the extraordinary work of

Dr. Cox but to do it with a diff erent

fl avor. I would not envisage any immedi-

ate revolutionary changes but see change

as an inevitable evolution,” Dr. Zietman

said. “I plan to continue the close liaison

with the ASTRO Board of Directors but

maintain a healthy independence from it.

To me, if the science and safe delivery

of radiation therapy is the body of our

specialty, then ASTRO and the Red

Journal are its right and left arms,

independent but clearly linked.”

HIS GOALS FOR THE JOURNAL INCLUDE:• Producing the most readable journal possible with a high quality of

writing and greater use of images and covers.

• Reaffi rming the commitment to the best science, the most rigorous ethics, the avoidance of confl icts, and transparency and full disclosure.

• Creating new features such as Washington reports, creative writing, a digest of literature from other journals and video submissions.

• Creating more alignment with the American Board of Radiology and the career-long educational needs of radiation oncologists.

• Expanding the interest of other nations in the journal. With Web technology, it is possible to envision electronic supplements in other languages, such as Japanese, Chinese or Spanish.

Dr. Zietman says he intends to share

the responsibility of the Red Journal

with a global panel of senior editors

including one who will work with him

on electronic initiatives. He has already

begun preparing for the transition by

talking with other editors to learn best

practices before he assembles his editorial

board. In February, he met with Dr. Cox

in Houston to work out a succession plan.

Dr. Zietman’s fi rst issue will be January

2012.

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ASTRO provides patient support year-round with Survivor Circle grants

he Survivor Circle grant is a funding initiative that provides gifts of fi nancial support to non-disease site specifi c cancer support organizations

in the states where ASTRO holds its annual scientifi c meeting.

The emphasis of this initiative is to provide cancer support organizations with the funding to assist in continuing, growing or creating programs to help

cancer patients, cancer survivors and their families from diagnosis through survivorship. The two recipients of the 2009 Survivor Circle Grant Program, Gilda’s Club Chicago and Halos of Hope, each received a grant of $10,000.

As part of their award, they were asked to update the ASTRO membership on their progress. This is the second of their two updates.

Gilda’s Club ChicagoBy Stephen Majsak, director of development,

Gilda’s Club Chicago

THIS PROVIDES A FINAL REPORT ON THE SURVIVOR CIRCLE grant awarded to Gilda’s Club Chicago. Th e grant

was used to support Gilda’s Club Chicago’s program, which

provides social, emotional and informational support to those

living with cancer, along with family and friends.

Our fi scal year 2010 goal was to enroll 600 new members

and generate 9,500 member visits. At year-end, we are

projected to serve 759 individuals and host 10,220 visits

through our Clubhouse and hospital sites:

• Total visits are up from 9,843 in fi scal year 2009 to 10,220

visits in fi scal year 2010.

• Total members served is up from

750 in fi scal year 2009 to

759 individuals in

fi scal year 2010.

GGi

visits in fi scal year 2010.

• Total member

750 in

T

Laura Thevenot,

ASTRO CEO, and

Rep. Parker Griffi th,

present members of

Gilda’s Club Chicago’s

board with a $10,000

grant check.

17A S T R O N E W S | S P R I N G | 2 0 1 1 17A S T R O NO N E W S | S P R I NI N G | 2 0 1 1

Halos of HopeBy Pam Haschke, president, Halos of Hope, and

Kathi Brown-Wright, vice-president of marketing,

Halos of Hope

IN OUR APPLICATION, HALOS OF HOPE requested the

Survivor Circle grant so that we could fund expansion of our

distribution capabilities, enabling us to regularly deliver caps

to cancer centers and hospitals in communities across the

U.S. Th e program that we asked ASTRO to fund was a new

approach to distribution and cap collection through locally-

based donation locations.

We needed initial funding to prove this revised distribu-

tion model would work and we could expand our scope and

outreach to serve more cancer patients across the U.S. As

ASTRO might recall, prior to the grant award, Halos of Hope

was reliant upon a handful of volunteers to tag each donated

hat and pack and mail them to our centers. Th is approach

was sustainable in nominal quantities but did not allow for

expansion, and hats were not sent out on a regular basis.

(Continued on Page 18)

In addition we have made progress on our plans to expand

hours at our Gilda’s Club Chicago satellites in the city’s

leading academic medical centers:

At Northwestern University Medical Center

o We have expanded programming from one afternoon

to three days (from four hours to 15 hours).

o We now have outpatient and inpatient programming.

At Rush University Medical Center

o We have added a weekly caregiver support group, two

weekly support groups for minorities and a support

group for Polish-speaking patients.

o We have two outpatient program locations as well as

impatient programming.

At the University of Chicago Medical Center

o We are re-evaluating our inpatient program and are

now serving patients in the infusion room where they

are receiving medical treatment.

We have also have made a number of strategic changes to

enhance the program at the main Clubhouse:

We continue to partner with Chicago-based 501c3 non-

profi t Clearbrook for the tagging and shipping of caps to

cancer centers across the country. Clearbrook off ers an adult

training program for those with developmental disabilities,

enabling them to learn employment skills and earn wages to

help them feel more independent. Tagging, packing and ship-

ping Halos of Hope caps is a perfect fi t in terms of tasks best

suited for Clearbrook clientele. We have been able to lever-

age Clearbrook’s relationships with UPS and FedEx Ground,

keeping our shipping costs manageable.

• We moved our “Noogie Night” kids activities from evening

programming to a Saturday program so that parents could

take advantage of parenting workshops and activities when

their children are involved in Noogieland activities.

• We have expanded our teen activities with the guidance of

a teen council made up of teen members, adding activi-

ties like hip-hop classes and a bowling night to provide

activities that the council has identifi ed as having the most

interest to teen members.

• We have added a number of family activities (e.g., Family

Night at the Circus, Chicago Cubs and Chicago White

Sox tickets, movie nights) and have received strong feed-

back that these events provide an important opportunity

for families to share time together, strengthening family

bonds at a time when going to fun events together can

otherwise take second priority to doctors visits and medical

concerns.

Gilda’s Club Chicago continues to off er over 200 activities

each month for those impacted by cancer. All of our programs

are off ered free of charge. Your support from the Survivor

Circle grant has made these achievements possible. Th ank you.

andpr

Rep. Parker Griffi th and Laura Thevenot, ASTRO CEO,

present Pam Haschke, president and founder of Halos

of Hope, with a $10,000 grant check.


Cap contributions through local yarn shops are growing

steadily. Additionally, Halos of Hope was recognized by DRG

Network Inc. and Arts in Action Inc., which will continue to

foster relationships with the shops who carry their products

and provides an additional source of funding.

