Newsletter

April 2014 Volume 1, Issue 1

Mission
The Radiation therapy intellectual forum was established in 2013 to recognize competence of Trainees in oncology department. Trainee medical physicist and trainee radiation therapy technologist at Aga Khan University are the members of this forum. The mission of the RTIF is to serve the cancer patient by using innovative skills and knowledge. Up to now there are more than 10 session conducted on academic growth of trainees. These sessions covers physics and methodology related to radiation therapy. Beside academics RTIF also focus on professional growth of its members and arrange different activities regarding professional development. Last but not least we also think through the entertainment sessions which give sense of freshness in our busy and tough routine. --Safdar Mushkin (AKUH)

Inside this newsletter:

Mission Foreword Message Reviewed Articles Pros and cons in clinical Practice of IMRT Small field Dosimetry Activities 1 1 2 2 2

Foreword
In the name of Allah, the most Beneficent & the most Merciful Darood to Syed ul Mursaleen (SAW - PBUH) 'Knowledge is the best asset' My Dear Junior Colleagues Assalam o Alaikum Our vibrant Radiation Oncology Community is growing with a pace unmatched with any other specialty of medicine. Our beloved country is seeing a positive change in terms of provision of modern up to date care to our cancer patients. Let's join hands and work together for this noble cause and let's aim for the betterment of our professional training programs which will surely result in the enhancement of better management of our cancer patients. Hard working Doctors, Physicists & R.T.T.s across the four corners of the country are striving hard for the sake of underprivileged cancer patients. Their commitment to humanity can only be rewarded by Allah Subhanaho WA Taala. Professional accomplishment and dedicated efforts against the odds cannot be paid or rewarded in this world. We had a milestone consensus on national Synchronization of compatible training in the country and now we are heading towards the new era of uniformity of care across the region. I was delighted to know that MashaAllah, all 16 of you are working like a team for this Intellectual Forum and my wishes and prayers are with you all. "Only those who see the invisible can do the impossible" - Dr. B. Lown Best regards A Nadeem Abbasi, Assoc. Prof. MBBS (Dow), FFR, RCSI (Dublin), CCST (UK), CCST (Eire) General Secretary, PSCO, Head, Dept. of Radiation Oncology Chief Radiation Oncologist / Director, Residency PGM Aga Khan University
1

Members
Guhfran Ali Safdar Mushkin Sharaib Ahmed Ali Sajid Sohail Qureshi Zeeshan Ansari Waqar Ahmed Wajahat jamil Saad Bin Saeed Khadeja Marium Sehrish Inam Naqash Tanoli Awais Sani Iqra Riaz Qurat-ul-Ain Rubina Shams

Message
We should be proud of principle stand taking by our trainee for their own professional growth. The strength of this forum is knowledge sharing and enhancing the pace of study by inviting subject expert for seminars. The combine group of RTT and Physics Trainee deserve appreciation and applaud for the kind work and determination that they have shown. We feel lucky to have such trainees; they are assets to our Department. Regards Asad Yousuf Medical Physicist Section of Radiation Oncology, Department of Oncology The Aga Khan University Hospital,

Reviewed Articles Pros and Cons in Clinical Practice of IMRT

IMRT has attracted wide spread interest because of its dosimetric and potential clinical advantages. Numerous dosimetry studies on linear accelerator based IMRT treatments of different anatomical sites have been proven that IMRT can have definite dosimetry advantages over 2D and conventional 3DCRT treatments. At AKUH, there is one Linac with IMRT facility (8 years old, 40-50 3DCRT patients per day) and one IMRT planning work station (i.e. one HELIOS license, without large field IMRT). There are issues in clinical implementation of IMRT such as high cost, sophisticate equipment, computer networks, dosimetry, immobilization devices and quality assurance (QA) systems. The delivery of IMRT is complex and time consuming procedure in terms of amount of work involved and physicist work in particular is much high. Contouring of targets for treatment and organs at risk OARs is a tedious and time consuming process in IMRT because of the large number of CT images involved and the level of precision required. Furthermore, IMRT treatments are more sensitive to geometrical errors because of their higher dose conformity indices. Accurate determination of the target volume and the geometry of the organs at risk (OAR) are most important and immobilization should be able to achieve an interfraction and intra-fraction patient positioning accuracy of within 3 mm throughout the course of the fractionated IMRT treatment. The performance of the machines used for treatment and the accuracy and the stability of their dosimetry and MLC systems are also required. Higher integral dose to be delivered to the normal tissues of the patient b/c of more radiation beams. This can result in an increased risk of malignancies induced by secondary radiation. It is vital that radiation oncologists develop IMRT treatment protocols that either are currently accepted based on outcome data in peer-reviewed journals or follow existing multi-institutional IMRT protocols. The decision process for using IMRT in clinical practice requires an understanding of the accepted peer-review practices that take into account the risks and benefits of such therapy compared with conventional treatment techniques. Saad Bin Saeed (AKUH)

