The Department of Radiation Oncology is a newly commissioned facility at Aga Khan University Hospital (AKUH) based at the Ibn Zuhr building. The department has three consultant radiation oncologists. The cancer patients are being treated at this facility with state-of-the-art equipment and planning systems.
The following equipment is used in this service in order to deliver meticulous well-planned radiotherapy to cancer patients with high level of precision and quality:
- Two Linear Accelerators – Varian
- Dual Photon (6 and 18 MV) and multiple electron energies (6,9,12,15,18 MeV)
- Multi leaf collimation (MLC)
- Simulator Varian Acuity
- Eclipse Treatment Planning System
- 3-Dimensional Conformal CT planning
- Full mould room facilities with Cerro bend pouring
In addition to these features, a fully equipped High Dose Rate Brachytherapy suite and mould room are located at the basement floor of Ibn Zuhr Building. There is a Treatment Planning area where the oncologists review scans and work on treatment plans with the physics team.
In addition to the clinical staff, the department comprises the following sections:
Medical Physics team
- One Chief Medical Physicist
- Two Senior Medical Physicists
- Two Junior Medical Physicists
Radiation Therapy Technologists (RTT)
- One RTT Supervisor
- Radiotherapy Technologists working on Linear Accelerators, Mould Room and Simulator
- Two Registered Nurses & 1 NA
- Department Manager
- Admin.support staff
The radiation oncology department works closely with other faculty members of the University. It has a very close working relationship with the departments of Medical Oncology, Radiology, Pathology and Surgery. Multi-disciplinary tumor board meetings are held on a weekly basis.
Consultation clinics for Radiation Oncology are held four days a week from Monday to Thursday where patients are assessed and treatment options are discussed with the patients and their families. Later on, the process of booking various steps of planning commences including simulation, mould room preparation, computer planning, etc.
The Department of Radiation Oncology will be participating in clinical trials and other research protocols developed in-house or as members of the international multi-centre clinical trials.
The Department has a Quality Improvement Committee (QIC) which is represented by each section of Radiation Oncology. All the quality procedures and parameters are monitored and documented. The QIC meets on first Saturday of every month. The head of QIC acts as the management representative for the University-based Quality Improvement Co-ordination Committee (QICC).
Postgraduate Training Programme
Postgraduate training programme in Radiation Oncology is intended to be an interactive learning process. The self actuated, thoughtful, and motivated postgraduate trainee will find AKU to be an environment which is rich in learning resources. These include the faculty, patients, libraries, computers and electronic media, as well as peers and other students. Trainees are expected to utilise all these to enhance their clinical skills and orientation.
Postgraduate training in Radiation Oncology is intended to provide the trainee with the practical clinical experience necessary to develop the knowledge and clinical skills required to manage patients with the wide spectrum of malignancies as well as the complications of these malignancies and their treatment.
In general, the trainee should be able to:
- Evaluate the appropriateness of the diagnosis and management plan prior to assessing the referred patient in radiation oncology clinic
- Assess the general performance status of the cancer patient
- Assess the patient by doing general and site specific physical examination
- Stage the disease and develop an overall plan of management in collaboration with other related specialists
- Plan and supervise the delivery of radiation treatment
- Follow the patient's course during treatment and afterwards, and deal with complications of the disease and treatment
- Interact and communicate with the patient and family in a sensitive yet informative manner
- Clinical Skills
- Technical Skills
- Attitude and Communication Skills
- Ethics and professionalism
- Information Technology
- Cancer Research
Duration and basic approach of training
The postgraduate teaching programme of the Department of Radiation Oncology includes a four-year fully structured training programme, offering clinical training in radiation oncology adherent to the requirements of the College of Physicians and Surgeons Pakistan.
Specific rotation structure is being devised in order to coach the trainees in the most comprehensive system of multidisciplinary team working environment. The Resident will learn to function in harmony with other members of the health care team and become proficient in interpersonal relationships and in the organisation and management of patient care.
Provision of the opportunity to function within the context of a multi-disciplinary team approach to cancer patients care through interacting effectively with specialists of other disciplines, nurses, unit receptionists, nutritionists, pharmacists, physiotherapists, social services and other paramedical personnel.
Over the training period of four years, the Residency Programme provides extensive experience and training to residents who acquire the knowledge, skills and attitudes required to practice as a specialist.
It is internationally recognised that care and management of cancer patients can be effectively delivered via multidisciplinary approach. An oncologist interacts with almost all the disciplines of medicine on a regular basis. S/he plays an important role in the organisation and activities of a multidisciplinary team.
The main objective of extra-oncological rotations is to give a comprehensive and versatile vision of cancer care to the trainee radiation oncologist.