As provided in our August update, yarn shop owners asked

us to think about participating in local, regional or national

events targeted to our volunteer population of knitters/

crocheters/crafters in an eff ort to broaden awareness. Halos has

been off ered an opportunity to work with XRX Inc., publisher

of Knitters Magazine, a variety of books and sponsor of the

Stitches Markets held four times each year. Th e chief executive

offi cer of XRX has off ered us an opportunity to participate in

all four regional Stitches Markets next year based upon the

success we had with our participation in Stitches Midwest in

late August. Halos had well over 1,500 people visit our booth

during the four-day venue, creating additional awareness with

individual volunteers and yarn shops and with social crafting

networks such as the Crafty Angels, a national organization

based in Illinois, several youth groups and Girl Scout troops

looking for opportunities to serve the community.

Halos will participate in the Midwest show again in

August 2011. We had a booth at the west show in Santa Clara,

Calif. (February), and will have booth at the south show in

Atlanta (April) and the east show in Connecticut (October),

thanks to our new relationship with the XRX team.

At the end of 2009, Halos of Hope cancer caps could be

found in 150 centers located in 40 states. As of November 1,

2010, our caps are now available to help cancer patients in 302

centers across all 50 U.S. states, and we have reached some in

need in Canada and the United Kingdom. Th is represents a

100 percent increase in cancer centers served.

We continue to focus our expansion to cancer centers in

economically-repressed areas throughout the country, as we

feel they have the greatest need to help cancer patients under-

going treatments with limited insurance or funds. Th at said,

several locations of the American Cancer Society have reached

out to us to provide hats for the patients they serve. Previously,

Halos had worked with ACS offi ces in Illinois but not beyond

the state border. We are excited about this opportunity.

Halos also partnered with three young people who were

trying to make things better for cancer patients in their

communities.

• Alex Speidel from Pennsylvania became an Eagle Scout

this year based on a community service campaign to

provide a Satchel of Caring to men diagnosed with cancer.

One hundred and twenty Halos specially crafted for men

were donated to Alex’s campaign.

• Asjá McCullough from South Carolina is a brain cancer

survivor who wanted to help kids at St. Jude’s hospital feel

a little stronger through their cancer experience. She asked

for kids hats to be donated so she could give back to the

hospital that helped her survive. Eighty hats were donated

to Asjá’s cause.

• Bethany Mejean from Kentucky is vying for a governor’s

scholarship in her home state. Her leadership project was

to rally knitters and crocheters to make and donate hats

for cancer patients. Using the social network site Ravelry,

Bethany began Stitches for the Cure. Halos partnered with

Bethany to do further outreach through other social media

outlets (Facebook and Twitter) and through local standard

media. Th is eff ort is bringing in 182 hats to Halos’ inven-

tories. Th ese hats will be sent to cancer centers in need

throughout Bethany’s home state of Kentucky. Her schol-

arship application was submitted on December 2, 2010.

We will continue to support programs such as these to help

young people striving to become leaders and ensure cancer

patients receive much needed comfort through their

treatments.

As previously reported, the critical statistic for this project

is the sustained increase in numbers of hats sent as compared

to last year. With Clearbrook clientele tagging, packing and

shipping our caps, we are able to send hats to cancer centers on

a weekly basis, meaning more hats are available to help those

who have lost their hair due to radiation or chemotherapy

treatments. Our growth in caps distributed still exceeds last

year’s totals by over 240 percent.

Lastly, based on a relationship our founder, Pamela

Haschke, established with Richard Nares in late 2006 as she

was conceptualizing Halos of Hope as a possible not-for-profi t

and the ongoing dialogue between our organizations, we are

absolutely thrilled that ASTRO selected the Emilio Nares

Foundation as a 2010 Survivor Circle Partner. We gladly pass

our torch to an organization that gave us a lot of insights and

encouragement to launch Halos and help us grow!

(Continued from Page 17)Survivor Circle grants

Halos had well over 1,500 people visit our booth during the four-day venue, creating additional awareness with individual volunteers and yarn shops and with social crafting networks such as the Crafty Angels, a national organization based in Illinois, several youth groups and Girl Scout troops looking for opportunities to serve the community.


THE MANAGEMENT OF CANCER PATIENTS with radiation therapy has

been a team eff ort since the discovery of

X-rays over 100 years ago. Revelations

in Th e New York Times over the past year

have highlighted the critical importance

of timely, adequate and appropriate

quality assurance guidelines and the

disastrous outcomes when such

algorithms are either not in place or

ignored.

ASTRO took a proactive position

and issued Target Safely, a patient

protection plan, in early 2010 to under-

score the Society’s unfl agging support of

patient safety, fi rst and foremost.

ASTRO’s dedication to this plan was

reaffi rmed in January of this year.

What may be lost in the noise,

however, is the crucial role that medical

physicists play in the eff ective delivery of

modern, complex radiotherapy regimens.

In 1997, the Committee for Accredi-

tation of Medical Physics Education

Programs began accrediting physics

residency programs. Th e graph above

illustrates the slow but steady progres-

sion of accredited programs beginning in

1997. It is anticipated that there will be

between 70-80 accredited programs by

the end of 2012 with approximately

20 programs currently under review.

Th is exponential growth should

meet anticipated clinical demands. At

the urging of the American Board of

Medical Specialties, the American

Board of Radiology, in conjunction with

the American Association of Physicists

in Medicine (AAPM), has made the

successful completion of an accredited

residency program a requirement for

those individuals applying for certifi ca-

tion in 2014.

Accredited programs will provide

24 months of robust training with

intensive clinical exposure. Reaccredita-

tion will be required every fi ve years.

Now, more than ever, it is clear that

well-trained physicists, preferably from

accredited programs, are vital to the safe

delivery of complex radiotherapy plans

such as IMRT, SRS and SBRT.

Radiation oncologists are encour-

aged to hire physicists who graduate

from such programs and successfully

meet the rigid guidelines established for

board certifi cation. Adequate fi nancing

for these residency programs, however,

continues to be a daunting challenge.

Proper Accreditation Council for

Graduate Medical Education classifi ca-

tion of these programs to ensure Centers

for Medicare and Medicaid Services

(CMS) reimbursement is strongly

recommended. Th e ASTRO Board

MEDICAL PHYSICISTS’ ACCREDITATION A KEY ASPECT OF PATIENT SAFETY

BY ERIC E. KLEIN, PH.D.

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

YEAR

45

40

35

30

25

20

15

10

5

0

CAMPEP ACCREDITED RESIDENCY PROGRAMS

RE

SID

EN

CY

PR

OG

RA

MS

recognizes this critical need and has

issued a statement to support CMS

reimbursement and has asked depart-

ment chairs to “lobby for sustained

funding for physics residency programs

within their institution.”

Medical physicists are integral to

the fundamental operation of a high-

quality radiation oncology program. It is

incumbent upon those in hiring posi-

tions to select individuals with suffi cient

training and adequate clinical experience

to oversee the physics aspects of their

programs. Anything less is a disservice

to our patients and our specialty.

Further information can be found

at http://campep.org/res.asp and from

an AAPM subcommittee on residency

programs at www.aapm.org.

Dr. Klein is the chief of physics at the Wash-

ington University of St. Louis Department of

Radiation Oncology.


