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Standardized collection and use of clinical patient-reported outcomes (PRO) have potential to benefit the care of individual patients and improve radiotherapy system performance. Its centralized health-care system makes Canada a prime candidate to take a leader and collaborator role in international endeavors to promote expansion of patient-reported outcome collection and use in radiotherapy. The current review discusses the development of a pan-Canadian approach to PRO use, through a quality improvement initiative led by the Canadian Partnership for Quality Radiotherapy (CPQR), a unique partnership of Canadian radiotherapy professional organizations (Canadian Association of Radiation Oncology-CARO, Canadian Organization of Medical Physicists-COMP, and the Canadian Association of Medical Radiation Technologists-CAMRT).

The focus of work of medical physicists in 1980’s was on quality control and quality assurance. Radiation safety was important but was dominated by occupational radiation protection. A series of over exposures of patients in radiotherapy, nuclear medicine and observation of skin injuries among patients undergoing interventional procedures in 1990’s started creating the need for focus on patient protection. It gave medical physicists new directions to develop expertise in patient dosimetry and dose management. Publications creating awareness on cancer risks from CT in early part of the current century and over exposures in CT in 2008 brought radiation risks in public domain and created challenging situations for medical physicists. Increasing multiple exposures of individual patient and patient doses of few tens of mSv or exceeding 100 mSv are increasing the role of medical physicists. Expansion of usage of fluoroscopy in the hands of clinical professionals with hardly any training in radiation protection shall require further role for medical physicists. The increasing publications in journals, recent changes in Safety Standards, California law, all increase responsibilities of medical physicists in patient protection. Newer technological developments in dose efficiency and protective devices increase percentage of time devoted by medical physicists on radiation protection activities. Without radiation protection, the roles, responsibilities and day-to-day involvement of medical physicists in diagnostic radiology becomes questionable. In coming years either medical radiation protection may emerge as a specialty or medical physicists will have to keep major part of day-to-day work on radiation protection. Learning Objectives: 1. To understand how radiation protection has been increasing its role in day-to-day activities of medical physicist 2. To be aware about international safety Standards, national and State regulations that require higher attention to radiation protection than in past 3. To be aware about possible emergence of medical radiation protection as a specialty and challenges for medical physicists.

The focus of work of medical physicists in 1980's was on quality control and quality assurance. Radiation safety was important but was dominated by occupational radiation protection. A series of over exposures of patients in radiotherapy, nuclear medicine and observation of skin injuries among patients undergoing interventional procedures in 1990's started creating the need for focus on patient protection. It gave medical physicists new directions to develop expertise in patient dosimetry and dose management. Publications creating awareness on cancer risks from CT in early part of the current century and over exposures in CT in 2008 brought radiation risks in public domain and created challenging situations for medical physicists. Increasing multiple exposures of individual patient and patient doses of few tens of mSv or exceeding 100 mSv are increasing the role of medical physicists. Expansion of usage of fluoroscopy in the hands of clinical professionals with hardly any training in radiation protection shall require further role for medical physicists. The increasing publications in journals, recent changes in Safety Standards, California law, all increase responsibilities of medical physicists in patient protection. Newer technological developments in dose efficiency and protective devices increase percentage of time devoted by medical physicists on radiation protection activities. Without radiation protection, the roles, responsibilities and day-to-day involvement of medical physicists in diagnostic radiology becomes questionable. In coming years either medical radiation protection may emerge as a specialty or medical physicists will have to keep major part of day-to-day work on radiation protection. Learning Objectives: 1.To understand how radiation protection has been increasing its role in day-to-day activities of medical physicist 2.To be aware about international safety Standards, national and State regulations that require higher attention to radiation protection than in past 3.To be aware about possible emergence of medical radiation protection as a specialty and challenges for medical physicists.

Purpose: Discrepancies in absolute dose values have been detected between the ViewRay treatment planning system and ArcCHECK readings when performing delivery quality assurance on the ViewRay system with the ArcCHECK-MR diode array (SunNuclear Corporation). In this work, we investigate whether these discrepancies are due to errors in the ViewRay planning and/or delivery system or due to errors in the ArcCHECK’s readings. Methods: Gamma analysis was performed on 19 ViewRay patient plans using the ArcCHECK. Frequency analysis on the dose differences was performed. To investigate whether discrepancies were due to measurement or delivery error, 10 diodes in low-gradient dose regions were chosen to compare with ion chamber measurements in a PMMA phantom with the same size and shape as the ArcCHECK, provided by SunNuclear. The diodes chosen all had significant discrepancies in absolute dose values compared to the ViewRay TPS. Absolute doses to PMMA were compared between the ViewRay TPS calculations, ArcCHECK measurements, and measurements in the PMMA phantom. Results: Three of the 19 patient plans had 3%/3mm gamma passing rates less than 95%, and ten of the 19 plans had 2%/2mm passing rates less than 95%. Frequency analysis implied a non-random error process. Out of the 10 diode locations measured, ion chamber measurements were all within 2.2% error relative to the TPS and had a mean error of 1.2%. ArcCHECK measurements ranged from 4.5% to over 15% error relative to the TPS and had a mean error of 8.0%. Conclusion: The ArcCHECK performs well for quality assurance on the ViewRay under most circumstances. However, under certain conditions the absolute dose readings are significantly higher compared to the planned doses. As the ion chamber measurements consistently agree with the TPS, it can be concluded that the discrepancies are due to ArcCHECK measurement error and not TPS or delivery system error. This work was funded by the Bhudatt Paliwal Professorship and the University of Wisconsin Medical Radiation Research Center.

