Imaging, Fluoroscopy and

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1 April 2012 ASIPP Educational Services Excellence in education of Interventional Pain Physicians Imaging, Fluoroscopy and Radiation Safety AMA PRA Category 1 Credits Welcome to Memphis, Tennessee...a vibrant city that s home to some of the world s most melodious music, tastiest food, authentic culture and you-can t-find-it-anywhere-else fun. The ASIPP Cadaver Workshop will be held at The Medical Education & Research Institute, a nonprofit medical teaching and training facility. The MERI conducts state-of-the-art, hands-on educational courses for physicians from across the country and around the world. At the MERI, medical professionals are introduced to the latest innovations in medicine, and have the opportunity to learn first-hand about the most up-to-date medial techniques and technologies. Accommodations and Review Courses will be at The Hilton Memphis hotel located in the heart of the East Memphis business district and a short drive from Beale Street, FedEx Forum, Elvis Presley s Graceland, the Memphis Zoo, Liberty Bowl, Memphis International Airport (MEM), The University of Memphis, The University of Tennessee at Memphis, the Civil Rights Museum, the Loraine Hotel, and downtown Memphis, Tennessee. Whether you are on a vacation, with a group or meeting, or on an individual business trip, this Hilton hotel in Memphis, TN has something for everyone, including meeting rooms and public space. Guests will enjoy the superbly furnished residential rooms. The Hilton Memphis, Tennessee hotel features breathtaking views of the Memphis, TN skyline in every room because of our floor to ceiling windows. Hotel, Review Courses, and Examinations Location: Hilton Memphis, 939 Ridgelake Blvd., Memphis, TN P: Cadaver Workshop Location: Medical Education & Research Institute, 44 South Cleveland, Memphis, TN Specials: $100 for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting for Attendees 10% off New Books: Foundations, Clinical Aspects, and/or Board Review Self-Assessment (available in hard copy and DVD) 50% Off Meeting Fee to Fellows & Residents Early Registraion Discount American Society of Interventional Pain Physicians The Voice of Interventional Pain Management since 1998

