Question: This is Dr. Ron Dorn. I'm Vice-chairman of the History Committee of the American Society for Radiation Oncology -- ASTRO -- and this morning it's my pleasure to interview Dr. William Hendee. For the next hour or so we want to get a long perspective of your career, Dr. Hendee. And, Dr. Ibbott, I want you to chime in with questions or insight as we go along because I know you two have known each other for a long time. Dr. Hendee is an esteemed medical radiation physicist and currently editor, I think -- Bill, is that right? -- of medical physics?
Dr. Hendee: Yes, I have been editor since 2005, so this is my ninth and final year as editor.
Question: And joining us is Dr. Geoffrey Ibbott, who is currently director of medical radiation physics at MD Anderson. Did I get that right, Geoff?
Dr. Ibbott: That's correct. My title actually is chairman of the department of radiation physics because of our unusual structure at MD Anderson.
Question: Wonderful. Well, Dr. Ibbott has known Dr. Hendee for many years, so I appreciate you joining us, Dr. Ibbott. So, Dr. Hendee, we'd really like to start as usual with these kinds of interviews right at the beginning. And we'd love to begin with your childhood and the course that led you into medical radiation physics.
Dr. Hendee: I'd be happy to tell you that. It's a very serendipitous course. I grew up in the country of Mississippi, went to Forest Hill High School which was a consolidated elementary, middle and high school about 15 or 20 miles outside of Jackson, Mississippi. And then I became interested in physics because I had an inspiring physics teacher. That's usually how we generate our interest in a certain subject discipline. And I went to Tulane University on a football scholarship and was at Tulane for a little over two years. In my junior year, I left Tulane and the reason I left Tulane, and the football scholarship, was because I could not get the requisite physics courses to graduate in four years and also play football. And I had to make a choice, and my choice was to study physics. So I transferred to a small college in Mississippi called Millsaps College. I got my bachelors degree there in physics which was a very good decision, as a matter of fact, because I had a lot of freedom to work in the laboratory and study physics. From there I received an atomic energy commission fellowship to study at Vanderbilt University. So I was at Vanderbilt working on my masters degree in a PhD program, and then I got married, my wife got pregnant, and I was making $2500 a year on my fellowship. That was not enough to support a wife and a child, and she would not be able to continue work as an elementary school teacher because back then women could not teach in public schools once they began to show that they were pregnant, so she would not be able to teach. I went to a meeting in Boston of the Health Physics Society which was part of my fellowship training and I saw an advertisement on the bulletin board for a fellowship in medical physics that paid up to $6000 a year, which back in those times was an amazingly lucrative fellowship. And so I waited around for the person who posted the advertisement on the bulletin board and met him, and that was Jack Krohmer. Jack was a medical physicist at the University of Texas based at Southwestern Medical School. And I applied for that fellowship, received it and went to Texas in 1960. I got my PhD in 1962, working with Jack Krohmer and Fred Bonte, who was the chairman of radiology at that time, and Bill Zebrun, who was a cellular biologist. And so my PhD was in medical physics. That was pretty rare back then. And then I taught physics at the same small college that I had graduated from, Millsaps College in Jackson, Mississippi, for three years. I went back to participate in the civil rights movement in Mississippi and became chairman of the department of physics and astronomy in my last two years there.
Question: At what school was that, again?
Dr. Hendee: That's at Millsaps College in Jackson, Mississippi.
Question: Back at your alma mater.
Dr. Hendee: Yes, that was my alma mater. I taught there for three years and then for several reasons, which we don't need to go into, I left Millsaps and went to the University of Colorado. That was in 1965. And so that's the early history. I had not met Geoff Ibbott at that point yet, so Geoff can't really comment on too much of that part of the history, but, Ron, you may have some questions.
Question: Well, that was quite a move from the southeast up to Colorado. Had you an interest in moving to the Rocky Mountain area? Was that a job-related move or...
Dr. Hendee: I actually quit my job at Millsaps before I had a place to go because of a dispute with the president of the college who was conducting an inquisition of the students to find out which members of the faculty were homosexual.
Question: Oh, for heaven's sake.
