Report of the Ad Hoc Committee to Help Integration of Effort (AHHIE)-3BBB2B4C

This ad hoc committee has analyzed the problem of overlapping interests between groups and developed four general models for better integrating effort, and provided recommendations (detailed in Section 7.3, Recommendations 2 and 3) and examples for possible ways to address some current organizational barriers to collaboration. The four models can be combined in a number of different ways to update the compositions of groups and their locations in the organizational chart, to enhance collaboration and integration of effort. The examples following each recommendation are intended to clarify the recommendations and to present one of several possible approaches to addressing overlapping interests; they should not be seen as prescriptive recommendations but as starting points for discussion.

If the Board approves the general approach presented in this report, it will fall to the councils and committees to affect appropriate changes for existing AAPM groups and for those that may arise in the future. Changes to AAPM groups and organizational structure require input from, and consideration of, all stakeholders that might be affected. As discussed in some of the examples, overlapping interests often could be addressed using more than one of the approaches; each might have different advantages and detriments, as might making no change from what currently exists.

Any given change in the organization may or may not improve the integration and coordination of effort between relevant stakeholders. We recommend that groups welcome the opportunity to explore new ways to foster collaboration within the AAPM and that they are willing try new organizational arrangements for a pilot period. Given the recommended pattern of rotations between chairs and vice-chairs, a minimum trial period of four years would be needed to allow assessment of the effects of changes to the organizational structure. Even if the changes do not result in improved communication and collaboration in some areas of the organization, substantial improvements may have occurred in other areas and AAPM, as an association, will have learned lessons that could help in the next round of effort to ensure coordination and integration of effort within the AAPM. As a society, we must take these steps and see beyond that with which we are familiar and comfortable.

This committee recommends the following action item for the AAPM Board of Directors:

1. The Board Directs the Councils to begin discussions on methodologies to facilitate coordination among various AAPM groups.

a. The discussions shall consider the use of the models presented in this report’s recommendations and examples, but may include other approaches.

b. Operational or organizational changes shall include in the discussion and decision making all potentially affected stakeholders.

c. Changes will be given pilot durations long enough to evaluate their effectiveness, and be evaluated at least by the end of the duration.

d. The councils will include in their reports to the Board assessments of changes made.

2. The Board shall take action to implement Recommendations 1, 5 and 6 in this report.

4 Introduction

With the growth of AAPM membership and activities, the number of AAPM volunteers comprises almost 22% of the membership (over 1500 members and, in addition, about 570 volunteers who are not members), and the number of councils, committees, subcommittees (SubCs), working groups (WGs) and task groups (TGs) has grown to more than 360. AAPM leadership continues to identify gaps in communication and coordination across these groups. This has led to redundant and overlapping or wasted efforts, lack of involvement by some relevant stakeholder groups within the AAPM, and the potential for contradictory approaches or recommendations. The hierarchical organizational structure of the AAPM has, for the most part, facilitated the work of the society and works well in most situations. However, it has also fostered silo mentalities that impede cooperation between groups in different parts of the organization. Cooperation between groups that share some aspects of a topic, but consider it from different perspectives, would strengthen the work produced by the AAPM; diversity in groups increases the likelihood of success.

Recognizing this as a problem and a potential opportunity, in 2018, the Ad Hoc Committee to Help Integration of Effort (AHHIE) was created with the following charges:

1. To design proposals that could facilitate efforts that cut across councils and among committees within and improve cooperative efforts.

2. To develop solutions to initiate and/or promote the efficiency of cooperative work across councils and committees.

3. To develop solutions for the general organizational structure of the AAPM that foster collaborations.

Recommendations that address these charges might require changes to the AAPM organizational structure. Because the AAPM is a mature organization, the two approaches to structural change are either a radical transformation or a gradual, stepwise approach. The AHHIE Committee members agreed that in completing its charge, an important goal was to minimize disruption to the AAPM. Therefore, a radical change in the organizational structure was not pursued.

The recommendations from this committee are targeted at creating an environment to encourage and support cooperation between members with different backgrounds, all while trying not to disrupt the society.

In this report, the term, “group” is used to generically indicate any organizational body within the AAPM, such as a council, committee, SubC, WG, TG or unit. The four councils are denoted as AC (Administrative Council), EC (Education Council), PC (Professional Council), and SC (Science Council).

5 Methodology

The AHHIE developed a list of issues related to communication and coordination across groups within the AAPM to help initiate our efforts. These issues were based on the experience of the AHHIE Committee members. The issues were consolidated into a list of six questions, each with an associated list of sub-questions. Sub-groups within the AHHIE Committee worked to answer the developed questions. The answers to these questions guided discussions on how to resolve the underlying issues and specific recommendations were developed. Communication with external entities is outside the scope of this Ad-Hoc. The questions and answers comprise Table 1.

Table 1. Questions and answers related to communication and coordination across groups within the AAPM.

