RADIATION THERAPY DEPARTMENT

WHAT IS RADIATION THERAPY?

Radiation Therapy department services are clinical
specialties devoted to the treatment of patients with
cancer and other tissue growths. It is basically a tissue
destroying procedure.

Radiation therapy most often uses X-rays, but protons or

other types of energy can also be used.

The term "radiation therapy" most often refers to external

beam radiation therapy. During this type of radiation, the
high-energy beams come from a machine outside of your
body, however in brachytherapy procedure radiation is
placed inside your body.
External Radiation

Internal Radiation
 To obtain an optimal balance between delivering a high dose to target volume
and a low dose to intervening tissues.

Localized treatment i.e.to kill the cancer cells at the location.

Also be used as palliation, or palliative care, which is aimed at reducing

symptoms but not curing the underlying disease.

Medical Expert Role: Present cases in a clear, concise, integrated, and

OBJECTIVES problem based manner.
Communicator Role: Develop rapport and healthy therapeutic alliance with
patients and family members.
Collaborator Role: Work collaboratively with primary care physicians to
ensure continuity of care upon discharge.
Manager Role: Learn how to effectively “get things done” in a timely and
complete manner within the hospital.
IMPORTANCE OF RADIOTHERAPY

Radiation therapy or radiotherapy is mainly used to destroy cancer

cells and slow tumor growth while limiting the harm to nearby healthy
tissue. Sometimes, doctors recommend radiation therapy as the first
cancer treatment.

When it is not possible to destroy all the cancer, doctors may use
radiation therapy to shrink tumors and relieve symptoms (palliative
radiation therapy). Hence it helps to improve a person’s quality of life.

For many people, radiation therapy eliminates the existing cancer. This
benefit is greater than the small risk that the treatment could cause a
new cancer in the future.
 RADIOLOGY NO RADIOLOGY

5-year local recurrence 7% 26%

(BCS)

5-year local recurrence 6% 23%

(post-mastectomy)

15-year mortality (BCS) 30.5% 35.5%

15-year mortality 54.7% 60.1%

(post mastectomy)
STRUCTURAL PLANNING Architecture: One of the most important influences of a
medical department is its architecture. Spaces which
are being planned for handling emotions of a person
must be sensitive to people inhabiting the hospital,
short term or long duration, either way. Interior design
spaces are to be intended for ease, calm, peace,
comfort, assurance and uplifting of the senses.

At the same time, these must be appropriate in image

and cost; rightly suiting the context (patient, religious
sentiments if any) of the society and/or the
stakeholders. Even the comfortable aspects applicable
to doctors, staff, nurses, technicians, who visit the
hospital for the services must be included in developing
the language of the architecture of such spaces.

A good practice is to amalgamate ecology and

environment as improved healing effects of the natural
surroundings is a definite upshot.
 LOCATION
The department must be carefully located, conforming to BARC’s mandatory shielding requirements as a
protection against radiation, a basement floor plan is most suitable, the location should have 3 foot thick walls
and ceilings and required access for the placement and removal of equipment. It should be so located that it
doesn't block future expansion plan. Ideally it should be on the ground floor close to the outpatient department,
the department should be close to the vertical transport facilities.

The basement floor plan: In leveled land plots or plains, constructing the Radiotherapy department in basements
is ideal. For basement bunkers, a hatch in the road should be planned in advance to lower the LINAC equipment
from ground level; and the entire Radiotherapy department should be developed on that same level of basement
preferably.
 A radiotherapy unit can be divided into a few transitional
zones:

Z • Public zone comprises a reception area (the control

O station) and a waiting area for family members (after

N patient is taken into patient zone)

• Patient zone consists of a changing room for patient and
I a waiting area for the patient before he/she is taken into

N treatment zone.
• Treatment zone is the area where patient receives
G radiotherapy.
• Treatment Planning zone is where doctors sit (preferably
2D LAYOUT
 DESIGN CONSIDERATIONS
Accessibility- Design should provide ease of access for wheelchair bound patients in all patient areas
including Reception desk, Consult, Interview, Mould fittings rooms and Radiation Treatment bunkers.
Waiting areas should include spaces for wheelchairs and suitable seating for patients with disabilities
or mobility aids.

Doors - All entry points, doors or openings requiring bed/trolley access including Radiation Therapy
and Procedure Rooms are recommended to be a minimum of 1400 mm wide, unobstructed. Larger
openings may be required for special equipment to allow the maneuvering of equipment without manual
handling risks and risk of damage. Within workshop and appliance room areas, the number of doors
should be kept to a minimum to facilitate the movement of equipment; double doors should be provided
to all workshop areas.
 CONT.

Ergonomics - Heights and depths of benches and workstations in the radiation treatment area
need to allow staff to efficiently work from standing and seated positions. The emergency stop
button should be placed within easy reach of attending staff.

