Reimbursement for radiation oncology services is changing, and these changes and updates are impacting hospitals, freestanding facilities, provider-based departments, and physicians.  These changes are related to the new Alternative Payment Model (APM) that has been instituted in radiation oncology across the nation.  Keeping up-to-date on all of the changes can seem daunting.  This session will provide a look at the reimbursement changes, delineate the differences between the fee-for-service world and the new payment model, provide information on where to find resources about the changes, and help to understand how these changes impact reimbursement and staff workflows for cancer services.  

Learner Outcomes:

1. List the recent reimbursement updates from Medicare impacting radiation oncology
2. Define the expectations and requirements that have been implemented for payment in the 2021 calendar year and beyond
3. Explain how clinical workflows and EMR system customization may be impacted to allow for required reporting 
4. Identify how this model may shift clinical practice patterns, treatment techniques and fractionation

CE Credits = 1.0

Adam Brown CMD, BSRT(T), Director of Client Services

Tamara Syverson, BSRT(T), CHONC, Executive Director, Client Services

Sponsored by RaySearch

In this session, discover the power of automation in adaptive therapy. We are in a paradigm shift in the way we approach treatment planning and more specifically adaptive therapy. Advanced technology and automation have made the one size fit all approach a thing of the past. We can now make it personal. Through deep learning segmentation, automation tools and a comprehensive adaptive suite, RayStation has redefined adaptive therapy.

LearnerOutcomes:

1. Explain current limitations in adaptive therapy
2. Discover the need for a more personalized approach to treatment planning through adaptive therapy and dose tracking
3. Explain basic day to day automation tools and how they can streamline adaptive therapy workflows
4. Discover the power of adding deep learning segmentation to redefine adaptive therapy in radiation oncology

CE Credits = 1.0

Joseph Dunlap, BS, CMD, Senior Applications Specialist

This session will cover the typical coding and compliance patterns for IMRT, SRS, HDR and 3D. It will also cover the differences that occur in both hospital and freestanding environments. This comprehensive approach will allow for dosimetrists to have an appreciation of how the entire department is connected and how to best influence positive outcomes for the team in the Radiation Oncology division. 
Compliance is always a potential risk, as such, this session will discuss proactive measures in which practical actions can be put in place that are relatively easy to manage while materially decreasing exposure to audits whether government or commercial payers. 
The session will outline visios and techniques we have found that benefit the facility and team members and how this behavior affects payment rates and payer regulations. 
Lastly, RO-APM, the preparation, necessary as well as the process for submission and payment will be reviewed. Q&A will be encouraged from members. 

Learner Outcomes:

1. Review Coding for various Dx in both a Hospital and Freestanding facility for Radiation Oncology
2. Explain Radiation Oncology Alternative Payment Methodology, RO-APM compared to typical coding patterns
3. Practice daily Compliance updates and requirements for Radiation Oncology Coding

CE Credits = 1.0

Ron DiGiaimo, MBA, FACHE, Chairman of the Board

The increased scrutiny evaluating tangent breast treatment plans has led to widespread interest in more accurately knowing various dose metrics associated with skin, lung, heart and target doses. These metrics may be used to predict unfavorable outcomes such as skin toxicity or lymphedema. 
Benchmarks for acceptable planning have historically been based on a Collapsed Cone (CC) or Pencil Beam (PB) dose calculation algorithm, but the evaluation of these benchmarks using a more accurate algorithm is necessary. 

Learner Outcomes:
1. Explain the differences between CC vs MC dose calculation algorithms in the Monaco TPS
2. Explain the differences between CC vs MC breast planning, including the change in target coverage and lung dose
3. Discuss clinical reasons to adopt MC or continue to use CC

CE Credits = 1.0

Matthew Goss, MS, DABR, Senior Medical Physicist

Adjuvant post-mastectomy radiation therapy (PMRT) and post-lumpectomy regional nodal irradiation (RNI), with the targeting of the breast/chest wall and regional lymph nodes, are an integral part of the treatment of patients with node-positive breast cancer. The deep-inspiration breath-hold (DIBH) technique has been extensively reported on for left-sided cancers to improve cardiac dosimetry, but it has not been well studied for right-sided breast cancers. When organs at risk (OARs) do not meet dose constraints on free-breathing scans for right-sided PMRT/RNI, intensity-modulated radiation therapy (IMRT) is the only option if a DIBH scan is not acquired. However, getting IMRT approval from insurance companies can be an obstacle to optimal care for these patients. 