Dr. Hendee: Yeah, I know. Mississippi was a strange place back in the '60s. And also because we had a lot of young faculty at the college who had come there for purposes of working in the civil rights movement, and one by one they left because of threats against them and their families and that sort of thing. I certainly had plenty of that myself. And so it was not a very hospitable environment for people that had more - a more liberal ecumenical outlook on how society should function. So there were lots of reasons for leaving Millsaps. Those were two of them. And I had to find a job, and so I applied to an advertisement that I saw in the Health Physics Journal about a medical physicist needed in Colorado. That was the job that I ultimately obtained and moved there in early June of 1965.
Question: Okay. So to step back just a second, prior to you responding to Jack Krohmer's advertisement, were you interested in medical physics at that point? With a physics background myself, there are a lot of different areas of physics that you might find interesting. So during your undergraduate years, did you develop that interest in medical physics, or was responding to that flier one of the reasons you made that move?
Dr. Hendee: I was responding to the flier. At Vanderbilt I was working in acoustics with Dr. Robert Lageman and was on an atomic energy commission fellowship which was more focused on radiation protection around nuclear reactors and that sort of thing. When I applied for the position in medical physics, one of my first questions to Jack Krohmer was, “Okay, so this is a fellowship in medical physics. What's medical physics?” So I had no idea and he told me what it was and I thought, well, that sounds pretty interesting and it's not too unrelated to some of my courses at Vanderbilt in radiation physics taught by people that Geoff will recognize -- Myron Fair, K. Z. Morgan and Elda Anderson. So I could see some connection between some of the courses I had taken in radiation physics at Vanderbilt and medical physics as a career option, but I really knew very little about medical physics, and Jack explained enough to me to suggest that it might be a viable career option and I needed the fellowship because I wasn't going to be able to stay in school on an atomic energy commission fellowship and support a wife and a child.
Question: So that brings us to Colorado and I gather from just talking with you and Dr. Ibbott ahead of time, that's where the two of you originally met.
Dr. Hendee: Indeed. And Geoff can make sure that I get the date right here. When I went to the University of Colorado, I went to work in therapy physics because there was really no diagnostic physics at the time. So I went to work in therapy physics and we had a cobalt-60 machine that would be considered an antique now. It was a Picker C-10000 unit which meant 10,000 Curies, and it had a 95-centimeter source-to-axis distance with a pretty wobbly gantry. When did we start working together? Was it ’66 or '67?
Dr.Ibbott: Yeah, we started in '67, so my dad approached you the first time in '66.
Dr. Hendee: That's when I thought. I'd only been there a few months and Geoff's dad, Frank Ibbott, was the head of laboratory medicine in Colorado. And he approached me about his son who was a high school student who was interested in physics and wondered if I could find a position for him during the summer. I could not because Geoff was not old enough at the time to work in a radiation environment. He came back in 1967 and asked me the same question -- but Geoff was 18 and was finishing high school so Geoff and I started to work together that summer.
Dr. Ibbott: That's right. And so you hired me that summer, I worked pretty much through the summer, and I went away to Oregon for a year and came back and worked the second summer for you, and that would have been '68. And at the end of that summer you suggested I transfer to a college in Colorado in Denver and continue working part time while I was going to school. And that really set me on my course.
Question: That relationship goes back a long way. That's a great story. So, Dr. Hendee, at Colorado, this is actually about the time when I first came across your name. I was in training with Klig at New Mexico, Dr. Kligerman. And back in those days as a radiation oncology resident, our three-textbook bibles for training were Fletcher’s “Textbook of Radiotherapy”, Eric Hall’s “Radiobiology for the Radiologist”, and then your textbook ”Medical Radiation Physics.” So I'd be very interested to hear about the evolution and genesis of that textbook because that has had great influence on me and so many generations of radiation oncology trainees.
Dr. Hendee: Thank you, Ron. When I first came to Colorado, I began to teach the residents. And back then, of course, everything was general radiology. There was not a separation of radiation oncology from diagnostic radiology. You will recall that.
