Mayo School of Continuous Professional DevelopmentRadioactive Seed Localized Breast Surgery Workshop ! NE NOW I R ONL .edu/cme/ ISTE ayo REG ://www.m ttp h Friday, July 19, 2013 Mayo Clinic • Rochester, MN
Mayo School of CPD reserves the right to cancel or postpone any course due to unforeseencircumstances. In the unlikely event Mayo School of CPD must cancel or postpone thiscourse, Mayo School of CPD will refund the registration fee, but is not responsible for anyrelated costs, charges, or expenses to participants, including fees assessed by airline/travel/lodging agencies.TravelRochester, Minnesota, is a friendly city that greets thousands of visitors from around theworld each year. Travelers may arrange to fly directly into the Rochester InternationalAirport (RST), which is located approximately 10 miles from the downtown Mayo Cliniccampus. Travelers may also choose to fly into the Minneapolis-St. Paul InternationalAirport (MSP), located 80 miles north of Rochester, MN. Access to and from bothairports is provided by taxi, shuttle service, and rental car. Rochester Direct shuttleprovides transportation between Minneapolis airport and several Rochester locations.For reservations, call Rochester Direct at 800-280-9270 or visit:www.gorochesterdirect.comMayo Clinic’s appointed travel company, Carlson Wagonlit Travel, is available to assistwith your travel arrangements. To make your reservation, phone Carlson WagonlitTravel toll-free at 1-866-629-6885. Note to Travelers flying directly to Rochester: Several cities in the United States arenamed Rochester. When you make airline reservations and check your baggage, be surethat your destination is Rochester, Minnesota (RST) and that your baggage has beenproperly tagged.Travel arrangements are the sole responsibility of the individual registrant.Lodging AccommodationsIf you choose to stay in Rochester, area hotels are easily accessible and eager toaccommodate your needs. Many downtown hotels are connected by skyway andpedestrian subway to conference facilities, downtown shops, and restaurants. You maywish to visit the Rochester Convention and Visitors Bureau website (www.rochestercvb.org) and/or www.rochester411.com for accommodation options and area information.Leisure ActivitiesPublic tours of Mayo Clinic are provided each day of the week beginning at 10:00 am,except for holidays. The tours originate from Judd Auditorium, Subway Level of theMayo Building, and last approximately 1.5 hours. The tour includes a 20-minute film onthe history and operation of the Mayo Clinic plus visits to points of interest in the Mayo,Plummer and Hilton Buildings. Please make advance reservations by calling 507-538-0440.Mall of America, the largest fully-enclosed retail and family entertainment complex inthe United States, is an easy 90-minute drive or shuttle ride from Rochester, Minnesota.Along with 500 retail stores, restaurants, and nightclubs, the mall features an indoortheme park and an aquarium.Mayo Clinic FacultyCourse DirectorsJames W. Jakub, M.D. Robert W. Maxwell, M.D.Associate Professor of Surgery Instructor in RadiologyDepartment of Surgery Department of RadiologyCourse FacultyKelly L. Classic Robert T. Fazzio, M.D. Ph.D.Assistant Professor of Medical Physics Instructor in RadiologyDepartment of Safety Department of RadiologyAmy C. Degnim, M.D. Tina J. Hieken, M.D.Associate Professor of Surgery Associate Professor of SurgeryDepartment of Gastroenterology & Department of GastroenterologyGeneral Surgery & General Surgery
PROGRAM SCHEDULEFriday, July 19, 201311:30 a.m. Registration and Lunch with Faculty Elizabethan Ballroom Kahler Grand Hotel, First Floor12:30 p.m. Move to Crisp Lecture Hall Gonda Building, 19-10112:45 p.m. Introduction and Welcome12:50 p.m. Considerations for Radiologists Robert W. Maxwell, M.D.1:20 p.m. Considerations for Surgeons James W. Jakub, M.D.2:00 p.m. Concurrent Hands-On Skills Sessions Placement of Radioactive Seeds Mayo Clinic Department of Radiology Gonda Building, 2nd Floor Robert W. Maxwell, M.D., Robert T. Fazzio, M.D. Ph.D. Surgical Excision of Seeds Nygaard Lecture Hall Siebens 4-05 James W. Jakub, M.D., Amy C. Degnim, M.D., Tina J. Hieken, M.D.3:00 p.m. Radiation Safety Issues and Protocols Kelly L. Classic, CMHP3:25 p.m. How to Begin a Seed Program at Your Institution Amy C. Degnim, M.D.3:55 p.m. Refreshment Break4:10 p.m. Coding and Billing Tina J. Hieken, M.D.4:30 p.m. Lessons Learned: How to Stay Out of Trouble Amy C. Degnim, M.D.4:50 p.m. Questions and Answers Kelly L. Classic, CMHP, Amy C. Degnim, M.D., James W. Jakub, M.D., Robert W. Maxwell, M.D.5:15 p.m. Adjourn
