Radiation Oncology History

In May, 1988, Dr. Sydney Evans, Chairperson of the ACVR Radiation Oncology Committee, prepared a questionnaire seeking information on the present status of radiation oncology in the profession and the ACVR, and asking for suggestions regarding what future position radiation oncology should occupy within the ACVR. One problem which had been previously identified was how to incorporate radiation oncology expertise of non-ACVR members into the College. In responding to the questionnaire, Dr. Edward Gillette suggested this could be accomplished via the ACVR Associate Member route.

Dr. Donald Thrall subsequently nominated Dr. Mark Dewhirst for Associate Member status in the American College of Veterinary Radiology. The purpose of this nomination was to recognize the professional contributions in radiation oncology Dr. Dewhirst had made, and to augment the radiation oncology expertise within the ACVR. This nomination was not approved by ACVR Council because Dr. Dewhirst had no previous involvement with the College. Thus, it appeared that Associate Membership status was reserved for individuals who had been previously active in College affairs and, as such, would not be a viable mechanism for solidification of radiation oncology expertise in the College and profession.

In response to growing concern regarding the future of radiation oncology, and the failure of Associate Membership status to allow recognition of radiation oncology expertise by non-ACVR individuals, Dr. Thrall indicated in a letter to Dr. Sydney Evans that consideration should be given to formation of an Affiliate Group in Radiation Oncology. In the letter it was stated,

"...Radiation oncology is becoming more and more popular in our profession. It is being practiced by individuals who have had their training primarily in the areas of diagnostic radiology, radiation therapy and physics and others trained primarily as clinical oncologists. Although there are debatable pros and cons on exactly what is the most practical and relevant training program for those actively involved in the practice of radiation oncology, it is my opinion that there is now a critical mass of people concerned with this modality that some recognition of radiation oncologic expertise should exist...

I believe the time has come for the formation of some 'body' to officially recognize expertise in radiation oncology. I believe this action will serve to: 1) encourage the development of teaching personnel and training programs in radiation oncology, 2) assist with modification of existing residency programs to be more encompassing in terms of radiation oncologic expertise, 3) formulate comprehensive examinations to determine the competence of voluntary candidates for certification, 4) unite the effort of those interested in service and investigative aspects of radiation oncology. Although the above will indirectly improve the quality of radiation oncology practice available to the public, it should be made very unambiguous from the outset that this 'body' is not intended to regulate in any way the practice of radiation oncology by licensed veterinarians...

The fruition of forming a specialty group in the ACVR to recognize expertise in radiation oncology which will appeal to those in other disciplines, such as medical or surgical oncology, depends upon acceptance of the philosophy that radiation oncologists do not have to be experts in image interpretation. It is not the purpose of this new group to examine and certify individuals in image interpretation...

Therefore, I believe the stage is set for us to formulate a Specialty of Radiation Oncology under the ACVR umbrella in which it will be possible for individuals who are not experts in image interpretation to become Diplomates. Thus, I urge the ACVR Radiation Committee to propose to Council that the Specialty of Radiation Oncology be formally established within the ACVR and that it be possible to confer Diplomate status in this Specialty..."

The Radiation Oncology Committee endorsed, in principle, the concept of establishing an Affiliate of Radiation Oncology and this message was relayed to ACVR Council. In September, 1989, the Radiation Oncology Committee of the ACVR, (Thrall-chair, Chess Adams, Sydney Evans, Pat Gavin, Glen King, Jimmy Lattimer, Ron Burk) was given the charge of considering the potential establishment of a radiation oncology subspecialty. Draft documents pertaining to the structure of the Affiliate within the ACVR, and prerequisites for certification and examination were prepared. In these early documents a critical point was the necessity of trainees in disciplines other than radiology to be able to qualify to take the examination in radiation oncology. In February, 1990, a request was submitted to the ACVR Council requesting creation of an affiliate of radiation oncology. A plan for initiation of the affiliate, and prerequisites for certification were also submitted.

In a response received in July, 1990 it was stated that the Council looked favorably on the proposal, and that the ACVR was the natural home for any specialty group in radiation oncology. The Radiation Oncology Committee was charged with continuing to develop the concept of an Affiliate of Radiation Oncology, concentrating specifically on examination structure, representation of the Affiliate of the administrative structure of the ACVR, qualification for examination, and training program guidelines. At the Winter 1990 meeting of the Council of the ACVR, Dr. Thrall presented the proposal to establish an Affiliate of Radiation Oncology and Council responded favorably. The Radiation Oncology Committee was charged with continuing to develop the examination structure, and residency guidelines.