Size of the Unit - The size of the Radiation Oncology Unit will be determined by the Clinical
Services Plan establishing the intended services scope and complexity. In a satellite facility,
where cancer services are collocated, two Radiotherapy Treatment rooms (bunkers) is the
minimum viable number.
 SPACE REQUIREMENTS
Serial No. Rooms Area covered

1. Reception 10 m sq

2. Waiting Area 20 m sq

3. Toilet (Public) 4 m sq

4. Offices (2 persons ) 12 m sq

5. Records 8 m sq

6. Meeting Room 15 m sq

7. Consultation Room 14 m sq

8. Mould room workshop 20 m sq

9. Toilet ( patient ) 4 m sq
 Serial Rooms Area Covered
No

10. Simulator Room 40 m sq

11. Simulator Control Room 17 m sq

12. Treatment Room 128 m sq

13. Treatment Control Room 17 m sq

14. Cleaner’s Room 5 m sq

15. Store- Equipment 10 m sq

16. Staff Room 20 m sq

17. Clean Utility Room 12 m sq

18. Dirty Utility Room 12 m sq

LINEAR ACCELERATOR BIG BORE CT SCANNER

TOMO THERAPY ACTIVE BREATHING COORDINATOR

CT SIMULATOR
BIG BORE CT SCANNER

BRACHYTHERAPY

VARIAN
TRUEBEAM
 PROCESS FLOW
The process of radiation therapy will be customized for patients,
depending on which form of radiation therapy patients and their
physicians choose as their options. Overall, there are five basic steps
of radiation therapy.

Initial Consultation : Consul­tation is the first step of the radiation

therapy process. This involves an appointment with a radiation
oncologist, who reviews a patient’s medical records, pathology reports
and radiology images and performs a physical exami­nation.

Simulation: Following the patients initial consultation, you will

undergo a “simulation” process. The simulation allows the radiation
oncologist to define the exact location and configuration of the
treatment for cancer or tumor. “Immobilization” devices such as mesh
masks or form-fit body molds to maintain body position the same on a
day to day basis.
Treatment planning: This step of the radiation process involves the
radiation oncologist, the physicist and dosimeters. Using the CT scan
images (and a MRI or PET, if needed), they work together to design the
field of radiation therapy treatment. The focus of treatment planning is
to deliver a high dose of radiation to the tumor while limiting the dose
received by surrounding tissue that is normal.

Treatment Delivery: On the first day of treatment, the patient is placed

in the position for treatment using immobi­lization devices that might be
necessary for them. Radiation therapists are responsible for positioning
the patient and for delivering the radiation dose prescribed by the
radiation oncologist.

Post Treatment Follow-Up: Upon completion of your treatment, a follow-

up appointment will be scheduled to monitor the recovery and overall
health of our patients. Additional diagnostic tests may be ordered.
INTER-DEPARTMENTAL CORRELATION
• The definition of interdepartmental is between more
than one department. When the
marketing department and the
engineering department come together in a joint effort
to design a product, this is an example of
an interdepartmental effort. 

• Since most patients are outpatients and ambulatory,

proximity to or easy accessibility from the outpatient
department is important. The department should also
be close to vertical transport facilities. Radiation
therapy is best located where it will adjoin the earth on
several sides and has no department..
ORGANIZATION
 POLICIES AND SAFETY REGULATIONS
Various policies issued by BARC-

1.Radiation symbol or Warning sign: - The radiation symbol or

warning sign shall be prominently displayed at all time-
a)on externally visible surfaces of radiation equipment, and containers
for storage of radioactive materials.
b) at the entrance of controlled area and supervised area

2. Nomination and approval of Radiological safety officer-

The Radiological Safety Officer shall: a) carry out routine
measurements and analysis on radiation and radioactivity levels in the
controlled and supervised area.
(b) investigate any situation that could lead to potential exposures

3. Modification of radiation installation or change in

working condition:-
No modification to an existing radiation installation or no change in
working conditions therein, affecting safety shall be done without the
prior approval of the competent authority.
GENERAL RADIATION SAFETY

In most cases for systemic radiation

treatment, the safety precautions that
should be followed are-
1. Wash your laundry separately from the
rest of the household, including towels and
sheets.
2. Drink extra fluids to flush the radioactive
material out of your body.
3. Flush the toilet twice after each use, and
wash your hands well after using the toilet.
4. Avoid contact with infants, children, and
women who are pregnant for a specific
amount of time.
5. Use separate utensils and towels.
● Radiation therapy typically takes treatment sessions
five days a week for 1 to 10 weeks. The total number
RADIATION
of treatments depends on the size and type of cancer.
Each session usually takes about 10 to 30 minutes.
THERAPY
Often, the individual is given each weekend off from
therapy, which helps with the restoration of normal
PROCEDURE
cells.