This study aims to compare the dosimetric parameters of OARs in patients receiving PMRT or RNI for right-sided breast cancer between plans using free-breathing (FB) 3D conformal radiation therapy (3DCRT), FB IMRT, and DIBH 3DCRT techniques. We hypothesize that the use of DIBH 3DCRT will allow for adequate coverage of planning target volumes (PTVs) without unacceptable doses to OARs based upon our institutional dose constraints. 

Learner Outcomes: 

1. Recognize the importance of obtaining DIBH scans for right-sided breast cancer patients receiving PMRT or RNI to optimize treatment planning
2. Demonstrate the ability to create and compare FB 3DCRT, DIBH 3DCRT, and FB IMRT plans and apply that knowledge to their treatment planning decision process
3. Identify the dosimetric parameters that necessitate FB IMRT or DIBH 3DCRT scans for PMRT or RNI patients

CE Credits = 1.0

Kylee Lindsey, CMD, BSRT(T), Medical Dosimetrist

Karla Kuhn, CMD, Lead Dosimetrist

With Head and Neck (HN) proton planning, sinus filling uncertainty is one of the main challenges that we faced.  The school of thought is to not have proton beams going through sinuses when treating HN volumes. However, in cases where the sinus is involved in the target, there is no choice but to treat through the sinus. This session will explore a re-treat HN case involving squamous cell carcinoma of the nasal cavity using duplicated CT scans with various sinus filings to produce a robust six-field optimization plan. The HN plans will be explored with and without the additional CT scans considered on target coverage, OAR doses, target robustness, and weekly quality assurance CT scans taken during the treatment sequence. 

Learner Outcomes: 

1. Outline the optimization parameters and objectives
2. Consider the logic behind the six-field beam arrangement. 
3. Explain the difference between the QACT results of the HN plan with duplicated CT scans considered and the HN plan without the additional CT scans. 
4. Discuss the difference between both plans on OAR doses and Target Robustness

CE Credits = 1.0

David Alicia, CMD, Medical Dosimetrist

Medical dosimetry is an ever-evolving and adapting field. It was challenged recently to meet the needs of a worldwide crisis. In January 2020, the United States had its first case of the Coronavirus Disease 2019 (COVID-19) that had started in Wuhan, China just a few months earlier. It rapidly spread throughout the world, shutting down cities and countries with it. This historic pandemic has temporarily - and possibly permanently - changed many aspects of what was previously considered normal.   Cancer treatment centers around the globe reacted differently to the pandemic, though many changed their workflows and procedures to accommodate the safety of their uniquely high-risk patient population. This seminar explores the ways that these changes affected medical dosimetrists around the United States, based on a nationwide survey taken in March 2021. Specifically, it will focus on the types of changes that were experienced by medical dosimetrists, how long they lasted, and if any of them are expected to be permanent.  

Learner Outcomes: 

1. Describe how M.D. Anderson's Proton Therapy Center reacted to the pandemic and how it affected their medical dosimetrists
2. Describe how other medical dosimetrists were affected in the United States
3. Discuss whether medical dosimetry has been permanently affected by COVID-19

CE Credits = 0.5

Christine Chung, BS, CMD, Medical Dosimetrist

Sponsored by Elekta

Stereotactic body radiation therapy, or SBRT, is an effective treatment technique for early-stage lung cancer.  For patients and hospitals, SBRT provides a better overall experience with fewer sessions; less time in hospital; and avoids surgical complications. 

Learner Outcomes:

1. Explain how to plan in Monaco to provide the best plan quality for SBRT Lung
2. Discuss how Monaco leverages the dynamic capabilities of the Versa HD to deliver Lung SBRT
3. Discuss how Elekta’s Symmetry makes it possible for patients to be treated quickly and accurately, along with excellent plan quality

CE Credits = 1.0

David Ly, Radiation Oncology Clinical Specialist

Sponsored by Varian

Peer review, at all levels, is becoming increasingly more important in radiation oncology due to increased workloads, inadequate staffing, and advanced complex treatment processes.  Everyone is capable of making a mistake.  The goal of radiation oncology is to reduce variation and increase quality throughout the total treatment process.  Utilizing checklists and scorecards can greatly contribute to this goal.  They can be used in the peer-review process.  This discussion will focus on: 

• importance of peer review
• peer review processes
• barriers to execution
• methods of intervention
• technology-enabled software
• strengths and weaknesses of using scorecards to increase plan quality
• how the roles in radiation oncology may evolve to through the use of peer review