2 Message From ASIPP Chairman On behalf of the Board of the American Society of Interventional Pain Physicians, it is my pleasure to invite you to attend the Comprehensive Fluoroscopy and Radiation Safety Interventional Pain Management Review Course on April The ABIPP Competency Certification examination in Fluoroscopic Interpretation and Radiation Safety will be administered at the conclusion of the course, on Sunday, April 15. We have revised our program to meet the continuing needs of interventionalists, based on member input and a needs assessment. This course provides educational information on fluoroscopy radiation risks and methods to reduce these risks to both patient and personnel, fluoroscopic interpretation, appropriate needle placement, medical and legal compliance, and billing and coding. Participants will benefit from the course by improving existing skills, learning new skills, or prepare for the inter-ventional techniques certification examination, or prepare for the board examination. This course is an essential component for interventional pain physicians and provides educational opportunities to assist you in providing high quality, competent, safe, accessible, and cost-efficient services to your patients. The accompanying examination (open to physicians only) and this course, as with all ASIPP courses, focuses on doing the right things, the right way, and for the right reasons. Whether you have been practicing interventional pain management for many years or are new to the field with basic skills, we are confident you will find this fluoroscopy review course and beneficial, as it is essential to learn new and relevant information to survive in the new millennium. Our faculty consists of many experts in the field of fluoroscopy and interventional techniques. We hope you will take advantage of this exceptional opportunity for professional enhancement. The seminar will take place at the Hilton Memphis in Memphis, TN. We look forward to seeing you in Memphis. If you have any questions, please feel free to contact me at 2831 Lone Oak Road, Paducah, KY 42003, phone: ext. 101, fax: , or drm@ asipp.org Thank you, Laxmaiah Manchikanti, MD Chairman of the Board and Chief Executive Officer, ASIPP American Society of Interventional Pain Physicians The Voice of Interventional Pain Management since Lakeview Drive, Paducah, KY Phone: Fax: asipp@asipp.org Web Site: CHIEF EXECUTIVE OFFICER And Chairman of the Board Laxmaiah Manchikanti, MD Paducah, KY PRESIDENT Standiford Helm II, MD Laguna Hills, CA IMMEDIATE PAST PRESIDENT Allan T. Parr, MD Covington, LA PRESIDENT-ELECT Frank J.E. Falco, MD Newark, DE First EXECUTIVE VICE PRESIDENT Hans C. Hansen, MD Conover, NC Second EXECUTIVE VICE PRESIDENT Ramsin M. Benyamin, MD Bloomington, IL VICE PRESIDENT STRATEGIC PLANNING David L. Caraway, MD, PhD Huntington, WV SECRETARY Sukdeb Datta, MD Summit, NJ TREASURER Aaron K. Calodney, MD Tyler, TX LIFETIME DIRECTORS Cyrus E. Bakhit, MD Roanoke, VA Laxmaiah Manchikanti, MD Paducah, KY Bentley A. Ogoke, MD Mount Vernon, NY Vijay Singh, MD Niagara, WI DIRECTORS AT LARGE Mark V. Boswell, MD, PhD Louisville, KY David Bryce, MD Middleton, WI Scott E. Glaser, MD Burr Ridge, IL Haroon Hameed Baltimore, MD Rodney L. Jones, MD Wichita, KS David S. Kloth, MD Danbury, CT Gabor B. Racz, MD Lubbock, TX Francis Reigler, MD Malibu, CA Xiulu Ruan, MD Mobile, AL David M. Schultz, MD Minneapolis, MN Peter S. Staats, MD Shrewsbury, NJ John R. Swicegood, MD Fort Smith, AR DIRECTORS EMERITUS W. Stephen Minore, MD Love Park, IL Joshua A Hirsch, MD Boston, MA PAIN PHYSICIAN EDITOR-IN-CHIEF Howard S. Smith, MD Albany, NY AMA DELEGATES Laxmaiah Manchikanti, MD Paducah, KY Lee Snook, MD Sacramento, CA STAFF Melinda Martin, Director of Operations Ray Lane, Director of Public Relations Holly Long, Coordinator of Editorial Services Vidyasagar Pampati, Statistician and Programmer Molly White, Editorial Assistant Paula Reynolds Spear, Meeting Coordinator Tom Prigge, Multimedia Specialist Cindy Rogers, Administrative Assistant Government Affairs Counsel Senator Tim Hutchinson and Randi Hutchinson, Esq Dickstein Shapiro Morin & Oshinsky, LLP 1825 Eye Street NW Washington, DC HutchinsonT@dsmo.com Legislative Counsel Jeff Mortier, Legislative Partner Ryan, Mackinnon, Vasapoli and Berzok, LLP 1634 Eye Street NW, Suite 1200 Washington, DC General Counsel Erin Brisbay McMahon, JD Wyatt, Tarrant & Combs, LLP 250 West Main Street, Suite 1600 Lexington, KY emcmahon@wyattfirm.com 2 American Society of Interventional Pain Physicians

3 Description Americans with disabilities Act scription This 2-day Comprehensive Imaging Review Course is planned as a CME activity to prepare physicians seeking competency certification in or an in-depth review for the interventional pain physician or other staff in areas of fluoroscopic interpretation and radiation safety. This course will provide in-depth evaluation of the knowledge of the participants with extensive review of subject(s). Americans with Disabilities Act & Special Services Organizers fully comply with the legal requirements of the Americans with Disabilities Act and the rules and regulations thereof. If any participant in these educational activities is in need of accommodations, please contact the organizers at (270) at least 10 days prior to each conference. Category I Credit As part of this 2-day Review Course, we will provide you with the following: Syllabus with outlines of the lectures and accompanying questions, distributed at the meeting. Educational Objectives The Institute for Medical Studies will determine these educational activities for up to AMA PRA Category 1 Credits. Physicians should only claim credit commensurate with the extent of their participation in the activity. The 2-day intensive review course is intended to present interventional pain management specialists and other providers an in-depth review of multiple areas of interventional pain management including fluoroscopic interpretation and radiation safety, in order for participants to demonstrate skills for competency certification. OUTCOME Prepare physicians for competency certification and provide physicians and other healthcare professionals with an in-depth study of interventional pain management, including fluoroscopic interpretations and radiation safety so that patients are not exposed to unsafe levels of radiation, and they receive the most up-to-date diagnosis and treatment afforded in pain management. Accreditation Statement This course has received CME Credits and is a CME activity that has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the Joint Sponsorship of the Institute for Medical Studies and the American Society of Interventional Pain Physicians. The Institute for Medical Studies is accredited by the ACCME to provide continuing medical education for physicians. Accommodations Hilton Memphis 939 Ridge Lake Blvd, Memphis TN The guest rooms at the Hilton Memphis are all spacious, and they include a large work desk. These are equipped with telephones, with modem data ports and voice messaging, and wireless high speed Internet access Inform the agent that you are booking for ASIPP. We have secured a group room rate of $115. Reserve rooms early all unbooked rooms will be released March 20, No duplication or distribution of materials, or recording of lectures associated. There is NO commercial support for this course. American Society of Interventional Pain Physicians 3