Dr. Hendee: And so I was teaching the residents, and the residents asked the chief of radiation oncology, Carlos Garciga, if they could record my lectures. And so they began to record my lectures even in the first year of my teaching, and then they did it again in the second year in a more polished version. Carlos' secretary would type these things up and run them off on a mimeograph machine. And so at the end of the course, especially in that second year, I had a stack of my lectures. I didn't really use a textbook because there was not a satisfactory textbook. And so I had a visit from the Yearbook Medical Publisher's representative. His name was Fred Rogers, and he came around to institutions once a year to see if there were any prospective textbooks around. The chairman of radiology, Marvin Daves, sent him down to me and that ended up with my signing a contract to write the first edition of “Medical Radiation Physics” which is now in its fifth edition. It has evolved, of course. “Medical Radiation Physics” covered both oncology and diagnostic, but then in the second edition I split it into two books, one in therapy physics and one in imaging physics, and that's the situation today.
Question: Yes, and I also have a copy of that after it split. Before we started the interview I was looking at my very underlined, annotated, dog-eared edition of the first edition of your textbook, and I was talking with Dr. Ibbott about noticing acknowledgments to him and his mother and father in the introduction. So it further confirms the relationship between you two for many years.
Dr. Hendee: Actually, Geoff's mother did a lot of the illustrations early on in the first couple of editions of that book. She was a medical illustrator and a wonderful person. So you're right, it's been a close relationship with the entire Ibbott family. It's been very rewarding to me.
Question: Well, thank you for the textbook because it saved my life when I was going before the boards.
Dr. Hendee: Thank you. By the way, I didn't realize that you had trained at University of New Mexico, but I was a consultant to the meson physics effort run by Mort Kligerman to use pions for treatment of patients, as you will recall, using the LAMPF facilities at Los Alamos. And I was a consultant along with Peter Almond and Bengt Bjarngard. The three of us were consultants to that project. So I was a recipient of something that you probably were the recipient of as well, and that is the 3:00 a.m. phone calls from an insomniac named Mort Kligerman.
Question: Oh, yes. Indeed, I had. Those were great years. I do recall that you were a consultant on that project for two of my three years of residency. I was actually Klig's only resident on that project for a year, so I remember many middle-of-the-night phone calls. You're absolutely correct. He was quite something. Describe for us, if you will, Dr. Hendee, your move from Colorado to Wisconsin in the 1980s.
Dr. Hendee: Well, I'll be happy to do that. Actually I was at Colorado from 1965 to 1985, and at Colorado we did a lot of things -- and Geoff will remember some of these things, let me just mention a couple. We established the Rocky Mountain Radiation Therapy Planning Network using a timeshared computer owned by the Denver Rio Grande Railroad and put teletype terminals in hospitals around the Rocky Mountain area so that they could enter data and then get -- well, they weren't graphical isodose distributions, but they could get tabulated printouts of multi-field dose distributions for cobalt-60 treatments of patients. Geoff, do you remember that?
Dr. Ibbott: I remember that well. And as I remember, we looked at the Memorial Sloan-Kettering system which I think had people send information to Memorial and they did the plan and sent it back. And your idea was to create a system where we'd provide the infrastructure but people would actually be doing their own treatment planning in their own clinics on these teletype machines.
Dr. Hendee: That's correct. And we had a lot of those machines around in Wyoming and Nebraska and Kansas and Colorado and I don't remember where else.
Question: Yeah, and I don't remember that we had one at New Mexico, but memory fades a bit with time.
Dr. Hendee: Well, I don't think you did because you had a physicist at the University of New Mexico named Ed Barnes.
Dr. Hendee: We put these terminals in places where there was not a physicist so there was no treatment planning going on.
Question: Right. And Chuck Kelsey was there also.
Dr. Hendee: Chuck followed Ed Barnes.
Question: Right, right.
Dr. Hendee: I just had dinner with Chuck Kelsey two weeks ago.
Question: Oh, you did. Wow.
Dr. Hendee: So a couple of other things -- we established a graduate and postdoctoral program in medical physics in Colorado. And one interesting tidbit that you might be interested in, Phil Rubin started the Vail Creative Concepts in Cancer meeting in December every year at Vail, and I was involved in the planning of those conferences very early on. That would have been back in the early 1970s. Those conferences stopped a few years ago because those of us who were involved and kind of kept that conference going for many years have all gotten too old to go skiing, and that was a skiing conference. But it went on for about 30 years and one of the interesting things I can remember very well was one evening when Jim Youker and I sat down with Phil Rubin in the lobby of the Lodge at Vail to discuss Phil Rubin's idea of starting a journal in radiation oncology which we encouraged him to do. That discussion led ultimately to the Red Journal.