B Y B A R B A R A M U T H , D I R E C TO R O F R E S E A R C H , B A R B A R A M @ A S T R O. O R G

ASTRO’s annual member survey was made available online to all members between July 7, 2010, and September 1, 2010. This year, in addition to the demographics and questions about education needs, the survey focused on an assessment of the kinds of therapy currently being used by members and the importance to members of some aspects of ASTRO’s strategic plan.

We sent announcements of the survey in fi ve ASTROgrams and two targeted e-mail announcements. There were 1,718 valid surveys returned or approximately 17 percent of ASTRO mem-bership. A response rate of 15-20 percent is fairly standard for online surveys such as the ASTRO member survey, but having a larger proportion of members responding to the annual mem-ber survey will help ASTRO better identify and serve the needs of all of its membership. What follows is a brief summary of some of the fi ndings from the survey data.

Annual member survey results show

what ASTRO members value

Member survey


CHART 1: RESPONDENT DEMOGRAPHIC – PROFESSION

Of the 1,718 respondents to the member survey, 1,168 (68.1 percent) stated they were either radiation oncologists or clinical oncologists (i.e., overseas physicians who are qualifi ed to administer radiation therapy), 340 (19.8 percent) described themselves as medical physi-cists, 22 (1.3 percent) described themselves as radiation biologists, 44 (2.5 percent) described themselves as oncology nurses or nurse practitioners, 25 (1.5 percent) as radiation therapists, 22 (1.3 percent) as dosimetrists, and 27 (1.6 percent) described themselves as retired. ASTRO members practice their professions in many countries. Of those countries, 69.5 percent of respondents indicated that they practice in the U.S., 4.6 percent in Canada, 1 percent in China, 1.3 percent in India, 3.6 percent in Japan, 1.7 percent in Germany, 2.1 percent in Brazil and 1.3 percent in Italy. The remaining 15 percent are distributed among an additional 54 countries in Europe, Asia, Oceania, Latin America and Africa. When asked about the population density of their practice loca-tion, 65.2 percent of respondents said they practiced in an urban area, 22.1 percent in a suburban community and 9.6 percent in a rural area.

CHART 1: Respondent demographics - profession

Radiation Biologist 1.3%

Medical Dosimetrist 1.3%

Radiation Therapist 1.5%

Oncology Nurse/ Nurse Practitioner 2.5%

Radiation/Clinical Oncologist 68.1%

Medical Physicist 19.8%

Other 2.6%

Retired 1.6%

Practice Administrator 1.3%

CHART 2: Primary employment arrangement

of U.S. based radiation oncologists

Not in Clinical Practice 0.2% Other 5 %

Locum Tenens 4.8 %

Employee of Group Practice 15%

Academic GroupPractice 34%

Partner in Private/Group Practice 29%

Hospital 12%CHART 2: EMPLOYMENT ARRANGEMENT About one-third (34 percent) of respondents indicated that they work for an academic or faculty group practice, and about half (56 percent) work either in a community hospital or a private practice. When asked to describe their work setting, about half of the respondents (49 percent) indicated that they worked in hospital- based settings, with a quarter (28 percent) in freestanding clinics and a quarter (23 percent) working in academic settings. When asked to describe the other services provided to patients by their practice, 22.5 percent of radiation oncologists practicing in the U.S. indicated that their practice provides medical oncol-ogy, 20.3 percent diagnostic radiology, 15.1 percent urology and 15.2 percent indicated that their practice provides surgical oncology services to their patients as well as radiation oncology.



CHART 3: Modes of therapy currently used*

Currently using

Plan to use in next 18 months

Not using

100%

80%

60%

40%

20%

0%

IMRT

IGRT

Brac

hyth

erap

y

Elec

tron

ic m

edic

al re

cord

s

Func

tiona

l im

agin

g

SRS

SBRT

Radi

osen

sitiz

ers

Uns

eale

d so

urce

s

Radi

opro

tect

ors

IORT

Part

icle

bea

m th

erap

y

Hyp

erth

erm

ia

*By U.S.-based radiation oncologists

CHART 4: Importance of aspects of ASTRO’s strategic plan

100%

80%

60%

40%

20%

0%

Educ

atin

g Co

ngre

ss

Rais

ing

publ

ic a

war

enes

s

Dev

elop

ing

clin

ical

pr

actic

e gu

idel

ines

Prom

otin

g im

prov

emen

t o

f pat

ient

safe

ty

Prov

idin

g pr

ofes

sion

al e

duca

tion

Info

rmin

g m

embe

rs o

f re

gula

tory

issu

es

Prom

otin

g re

sear

ch

Prov

idin

g ne

twor

king

op

port

uniti

es

Prov

idin

g ac

cred

itatio

n to

RO

pra

ctic

es

Prov

idin

g re

sear

ch

fund

ing

Very important

Somewhat important

Not very important

Member survey | continued from Page 21


CHART 5: Importance of member benefi ts

100%

80%

60%

40%

20%

0%

Red

Jour

nal (

IJRO

BP)

subs

crip

tion

Cont

inui

ng e

duca

tion

oppo

rtun

ities

Advo

cacy

(leg

isla

tive/

regu

lato

ry/in

sure

rs)

Gui

danc

e on

regu

lato

ry

reim

burs

emen

t iss

ues

Regi

stra

tion

disc

ount

s to

educ

atio

nal m

eetin

gs

Onl

ine

mem

ber d

irect

ory

Patie

nt in

form

atio

n br

ochu

res

Net

wor

king

opp

ortu

nitie

s

Ans

wer

ing

codi

ng

ques

tions

Tech

nolo

gy in

tegr

atio

n so

lutu

ions

(IH

E-RO

)

Supp

ort f

or re

sear

ch

activ

ities

Care

er C

ente

r

Fund

ing

oppo

rtun

ities

for

rese

arch

ers

AST

ROgr

ams/

wee

kly

e-ne

wsl

ette

r

RO M

arke

tPla

ce (d

igita

l bu

yers

gui

de)

ASTR

One

ws q

uart

erly

m

agaz

ine

Very important

Somewhat important

Not very important

CHART 3: MODES OF THERAPY

Radiation oncologists were asked what modes of therapy they used in their practice. The three most popular modes were IMRT, IGRT and brachytherapy. The three least named therapies were IORT, particle beam and hyperthermia.

CHART 4: IMPORTANCE OF ASPECTS OF ASTRO’S STRATEGIC PLAN

Respondents were asked about the importance of diff erent aspects of ASTRO’s strategic plan. The three most important aspects to the survey respondents were educating Congress/regulators about radia-tion oncology, raising the public awareness of radiation oncology as an eff ective form of treatment and developing clinical practice guidelines. When asked how well ASTRO performs with respect to the strategic objectives, the highest rated performance was providing professional education (75 percent said ASTRO does it very well), followed by educating Congress/regulators about radiation oncology (61.6 percent) and informing members of regulatory issues (58.3 percent).

