Naomi Rachel Schechter, MD

Chapter: California Radiological Society
Member Date: 05-21-2012

Personal Testimony

Do You Feel Like an Ostrich?

Lift Up Your Head and Join an ACR Practice Parameter Committee
“Mom, what is that?”
“Olivia the Ostrich,” I said, reading the zoo sign.
“How can it breathe with its head in the sand?”
“Not sure, honey,” I read on, holding my breath, hoping to find some good data. “Don’t think it’s really burying its head in the sand, at least not on purpose. It’s just focusing on digging a hole.”
I turned my gaze to my daughter, my heart filled with warmth. “Ostriches dig shallow holes in the ground to use as nests for their eggs, and then turn them several times a day with their beaks. Makes sense, right? Especially in this heat. She has to look after her babies first.” 1
My left eye started to twitch. I turned my gaze back to the ostrich. My daughter and I both stared transfixed for what seemed like an eternity. “I’m sure Olivia will look up soon.”
“I hope so, momma . . . before it turns dark, and all her friends are gone.”
“Me, too, honey.”
* * *
Monday morning back in my air-conditioned office, I emailed an old friend. “Dear Phil, Remember me? New academic position, kids growing up, have a little room on my plate . . . . Any idea on how I might re-connect?”
Phil responds, almost too quickly, “The ACR. For radiation oncologists, the ACR is a perfect way to make a difference. The group is relatively small, compared with ASTRO. You can get on a committee. And the work they do is really meaningful, impacts us all.”
“Really. Who should I talk to?”
“Seth. Seth Rosenthal.”
“Thank you, got it.”
Six months would pass if I did not immediately act. I gave in to the impulse and emailed Dr. Rosenthal, offering to volunteer for the ACR. Any capacity.
He took me up on the offer. ACR Radiation Oncology Practice Parameters1 Committee.
No turning back.
* * *
What did I get myself into? I wondered, as the practice parameter committee members pondered deeply the choice between a “should” and a “would” and a “could,” or was it a “must” and a “may.” The smell of corn sweetened the air. The starchy spaghetti froth overflowed and made a crinkling sound as it struck the fire under the over-boiling pot, almost putting it out.
“Mom, is dinner ready?”
“Just a minute, honey,” I whispered. I lifted my left pointer finger to my lips, and then motioned to my older daughter on the couch to take care of the stove. I then bundled my computer and phone in my arms and moved swiftly to my home office. My cushy bed.
Where were we? “Yes, a must it is. I agree. But let’s soften the statement in line 185. Use a may there.” The team agreed. Joyce made the adjustments.
Dr. Rosenthal joined the online conference call - just finished his clinic in Roseville, California. Phil had to go – it was already 8 pm on the East Coast, and a sweet child’s voice called - dinner had to be served. Finding a time for all participants to be available was a project (and-a-half) in-itself. Two to three online go-to-meeting conference calls were necessary per parameter reviewed. The rest of the changes could be managed by email - usually. Fortunately, Joyce and Shannon expertly managed to arrange the meetings. Thanks to doodle and their friendly demeanor.
“Welcome, Dr. Rosenthal. Bye, Phil. We’re on line 185. What do people think of Dr. Evan’s comments?” Line by line the remaining team worked their way through the parameter – gently treading, careful not to run each other over.
I had learned to distinguish the speakers by voice. It was not so easy at first. The ACR served as the umbrella organization, with each collaborating society providing 1-3 representatives. Remember, Joyce said one of the committees has seventeen members. Be grateful yours has only six! I hit the speaker phone button, and then “mute.” I could always email my comments in later.
“I approve Dr. Evan’s comment, line 302.”
“Can we reword it slightly?”
“What do you suggest . . .?”
“Can we go back to section 2.3 and see if it fits better there?”
“I think we need a new intro. What do you think?”
“I think we need to change the should to a could. And maybe add a new section to address the recently approved agent . . .”
“Great idea.”
I reflected. Winding through the parameter revisions reminded me of a swim team field trip - tubing down a river. Occasionally rushing forward. Occasionally stalling and discussing the grand view. Occasionally spinning with friends in the whirlpools. Or playing bumper cars - pushing and pulling each other along, section by section.
The committee members respected each other, the expertise which qualified each to enjoy the ride. They learned to trust themselves, and to rely on each other when the waters became choppy.
“I think we’re done for the night!” Joyce chimed in. The members divided up the remaining assignments based on their specialty interests.
“I’ll find the reference for line 53.”
“I’ll write a new intro.”
“I’ll rework section 3.0.”
Sounded great. The resulting parameter would certainly be better in the end.
I hoped Joyce recognized the voices. Joyce Kidwell always did keep track so well of everyone’s assignments - supplying gentle email nudges here and there to keep the team on pace. Dr. Alan Hartford, the confidently optimistic committee Chairman, always sang her praises. Deservedly so.
I could hear him. “Joyce is a wonder.”
All would agree.
[1] Wonder of the day #1425. Available at: Accessed July 23, 2018.
[2] American College of Radiology. Radiation Oncology Practice Parameters & Technical Standards. Available at: Accessed July 23, 2018.
Table 1. Status of Practice Parameters – Radiation Oncology 2019 Cycle
Name of Parameter/Standard Primary Reviewer/Drafter Last Revised Begin Review 
ACR–ABS–ACNM–ASTRO–SIR–SNMMI Practice Parameter for Radio-embolization with Microsphere Brachytherapy Device (RMBD) for Treatment of Liver Malignancies Kelvin Hong, MD, Chair
Co-Sponsored With Interventional and Cardiovascular Radiology, and Nuclear Medicine and Molecular Imaging
2014  2017
ACR–ASTRO Practice Parameter for Communication: Radiation Oncology Naomi Schechter, MD, Chair 2014  2017
ACR–ASTRO Practice Parameter for the Performance of Stereotactic Body Radiation Therapy Samuel Chao, MD, Chair 2014  2017
ACR–ASTRO Practice Parameter for Image-Guided Radiation Therapy (IGRT) Join Luh, MD, Chair 2014  2017
ACR–ACNM–ASTRO–SNMMI Practice Parameter for Unsealed Sources Kevin Banks, MD, Co-Chair
Bassem Zaki, MD, Co-Chair
(Brought Back Early)
ACR–ACNM–ASTRO–SNMMI Practice Parameter for Iodine-131 Therapy  
Perry Grigsby, MD, Co-Chair
William Spies, MD, Co-Chair
New  2017
ACR–ACNM–ASTRO–SNMMI Practice Parameter for Radium-223  
Mark Hurwitz, MD, Co-Chair
Eric Rohren, MD, PhD, Co-Chair
New  2017
Table 2. Status of Practice Parameters – Radiation Oncology 2020 Cycle
 Name of Parameter/Standard Last Revised  Begin Review 
 ACR–ABS Practice Parameter for the Performance of Radionuclide-Based High-Dose-Rate Brachytherapy  2015  2018
 ACR–ABS Practice Parameter for the Performance of Low-Dose-Rate Brachytherapy  2015  2018
 ACR–ABS Practice Parameter for Trans-perineal Permanent Brachytherapy of Prostate Cancer  2015  2018