Be less curious about people and more curious about ideas-Marie Curie

Small Field Dosimetry

In a modern world number of tele-therapy treatment modalities, such as Intensity modulated radiation therapy (IMRT), Volumetric modulation radiotherapy (VMAT) , Stereotactic radiosurgery (SRS) and image guided radiotherapy has increased, requirement of dosimetry protocol and quality assurance become more important, especially with usages of small fields. Using small radiation fields allows the dose to be placed very precisely in the target volume and at the same time to spare healthy tissue which may be in close vicinity. All in all, there is an increasing demand to characterize small field dosimetry. A small field is defined as a field smaller than the lateral range of charged particles. Nonstandard fields are either made of small fields or whenever non-equilibrium conditions exist; for example, the size of the penumbrae is similar to the field size. The relative dosimetry of small fields constitute problems due absence of common protocol and exact recommendations. For these fields, dosimetric errors have become considerably larger than in conventional beams mostly due to two reasons; a) b) The reference conditions recommended by conventional Codes of Practice cannot be established in some machines. The measurement of absorbed dose to water in composite fields is not standardized.

The radiation leftover from the Big Bang is the same as that in your microwave oven but very much less powerful. It would heat your pizza only to -271.30 C, not much good for defrosting the pizza, let alone cooking it.

Commissioning a treatment planning system for such small fields poses many unique challenges. Notably, planning system accuracy for small fields is often more sensitive to modeling than for large fields. In particular, source size and MLC modeling impact dose calculation for small fields more so than for larger fields. Second, complicating the issue of commissioning small radiotherapy fields is the challenge in making accurate small field dose measurements. The challenges of penumbra size versus detector size and the impact of changes in the energy spectrum on detector response, all complicate the measurement process. Recent years, accurate dosimetry in small photon fields is currently a hot topic in radiotherapy; In order to develop standardized recommendations for dosimetry procedures and detectors, an international working group on reference dosimetry of small and nonstandard fields has been established by the International Atomic Energy Agency (IAEA) in cooperation with the American Association of Physicists in Medicine (AAPM). This working relation witness some major conferences and meetings as mention for the readers interest. Meeting of the American Association of Physicists in Medicine (AAPM) and IAEA Dosimetry & QA symposium in 2010, PTW Joint AAPM/COMP Meeting in Vancouver, Canada, 31 July - 4 August 2011 54th Annual Meeting of AAPM in Charlotte, NC July 29-Aug 02, 2012 AAPM spring clinical meeting in Arizona, March 16th -19th ,2013

--Stephen Hawking

New formalism for the dosimetry of small and composite fields is still a matter of scientific research; international standard are being developed and number working groups publish their report on this issue as a guideline for clinical Physicists but none of those are finalized yet as protocol dosimetry in small fields is still a matter of scientific research. .--Asad Yousuf

Activities
RT Intellectual Forum Physics Lab, Jena Bi Building Aga Khan University Hospital Karachi Pakistan 7400

E-mail:

Trainee intellectual form organized many events regarding academics, professional development regularly and entertainment events occasionally. The academic part is the most important part of our activities .Through it the members boost their knowledge and skills related to radiation therapy and keep them self-up to date regarding new research and developments in the field of radiation oncology. Our members participate in these events actively and give their maximum inputs to benefit others. We have grabbed some of the memorable moments from different sessions.

traineesintellectualforum @gmail.com
Web site address

Rtif.weebly.com

Ideas pathway of success

All activities are closely monitored by our supervisors and instructor in order to obtain the best output of these activities. Through these activities the participants enhance their self-confidence and motivation.

Credits Editors Safdar Mushkin Saad Bin Saeed Advisors Dr. Nadeem Abbasi Asad Yousuf Shahbaz Ahmed