CHART 5: IMPORTANCE OF MEMBER BENEFITS Survey respondents felt that the three most important benefi ts provided to them by ASTRO were the International Journal of Radiation Oncology•Biology•Physics (Red Journal) (88.7 percent said it was very important), continuing education opportunities (85.6 percent) and advocacy (78.1 percent).

Membership in ASTRO continues to grow. In 2010 we experienced a 3 percent increase in the number of dues paying members, bringing the total membership to 10,098. The greatest number of new members reside in the United States, Canada and Japan. When asked about their experience with ASTRO staff , 88 percent of those who had requested help or information from the staff either said that their experience was excellent, very good or good, with only 4.3 percent indicating that it had been a poor experience. “The membership survey, administered annually, helps ASTRO leaders to stay in tune with our member demographics and needs,” Anna Arnone, vice-president of member relations and communica-tions, said. “It is a valuable tool that assists us in directing our program development throughout the year as well as evaluating the eff ectiveness of our eff orts. Thank you to everyone who took the time to complete the survey.”

24 A S T R O N E W S | S P R I N G | 2 0 1 124 A S T R O N E W S | S P R I N G | 2 0 1 1

he National Institutes of Health (NIH) is

projecting medical expenditures for cancer

care in 2020 to reach at least $158 billion,

an increase of 27 percent over the $124.6

billion projected for 2010. However, if

cutting-edge tools for diagnosis, treatment

and follow-up care get increasingly more

expensive, costs could reach as high as

$207 billion in the next decade.

Projections from this NIH study,

which appeared in the January 12, 2011,

Journal of the National Cancer Institute, used

current data on cancer incidence, survival

and costs of care combined with the U.S. Census

Bureau’s projected U.S. population rates to determine the

2020 projection of $158 billion.

Additional analyses were conducted to account for

changes in incidence, survival rates and treatment costs.

At a 2 percent increase in medical costs, the projected 2020

expenditures increased to $178 billion. Costs increase to

$207 billion at a 5 percent increase.

“Rising health care costs pose a challenge for policy

makers charged with allocating future resources on cancer

research, treatment and prevention,” Angela Mariotto, Ph.D.,

study author and chief of the data modeling branch at the

National Cancer Institute’s Surveillance Research Program,

said. “Because it is diffi cult to anticipate future developments

of cancer control technologies and their impact on the burden

of cancer, we evaluated a variety of possible scenarios.”

According to researchers, there were 13.8 million cancer

survivors alive in 2010, with 58 percent aged 65 years or

older. In 2020, the number of cancer survivors is expected to

increase by 31 percent to 18.1 million, with the largest portion

of that increase to be among American age 65 and older.

“Th e rising costs of cancer care illustrate how important it

is for us to advance the science of cancer prevention and treat-

ment to ensure that we’re using the most eff ective approaches,”

Robert Croyle, Ph.D., NCI Division of Cancer Control and

Population Sciences director, said. “Th is is especially impor-

tant for elderly cancer patients with other complex health

problems.”

According to ASTRO, Americans living longer with

cancer and living longer in general combined with the increas-

ing costs of treatment, highlights the need for ensuring that

spending on cancer treatments is effi cient.

“Ineffi ciencies in the health care system and cancer care

must be addressed. ASTRO’s top advocacy priorities are

focused on making sure that health care dollars are spent on

appropriate and safe cancer treatments,” Bharat Mittal, M.D.,

FASTRO, vice-chairman of ASTRO’s government relations

council and chairman of radiation oncology at Northwestern

Memorial Hospital in Chicago, said.

“We are working hard to close the abusive self-referral

loophole that allows precious health care resources to be

squandered on unnecessary treatments. We also are promot-

ing a number of safety initiatives through our Target Safely

campaign to help ensure that spending on radiation therapy

treatments isn’t wasted on ineff ective treatments or errors.”

Th is report also raises questions about the adequacy of

the radiation oncology workforce and whether there are

suffi cient numbers of radiation oncologists, medical

physicists, dosimetrists, therapists, nurses and other allied

professionals to meet the expected needs of future cancer

patients. ASTRO’s Workforce Committee will be conducting

a survey later this year to examine this question.

For more information on the cost projections, visit

http://costprojections.cancer.gov.

BY NICOLE NAPOLI , COMMUNICATIONS MANAGER, [email protected]

TCancer care costs projected to increase over $30 billion by 2020

ASTRO’s top advocacy priorities are focused on making sure that health care dollars are spent on appropriate and safe cancer treatments. . .


SINCE MID-2007, MEDICARE has been operating a voluntary

quality reporting program, the Physician Quality Reporting

System (PQRS), formerly known as the Physician Qual-

ity Reporting Initiative (PQRI). Th rough this program, the

Centers for Medicare and Medicaid Services (CMS) provides

an incentive payment to eligible professionals who satis-

factorily report data on quality measures. All participating

providers also receive confi dential feedback reports. While

historically a voluntary program, the Patient Protection and

Aff ordable Care Act (H.R. 3590) signed into law by President

Obama on March 23, 2010, established penalties for provid-

ers who do not successfully participate in PQRS. Th is change

in the program, from voluntary bonuses for participation to

reductions in payment for nonsuccessful participation, has

increased the pressure on physicians to participate.

2011 PQRS Program

Eligible professionals may choose to report PQRS measures

on fee-for-service Medicare benefi ciaries to CMS through

their Part B claims, a qualifi ed registry or via a qualifi ed

electronic health record (EHR) product. While many of the

elements of the program have remained the same from previ-

ous years, CMS is making a number of changes to PQRS for

2011.

2011 Reporting Periods – CMS has established six-month and

12-month reporting periods. Th e 2011 reporting periods are

the same as 2010.

• Claims-based – 12 month (January 1-December 31,

2011)

• Claims-based – six month (July 1-December 31, 2011)

• Registry-based – 12 month (Jauary 1-December 31,

2011)

• Registry-based – six month (July 1-December 31, 2011)

• EHR-based – 12 month (January 1-December 31, 2011)

Criteria for successfully reporting – Th ere is a reduction in the

reporting requirements for claims-based reporting of indi-

vidual measures from 80 percent to 50 percent of applicable

Part B patients, which lessens the burden on eligible profes-

sionals to qualify for incentive payments. Registry-based and

EHR-based reporting remains at 80 percent to be considered

a successful participant.

Incentive Payments – A 1 percent incentive payment has been

established for program year 2011 and a 0.5 percent payment

for program years 2012 through 2014. A penalty will be

implemented after CY 2014 for those who do not satisfacto-

rily report.

Maintenance of Certifi cation Program – Eligible professionals

may qualify for an additional 0.5 percent incentive beginning

in 2011 if they satisfactorily report data on the Physician

Quality Reporting System and participate in a Maintenance

of Certifi cation Program.