The rotations will be started in the third year of training. In the fourth year, all the CPSP rotations are covered. The trainees will rotate to departments which interact very closely with the radiation oncologist. It is intended that they would develop a sense of team work and would have a clearer understanding of viewpoints and opinions of other specialist colleagues.
Rotations will take place during the third year of training (as per CPSP requirements).
Internal Medicine (3 months)
- To follow the training schedule of internal medicine year three resident
- To perform all ward and emergency duties as per schedule set up by the Internal Medicine supervisor
- To attend all teaching activities
- To present at least two presentations at residents teaching activities
- To present at least one relevant article at the Journal Club during the period of rotation
- Doing diagnostic and therapeutic paracentesis and thoracocentesis.
Medical Oncology (3 months)
- To learn about chemotherapy regimens for various malignancies
- Administration of the chemotherapeutic agents
- To manage the side effects of systemic chemotherapy
- To know the antidotes of various drug reactions
- Management of febrile neutropaenia
- Management of medical oncology emergencies like tumor lysis syndrome etc
- To follow the schedule of medical oncology resident year three
- Resident will follow the full Medical oncology curriculum and goals will be achieved in three months
- To present at least two presentations at the weekly residents discussion session
- To present at least one relevant article at the Journal Club.
Pathology (2 months)
- To know the steps of gross examination of the specimens of common tumors e.g. breast, colon, lung, gynaecology, head and neck
- H&E staining of slides
- To attend daily interdepartmental consultation meetings
- To do FNA and to prepare the slides
- To learn the bone marrow biopsy procedure
- To know the principles of management of haematological malignancies
- To attend two clinics per week
- To follow the haematology resident year three schedule
- To manage the common haematological conditions.
Diagnostic Radiology (6 weeks)
- Interpretation of Plain X-rays e.g. chest x-ray PA and lateral views, x-rays of abdomen and of bones
- Interpretation of X-rays with contrast e.g. Barium
- CT Scan techniques and interpretation with and without contrast
- MRI techniques and interpretation of the films and reporting
- Indications and relevant use of Ultrasonography with special reference to Oncological practice
- To spend full time with radiology resident and to follow the full schedule of resident year three
- To be rotated with section heads of all sections of Radiology Department
- To attend the CT guided and US guided biopsy procedures.
Nuclear Medicine (6 weeks)
- To know the basic principles of doing all the diagnostic scans related to oncology. Like bone scan, thyroid scan, MUGA scan brain and liver scans
- To know the dosages of isotopes used for each scan
- To learn all aspects of the management of patients treated with radioactive iodine for thyroid cancers.(This includes aspects of radiation protection as well.)
Anaesthesia (2 weeks)
- To be attached with the consultant anaesthetists managing the paediatric and gynaecology patients
- To know the protocols of giving anesthesia for procedures like during paediatric radiation therapy and D&C of gynaecology patients.
Psychiatry (2 weeks)
- To learn the basic principles of distress management in cancer patients
- To learn various aspects of dealing with psychiatric patients suffering from cancer
- To attend at least four psychotherapy sessions during this two weeks rotation
- To learn psychological aspects of breaking bad news to the family of a cancer patient
- The resident are expected to give a presentation after the completion of this rotation covering areas like anxiety, depression, why me phenomenon, body image disturbances, short and long term psychological support of cancer patients.
As per clinical training requirement, the option of elective training rotations would be discussed with the trainee and the same would be arranged in appropriate departments.
Department of Radiation Oncology recruits all its staff on the basis of open competition and merit. The first step of hiring a resident is an open advertisement in the print media. Residents are recruited in accordance with the policies prepared by the Interns and Residents Committee.
All the existing AKUH Human Resources policies would be followed throughout the recruitment process.
The applicant must hold an MBBS degree and a 12 months house job/internship certificate. S/he should have already cleared the FCPS-Part I in Radiology.
Applicants are then subjected to appear in an MCQ exam, conducted by PGME (postgraduate medical education) department. This exam will be conducted on an annual basis.
The successful candidates will then be shortlisted and called for an interview. Two separate examiners, who also score separately, interview the candidates. Selected candidates are asked to attend a three-day orientation programme arranged by PGME.
Dr Nadeem Abbasi
MBBS(Dow),FFR,RCSI(Dublin),CCST(UK),CCST(Eire), DRT Planning(Brussels)
Head, Department of Radiation Oncology & Chief Radiation Oncologist
Director, Residency Programme
Dr Nasir Ali
MBBS Punjab; FCPS Pakistan; Radiation Oncologist
Residency Programme Coordinator
Dr Khursheed Khan
MBBS,FCPS Pakistan, Radiation Oncologist