Table 3. Currently Published Practice Parameters and Technical Standards
Name of Parameter/Standard   Primary Reviewer/Drafter  Last Revised
 ACR–ABS Practice Parameter for Electronically-Generated, Low-Energy Radiation Sources (ELS)  Laurie Gaspar, MD, MBA and Phillip Devlin, MD, Co-Chairs Effective 08/01/16
Next Revision: 2021
 ACR Practice Parameter for 3D External Beam Radiation Planning and Conformal Therapy  Brian Goldsmith, MD, Chair
Effective 10/01/16
Next Revision: 2021
 ACR Practice Parameter for Intensity Modulated Radiation Therapy (IMRT)  Alan Hartford, MD, PhD, Chair Effective 10/01/16
Next Revision: 2021
 ACR Practice Parameter for the Performance of Brain Stereotactic Radiosurgery  Steven Seung, MD, PhD, Chair Effective 10/01/16
Next Revision: 2021
 ACR–ASTRO Practice Parameter for the Performance of Total Body Irradiation  Leslie Jarvis, MD, Chair Effective 08/01/17
Next Revision: 2022
 ACR–ASTRO Practice Parameter on Informed Consent – Radiation Oncology  Naomi Schechter, MD, Chair Effective 10/01/17
Next Revision: 2022
 ACR Practice Parameter on the Physician Expert Witness in Radiology and Radiation Oncology  Candice Johnstone, MD, Chair Effective 10/01/17
Next Revision: 2022
 ACR–ASTRO Practice Parameter for the Performance of Proton Beam Radiation Therapy  Helen Shih, MD, Chair Effective 08/01/18
Next Revision: 2023
 ACR–ASTRO Practice Parameter for Radiation Oncology  Patrick Conway, MD, Chair Effective 08/01/18
Next Revision: 2023
ACR = American College of Radiology
ABS = American Brachytherapy Society
ACNM = American College of Nuclear Medicine
ASTRO = American Society for Radiation Oncology
SIR = Society of Interventional Radiology
SNMMI = Society of Nuclear Medicine and Molecular Imaging