Question	Sub-Questions	Answers
5.1 Where are the overlapping areas between councils?	5.1.1 With which councils does the AC overlap?	Some portions of all Councils
	5.1.2 With which councils does the EC overlap?	AC, PC, and SC to a small extent
	5.1.3 With which councils does the PC overlap?	Primarily SC
	5.1.4 With which councils does the SC overlap?	Primarily PC
5.2 How do we identify groups with overlapping charges?	5.2.1 How to identify overlap within a committee?	Inventory to be performed by committee chair with involvement of all SubC chairs, with the assistance of keywords, the newly instituted progress report forms, and the dashboard tool. The keywords and dashboard tool are both being developed by newly formed working groups.
	5.2.2 How to identify overlap between committees?	Inventory to be performed by council chair with involvement of all committee chairs, with assistance of keywords, progress reports, and dashboards.
	5.2.3 How to identify overlap between groups in different councils?	Inventory to be performed by council chairs with involvement of the Executive Committee (EXCOM), with assistance of keywords, progress reports.
	5.2.4 How to identify overlap between groups under the Board?	Inventory to be performed by all chairs of groups reporting to the Board, with assistance of keywords, progress reports, and dashboards. The process will be facilitated by EXCOM.
5.3 How do we coordinate groups with closely related charges?	5.3.1 Is the intra-AAPM liaison system working (AAPM group to AAPM group)?	Not in general. While we have had situations for specific TG reports where liaison positions have been effective, there are many examples where they have not worked in a comprehensive and strategic way, either between groups within a council or groups in different councils. Because of their lack of effectiveness, many liaison positions between AAPM groups were deleted several years ago.
	5.3.2 Is it clear from the website what each group is working on?	Councils and committees defined in the By-Laws or Rules have a link on their landing page to their Purpose, as specified by the By-Laws or Rules. Charges must be provided for groups not defined in Rules or By-Laws. There are gaps in the information on the landing pages for some groups and some are out of date.
	5.3.3 Can Rules be changed to allow groups to report to two parent groups?	Yes, the Rules can be changed to provide for this. However, the current database does not support reporting to two or more parent groups, and thus the database would need to be modified.
	5.3.4 What is the role of staff in helping with integration?	Headquarters (HQ) staff should ensure accuracy and completeness of the information provided on the home page of each group and bring to the attention of the appropriate chairs any potential overlap, if they become aware of it. HQ staff should participate in the design of software solutions to support integration. They should help proponents of a new group check the group dashboard and keywords and remind proponents to discuss their proposals with all potential stakeholders so that proponents come forward with a proposal that addresses integration of effort and follows the recommendations of this report.
5.4 How do we coordinate Medical Physics Practice Guideline (MPPG) development related to appropriate TG reports?	5.4.1 Do we have clarity on mission and format for TG reports?	Discussions are ongoing between the leadership of SC and PC and procedures and forms have been developed to standardize the process of proposing and evaluating progress of TGs, reviewing TG reports, and coordinating TGs and potential MPPGs (see below).
	5.4.2 How do we communicate which reports are being proposed or in progress?	New processes have been approved and are being implemented to review proposals for new TGs. New approaches have been implemented to gather periodic status updates from TG Chairs for existing TGs. During the TG proposal evaluation, the Subcommittee on Practice Guidelines (SPG) is notified, as will be other groups with shared keywords, to establish whether an MPPG may be needed. When reports are in review, the Clinical Practice Committee (PICR) is included in the review and has a second opportunity to initiate an MPPG.
5.5 Are there meeting coordination issues that are not being addressed by the Meeting Coordination Committee (MCC)?	5.5.1 Are we avoiding excessive duplication at our meetings?	Yes, the current MCC is coordinating suggestions and content across AAPM meetings. Program ideas are shared between meeting chairs and track chairs. Integration efforts appear to have been very successful here.
	5.5.2 Are we avoiding excessive overlap between tracks at the annual meeting?	Yes, MCC and Annual Meeting SubC (AMSC) coordinate content for the AAPM Annual Meeting, MCC uses its fall retreat to ensure coordination among meetings, and the AMSC meets immediately after the retreat and uses that time to coordinate content among the different track directors for the annual meeting.
5.6 Are there AAPM chapter activities that should be coordinated with the AAPM national organization?	5.6.1 Are there opportunities for collaboration and integration of effort between activities of the national organization and those of regional organizations?	Collaborations have been formed between the Public Education Committee (PE), which is developing public-education materials, and the Regional Organization Committee (RO), which will have members co-develop and deliver presentations at local venues. A SubC under RO has been formed to coordinate these efforts. A collaboration has also been developed between RO and the Corporate Advisory Committee (CAB) for coordination of chapter meeting logistics (TG 347).
	5.6.2 Can presentations and scheduling of officers to speak at chapter meetings be coordinated?	Yes. EXCOM and RO have agreed to develop a coordinated mechanism for obtaining Commission of Accreditation of Medical Physics Educational Programs (CAMPEP) and Self-Assessment Modules approvals, and a coordinated scheduling mechanism for presentations from AAPM officers at local chapters. A SubC under RO will be formed to work on this.

6 6 General Findings

A core finding was that AAPM needs to improve its ability to collect, manage, and transfer information across the organization to avoid the wasting of effort that occurs when volunteers in one area of the organization are unaware of activities of others. Currently, efficient navigation and communication within the AAPM depends on an individual volunteer’s access to information across multiple levels of the organization. In many cases, organizational memory of best practices and procedures, important contacts and relationships, and lessons learned from the past reside with individuals. One of the barriers to effective collaboration is a lack of clarity and transparency in the charges of some groups within AAPM. It will have the added benefit of providing much greater transparency for the membership and the ability to more easily identify who to approach with questions, concerns, or requests to be involved.

The AAPM is currently making several improvements in organizational communications. Some of the changes underway, or planned for the near future, include:

· A vital effort is currently underway to update the charges and develop keywords for each group. This will provide a logical framework to help identify areas of common interest and then facilitate collaboration, remove unecessary overlap, identify opportunities for new entities, or to merge efforts for greater efficiency.

· The standardization of TG formation within SC, as noted in Section 5.4. After piloting this in SC, it will be expanded to all Councils.

· The expansion and modification of the new TG-proposal process to create a common procedure for creating new WGs, SubCs, or committees, and the placement of links for these forms in all windows in the AAPM organization tree.

· The formation of a WG to standardize, expand, and maintain an official set of keywords that will be used for all AAPM groups, meetings, video archives, and anywhere else in the organization where useful.

· The development of a dashboard that lists all groups in the AAPM with their associated keywords. Proposed new groups will automatically be added to the dashboard and notice will be sent to any other group having a common keyword.

· A collaboration between RO and CAB for coordination of chapter meetings, as noted in Section 5.6.1.

