Past AAPM President: 1999.

My term as the 40th President of the American Association of Physicists in Medicine (AAPM) began in January 1999. At the time, I was an Associate Professor and Director of Medical Physics at the University of Kentucky, in Lexington, KY. I had arrived there in 1994 after having started my career in medical physics literally right out of high school, when I took a summer job at the University of Colorado Medical Center with a newly arrived medical physicist, William R. Hendee, PhD. I stayed at Colorado for 20 years and completed my BA, MS, and PhD part-time while working full time for most of those years. It is impossible to overstate the gratitude I feel toward Bill, who put up with my chaotic private life while providing guidance and encouragement, as well as many opportunities to become productive at work and active in the AAPM. Following Bill's example, I took an active role in the new graduate program in medical physics and supervised many of the students who conducted their training and research work in radiation therapy physics. My interests in education led me to pursue opportunities in academic medical centers throughout my career. Also at Bill's urging, I became interested in professional issues, and in the early 1970s, worked with Bill to create a Medicare payment schedule that ultimately evolved into the current procedural terminology (CPT) codes we use today. In 1990, my wife Diane and I had just married and decided we were ready to consider other opportunities. We moved to Connecticut where I spent 4 years at the Yale-New Haven Hospital working with Robert Schulz and Ravi Nath. The collaboration with Bob and a postdoc named Marek Maryanski sparked an interest in 3D dosimetry; a research avenue I continue to pursue. In 1994, I was recruited to Kentucky by the new chair of the Department of Radiation Medicine, Mohammed Mohiuddin, who had moved from Thomas Jefferson Hospital in Philadelphia. I stayed at Kentucky until January 2001 when I moved to MD Anderson Cancer Center in Houston, TX. Consequently, I served my 3 years on the Executive Committee while at Kentucky. Several activities helped prepare me for service on the Executive Committee. First, I had been, most recently, a member of the Board of Directors from 1995 to 1997, and chair of the Professional Council from 1993 to 1997. On my way to becoming Professional Council chair, I served on the Trilateral Committee and several Professional Council committees and task groups. From 1994 to 2000, I was also a member of the Radiation Therapy Committee (RTC), and this was the second time I had served on this committee; my first term was in the late 1970s. Through the RTC, I became involved with several scientific committees and task groups, including some involved with brachytherapy and ion chamber calibrations. These interests led to my involvement with the Council on Ionizing Radiation Measurements and Standards; an advisory council to the National Institute of Standards and Technology. In alignment with my interests in education, I was fortunate to have been a member of a number of committees and task groups organized under the Education Council, including as chair of the Committee of Academic Program Directors—the precursor to Commission on Accreditation of Medical Physics Education Programs (CAMPEP). Much was accomplished during 1999, thanks to the dedicated work of the Executive Committee: Chairman of the Board Lawrence Rothenberg, President Elect Kenneth Hogstrom, Treasurer Melissa Martin, and Secretary Jim Galvin. During my term as President, I continued to pursue professional activities. I remained a member of the Trilateral Committee, whose focus was to maximize the lobbying effectiveness of medical physicists through the AAPM, the American College of Radiology (ACR), and the American College of Medical Physics (ACMP). At this time, the new field of intravascular brachytherapy was emerging. This treatment modality raised great concerns among radiologists and radiation oncologists who, for very defensible reasons, objected to the use of radiation and radioactive materials by other medical specialists. At the same time, it was clear to us that medical physicists needed to be involved to ensure that the procedure was conducted safely and effectively, and this meant collaborating with the American College of Cardiology, as well as making contact with the American Society for Therapeutic Radiology and Oncology (ASTRO) (as it was known in those days), the Radiological Society of North America (RSNA), and the ACR. Fortunately, the physician leadership at these societies was supportive and appreciated the difficult position medical physicists were placed in. I am especially grateful to the late Dr. Larry Kun, then President of ASTRO, with whom I had many productive conversations over this issue. Our discussions led to the creation of the Vascular Brachytherapy Roundtable, which produced a document called “Roles of Various Specialists in Intravascular Brachytherapy.” Other activities in support of professional stature involved negotiations between the American Board of Radiology (ABR) and the American Board of Medical Physics (ABMP). ABR Trustees Bill Hendee, Steve Thomas, and Bhudatt Paliwal worked to progress the recommendations of the Board Unification Committee in ways that would preserve the recognition of ABMP certification while offering a