BY SHEILA MADHANI, ASSISTANT DIRECTOR OF HEALTH POLICY, [email protected]

Medicare physician quality reporting

TRANSITIONING FROM CARROTS TO STICKS AND WHAT THIS MEANS FOR THE PRACTICING RADIATION ONCOLOGIST

HEALTHpolicy

PQRS BONUS AND PENALTY SCHEDULE

Successful PQRS + No MOC Successful PQRS + MOC

2011 1.0 percent 1.5 percent2012 0.5 percent 1.0 percent2013 0.5 percent 1.0 percent2014 0.5 percent 1.0 percent2015 -1.5 percent2016 -2.0 percent



ASTRO PQRS Measures

Measures consist of two major components: a denominator

that describes the eligible cases for a measure (the eligible

patient population associated with a measure’s numerator) and

a numerator that describes the clinical action required by the

measure for reporting and performance. Each component is

defi ned by specifi c codes described in each measure specifi ca-

tion along with reporting instructions and use of modifi ers.

CMS has identifi ed 194 quality measures for the 2011 PQRS

program. Th e following radiation oncology measures are

eligible to be reported for either claims-based or registry-

based reporting in the 2011 PQRS program; these are the

same measures that were eligible for the 2010 program:

• #71 - Breast Cancer: Hormonal Th erapy for Stage

IC-IIIC Estrogen Receptor/Progesterone Receptor

(ER/PR) Positive Breast Cancer.

• #102 - Prostate Cancer: Avoidance of Overuse of Bone

Scan for Staging Low-risk Prostate Cancer Patients.

• #104 - Prostate Cancer: Adjuvant Hormonal Th erapy for

High-risk Prostate Cancer Patients.

• #105 - Prostate Cancer: Th ree-dimensional (3-D)

Radiotherapy.

• #156 - Oncology: Radiation Dose Limits to Normal

Tissues.

• #194 - Oncology: Cancer Stage Documented.

Th e CMS 2011 Measure Specifi cations and Release Notes

document provides detailed instructions on the proper way

to report PQRS measures. Th is document is available at

www.cms.gov/pqri.

Future of Quality Reporting in the Medicare Program

CMS has committed itself to pursuing a much broader

approach to value based purchasing. Numerous provisions in

the health reform legislation have provided the agency with

the authority to pursue these goals. Th e upcoming changes in

PQRS mark the beginning of more expansive changes link-

ing Medicare physician payment to some method of quality

measurement. To prepare for these future changes, ASTRO

believes members should gain experience in PQRS and

other similar programs. Th e Society urges members who

are not currently participating in PQRS to begin exploring

the feasibility of implementing it into their practices.

Promoting the high-quality provision of radiation oncology

services is one of the highest priorities for ASTRO.

Th e Society will continue to engage with CMS to better

understand how these evolving payment reforms impact

radiation oncology and advocate for the ASTRO membership

and the patients they serve.

More information on PQRS is available at www.astro.org

or www.cms.gov/pqri.

(Continued from Page 25)

HEALTHpolicyJoin us in Miami Beach this October

as we explore the benefi ts of

“Patient-focused, High-quality, Multidisciplinary Care.”

53rd ANNUAL MEETING

OCTOBER 2-6, 2011

MIAMI BEACH CONVENTION CENTER

MIAMI BEACH, FLA.

www.astro.org/annualmeeting

Attend the largest radiation

oncology event in the world where

new technology is released,

breaking science is explored

and the patient remains

our constant priority.


A FUNDAMENTAL ISSUE IN SBRT is whether the linear-quadratic (LQ )

model is a valid method to assess the

biologically eff ective dose at the high

doses typically encountered in radiosur-

gery. Th is point was debated in back-

to-back papers in Seminars in Radiation

Oncology1,2 where Brenner argued that

LQ formalism was appropriate whilst

Kirkpatrick and colleagues suggested it

was inappropriate.

Brenner’s argument is based on the

robustness of the LQ model to predict

fractionation and dose-rate eff ects in

experimental models in vitro and in vivo

at doses up to 10 Gy. Th is conclusion

is based on the premise that cell kill-

ing is the dominant process mediating

the radiotherapeutic response for both

early and late eff ects including vascular

eff ects.

Brenner argued that, to date, there

is no evidence of problems when LQ

has been applied in the clinic. However,

this was the crux of Kirkpatrick and

colleagues’ argument. Th ey suggested

that a variety of studies suggested that

the administration of a single high dose

of radiation in vivo had a much greater

eff ect than predicted by the LQ model.

Th ey cited several examples includ-

ing Leigh et al3 who calculated that the

dose to obtain a high probability of

tumor control for brain lesions would

be at least 25 to 35 Gy using the LQ

model, which was much higher than

the observed clinically eff ective radio-

surgical dose, which was in the range

of 15-20 Gy.

Kirkpatrick maintained that there

was a disconnect between in vitro cell

survival data and observed clinical data

that suggests there is more than one

mechanism of radiation damage and

that these operate diff erentially at low

and high doses. In addition, Kirkpatrick

argues, the LQ model does not eff ec-

tively address the potential existence of

radioresistant cancer stem cells, which

may require a threshold dose to be

crossed before their death is triggered.

Unequivocal evidence has been

presented by Fuks and colleagues that

vascular endothelial damage is activated

above 10 Gy per fraction4 and that the

ceramide pathway orchestrated by acid

sphingomyelinase (ASMase) operates

as a rheostat that regulates the balance

between endothelial survival and death

and thus tumor response5.

Damage to vascular/stromal

elements are further supported by

pathological observations after

BY GEORGE D. WILSON, PH.D.

WHAT DO WE KNOW ABOUT THE TUMOR BIOLOGY OF STEREOTACTIC RADIOSURGERY?

BIOLOGYbytes

In a previous Biology Bytes we discussed two papers published in the July 2010 edition

of the International Journal of Radiation Oncology•Biology•Physics, which

highlighted the development of models of SBRT normal tissue eff ects both in the

preclinical and clinical settings. As SBRT continues to gain more and more popular-

ity (as well as press), there is a need to examine and study the radiobiology of SBRT

at the tumor level to provide a rational explanation for the diversity of doses and

hypofractionation schemes employed and to establish whether tumor response can

be improved.



radiosurgery, which show profound

changes in vasculature, and from studies

on arteriovenous malformations6 where

obliteration of abnormal vasculature and

damage to the surrounding normal tis-

sue are rare below single doses of 12 Gy

but climb steeply with increasing doses

above this threshold.

Another line of evidence has

suggested that CD8+ T cells may be

responsible for the therapeutic eff ects

of ablative radiation7. Th e delivery of an

ablative dose of radiation of 15-25 Gy

was found to cause a signifi cant increase

in T cell priming in draining lymphoid

tissue, leading to reduction or eradica-

tion of the primary tumor or distant

metastasis in a CD8+ T cell dependent

fashion in an animal model.

Th erefore, evidence would seem to

suggest that there are several potential

disparate mechanisms for cell killing in

the high dose range and that the LQ

model overestimates radiation cell kill-

ing at these doses as a consequence of

the model’s prediction of a continuous

downward bend (ßd2) in the survival

curve in contradiction with some

experimental data, which suggests that

the dose-response may be linear above

12 Gy8.

Other models have been described

to better predict the response at higher

doses using modifi ed LQ formalism.