· The coordination of content across all AAPM meetings, except chapter meeting, by MCC.

· The development and implementation of online status update forms, including waypoints for TGs to facilitate annual reporting of progress and activities by all groups. For example, status reports on TG reports include drop-down options on the percent of writing that is complete, followed by the stage in the review process. This allows leadership to monitor progress on the writing and reviewing of reports. It also provides regular access to leadership and members on the status of a group.

The remainder of this report presents recommendations that will further help the integration of effort in the AAPM by addressing the following three aspects of integration efforts.

6.1 Facilitating collaborative work across councils and committees (Charge 1)

Overlapping and redundant efforts across committees and councils are symptoms of gaps in communication and coordination. To address such gaps, volunteers leading AAPM groups need to be able to identify potential overlaps. They require tools to support them since volunteers are already investing significant time into supporting the mission of the AAPM. As noted above, there are recent activities underway to develop new tools to support this effort, and Section 7.2 expands on our recommendation to address this issue.

6.2 Efficiency of collaborative work (Charge 2)

Once groups are tasked with coordinating their work, including cross-council groups, sustaining effective communication is a major challenge. Even groups created to bridge the work between other groups, or groups that address topics that fall into more than one group, find it difficult to maintain effective communication over time and through leadership transitions. The scope of this ad-hoc committee was to create recommendations for facilitating collaborative work within the AAPM. Section 7 contains the recommendations that address this charge.

6.3 Organizational structure (Charge 3)

This ad-hoc committee discussed several organizational structures. These can be divided into mechanistic and organic characteristics (Burns and Stalker 1961). Some structures that were considerably different from that currently used by the AAPM were considered. The current organizational structure of the AAPM is driven by the hierarchical, council structure. This ad-hoc committee felt that changing the council structure, for example, having 340 groups reside under EXCOM or the Board, would be unwieldy to manage, and that it would detract from the strength of the AAPM. The council and committee structure facilitates most of the work on the major topics relevant to the council or committee. Completely eliminating that part of the current organizational structure would lead to a great loss of efficiency and effectiveness. Moreover, any restructuring of groups different from the current council structure would still lead to some groups existing that share responsibilities and interests. There is simply no organizational structure that could avoid overlap altogether and yet provides the necessary efficiency. We therefore have focused on recommendations that would work under the current council structure.

7 Specific Findings and Recommendations

7.1 Guidelines on implementing the recommended changes

This ad hoc committee has analyzed the problem of overlapping interests between groups and developed four general models for better integrating effort, and provided recommendations and examples for possible ways to address some current organizational barriers to collaboration. The four recommendations can be combined in a number of different ways to update the compositions of groups, and their locations in the organizational chart, to enhance collaboration and integration of effort. The examples following each recommendation are intended to clarify the recommendations and to present one of several possible approaches to addressing overlapping interests; they should not be seen as prescriptive recommendations but as starting points for discussion.

7.2 Identifying groups with overlapping charges

The purpose and activities of each council and standing committees are specified in the By-Laws and Rules. There are many opportunities for overlap, as noted in the table in Section 5. This section provides specific recommendations to help identify overlap or redundancies between groups as well as methods of monitoring group activities to identify the potential for such problems.

Recommendation 1: Develop and promulgate within the AAPM tools to facilitate communications within and between councils or groups that will allow groups to:

a) Review their charge or description in the Bylaws or Rules and ensure that the appropriate information is on the group’s listing in the AAPM’s organization tree.

b) Ensure that all groups are assigned appropriate key words from a standardized key-word list.

c) Manage a dashboard that is available to all AAPM members and lists all AAPM groups via their searchable keywords and their purpose or charges.

d) Integrate the proposal process for all groups into the dashboard tool to provide automatic notice to all councils and any other group that shares keywords with a proposed group.

e) Develop and manage processes to alert councils and other possibly related groups of any potential overlaps that may exist between a proposed new group and existing groups. The group formation proposal request will need to provide specific recommendations on how to address the potential overlaps on their group formation cover sheet. The dashboard tool will call attention to these potential overlapping groups with shared interests.

Organizational changes in the AAPM will also be required, particularly:

a) Modifying the AAPM organizational tree to show all parents of a group, as discussed in Recommendation 2b, and clearly indicate those groups with more than one parent.

b) Having group chairs actively monitor what components are missing in the dashboard, keywords, charges, and progress reports.

c) Making the chairs of groups responsible, when completing the annual progress report, to assess if there are changes in topics addressed by the group that could alter the situation of overlaps with other groups. An example would be scope creep of a TG report that could create an overlap situation that did not exist at the time that the TG was formed.

This recommendation will require software tools and procedures for identifying and resolving overlaps at the time that a group is proposed. New tools and procedures also will support creation of a chair’s annual report that identifies areas requiring new or continued harmonization of effort. The report will flag potentially overlapping areas to facilitate discussion with chairs of those groups involved. As noted above, these tools and procedures are in the process of being developed.

7.3 Coordinating the work of groups with closely related charges

7.3.1 Recommendation 2: Merging groups

For groups that have closely related charges or interests, even if the overlapping charges or interests do not constitute the majority of the charges of both groups, we recommend merging them into one group. Option 2a is recommended for merging groups having the same parent, and option 2b for the situation where the groups have different parents. Option 2b is sometimes referred to as the co-parenting model.

7.3.1.1 Recommendation 2a: Merging groups with the same parent

For groups with the same parent (e.g., within a single council or committee) that have closely related charges or interests, we recommend merging them into one group under the same parent group, as shown schematically in Figure 1.

Figure 1. Graphical description of Recommendation 2a. In these trees, the solid line indicates that the group on the bottom reports to the group on the top. The left side shows the two groups with overlap (Child A and Child B). The right side shows the groups merged into one group.

