STROnewsWINTER 2011

INTRODUCING THE NEW WWW.ASTRO.ORG

You spoke; we listened! ASTRO’s new website better refl ects, meets members’ needs

PLUS: SURVIVOR CIRCLE WINNER

JAMES D. COX RETIRES AS RED JOURNAL EDITOR

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ASTROnews (ISSN 1523-4185) is published quarterly at 8280 Willow Oaks Corporate Drive, Suite 500, Fairfax, VA 22031. Dues for individual membership in the American Society for Radiation Oncology are $475 (U.S.), which includes $38 for an ASTROnews subscrip-tion. Periodicals Postage Paid at Fairfax, VA 22030-9998 and at additional mailing offi ces.

Copyright 2011 ASTRO. All rights reserved.

POSTMASTER: Send address changes to ASTROnews, 8280 Willow Oaks Corporate Drive, Suite 500, Fairfax, VA 22031. Telephone: 703-502-1550; Fax: 703-502-7852; Website: www.astro.org/astronews. Printed in the U.S.A., by HBP in Hagerstown, Md.

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AMERICAN SOCIETY FOR RADIATION ONCOLOGY

SENIOR EDITOR: Thomas Eichler, MDPUBLISHER Laura I. Thevenot

EDITORIAL DIRECTOR: Beth BukataMANAGING EDITOR: Nicole Napoli

DESIGN/PRODUCTION: Kimberly KerinONLINE DESIGN: Benjamin Reese

ADVERTISING: Gene Conselyea, Triple Threat Media 732-598-3232 gene@triplethreatmedia.com

CONTRIBUTING EDITORS:

Sidrah Abdul Anna Arnone Katherine Bennett Daneen Grooms Lindsay Hoff man Jason Hoolsema Todd Karstaedt Sheila Madhani Cristin Watson

news

VOLUME 14 • NUMBER 4

STRO

InsideEditor’s Notes 4

Chairman’s Update 5

Special Report 7

Society NewsNew offi cers 8

Memoriam 8

Honors 9

Ambassadors 10

12 Survivor Circle winner Meet this year’s recipient, 8-year-old cancer survivor Bella Rodriguez-

Torres, and learn about her family’s dedication to raising awareness of

pediatric cancers.

14 A brand new website ASTRO’s new website gives you quicker access to tools for your practice

and patients.

18 Membership survey Th e results of the annual membership survey are in. Read how membership

demographics are changing and how members ranked Society benefi ts and

services.

22 Red Journal editor retires After 15 years, James D. Cox, MD, FASTRO, will end his tenure as the

International Journal of Radiation Oncology•Biology•Physics editor.

25 Remembering Malcolm Bagshaw, MD, FASTRO Colleagues pay tribute to a former ASTRO president and gold medalist.

Nurses 27

Fellowship 28

Health Policy 29

IHE-RO 31

12

22

Understanding your unique needs—and those of your patients—is at the center of everything

Accuray does. We are committed to creating precise and individualized radiation oncology solutions

that make sense—so you can personalize treatment and achieve the best possible outcome for each

and every patient.

ADVANCING RADIATION ONCOLOGY TOGETHER

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(Continued on Page 6)

EDITOR’Snotes BY THOMAS EICHLER, MD

AT 7:00 P.M. ON OCTOBER 1, I was

enjoying the largesse of the UCLA

Department of Radiation Oncology

at their reception in the Loews hotel

in Miami Beach, Fla., at this years’

ASTRO Annual Meeting. Among the

many friends and colleagues encoun-

tered that evening, one exchange stood

out.

I chatted briefl y with former

ASTRO President (and former

ASTROnews editor) Prabhakar

Tripuraneni, MD, FASTRO, who

suggested that I read the current issue

of Th e New Yorker, which included a

very intriguing article by Atul Gawa-

nde, MD. I assured Dr. Tripuraneni

that, as a longtime subscriber, my

copy of the magazine would be sitting

in a formidable pile of mail to bur-

row through when I returned home to

Richmond, Va.

I had actually forgotten our conver-

sation when I came across the issue in

question and scanned the contents for

the recommended article. Many of you

are familiar with Dr. Gawande, a sur-

geon at Brigham and Women’s Hospital

in Boston, and his prior publications

including “Better: A Surgeon’s Notes

On Performance” (2007, Henry Holt

and Company) and “Th e Checklist

Manifesto: How To Get Th ings Right”

(2009, Metropolitan Books), among

others.

In 2010, his poignant article dis-

cussing end-of-life issues, “Letting

Go: What Should Medicine Do

When It Can’t Save Your Life?”

(Th e New Yorker, August 2, 2010), won a

National Magazine Award. In 2008, he

delivered the second keynote address at

the ASTRO Annual Meeting in Boston

titled “Medical Errors and Performance

in Medicine.”

Dr. Gawande has devoted the bulk

of his writing and lecturing to quality

improvement in medicine, a truly laud-

able goal in a profession that has had

problems with such rudimentary issues

as laterality at the time of surgery. Th e

one thing that has always drawn me to

Dr. Gawande’s writing, however, is his

willingness to insert himself into the

discussion and his ability to learn from

his own experiences, both successes and

failures. Th is most recent article is no

diff erent.

“Personal Best: Top athletes and

singers have coaches. Should you?”

(Th e New Yorker, October 3, 2011) is

a tale of one physician’s recognition

that his skill level has peaked and his

subsequent quest for personal improve-

ment. Th ere is general acknowledgement

that surgical (and even clinical) skills

improve during the fi rst few years in

practice, then essentially plateau and,

DOES LEARNING EVER END?

in some instances, begin an inexorable

decline into mere competence over the

course of a 20 to 30 year career.

Over a period of time, the prudent

physician can learn how to anticipate a

potential problem during a surgical pro-

cedure or a colonoscopy or in the midst

of dialysis. As Dr. Gawande notes, “you

learn how to either prevent or respond

to those problems.” But what happens

when you stop improving? What can an

individual do to re-gain a peak perfor-

mance level?

Most baseball fans know who José

Bautista is. Almost no one knows who

Dwayne Murphy is. Th e Pittsburgh

Pirates originally drafted Bautista in

2000. He eventually made it to the

major leagues as a member of the 2004

Baltimore Orioles. He spent the next

fi ve seasons being traded seven times

before landing in Toronto in 2008.

As a rookie, he was touted by the

Baseball America “2004 Prospect

Handbook”: “Bautista has a quick bat

and can catch up to the best fastballs.

His power potential is his best tool.” But

that wasn’t the way it played out on the

fi eld.

He was average, at best, and showed

only fl ashes of the power of which he

was felt to be capable.

Th at all changed when he met

Dwayne Murphy, the Blue Jays hitting

coach. His “grip it and rip it” coaching

philosophy is not a fi t for every hitter,

but for José Bautista it was a revelation.

Murphy convinced Bautista to start his

swing earlier, with an increase in fl y

balls leading to more home runs … a lot

more home runs.

After hitting 13 home runs in 2008

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

KEEPING THE FOCUS ON THE PATIENT

THE THEME FOR THE 53RD ANNUAL MEETING of the American Society

for Radiation Oncology was “Patient-

Focused, High-Quality, Multidisci-

plinary Care,” and the meeting

logo/tagline for this and future

ASTRO meetings is “Science-based,

Patient-driven.”

As we hear of new or updated clini-

cal trials outcomes, practice-changing

research, the latest scientifi c fi ndings,

and new treatment techniques and tech-

nology, the foremost goal should be to

translate this information into the best

possible care of our individual patients.

In an era of increasingly sophisti-

cated technology, however, it becomes

more challenging for radiation oncology

physicians to spend adequate time with

their patients (history, physical exams,

communicating eff ectively with regard

to diagnosis, prognosis and treatment

options) and our multidisciplinary team

of colleagues. An increasing amount of

our time is spent defi ning tumor target

volumes and normal tissue/organ

constraints and subsequently evaluating

a variety of treatment plans (3-D CRT,

IMRT, IGRT).

In spite of the pending changes in

reimbursement and health care reform,

I am hopeful that we will continue to

think of our surgical and medical

oncology/hematology colleagues as

members of a patient-focused,

multidisciplinary team who work closely

together to provide high-quality diagno-

ses and care for our joint cancer patients

instead of perceiving them as competi-

tors for more limited health care dollars.

William J. (Will) Mayo (1861-1939)

noted: “As we grow in learning, we more

justly appreciate our dependence upon

each other. Th e best interest of the patient

is the only interest to be considered, and in

order that the sick may have the benefi t

of advancing knowledge, union of forces

is necessary.”

How do we ensure that we maintain

our primary focus on the patient, instead

of on new technology and patient reim-

bursement (Note: I am well aware of the

importance of both new technology and

appropriate reimbursement in

the care of our patients)? We need to

remember the idealism with which we

entered the fi eld of medicine and

deciding to recommit to some of the

oaths we may have repeated as we

graduated from medical school.

Included in the 1964 modernized

version of the Hippocratic Oath are

three principles that are worthy of our

focus today (my own edits are added):

CHAIRMAN’Supdate BY L E O N A R D L . G U N D E R S O N , M D, M S , FA S T R O C H A I R M A N , B OA R D O F D I R E C TO R S

(Continued on Page 6)

• I will apply, for the benefi t of the sick,

all measures that are required, avoiding

those twin traps of overtreatment

and therapeutic nihilism.

• I will remember there is art to medicine

as well as science, and that warmth,

sympathy and understanding may

outweigh the surgeon’s knife, the

chemist’s drug (or the rad onc’s

linac).

• I will remember that I do not treat a

fever chart, a cancerous growth, but

a sick human being, whose illness

may aff ect the person’s family and

economic stability.

Th e Presidential Symposium

for ASTRO 2011 focused on the

need for integrated, multidisciplinary

approaches in both the diagnosis and

treatment of our patients who have

especially diffi cult cancers.

Th e moderators and speakers were

leaders in their areas of science who

discussed issues of imaging and multi-

disciplinary consultations to determine

the need for one or multiple treatment

modalities, determination and implica-

tions of treatment sequencing, outcomes

(survival, relapse, risks), and the future

of individualized, molecular-based

patient treatment (i.e., why put all

patients through the risks of aggressive,

multimodality treatment approaches

if we can sub-select those most apt to

benefi t?).

As an organization, ASTRO

continues to feel strongly about achiev-

ing the proper balance between science,

technology and patient care/outcomes.

6 A S T R O N E W S | W I N T E R | 2 0 1 1

CHAIRMAN’Supdate(Continued from Page 5)

Of the six major goals in the ASTRO

Board of Directors strategic plan devel-

oped in 2010-2011, three have a strong

patient focus:

• ASTRO will provide state-of-the art

education and lifelong professional

development in the eff ective use of

radiation as a tool in the treatment of

patients with cancer.