In March of 1991, the first detailed draft of a training program description was submitted to ACVR Council. It was also requested of Council that the responsibility for developing the Affiliate of Radiation Oncology be undertaken by an Organizing Committee, the members of which would eventually be Charter Diplomates in the Affiliate.
The proposal to establish the Affiliate was again discussed at the mid-year ACVR Council meeting in April, 1991. Dr. Thrall participated via conference call, and Dr. Bud Ames, AVMA Staff Consultant to the ABVS was also in attendance. In general, the ACVR Council was supportive of the proposal to establish the Affiliate. Dr. Ames provided information regarding the procedures to follow for petitioning the ABVS regarding recognition of a new subspecialty, and also indicated that an in-depth study of the possibility that the Affiliate of Radiation Oncology be conjointly sponsored by the ACVR and ACVIM would be necessary before ABVS would consider the proposal. This charge to study conjoint sponsorship was based on the theory that oncology already existed in the ACVIM and that dual sponsorship would solidify the Affiliate.

Shortly after the midyear council meeting, Dr. Wortman submitted a formal letter of intent to the ABVS that the ACVR would be pursuing recognition of an Affiliate of Radiation Oncology, and that we would also study the possibility of a conjoint relationship with the ACVIM. Guidelines for formation of new specialty groups indicated that a formal petition would have to be filed with ABVS by December 1, 1991.

The Radiation Oncology Committee continued to be the body studying the development of the Affiliate. Membership remained unchanged except for the addition of Dr. Edward Gillette. The Radiation Oncology Committee recommended that an Official Organizing Committee of the Affiliate be formed. Each member of the Radiation Oncology Committee submitted nominations for Organizing Committee membership to the ACVR Council. Subsequently, Council prepared an announcement of the Organizing Committee and issued a request for applications and nominations. The ABVS identified two members to serve as liaisons with the Radiation Oncology Committee. They were Drs. John Fessler, and Carl Olsen.

In September, 1991 drafts of the Proposal to Establish the Affiliate, the Training Program Description and the Affiliate Constitution were sent to the ABVS liaison members, and to Dr. Pyle as the ABVS representative of the ACVIM. Regarding conjoint sponsorship of the Affiliate by ACVIM and ACVR, the Radiation Oncology Committee had taken the position that the Affiliate should be associated only with the ACVR, not favoring the conjoint relationship with ACVIM. We wrote,

"...The development of the specialty of radiation oncology by physicians has taken a path similar to that of the emergence of the Affiliate of Radiation Oncology in veterinary medicine. Initially, physicians treating cancer with radiation were trained and certified as diagnostic radiologists. There were three factors which made it apparent that training programs in diagnostic radiology could no longer afford to devote sufficient time to adequately train individuals in radiation oncology. These were: 1) the explosion of diagnostic imaging technology and modalities, e.g. diagnostic ultrasound, computed tomography, magnetic resonance imaging, 2) the sophistication of radiation oncology technology, and 3) the identification of cellular biology, radiation biology and radiation physics as critical parts of radiation oncology. This explosion of knowledge and technology has made it impractical for training programs in human medicine to combine diagnostic and therapeutic radiology.

Exactly the same explosion of diagnostic radiologic and radiation oncologic knowledge has occurred in veterinary medicine. In addition to diagnostic radiology a number of other imaging modalities are commonly used in veterinary medicine. These include diagnostic ultrasound, nuclear imaging, computed tomography and magnetic resonance imaging. It is impossible in a three year veterinary diagnostic radiology training program to prepare residents for successfully completing the certification examination of the American College of Veterinary Radiology, which naturally emphasizes diagnostic imaging, and at the same time to provide adequate training in radiation oncology. Under present conditions, radiation oncology is often relegated to a minor part of radiology training programs.

The American College of Veterinary Radiology recognizes the limited training being made available in radiation oncology and, as such, the requirement for examination in radiation oncology is an optional rather than a required segment of the oral portion of the ACVR certification examination. Less emphasis is being placed on radiation oncology today because of the explosion of knowledge relating to diagnostic imaging. As a result, most radiology residents attain a level of understanding of radiation oncology sufficient only to pass the written examination of the American College of Veterinary Radiology. This de-emphasizing of radiation oncology in radiology training programs will ultimately decrease the competence of those veterinarians practicing radiation oncology. There is no current mechanism to assure that veterinarians performing radiation oncology in the next generation will be adequately trained to do so.