Example of Recommendation 2a: At the 2019 RSNA Tomosynthesis Subcommittee (TSC) meeting, the Tomosynthesis and Mammography Subcommittees of the Imaging Physics Committee (IPC) merged into the new Breast X-ray Imaging Subcommittee, all within the IPC. The Breast X-ray Imaging SubC includes most x-ray breast imaging techniques; collaborations with the CT SubC (CTSC) still need to be established. This example is shown schematically in Figure 2.

Figure 2. An example of Recommendation 2a, where two SubCs involved in x-ray imaging of the breast were merged to integrate their overlapping activities.

7.3.1.2 Recommendation 2b: Merging groups with different parents

For groups with different parents (e.g., in different councils or committees) that have closely related charges or interests, even if the overlap does not constitute the majority of the charges of both groups, we recommend merging the groups into one group and designating the most appropriate parent group as its official home, as determined by that council chair and relevant committee chairs if it is within one council, and among the council chairs, relevant committee chairs and the Executive Committee if it is across councils. The concept of Recommendation 2b is shown schematically in Figure 3.

Figure 3. Graphical description of Recommendation 2b. In this figure, the solid connecting line indicates reporting to the primary parent, just as in Figures 1 and 2. The dashed line indicates secondary reporting to a co-parent group (Parent A).

Co-parenting and rotating chairs: Each parent group names members to the blended group from the original child groups (in Figure 3, Child A and Child B) in proportion by agreement between the parents and the councils involved. In addition to these appointed members, additional members from the Association membership at large may be appropriate. The chair and vice-chair of a co-parented group will rotate between members appointed by the parent and co-parent groups. We recommend rotating these individuals on a yearly basis so that when one is chair, the other is vice-chair. These two individuals must be voting members of the parent group whose focus they are representing, usually with the chair sitting on one of the parent groups and the vice-chair sitting on the other. A potential rotation is shown schematically in Table 2. The chair and vice-chair would be ex-officio, voting members of the parent group that appointed them.

Table 2. An example of the rotation of the leadership in a blended group, beginning with the formation of the group.

Year	Person 1	Person 2	Person 3	Person 4	Person 5
1	Chair	Vice-chair
2	Vice-chair	Chair	Member
3	Chair	Vice-chair	Member
4	Member	Chair	Vice-chair
5	Member	Vice-chair	Chair	Member
6	Member	Chair	Vice-chair	Member
7		Member	Chair	Vice-chair
8			Vice-chair	Chair	Member
9			Chair	Vice-chair	Member
10			Member	Chair	Vice-chair
11				Vice-chair	Chair
12				Chair	Vice-chair
13				Member	Chair
14					Vice-chair

While it may sound inefficient to change chairs annually, if the vice-chair serves effectively as the chair designate, and a spirit of collaboration and joint ownership is maintained, there should be no loss of efficiency during the transition. In addition, the appointments should be offset such that when either the chair or vice-chair rotates off the group, continuity will be maintained. If three groups are parents of an interdisciplinary group, the rotation of chairs would be between members of each parent group. Minutes and reports of co-parented groups shall be jointly developed by the chair and vice-chair(s) and provided to all parent groups.

First example of Recommendation 2b: An example of Recommendation 2b was the 2017 merger between the Radiation Safety SubC of the Therapy Physics Committee (TPC) into the Radiological Protection SubC of the IPC (RPSC). The resultant group remained under IPC, but reports to both IPC and TPC, as shown in Figure 4. The success of this model depends on the diligence of the chair and vice-chair pair in collaborating with each other and in reporting to their respective parent groups.

Figure 4. An illustration of Recommendation 2b is the merger of the Radiation Safety Subcommittee and the Radiation Protection Subcommittee. The result is a co-parenting model.

7.3.2 Recommendation 3: Create new groups

Some groups have closely related charges or interests but reasons may exist that make it undesirable to merge the groups, for example if the overlapping charges or interests comprise only a small portion of the charges for each of the two groups. For groups having different parents, where it is agreed by the relevant parent group and Council chairs that it does not make sense to merge the two groups, we recommend creating a new group, either directly under the parent group (Recommendation 3a) or under a new parent (Recommendation 3b).

7.3.2.1 Recommendation 3a: Create an integrated group from groups under the same parent

When the charges of multiple groups have significant overlap, yet at the same time have other quite distinct charges, merging the groups is not recommended. However, the necessary communication between the groups could be facilitated by the formation of a new group in the organizational chart, at approximately the same level as the existing distinct but overlapping groups. This new group would become the home for new subordinate groups created to address the overlapping areas in the original distinct but overlapping groups, both of which reside under the same parent. This new home group (for multiple integrated groups) may contain members from the original overlapping groups and other new members. The members of the integrated groups could be a subset of the members of the original overlapping groups. The chair and vice-chair of the new integrated group would alternate chairing their group, as described in Recommendation 2b. Figure 5 illustrates schematically the process for Recommendation 3a.

Figure 5. Illustration of Recommendation 3a. The shaded box indicates the new group. In some cases the child C may adequately address the potential overlaps. In other cases, it would be anticipated that multiple integrated groups would be formed under Child C to address additional areas of overlap that exist in other groups residing under the same parent group.

First example of Recommendation 3a: Cone-beam CT technology is used in a diverse range of diagnostic, interventional, and radiation therapy applications. No single group in the IPC stands out to be the natural home for which all these applications would be addressed. To address this, a new subcommittee could be formed under IPC, the 3D X-ray Imaging Subcommittee (3DXSC) with members from, and reporting to, CTSC, SCRF, TSC and the Imaging in Therapy Committee (ITC) proposed as the second example of Recommendation 3b.

Second example of Recommendation 3a:

An example of the use of approach 3a comes from trying to determine how to deal with hybrid imaging modalities, such as PET/CT and PET/MR. The IPC is structured mostly by equipment modality, raising the question of which group should focus on the topic of PET/CT, for example. A possible approach is the creation of a new IPC subcommittee for hybrid imaging, which will serve as a home for such groups, as shown in Figure 6.