Th ese include Park et al9 who described

the eff ects of radiation in the ablative

dose range using a universal survival

curve (USC) model, which combined

the LQ and multitarget models using a

transition dose to separate the two

fi tting components of the model.

Although the multitarget model

may not radiobiologically explain the

underlying processes involved in the

response to high doses, it was found to

describe measured data better than the

LQ model over a broad dose range.

Using the LQ model, the potency of

the doses used in the Indiana University

phase II trial of SBRT for medically

inoperable NSCLC (20 Gy x 3) was

estimated to be 1.7 times greater than

the biological eff ectiveness of a similar

Japanese trial delivering 12 Gy x 4.

However, when the USC model was

used, the potency of the Indiana Univer-

sity regimen was only 1.34 times more

than the Japanese regimen9.

Other models have included the

generalized LQ (gLQ ) model in which

the reduction of conversion of sublethal

to lethal injury in hypofractionated abla-

tive dose radiation is taken into account

and the actual eff ect of the radiation is

lower than what was estimated by the

LQ model10.

Modeling may never fully describe

the complexity of the biological pro-

cesses involved in the response to

high dose per fraction radiation, but

it might facilitate the ability to design

optimal radiosurgery treatment plans.

Ultimately, radiosurgery treatment doses

and fractionation will be based on clini-

cal experience and prospective trials of

effi cacy and normal tissue toxicity.

One of the biological criticisms of

the severe hypofractionation sched-

ules employed in SBRT is the issue

of hypoxia. Conventional radiation is

eff ective against hypoxic cells because

of effi cient reoxygenation between

fractions, but this process may be

seriously curtailed in SBRT. Like most

radiobiological issues there are diff erent

viewpoints in the literature.

Recently, Carlson and colleagues11

developed a model to account for

variations in the distribution of tumor

hypoxia, tumor intrinsic radiosensitivity

and changes in radiation dose fraction-

ation. Th e model predicts a loss of up

to three logs of cell kill as the dose per

fraction is increased from 2.0-2.2 Gy to

a large single fraction of 18.3-23.8 Gy.

Th e loss in cell killing was

attributed to changes in the eff ective

radiosensitivity due to heterogeneous

oxygenation, reduction in interfraction

reoxygenation and an increased impor-

tance of maximally resistant cells (i.e.,

the hypoxic fraction) as the total dose is

delivered in less fractions.

Th ese observations suggest the

rational use of a hypoxic radiosensitizing

agent during SBRT to gain maximum

therapeutic benefi t. However, another

modeling study from Ruggieri and

colleagues12 suggested that the non-

homogeneous dose delivery intrinsic to

SBRT for small NSCLC lesions, which

results in simultaneous dose-boosting to

about 50 percent of the tumor volume,

could counterbalance the loss of reoxy-

genation within a few fractions.

Searching for references on PubMed

that contain “SBRT” and “biology”

reveals very few hits emphasizing that

this is an area of modern radiotherapy

where the biology needs to catch up

with the clinic13.

As we reported in a previous

Biology Bytes, small animal platforms

are now developed to simulate a

Modeling may never fully describe the complexity of the biological processes involved in the response to high dose per fraction radiation, but it might facilitate the ability to design optimal radiosurgery treatment plans.

BIOLOGYbytesContinued from Page 27


realistic SBRT delivery in experimental

animals14 and other recent developments

in image guided small animal irradiators

could also be adapted to simulate

SBRT15.

However, a wealth of knowledge

already exists in the radiobiology archive

from the ‘60s, ‘70s and ‘80s where large

doses per fraction were used for ease of

experimental design in experimental

studies, which need to be revisited.

ENDNOTES

1. Kirkpatrick JP, Meyer JJ, Marks LB. The linear-quadratic model is inappropriate to model high dose per fraction eff ects in radiosurgery. Semin Radiat Oncol 2008;18:240-243.

2. Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeff ec-tive doses at large doses per fraction. Semin Radiat Oncol 2008;18:234-239.

3. Leith JT, Cook S, Chougule P, et al. Intrinsic and extrinsic characteristics of human tumors relevant to radiosurgery: comparative cellular radiosensitivity and hypoxic percentages. Acta Neurochir Suppl 1994;62:18-27.

4. Garcia-Barros M, Paris F, Cordon-Cardo C, et al. Tumor response to radiotherapy regulated by endothelial cell apoptosis. Science 2003;300:1155-1159.

5. Truman JP, Garcia-Barros M, Kaag M, et al. Endothelial membrane remodeling is obligate for anti-angiogenic radiosensitization during tumor radiosurgery. PLoS One 2010;5(8):e12310 (epub).

6. Szeifert GT, Kondziolka D, Atteberry DS, et al. Radiosurgical pathology of brain tumors: metastases, schwannomas, meningiomas, astrocytomas, hemangioblastomas. Prog Neurol Surg 2007;20:91-105.

7. Lee Y, Auh SL, Wang Y, et al. Therapeutic eff ects of ablative radiation on local tumor require CD8+ T cells: changing strategies for cancer treatment. Blood 2009;114:589-595.

8. Marks LB. Extrapolating hypofractionated radiation schemes from radiosurgery data: regarding Hall et al., IJROBP 21:819-824; 1991 and Hall and Brenner, IJROBP 25:381-385; 1993. Int J Radiat Oncol Biol Phys 1995;32:274-276.

9. Park C, Papiez L, Zhang S, et al. Universal survival curve and single fraction equivalent dose: useful tools in understanding potency of ablative radiotherapy. Int J Radiat Oncol Biol Phys 2008;70:847-852.

10. Wang JZ, Huang Z, Lo SS, et al. A generalized linear-quadratic model for radiosurgery, stereotactic body radiation therapy, and high-dose rate brachytherapy. Sci Transl Med 2010;2:39ra48 (epub).

11. Carlson DJ, Keall PJ, Loo BW, Jr., et al. Hypofractionation Results in Reduced Tumor Cell Kill Com-pared to Conventional Fractionation for Tumors with Regions of Hypoxia. Int J Radiat Oncol Biol Phys 2010 Dec 21.(epub)

12. Ruggieri R, Naccarato S, Nahum AE. Severe hypofractionation: non-homogeneous tumour dose delivery can counteract tumour hypoxia. Acta Oncol 2010; 49:1304-1314.

13. Hadziahmetovic M, Loo BW, Timmerman RD, et al. Stereotactic body radiation therapy (stereotactic ablative radiotherapy) for stage I non-small cell lung cancer--updates of radiobiology, techniques, and clinical outcomes. Discov Med 2010; 9:411-417.

14. Cho J, Kodym R, Seliounine S, et al. High dose-per-fraction irradiation of limited lung volumes using an image-guided, highly focused irradiator: simulating stereotactic body radiotherapy regi-mens in a small-animal model. Int J Radiat Oncol Biol Phys 2010; 77:895-902.