• ASTRO will advance science

through research and innovation

to improve clinical outcomes for each

patient.

• ASTRO will shape the framework

for the delivery of safe, high-quality

health care to all cancer patients by the

radiation oncology team.

Major areas of focus for ASTRO during

the coming year with regard to quality

and safety of patient care include:

• Exploring the viability of setting up

an error reporting system.

• Setting up infrastructure of the new

Clinical Aff airs and Quality

Council.

• Expanding activities in both guide-

lines and best practices arenas.

• Quality measure development.

• Major PAAROT (Performance

Assessment for the Advancement

of Radiation Oncology Treatment)

expansion and modifi cation to tie

it into PQRS (Physician Quality

Reporting System).

With regard to medical error reporting,

ASTRO’s Target Safely program

included a recommendation for de-

termining whether such a mechanism

could be used to improve patient care

and reduce errors. A key question was

“How do you get providers to voluntarily

report this sensitive information about

errors and near misses?”

Th e answer lies in the Patient Safety

and Quality Improvement Act passed by

EDITOR’Snotes(Continued from Page 4)Congress in 2005, which created Patient

Safety Organizations (PSOs) to improve

quality and safety through data collec-

tion and analysis. A key attribute of

PSOs is that the collected data has strict

privilege and confi dentiality protections

(i.e., is not discoverable)!

ASTRO’s Board has endorsed the

PSO model for medical error reporting,

and ASTRO staff is exploring collabo-

ration with a PSO with a proposal due

to the ASTRO Board in 2012.

Since quality and safety consider-

ations are paramount to ASTRO

members, a new Clinical Aff airs and

Quality Council has been created to

provide strategic leadership and to

centralize, coordinate and prioritize the

eff orts to determine “correct treatment,”

identify gaps in care and inform ASTRO

members about their performance.

Information will be gathered from

the PAAROT program, practice ac-

creditation surveys and a nationwide

radiation oncology registry that is under

development by the Radiation Oncology

Institute (ROI). ASTRO will continue

to develop evidence-based guidelines but

plans to improve methods for systematic

review and to articulate recommenda-

tions so they can be used for measure

development.

To complement guideline eff orts,

the ASTRO Board approved creation of

best practices clinical statements using

RAND methodology, which makes use

of all available evidence ranging from

randomized phase III trials to expert

opinions. Th e fi rst statements are

expected by mid- to late 2012.

Creation of the new Clinical Aff airs

and Quality Council will bring focus

and representation to important quality

and safety issues, centered on the radia-

tion oncology team and the patient, to

the ASTRO Board.

Dr. Gunderson is an emeritus professor and

consultant at the Mayo Clinic in Arizona.

He accepts comments on his editorial at

communications@astro.org.

and 17 in 2010, the coaching clicked

and Bautista connected for an astound-

ing 54 in 2010 and another 43 homers in

2011. Coaching.

Athletes are hardly alone. Opera

singers, such as the iridescent Dawn

Upshaw (a breast cancer survivor) and

the Italian soprano Cecilia Bartoli,

routinely employ vocal teachers, often

remaining with the same instructor

throughout their professional careers.

Politicians employ debate coaches; actors

employ acting coaches. Are doctors that

diff erent?

Yes … and no.

In Dr. Gawande’s case, he recog-

nized that his complication rates were

initially better than the national average

and then slowly rose to slightly above

that average. But rather than just assum-

ing it was a statistical fl uke or, worse,

ignoring the data, he actively looked for

a solution.

He invited a surgical mentor,

Robert Osteen, MD, into the OR to

observe his cases, take notes and then

critique his technique and intraoperative

decisions. Dr. Osteen observed mul-

tiple procedures and then met with his

former student to off er his remarks and

recommendations.

“Osteen has continued to coach me

in the months since that experiment”,

writes Dr. Gawande. “I take his obser-

vations, work on them for a few weeks,

and then get together with him again.”

As a result, Dr. Gawande’s complication

rate has fallen.

Where does coaching fi t into a ra-

diation oncologist’s practice? Who could

you invite to coach? We already have

something that resembles coaching with

weekly chart rounds where (at the very

least) all new cases are discussed and

peer reviewed for appropriateness and

safety.

(Continued on Page 32)

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SPECIALreport BY LAURA THEVENOT

ACKNOWLEDGING DATABASE, WEBSITE DIFFICULTIES

BY NOW, MOST OF YOU ARE AWARE THAT ASTRO launched a newly rede-

signed and reorganized website. It looks

amazing and will off er members easier

access to the tools they need to provide

their patients with the best possible care.

We are very proud of it and hope you

are too.

What you may be less aware of

is that months before the website was

complete, ASTRO implemented a new

database that controls how information

is stored on the backend of ASTRO’s

website.

Th is database includes member login

information, product information that

allows you to order from the website,

course and meeting information that

allows you to register for these services

online, and all the other detailed infor-

mation that keeps the Society running.

Both were complex and time con-

suming projects but very important ones

to be able to off er you the services and

access to member benefi ts that you want

and deserve. While, we spent over

a year developing the database and

website, there were several bugs that

popped up once they went live that may

have made member use of the website

diffi cult.

I am aware that these problems

occurred and want to apologize for the

inconvenience this caused our members.

Due to the complexity of the system, I

expected a few bugs. I am not willing to

accept that some members were overly

inconvenienced and not able to access

the member benefi ts they were promised

when joining the Society.

I’m happy to say that as of today

99 percent of the bugs have been worked

out and both the new database and

website are running beautifully. Our

staff worked around the clock to fi x

the problems in the system and answer

member calls pertaining to website

diffi culties.

Th e following most common

problems have been rectifi ed by

ASTRO staff :

• Issues creating a new Web user

account in the new system.

• Registering for a meeting.

• Access to both journals.

• Learning Management System

(LMS) issues (i.e., inability to

purchase and launch a course).

• Website latency issues.

Member satisfaction is our number

one priority, and I want to again apolo-

gize for any dissatisfaction the database

implementation caused. I am confi dent

that the new database will ultimately

improve your website experience and

make it easier to access the member

benefi ts you count on from ASTRO.

I also want to acknowledge my

entire IT team, led by Jason Hoolsema,

who spent days, nights and weekends

launching our new system. While there

were bumps, they never lost sight of our

mission as staff members—to help you

help your patients.

Laura Th evenot is ASTRO’s chief execu-

tive offi cer. She welcomes comments on this

column at communications@astro.org.

Member satisfaction is our number one priority, and I want to again apologize for any dissatisfaction the database implementation caused. I am confi dent that the new database will ultimately improve your website experience and make it easier to access the member benefi ts you count on from ASTRO.

8 A S T R O N E W S | W I N T E R | 2 0 1 1

SOCIETYnews

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

Malcolm A. Bagshaw, MD, FASTROVeronique Benk, MDKetayun A. Dinshaw

Frank Ellis, MDLucien Vanuytsel, MD, PhD

Harold W.C. Ward, MD

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

ASTRO members elected seven representatives to the Board of Directors and Nominating

Committee for the 2011-2012 Society year. Th e new offi cers began their terms at the 53rd

Annual Meeting in Miami Beach, Fla.

“Strong leaders are essential to the success of an organization like ASTRO, and I am honored

to announce the new offi cers that our members have elected,” Anthony L. Zietman, MD,

ASTRO immediate past chairman, said. “I am confi dent these dedicated individuals will bring

the same level of expertise and commitment to the Society that our members and the patients

they serve have come to expect. I off er my sincere congratulations to each of the new offi cers.”

NEW SOCIETY OFFICERS ELECTED

THE NEW OFFICERS ARE: (LEFT TO RIGHT)

President-elect

Colleen Lawton, MD, FASTRO

Health Policy Vice-chairman

Brian Kavanagh, MD

Research Council Vice-chairman

Mary K. Martel, PhD, FASTRO

THE NEW NOMINATING COMMITTEE MEMBERS ARE:

Nominating Committee Academic Physicians

Beth A. Erickson, MD

Robert L. Foote, MD, FASTRO

Nominating Committee Community Practice Physicians

Gregg E. Franklin, MD, PhD

William R. Noyes, MD, MBA

B O A R D | M E M B E R S H I P

9A S T R O N E W S | W I N T E R | 2 0 1 1

ASTRO proudly recognizes our 2011

Corporate Ambassadors for their outstanding

year-round leadership and support of radiation

oncology.

2011 AMBASSADOR Recognition

C. Norman Coleman, MD,

FASTRO, associate director of

the Radiation Research Program

and a senior investigator in the

Radiation Oncology Branch in

the National Cancer Institute,

was awarded the 2011 Samuel

J. Heyman Service to America

Homeland Security Medal for

his work developing the blue-

print for the United States’

medical response to radiological

and nuclear incidents and for as-

sisting with the response to the

combined disaster in Fukushima, Japan.

Th e Sammies are presented by the

Partnership for Public Service, a non-

profi t organization focused on federal

employee issues, and pay tribute to

federal government employees by

recognizing those who have made

signifi cant contributions to the country.

Honorees are chosen based on their

commitment and innovation, as well as

their work’s impact on addressing the

needs of the nation.

Dr. Coleman was instrumental in the

U.S. disaster response after the earth-

quake and tsunami that struck Japan in

March. He was part of the response

team on the ground in Japan and said

the initial goal was to provide advice and

assistance to the ambassador relating

to radiation issues for the embassy

employees and U.S. citizens in Japan, but

this soon expanded to participation in a

Japan-U.S. Working Group on medical

research and communication issues.

“Th at health and medical conse-

quences are recognized in the Homeland

Security category shows the importance

of the eff orts of the Department of

Health and Human Services and our

ASTRO MEMBER HONORED WITH FEDERAL SERVICE MEDAL

SOCIETYnews

collaborating agencies,” he said. “On a

personal level, there are few rewards as

gratifying as service to others and our

team at HHS and NCI are pleased to

have the eff orts recognized.”

Dr. Coleman was presented with his

award by Secretary of Energy Stephen

Chu, PhD, at a black tie gala in Wash-

ington on September 15, 2011. Nine

federal employees were honored this year

with medals such as the Career Achieve-

ment Medal, Science and Environment

Medal and Call to Service Medal,

among others.

“Th e scope of possibilities that can be

accomplished and public needs that can

be met through the federal government

are unique and broad reaching,” Dr.

Coleman said. “Having a creative and

multi-talented workforce is important.

Recognizing federal service can demon-

strate to the public what they are getting

for their investment and also can help

serve to recruit talented people.”

