Code of ethics for the American Association of Physicists in Medicine (Revised): Report of Task Group 109.

The American Association of Physicists in Medicine (AAPM) has established a comprehensive Code of Ethics for its members. The Code is a formal part of AAPM governance, maintained as Professional Policy 24, and includes both principles of ethical practice and the rules by which a complaint will be adjudicated. The structure and content of the Code have been crafted to also serve the much broader purpose of giving practical ethical guidance to AAPM members for making sound decisions in their professional lives. The Code is structured in four major parts: a Preamble, a set of ten guiding Principles, Guidelines that elucidate the application of the Principles in various practice settings, and the formal Complaint process. Guidelines have been included to address evolving social and cultural norms, such as the use of social media and the broadening scope of considerations important in an evolving workplace. The document presented here is the first major revision of the AAPM Code of Ethics since 2008. This revision was approved by the Board of Directors to become effective 1 January 2019.

A preplanning method for stereotactic radiosurgery to improve treatment workflow.

Frame-based stereotactic radiosurgery (SRS) requires fixation of an invasive head ring to ensure accurate targeting. Minimizing waiting time with a fixed head ring is important for patient comfort and satisfaction. We report a practical preplanning solution for the Brainlab iPlan treatment planning system that reduces waiting time by expediting the planning process on treatment day. A water-filled anthropomorphic head phantom was used to acquire a surrogate CT image set for preplanning and fused with patient's MRI, which was obtained before the day of treatment. Once an acceptable preplan was obtained, it was saved as a plan template and the phantom image set was removed from the Brainlab database to prevent any confusion and mix-up of image sets. On the treatment day, the patient's CT and MRI were fused, and the customized beam settings of the preplan template were then applied and optimized. Up to 10-fold of reduction in treatment plan time was demonstrated by bench testing with multiple planners and a variety of cases. Loading the plan template and fine-tuning the preconfigured beam settings took only a small fraction of the preplan time to restore the conformity and dose falloff comparable to those of the preplan. For instance, preplan time was 2 hr for a two-isocenter case, whereas, it took less than 20 min for a less experienced planner to plan it on the day of treat-ment using the preplan method. The SRS preplanning technique implemented in this study for the Brainlab iPlan treatment planning system offers an opportunity to explore possible beam configurations thoroughly, optimize planning parameters, resolve gantry angle clearance issues, and communicate and address challenges with physicians before the treatment day. Preplanning has been proven to improve plan quality and to improve efficiency in our clinic, especially for multiple-isocenter and dosimetrically challenging cases.

Ethics and professionalism in medical physics: a survey of AAPM members.

PURPOSE: To assess current education, practices, attitudes, and perceptions pertaining to ethics and professionalism in medical physics. METHODS: A link to a web-based survey was distributed to the American Association of Physicists in Medicine (AAPM) e-mail membership list, with a follow-up e-mail sent two weeks later. The survey included questions about ethics/professionalism education, direct personal knowledge of ethically questionable practices in clinical care, research, education (teaching and mentoring), and professionalism, respondents' assessment of their ability to address ethical/professional dilemmas, and demographics. For analysis, reports of unethical or ethically questionable practices or behaviors by approximately 40% or more of respondents were classified as "frequent." RESULTS: Partial or complete responses were received from 18% (1394/7708) of AAPM members. Overall, 60% (827/1377) of the respondents stated that they had not received ethics/professionalism education during their medical physics training. Respondents currently in training were more likely to state that they received instruction in ethics/professionalism (80%, 127/159) versus respondents who were post-training (35%, 401/1159). Respondents' preferred method of instruction in ethics/professionalism was structured periodic discussions involving both faculty and students/trainees. More than 90% (1271/1384) supported continuing education in ethics/professionalism and 75% (1043/1386) stated they would attend ethics/professionalism sessions at professional/scientific meetings. In the research setting, reports about ethically questionable authorship assignment were frequent (approximately 40%) whereas incidents of ethically questionable practices about human subjects protections were quite infrequent (5%). In the clinical setting, there was frequent recollection of incidents regarding lack of training, resources and skills, and error/incident reporting. In the educational setting, incidents of unethical or ethically questionable practices were only frequently recollected with respect to mentorship/guidance. With respect to professional conduct, favoritism, hostile work/learning environment, and maltreatment of subordinates and colleagues were frequently reported. A significantly larger proportion of women reported experiences with hostile work/learning environments, favoritism, poor mentorship, unfairness in educational settings, and concerns about student privacy and confidentiality. CONCLUSIONS: The survey found broad interest in ethics/professionalism topics and revealed that these topics were being integrated into the curriculum at many institutions. The incorporation of ethics and professionalism instruction into both graduate education and postgraduate training of medical physicists, and into their subsequent lifelong continuing education is important given the nontrivial number of medical physicists who had direct personal knowledge of unethical or ethically questionable incidents in clinical practice, research, education, and professionalism.