Figure 6. An example of Recommendation 3a is the creation of a Hybrid Imaging SubC, which will serve as the parent for groups formed specifically to address modalities that combine aspects of the modality-specific children groups under IPC, focusing on the issues arising due to the combination of modalities.

This example creates a new subcommittee under IPC, the Hybrid Imaging Subcommittee (HISC), composed of members of the Nuclear Medicine SC (NMSC), CTSC, Magnetic Resonance SC (MRSC) and any other subcommittee involved with hybrid imaging units. This approach recognizes that the equipment aspects of the hybrid imaging modalities are best addressed, for the most part, by members of the SubCs for each component device, such as the NMSC and the 3DXSC for their respective parts of a PET/CT unit. What is unique and beneficial about hybrid modalities is not just the physical integration of two or more technologies within one system, but also the computational and display methods used to register and integrate the resultant images. In general, issues encountered by one hybrid modality may be very similar to some of those encountered by other hybrid systems. Sharing knowledge about these integration issues amongst all the groups dealing with various permutations of hybrid imaging devices will provide a consistent approach that can benefit each hybrid modality. This avoids reinventing wheels and avoids wasting volunteer resources. The HISC would have several WGs under it, each addressing specific combinations of equipment. Methods, ideas or processes developed in one hybrid WG can be readily shared within the new HISC. The HISC would utilize a three-way rotation of chairs between NMSC, CTSC and MRSC. If the use of ultrasound in combined equipment becomes significant, the chair rotation would be re-evaluated.

7.3.2.2 Recommendation 3b: Create an integrated group from groups under different parents

As with Recommendation 3a, groups may exist that have closely related charges or interests. Because the overlapping interests of the two groups, although potentially broad in scope, represent only a portion of the charges to each group, it may not make sense to merge the two groups.

Consider the scenario when a new group needs to be formed to combine significant aspects of existing groups that reside under different parents. Here, a possible approach first creates a new parent group, one level higher in the organizational hierarchy than the groups that have significant overlap. Subsequently, a new child group would be formed to address the new topic and charges, and placed under the new parent group at an equal level in the organizational chart as the original groups with overlapping interests. This new child group would comprise a subset of members from the two existing groups with overlapping interests, as well as other new members. The newly formed parent group would serve as the home for other new groups formed to integrate overlapping activities of separate groups under the original parents. The chair and vice-chair of the newly created group would alternate chairing, as described in Recommendation 2b. Figure 7 shows this general recommendation schematically.

Figure 7. A schematic representation of Recommendation 3b. Shaded boxes indicate new groups.

First example of Recommendation 3b: International efforts are an important part of the AAPM. For example, AAPM has about 1500 members living outside of the U.S. and Canada. AAPM’s international activities are currently under the purview of the International Affairs Committee (IAC), under AC, the International Educational Affairs Committee (IEAC), under EC, and other groups, including SC, PC, and EXCOM. In December of 2019, the Ad-Hoc Committee for Defining the Structure, Charges and Budget for 2020 of the International Committee (AHIC) presented its recommendations to the Board. The unanimous recommendation from the AHIC was the need to consolidate all international activities of the AAPM into a new International Council (IC). The Ad Hoc Committee to Establish an International Council (AHEIC) was then formed to prepare a proposal that was approved by the Board in April 2020 and was approved by the Membership in August 2020.

Second example of Recommendation 3b: The Ad Hoc committee members discussed the importance of including imaging physics expertise in groups focused on radiation therapy applications that have imaging as a foundational aspect, such as MR-Linac QA. The creation of the IPC and TPC was in part motivated by the need to more efficiently manage an ever-increasing volunteer workload. In some instances, however, it has resulted in a decreased integration of imaging and therapy expertise. When SC discusses how to address the need for improved integration between imaging and therapy, it may be relevant to revisit that history.

Several process changes are underway in SC that may positively impact the integration of imaging and therapy physics. For example, the revised TG creation process requires submission of a letter of intent (LOI). The Working Group on Task Group Creation (WGTGC) includes the IPC, TPC, Research Committee, and Data Sciences Committee chairs and vice-chairs, along with SC leadership. This ensures a broad representation of expertise in the WGTSC, which evaluates the merit, scope, and composition of proposed TGs and assesses the diversity of the proposed members, which includes diversity of expertise. As recommended in this report, SC has already endorsed co-parenting of groups to provide better communication between two (or more) parent groups that are similarly invested in the work of the child group. The success of the co-parenting model, and the tools made available to visualize co-parenting relationships, will be relevant when SC determines how to ensure the integration of imaging and therapy expertise in its work.

Finally, this Ad Hoc committee recommends that SC consider whether a new committee created under it, the Imaging in Therapy Committee (ITC), would be a more appropriate home for groups addressing imaging issues in therapy, both in radiation therapy and non-radiation therapy technologies. Subcommittees under ITC would be composed of several members from IPC and TPC, as well as committee members with special expertise in the topic of the new SubC who may not be a member of IPC or TPC. Here, the knowledge and experience gained in addressing topics related to imaging in therapy applications will grow over time such that this expertise can be leveraged for other imaging in therapy applications. This recommendation solves another quandary; the ITC also would be an appropriate overarching home for an MR in Radiotherapy SubC (MRRTSC), as was recommended by the recent Ad Hoc Committee on MR in Radiotherapy (AHMRIRT). Other groups currently under the Therapy Imaging SubC (TISC) would also reside under ITC. For each of the groups in the ITC, the chair and vice-chair would follow the guidance of Recommendation 2b. A fuller illustration of the ITC concept is shown later in the report (Figure 9b).[CHM1]

Third example of Recommendation 3b: Radionuclide therapy involves the expertise of AAPM members belonging to multiple different groups, most notably the Nuclear Medicine SubC (NMSC) of the IPC and the Brachytherapy SubC (BTSC) of TPC, both residing within SC. The upper part of the Figure 7 illustrates the quandary of where to put the proposed radionuclide therapy WG, and the lower part, one possible solution. This example presumes the creation of the ITC.