H O N O R S

BY NICOLE NAPOLI, COMMUNICATIONS MANAGER, NICOLEN@ASTRO.ORG

Secretary of Energy Stephen Chu, PhD,(right) presents C. Norman Coleman, MD,(left) with a Samuel J. Heyman Service to America Homeland Security Medal.

10 A S T R O N E W S | W I N T E R | 2 0 1 1

SOCIETYnews A M B A S S A D O R S | C O R P O R AT E R E L AT I O N S

1) MEVION Medical Systems:

Najeeb Mohideen, MD, Robert Lavey, MD, MPH, and Laura Dawson, MD, thank Joseph Jachinowski, Thomas Faris, Earl Cleveland, Marc Buntaine, Ken Gall, PhD, Skip Rosenthal and Lio-nel Bouchet, PhD, for their Bronze level support.

2) Accuray:

Jatinder Palta, PhD, C. Leland Rogers, MD, Brian Kavanagh, MD, Bharat B. Mit-tal, MD, FASTRO, and Amar Rewari, MD, MBA, thank Chris Raanes, Derek Ber-tocci, Kelly Londy, Euan Thomson, PhD, Darren Milliken and Omar Dawood for their Corporate Ambassadorship.

3) Brainlab:

Laura Dawson, MD, Deborah Kuban, MD, FASTRO, Robert Lavey, MD, MPH, and Najeeb Mohideen, MD, thank Sean Clark, David Brett and Jason Chandler for their Corporate Ambassadorship.

THANK YOU TO OUR 2011 ASTRO AMBASSADORS AND ANNUAL MEETING SUPPORTERS

A contemporary convention center in a city with a vibrant cosmopolitan infl uence helped make Miami Beach, Fla., an exceptional site for ASTRO’s 53rd Annual Meeting. The Exhibit Hall featured

the latest technology, products and services in radiation oncology and cancer care. We’d like to take this opportunity to highlight some of the industry leaders:

ASTRO’s Corporate Ambassadors and Annual Meeting Supporters.

1

2

3

11A S T R O N E W S | W I N T E R | 2 0 1 1

4) Radiation Business Solutions:

Bharat B. Mittal, MD, FASTRO, C. Leland Rogers, MD, Jatinder R. Palta, PhD, Brian Kavanagh, MD, MPH, and Amar Rewari, MD, thank Dan Moore, Anoma Moore and Jeff Matlock for their Corporate Ambassadorship.

4

6

7

5) Viewray:

Robert Lavey, MD, MPH, Najeeb Mohideen, MD, and Laura Dawson, MD, thank Richard Stark, James Dempsey and Gregory Ayers for their Bronze support.

6) Varian Medical Systems:

Bharat B. Mittal, MD, FASTRO, C. Leland Rogers, MD, Jatinder R. Palta, PhD, Brian Kavanagh, MD, MPH, and Amar Rewari, MD, thank Dow Wilson and others from Varian for their Silver level support and Corporate Ambassadorship.

7) Elekta:

Colleen Lawton MD, FASTRO, Najeeb Mohideen MD, Robert Lavey, MD, MPH, and Laura Dawson, MD, thank Tomas Puusepp, Jay Hoey, Mark Arnold and Scott Soehl for their Corporate Ambassadorship.

8) Vertual Ltd.:

Arthur Kay, Jan Antons, Andy Beavis, Mark Holland, James Ward meet with Jatinder R. Palta, PhD, C. Leland Rogers, MD, Brian Kavanagh, MD, MPH, and Amar Rewari, MD, in thanks for their Copper level support.

9) GE Healthcare:

Rahul Parikh, MD, and Michael L. Steinberg, MD, FASTRO, thank Paul Anderson, Timea Zsiray, Clint Lord and Mark Marsico for their long standing corporate Ambassadorship.

8

9

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12 A S T R O N E W S | W I N T E R | 2 0 1 1

WHEN 4-YEAR-OLD BELLA RODRIGUEZ-TORRES WOKE UP ON JULY 17, 2007, SHE COULDN’T MOVE HER LEGS. “As parents we were in shock yet optimistic that this paraly-

sis would not be anything serious and would only be temporary,”

Raymond Rodriguez-Torres, Bella’s father, said.

But, initial tests showed that might not be true. Bella’s on-

cologist discovered a large tumor wrapped around Bella’s spine

and cancer in nine other areas of her body. She was offi cially

diagnosed with stage 4 metastatic alveolar rhabdomyosarcoma

and given a prognosis of permanent paralysis and a few months’

life expectancy.

Bella remained wheelchair bound for four months and

refused to show anyone her legs. Raymond said she kept

them covered with a blanket because she was so frustrated she

couldn’t walk.

“We scoured the earth as a family for treatment options

and were told Bella would never walk again and would

only live a few months,” Raymond said. “We turned to the

only one who could help us and that was the Almighty.”

Today, four years later, Bella is an active 8 year old and

winner of ASTRO’s 2011 Survivor Circle Award.

“Bella’s positive attitude is truly amazing. She never

complained when she underwent all of her cancer treat-

ments,” Raymond said. “She has absolutely no fear and is

now living a full life as a healthy, happy 8 year old.”

Th e Survivor Circle Award recognizes a person living with

cancer in the Miami area who has devoted his or her time to

helping others who are living with cancer in their community.

Raymond accepted the award on behalf of Bella during the

awards ceremony at ASTRO’s 53rd Annual Meeting in

Miami Beach, Fla.

“ASTRO is proud to honor Bella with this year’s

Survivor Circle Award. Her remarkable spirit is an inspiration

to other pediatric cancer patients and their families,” Leonard

L. Gunderson, ASTRO chairman, said. “It is critical to con-

tinue supporting pediatric cancer research, which has greatly

improved overall survival for children with cancer and has the

potential to cure even more young patients.”

8 year old cancer survivor defi es odds, continues to win cancer battle

T E R | 2 0 1 1

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BY NICOLE NAPOLI, COMMUNICATIONS MANAGER, NICOLEN@ASTRO.ORG

“Bella’s positive attitude is truly amazing. She is now living a full life as a healthy, happy 8 year old.”

13A S T R O N E W S | A N N UA L M E E T I N G | 2 0 1 1

THE FIGHT AGAINST CANCER

After her diagnosis in 2007, Bella underwent surgery, high-

dose chemotherapy and 16 weeks of radiation treatment over

the course of a year. She was treated at Miami Children’s

Hospital and the University of Florida Proton Institute. She

was declared cancer free in early 2008.

One year later, a tumor was found in Bella’s brain. She

underwent six months of treatment, including chemotherapy

at Miami Children’s hospital, whole brain photon radiation at

Joe DiMaggio children’s Hospital in Hollywood, Fla., and 8H9

radiolabled antibody via an Ommaya reservoir at Memorial

Sloan-Kettering Cancer Center in New York.

She was again declared cancer free in November 2009 and

remained in remission for two years.

On September 28, 2011, days before she was to attend the

ASTRO Annual Meeting, Bella went to Memorial Sloan-

Kettering Cancer Center in New York for a follow-up visit.

Routine scans detected a malignant tumor in her right ovary

and she had emergency surgery to remove the ovary and tumor.

Days later, Bella was out of bed, moving and ready to go

home to Florida.

As of press time Bella does not have circulating cancer

cells and her bone marrow is cancer free.

“Bella is a very special child; a fi ghter who does not have

an ounce of quit within her,” Raymond said. “While this road

has been diffi cult, our faith in God and faith that a cure

will be found sustains us.”

GIVING BACK

Bella and her family have devoted their time since Bella’s

diagnosis to the fi ght against pediatric cancers.

Raymond has organized several fundraisers on behalf of

Bella for CureSearch, an organization that funds and sup-

ports childhood cancer research and provides information and

resources to children and their families. Raymond served as

chairman of the inaugural Miami CureSearch Walk, which

raised more than $80,000 for the organization. Bella will

donate her $1,000 Survivor Circle prize to CureSearch.

“We believe that to he or she that much is given, much is

expected,” Raymond said. “We have received the greatest gift

we could ask for: Bella’s life free from cancer and paralysis. We

can never stop giving thanks and giving back to help fi nd a

cure.”

Raymond also authored the book, “Why not me? A true

story of a miracle in Miami,” which chronicles Bella’s journey

through her cancer diagnosis, treatments and survivorship.

One hundred percent of the proceeds go to childhood cancer

research, and the book has earned over $40,000 so far.

“Pediatric cancer research is underfunded, and while child-

hood cancer is rare, it is the number one killer of children,”

Raymond said. “Many treatments are 20 to 30 years old, and

greater awareness, funding and support for children and

families fi ghting childhood cancer is desperately needed.”

For more information on the Survivor Circle Award,

visit www.rtanswers.org.

To follow Bella’s fi ght against cancer, visit

www.prayforbella.com. To learn more about Raymond’s book

visit www.WhyNotMebook.com.

Raymond Rodriguez-Torres accepted the Survivor Circle Award and $1,000 prize on behalf of his daughter Bella during the 2011 Annual Meeting in Miami Beach, Fla. Raymond and Bella will donate the prize to CureSearch, an organization dedicated to funding and supporting childhood cancer research.

14 A S T R O N E W S | W I N T E R | 2 0 1 1

Introducinga brand new

“Th is site was designed with our members in mind and imple-

mented features chosen to help our members better serve their

patients by giving them easier access to the resources ASTRO

provides,” Laura Th evenot, ASTRO CEO, said. “We listened

to what the members wanted from the Society’s website and

made it a reality. I think everyone will be pleased with the new

www.astro.org.”

ASTRO’s last website was designed in early 2007; it was

the second redesign since ASTRO went online in 1998 (the

fi rst was in 2003). Over the past several years, members have

said they wanted a site that more closely refl ected the way

they practice. ASTRO’s redesigned website has carefully taken

member feedback into account with the aim of providing all

users with the most seamless way to use the features that they

need.

BY BETH BUKATA, DIRECTOR OF COMMUNICATIONS, BETHB@ASTRO.ORG, AND NICOLE NAPOLI, COMMUNICATIONS MANAGER, NICOLEN@ASTRO.ORG

Following two years of rigorous planning, ASTRO launched

a redesigned website on November 29 that allows the

membership easier and more intuitive access to the parts

of their ASTRO membership they value most.

“Websites become outdated quickly,” Jason Hoolsema,

ASTRO IT director, said. “Since technology changes at such

a rapid pace, people expect websites and online capabilities to

change just as rapidly. We want to be able to provide the most

cutting-edge advances to our members with our website.”

