michael masiar m.s. dabr -...

Michael Masiar M.S. DABR Position: Certified Medical Physicist Therapy Physics, Inc. 2501 Cherry Ave, Ste 270 Signal Hill, CA 90755 Phone: (562) 317-0650 Email: [email protected] Certification: American Board of Radiology - Diagnostic Medical Physics - May, 2014 State of California Approved Physicist List: Approved to Provide Medical Physics Support Services for Mammography in the State of California - MQA #0226 Qualified in Digital Mammography and Digital Breast Tomosynthesis ACR Accreditation Programs Qualified For: Mammography CT MRI Breast MRI Nuclear Medicine & PET Stereotactic Breast Biopsy Education: State University of New York at Stony Brook - M.S. - December 2009 -

Biomedical Engineering University of Pittsburgh - B.S. - April 2008 - Physics Experience: Astarita Associates, Long Island, NY - Medical Physicist -

August 2011 - December 2014 Professional Societies: American Association of Physicists in Medicine (AAPM) Publications:

Y. Hu, M. Masiar, and W. Zhao. Breast structural noise in digital breast tomosynthesis and its dependence on reconstruction methods. (International Workshop on Digital Mammography, 2010)

Certificate of Completion

Michael Masiar, MS, DABR

In recognition of successful completion of the GE Healthcare Digital Breast Tomosynthesis Supplemental Training Program

Jessie Jacob, MD, MMMGE Chief Medical Officer, Women's Health

August 3, 2015

9/24/2018 CEU COMBINED REPORT

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MULTI-SOCIETY CREDIT REPORT FOR Michael Masiar

DATE RANGE: 09/30/2015 TO: 09/24/2018 CREDIT TYPE: ALL REPORT DATE: 09/24/2018

SPONSOR PROGRAM SESSIONID DESCRIPTION DATE TYPE EARNED

AAPM 2018 AAPMAnnual Meeting

Radiation Dose and Image Quality in Fluoroscopy: Part 1-(2018 AAPM Annual Meeting (SAM Imaging EducationalCourse))

08/01/2018 SAM 1.5


Imaging Artifacts - CT, MRI, and Mammography-(2018 AAPMAnnual Meeting (SAM Practical Medical Physics)) 08/01/2018 SAM 2


Workforce Supply/Demand Into The Future-(2018 AAPMAnnual Meeting (SAM Professional Symposium)) 08/01/2018 SAM 1


Breaking Out of the Clinic: Nontraditional Medical PhysicsCareers-(2018 AAPM Annual Meeting (SAM ProfessionalSymposium))

08/01/2018 SAM 1

AAPM60th AAPMAnnual Meeting& Exhibition

Imaging Artifacts - CT, MRI, and Mammography 08/01/2018 MPCEC 2


Workforce SupplyDemand Into The Future 08/01/2018 MPCEC 1


Radiation Dose and Image Quality in Fluoroscopy: Part 1 08/01/2018 MPCEC 1.5


ABR Exam Prep: Diagnostic ImagingNuclear Medicine Part 2 3 08/01/2018 MPCEC 1


Breaking Out of the Clinic: Nontraditional Medical PhysicsCareers 08/01/2018 MPCEC 1


ACR Updates - CT, MR, NM/PET & US-(2018 AAPM AnnualMeeting (SAM Imaging Educational Course)) 07/31/2018 SAM 1.5


Breast Imaging and Interventions-(2018 AAPM Annual Meeting(SAM Imaging Educational Course)) 07/31/2018 SAM 2


AIP Science Communication Award, "Strange Glow: The Storyof Radiation"-(2018 AAPM Annual Meeting (SAM PracticalMedical Physics))

07/31/2018 SAM 1.25


AIP Science Communication Award, Strange Glow: The Story ofRadiation 07/31/2018 MPCEC 1.25


Breast Imaging 07/31/2018 MPCEC 2


Breast Imaging and Interventions 07/31/2018 MPCEC 2


ACR Updates - CT, MR, NMPET US 07/31/2018 MPCEC 1.5


Session in Memory of Phil Heintz: Patient Dose Calculations inImaging - Fluoro, CT, and Fetal-(2018 AAPM Annual Meeting(SAM Practical Medical Physics))