Question: I did not realize that some of the initial discussions on that occurred at that conference. I actually attended a couple of those conferences when he moved it over to Snowbird and then back to Vail back in the late '70s and early '80s. So that's very interesting about the evolution of the Red Journal from those discussions.
Dr. Hendee: It was not an official part of the meeting. It was just the three of us getting together by the fire in the lobby at the lodge talking about his idea. That was a great conference; it brought together people from different disciplines. Too bad it's not going on today. In 1975, I was asked to be acting chair of the department of radiology at Colorado, which included radiation oncology at the time under the leadership of Bing Johnson. I was acting chair for a year while the chair, Marvin Daves, was on a Sabbatical. When Marvin came back, he resigned from the chairmanship. I stayed on as acting chair for another six months through the search process, which went on unsuccessfully and ultimately I became the chair. I moved from acting chair to chair and chaired the department of radiology from 1976 to 1985.
Question: And, Dr. Ibbott, were you still there at Colorado during that time?
Dr. Ibbott: Yes, I certainly was. And I'm sure, Ron, you're aware that Bill becoming chairman of an academic radiology department was extremely unusual and, as far as I know, was the only time that a physicist has been chairman of an academic radiology department.
Question: Yes, very unusual for sure.
Dr. Ibbott: And, Bill, was it as a result of the Phil Rubin conferences that you started the Winter Institute of Medical Physics at about that same time?
Dr. Hendee: Yeah, that was the model that we used and so yes, indeed, we started the Winter Institute of Medical Physics meetings in Dillon. Gosh, it's been a long time ago. That was about 30 years ago, too, now. And those conferences are still going on quite successfully, as you know.
Dr. Ibbott: That's right.
Dr. Hendee: Also, Ron, at that time there was a radiological physics center based in Houston at MD Anderson which, before becoming chairman of radiation physics, Geoff was the director of. And that center worked under the -- Geoff, you have to explain this a little bit -- that center worked under the radiation therapy oncology group to provide standardization of dosimetry of institutions that were involved in RTOG protocols.
Dr. Ibbott: That's right. It was not limited to the RTOG, although RTOG was certainly the most important customer, if you will, of the RPC. And it came about through a request from the NCI that the AAPM solicit proposals to build the RPC, and MD Anderson was the successful submitter of that proposal. But it actually was interesting that it was worked through the AAPM.
Question: And I remember working with RPC on many occasions at different institutions where I worked for getting approval for protocol work. Had great, great contribution to our field.
Dr. Hendee: Ron, the NCI supported the RPC, I think. Right, Geoff?
Dr. Ibbott: Yes. It's in its, I think, 44th year of funding from the NCI.
Dr. Hendee: I think the NCI was sufficiently enamored with that process that in 1975 they funded six more centers called Centers for Radiological Physics, and they were based in six different locations around the country -- New York, Seattle, Texas, again at MD Anderson, Pittsburgh and New York. They were to expand beyond what the RPC was doing and provide support services to NCI projects beyond those of RTOG and beyond those that the RPC was doing. One of the centers was located in Denver at our place, and those centers lasted for six years -- from 1975 to 1981 -- and then they were dissolved. I was the director of the Center for Radiological Physics in Denver, so we covered the Rocky Mountain region. I never was privy to the reason why those centers were discontinued. And there has been periodic interest at the NCI in re-establishing those centers as an expansion of the RPC work, but that has never really materialized into anything concrete.
Question: Well, this is just fascinating history. So, Bill, take us from Colorado to Wisconsin.