To assist ASTRO staff in the redesign process, ASTRO

hired Th e Berndt Group, one of the oldest and best respected

development and interactive brand communications fi rms in

the Washington/Baltimore area.

“Th e Berndt Group was selected for their strong Web

development, with emphasis on usability and brand impact,”

Hoolsema said. “Th e ideas they brought to the table for

making our site more robust and interactive were exactly what

we were looking for to enhance www.astro.org.”

www.ASTRO.org*

* See Page 7 for a column from ASTRO CEO Laura Thevenot addressing glitches with the website launch and how ASTRO staff rectifi ed the problems.

15A S T R O N E W S | W I N T E R | 2 0 1 1

THE HOMEPAGETh e new website is

divided into eight main

navigation areas: News

and Media Center, Educa-

tional Resources, Meetings

and Events, Clinical Practice,

Research, Practice Manage-

ment, Advocacy and Mem-

bership, which are displayed

across the top of the entire site.

Th ese will allow easy navigation

to breaking news, meeting registra-

tions, guidelines, coding information

and legislative updates.

Th e homepage also off ers direct

links to the International Journal of

Radiation Oncology•Biology•Physics (Red

Journal) and Practical Radiation Oncol-

ogy (PRO), an easy to fi nd log in box to

access My ASTRO, and featured news and

resources from within the site.

My ASTRO My ASTRO is a central location where you

can access all aspects of your ASTRO member-

ship. When you log in to My ASTRO using your

unique user ID and password, you will have access

to your committee appointments, a history of orders

placed, a listing of past courses you have taken and

future courses you are registered for, access to your My

MOC transcript, and an expanded profi le that includes

your practice location, modalities used and disease sites

treated.

You will now be able to update your profi le informa-

tion in this section to ensure ASTRO has your most

up-to-date contact information. Here you can also man-

age your Red Journal, PRO, and ASTROnews subscriptions,

including updating mailing information and setting alternate

addresses so you never miss an issue.

Access to a complete history of your interactions with

the Society is unprecedented for our website and made (Continued on Page 16)

16 A S T R O N E W S | W I N T E R | 2 0 1 1

possible through the deployment of a

new membership database. Th e new

database was initially launched in April,

but its capabilities couldn’t be fully real-

ized until the new website launched.

NEWS AND MEDIA CENTER Th e News and Media Center will

include feeds from industry news and

highlight the most important news

in the Society. It will pull from

ASTROnews, press releases,

ASTROgrams, Medicare News, What’s

Happening in Washington, meeting

pages and more to bring you the latest

ASTRO developments on one page.

It will also include expanded

versions of the print version of

ASTROnews and online only

ASTROnews supplements covering

Advocacy Day and the Annual Meeting.

CLINICAL PRACTICEA common complaint about the

old site was the diffi culty in fi nding

guidelines and white papers. On the

new site, these documents plus best

practices information will all be

located under a central section—

Clinical Practice. Documents are or-

ganized by type and alphabetically for

quick reference. Th is section will also

hold updates to Target Safely, ASTRO’s

patient protection initiative.

And this is just phase one of the

new website. Over the next two years

ASTRO will implement additional

features to make the site even more

interactive and member focused, includ-

ing a redesigned member directory with

improved functionality.

“While many new features will be

available once the site goes live, ASTRO

will remain innovative when it comes to

our online presence,” Hoolsema said.

“We will continue to make upgrades and

implement new features that improve

the users’ experience and keep ASTRO

up-to-date with emerging technologies.”

www.astro.orgNOTEWORTHY NEW FEATURES:• Membership applications can now be completed online.• Confl ict of interest forms can be updated electronically year-round.• Committee members can now access committee rosters online.• Red Journal and PRO subscriptions can be accessed and managed from

the ASTRO site.• Past order histories, past and future courses, and personal profi le

information can be viewed and managed easily.• ASTROnews is available as a dynamic magazine, not just a PDF.• All ASTRO and industry news can be found in one location—the News and

Media Center.• Guidelines and white papers are located in the same section of the site

and are easier to navigate to.

(Continued from Page 15)

17A S T R O N E W S | W I N T E R | 2 0 1 1

g

18 A S T R O N E W S | W I N T E R | 2 0 1 1

membership

MORE THAN 10,000 RADIATION ONCOLOGY professionals from around

the globe turn to ASTRO as their

resource for information, guidance,

professional development and advocacy.

While 60 percent of our members are

radiation oncologists, membership in

ASTRO today is comprised of individ-

uals who represent the entire radiation

oncology treatment team.

Th e majority of members, 75

percent, are based in the United States;

however, in the past few years, we have

witnessed increased growth in our

international membership, which now

Members speak out on ASTRO, radiation oncology

accounts for 25 percent of membership.

ASTRO is committed to serving the

needs of our members through ongo-

ing research, education, maintenance of

certifi cation, advocacy and cost-saving

member benefi ts. To help us understand

the needs of our members, we conduct an

annual membership survey, asking ques-

tions ranging from where members work

to their emerging needs.

Members received an email link to

the 2011 Annual Membership Survey

on July 22, 2011, with four follow up

email reminders in August and the

survey closed on September 1, 2011.

ASTRO recorded 1,444 completed

surveys representing the views and

opinions of approximately 17 percent of

our members. A brief summary of the

survey fi ndings follows.

RESPONDENT DEMOGRAPHICS

Sixty-one percent of survey respon-

dents described themselves as radiation

oncologists, 20 percent physicists, 8

percent radiation oncology residents

and the remaining 11 percent included

clinical oncologists, radiation biologists,

medical dosemetrists, oncology nurses,

radiation therapists, administrators,

nurse practitioners and others, each

representing about 1 percent.

More than half (57 percent) of

radiation oncologists and exactly half of

medical physicists indicated that they

have time-limited certifi cations.

When asked about the population

density of their practice location, 69

percent indicated their primary practice

location was in an urban area, which

is up 4 percent from last year and 10

percent from 2005. Th irty-three percent

of respondents indicated that a free-

standing radiation oncology practice

owned by a non-radiation oncologist,

i.e., specialty owned, was located in

their community.

Sixty-nine percent of the survey

respondents indicated that their pri-

mary practice was located in the United

States. Of the 447 respondents who

said their primary practice was located

outside of the U.S., 17 percent said their

practice was in Canada, 12 percent in

Japan and 6 percent in Th e Netherlands.

Th e remaining respondents are from 56

countries located throughout the world.

BY ANNA ARNONE, VICE-PRESIDENT OF MEMBER RELATIONS AND COMMUNICATIONS, ANNAA@ASTRO.ORG

RESULTS OF ANNUAL MEMBER SURVEY SHOW MEMBERS’ SATISFACTION WITH SOCIETY

Other 3%

Rural 8%

Suburban 21%

Urban 69%

2) PRIMARY PRACTICE LOCATION

1) YEAR OF CERTIFICATION

RADIATION ONCOLOGISTS MEDICAL PHYSICISTS

1995 and Beyond

Time-limited Certifi cation

1994 and Before

Lifetime Certifi cation

2002 and Beyond

Time-limited Certifi cation

2001 and Before

Lifetime Certifi cation

57%

43%

50%

50%

19A S T R O N E W S | W I N T E R | 2 0 1 1

(Continued on Page 20)

EMPLOYMENT ARRANGEMENT

More than one-third of all respondents

said they work for an academic/

university system and more than half

work in a private/group practice or

hospital.

When asked to describe their pri-

mary work setting, 64 percent of

the respondents said they worked in a

hospital based setting, which is up

15 percent from last year.

MEMBER SATISFACTION WITH

ASTRO

ASTRO members indicated that they

were satisfi ed with their membership

experience. Eighty-eight percent of re-

spondents who participated in ASTRO

activities/events agreed that participa-

tion in ASTRO was a good use of their

time. Eighty percent were satisfi ed

with ASTRO’s educational off erings.

Forty percent of respondents contacted

ASTRO staff over the past year and

only 6 percent of those who contacted

ASTRO rated their experience as poor

or below.

CHALLENGES

Domestic physician respondents identi-

fi ed reimbursement, health care reform

and practice encroachment as the three

most challenging issues faced by

their practice. In 2007, the top three

challenges facing physicians were

regulatory compliance, practice

encroachment and increased overhead.

On average, private/group practices face

the most challenges in their practice.

Reimbursement/payment cuts 8.27

Health care reform 7.81

Practice encroachment 7.28

Regulatory compliance 6.78

Achieving better patient outcomes 6.73

Participating in quality improvement activities 6.57

Identifying areas for quality improvement and patient safety 6.45

Malpractice issues 5.51

5) CHALLENGES TO PRACTICE

(as reported by radiation oncologists in the U.S.) 0 1 2 3 4 5 6 7 8 9 10

ALL RESPONDENTS U.S. RADIATION ONCOLOGISTS

Academic/University System 38% 36%

Hospital 26% 21%

Private/Group Practice 26% 35%

Government/Public System/Military 3% 3%

Independent Contractor/Locum Tenens 3% 3%

Industry 1% 0%

Other 3% 3%

3) PRIMARY EMPLOYER

4) PRIMARY WORK SETTING

ALL RESPONDENTS U.S. RADIATION ONCOLOGISTS

Hospital-based 64% 64%

Freestanding/Satellite Clinic 16% 14%

Both Hospital-based and

Freestanding/Satellite Clinic 18% 18%

Other 3% 2%

20 A S T R O N E W S | W I N T E R | 2 0 1 1

membership

Educating Congress or regulators 9.20Raising public awareness 8.87Advocating with insurers for coverage 8.81Providing professional education development 8.71Providing information on regulatory issues 8.71Developing clinical practice guidelines 8.70Promoting improvement of quality care and patient safety 8.63Promoting research to improve clinical outcomes 8.36Providing accreditation to RO practices 7.91Providing funding opportunities 7.37

Members were asked to rate the functions ASTRO serves. U.S. respondents indicated that educating Congress or regulators, raising public awareness and advocating with insurers for coverage were the most important functions. However, all functions received a very high importance rating.

0 1 2 3 4 5 6 7 8 9 10

7) IMPORTANCE OF ASTRO FUNCTIONS AND BENEFITS

Members were asked how they prefer to access/read the Red Journal and PRO. While more than half of the respondents indicated that they read the print version of both journals, more than one-third of the respondents access or read the journals online.

8) HOW MEMBERS ACCESS/READ ASTRO JOURNALS

IJROBP PRO

Print 67% 53%

Online, at journal site 39% 20%

Online, as part of institutional subscription 38% 16%

PubMed and other article search engines 39% 14%

Google and other general search engines 19% 6%

N/A Do not read it 2% 14%

6) CHALLENGES TO PRACTICE IN DIFFERENT WORK SETTINGS

(as reported by radiation oncologists in the U.S.) Based on highest of 10 percent.