07/30/2018 SAM 1.5


Online Longitudinal Assessment (OLA) and the Evolution of theABR Medical Physics Maintenance of Certification (MOC)-(2018AAPM Annual Meeting (SAM Professional Symposium))

07/30/2018 SAM 1


Building a Successful Adaptive Radiotherapy Program 07/30/2018 MPCEC 2


Session in Memory of Phil Heintz: Patient Dose Calculations inImaging - Fluoro, CT, and Fetal 07/30/2018 MPCEC 1.5


Presidents Symposium: Beyond the Future 07/30/2018 MPCEC 2

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AAPM 60th AAPMAnnual Meeting& Exhibition

Online Longitudinal Assessment OLA and the Evolution of theABR Medical Physics Maintenance of Certification MOC

07/30/2018 MPCEC 1


General Poster Credits 07/29/2018 MPCEC 8

AAPMAAPM OnlineContinuingEducation

Surveying and QC of Stereotactic Breast Biopsy Units for ACRAccreditation-(Diagnostic Radiology: Mammography) 11/30/2017 SA-

CME 1


Comparative performance of modern digital mammographysystems-(Diagnostic Radiology: Mammography) 11/30/2017 SA-

CME 1


Accreditation of Stereotactic Breast Biopsy and BreastUltrasound Systems-(Diagnostic Radiology: Mammography) 11/30/2017 SA-

CME 1


Development and validation of a new guidance device forlateral approach stereotactic breast biopsy-(DiagnosticRadiology: Mammography)

11/30/2017 SA-CME 1

AAPM

2017 AAPMOnlineContinuingEducation

2209-N Accreditation of Stereotactic Breast Biopsy and BreastUltrasound Systems 11/30/2017 MPCEC 1

AAPM


2249-N Development and validation of a new guidance devicefor lateral approach stereotactic breast biopsy 11/30/2017 MPCEC 1

AAPM


2332-N Surveying and QC of Stereotactic Breast Biopsy Unitsfor ACR Accreditation 11/30/2017 MPCEC 1

AAPM


2203-N Comparative performance of modern digitalmammography systems 11/30/2017 MPCEC 1


Force balancing in mammographic compression-(DiagnosticRadiology: Mammography) 09/14/2017 SA-

CME 1


Noise in Digital Mammography-(Diagnostic Radiology:Mammography) 09/14/2017 SA-

CME 1


Establishing minimum performance standards, calibrationintervals and optimal exposure values for a whole breast digitalunit-(Diagnostic Radiology: Mammography)

09/14/2017 SA-CME 1

AAPM


2125-N Noise in Digital Mammography 09/14/2017 MPCEC 1

AAPM


1565-N Establishing minimum performance standards,calibration intervals and optimal exposure values for a wholebreast digital unit

09/14/2017 MPCEC 1

AAPM


2349-N Force balancing in mammographic compression 09/14/2017 MPCEC 1


Computed Tomography Imaging: From the Order to DoseMonitoring and Review-(2017 AAPM Annual Meeting (SAMImaging Educational Course))

08/03/2017 SAM 2


Adult Learning (Andragogy) Techniques for Medical Physics-(2017 AAPM Annual Meeting (SAM Professional Symposium)) 08/03/2017 SAM 1


Computed Tomography Imaging: From the Order to DoseMonitoring and Review 08/03/2017 MPCEC 2


Diagnostic Workforce Study Report 08/03/2017 MPCEC 1


Adult Learning Andragogy Techniques for Medical Physics 08/03/2017 MPCEC 1




Implementation of the 2016 ACR Digital Mammography QualityControl Manual-(2017 AAPM Annual Meeting (SAM ImagingEducational Course))

08/02/2017 SAM 2


Low Dose CT: Where Do We Stand Now?-(2017 AAPM AnnualMeeting (SAM Imaging Scientific Symposium)) 08/02/2017 SAM 2


MamTomoMBI 08/02/2017 MPCEC 1.5


Low Dose CT: Where Do We Stand Now 08/02/2017 MPCEC 2


Implementation of the 2016 ACR Digital Mammography QualityControl Manual 08/02/2017 MPCEC 2