Dr. Hendee: I'd be happy to do that. There's an intermediate step. I moved from Colorado in 1985, and I'll explain why. I was chairman of radiology there. I moved from there to Chicago, and I was recruited by the American Medical Association as vice president of the American Medical Association in charge of science technology and public health. And this was in response to the interest of the board of trustees at the AMA in re-establishing a strong science and educational component to the programs of the AMA. The AMA was founded back in the late 1800s as an educational and scientific organization founded in response to the need to get many of the patent medicines off the market and try to make medicine more scientific. But over the years and especially following World War II and the advent in the Johnson administration of Title 19 for Medicare, and those kinds of things, the AMA became much more intensely political and became essentially a political lobby, and science and education withered. And the board of trustees of the AMA decided back in the early 1980s that they had to re-establish education and science in the AMA in order to have credibility when they tried to influence legislation. And so I was recruited there to rebuild the science and technology and public health part, and another person was recruited for the education part. And so I moved from Colorado to take that position. Now, I won't go into the whole details of how that happened, but it was the right move at the right time for me because I had been chairman for nine years, ten years when you consider the acting chairmanship and, Ron, you may remember that in 1983 the Tax Equity and Fiscal Responsibility Act established DRGs for radiology procedures which was, in terms of Medicare, a cap on reimbursement.
Dr. Hendee: And that was the beginning of a big change for procedurally-oriented healthcare, especially radiology. Radiology was no longer viewed the way it had been viewed which was as a profit center for a hospital because of the caps on reimbursement. So I thought, well, this is kind of the end of the golden era for radiology. That happened in 1983 and I began to think maybe it's time for me to step down as chair. I had agreed with the dean that I would be chair for seven years. Also, my family (wife and seven kids) lived out on a working farm in Colorado. I raised all my kids on the farm, and my last two sons were on their way to college that year. They didn't take any of the farm work with them. And I had two daughters who were younger who were farm girls and I thought, well, I need to move off the farm. I can't keep up with the farm without my boys and my daughters need to have a little more sophistication. They were freshmen in high school. So I decided to step down as chairman and move back to Denver. And it was very unexciting for me, but I thought it was the best thing for my wife and girls. And then this offer came out from the AMA, kind of out of the blue. And I looked at that offer very carefully and ultimately decided to take it. So my wife and I, and the two girls, moved to Chicago in 1985. I was vice president of the AMA and spent half my time in Washington, DC, and half my time in Chicago and was there until 1991. There was a major shift in leadership at the AMA over that period with the chief executive officer being caught up in a financial scandal and ultimately forced to resign, and the leadership transposed to another person who did not have the same strong support for science and education. So I decided, well, this is not the place I want my future to be, and I also miss academics. So in 1991, I moved to the Medical College of Wisconsin in Milwaukee initially as a senior associate dean for research and vice president for technology, but ultimately also became the dean of the graduate school at the Medical College of Wisconsin and also vice chair of radiology at the Medical College of Wisconsin, with appointments in radiology, radiation oncology, biophysics and bioethics. I remained in that position from 1991 to 2006, and for a brief period I also served as dean of the medical school during the search for a new dean of the school.
Question: And was Jim Cox still there when you first went to MCW?
Dr. Hendee: No. Jim had been gone a long time and the person that took over for Jim was Frank Wilson, whom I'm sure you know. I've known Jim Cox for many, many years. I was on a study section of the NIH with him long before I went to Milwaukee. And I had met Jim earlier as a visiting professor when I went to Milwaukee one time when Jim was the chief of radiation therapy there.
Question: Yeah, and Frank Wilson has been a member of our History Committee. He's got an incredible depth of knowledge on the history of radiation, radiology and radiation oncology. We know Frank well.
Dr. Ibbott: If I may jump in, both Frank Wilson and Jim Cox were graduates of the Penrose program with del Regato. Did you happen to know them then? Because I know there were ties with the Penrose program and Colorado.
Dr. Hendee: Are you asking me or Ron?
Dr. Ibbott: I'm asking you.
Dr. Hendee: I did not know them as residents. I knew Juan del Regato very well. And I knew his associate down there whose name I'm blocking on very well, as well. And I was often at Penrose for meetings and that sort of thing. But I did not know his residents.
Question: So what an interesting job change for you, I imagine, going from a chairman of radiology at Colorado to a position that addressed science and technology in the broader medical community with the AMA.