The American College of Veterinary Radiology, however, also recognizes the importance of providing training in radiation oncology, and maintaining a cohort of adequately trained veterinarians. This is documented by the granting of approval by the Executive Council for establishment of the Affiliate of Radiation Oncology under the auspices of the ACVR.

Radiation Oncology as practiced by physicians and veterinarians has its roots in diagnostic radiology. Additionally, virtually all contemporary National and International experts in veterinary radiation oncology are Diplomates of the American College of Veterinary Radiology. Finally, existing training programs in radiation oncology ... are directed by Diplomates of the American College of Veterinary Radiology. Therefore. it is justifiable and reasonable that a newly formed Affiliate of Radiation Oncology be established within the American College of Veterinary Radiology.

The American College of Veterinary Radiology also recognizes the philosophy of the American Veterinary Medical Association and the American Board of Veterinary Specialties in consideration of so-called Conjoined Affiliate groups. Therefore, it is reasonable that some attention be given to the possibility that the newly formed Affiliate of Veterinary Radiation Oncology be co-sponsored with the ACVR by another specialty College. One obvious co-sponsorship arrangement would be between the American College of Veterinary Radiology and the American College of Veterinary Internal Medicine, under which the Specialty of Medical Oncology was created.

At this time, the American College of Veterinary Radiology believes that the Affiliate of Radiation Oncology should be associated solely with the American College of Veterinary Radiology. As mentioned earlier, veterinary radiation oncology has its roots in diagnostic radiology, most contemporary experts in veterinary radiation oncology are Diplomates of the American College of Veterinary Radiology, and existing training programs are directed by Diplomates of the ACVR.

Additionally, Diplomates of the Specialty of Medical Oncology of the American College of Veterinary Internal Medicine have as a primary area of expertise the treatment of cancer with chemotherapy and/or immunotherapy. Radiation oncologists, on the other hand, have as a primary area of expertise, the treatment of cancer with ionizing radiation. Admittedly, there is a need for radiation oncologists to have an appreciation of some of the basic principles of medical oncology, and vice versa. However, medical and radiation oncology are distinct entities, each with huge knowledge bases and little specific overlap. Having the Affiliate of Radiation Oncology sponsored by the American College of Veterinary Internal Medicine and the American College of Veterinary Radiology would seem to serve no immediate advantage over having sole sponsorship by the American College of Veterinary Radiology. A commonalty of cancer is insufficient to justify co-sponsorship of an Affiliate of Radiation Oncology by Radiologists and Internists. Such fragmentation would also be significantly more difficult to administrate than if sponsorship were by one existing Specialty College. Radiation Oncology has always been aligned with the use of ionizing radiation, much as has the specialty of diagnostic radiology, and it makes sense to have the same sponsoring group. Additionally ... the ACVIM has been kept informed regarding the status of organization of the Affiliate of Radiation Oncology. The establishment of an Affiliate of Radiation Oncology in the ACVR was discussed at a recent meeting of the Specialty of Medical Oncology (San Diego, May 1992). There was no objection to the movement and the Specialty of Medical Oncology did not express a desire to take an active role in the development of the Affiliate of Radiation Oncology.

Finally, as is apparent from the description of the proposed training program in radiation oncology, requirements of the training program in radiation oncology can be met by individuals in various disciplines. Sponsorship of the Affiliate of Radiation Oncology by the American College of Veterinary Radiology will in no way limit accessibility of radiation oncology training programs, or the certification examination, to those individuals participating in or having completed diagnostic radiology residency programs. The ACVR recognizes the importance of establishing an accessible "route of entry" into the Affiliate of Radiation Oncology."

Regarding the review of the proposal by ABVS liaison members, comments from both individuals (Olson & Fessler) were helpful in further developing the petition, but the diligent effort expended by John Fessler deserves special notation. His critical review of the Petition revealed several weaknesses which seriously jeopardized the likelihood that ABVS would look favorably on the proposal. Therefore, the ACVR Council recommended that the petition be withheld for one additional year for refinement, and not be submitted until December of 1992.