Figure 7. This figure illustrates the quandary of determining where to house a radionuclide therapy group, since it shares expertise associated with nuclear medicine, brachytherapy and imaging in therapy groups. The lower panel shows a solution where the ITC is formed under SC to be the home for the several groups working on therapy applications with intensive imaging components, and placing a Radionuclide Therapy SubC (RNTSC) in the new ITC.

7.3.3 Examples of combining recommendations

First example of combining recommendations - DaRT: With the formation of the RNTSC according to Recommendation 3b, another quandary can be addressed based on the principles of Recommendation 2b (co-parenting). Diffusing Alpha-Emitters Radiation Therapy (DaRT) uses alpha emitters in a wire needles to administer radionuclide therapy to tumors. The radionuclide, ²²⁴Ra, decays into ²²⁰Rn through diffusion of the alpha-emitting radionuclide’s daughter. As such, it behaves in some respects as brachytherapy and in other respects as radionuclide therapy. An appropriate home for a group focused on this topic could be created using a combination of Recommendation 3b to first form RNTSC and then using a co-parenting model similar to Recommendation 2b to establish a new WG under the BTSC of TPC, co-parented by the RNTSC created under ITC, with chair and vice-chair selected from those two SubCs. Figure 8 shows this recommendation schematically.

Figure 8. An illustration of using a co-parenting model based on Recommendation 2b for the creation of a Diffusing Alpha-Emitters Radiation Therapy (DaRT) WG. The co-parenting recommendation could place it under the BTSC with co-parenting by the RNTSC, which was created using Recommendation 3b.

Second example of combining recommendations – Radiation Protection: In 2005, the Radiation

Safety Committee of SC was split into the Radiological Protection Subcommittee (RPSC) under the IPC and the Radiation Safety Subcommittee (RSSC) of TPC. The two worked both singly and jointly on projects. As discussed above with Recommendation 2a, in 2017, the RSSC was subsumed into the RPSC, which remained under IPC, but reported jointly to both IPC and TPC. This co-reporting situation has worked well, albeit much of its success has been due to the efforts of the chair and vice-chair and their diligent cooperation. The chair and vice-chair currently switch on a three-year cycle. In the future, they could rotate as the model from Recommendation 2b is essential to maintaining this level of close collaboration.

Third example of combining recommendations – Safety Committee: The Work Group on Prevention of Errors in Radiation Oncology (WGPE) sits under the Quality Assurance and Outcomes Improvement Subcommittee (QASC) of TPC. While conceptually, reduction of errors should improve outcomes, the WGPE actually addresses safety and error prevention that is applicable in imaging as well as in all aspects of health care. The WGPE has found it difficult to propagate its work beyond radiation oncology both because of limits to the WG’s charge and the lack of integration with the imaging side of SC.

The safety procedures developed by TG 100 need to be disseminated throughout the AAPM. This requires educational materials and programs, practice guidelines, scientific developments, coordination of meetings, and working with governmental agencies, which are types of activities associated with different councils within the AAPM (i.e., EC, PC, SC, and AC, respectively), and apply equally in imaging as well as therapy. Presently, the home of the WG tasked with the dissemination and broad adoption of the TG-100 recommendations (WG100) is in the AC. WG100 does not have members officially representing other councils. Much of its work involves the coordination of efforts among the relevant councils, coming to those councils as a guest and petitioner. WG 100 also has several units under it.

The Vendor Relations and Product Usability Subcommittee (VRPUSC) is under the Clinical Practice Committee (PICR) in PC. The VRPUSC focuses on identifying issues users encounter with products, particularly safety issues, and then work with vendors to eliminate problems.

There often is a lack of coordination among these groups working on safety. As safety becomes an increasing interest in healthcare, better integration of the work of these groups would be advantageous.

Addressing the issues discussed forms a Safety Committee under SC that would house the RPSC, an Error Reduction Subcommittee (ERSC), an Incident Learning Subcommittee (ILSC, which would be a home for the Radiation Oncology Incident Learning System WGs and, when it is formed, a Diagnostic Incident Learning System WG), the VRPUSC and the Quality Management Subcommittee (QMSC) that would assume the responsibilities of the WG100. Some of the SubCs would have secondary reporting responsibilities due to co-parenting, for example the VRPUSC would report to PICR and the Corporate Relations Committee, the latter to provide a conduit for discussions with vendors. QMSC would need members from each council as well as representation from therapy and imaging. In all cases, the chair and vice-chair should provide for diversity, and rotate according to Recommendation 2b. Much of this organization can be seen in Figure 9b, although the linkages to those groups outside of SC become difficult to show.

A strong argument could be made for the Safety Committee to fall under PC since PC also is the home for the Clinical Practice Committee, because much of the focus of safety in medical physics lies with patient care and the use of devices or pharmaceuticals in healthcare.

Fourth Example of combining recommendations – Effects on Science Council: Figure 9a shows a partial organizational structure of SC focusing on the groups relevant to this discussion. The official organizational tree for SC, viewable on the AAPM webpage, demonstrates that SC is an expansive council. SC has been a particular focus of this report because of the extremely large number of groups it contains (5 committees, 22 SubCs, ~42 WGs, and ~70 TGs), which results in a high potential to have groups with overlapping interests and charges. This is not surprising given the multi-disciplinary nature of our field. Figure 9b shows an example of the cumulative effects of the recommendations in this report on SC.