Dr. Hendee: That's right. And it was a glorious six years. I wouldn't take anything for having done it because it really expanded my appreciation of what all of medicine is like, not just one specific discipline. So it was a great experience. I spent a lot of time in Washington meeting with agencies and political action groups and other organizations, and meeting with congressmen. So it was a wonderful experience and it lasted about as long as it should have lasted. And I thought, well, you know, long term I miss academics too much to stay in this position and with the transition of leadership I thought it was the right time. But it was a great experience. Every experience I've had has been great and I've shifted jobs quite a bit. And I always tell young people that what they think their career is going to be is probably not at all what it is going to ultimately end up being. They have to remain open and flexible to opportunities, and when you see an opportunity to learn something new and something more, you should consider it.
Question: Which actually leads me to my next question because looking at your career arc, I imagine that the experience with the AMA had much to do with some of the programs that you have been involved with in Wisconsin outside of the specifics of medical radiation physics.
Dr. Hendee: Well, I think anyone who has had the opportunity to see medicine in a broader perspective gains a great deal from that perspective. And so I think so. I would like to think that that's been the case. I'm still on the faculty at the Medical College of Wisconsin even though I retired from my administrative positions in 2005 and 2006. And I'm on the faculty of several other institutions as well.
Question: So I'm interested in, if I saw this correctly, you've been involved in a biotechnology promotion in Wisconsin, also bioethics work.
Dr. Hendee: That's correct. I was president of the MCW Research Foundation when I was full time at the college. And that is the technology transfer, patenting and licensing startup development activities within the college. So that got me interested in that -- but beyond that we tried to do a lot to develop Wisconsin as an entrepreneurial forward-thinking state when it comes to biotechnology and medical technology. And the idea was there's a corridor that goes from Chicago, especially the northern part of Chicago which is where most of the advanced instrumentation and technology companies are -- from Chicago to Milwaukee to Madison was a natural corridor. And so we did a lot to try to develop that corridor into sort of like Highway 128 in Boston or Research Triangle Park in North Carolina. So that was the biotechnology and medical technology part of it. And the bioethics just came out of my own interests. When I was at MCW my responsibilities as senior associate dean for research included animal research, human research, IRBs, the IACUC and disclosure of conflicts of interests. All those things fell into my bailiwick and so I obviously developed an interest in those things and we did quite a bit, actually. We developed video programs to help investigators understand how to prepare IRB applications and obtain informed consent and that sort of thing. So, yeah, that really stimulated my interest. Also, I taught two on-line courses in bioethics each year for the college. And I'm still very interested in bioethics and, in fact, the ten ethics modules that are on the RNSA website supported by several different organizations including ASTRO financially, are designed for both for residents and physicians in radiology, radiation oncology and medical physics as learning modules to understand better some of the ethical implications of the work that we do in radiation oncology and medical physics and radiology. I was the head of that project. That was my idea and the modules have been heavily utilized and are a good teaching tool for residents and also for practicing physicians.
Question: Yeah, so worthwhile for the trainees as well as those of us who have been in practice for many years. Bill, with your permission I would like to, without putting you on the spot, Dr. Ibbott, I would like to get your perspective on Dr. Hendee's contributions specifically within the medical radiation physics community as the two of you have now moved along in parallel careers for some time.
Dr. Ibbott: Oh, certainly. Bill has been a number of things. To me personally, of course, he's been a terrific mentor and guide, helping me develop my career. But he's done the same thing for many other people. He's done it directly in the same ways that he did with me in working closely with people, guiding their education, fostering their development by encouraging them to participate in various ways in our associations and other organizations. But he's also been an inspiration to countless people, I'm sure, less directly through his work in leading organizations such as the AAPM, ASTRO, the American College of Radiology and the American Board of Radiology. And I think one place that we haven't talked about yet is the American Board of Radiology and, as you know, Bill was president of the ABR while he was a trustee of the ABR. And while Bill was on the board, he made countless contributions that changed the direction of the ABR and influenced the examination process. And he's set in place principles that we still refer to today and I say we because I'm actually at an ABR meeting at the moment and some of the things that Bill set in place, as I say, we refer to as the principles that Bill set and they continue to guide us in assessing the exams and in the way that we evaluate candidates. So he's had a profound but also lasting influence on many of us and I count myself right in front of those people that Bill has had so much influence on.
