1. Arif Raza Radiotherapy Department

2. Introduction Clinical speciality for treatment of cancer Tissue destroying procedure Use of ionizing radiation Single or combined with other therapy Size of dept depends upon types of services and sophistication of equipments

3. Introduction Cobalt unit – used for deep radiation therapy Linear accelerator – wide range of oncology cases Simulator – set telegraphy field

4. Treatment steps Initial evaluation Treatment plan Application TPS for evaluation and plan

5. Brachytherapy Brachy means short distance Localized, precise and high-tech radiation therapy Radio-active source is placed in or near the tumour Increase cure rates and minimum side effects Radioactive cobalt, caesium or iridium is used in form of needles

6. Brachytherapy Completed in short duration and is cost effective Convenient for patient Does not require hospitalization

7. Superficial therapy Ionizing radiation with energies from 8 to 140 kilovolts Relatively soft X-rays Used for non-infiltrating cancers like skin cancers

8. Orthovoltage therapy Ionizing radiation with energies 150 to 400 kilovolts Used in treatment of infiltrating surface malignancies Intraoral, intervaginal treatment

9. Megavoltage therapy Ionizing radiation greater than one million volts Cobalt therapy and accelerators

10. Location Carefully located Conform to BARC’s shielding requirement Three foot thick walls and ceilings and access for equipment Should not block future expansion plan Ideally on ground floor close to OPD and radiology Close to vertical transport system No departments shall be below radiotherapy, thus basement is also a good option

11. Design Complex and requires experts advise during planning Legal requirements in designing Team of experts including radiation therapist, medical physicist, architects, engineers, equipment supplier and hospital planner shall be deployed Shall be designed to present a warm, cheerful and pleasant atmosphere

12. Design High density materials in walls, ceiling and floor to contain radiation Floor loading

13. Facilities and space requirements Reception-control Waiting area close to reception Dressing room Examination rooms Physician’s office Nurses’ station Therapy rooms and control rooms Physicists’ room with treatment computers Staff facilities Patient toilets Storage facilities

14. Elements of desiging Clinical examination section Reception area with registration room Examination and consultation Room for medical staff and social workers Waiting areas including trolley bays, storage, toilets Consultation room shall be separated from treatment area A darkened cubicle required for examining otolaringological patients

15. Elements of designing Treatment section Treatment planning room Computer assisted scanner Simulator Mould room Room for machinery

16. Elements of designing Access to radiation room Door with high lead shielding Door may require motor drive Maze arrangement preferable but consumes space Direct viewing window can be given in superficial or orthovolatge installation

17. Organization Shall be headed by Radiotherapy Physician assisted by other onco specialist Physicist who shall develop detail treatment plans for patients as prescribed by the physician Radiotherapy technicians to calibrate therapy equipment, verify doses, position patients and operate the machines

18. Organization Nurses to assist physician in examining patients and help during treatment Dietician to plan nutritional needs of patients Others – social workers, secretary, clerk, attendants, housekeeping and security staff

19. Problem situations Inefficient scheduling Lost charges Down time

20. Regulatory Processes Clearance of unit by AERB (Type approved or NOC) Approval of room layout plan (1:50 scale) Construction only on basis of approved plan Any modification shall be re-approved Appointment of staff Nomination and approval of radiological safety officer

21. Regulatory Processes Procurement of personnel monitors Measuring and monitoring equipments Authorization to procure radiation source

22. Thank you