Best Practices in Pediatric Imaging-(2017 AAPM AnnualMeeting (SAM Imaging Educational Course)) 08/01/2017 SAM 1


Non-conventional Multi-source X-Ray Imaging: Cardiac, BreastImaging and Cone Beam CT-(2017 AAPM Annual Meeting (SAMImaging Scientific Symposium))

08/01/2017 SAM 1.5


Compliance with AAPM, ACR, TJC Guidelines on CT ClinicalPractice-(2017 AAPM Annual Meeting (SAM Practical MedicalPhysics))

08/01/2017 SAM 1


DBT Quality Assurance: Medical Physicists Role, FromEquipment Evaluation to Soft Copy Image Display-(2017 AAPMAnnual Meeting (SAM Practical Medical Physics))

08/01/2017 SAM 1


Best Practices in Pediatric Imaging 08/01/2017 MPCEC 1.25


Non-conventional Multi-source X-Ray Imaging: Cardiac, BreastImaging and Cone Beam CT 08/01/2017 MPCEC 1.5


Compliance with AAPM, ACR, TJC Guidelines on CT ClinicalPractice 08/01/2017 MPCEC 1


DBT Quality Assurance: Medical Physicists Role, FromEquipment Evaluation to Soft Copy Image Display 08/01/2017 MPCEC 1


Deep Learning and Applications in Medical Imaging-(2017AAPM Annual Meeting (SAM Imaging Scientific Symposium)) 07/31/2017 SAM 2


Statistical Failings that Keep Us in the Dark & PracticalStatistics-(2017 AAPM Annual Meeting (SAM Practical MedicalPhysics))

07/31/2017 SAM 1.5


Presidents Symposium: Connecting Our Pathways Unifying OurProfession 07/31/2017 MPCEC 2


Statistical Failings that Keep Us in the Dark Practical Statistics 07/31/2017 MPCEC 1.5


Deep Learning and Applications in Medical Imaging 07/31/2017 MPCEC 2


MamRadFlu 07/30/2017 MPCEC 0.92


MRI 07/30/2017 MPCEC 2


General Poster Viewing 07/30/2017 MPCEC 2


Nuclear Medicine 07/30/2017 MPCEC 0.92

AAPM2017 AAPMSpring ClinicalMeeting

Current Topics in MR Imaging-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM)) 03/21/2017 SAM 2

AAPM 2017 AAPMSpring Clinical

Radiation Safety Officers Review-(2017 AAPM Spring ClinicalMeeting (Professional Symposium - SAM))

03/21/2017 SAM 2



Meeting

AAPM 2017 SpringClinical Meeting Radiation Safety Officers Review 03/21/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting Current Topics in MR Imaging 03/21/2017 MPCEC 2


Current Issues in CT Imaging-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM)) 03/20/2017 SAM 2


Dental Imaging: TG175 Report-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM)) 03/20/2017 SAM 1


Breast Ultrasound-(2017 AAPM Spring Clinical Meeting(Mammography Symposium - SAM)) 03/20/2017 SAM 1


Breast and General US Accreditation-(2017 AAPM SpringClinical Meeting (Mammography Symposium - SAM)) 03/20/2017 SAM 1

AAPM 2017 SpringClinical Meeting Current Issues in CT Imaging 03/20/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting Breast Ultrasound 03/20/2017 MPCEC 1

AAPM 2017 SpringClinical Meeting Regulatory Update 03/20/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting Dental Imaging: TG175 Report 03/20/2017 MPCEC 1

AAPM 2017 SpringClinical Meeting Breast and General US Accreditation 03/20/2017 MPCEC 1


Exposure Indices and Target Values in Radiography: What AreThey and How Can You Use Them?-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM))

03/19/2017 SAM 2


Clinical Trends in Breast Imaging-(2017 AAPM Spring ClinicalMeeting (Mammography Symposium - SAM)) 03/19/2017 SAM 2


FFDM Accreditation-(2017 AAPM Spring Clinical Meeting(Mammography Symposium - SAM)) 03/19/2017 SAM 1