4 Imaging, Fluoroscopy and Radiation Safety Friday April 13, :00am 7:45am Registration & Breakfast 7:45am 8:30am Introduction to ASIPP, ABIPP, and Review Course Frank J.E. Falco, MD 8:30am-9:30am Radiation Effects in Medicine - Learning from the Past Louis K. Wagner, PhD 9:30am 10:30am Principles and Mechanics of X-Ray and Fluoroscopy: Machine Design and Performance Louis K. Wagner, PhD 10:30am 10:45am Break 10:45am 11:45am Principles of CT, Myelo, MRI and Scanning Arthur S. Watanabe, MD 11:45am 12:45pm Lunch (Provided) 12:45pm 1:45pm Functional Radiation Safety for Personnel and Patients Louis K. Wagner, PhD 1:45pm 2:45pm Lumbar Spine: Plain X-Rays, Myelography, and CT Arthur S. Watanabe, MD 2:45pm 3:30pm Lumbar Spine: Fluoroscopy and Needle Placement Sheri Albers, DO 3:30pm 4:00pm Break 4:00pm 5:00pm Imaging and Fluoroscopy of Upper and Lower Extremities Mubin Syed, MD 5:30pm Adjourn Course Directors Laxmaiah Manchikanti, MD Chairman of the Board and CEO, ASIPP Medical Director. Pain Management Center of Paducah, KY Associate Clinical Professor of Anesthesiology and Perioperative Medicine University of Louisville Louisville, KY Standiford Helm, II, MD President, ASIPP Pacific Coast Pain Management Center, Laguna Hills, CA Frank J. E. Falco, MD President-Elect, ASIPP Medical Director, Midatlantic Spine, Newark, DE Course Faculty Sheri Albers, DO Director, RAD Research, Sacramento, CA Marvel Hammer, RN, CPC MJH Consulting, Denver, CO Mubin Syed, MD President, Dayton Interventional Radiology, Dayton, OH Clinical Associate Professor of Radiological Sciences Wright State University School of Medicine Louis K. Wagner, PhD Professor of Radiology Chief Physicist, University of Texas Medical School Houston, Texas Arthur S. Watanabe, MD Medical Director Spinal Diagnostics and Open MRI Spokane, Washington 4

5 Imaging, Fluoroscopy and Radiation Safety Saturday April 14, :00am 8:00am Registration & Breakfast 8:00am 9:00am Thorax, Chest and Abdomen: Imaging and Fluoroscopic Techniques Mubin Syed, MD 9:00am-10:00am Cervical and Thoracic Spine: Plain X-rays, Myelography and CT Arthur S. Watanabe, MD 10:00am 10:30am Break 10:30am 11:30am Cervical and Thoracic Spine: Fluoroscopy and Needle Placement Sheri Albers, DO 11:30am 12:30pm Head and Neck Imaging and Fluoroscopy Mubin Syed, MD 12:30pm 1:30pm Lunch (Provided) 1:30pm 2:30pm Cervical and Thoracic Spine: MRI Mubin Syed, MD 2:30pm 3:30pm Lumbar Spine: MRI Sheri Albers, DO 3:30pm 4:00pm Break 4:00pm 5:15pm Billing, Coding, and Compliance Aspects of Radiologic Services (X-ray, MRI, CT, and Fluoro) Marvel Hammer, RN, CPC Competency Examination Sunday April 15, :00am 8:30am REGISTRATION AND BREAKFAST FOR Competency Examination 8:45am Test Instruction and Examination (You will have 2 hours to complete the 100 question examination) 5