The focus of work of medical physicists in 1980’s was on quality control and quality assurance. Radiation safety was important but was dominated by occupational radiation protection. A series of over exposures of patients in radiotherapy, nuclear medicine and observation of skin injuries among patients undergoing interventional procedures in 1990’s started creating the need for focus on patient protection. It gave medical physicists new directions to develop expertise in patient dosimetry and dose management. Publications creating awareness on cancer risks from CT in early part of the current century and over exposures in CT in 2008 brought radiation risks in public domain and created challenging situations for medical physicists. Increasing multiple exposures of individual patient and patient doses of few tens of mSv or exceeding 100 mSv are increasing the role of medical physicists. Expansion of usage of fluoroscopy in the hands of clinical professionals with hardly any training in radiation protection shall require further role for medical physicists. The increasing publications in journals, recent changes in Safety Standards, California law, all increase responsibilities of medical physicists in patient protection. Newer technological developments in dose efficiency and protective devices increase percentage of time devoted by medical physicists on radiation protection activities. Without radiation protection, the roles, responsibilities and day-to-day involvement of medical physicists in diagnostic radiology becomes questionable. In coming years either medical radiation protection may emerge as a specialty or medical physicists will have to keep major part of day-to-day work on radiation protection. Learning Objectives: 1. To understand how radiation protection has been increasing its role in day-to-day activities of medical physicist 2. To be aware about international safety Standards, national and State regulations that require higher attention to radiation protection than in past 3. To be aware about possible emergence of medical radiation protection as a specialty and challenges for medical physicists.

Purpose: The validity of effective dose (ED) in medical applications, which mostly involving partial‐organ irradiation, has long been argued. We now propose a new algorithm of effective dose evaluation for medical radiation exposure. The new algorithm will include new Relative Volume Factors, or RVFs, to account for the relative irradiated volume of the partially‐irradiated organs, such as skin and bone marrow. Methods: To validate the proposed algorithm, three ED evaluation methods were applied to five neuro‐imaging protocols of a C‐arm cone‐beam CT: 1) MOSFET‐anthropomorphic‐ phantom measurement for organ doses, ED evaluated with the original ICRP algorithm; 2) using the same MOSFET‐measured organ doses, ED evaluated with the new algorithm; and 3) Monte Carlo (PCXMC, developed by STUK) dose estimation as gold standard. Results: For all five imaging protocols, the ED evaluations by the new algorithm agreed very well with the Monte Carlo simulation results (within 10% difference), whereas the original ICRP algorithm overestimated EDs by approximately a factor of 2. Conclusions: The proposed algorithm provides a more accurate estimation of ED in medical exposures than the original ICRP algorithm. It potentially establishes the ED as a more reasonable index for cross‐protocol dose comparison.

Recent media publicity about patients injured by mistakes in radiation therapy and other patients receiving excessive doses from computed tomography has emphasized the need for improved measures to keep patients safe during medical procedures employing ionizing radiation. In a list of technology health hazards compiled by the ECRI Institute for 2011, radiation therapy is listed as number 1 and computed tomography is listed as number 4. Missing from these analyses is recognition of the profound health benefits of computed tomography and radiation therapy. Still, safety and quality can be improved through a variety of measures being implemented by medical physicists. These measures help to allay concerns that medical physics is not doing enough to improve quality and safety in both medical imaging and radiation therapy.

As health care costs continue to escalate and reimbursements rates tighten, medical physicists must be prepared to demonstrate their economic value as well as their clinical value. This talk will review the major reimbursement processes that exist and the fundamental differences in how payment rates are established for hospital outpatient departments, free standing facilities and physicians. The CPT® coding system will be reviewed with special emphasis on the Continuing Medical Physics Consultation code 77336 and the Special Medical Radiation Physics Consultation code 77370. Proper reporting documentation will be discussed. Sources of information on reimbursement and coding will be identified. Finally, current activities of the AAPM Professional Economic Committee will be highlighted. Learning Objectives: 1. To understand the major reimbursement systems and how payment rates are established 2. To understand the CPT® coding system and the need for proper documentation in the clinic 3. To identify authoritative sources of reimbursement and coding information 4. To learn about AAPM PEC activities and how they benefit the membership

This presentation will examine the current trends in medical x‐ray imaging procedures in the United States. It will also examine the magnitude of radiation doses for various x‐ray imaging procedures. Special emphasis will be given to CT and nuclear medicine procedures. The results are based on the work done within the framework of National Council of Radiation of Protection Scientific Committee 6.2 formed to work on the estimation of radiation exposure to the US population from all sources. The intended goal of the Committee is to update the NCRP report 93 published in 1987. The subcommittee examined variety of data sources including commercial surveys, Medicare, Veterans Administration and insurance carrier data. Radiation exposure to the US population from medical exposures was then estimated based on the number of medical procedures grouped by modality and body parts and the radiation doses associated with each procedure. According to the preliminary results, the medicalradiation exposure to US population has increased by nearly 5.5 times compared to the previous NCRP publication (NCRP 93). The largest contributor to the collective dose to US population is seen with CT and Nuclear Medicine procedures. It is found that the CT procedures accounts for 14% of all medical x‐ray imaging procedures but contribute to nearly 49% of collective dose to US population. Similarly, the nuclear medicine procedure accounts to only 4% of all procedures but contribute to nearly 26% of collective dose to US population. Educational Objectives: 1. To familiarize with the types and distribution of medical imaging procedures in US. 2. To learn the magnitude of medicalradiation exposure to US population. 3. To examine the magnitude and distribution of procedures and doses from CT.