pathway to ABR certification for ABMP diplomates. Also during 1999, the AAPM's lease at the American Center for Physics (ACP) was approaching its end. We had to decide whether to move to another location or renew the lease at the ACP. We decided to stay, and this worked out very well for many years. We continued ongoing discussions in 1999 with ACR, ASTRO, and the Medicare agency over the proposal for a hospital outpatient prospective payment system (HOPPS). As new policies seemed to be on the verge of implementation, Mike Gillin, then chair of the Professional Council, and I left the annual meeting for a day to travel to Baltimore to meet with Medicare to discuss our concerns. We also corresponded with the developer of the system of Ambulatory Patient Groups (APGs) and Ambulatory Patient Classifications (APCs) who ultimately appreciated the role of medical physicists and made recommendations to Medicare that benefitted us. To a large extent, letters written by individuals to the Medicare agency influenced their decisions. I later learned that a large proportion of the letters (30%−40%) came from medical physicists, demonstrating the effectiveness of our campaign to educate our membership as well as the interest exhibited by medical physicists about the issue. Related to our engagement with Medicare, I met with a senior vice president of the Joint Commission on several occasions, which led to changes in their education of surveyors to emphasize the roles medical physicists play in radiology and radiation oncology. During 1999, we collaborated with the American Society of Radiologic Technologists and other organizations on the Alliance for Quality Medical Imaging and Therapy. The goal of the Alliance was to introduce legislation modifying the Consumer Patient Radiation Health and Safety Act of 1981, to strengthen the requirement for licensure of radiological technologists. This effort was largely successful and arguably raised the standard of education for these important staff members. Year 1999 also marked a change in our relationship with the Council of Radiation Control Program Directors (CRCPD). As written in our Newsletter (September/October 1999) by Jill Lipoti, chair of the CRCPD, her attendance at our annual meeting triggered the recognition that the CRCPD and the AAPM could collaborate in ways that would be mutually beneficial. She raised the idea of encouraging participation by medical physicists on the CRCPD committees that develop model regulations (the Suggested State Regulations committees) to help their members understand new developments and anticipate future needs for regulatory guidance. Jill recognized three of our members who already were active informally with the CRCPD: Melissa Martin, Keith Strauss, and Orhan Suliman. All three were made fellows at the 1999 annual meeting. Several important initiatives took place in the scientific arena during 1999. Among them, the new and long-anticipated calibration protocol we know as TG-51 was published, marking a change to the use of a dose-to-water ion chamber calibration coefficient. The AAPM collaborated with other radiological and engineering societies to conduct a major campaign of support for bills that would create a new National Institute for Biomedical Imaging and Bioengineering. I am confident that our support helped to ultimately culminate in the creation of the new institute. Our Education Council, chaired by Don Frey, collaborated with the RSNA on their project to engage the Disney Corporation to create a new exhibit at their Epcot Center. The exhibit was created and was called “Radiology—Exploring New Horizons” and was officially endorsed by the AAPM. In 1999, the Association was making strides in the rapidly expanding world of electronic communications. We had a web page, some members were receiving dues notices and other communications by email, and fully 10% of the subscribers to Medical Physics were reading the journal online. The Annual Meeting of 1999 was held at the Opryland Hotel in Nashville and marks the first and only time that the meeting has been held in a completely self-contained biosphere-like environment. The President's Symposium that year was on the topic of intravascular brachytherapy, and featured talks by a cardiologist, a radiation oncologist, and two medical physicists. Each speaker described his or her role, and also expressed opinions about the role of the other team members. The night out was held at the Grand Old Opry, and was notable for many things, including outstanding food, and especially a riveting solo performance by the daughter of one of our medical physicist colleagues. (Figure 1) Year 1999 had many challenges but they were overshadowed by the rewards and accomplishments the organization made as a team. I am especially grateful to Sal Trofi, Angela Keyser, and the rest of the headquarters staff for their dedication and support. The colleagues who served as Council chairs and members of the Board of Directors likewise were collaborative and generous with their time and effort. The year went by agonizingly slowly at times, and with wildfire rapidity at others. Overall, and in retrospect, I believe it was successful on all fronts: scientific, educational, and professional. For me personally, it was a great honor to serve the Association in this manner and an occasion to repay many colleagues for the opportunities afforded me.