Reimbursement 7.32 6.66 8.49

Health care reform 7.20 7.00 8.03

Practice encroachment 6.59 6.29 7.47

Regulatory compliance 6.47 6.48 6.71

Better patient outcomes 7.21 7.16 6.85

Quality improvement activities 6.57 6.53 6.57

Identifying areas to improve quality 6.57 6.77 6.49

Malpractice issues 5.33 5.40 5.71

ACADEMIC/UNIVERSITY SYSTEM HOSPITAL PRIVATE/GROUP PRACTICE

A closer look at the challenges by work setting reveals that while reimbursement, health care reform and practice encroachment are important to all work settings, they hit the private/group practice the hardest.

21A S T R O N E W S | W I N T E R | 2 0 1 1

9) INTERNATIONAL MEMBERS—IMPORTANCE OF ASTRO FUNCTIONS

Developing clinical practice guidelines 9.23

Promoting improvement of quality care and patient safety 9.03

Providing professional education development 8.91

Raising public awareness 8.79

Providing funding opportunities 8.16

International members identifi ed developing clinical practice guidelines, promoting improvement of quality care and patient safety and providing professional education development as the top three functions that ASTRO serves. Receiving the Red Journal and attending the Annual Meeting ranked at the top of the list when International Members were asked to rate importance of ASTRO benefi ts.

(as reported by international respondents) 0 1 2 3 4 5 6 7 8 9 10

When International members were asked why they joined ASTRO, comments included: “Because it is the most important, useful and reliable association in radiation oncology,” “To keep abreast of developments in the practice of radiation oncology throughout the world” and “ASTRO Annual Meetings are outstanding and through my ASTRO membership I am able to maintain contacts with members of task/working groups.”

10) USE OF MEMBER BENEFITS BY INTERNATIONAL RESPONDENTS

Red Journal 83%

Attend ASTRO Annual Meeting 80%

Clinical practice guidelines 54%

Patient information 19%

Attend ASTRO small meetings 14%

Participate in webinars 10%

Self-assessment modules 4%

Other 2%

(as reported by international respondents) 0 10 20 30 40 50 60 70 80 90 100

Th ank you to all members who took the time to complete this survey. We received a tremendous amount of valuable information, all of which we could not report here, but we will take all suggestions, recommendations and responses into consideration as we continue to work to serve our members. A special thanks to Barbara Muth, director of research, and Lindsey Mayberry, guidlines analyst, for compiling the data in this report.

22 A S T R O N E W S | W I N T E R | 2 0 1 1

James D. Cox retires

BY KATHERINE BENNET T, MANAGING EDITOR, SCIENTIFIC JOURNALS,

KATHERINEB@ASTRO.ORG

as Red Journal editor-in-chief

FOR THE PAST 15 YEARS, JAMES D. COX, MD, FASTRO, has been

the man behind the International Journal of Radiation Oncology•

Biology•Physics. He will step down as editor-in-chief offi cially on

December 31, 2011, after logging thousands of hours on behalf

of our specialty to build the Red Journal as the place for radiation

oncology research.

“Jim has a prodigious talent for getting the job done,” Martin Brown,

PhD, a biology senior editor who practices at Stanford University in

Stanford, Calif., said. “In addition to running the Division of Radiation

Oncology at the MD Anderson, he handled more than 1,000 manu-

scripts to the Red Journal every year. I thought the 200 or so

that I handled was a lot of work, but what Jim did was amazing.”

Dr. Cox published his fi rst issue in January 1997, taking over from

Philip Rubin, MD, FASTRO, who founded the journal in 1975. Prior to

the Red Journal, Cancer had been the offi cial journal of ASTRO. How-

ever, once the Red Journal was born, it became ASTRO’s offi cial journal.

Th e fi rst year, the Red Journal published six issues. By 1984, it was up to

15 issues a year, as it is today.

When Dr. Cox took over, the journal was poised for great changes,

many due to the Internet age. Under his leadership, the journal launched

its fi rst website at www.redjournal.org in 2001 where subscribers could

read articles online, including articles in press. About this time, the

journal also began to accept submissions online.

RED JOURNAL BY THE NUMBERS• Dr. Cox is personally responsible for publishing 15 issues a year

for 15 years—a total of 225 issues.

• In 1999, the number of new or original submissions to the

Red Journal was 794.

In 2010, the number of new or original submissions was 2,022.

• In 1995, the impact factor was 2.4. In 2010, the number was 4.592.

• In 1995, the journal’s circulation was 5,300. In 2011, that number

was 7,833.

• Th e journal built its fi rst website in 2001. Th ere are now more than

1.6 million articles downloaded each year from www.redjournal.org.

23A S T R O N E W S | W I N T E R | 2 0 1 1

ANTHONY ZIETMAN, MD, FASTRO, of

Massachusetts General Hospital, Harvard

Medical School in Boston, offi cially takes over

as editor-in-chief of the Red Journal on January

1, 2012. Dr. Zietman and his team of nine senior

editors and 38 associate editors began handling

new manuscript submissions on October 1,

2011, while outgoing editor-in-chief James D.

Cox, MD, FASTRO, and his team continued to

work on existing submissions and revised

manuscripts. Th at transition is now complete.

“Jim Cox and his team of staff and editors

have done a remarkable job over the past 15

years,” Dr. Zietman said. “It is very humbling

but incredibly exciting to be taking over the

helm of such a prestigious journal.”

Under Dr. Zietman’s tenure, the journal

is making several changes that will aff ect both

readers and authors. Authors will be required

to take a few extra steps during the manuscript

submission process, but these steps should help

improve transparency and lead to better reviews.

BY KATHERINE BENNET T,

MANAGING EDITOR, SCIENTIFIC JOURNALS

KATHERINEB@ASTRO.ORG

Red Journal changes implemented as new editor begins tenure

Allowing submissions electronically streamlined the operations

tremendously. Th is also led to a large increase in submissions, including

a spike in submissions from outside the U.S. and Canada.

Beyond the basic original journal, Dr. Cox introduced several new

article types to spur learning and thought among the community. One

of these was critical reviews where authors explore a topic in depth.

He also introduced the controversy section and book reviews.

“Having the opportunity to work closely with Jim has provided me

with an educational experience relating to editorial work and journal

management that has been incredibly rewarding,” Lynn D. Wilson,

MD, MPH, critical review editor for the journal and a radiation

oncologist at Yale University in New Haven, Conn., said. “It was an

honor for me to have been given the opportunity to work with Jim, and

the fi eld of radiation oncology has benefi tted substantially from his

superb leadership and oversight of the journal.”

Th e journal also saw an incredible rise in its impact factor under Dr.

Cox, rising from 2.6 in 1997 to nearly 4.6 in 2010. Th e impact factor

measures the number of citations for a journal and roughly means that

every article in the journal is cited 4.6 times in a two-year period.

“When I went into solo practice in a small town, I asked [Jim]

whether it would be possible for the journal to begin reviewing books,

which would address a need faced by physicians in my situation without

access to a well-stocked medical library,” David Shimm, MD, book

review editor for the Red Journal and a radiation oncologist at Beckley

Oncology Associates in Charleston, W.Va., said.

“His response to me was that I should feel free to take on this task.

Since I took on this responsibility in 2004, the journal has published

close to 70 book reviews, some of which I hope have guided readers in

making informed purchases. Dr. Cox deserves credit for being open to

suggestions and for backing his editors’ ideas.”

Under Dr. Cox’s leadership, the journal has become the most read

journal in the fi eld. In a recent survey conducted by Kantar Media,

90 percent of radiation oncologists said they read each issue of the Red

Journal. Th e next highest journal was only read by radiation oncologists

67 percent of the time.

“ASTRO and radiation oncology owe Jim a debt of gratitude for

all his work on the journal, including mentoring authors, editors and

reviewers,” Laura Th evenot, ASTRO CEO, said. “Th ere is no doubt

that the specialty and patient care are vastly improved due to the articles

published by him as editor.”

(Continued on Page 24)Dr. Cox’s fi rst and last Red Journal issues.

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

New editor begins tenure

acceptance and print publication

than is acceptable. In 2011 we

launched a pilot program to allow

some authors to go electronic only

in exchange for an earlier publica-

tion date; this will continue in 2012.

We will also be increasing our page

budget in 2012 to reduce the back-

log of accepted manuscripts.

4) $75 submission fee. To ensure that

authors receive a timely response

to their submission and that their

publication appears in the journal as

quickly as possible, the Red Jour-

nal is instituting a non-refundable

$75 fee for all clinical and critical

review articles. Th is will subsidize a

small portion of the editorial offi ce

support and help pay for the extra

pages in the journal that will help to

eliminate the backlog.

Th e journal is also making several

changes that will positively aff ect how

readers digest the information from the

articles published in the journal.

1) Improved page layout. In early

2012, we will debut a new page

design that is easier to read. Th is

will include a new summary box

feature that gives readers a 100-

word explanation of the highlights

of the paper.

2) Enhanced online features. Th e

online version of the journal has so

far been a Web-based version of the

print copy. Going forward, we will

be enhancing the site to give readers

additional information. Th is will

include online only materials,

including supplemental data, addi-

tional tables and fi gures, and videos

from the authors. Th e Red Journal

is also participating in the Article of

the Future project with Th e Lancet

Oncology; Elsevier, our publisher;

and other journals to test and

revamp the way users experience

the journal electronically. Th is will

include opportunities to read and

use the journal on mobile devices.

3) Cover art. Each issue will in-

clude artwork on the cover from a

member of the radiation oncology

community. Th e fi rst issue’s cover is

an oil painting by one of our distin-

guished physicists and the second

will be a spectacular photograph

from Africa by a Boston breast can-

cer radiation oncologist. ASTRO

members from all disciplines are

encouraged to submit art.

4) Oncology Scan article. Each issue

will feature an “Oncology Scan”

article written by an editor of the

Red Journal identifying a few

articles published recently outside

of the Red Journal that the editors

believe will have a big impact on

radiation oncology.

“Th e Red Journal exists due to the

incredible eff orts of the authors,

researchers, reviewers, editors and staff

members. I welcome any and all input

that can help me do my job better,”

Dr. Zietman said.

His email address at the journal is

redjournal@astro.org, and he welcomes

any feedback you would like to pass

along.

1) Switching to double-blind review. With single blind reviews, the

authors do not know the identities

of the reviewers, but the reviewers

do know the names and institutions

of the authors. By switching to a

double-blind review, authors will

“blind” their manuscript by taking

out identifying information in the

manuscript and separating the title

page. Th is will help cut down the

rare, but very unfortunate, instances

where reviewer bias toward a re-

searcher has aff ected the disposition

of a paper and will help alleviate

author fears about this possibility.