In March, 1992, a call was made by the ACVR Council for applications and nominations for the Organizing Committee of a proposed Affiliate of Radiation Oncology. At the mid-year Council meeting, 15 applications were reviewed and four members of the Organizing Committee were identified. They were Drs. Dewhirst, Gavin, Gillette and Thrall. This group was charged with continuing to develop the Affiliate. However, it must be noted that the members of the Radiation Oncology Committee of the ACVR, who had the responsibility of developing the plan for formation of a radiation oncology subspecialty in the ACVR, had wrestled with many difficult issues in establishing the Affiliate and without their hard work successful establishment of the Affiliate would have been less likely.

At the 1992 mid-year Council meeting an additional concern regarding the Affiliate was also relayed. It was suggested that the Affiliate not have a separate constitution but that it be governed by the ACVR constitution, with specific bylaws pertaining to the Affiliate.

Even though the formal petition to establish the Affiliate was not to be submitted to the ABVS until December of 1992, the ABVS was aware of the development of the Affiliate and the Committee on Development of New Specialties and Subspecialties (CDNSS) of the ABVS reviewed the draft petition on December 7, 1991. They also initiated an "information gathering" process from the profession regarding the establishment of the Affiliate. This is required by ABVS. Requests for opinions on development of the Affiliate were sent to specialty organizations, academies, societies, veterinary educational institutions, AAHA, state veterinary medical associations, other AVMA Councils and Boards, and to governmental and industrial organizations. A solicitation of opinions was also published in JAVMA. Additionally the CDNSS had concerns including perceived narrowness of Radiation Oncology with respect to the paucity of potential Diplomates, and overlap with ACVIM, Specialty of Oncology.

In May, 1992, a letter was sent by Dr. Thrall to Dr. Ralph Richardson, President of the Specialty of Oncology of the ACVIM informing him of the intention to establish an Affiliate of Radiation Oncology within the ACVR. The issue of conjoint sponsorship with ACVIM was also mentioned and the decision to proceed solely within the ACVR was relayed. Justification for this action was also provided.

In June, 1992, three members of the Organizing Committee (Dewhirst, Gillette, Thrall) met in Durham, NC to further refine the petition. Dr. Thrall was elected as Chairman of the Organizing Committee at that time. The subsequent discussion was fruitful, and resulted in substantive changes in the documentation to be submitted to the ACVR Council in August. Major changes were:

1. The specified length of the required training program was reduced from 36 to 24 months. It was a unanimous decision that adequate training in radiation oncology could be achieved in 24 months.

2. It was a unanimous decision that the examination structure be simplified from a two-part examination (originally proposed because the ACVR certification examination was two-part) to a one-part examination to be given at the end of the 24 month training period. This simplified the procedure for individuals in various disciplines to take the examination.

3. Specific numbers of patients treated, and imaging studies to be interpreted were deleted. It was a unanimous decision that such numbers are relatively meaningless and may make it difficult for some excellent radiation oncology training programs to be formally approved. The quality of training is more important than numbers of patients treated.

4. The relationship between the Subspecialty of Radiation Oncology and the ACVIM was judged to be acceptable as previously defined. There was no objection at a recent ACVIM meeting to the proposed affiliation of the Subspecialty of Radiation Oncology with the ACVR. (NOTE: Dr. Gillette, as a member of ACVIM Specialty of Oncology raised the issue of conjoint sponsorship of the Affiliate at the Business Meeting of the ACVIM at their meeting in May, 1992. There was no indication that ACVIM Specialty of Oncology wished to enter into a conjoint sponsorship).

In July, 1992, revised documents (Petition, Constitution, Training Program Description) were submitted to ACVR for consideration at the Yearly Council meeting in Orlando. Drs. Thrall and Gillette were in attendance at that meeting. The documents were approved for submission to the ABVS with minimal discussion. The ACVR Constitution was revised to accommodate subspecialty groups, and Bylaws were written for the Affiliate to replace the Draft Constitution.

In September, 1992, Dr. Watrous, ACVR President, sent the final draft of the documents (Petition, Bylaws, Training Program Description) to the ACVR membership for approval; approval rate was 99%. She then submitted these documents to the ABVS in October, 1992.