15. Wong J, Armour E, Kazanzides P, et al. High-resolution, small animal radiation research platform with x-ray tomographic guidance capabilities. Int J Radiat Oncol Biol Phys 2008;71:1591-1599.

At present SBRT represents an

exciting, eff ective yet almost empirically

designed radiation therapy. Increasing

our knowledge of the underlying biol-

ogy associated with modern high dose

delivery will only serve to improve the

therapeutic benefi t of this modality.

Dr. Wilson is chief of radiation biology at

William Beaumont Hospital in Royal Oak,

Mich.

Stay up-to-date with radiation oncology

coding and reimbursement

changes

Register now for these

upcoming 2011 webinars.

RADIATION ONCOLOGY

REIMBURSEMENT AND CODING

BASICS

June 9, 2011, 3:00 p.m.

Eastern timeThis webinar, led by Thomas Eichler, M.D., and William Noyes, M.D., is tailored for those interested in learning the basics of radiation oncology reimburse-ment and coding as well as those looking for a refresher course. Various topics will be covered including an overview of the structure of radiation oncology CPT codes, modifi ers, CCI edits and MUE edits.

CODING FREQUENTLY ASKED

QUESTIONS

September 15, 2011, 3:00 p.m.

Eastern timeIn this one-hour webinar, William Hartsell, M.D., and Gerald White, M.S., will address commonly asked coding questions pertaining to treatment planning and simulation, treatment devices, IGRT, physician supervision and more. Attendees will have an opportu-nity to submit questions in advance.

2012 FINAL RULES WEBINAR

December 8, 2011, 3:00 p.m.

Eastern timeJoin us for this not-to-be-missed webinar. Preparing you for the year ahead, ASTRO physician leaders, David Beyer, M.D., FASTRO, and Najeeb Mohideen, M.D., along with coding experts, will review the major Medicare payment policy and coding changes impacting the practice of radiation oncology for 2012.

Register for these

webinars at

www.astro.org/webinars.

Hartsell, M.D.,, anandd GeGeraraldld WWhite, M.S., will address commmo lnly askkedd coding questit ons pertainning to treatment plannnin ng and ssimulation, ttreata mentt deevvicees, IGRT, pphyysician suupeervision anndmmore. Attendeeess wwill have ann opporrtu-nnity too submit questions in advancee.

200000122 FINAL RUUUUULES WEEBINAR

Deecember 8,, 20011, 3:000 p.m.

Eaststeern timeeJoin us for this noot-to-be-mmissed webinar. Preepaparingng yyouou fforor thehe yyear ahead ASTRO phyhysisicicianan lleaders


Cancer Imaging and Radiation Therapy Symposium: A Multidisciplinary Approach

Join us in Atlanta this April as leaders from the world of radiation oncology, physics and diagnostic radiology discuss anatomic imaging, molecular and biology imaging, PET imaging, therapeutic target defi nition, and image guided therapeutic techniques from the prospective of all three disciplines. Over 140 abstracts have been submitted for poster viewing and the program includes 12 oral abstracts highlighting new ground-breaking science.

Discussion topics include:

• Anatomic imaging• Molecular and biological imaging• PET imaging• Diagnosis, staging and recurrence• Therapeutic target defi nition• Image guided therapeutic techniques• Normal tissue defi nition• Brachytherapy

Register by April 1, 2011, and save $50 to $100.

www.cancerimagingandrtsymposium.org

Atlanta Marriott Marquis | Atlanta | April 29-30, 2011

Register now for these two ASTRO Conferences

3B Research Forum: Benchtop to Bedside and Back

Do you have an idea you want to test in the lab?Do you have exciting data that you want to take to the clinic? Don’t know how to do it or who to talk to?

Join us at a new meeting that will bring together biologists, clinical researchers and junior faculty (including residents) interested in translational research for a lively discussion on current and innovative research in the fi eld of radiation oncology. Preeminent leaders in translational science will discuss topics critical to the fi eld. Special emphasis will be on targeting, with an introductory session titled “Understanding Targets, Patient Selection and Clinical Trial Design.”

Discussion topics include:

• DNA Repair • Cell signaling• Hypoxia/microenvironment • Biomarkers• Stem cells

Atlanta Marriott Marquis | Atlanta | May 1-2, 2011

This activity has been approved for

AMA PRA Category 1 Credit TM


Register by April 1 and save $60.

Register at www.astro.org/3bresearchforum.

TIME IS RUNNING

OUT


BY CINDY TOMLINSON, MANAGER OF REGULATORY AFFAIRS, CINDY [email protected]

has teamed up with FedEx to

help boost your bottom line.

ASTRO members* are now eligible to receive valuable discounts

of up to 29 percent on select FedEx shipping services.

Sign up at www.astro.org/membership and enter passcode YDJ1QR.

*Domestic members only.

Th e NRC has not yet initiated rule-

making; it is using this opportunity to

seek public comment as a way to gauge

whether or not a rulemaking is necessary.

ASTRO will be submitting comments.

FDA holds stakeholder meetings on

MDUFA reauthorization

As the Food and Drug Administration

(FDA) begins its negotiations on the re-

authorization of the Medical Device User

Fee Amendments of 2007 (MDUFA),

it will hold monthly meetings with rep-

resentatives of physician and consumer

advocacy groups to ensure continuity

and progress in these discussions. Th e

statutory authority for MDUFA expires

September 30, 2012, at which time new

legislation will be required for the FDA

to continue to collect user fees for the

medical device program. ASTRO staff

will be participating in these meetings.

at theAGENCIESsecurity guidelines are suffi cient and

should not be enhanced.

NRC seeks comments on radiation

protection regulations, guidance

Th e NRC held a series of public meet-

ings in the fall of 2010 to solicit input

on major issues associated with potential

updates to the NRC’s radiation protec-

tion regulations and guidance. Th e

agency has listed a number of questions

on which it is soliciting comments.

Th e issues include:

• Eff ective dose and numerical values.

• Occupational dose limits.

• Doses to special populations (in-

cluding limits for embryo/fetus of a

declared pregnant worker and limits

for members of the public).

• Incorporation of dose constraints.

ASTRO comments on NRC proposed

physical protection rules

In January, ASTRO commented on

the Nuclear Regulatory Commission’s

(NRC) proposed rules for the physical

protection of byproduct material. Th e

proposed rules are intended to establish

security requirements for the use and

transport of category 1 and category

2 quantities of radioactive material.

Th e NRC believes that this material is

risk-signifi cant and warrants additional

protection.

Th e proposed rules will require

enhanced security checks, including

fi ngerprinting, background and credit,

for those who will require unescorted

access to the materials. It will also re-

quire facilities to develop and implement

security plans.