Fifth example of combining recommendations – groups planning for the future: The upper right of Figure 9a show the Working Group on Future Research and Academic Medical Physics (WGFRMP, also referred to as FUTURE). Its charge, “To initiate, coordinate and lead activities to secure sustainable growth and improvement in the long-term future environment for high quality research and academic training of physicists in medicine” shares interests with two committees in PC that focus on the future of our profession.

The Medical Physics 3.0 Committee (MP30C) of PC seeks to change the practice of medical physics to make medical physicists more valuable in the future, and to change medical physics training to reflect the skills that will be needed in the future.

The Medical Physics Leadership Academy Committee (MPLAWG) also looks to the future of the medical physics community and the AAPM. It aims to improve the leadership skills of medical physicists to help them become leaders in the future, both within the AAPM and in the larger healthcare enterprise.

Each of these three committees focus on guiding medical physicists into the future. To develop a coordinated strategic plan for the future, which addresses academic, clinical, industry, and regulatory sectors of our profession, as well as the educational needs to succeed in these areas, these groups could be integrated, creating a committee focused holistically on the future of medical physics. There is no reason that an academic-oriented committee cannot reside in PC, which addresses issues impacting our overall profession, not just the clinical aspects of medical physics. Housing these groups together plays on their commonality – looking to the future – rather than their differences, professional vs. research, to help drive the AAPM toward its strategic goals. Thus, one possible approach would be to create a Medical Physics Horizon Committee (MPHC) under PC, and place MP30C, MPLAWG and WGFRMP as SubCs. The membership of MPHC would include representatives from SC, EC, and AC.

Figure 9a. A simplified version of the current organizational structure of SC, showing those groups pertinent to this discussion. The dashed yellow line shows a secondary reporting pathway for the RPSC.

Figure 9b. A simplified version of the proposed organizational structure of SC, illustrating the effect of the recommendations in this report. The boxes that are half gray and half black indicate that the group is a combination of members from the therapy and imaging communities representing TPC and IPC, respectively. Colored dots in a group’s box indicates that the group shall include members from groups in the box with the same color as the dot.

Sixth example of combining recommendations – Corporate Relations: The AAPM highly values our relationship with our corporate partners. There are two committees related to interactions with them under AC: the Corporate Advisory Committee (CAB) and the Corporate Relations Committee (CRC). Vendors also interact with the Technical Exhibits Subcommittee (TES) of the Meeting Coordination Committee (MCC), which is under AC. The Vice-Chair of the CAB comes from the CRC, so it is expected that these committees communicate effectively. The TES interacts intensively with vendors related to AAPM-sponsored meetings, but does not have a direct connection to CRC or CAB. One example of collaboration with vendors that crosses groups is the formation of a joint task group (TG 347) between CRC and the Regional Organization (RO).

An improvement in the organization could come through establishing the CRC, under AC, as the primary home for all groups that interface with vendors. The CAB, which interfaces closely with the CRC, would become a child of the CRC, and would function to advise the AAPM on matters of mutual interest, including new initiatives.

This example does not suggest moving the TES out of MCC. However, it is essential that TES membership continue to include a member from the CRC. A member of TES would also be appointed as a member of both the CRC and CAB.

A further suggestion would be that a member of CRC be appointed to RO, as chapter leaders work closely with vendors in securing support for, and handling the logistics of vendor participation in, chapter meetings.

This example shows that the recommendations can work in combination to better integrate groups working on the same topics or with the same groups. These changes are shown in Figure 10.

Figure 10. Diagram illustrating merging and rearranging groups to facilitate AAPM’s interactions with corporate partners and other vendors under the CRC. Above, showing the current organization and below, following the arrow reorganized to facilitate communication. Only the relevant groups under the parents involved are shown. Colored dots in a group’s box indicates that the group shall include members from groups in a box with the same color as the dot. For example, membership in TES of a member of CRC is represented by the blue dot (the CRC box is colored blue) in the TES green box. Similarly, there is a blue dot in the magenta RO box indicating that a member of RO comes from the CRC. The magenta dots in the CRC and CAB boxes denote that members in those groups come from the RO committee. TES would have seats in both the CRC and CAB, as shown by the light green dots in the blue CRC box and the purple CAB box. VRPUSC maintains its connection with PICR through a member of the VRPUSC coming from PICR (the red dot) and a member of the VRPUSC coming from the ERSC (the gold dot). PICR and VRPUSC would, in return, send a member to WGEP (the red and dark blue dots in the gold ERSC box).

7.4 Is the liaison system between groups within the AAPM working?

The AHHIE concluded that liaisons between groups within the AAPM were not working (see Section 5.3.1). As seen in Figure 9b, instead of liaisons, this committee recommends that full members of groups be named by other stakeholder groups, as well as organizational changes to affect increased communication among groups with common interests.

Recommendation 4. AAPM should only appoint liaisons to outside entities, not between different groups within the AAPM. We recommend elimination of the liaison positions among AAPM councils and other groups. Inter-council communication is best accomplished via monthly calls among the Council chairs and vice-chairs, along with their designated HQ staff team and EXCOM.

7.5 Is it clear from the website what each group is working on?

Many members have expressed frustration with finding groups on the AAPM website. While the new search capabilities (e.g., selecting whether one is looking in the member directory, committee tree, or Rules) have helped greatly in finding things, additional ways of visualizing the organizational structure are needed to address these frequently-voiced concerns. Recommendation 5 should address this issue.

Recommendation 5. There should be short webinars created that help members learn more broadly about the AAPM. The new link on the AAPM home page that has links to upcoming meetings will also help members learn more about the activities of various groups within the organization, and to join meetings in which they are interested.

Recommendation 6. The Keyword Taxonomy Working Group (KWTWG) should create guidelines and training for group chairs about the expectations for the keywords. Keywords should be reviewed by the parent committees. This will help support the broader effort to update the keywords within the organization.