6 Imaging, Fluoroscopy and Radiation Safety Non-Physician Registration Form Please type or print your information clearly Name (Last) (First) (Middle Initial) Organization Preferred mailing address m Organization m Home ORGANIZATION Address City State Zip Phone CELL Fax HOME Address City State Zip Phone CELL Fax Personal Data: (for statistical purposes only) Date of birth / / m MALE m FEMALE Certifications: m Radiologic Technologist m Physician Assistant m Nurse Practitioner m Registered Nurse m Master s Degree (MA) m Other) Years in Interventional Pain Management practice: m 1-5 m 6-10 m More than 10 Comprehensive Review Course ONLY On or before March 20, 2012: m $400 Member m $500 Non-Member After March 20, 2012: m $500 Member m $600 Non-Member Return completed form to: ABIPP 81 Lakeview Drive, Paducah, KY or Fax to (270) Payment Method (Please check one): m Mastercard m Visa m American Express m Discover m Check Credit Card NuMBER Expiration Date name On Card Authorized Signature (required on all credit card orders) m Enclosed (Payable to ASIPP) Check Number (Your application will not be processed if payment does not accompany registration form) Signature of applicant CANCELLATION POLICY: ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing and received by March 4, An administrative fee of $200 will be assessed. Cancellations after March 4, 2012 but prior to March 29, 2012, will forfeit 50% of their registration fee. No cancellations accepted after March 29, Refunds will be sent after the conclusion of the meeting. For your convenience and faster registration, register online at Examination and Certification for Physicians requires separate registration available on the next page 6

7 Imaging, Fluoroscopy and Radiation Safety Physician Registration Form Please type or print your information clearly Name (Last) (First) (Middle Initial) Organization Preferred mailing address m Organization m Home ORGANIZATION Address City State Zip Phone CELL Fax HOME Address City State Zip Phone CELL Fax Personal Data: (for statistical purposes only) Date of birth / / m MALE m FEMALE Medical degree: m MD m DO m Other (specify) I AM currently certified by the following board(s): m American Board of Anesthesiology m American Board of Psychiatry and Neurology m American Board of Physical Medicine & Rehabilitation m ABA Subspecialty in Pain Medicine m Fellow of Interventional Pain Practice (FIPP) m American Board of Interventional Pain Physicians (ABIPP) m Other ABMS Primary Board(s) m Other) Specialty designation: m 09 IPM m 72 Pain Medicine m Anesthesiology m Psychiatry m Neurology m Other What percentage of your clinical practice is in the field of Interventional Pain Management: m 0% m 1 49% m % Primary professional practice setting (please check all that apply): m Ambulatory surgery m Hospital m Office Practice STATE LICENSE: State License Number Years in Interventional Pain Management practice: m 1-5 m 6-10 m More than 10 Comprehensive Review Course On or before March 20, 2012: m $500 Member m $600 Non-Member After March 20, 2012: m $700 Member m $800 Non-Member Competency Certification Exam On or before March 20, 2012: m $400 After March 20, 2012: m $500 Fellows & Residents 50% Off on Review Course & Exam. Payment Method (Please check one) m Mastercard m Visa m American Express m Discover m Check Credit Card NuMBER Expiration Date name On Card Authorized Signature (required on all credit card orders) m Enclosed (Payable to ASIPP) Check Number (Your application will not be processed if payment does not accompany registration form) Return completed form to: ABIPP 81 Lakeview Drive, Paducah, KY or Fax to (270) CANCELLATION POLICY: ASIPP reserves the right to cancel this course upon reasonable notice and will assume no financial obligation to registrants for cancellation for reasons beyond its control. Registration fees will be refunded, however, costs incurred by the registrants, such as airline or hotel fees or penalties, are the responsibility of the registrants. ASIPP requires a 30-day notice of cancellation. Cancellations must be submitted in writing and received by March 4, An administrative fee of $200 will be assessed. Cancellations after March 4, 2012 but prior to March 29, 2012, will forfeit 50% of their registration fee. No cancellations accepted after March 29, Refunds will be sent after the conclusion of the meeting. For your convenience and faster registration, register online at Signature of applicant 7

8 American Society of Interventional Pain Physicians 81 Lakeview Drive, Paducah, KY The Voice of Interventional Pain Management since 1998 Imaging, Fluoroscopy and Radiation Safety AMA PRA Category 1 Credits Hotel, Review Courses, and Examinations Location: Hilton Memphis, 939 Ridgelake Blvd., Memphis, TN P: Cadaver Workshop Location: Medical Education & Research Institute, 44 South Cleveland, Memphis, TN Specials: $100 for Interventional Techniques in Chronic Spinal Pain and Chronic Non-Spinal Pain at Meeting for Attendees 10% off New Books: Foundations, Clinical Aspects, and/or Board Review Self-Assessment (available in hard copy and DVD) 50% Off Meeting Fee to Fellows & Residents Early Registraion Discount PRSRT STD U.S. Postage Paid Paducah, KY Permit #44