AAPM 2017 SpringClinical Meeting FFDM Accreditation 03/19/2017 MPCEC 1

AAPM 2017 SpringClinical Meeting

Exposure Indices and Target Values in Radiography: What AreThey and How Can You Use Them 03/19/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting Clinical Trends in Breast Imaging 03/19/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting ABR MOC Update Networking 03/19/2017 MPCEC 2


Protocol Review and Optimization-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM)) 03/18/2017 SAM 2


Nuclear Medicine TG177 Update-(2017 AAPM Spring ClinicalMeeting (Diagnostic Symposium - SAM)) 03/18/2017 SAM 1

AAPM 2017 SpringClinical Meeting Protocol Review and Optimization 03/18/2017 MPCEC 2

AAPM 2017 SpringClinical Meeting Nuclear Medicine TG177 Update 03/18/2017 MPCEC 1

MPCEC CREDIT EARNED 81.34SA-CME CREDIT EARNED 7

SAM CREDIT EARNED 44.75Specialty DetailFocus Credit Type Credit

NONE SAM 44.75

Self-Assessment CME SA-CME 7

Therapy Physics, Inc. Diagnostic Radiology Physics Services Radiation Protection Shielding Design Radiation Oncology Physics Services

2501 Cherry Ave, Ste 270, Signal Hill, CA 90755 Phone: 562-317-0650

Continuing Medical Physics Experience Michael Masiar, M.S. DABR - MQA # 0226

To demonstrate compliance with 21CFR 900.12 (a) (3) (iii) (B) - “the medical physicist shall have surveyed at least two mammography facilities and a total of at least six mammography units during the 24 months immediately preceding the date of the facility’s annual MQSA inspection or the last day of the calendar quarter or any date in-between the two.” I have provided the mammography physics services to the following facilities on the mammography units as listed below:

Simonmed Imaging San Bernardino, CA

GE Essential + Senoclaire DBT 12/5/2018

San Bernardino Medical Group San Bernardino, CA

Siemens Inspiration Pure 10/11/2018

Radiology Diagnostic Center Templeton, CA

Hologic Dimensions DBT

9/17/2018

Digital Medical Imaging Santa Maria, CA

Hologic Dimensions DBT Affirm Biopsy Add on (Stereotactic)

9/17/2018

St. Lukes Breast Cancer Detection Center Boise, ID (Rifleman St office)

Hologic Dimensions DBT 3/7/2018

St. Lukes Breast Cancer Detection Center (Rm 1) Nampa, ID


St. Lukes - Boise Breast Imaging (Rm 7) Boise, ID


Michael Masiar, M.S., DABR Certified Medical Physicist

Continuing Medical Physics Experience

I have provided medical physics services in accordance with ACR guidelines to the following facilities as listed below: Computed Tomography

Torrance Memorial Polak Imaging Pavilion Torrance, CA

Siemens Somatom Sensation 16 7/2/2018

College Medical Center Long Beach, CA

Toshiba Aquilion 64 9/6/2018

Mink Radiology Beverly Hills, CA

GE Brightspeed Elite 16 12/3/2018

Magnetic Resonance Imaging

Pueblo Radiology Santa Barbara, CA

Siemens Symphony 1.5T Siemens Verio 3T Philips Panorama HFO

6/21/2018 6/18/2018 4/30/2018

Centrelake Imaging and Oncology Downey, CA

GE Signa 1.5T 12/12/2018

Ultrasound

Radiology Diagnostic Center Templeton, CA

Philips iU22 (2 units) 5/17/2018

Digital Medical Imaging Santa Maria, CA

Philips iU22 (3 units) 6/21/2018

PET

Pomona Valley Medical Center Pomona, CA

Siemens Biograph PET 9/7/2018

Five Cities Medical Imaging Pismo Beach, CA

GE Discovery MI PET 5/18/2018

Michael Masiar, M.S., DABR

MAP ID Nos.

This document is copyright protected by the American College of Radiology. Any attempt to reproduce, copy, modify, alter or otherwise change or use this document without the express

written permission of the American College of Radiology is prohibited.

\\hqs-filesvr01.acr.org\DeptShare1\MammoMaster\Full App Pkg\FULL APPLICATION - Medical Physicist.doc Revised: 4/3/19

Each medical physicist who provides medical physics services at this facility must verify that they meet FDA requirements by completing a

copy of this form.