Learner Outcomes:

1. Identify the barriers that prevent peer review from being fully implemented in a department
2. Identify intervention methods to put in place for a sustainable peer review
3. Identify the use cases of a Plan Scorecard
4. Identify the anomalies of a Plan Scorecard

CE Credits = 1.0

Brent Murphy, MS, DABR, Senior Director-Professional Services

Thomas Costantino, MS, CMD, RT(T), Manager of Medical Dosimetry

James Wheeler, MD, PhD, Radiation Oncologist

Why do we need proton-specific education? How do we develop educational programs? Who are the experts in the field, and who is at the forefront of proton dosimetry? How does advanced education enhance the profession? We will discuss these questions and many more as we delve into the future of proton dosimetry and educational initiatives.  

Learner Outcomes:

1. Discuss the differences between photon and proton dosimetry  
2. Recognize the need for proton dosimetry education
3. Understand curriculum development and delivery
4. Engage in ideas for future content and programs

CE Credits = 1.0

Cheryl Turner, EdD, RT(R)(T), Director of Global Education and Training

Sponsored by Philips

The session will cover the new Pinnacle software features. IMRT with conventional and personalized planning.in Pinnacle. The workshop will help existing users streamline and improve their skills. Newer users will be introduced to the Pinnacle inverse planning module.

Learner Outcomes: 

1. Create a Conventional VMAT plan on Pinnacle
2. Create a Personalized VMAT plan
3. Use Feasibility to improve a Personalized VMAT plan

CE Credits = 0.5

Brett Milla, CMD, RT(R)(T), Product Support Engineer

Ted Poulton, CMD, RT(R)(T), Clinical Product Specialist

Dosimetry is a rapidly evolving field. More and more aspects of dosimetry are moving towards automation in regards to contouring, constraint evaluation, and planning. At one time these programs were reserved for research and academic centers. However, they are becoming more accessible to clinics both big and small through vendors. How can a busy center realistically and safely implement this technology? Technology that ideally streamlines a large portion of our professional responsibility and helps eliminate planning inconsistencies due to differing levels of experience or diligence.  How can we strive to ensure it achieves the same, if not a better, level of patient care achievable through completely manual methods? But most importantly, how do we most efficiently and effectively evaluate these programs to ensure they are both accessible to the whole dosimetry team and meaningfully utilized in the clinic? 
This session will examine one vendor's solution, RapidPlan, from a dosimetrist's point of view with a realistic evaluation of clinical implementation. An in-depth look at the program and how it works will be provided. Further, the session will review how to create and evaluate a prostate model from scratch to implement in the clinic. Another appealing aspect of the program is the availability of models implemented at other clinics. During this session, it will be reviewed how to validated and implemented a  head and neck model as well as a brain model from an outside facility in a way that was tailored to our needs.  

Learner Outcomes:

1. Outline the basic operation of an automated planning software
2. Describe the process of creating a model for clinical use based on a center's own patients
3. Discuss how to effectively manipulate and implement an outside facility's clinical model to their workflow

CE Credits = 1.0

Ashley Chackalayil, BS, CMD, Medical Dosimetrist

Medical Dosimetry is far more than a plan. The revenue aspect is critical for the viability of the department and service line. Ensuring that those responsible for the work understand the rules and all of the changes is crucial for timely payment. Post-COVID, as hospitals struggle to ramp back up, capturing all charges correctly is critical. This requires knowing the rules, where to look, and who to communicate with. This is not an automated task. Different modalities and protocols generate different charges. Now mix in the value-based care approach of the RO APM and it gets even more complex. So, how does the medical dosimetrist fit into this model and what can they do? What are providers and hospitals doing as a result of the changes? This session will discuss/inform on these important details.

Learner Outcomes:

1. Identify where the rules regulations come from for correct billing practices
2. Create a strategy for ensuring the correct codes are captured
3. Clarify where the dosimetry field is going and how the new technologies will be applied
4. Discuss and dissect the caveats when it comes to orders/documentation