Question: And thanks from those of us in radiation oncology for your interest, Dr. Hendee, specifically on the therapy side of things. I'd like to follow up Dr. Ibbott's comment. So at what point did you get involved with the American Board of Radiology?
Dr. Hendee: I was elected to the American Board of Radiology in 1995 as a member of the board, nominated by the AAPM and elected by the board. And so I was on the Board of Radiology for ten years -- one term for six years, one term for four years. The terms now are four years. You can serve once, and you can be elected to a second term. And it was through that involvement on the Board of Trustees that I was elected president by the board for two years from 2002 to 2004. However, I had been examining for the Board of Radiology since -- my first examination as an oral examiner was in Denver in 1970 and I have examined, since that time on the oral exam. I have been chairman of the written examination for general radiology -- that was back when there were such things as general radiologists -- and I was also the chair for several years of the written examination committee for medical physicists. So I've been involved with the Board of Radiology for a long, long time. I no longer examine orally for the Board of Radiology, and I think my last time to examine orally was a couple years ago. And for a long time I had an unbroken string of examining in every oral examination. And, Ron, you may not remember this, but at one time the board examined twice a year.
Question: Yes, yes.
Dr. Hendee: Once in the spring and once in the fall. Then it moved around from city to city. That's how it happened that it was in Denver in 1970. Ultimately the ABR settled on Louisville and there are still two exams, but the exam in the fall is a makeup exam for people who conditioned or failed.
Question: Yeah, I do remember the twice a year, though, for most of us going through it, just once is plenty.
Dr. Hendee: Absolutely, absolutely. And we used to examine radiologists orally in physics. Geoff, do you still give an oral exam for radiation oncologists still at the ABR?
Dr. Ibbott: Yes, it's going to continue. But the last oral exam for diagnostic radiology will be this June. But radiation oncology and medical physics will continue to give oral exams into the future.
Dr. Hendee: But physicists don't give oral exams for radiation oncologists anymore, right?
Dr. Ibbott: No, they don't do that anymore.
Question: And now, of course, we've had for several years the time-limited certificates. Were you involved at all with the evolution of the very appropriate idea that time-limited certificates should be the way to go and make sure on re-examination that folks are keeping up to date?
Dr. Hendee: Very much so. That all happened pretty much right during the time that I was president and then shortly thereafter when my successor, Steve Leibel, whom you knew...
Dr. Hendee: It was during that time that the MOC concept was developed in the examination process. And so I was involved in negotiations between the ABR and the ABMS because the ABR had to satisfy the conditions laid out for MOC by the ABMS and yet make it relevant to practicing radiologists and radiation oncologists and medical physicists. So, yes, I was very involved in that.
Question: Well, unfortunately, we're starting to run out of time and I would like to bring us full circle back to radiation oncology physics specifically. And I have two questions. One is a crystal ball question and the other is a blank check question. So starting with the crystal ball, what -- after all your years and contributing to the field, where do you see radiation oncology and radiation oncology physics going, say, in the next decade or so? Do you have any thoughts for us?
Dr. Hendee: I really do very much so. And that is I think we need to begin to talk about radiation oncology as precision oncology. Because we're able now through all the technological developments that have occurred to really pinpoint the delivery of radiation to primary tumors in a very localized and very precise way. It means that we need to understand more about tumor growth and we need to understand more about margins, so there's a lot of biology that's left to be understood. But with our IMRT and VMAT and proton beams and so many other ways to really precisely deliver radiation and know what we're doing when we are doing that, I think the future for radiation oncology is precision radiation oncology. I just finished reading Mukherjee's book on “The Emperor of All Maladies” which...
Question: Yes, wonderful book.
Dr. Hendee: I'm sure you've read it.
Dr. Hendee: It really makes you think about pinpointing delivery, not just external beams of radiation, but also of targeted pharmaceuticals that can search out and destroy tumors and tumor metastases. You know, the Paul Ehrlich magic bullet concept realized more than 100 years later. So I'm pretty optimistic that radiation oncology is going to be here for a long time and we're going to be able to deliver higher doses and destroy more primary tumors with fewer side effects of the radiation because of the precision with which we can deliver it.