2) Enhanced disclosure statements. All authors are now asked to

complete a disclosure statement at-

testing to disclosures regarding the

paper. Each author’s statement must

then be included in the manuscript.

Th e writeable PDF form can be

found on the International Com-

mittee of Medical Journal Editor’s

website at www.icmje.org. Th is

statement has rapidly become the

standard in scientifi c and academic

publishing and cannot be avoided.

3) Faster turnaround. Th e journal

editors are committed to improving

the speed at which a paper is

published in the journal. Over the

past several years, the number of

manuscripts submitted to the

journal has more than doubled.

Consequently, the number of high-

quality manuscripts accepted for

publication has increased while the

number of print pages has stayed

the same, leading to a far longer

time between

Each issue will include artwork on the cover from a member of the radiation oncology community. Th e fi rst issue’s cover is an oil painting by one of our distinguished physicists and the second will be a spectacular photograph from Africa by a Boston breast cancer radiation oncologist. ASTRO members from all disciplines are encouraged to submit art.

(Continued from Page 23)

25A S T R O N E W S | W I N T E R | 2 0 1 1

profi le

MALCOLM A. BAGSHAW, MD, FASTRO, A WORLD LEADER IN RADIATION ONCOLOGY, AGE 86, died September 18, 2011, at his home in Palo Alto, Calif., after an extended illness. Born June 24, 1925, in Adrian, Mich., Mal joined the Naval Reserve after high school, graduated from Wesleyan University in Middletown, Conn., and completed Yale University School of Medicine in 1950. After initial training in surgery, he transferred to radiology, completing a general radiology residency under the direction of Isadore Lampe, at the University of Michigan. In 1956, Mal was recruited by Henry Kaplan to join the faculty in the Department of Radiology at Stanford, fi rst located in the Stanford-Lane Hospital in San Francisco, and then moved to Stanford’s present location on the main campus in Palo Alto, Calif., in 1959. While an astute diagnostician, Mal’s fi rst love was therapy. He became director of therapeutic radiology in 1960 and succeeded Henry Kaplan as chairman of the Department of Radiology in 1972. In 1986, the department was split into two: diagnostic radi-ology and therapeutic radiology; Mal continued as chairman of the latter, which became radiation oncology in 1988. Mal was an extraordinary physician, investigator, teacher and leader. Known for his “can do” attitude with far reaching talents in innovation and problem solving and with extensive interests in and beyond medicine, he touched the lives of everyone with whom he came in contact. With his ever present ear-to-ear grin, everyone loved Malcolm. He was a man with endless numbers of friends who respected and admired him, a role model to countless numbers of students, resi-dents, fellows and colleagues, and a compassionate physician-healer to four decades of grateful patients.

Malcolm A. Bagshaw, MD, FASTRO

BY SARAH DONALDSON, MD, FASTRO, AND RICHARD HOPPE, MD, FASTRO

Remembering

THE WORLD OF

RADIATION ONCOLOGY

HAS LOST A HERO.

(Continued on Page 26)

26 A S T R O N E W S | W I N T E R | 2 0 1 1

One of his greatest attributes was his infectious personal-

ity; he inspired loyalty from all who worked with and for him,

with an ethic of “work hard, play hard.”

Mal’s most credited professional accomplishments include

his pioneering use of the medical linear accelerator, the fi rst

of which at Stanford was installed shortly after he joined the

department. He designed novel ways to treat everything from

small fi eld retinoblastoma therapy, to the whole-abdomen/

pelvis in ovarian cancer.

He pioneered a technique to treat the entire skin for

cutaneous lymphoma and used daily fl uoroscopic guidance

to localize the larynx—the fi rst example of image guided

radiation therapy. However, he is best known for contribu-

tions in the treatment of prostate cancer, where he developed

techniques that became the model for contemporary therapy.

In addition, Mal was one of the earliest investigators to

explore the use of radiation sensitizers and hyperthermia. He

spent a sabbatical at the Los Alamos National Laboratory

studying the use of Pi meson therapy.

For this lifetime of contributions, Mal was awarded the

highest honors in the fi eld including Gold Medals from

ASTRO, Nihon University in Toyko, del Regato Society,

the Gilbert Fletcher Society, ACR and RSNA, as well as the

Medal of Honor from the American Cancer Society.

He served as ASTRO president in 1972. Mal received

the Charles F. Kettering Prize of the General Motors Cancer

Research Foundation for his instrumental role in improv-

ing prostate cancer treatment by facilitating non-operative

therapy and thus helping preserve sexual potency and reduced

incidence of incontinence.

Mal was most proud of the many students and residents

whom he trained, many of whom have gone on to become

leaders in the fi eld. Shortly after retiring, he recognized that

he had trained several hundred radiation oncologists but

apologized for having lost count when the number exceeded

200!

Filled with an exuberance for life and true “ joie de vivre,”

Malcolm had many loves outside of medicine including: Stan-

ford athletics, marked by a noteworthy occasion when he led

the Stanford band at half-time; gliding and building his own

sail plane—in the living room of his home; bike riding, often

with his residents through the foothills to the Pacifi c coast;

native American art; photography; gardening; and playing the

guitar.

Mal was married nearly 50 years to his medical school

classmate Muriel Hanley Bagshaw, who died several years

earlier. He is survived by three children and spouses:

Cassandra Gay and husband Larry; David Bagshaw and wife

Wendy Petersmeyer; Sarah Machado and husband Basil; eight

grandchildren; and sister, Pauline Young, and her husband

Robert.

A memorial service and celebration of Malcolm’s life was

held October 10, 2011, at the Stanford Memorial Church. A

Malcolm A. Bagshaw Visiting Professor Fund has been set up

in his name. Contributions may be made to Stanford Univer-

sity, indicating the Malcolm A Bagshaw Visiting Professor

Fund, P.O. Box 20466, Stanford 94309 and/or to the

American Cancer Society.

Malcolm will remain a signifi cant portion of whom

we are and what we represent; we will continue to love him

always.

Dr. Donaldson and Dr. Hoppe are radiation oncologists at Sanford

University Medical Center and former colleagues of Dr. Bagshaw.L I N K I N G R AD I A T I ON ONCO LOG I S T S

Changing the Way We Practice

Online Community of Peers

Find us at booth # 2438 or go to www.chartrounds.com

Membership is Free.

profi le(Continued from Page 25)

27A S T R O N E W S | W I N T E R | 2 0 1 1

BY VANNA M. DEST, MSN, APRN, BC, AOCNNURSES

THE HISTORY OF ADVANCED PRACTICE NURSING began during the

20th century and over the past several

years has evolved into the oncology

arena. An Advanced Practice Nurse

(APN) is defi ned as a registered nurse

(RN) who has obtained a minimum of a

master’s degree in nursing with in depth

knowledge and skills of practices under

federal and state regulations (Antle,

Haas and Lester, 2003).

Th e oncology APN is defi ned as “a

registered nurse, prepared with a mini-

mum of a master’s degree in nursing,

who has acquired advanced, in depth

knowledge and preceptored clinical

experiences in oncology that enable he/

she to exhibit a high degree of indepen-

dent and collaborative judgment and

clinical skill in providing nursing care to

patients with cancer and their families”

(ONS Position Statement, 1997).

Th ere are four categories that have

emerged from APN training and they

include certifi ed midwives, certifi ed

nurse anesthetists, clinical nurse special-

ists and nurse practitioners. Th e roles of

the clinical nurse specialist and nurse

practitioner diff er in many aspects but

also have many common threads.

Educational preparation for both

include advanced pathophysiology,

pharmacology and advanced physical

assessment as well as specifi c coursework

and clinical experiences required to pre-

pare graduates to care for patients with

a past, current or potential diagnosis of

cancer. Both are educationally prepared

to provide advanced nursing care to

meet the specialized physiologic and

psychological needs of patients through-

out the continuum of care, including

cancer prevention and detection, cancer

diagnosis and treatment, rehabilitation,

RADIATION ONCOLOGY APN: an integral member of the radiation oncology team

survivorship and end-of-life care

(ONS Oncology Nurse Specialist Com-

petencies, 2008 and Oncology Nurse

Practitioner Competencies, 2007).

Th e clinical nurse specialist is an

expert clinician and patient advocate

who provides direct care for patients

with complex cancer-related prob-

lems and diagnoses. Th ey also work to

improve cost-eff ective patient outcomes

by advancing oncology nursing practice

and infl uencing the organizations and

systems in which care is provided. (ONS

Oncology Clinical Nurse Specialist

Competencies, 2008).

Th e clinical nurse specialist role has

been characterized by four sub roles,

which include expert clinician,

consultant, educator and researcher

(Bodansky, 1999).

Th e nurse practitioner is also an

expert clinician in a role that focuses on

assessment, diagnosis and management

of cancer and related disorders. Th e

nurse practitioner uses evidence-based

literature and works toward evidence-

based practice to eff ect a positive change

in the health of the patient and health

care delivered to the patient with a past,

current or potential diagnosis of cancer.

Most nurse practitioners also have

prescriptive authority (ONS Oncol-

ogy Nurse Practitioner Competencies,

2007).

In 2002, an ONS position paper

stated an oncology APN should be

utilized in all aspects of cancer care.

Th e roles and responsibilities of

the radiation oncology APN may vary

amongst departments and institutions,

but they consistently serve as expert

clinicians and resources for the radia-

tion oncology patient and the radiation

oncology team. Th eir role includes:

• Obtain thorough history and

perform physical examinations at

the time of consultation, follow-up

and weekly treatment visits as well

as unscheduled visits secondary to

urgent matters.*

• Collaboration with radiation oncolo-

gists to provide treatment and ensure

optimal patient care.

• Documentation for all patient visits.

• Symptom management.

• Formulation of diff erential diagnosis

for presenting symptoms.*

• Order pertinent radiology and

laboratory tests.*

• Prescribe medications and evaluate

response to interventions.*

• Assist in radiation related

procedures.

• Management of inpatients.*

• Collaboration with radiation oncol-

ogy nurses to ensure quality nursing

care measures.

• Collaboration with other members

of the radiation oncology team for

coordination of care.

• Collaboration with multidisciplinary

team.

• Participation in weekly chart rounds.

• Assist in coordination of clinical

trials in radiation.

• On-call responsibilities.*

• Development of policies and

procedures, Quality Assurance (QA)

involvement.

• Development of patient/family

education brochures and booklets.