CE Credits = 1.0

Jordan Johnson, MSHA, Chief Innovation Officer

RO-ILS: Radiation Oncology Incident Learning System®, is a free, online safety tool tied to a patient safety organization, with accompanying confidentiality and privilege protections outlined in the federal Patient Safety Act. Dosimetrists can utilize RO-ILS as a tool to improve processes surrounding treatment planning and nurture the desired safety culture. By tracking a variety of events, including incidents and near misses, individual facilities can identify error-prone procedures within their specific practice and then implement, and assess the effectiveness of, corrective action plans. Importantly, by contributing data to a standardized national database, common error pathways across the country are identified allowing for shared learning across institutions. The Radiation Oncology Healthcare Advisory Council (RO-HAC) is an interdisciplinary group of 12 radiation oncology professionals who provide subject matter expertise to RO-ILS by conducting data analysis on the national dataset and developing education for the community. Two dosimetrist members of the RO-HAC will discuss trends and multiple cases from the national RO-ILS database. Exemplified by RO-ILS events, the presentation will cover topics such as communication, documentation, contouring, planning, and treatment delivery, where the dosimetrist played a role in the variance. RO-ILS is cosponsored by ASTRO and AAPM with support with AAMD and ASRT, which enables facilities to enroll and participate in this important safety initiative free of charge. It is a program that benefits staff, our field, and our patients.

Learner Outcomes:
1. Identify treatment planning-related trends in the RO-ILS national database.  
2. Develop tools to analyze events and create effective corrective actions to mitigate future errors. 
3. Demonstrate the critical role dosimetrists must play in incident learning. 

CE Credits = 0.5

Allison Dalton, MSHA, CMD, RT(T), Supervisor of Proton Dosimetry and Radiation Therapy Services

Lee Hales, BSc, CMD, Chief Medical Dosimetrist

Brachytherapy is often seen as the realm of the medical physicist and the radiation oncologist. However, the qualified medical dosimetrist (QMD) can and should be an active member of the brachytherapy team. The AAMD Scope of Practice of a Medical Dosimetrist (2019) and the AAMD Practice Standards for the Medical Dosimetrist (2019) are designed to assist the QMD in defining their role in the technical services they provide in radiation oncology and patient care. The QMD in collaboration with the Qualified Medical Physicist (QMP) and the Radiation Oncologist (RO)/Authorized User (AU) may participate in a variety of tasks involved with providing brachytherapy services to patients. The level of involvement of the QMD in the brachytherapy team will depend upon a facility's policies & procedures, state & federal regulations, individual competency, and the desire to participate. 

This presentation will identify the technical services that the QMD may provide as a member of the brachytherapy team. Use the Decision-Making Model from the AAMD Scope of Practice of a Medical Dosimetrist (2019) in providing rational and logical guidance in determining the role of the QMD in the brachytherapy team at their facility/institution, being mindful of state & federal guidelines in administering ionizing radiation.  Lastly, the tasks and responsibilities of a QMD who spent 23 years as a brachytherapy dosimetrist will be reviewed.  

Learner Outcomes:

1. Identify the role of the QMD in brachytherapy services based upon the AAMD professional documents
2. Identify state & federal regulations that may limit/expand the role of the QMD in the brachytherapy services they can provide
3. Use the Decision-Making Model in the AAMD Scope of Practice of a Medical Dosimetrist (2019) to assist the QMD in determining their role in brachytherapy services they provided

CE Credits = 1.0

Paula Berner, BS, CMD, FAAMD, Medical Dosimetrist

 Many detailed decisions and factors go into the treatment planning process to come up with the best multiple SBRT target plan. For example, the number of isocenters to use, or the proximity of the targets to one another, and how to handle the dose spillage that may exist between them. Should dose contributions between targets even be counted?

Learner Outcomes:

1. Explain how to plan multiple SBRT targets
2. Outline when to use more than one isocenter with multiple SBRT targets
3. Discuss how to handle dose spillage between multiple SBRT targets
4. Differentiate dose criteria to think about when there are multiple targets close to each other

CE Credits = 0.5

Jeremy Donaghue, MS, DABR, Medical Physicist

Stereotactic body radiation therapy (SBRT) is a useful tool in the radiation arsenal.  Currently, there are numerous treatment sites that are NCCN guidelines approved for SBRT, including lung, prostate, liver, and others. Expansion to metastatic disease has occurred in the past for bone treatments and is now beginning to expand to other sites as new data suggests potential benefits to treating with this technique.  For dosimetrists, this requires careful consideration of many unique aspects. Clinically for physicians, there are a number of factors that determine the safety and feasibility of SBRT. Through exploring current clinical considerations, the basics of new clinical data, and important dosimetric parameters, SBRT can be performed more boldly, with careful consideration towards each patient’s clinical outcomes. 