● Radiation therapy involves the use of a linear

accelerator machine, which directs radiation at the
appropriate spot. The machine may move around the
table in order to direct the radiation at the appropriate
angles.

● You should feel no pain during this test. You’ll also be

able to communicate with your team via the room’s
intercom, if necessary. Your doctors will be nearby
in an adjacent room, monitoring the test.
 RADIATION
THERAPY
PROCEDURE
 It is expected that patient's medical records reflect the need for care/services
provided. The listing of records is not all inclusive. Providers must ensure all
DOCUMENTATION necessary records are submitted to support services rendered. They may
REQUIREMENTS include:

● Physician/Non Physician Practitioner (NPP) signed treatment plan.

● Practitioner and physician progress notes.

● Radiation oncologist review of dose-volume histograms for all targets

and critical structures.

● Signed and dated CT or MRI images of the target and all critical
structures.

● Diagnostic tests, radiological reports, lab results, pathology reports, and

other pertinent test results and interpretations to support diagnosis.

● Documentation of dosimetric verification of treatment setup and

delivery, signed by both the radiation oncologist and the medical
physicist.
 ACCIDENTS
A Radiation Accident is an unintended event, including operating errors,
equipment failures or other mishaps, the consequences of which are not
negligible from the point of view of protection or safety.

Types:
1. External : can results either in whole body exposure , partial body
exposure or localized skin exposure.

2. Radioactive contamination :
• External : External Radioactive contamination occurs from spillage of
RAM on skin or other extremities of body.
• Internal : Internal Radioactive contamination occurs most often as a
result of inhalation/ingestion of RAM in finely divided form
 PROBLEM SITUATIONS/
MANAGERIAL ISSUES

 Inefficient scheduling

 Lost charges

 Superfluous technicians

 Lack of patients at certain times of the day

 High percentage of down time of radiation

therapy machines
WHAT IS NUCLEAR MEDICINE???

The introduction of nuclear techniques in medicine has led to the

evolution of a new branch of medicine called Nuclear Medicine.
This branch utilizes radio pharmaceuticals for the diagnosis of
certain diseases, their follow-up and detecting recurrence. It also
treats certain diseases using radiopharmaceuticals.

Nuclear medicine are of 2 types –

In-vivo procedures and In-vitro procedures.

Some of the important applications of nuclear medicine are-

imaging of various organs such as heart, thyroid, liver, brain, bone,
kidney, etc.,
● In-Vivo: These procedures involve administration of radioactive (low-level)
isotopes, also called “radioisotopes”, to patients wherein they consume the
medicine - which then help in imagining of their internal parts & organs for
diagnosis.
● In-Vitro: in such procedures, the radioisotopes are added to any samples
collected from the patient.
● Examples of use cases of Nuclear medicine are for imagining of internal parts of
the body, investigations of the nervous system, and function studies of various
organs.
● A Gamma camera is mainly used for performing function studies while using
nuclear medicine.
 NUCLEAR MEDICINE
OBJECTIVE

Upon completion of training a resident is expected to function

independently as a nuclear medicine specialist with the ability to advice
on, supervise, perform and interpret imaging and non imaging diagnostic
procedures and perform therapy with unsealed radioactive sources to a
level of competence sufficient to function a consultant physician.

The residents must have developed professional attitudes appropriate to

a lifetime career in Nuclear Medicine, requires knowledge skills, and
attitudes for effective patient centered care and service to diverse
population.
 LOCATION & DESIGN OF NUCLEAR
MEDICINE DEPARTMENT

● Since the clinical departments benefits from the usage of nuclear

medicine, the nuclear department should be ideally placed at a
central location.
● Nuclear medicine involves dealing with hazardous radioactive
particles, so a department implementation must be planned such that
there is no exposure of radiation to staff and the public.
● Care should be taken to design the department in a way that
facilitates proper disposal of radioactive material used for nuclear
medicine.
DESIGN AND LAYOUT OF NUCLEAR
MEDICINE DEPARTMENT
WASTE MANAGEMENT LAYOUT
ORGANIZATION AND STAFFING
 CHALLENGES/PROBLEM
Technical challenges
S
Government Support
1. Local unavailability of radioisotope and 1.Fund
kits
2. Electricity Supply 2.Government need to
3. Infrastructure and equipment
4. Information Technology increase allocations to health
5. Radiation Safety
6. Radioactive waste management sector

Human resources challenge

Challenge to patient and their caregivers
1. Referring clinicians
1. Cost of nuclear medicine
2. Training and research in nuclear
2. 2. Quality of care / inadequacy of
medicine
nuclear medicine facilities
THANK YOU