Th e role of the APN in radiation oncol-

ogy continues to evolve but has been

proven to enhance the quality of care

provided to the radiation oncology

patient.

*role of nurse practitioner

28 A S T R O N E W S | W I N T E R | 2 0 1 1

BY ROSEMARY S. L. WONG, PHD, CHAIRMAN, COMMIT TEE FOR HEALTH CARE ACCESS AND TRAININGFELLOWSHIPgrants

THE ASTRO HEALTH CARE ACCESS AND TRAINING SUBCOMMITTEE (HATS) is continuously working to

advance the role of minorities within the

fi eld of radiation oncology by increas-

ing early educational and professional

opportunities and improving cancer

awareness and access to state-of-the-art

treatments.

Th e ASTRO Minority Summer

Fellowship Grant was initiated in 2010

for underrepresented medical students

who are interested in gaining expo-

sure to either clinical or basic research

experiences in radiation oncology. Th e

goal of the fellowship is to lead to train-

ing, publications and mentorship that

ultimately translate into a greater chance

of acceptance into highly competitive

radiation oncology residency positions.

And the program is beginning to

show signs of success, as one of its fi rst

participants has been accepted into the

UCLA residency program.

Th e fi rst clinical research awardee,

Jean-Claude Rwigema successfully com-

MINORITY FELLOWSHIP PROGRAM PROVES SUCCESSFUL First participant accepted into radiation oncology residency

pleted his research last summer, titled

“Stereotactic Radiosurgery for Resected

Brain Metastases,” with Dwight Heron,

MD, at the University of Pittsburgh.

He has already published one article,

presented his poster at ASTRO’s 2010

Annual Meeting and submitted a manu-

script for publication.

He will begin his residency at

UCLA in 2012. Rwigema has

established high standards for future

awardees to follow and serves as a good

indication that this fellowship program

may have achieved one of its most

important goals.

Th e 2010 basic research awardee,

Kimberly Th omas, completed her

research project, titled “External

Th ermal Enhancement with Magnetic

Nanoparticles for the Sensitization of

Breast Cancer Stem Cells to Radiation

Th erapy,” with Sunil Krishnan, MD,

at MD Anderson Cancer Center in

Houston this summer. Th omas is work-

ing on her fi nal report and will submit

an abstract for ASTRO’s 2012 Annual

Meeting in Boston.

Th e 2011 clinical award winner,

Melissa Liriano, is a MD/PhD student

at the University of Maryland School of

Medicine in Baltimore and completed

her research project, titled “A Retro-

spective Study on Stage III NSCLC

Patients: Factors Predicting Pathologic

Complete Response Following High

Dose Chemoradiation,” with Steven

Feigenberg, MD, at University of Mary-

land School of Medicine this summer.

By increasing the retrospective

analysis to 400 patients instead of the

proposed 150 patients in her applica-

tion, she and her mentor believe that

following data analysis, some signifi cant

factors can be found to predict patient

outcomes.

Th e 2011 basic science awardee,

Iman Washington, also completed her

research titled “Defi ning the Role of p21

in Radiation-induced Myocardial Injury,”

with David Kirsch, MD, PhD, at Duke

University in Durham, N.C., this sum-

mer. Liriano and Washington’s fi nal

reports were due to ASTRO at the end

of November and both plan on

submitting an abstract for ASTRO’s

2012 Annual Meeting.

With the support and recommen-

dation of Education Council Chair-

man Bruce Haff ty, MD, FASTRO,

and Education Council Vice-chairman

Laura Dawson, MD, HATS successfully

obtained approval from the Board of

Directors to continue funding the award

for three more years.

Th e Committee for Health Care

Access and Training plans to evaluate

data at the end of the funding period to

determine the success of and continued

funding for the award.

Th is fellowship off ers each student a

stipend for an eight-week training pro-

gram and fi nancial support to attend and

present at the ASTRO Annual Meeting.

Th e next application deadline is March 1,

2012.

First or second year U.S. medical

students interested in radiation oncology

are eligible, and more senior students

are considered on a case-by-case basis.

Identifi cation of a mentor with the needed

research experience to help the fellow

achieve the stated goals is essential.

To apply for the 2012 award please

visit www.astro.org/Research/Funding-

Opportunities.

May Abdel-Wahab, MD, PhD, immedi-ate past chairman of HATS, Jean-Claude Rwigema, the 2010 grant awardee, and his mentor, Dwight Heron, MD, at the 2010 Annual Meeting where Rwigema presented a poster.

29A S T R O N E W S | W I N T E R | 2 0 1 1

THE FINAL RULES PUBLISHED BY CMS

in November, in addition to codifying

the fee schedule for the coming year,

unveil new codes and their valuation as

of January 1, 2012. Although there are

relatively few changes aff ecting radia-

tion oncology, there are many important

coding and payment related updates

for 2012 that will assist in the eff ective

operation of your practice.

NEW AND REVISED 2012 CPT

CODE CHANGES

All changes described below are eff ec-

tive January 1, 2012.

Intraoperative Radiation Th erapy (IORT)

A new set of CPT codes was developed

to describe IORT delivery and manage-

ment services.

77424 Intraoperative radiation treatment delivery, X-ray, single treatment sessionCode 77424 describes photon based

IORT treatment delivery.

77425 Intraoperative radiation treatment delivery, electrons, single treatment sessionCPT Code 77425 describes IORT treat-

ment delivery using electrons.

CPT codes 77424 and 77425 were cre-

ated because there were no specifi c CPT

codes that described IORT treatment

delivery using photons or electrons.

Separate codes were necessary for these

modalities as there are signifi cant diff er-

ences in the type of radiation protection

that is necessary for delivery of photons

versus electrons. Th ese codes are techni-

cal only codes and are typically reported

in the facility setting.

77469 Intraoperative radiation treat-ment managementCPT code 77469 is also a new code for

2012. Th is code will be used to describe

the physician work of IORT manage-

ment for either photon or electron based

IORT treatment delivery. CPT code

77469 is typically performed in the

facility setting. Th e elements of physi-

cian work captured by CPT code 77469

include simulation, treatment device de-

sign and construction, radiation therapy

management, and a special treatment

procedure.

Th e development of the IORT

codes for 2012 has also resulted in the

revision of existing radiation oncology

codes 77427 and 77470 to allow for

separate identifi cation of IORT treat-

ment delivery and management.

77427 Radiation treatment manage-ment, 5 treatmentsCPT code 77427 is an existing code

used for weekly management of radio-

therapy services. IORT services are

intended to include simulations neces-

sary for radiation treatment delivery but

do not include evaluation and manage-

ment services provided outside of the

treatment management session. As a

result, a guideline has been included to

note that code 77469 represents only the

intraoperative session management and

does not include medical evaluation and

management outside of the session.

Th e following language was added

to the introductory language of CPT

code 77427: “77469 represents only the

intraoperative session management and

does not include medical evaluation and

management outside of the session.”

BY DANEEN GROOMS, HEALTH POLICY ANALYST, DANEENG@ASTRO.ORG, AND SHEILA MADHANI, ASSISTANT DIRECTOR OF HEALTH POLICY, SHEILAM@ASTRO.ORG

WHAT’S NEW IN RADIATION ONCOLOGY CODING FOR 2012

HEALTHpolicy

77470 Special treatment procedure (e.g. total body irradiation, hemibody radiation, per oral or endocaviatry irradiation)(77470 assumes that the procedure is

performed 1 or more times during the

course of therapy, in addition to daily or

weekly patient management)

(For intraoperative radiation treatment

delivery and management, see 7424,

77425, 77469)

CPT 77470, which describes

special treatment procedures, has

been revised to remove the term “intra-

operative cone” from the language.

A parenthetical has also been added to

direct users to the appropriate codes for

IORT.

77421 Stereoscopic X-ray guidance for lo-calization of target volume for the delivery of radiation therapy (Do not report 77421 in conjunction

with 77432, 77435)

(For placement of interstitial device[s]

for radiation therapy guidance, see

31627, 32553, 49411, 55876)

(Do not report 77421 more than once per

treatment delivery session)

CPT code 77421 is an existing

code used for stereoscopic X-ray based

image guided radiation therapy. Th e

code was revised to include a paren-

thetical clarifying how often the code

can be reported.

0182T High dose rate electronic brachy-therapy, per fractionTh e CPT Editorial Panel approved the

extension of the category III status of

CPT code 0182T for another fi ve years.

ASTRO supported the panel’s decision

and is pleased with the extension of the

category III status of the code. ASTRO (Continued on Page 30)

30 A S T R O N E W S | W I N T E R | 2 0 1 1

HEALTHpolicy(Continued from Page 29)

believes electronic brachytherapy is an

important development in the fi eld of

radiation oncology, but more time is

needed for maturation of the literature

to meet the criteria for a category I code.

UPDATES TO THE NATIONAL

CORRECT CODING INITIATIVE

(NCCI)

Th e NCCI is a series of coding edits

used by Medicare to prevent billing of

similar services identifi ed by Medicare

as inappropriate to be billed together.

Some edits, however, may be overridden

with the appropriate use of a modifi er. A

number of edits were implemented this

past year, including:

• Eff ective July 1, 2011, Medicare

allows the use of NCCI-associated

modifi ers for CPT code 77418

(Radiation tx delivery IMRT) with

code 77338 (Design mlc device for

imrt).

• Eff ective October 1, 2011, Medicare

allows the use of NCCI-associated

modifi ers for CPT code 77338 (De-

sign mlc device for imrt) with treat-

ment device codes 77332-77334.

• Eff ective October 1, 2011, Medicare

allows the use of NCCI-associated

modifi ers for IMRT treatment

delivery (CPT code 77418) with

treatment device codes 77332-77334

in situations where a second treat-

ment device is required at a later

date due to decreased tumor volume

or patient weight and where the

device is designed and constructed

on the same date of service as an

IMRT treatment.

• Eff ective October 1, 2011, CMS

modifi ed the edits bundling HDR

brachytherapy codes (77785-77787)

with one another to allow the use

of NCCI-associated modifi ers in

situations where the patient receives

HDR brachytherapy twice on the

same date of service and the second

session requires fewer channels.

NCCI edits are updated quarterly, with

additional information available on the

Medicare website: www.cms.gov/

NationalCorrectCodiNitEd/01_overview.

asp.

ASTRO CODING RESOURCES

ASTRO has a number of resources to help

members stay abreast of coding changes

and Medicare payment policy updates.

ASTRO/ACR Coding Guide

Beginning in 2012, ASTRO is off er-

ing one, two and three year Web license

subscriptions in addition to the ASTRO/

ACR Guide to Radiation Oncology Coding

(Coding Guide), which includes 2011

and 2012 updates.Visit www.astro.org to

order your copy.