Please print and complete this form. Signature dates must be within one year from the date of the most recent medical physicist’s Annual

Survey report. Original, electronic or faxed signatures are required and considered legally binding for this document. Stamped signatures are

not acceptable. Complete all sections; an incomplete application will delay your accreditation.

PRIVILEGED and CONFIDENTIAL • PEER REVIEW Code of Virginia 8.01-581.17

PERSONNEL • MEDICAL PHYSICIST

1. Name: LAST NAME FIRST NAME MI DEGREE

2. ACR Membership ID#: (optional)

3. Initial qualifying date (earliest date qualified to do mammography physics. Medical physicists qualifying prior to the MQSA Interim Rules

should check “prior to October 1, 1994.”):

prior to October 1, 1994 or specify date after October 1, 1994 / MO YR

INITIAL QUALIFICATIONS

4. Do you meet FDA requirements for initial qualifications for medical physicists? (complete ONLY the column that pertains to you)

FDA Requirements Initial Qualifications

(Master’s degree or higher)

Alternative Initial Qualifications must have met before April 28, 1999

(Bachelor’s degree)

Qualified as a medical physicist under FDA's interim regulations and retained that qualification by maintenance of the active status of licensure, approval, or certification?

Not applicable 1No

2Yes

Board Certified by either the 1. American Board of Radiology (ABR) in Diagnostic Radiological

Physics* (alone or combined with another sub-specialty), Radiological Physics, Roentgen Ray or Gamma Ray Physics or X-Ray and Radium Physics, or

2. American Board of Medical Physics (ABMP) in Diagnostic Imaging Physics

*also, effective 2011, Diagnostic Medical Physics

Board Year Board Year

ABR ABR

ABMP ABMP

State licensed? 1No

2Yes

1No

2Yes

State approved? 1No

2Yes

1No

2Yes

Meet the following degree requirement in a physical science from an accredited institution?

Master’s degree or higher

1No

2Yes

Bachelor’s degree obtained before training and initial experience

1No

2Yes

Have no less than the following semester hours or equivalent of college undergraduate or graduate level physics?

20 semester hours or equivalent

1No

2Yes

10 semester hours or equivalent

1No

2Yes

Have the following contact hours of documented specialized training in conducting surveys of mammography facilities?

20 hours

1No

2Yes

40 hours

1No

2Yes

Have experience conducting surveys of at least one mammography facility and the following number of mammography units? (No more than one survey of a specific unit within a period of 60 days may be counted towards the total mammography unit survey requirement. If experience was acquired after April 28, 1999, it must be under the direct supervision of a qualified medical physicist).

10 units

1No

2Yes

20 units

1No

2Yes

Masiar Michael S MS

05283501

3 12

2014

MAP ID Nos.

This document is copyright protected by the American College of Radiology. Any attempt to reproduce, copy, modify, alter or otherwise change or use this document without the express

written permission of the American College of Radiology is prohibited.

\\hqs-filesvr01.acr.org\DeptShare1\MammoMaster\Full App Pkg\FULL APPLICATION - Medical Physicist.doc Revised: 4/3/19

New modalities: You must have received at least 8 hours of modality-specific training (e.g., full-field digital or screen-film) in

surveying these systems before independently performing surveys on these systems. Have you received this training? (may be

included in the above formal mammography education or obtained separately)

Full-field digital mammography (direct capture digital and/or computed radiography) 1No

2Yes

Screen-film mammography 1No

2Yes

Digital Breast Tomosynthesis (DBT) 1No

2Yes

CONTINUING EXPERIENCE

5. How many mammography facilities and units have you surveyed over the previous 24-month period?

# facilities: # units:

If less than 2 facilities and 6 units, are you in the process of requalifying?

1No

2Yes

CONTINUING EDUCATION

6. Have you earned at least 15 continuing education units in mammography in a 36-month period? (see FDA’s Policy Guidance Help

System for acceptable subject areas)

1No

2Yes

If you answered “No”, are you in the process of requalifying?

1No

2Yes

I certify that the information provided is true and correct.

Executed on: DATE SIGNATURE OF MEDICAL PHYSICIST

>5 >10

5/10/2019

michael masiar m.s. dabr -...

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