Radiation Therapy in India

Dr. V. Lokesh M.D

Dr. T.R . Arul Ponni

Kidwai Memorial Institute of Oncology, Bangalore

Population• India accounts for some 2.4 percent of the world's

landmass but is home to about 16 percent of the global population

• Persons      1,027,015,247    - Males             531,277,078    - Females         495,738,169

• Total literacy rate 65.38%.

• Almost 40% of Indians are younger than 15 years of age.

• About 70% of the people live in more than 550,000

villages,

Cancer Burden• Globally 7.6 million new cancer cases

• 52% occur in developing countries

• The estimated new cases of cancer in India per year is nearly 650,000 lakhs

• Next millenniums estimated to be 8,06,000.

• The Cancer in women constitutes more than 50% of the total cancer.

• Cancer incidence: 80-90/ 100,000 population (Developed 1/3 – 1/4th)– Rural : 55-90/100,000 – Urban : 70-90/100,000

Radiation Therapy - India

Teletherapy• Cobalt – 60 : 246• Cesium-137 : 09• Linear Accelerator : 44

Brach therapy• LDR : 37• HDR : 46• I/C : 76• ISB : 28

Radiation Protection InfrastructureBhabha Atomic Research Centre, Mumbai• on very sound footing • constantly being strengthened based on experience and continued

research • India has accorded high priority to safety in dealing with the use

of radiation and radiation sources – Atomic Energy Act, 1962 – Radiation Protection Rules in 1971

• Apex regulatory body - the Atomic Energy Regulatory Board - 1983 - for regulating the use of ionizing radiation in the country

• Crisis Management Group (CMG) has been functioning since 1987 in DAE. In the event of any radiological or nuclear emergency in the public domain

Major practices in Radiation Protection in India

Ur-Th mining and millings - 8 units at 3 centres Nuclear Fuel cycle facilities - 2 units Research Reactors - 4 Power Reactors - 14 in operation Production of Radioisotopes - 3 units Diagnostic X-ray machines - about 40000 units X-ray fluorescence - 120 units Teletherapy units - 260 units at 170 centres Brachytherapy (HDR+LDR) units - 70 units Industrial Irradiators - 13 units Nuclear Gauges - 6500 units Users of unsealed sources of low activities, RIA-500 centres Users of unsealed sources/ material with higher activities-150 centres Manufacturers of products containing Radioactive material-200 units

Karnataka State

• In Karnataka a state in the southern part of India

• 35,000 incident cancers

• prevalent cancer accounts to about 1,50,000.

• More than one third are seen and attended to at Kidwai Memorial Institute of Oncology.

• Most of these cancers, especially in women are easily accessible and have sensitive early detection tests and techniques. In addition, Cervix and oral cancers have well established phases of evolution from pre cancer to cancer. Thus are ideally suited for both primary and secondary prevention.

Kidwai Memorial Institute of Oncology

Kidwai Memorial Institute of Oncology Bangalore, Karnataka State

•Regional Center for Cancer Research and Treatment

•Teaching Hospital:

DM Medical Oncology

MCh Surgical Oncology

MD & Diploma Radiation Oncology

DNB Pathology

BSc Medical Technology(Radiotherapy, Radiology, Laboratory Technology etc)

•Multidisciplinary Management

Radiation Therapy at KMIO

• Total Number of Cancer Patients Registered = 12,000

• Radiation Oncology = 6000

• Daily : 300 patients are on Teletherapy

• Total Number of Cases treated with– Teletherapy : 3500 / year– Brachytherapy : 320 / year

Teletherapy• Linear Accelerator Clinac 2000 :1• Telecobalt

» Th-80 : 1» GMX : 1» Th780C : 1» Th780E : 2» ATC : 1

• Telecesium :1• 100Kv :1• Simulator X-ray :1

1970s

1976

1990s

Brachytherapy

• Remote : – LDR: Selectron - 137Cs Pellets (1981)– HDR: Gamma Med

• Manual :– Cs Needles, Tubes– Iridium Wire / templates– MAL : I/C – 5 nos, ILBT : 1 (Cs Tubes)– MAL : Ovoids, Vaginal Cylinders

Mould Room

• Styrofoam Cutter : 2

• Thermoplast Water Heater : 1

• Perspex Cast Unit : 1

• Tissue Compensators : Aluminum

• Cerrobend Alloy Melting Unit : 1

Other Essential Equipments• Capintec Therarad Beam Level Dosimeter System• Phantom: Rando , Polystyrene• Gamma Area Monitors• Isotope Calibrator CALRAD with Cobalt-57 check

Source• Beta Gamma Survey Meter (LUDLUM)• Survey Meter for Table Top Contamination• Gamma Survey Meter- PLA- Range 50-5000

mR/hour• TDL Furnace – 2nos

Radiation Oncology

• Consultant Doctors : 16

• Nurses : 10

• Radiotherapist : 25

• Total Admissions in Wards: 1700/year

• Simulations x-rays done : 5500/year

• Brachytherapy : 3-6 patients / day

Medical Physics in Karnataka• AMPI : Guidelines similar to AAPM & HPA• Responsibilities:

– Equipment selection , Maintenance & installation, Planning– Calibration of equipments and Quality Assurance– Treatment Planning– Research and Development– Radiation Safety

• Code of Ethics of Medical Physics COMP1997 • ICMR Regulations 1998 Medical Physicists:

– Karnataka - 29– KMIO - 09

Services Offered by Medical Physics

• Patient Care (w.r.t RT planning- Dose/Spatial Distribution/TLD Measurements/Port Filming )

• Radiological Dosimetry• RT External /Brachytherapy• Quality Assurance• Training

• RSO : AERB Guidelines - Status Information Annually

• Personnel Monitoring : TLD

KMIO : Radiological Laboratory

• Calibration Certificate: – Beam Level Dosimeters : 20-30/year– Rectal Dosimeters : 4-9/year– Monitoring Instruments. : 1-3/ year

• Radiation Sterilization Plant (CGS - 300) : 1989 -sterilize the disposable medical and surgical instruments by gamma radiation.

• Nuclear Medicine Facility : Diagnostic & Therapeutic

Future Needs

• To acquire State of the Art Machinery like IMRT / 3D CRT/ Stereotactic / Virtual /PET

• To Computerize the Patient Data and Hospital Management System

• Maintain safety standard • To develop and Implement Protocols• To create good working environment where every

one works efficiently and take responsibility• Frequent Education Programmes on safety aspects

to various levels of staff involved in patients care.

Acknowledgements

• IAEA

• KAERI

• Dr. Oliver

• Dr. Lillien

• Other Participants