Coding Frequently Asked Questions (FAQs)

and Tips

A series of coding FAQs and tips are now

posted on the ASTRO website. Th ese ad-

dress many of the most commonly received

inquiries related to radiation oncology

coding. Th e coding FAQs and tips may be

viewed at www.astro.org/Practice-

Management/Radiation-Oncology-

Coding.

2012 Coding and Reimbursement Webinars

ASTRO will be off ering quarterly Health

Policy webinars addressing various topics

relevant to the radiation oncology commu-

nity. Th e schedule for 2012 is:

• Radiation Oncology Benefi t Managers

(March 2012)

• Physician Value-Based Purchasing

( June 2012)

• Coding Frequently Asked Questions

(September 2012)

• 2013 Final Rules Webinar

(December 2012)

Medicare News Updates

Members can fi nd timely updates on

coding and reimbursement news released

by CMS at www.astro.org/Practice-

Management/Reimbursement/Medicare.

Th e CMS website is another resource

available to members seeking information

on coding and reimbursement information.

STATEMENT REQUIRED BY U.S. POSTAL SERVICE SHOWING THE OWNERSHIP, MANAGEMENT AND CIRCULATION OF ASTRONEWS1. Publication Title: ASTROnews2. Publication Number: 1523-4185

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10. Owner: American Society for Radiation Oncology,

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18. I certify that all information furnished on this form is true and

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31A S T R O N E W S | W I N T E R | 2 0 1 1

IHE-RO BY CARNELL J. HAMPTON, PHD, AND JAMES J. URBANIC, MD, MEMBERS, IHE-RO COMMIT TEE

WHEN FACED WITH A CHALLENGING CLINICAL CASE, it helps to have an

arsenal of the best planning tools avail-

able from which to create a treatment

plan with optimal effi cacy. A mix of

treatment planning technologies in some

radiotherapy clinics refl ects what can be

described as “niche planning,” provid-

ing users with specialized capabilities

that complement basic 3-D and IMRT

planning.

Clinics can be upgraded by simply

adding a stand-alone treatment planning

computer from a vendor diff erent than

the one supplying more basic capabili-

ties. In other cases, multiple planning

systems exist as a legacy but continue to

be in used in the clinic.

Whether this piecemeal approach to

purchasing technology is optimal or not,

many clinics fi nd themselves “multiven-

dor” for a variety of reasons, including

budget constraints, new delivery systems

purchases, planned program expansion

and even non-strategic program

development.

Th e need for communication

between systems is exactly what

IHE-RO’s Advanced RT Objects profi le

was designed to facilitate.

CLNICAL CASE STUDY

In 2010, Wake Forest Baptist Health in

Winston-Salem, N.C., began to evalu-

ate a new Treatment Planning System

(TPS) for clinical use, which had been

acquired along with a new delivery

system. With an older version of Philips

Pinnacle (V 8.03) as our core TPS

providing routine 3-D conformal, step-

and-shoot IMRT and brachytherapy

treatments, the newly acquired Elekta

Monaco (V 2.04) TPS provided the

IHE-RO ADVANCED RT OBJECTS IN ACTIONA comparison of treatment plans from two treatment planning systems

additional capability of planning VMAT

deliveries on our new linac.

In the last stages of a commissioning

process, our planners began to evaluate

clinical cases to investigate the potential

dosimetric benefi ts of VMAT plans for

the delivery of SBRT to early-stage lung

cancers. For one patient, a 67-year old

with two right upper lobe lesions located

near the chest wall, a plan was devel-

oped using our standard technique—a

Pinnacle-planned, isocentric 3-D con-

formal delivery to each isocenter—and a

Monaco-planned VMAT approach that

used a single arc to deliver dose simulta-

neously to the two lesions.

With our version of the Pinnacle

TPS limited to DICOM-RT plan export

functionality only and possessing no

tools for review of plans from disparate

planning systems, the composite 3-D

conformal plan, developed using Pinna-

cle, was sent via DICOM to the Monaco

workstation for plan review and side-

by-side comparison with the VMAT

treatment planned using Monaco.

A DICOM export of the treatment

planning image dataset, RT Plan, RT

structures and composite RT dose data

was received and imported into the

Monaco system, which supports the

IHE-RO’s Advanced RT Objects inte-

gration profi le. Within the plan review

module, the treatment plan data of the

3-D conformal and VMAT plans were

available for comparison, including the

dose cloud overlaid atop the planning

CT scan, the beam arrangements and

DVH information.

Using these tools, we were able

to determine that the VMAT plan

provided normal tissue sparing within

tolerance and provided slightly superior

coverage of the PTV when compared

with the 3-D conformal plan. Th e

Advanced Objects integration protocol

proved crucial in providing a means of

easily comparing plans from two treat-

ment planning systems.

For this patient, the VMAT plan

was chosen for treatment delivery,

Elekta Monaco TPS Plan Review comparing plans targeting two right lung targets: (a) a VMAT plan and (b) a composite 3-D conformal plan. (c) DVH comparing target cover-age for PTV 1 (red) and PTV2 (green) as well as normal tissue sparing for the two plans.

(Continued on Page 32)

32 A S T R O N E W S | W I N T E R | 2 0 1 1

Th en there are those surveys

conducted every three years by the

American College of Surgeons for

accreditation of your cancer program

with the accompanying standards for

compliance. Neither of these feels like

having a coach for critical assessment

and self-improvement, however.

Th e closest thing I can come up

with to resemble a coach is an

ASTRO/ACR Accreditation Survey,

but even this falls short of the mark.

Th ese are programmatic by nature and

not designed to evaluate an individual’s

skill set, decision-making or patient

interaction.

Th is sort of an assessment requires

another set of eyes and ears to spend

time during consults (How do you inter-

relate with the patient?), treatment plan-

ning (Does everything require IMRT?)

and treatment management (Are you

actually examining the patient or is it a

cursory experience?) to make any

worthwhile critical recommendations.

Our own egos (“I’m an expert!”)

may be the most signifi cant impediment

to inviting another practitioner

to observe and to critique us. As Dr.

Gawande noted, “Th is is why it will

never be easy to submit to coaching,

especially for those who are well along

in their careers.”

So, what’s the answer? I suspect

it may come down to swallowing your

pride and “experimenting” with a

coach. How? Maybe you could invite a

colleague from another practice or from

your training program to spend a week

with you to monitor all aspects of your

individual practice.

If your scope of practice is narrow,

EDITOR’Snotes(Continued from Page 6) for example LDR prostate implants

solamente, bring in an experienced

brachytherapist to evaluate your

technique. I don’t think there’s a single

answer to this question, but I do think

that a coach, in some manifestation,

could lead to practical improvement on

a variety of levels. And if this results in

better outcomes with less morbidity for

even one patient, you’ve made a prudent

decision.

Remember: when in doubt, swing

earlier…

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 communications@astro.org.

providing a 50 percent reduction in

delivery time versus IGRT localization

and sequential delivery of 18 conformal

RT beams to the two distinct isocenters.

CONCLUSION

Th e possession of multiple planning

systems, without the capability of com-

parative plan review, makes the task of

maintaining such systems all cost, with

little benefi t. Th e Advanced RT Objects

features implemented in the Monaco

TPS add value to a niche TPS in use

within our clinic and make it an essential

tool for plan comparison.

As clinicians and physicists, we are

thankful that with adoption of the

Advanced RT objects integration profi le,

the end user is now free to adopt the mix

of technologies that provide the most

benefi t to patients without sacrifi ce of

functionality.

For more information, visit

www.astro.org/PracticeManagement/

IHE-RO.

Drs. Hampton and Urbanic are assistant

professors of radiation oncology at Wake

Forest Baptist Health in Winston-Salem, N.C.

IHE-RO(Continued from Page 31)

R A D I A T I O N T H E R A P YMeetings2012

MULTIDISCIPLINARY HEAD AND NECK CANCER SYMPOSIUM

January 26-28, 2012 • Arizona Biltmore, Phoenix

www.headandnecksymposium.org • Co-sponsors – AHNS, ASCO, ASTRO and SNM

ADVOCACY DAY

March 25-27, 2012 • The Liaison Capitol Hill Hotel, Washington

SPRING REFRESHER COURSE

April 13-15, 2012 • Westin Chicago River North, Chicago

www.astro.org/springrefresher

STATE OF THE ART TECHNIQUES IN IMRT, IGRT, SBRT, PROTON AND

BRACHYTHERAPY: Emphasis on Quality and SafetyMay 4-6, 2012 • Encore at Wynn Las Vegas, Las Vegas

www.astro.org/stateofthearttechniques

2012 CHICAGO MULTIDISCIPLINARY SYMPOSIUM IN THORACIC ONCOLOGY

September 6-8, 2012 • Chicago Marriott Downtown Magnifi cent Mile, Chicago

www.thoracicsymposium.org

Co-sponsors – ASCO, ASTRO, IASLC and The University of Chicago

ASTRO ANNUAL MEETINGOctober 28-31, 2012 • Boston Convention and Exhibition Center, Boston

www.astro.org/annualmeeting

Visit www.astro.org for more information.

Alignment Concerns?In a study of 111 lung SBRT patients, pitch or roll corrections during patient setup were required

in about 90% of the cases, with corrections of greater than 1.0° needed in 52.3% of cases.*

In a study of In a sIn a scorrectionscorrectorrect

in about 9in ain aboogreatergreaterggreater

Protura Robotic Patient Positioning System

800.842.8688 | +1 712.737.8688 | WWW.CIVCO.COM* Study performed by Lynn Cancer Institute, Boca Raton Regional Hospital

COPYRIGHT © 2012. CIVCO IS A REGISTERED TRADEMARK OF CIVCO MEDICAL SOLUTIONS. PROTURA IS A TRADEMARK OF CIVCO. ALL PRODUCTS MAY NOT BE LICENSED IN ACCORDANCE WITH CANADIAN LAW. 2012A0724

Protura™ Robotic Patient PositioningDelivering efficient IGRT treatments requires integration and automation between patient positioning and image guidance systems. CIVCO’s Protura integrates with any IGRT system, including automated application of translational and rotational corrections. This integration ensures the treatment planned is the treatment delivered.

The accuracy and repeatability of the Protura System robotics (0.1 mm / 0.1°) provide the clinical confidence to set the most appropriate treatment margin and prescription dose for each patient

Integrated: The Protura System integrates with 2D & 3D IGRT systems, automating all 6 translational and rotational corrections

Efficient: Protura System corrections can be remotely applied from the treatment control console, saving significant time for every treatment fraction delivered