Implementation of Recommendation 6 will greatly assist members in finding groups whose charge or activities relate to specific topics. While group chairs are currently able to add keywords to their homepage, few have done so. Even for those that have keywords, the keywords need to be standardized. For example, a member might look for “CBCT” or “cone-beam CT,” neither of which match the phrase “cone beam CT” entered by the TG chair. The development and use of a standardized, categorized menu of keywords will allow members to select words that relate to the topic that they are looking for, without having to guess what keyword the chair entered or how it was abbreviated.

7.6 Special coordination of TG reports and MPPGs

Coordination between TG reports and MPPGs has been inconsistent. PC and SC leadership have, over the past year, worked on proposals to better synchronize the generation of MPPGs related to a TG report, including the timing for the creation of MPPGs. The planned participation of PICR and SPG during the formation of TGs will provide an opportunity to determine if an MPPG would be appropriate for a given TG report. The new review process uses the AAPM’s Report Management System (ReMS) to identify when reports are ready for input from PICR and SPG and for consideration of an MPPG.

7.7 Public Relations issues

One of the most important areas with a large potential for inconsistent messaging is AAPM communications with external entities, including professional, governmental, and patient groups as well as the general public. In a review of AAPM groups by the Strategic Planning Committee (SPC), 26 groups were identified as having the potential for communicating some aspect of AAPM activities or positions with those outside the society. Because this critical issue is currently the topic of the Ad-hoc Committee on External Communications and Social Media (AHECSM), it is not discussed in this report. The AHECSM is reaching out to AAPM groups focusing on external communications, such as Regional Organization Outreach SubC (ROOSC) under AC and Public Education Committee (PE) under EC.

8 Concluding Remarks

The overarching goal of this ad hoc committee was to provide guidance to help make organizational structures and process changes in order to improve communication and collaboration between groups working in similar domains within the AAPM. The principles that guide our conversations and recommendations included:

1. Communication and cooperation between groups that share substantial interests in a topic ensure that the topic is considered from different perspectives, which will ultimately strengthen the work of the AAPM and lead to more consistent and multi-disciplinary recommendations.

2. Different, and often complementary, views add depth, breadth, and diversity to groups, and lead to more robust, integrated, and comprehensive solutions.

3. AAPM’s organizational structure needs to not only support, but also to require, integration of the efforts of overlapping groups from different committees and councils.

4. The AAPM needs to intentionally dismantle the current silo approach, where activities must be forced into one committee or council or a different committee of council. While only one group has been formed with the intent of having dual-reporting to two parent groups, these relationships are informal, not recognized in our current committee tree structure.

Our recommendations provide constructs that bridge related activities occurring in different groups, or between members with different backgrounds or work environments, by building an objective and consistent approach, where inclusion of all relevant skills sets and experiences becomes normative and easily accomplished.

To this end the committee makes the following recommendations:

Recommendation 1 related to the development and promulgation of actions and tools to facilitate communications within and between AAPM groups (Section 7.2).

Recommendation 2, which gives guidance on merging groups with closely related charges or interests and provides a model for rotation of the chair and vice-chair of blended groups (Section 7.3.1).

Recommendation 3, which gives guidance on creating new groups to address groups with closely related charges or interests (Section 7.3.2).

Recommendation 4, specifying that the AAPM should only appoint liaisons to outside entities, not between different groups within the AAPM (Section 7.4)

Recommendation 5, that there should be short webinars created that help members learn more broadly about the AAPM (Section 7.5).

Recommendation 6, that the Keyword Taxonomy Working Group (KWTWG) should create guidelines and training for group chairs about the expectations for the keywords, and that keywords should be reviewed by committee chairs (Section 7.5).

Towards implementing these recommendations, this committee present the following action item for the AAPM Board of Directors:

1. The Board Directs the Councils to begin discussions on methodologies to facilitate coordination among various AAPM groups.

a. The discussions shall consider the use of the models presented in this report’s recommendations and examples, but may include other approaches.

b. Operational or organizational changes shall include in the discussion and decision making all potentially affected stakeholders.

c. Changes will be given pilot durations long enough to evaluate their effectiveness, and be evaluated at least by the end of the duration.

d. The councils will include in their reports to the Board assessments of changes made.

2. The Board shall take action to implement Recommendations 1, 5 and 6 in this report.

This ad hoc committee has presents four general models for better integrating effort in Section 7.3, and examples for possible ways to address some current organizational barriers to collaboration. The four models can be combined in a number of different ways to update the compositions of groups and their locations in the organizational chart, to enhance collaboration and integration of effort. The examples following each recommendation are intended to clarify the recommendations and to present one of several possible approaches to addressing overlapping interests; they should not be seen as prescriptive recommendations but as starting points for discussion.

Any given change in the organization may or may not improve the integration and coordination of effort between relevant stakeholders. We recommend that all groups welcome the opportunity to explore new ways to foster collaboration within the AAPM and that they are willing try new organizational arrangements for a pilot period. Given the recommended pattern of rotations between chairs and vice-chairs, a minimum trial period of four years would be needed to allow assessment of the effects of changes to the organizational structure. Even if the changes do not result in improved communication and collaboration in some areas of the organization, substantial improvements may have occurred in other areas and AAPM, as an association, will have learned lessons that could help in the next round of effort to ensure coordination and integration of effort within the AAPM. As a society, we must take these steps and see beyond that with which we are familiar and comfortable.

The biggest impediments, however, to integrating the effort of groups within the AAPM that work on similar topics is inertia and resistance to change, which in some cases has been strong. However, to ensure that all relevant skills sets and experiences are brought to bear on an activity or work product, the AAPM must embrace an integrated organizational model. This will require change and change can be uncomfortable, but if we continue to operate in the way we have always operated, we will continue to experience the negative effects of a silo mentality that we have always experienced, including frustration and disenfranchisement of volunteers. Achieving changes in our results requires making changes in our methods.

a) Author to whom correspondence should be addressed. Electronic mail: brthomad@wisc.edu.

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