The petition was considered by the CDNSS at their meeting on December 7, 1992. Results of the polling of the profession were reviewed, and these were positive. The concept of an Affiliate of Radiation Oncology was received favorably. However, CDNSS remained concerned about involvement of ACVIM in sponsorship of the Affiliate and advised the Affiliate that a dialogue with ACVIM be established to consider such. The petition would not be forwarded to ABVS for consideration at this time. CDNSS established an ad hoc committee on Conjoint Boards consisting of Drs. Pyle, Burt, Fessler, Lorenz and Park.

Dr. Lorenz telephoned Dr. Thrall in December, 1992 and indicated that CDNSS felt strongly that a conjoined specialty with ACVIM was appropriate. He also said that CDNSS was not convinced the ACVR had thoroughly investigated the conjoined sponsorship with ACVIM.

Fortunately, to expedite matters, Dr. Lee Pyle convened a meeting of the Conjoint Board ad hoc committee with representatives of the ACVIM and ACVR to discuss the issue. This meeting was held on March 7, 1993 in Schaumburg, IL. Attendees were Drs. Bud Ames (AVMA), Jim Burt (ACVR representative to ABVS), Jack Fessler (ACVS representative to ABVS), Ed Gillette (Radiation Oncology), Mike Lorenz (Ad Hoc ABVS member), John Lund (ABVS Chair), Dick Park (ACVR representative to ABVS), Lee Pyle (ACVIM representative to ABVS, Chair of Conjoint Board Committee), Ralph Richardson (ACVIM-Oncology), and Don Thrall (Radiation Oncology). The discussion focused primarily on issues of patient care, duplication of training and experience, and accessibility of the Radiation Oncology group to individuals other than those training in diagnostic radiology. All of these issues had been addressed in the submitted petition, and following a healthy discussion a consensus was reached that there was no obvious advantage to the Radiation Oncology affiliate being a conjoined relationship between the ACVR and ACVIM. Drs. Lee Pyle, Jack Fessler, Dick Park and Jim Burt were vocal supporters of the proposal for the Affiliate to reside within the ACVR and their input was very helpful in reaching the consensus.

Because of the delay associated with resolving the Conjoint Board issue, the petition could not be voted on at the 1993 meeting of the ABVS (held in Schaumburg, IL on March 7 and 8, 1993). The petition was, however, discussed at the 1993 meeting of the ABVS (the day after the Conjoint Board Committee meeting), and a memorandum was received from Bud Ames which stated that the petition would be sent to Drs. Fowler and Helper of the ABVS for their review in preparation for full ABVS review in 1994. This would allow any problematic issues to be addressed one last time before the entire ABVS reviewed the petition in March of 1994.

In April, 1993, the ACVR Council unanimously approved the members of the Organizing Committee to be Charter Diplomates of the Affiliate.

The Organizing Committee began the process of writing the examination. Four sections were identified: radiation biology and related material, radiation oncology physics, clinical aspects of radiation oncology, and the basic science aspects of radiation oncology. A letter was sent to 44 Diplomates of the Specialty of Oncology of the ACVIM regarding the examination in radiation oncology and asking for questions. Questions were submitted by two individuals, Drs. Madewell and Ogilvie. An announcement appeared in the September 15, 1993 issue of JAVMA announcing that the first examination in radiation oncology would be given in conjunction with the International Veterinary Radiology Association meeting in Philadelphia in August, 1994. This, of course, was contingent on the Affiliate being approved by the ABVS.

In June, 1993, the comments of the two new ABVS reviewers (Drs. Fowler and Helper) were received. These reviewers raised new concerns including the small number of members of the Organizing Committee, the fact that time-limited certification had not been addressed, and whether there will be a publication requirement. The Organizing Committee assessed these issues and in October responded to Dr. Charles Williams, ABVS Chair. We argued that because the Affiliate was associated with the ACVR, four members of the Organizing Committee would be sufficient; additionally the bulk of the work was already completed. We stated that time-limited certification was being considered by the ACVR and that the Affiliate will join in these discussions. We indicated that a publication requirement was not desirable as this has little direct relevance to clinical practice of radiation oncology.

In September, 1993, the application form to take the certification examination was reviewed by ACVR Council and approved. Previously it was also the plan for Council to approve the examination, but in the interest of keeping the examination confidential, a request that the review be waived was also approved.