ASTRO expressed concern over the

proposed rules, stating that the current

Chief, Clinical Physics Department of Medical Physics

Memorial Hospital for Cancer and Allied Diseases Memorial Sloan-Kettering Cancer Center

Memorial Sloan-Kettering Cancer Center seeks an individual to direct the Clinical Physics (External Beam Radiotherapy, Brachytherapy and Dosimetry) Service of the Department of Medical Physics, Memorial Hospital for Cancer and Allied Diseases. Memorial Hospital is internationally recognized for its contributions in cutting edge development of innovative technologies such as IMRT, IGRT, IORT, SRS, PET, and MRI.

Candidates must be Board Certified in Therapeutic Physics by the ABR or ABMP and be able to be licensed in the State of New York. The candidate must have significant experience in the practice of clinical physics in an academic hospital setting. Previous leadership experience and national recognition in the discipline of radiation oncology physics should be demonstrated. Ideal candidates will have a record of significant academic achievement and will be leaders of their own program within the realm of medical physics. Demonstrated commitment to innovation and application of new technologies is strongly encouraged.

MSKCC is in a dynamic period of program expansion, with the opening of the new Evelyn H. Lauder Breast and Imaging Center (BAIC), the Center for Image Guided Intervention (CIGI) and two new regional sites. The Human Oncology and Pathogenesis Program (HOPP) is intended to provide a basis for translational basic research and the active recruitment of physician scientists to expand the research mission of the institution. There are also opportunities for tri-institutional collaborations and program development with MSKCC’s neighbors, the Weill Medical College of Cornell University, the New York Presbyterian Hospital, and the Rockefeller University.

Interested applicants should forward curriculum vitae and bibliography to: Jean St. Germain, MS, Chair, Search Committee c/o Clara Irizarry, MPA Manager, Office of Academic Recruitment, MH Memorial Sloan-Kettering Cancer Center 1275 York Avenue, New York, NY 10065 212-639-5819 | e-mail: [email protected]

MSKCC is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply.

SpringRefresher Course

SPRING REFRESHER COURSE April 8-10, 2011

Delve into radiation treatment for various disease sites and explore safety issues most commonly encountered in radiation oncology at the 2011 ASTRO Spring Refresher Course. This two-and-a-half day meeting will be held at the Sheraton Chicago Hotel and Towers; those who register on or before March 31, 2011, will receive $75 off their registration.

Register today at www.astro.org/springrefresher.

CANCER IMAGING AND RADIATION THERAPY SYMPOSIUM: A MULTIDISCIPLINARY APPROACHApril 29-30, 2011

Co-sponsored by ASTRO and RSNA

Join us in Atlanta as we take a multidisciplinary look at cancer staging and treatment, focusing on the many points of contact between imaging and radiation oncology from the day of diagnosis through the entire course of the patient’s disease. Over 140 abstracts have been selected covering topics such as: image guided therapeutic techniques, therapeutic target defi nition, diagnosis, staging and recurrence, and PET imaging.

Register by April 1, 2011, and save $50.

Visit www.cancerimagingandrtsymposium.org

to register.

3B RESEARCH FORUM: BENCHTOP TO BEDSIDE AND BACKMay 1-2, 2011

Engage in a discussion on translational science and research with leading experts in the fi eld May 1-2, 2011, at the Atlanta Marriott Marquis. Topics include research that could lead to improve-ments in patient treatment and individualized care. Special em-phasis will be placed on targeting, with an introductory session titled “Understanding Targets, Patient Selection and Clinical Trial Design.”

Save $60 when you register by Friday, April 1, 2011, at

www.astro.org/3bresearchforum.

A M E R I C A N S O C I E T Y F O R R A D I AT I O N O N C O LO G Y

RADIATION ONCOLOGY REIMBURSEMENT AND CODING BASICSJune 9, 2011, 3:00 p.m. Eastern time

This webinar, led by Thomas Eichler, M.D., and William Noyes, M.D., is tailored for those interested in learning the basics of radiation oncology reimbursement and coding as well as those looking for a refresher course. Various topics will be covered including an overview of the structure of radiation oncology CPT codes, modi-fi ers, CCI edits and MUE edits.

Register for this webinar at www.astro.org/webinars.

CODING FREQUENTLY ASKED QUESTIONSSeptember 15, 2011, 3:00 p.m. Eastern time

In this webinar, William Hartsell, M.D., and Gerald White, M.S., will address commonly asked coding questions pertaining to treatment planning and simulation, treatment devices, IGRT, physician supervision and more. Attendees will have an opportunity to submit questions in advance.

Register for this webinar at www.astro.org/webinars.

ASTRO’S 53RD ANNUAL MEETING

October 2-6, 2011

Miami Beach Convention

Center, Miami Beach, Fla.

Each day, evolving technology, reimbursement adjustments and health care reform all vie for the attention of radiation oncologists, but one thing remains our constant priority—the needs of the patient. Despite this ever-changing health care landscape it is imperative that oncologists continue to put the needs of the patient fi rst. Through multidisciplinary teamwork and a commit-ment to high-quality care for our patients, radiation oncologists can deliver superior care and receive superior results. Join us in Miami Beach, Fla., this October as we explore the benefi ts of “Patient-focused, High-quality, Multidisciplinary Care” as the theme of this year’s meeting.

www.astro.org/annualmeeting

Registration opens June 1, 2011.

Please visit www.astro.org for regular updates about our meetings.

Upcoming Society Events

For streaming updates follow us on Facebook and Twitter.

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Listening. It’s made all the difference in how people think about us and how we think about our next innovations. By doing more listening than talking and through collaboration with our customers worldwide, Elekta produces many clinically relevant firsts that continue to define and raise the standard of human care. You certainly can hear a lot just by listening. Visit us at elekta.com/experience.

Improved Body Pro-Lok™ for SBRTCIVCO’s Body Pro-Lok is the benchmark for comfortable, accurate immobilization for SBRT. Since its introduction 3 years ago, CIVCO has consistently enhanced Body Pro-Lok with improvements and additional accessories. Through listening to feedback from loyal users and clinical leaders, CIVCO has developed a comfortable and flexible SBRT immobilization system.

Laser-Lok™ - shines a cross hair on the patient, to assist in verifying patient position in relation to the system

- provides a system for utilizing Body Pro-Lok bridges and accessories without the full Body Pro-Lok Platform or the Universal Couchtop. The open design features fewer solid areas than the Body Pro-Lok Platform assisting in reducing attenuation

- this improved bridge adds angle, tilt and clam angle adjustments to the shoulder pads. The improved clamp system allows for lower reach and increased durability

- this new bridge now goes even lower providing more options for smaller adults and pediatric patients

800.842.8688 | +1 712.737.8688 | WWW.CIVCO.COMCOPYRIGHT © 2011. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. BODY PRO-LOK AND LASER-LOK ARE TRADEMARKS OF

CIVCO. ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANADIAN LAW. 2011A0644

Laser-Lok

Rails-Only System (Prodigy version)

Shoulder Restraint Bridge 2

New Type-1B Bridge

New Visions for SBRT Immobilization

Years of InnovationCIVCO Medical Solutions

1981-2011

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