Question: And I absolutely agree with that. One of the reasons why this field has been such an incredibly exciting career for us all these years. And then let me follow up that question with the blank check question. So if you got a grant from anywhere including the government with an unlimited amount of money, what kind of research would you like to see done to pursue those lines?
Dr. Hendee: I think it just goes right in with my previous comments and that is if we could develop targeted pharmaceuticals or targeted antibodies or targeted nano particles that would attack a tumor locally because they're attracted into that tumor and you can destroy the cells of that tumor. I think that's worth a tremendous investment to be able to ultimately achieve that goal. So that's where my investment would go, would be exactly into that sort of research.
Question: What do you think, Dr. Ibbott? Same general idea or is there an area of interest that you would like to see resources directed?
Dr. Ibbott: I think Bill is right. I think that there are tremendous opportunities for targeted radionuclides or other devices, other vectors. I think also we are doing better, but we have to get much better at aiming beams of radiation. And our image guidance systems have improved enormously in the last decade, but there are clearly opportunities to do a lot more. And we're just scratching the surface now, for example, we have very preliminary prototype versions of MR-guided radiation therapy machines. And I think that's probably going to be the next step and there will be steps after that we haven't envisioned yet that will improve the way we can deliver external beams of radiation as well.
Question: Yeah, well, that's absolutely wonderful.
Dr. Ibbott: And I'll mention one other thing because I know Bill has been very involved in this aspect as well. At the same time that we improve our delivery capabilities, we have to maintain our focus on patient safety. And that's been a big issue and will continue to be a big issue as our treatment devices and other systems get more and more complex, the chance of an error and the chances of that error being extremely consequential increase. So we have to maintain that focus and, as I said, Bill is being instrumental in helping us do that.
Dr. Hendee: So let me just say one thing to what Geoff said because I couldn't agree more about the safety aspects and that is I don't think that we do enough yet in educating physicians and physicists about quality and safety, and especially safety of the highly complex technological devices that are used in radiation oncology. The Bogdanich articles in The New York Times pointed this out very clearly. And, in fact, we called a meeting in Miami in 2009 that was a joint effort of ASTRO and AAPM. It was called Safety in Radiation Oncology: A Call to Action. And coming out of that have been several initiatives and amongst those initiatives is the Board of Radiology asking more questions on quality and safety. And I'm hoping that these concepts are being integrated into teaching programs for radiation oncology residents and for medical physicists. I expect not as much as they should be, and we need to make, I think, an even greater effort to educate the people that are responsible for delivering those treatments as to how to do that in the safest way possible.
Question: Well, and after all, they're such an important part of our taking good care of these patients, so I couldn't agree more and I really appreciate your work in that area. Well, Dr. Hendee, it's been a privilege for me to have this opportunity to discuss your career and to get your insights and I appreciate very much you taking the time. And, Dr. Ibbott, I know Bill and I -- Bill agrees with me -- we appreciate your joining us for this hour and providing your insight and drawing on your years of relationship with Dr. Hendee.
Dr. Ibbott: It was a great pleasure for me and thank you for inviting me.
Question: You are very welcome. And thank you again, Dr. Hendee. It's been a pleasure.
Dr. Hendee: Well, Ron, just let me say two things. One is it's been a great pleasure and an honor for me. I really appreciate your choosing me. I was a little puzzled by why you did so, but it's been an honor. It's been great to talk to you. You are a very easy person to talk to. I just want to say one thing to Geoff. Geoff, it's been an absolute pleasure over God only knows how many years now -- 40 years, 40-something years? -- to work with you. You've been a great colleague and a great friend.
Dr. Ibbott: Thank you, Bill. I feel the same way. And I know my career would have been very different if I hadn't met you when I did.
Dr. Hendee: I think I would have seen you on the bandstand somewhere playing your bass.
Dr. Ibbott: That's possible. I might have gone in a completely different direction. And that might have been great, too. But, boy, I've been very grateful for the career I've had and the influence you've had on it.
Question: Well, thank you both again very much.
Dr. Hendee: Thanks, Ron.