The entire Organizing Committee met in Raleigh, NC on January 29, 1994 to review the examination. Each of the four sections were reviewed, question by question. There were over 300 total questions of the following formats: multiple choice, matching, short answer, true-false and essay. All questions were referenced.
Fourteen applications were received to take the first certification examination. These were reviewed by the Organizing Committee and all applications were approved. There were applications from 7 males and 7 females. Three applicants were ACVIM Diplomates, six were ACVR Diplomates and 1 an ACVS Diplomate. Five of the fourteen were veterinary school faculty, five were in practice, and four were associated with other institutions.

In December, 1993 Dr. Thrall received a letter from Dr. Charles Williams, Chairman of the ABVS, and a telephone call from the Dr. Ames. These communications indicated there was ABVS concern regarding the size and makeup of the Organizing Committee. Specifically, there was concern that the Organizing Committee was composed entirely of academicians, and that all had trained at Colorado State University. Dr. Ames also spoke with Dr. Gillette, and Dr. Nyland, the ACVR President. Dr. Ames indicated that the ACVR should strongly consider adding additional members to the Organizing Committee to address these concerns. The Organizing Committee elected not to address concerns regarding the makeup of the Organizing Committee as this task had been initiated and completed by ACVR Council. Therefore, in consideration of Dr. Ames Comments, ACVR Council reconsidered the structure of the Radiation Oncology Organizing Committee.

In January, 1994, Dr. Nyland sent a letter to Council members regarding this issue. Dr. Nyland reviewed the concerns of ABVS and presented Council members with various options for responding to the ABVS. These matters were discussed during a conference call and after considerable debate, it was decided that the College would not add additional members to the Organizing Committee at this time. It was also decided that Dr. Nyland would attend the ABVS meeting to address this decision.

In the meantime, the Organizing Committee addressed the remaining issues. First, the Organizing Committee emphasized that its present members are actively involved with the clinical practice of radiation oncology. Second, although all members of the Organizing Committee trained at Colorado State University, three members have been away from Colorado State University for between 14 and 20 years. Third, we indicated that four Organizing Committee members could be productive as essentially all the work in organizing the Affiliate was completed.

In addition to Dr. Richard Park, the ACVR representative to the ABVS, Drs. Thrall, Gillette, and Nyland attended the ABVS meeting on March 6, 1994 to answer questions, and defend the petition. I am pleased to report that the petition for the Affiliate of Radiation Oncology was successfully defended and was given provisional approval by the ABVS. The several remaining concerns were satisfactorily addressed.

The ABVS will now recommend approval of the Affiliate to the AVMA's Council on Education and House of Delegates which will meet at the AVMA meeting in San Francisco in July, 1994. The first examination, pending full approval of the Affiliate, will take place in Philadelphia in August, 1994.

Thus, after initiatives which began in the Spring of 1988, it now appears highly likely that a specialty organization in radiation oncology with the ability to confer Diplomate status will exist as an Affiliate of the ACVR. The Organizing Committee views this as an exciting time in veterinary radiation oncology and believes the animal-owning public and the profession will both benefit from this action.

Thanks must be expressed to those who have worked very hard with me to make the Affiliate a reality. First to Drs. Chess Adams, Ron Burk, Sydney Evans, Pat Gavin, Ed Gillette, Glen King, Jim Lattimer, and Mike Walker, ACVR Radiation Oncology Committee members who first debated the feasibility of establishing a specialty group in radiation oncology, and prepared and critiqued original drafts of the petition and training program description. Next, to Drs Jim Burt and Dick Park who as ACVR representatives to the ABVS lobbied very hard for acceptance of the Affiliate. Also to Dr. John Fessler who made numerous valuable suggestions for alteration of the petition. Additionally to Drs. Mary Mahaffey, Mike Walker, Jeff Wortman, Bill Brawner, Barbara Watrous, and Tom Nyland, ACVR Presidents during the time when the Affiliate developed from an idea into reality, who were instrumental in leading the acceptance of the concept and development of a subspecialty group in the ACVR. Gratitude is also expressed to all members of ACVR Council during this period of time, who spent considerable time and energy reading and refining submitted documents, and strategically planning for institution of the Affiliate. Finally, to the other members of the Organizing Committee, Drs. Mark Dewhirst, Pat Gavin and Ed Gillette, who worked extremely hard fine-tuning the petition, training program description and Bylaws, addressing various concerns and writing the first certification examination.

Respectfully submitted, March 21, 1994.
Donald E. Thrall, DVM, PhD
Organizing Committee Chair