Course DescriptionThis multidisciplinary educational workshop is designed to teach a new technique forthe localization and surgical management of breast cancer. The workshop will consist ofdidactic as well as an optional hands-on skills session.Topics include: Radiation Safety Issues and Protocols, Coding and Billing, How to Begina Seed Program at Your Institution, Lessons Learned: How-to Stay Out of Trouble.Course Learning ObjectivesUpon conclusion of this program, participants should be able to:• Describe advantages of a radioactive seed localized procedure.• utline the steps needed to implement a radioactive seed localized breast program at O participants’ institutions.• pply techniques of radioactive seed placement and radioactive seed localized breast A surgery.Attendance at this Mayo course does not indicate nor guarantee competence orproficiency in the performance of any procedures which may be discussed or taught inthis course.Intended AudienceThis workshop is intended to provide surgeons, radiologists, radiation safety officers,and office managers with the knowledge and techniques to offer radioactive guidedbreast surgery in their respective communities.CreditCollege of Medicine, Mayo Clinic, is accredited by the Accreditation Council forContinuing Medical Education to provide continuing medical education for physicians.College of Medicine, Mayo Clinic, designates this educational activity for a maximum of4.75 AMA PRA Category 1 Credits™. Physicians should only claim credit commensuratewith the extent of their participation in the activity.Date and LocationThe Radioactive Seed and Localized Breast Surgery Workshop will be held Friday, July19, 2013. Check-in and Lunch with Faculty will begin at 11:30 a.m. on the first floor ofthe Kahler Grand Hotel in the Elizabethan Ballroom. For the remainder of the workshop,course headquarters will be located in Crisp Lecture Hall on the 19th floor (19-101) of theGonda Building, Mayo Clinic, 200 First Street SW, Rochester, Minnesota. Meetingfacilities are easily accessible by skyway and pedestrian subway, which connect MayoClinic to shops, restaurants, and hotels.RegistrationTo register online, visit http://www.mayo.edu/cme/radiology-2013r853, or completethe attached registration form and return by mail or fax. The registration fee includestuition, printed course syllabus, Lunch with Faculty, and afternoon break refreshments.Although it is not Mayo School of Continuous Professional Development (CPD) policy tolimit the number of registrants for a course, conference room facilities may necessitateclosing of enrollment; therefore, early registration is advised. A letter of confirmationwill be sent upon receipt of payment and completed registration form. Please presentthe confirmation letter when checking in at the meeting registration desk.Cancellation PolicyIf you cancel your participation in this course, your registration fee, less a $75 administrativefee, will be refunded when written notification is received by Mayo School of CPD beforeJuly 5, 2013 (email: firstname.lastname@example.org or fax: 507-284-0532). No refunds will be made on orafter July 5, 2013. Canceled registrations are non-transferable.
REGISTRATION FORM 2013R853Radioactive Seed Localization Breast Surgery WorkshopJuly 19, 2013Mayo ClinicRochester, MNRegister online at: http://www.mayo.edu/cme/radiology-2013r853Mail or FAX form with payment to:Mayo School of Continuous Professional Development Phone: 800-323-2688 or 507-284-2509Plummer 2-60 FAX: 507-284-0532200 First Street SW E-mail: email@example.comRochester, MN 55905 Web site: www.mayo.edu/cmeContact Information (Please print or type all information. You may duplicate this form for multiple registrations.)Name of Registrant – first name, middle name or initial, and last name Degree – select all that apply MD DO PhD PA NP Other - specifyName of Institution Medical SpecialtyPreferred Mailing Address – select one Work/Business HomeAddress – street address Phone – include all country and city/area codes as needed along with complete phone numberCity State or Province ZIP or Postal Code CountryFAX – include all country and city/area codes as needed along with FAX Location – select onecomplete phone number Work/Business HomeE-mail Address(NOTE: E-mail is the Mayo School of CPD’s primary form of correspondence.) If you have special assistance needs or dietary restrictions, describe here: SPECIAL NEEDSRegistration FeeGeneral Session and Hands-On Skills Session $595 $_______________Please indicate which session (select only one): Placement of Radioactive Seeds (Radiology) Surgical Excision of Seeds (Surgery)General Session Only $495 $_______________Total Payment Enclosed: $_______________Payment Information - (US funds only) *Wire transfers will be assessed a $25 USD fee. Check is enclosed in the amount shown at right – make checks payable to Mayo Clinic Payment Total*Credit Card – select one Discover MasterCard VisaAccount Number Exp Date – mm/yyName of Cardholder – as it appears on the card Signature of Cardholder – required X