Learner Outcomes: 

1. List the guidelines approved uses for SBRT in cancer care 
2. Explain the evolving area of SBRT for metastatic disease
3. Discuss clinical applications that MDs and dosimetrists can consider in delivering SBRT to maximize clinical outcomes

CE Credits = 1.0

Lindsay Puckett, MD, Assistant Professor

This session will show how we can employ the various technologies in unison with a service line approach to streamline the radiation oncology workflow to improve efficiency, and communication as well as to make educated financial decisions for the department.  

Learners Outcome: 

1. Explain how to improve efficiency in radiation oncology 
2. Streamline workflows 
3. Define a service line approach 
4. Discuss the importance of quality communication

CE Credits = 1.0

Shailja Patel, BS, Clinical Dosimetrist

Lehendrick Turner, MBA, MHA, CMD, Director of Business and Clinical Operations

Sponsored by MIM Software

Technology, including artificial intelligence, continues to advance, and the role of the medical dosimetrist must evolve to ensure an efficient and effective treatment planning process.  

As more tasks become automated, it will be critical for dosimetrists to embrace and deploy new technologies that allow them to provide greater value to their physicians. One area for improvement is in the extensive pre-planning work done prior to actual plan creation.

During this session, participants will learn how deep learning segmentation methods are being deployed in clinics to increase the efficiency of OAR segmentation. 

However, this session will not stop there. Auto-segmentation, while important, is in reality only a small piece of your overall contouring clinical workflow that has potential bottlenecks. 

MIM Premier, which was built to address the broader pre-planning workflow and ensure that efficiency is properly balanced with the highest quality, will also be demonstrated. 

Participants will learn how automation can be effectively leveraged to achieve true standardization and free up the dosimetrist’s time to focus on other plan quality elements.

Learner Outcomes:

1. Explain how deep learning auto-segmentation can increase clinical efficiency
2. Discuss how to reduce clinical uncertainties and improve contour quality
3. Explain how automation can be leveraged to achieve true standardization and allow more time to be focused on other plan quality elements

CE Credits = 1.0

Paul Jacobs, Research Team Lead for Algorithm Development

​Matt Gerace, MS, Director of Radiation Oncology

The novel coronavirus and the disease it causes, COVID-19, are among the more unpredictable health crises we have faced in recent times.  Radiation Oncology is situated at a uniquely precarious intersection between the desire to safeguard a vulnerable patient population while providing necessary treatment in a timely manner so as to not compromise oncologic outcomes.  A paradigm-shifting adaptation is imperative for Radiation Oncology leaders to address workflows in these challenging times.     
This session will highlight some leadership best practices to navigate the adaptive challenges we have faced in the Radiation Oncology Administration.   

Learner Outcomes:

1. Discuss real-time workflow adaptations
2. Explain billing/coding guidelines 
3. Outline clinic risk mitigation strategies

CE Credits = 1.0

Debra Corbin, RT(T), Director of Radiation Oncology

Jana Grienke, MHA, ROCC, Clinical Department Administrator

Dosimetrists have a unique skillset that yields results in radiation oncology. Their knowledge of cancer, clinical protocols, and technology is well-known and utilized to provide the best quality care for patients. This knowledge can be used to assist administration teams and provide new opportunities for dosimetrists. These opportunities include joining administration leadership and providing a strategy for prior authorization teams.  A streamlined authorization process can make a big difference in improving patient access, reducing delays, and impacting clinical outcomes. As clinical volume increases, improving access to care and reducing wait times will be key focus areas. For patients, often, getting the initial appointment is a challenge. For this reason, quicker planning timelines are often observed by clinical teams. It is up to oncology administration to avoid further delays in authorization to provide quality in both patient care and working environments. Adding dosimetrists to prior authorization improves communication and understanding which reduces the amount of administrative burden on physicians.   By developing an insurance authorization management strategy that focuses on front-end prior authorization, patients can access care faster and physicians can spend more time with patients. Legion Healthcare Partners has developed a radiation oncology-specific model that improves patients’ access to care. This model has been proven to reduce administrative burden, comparative plans, and the time needed for insurance authorization.   

Learner Outcomes:

1. Discuss prior authorization and the current challenges to patient care
2. Explain how to maximize patient benefits for government and commercial payors
3. Summarize how a dosimetrist can assist prior authorization
4. Discuss high-level denial and appeal strategies related to prior authorization

CE Credits = 1.0

Lehendrick Turner, MBA, MHA, CMD, Director of Business and Clinical Operations

Matthew Palmer, MBA, CMD, President and Chief Operating Officer