Dr S.S. Solanki MD (Radiation Oncology ) Consultant , Radiation Oncology “BA” Lilaben Chimanlal Parikh Cancer Centre, Navsari , Gujrat
Topic for this presentation Facilities at Ba cancer Centre Self developed “Electronic Medical Record System” How we practice Radiation therapy- Immobilization, planning and plan execution. Systematic review of Patients treated in year 2011.
Facilities to offer At PresentDiagnostic- CT Scan, X Ray facility, USGLaboratory- Simple lab testTherapeutic- Radiation Oncology including External Beam Radiotherapy (IMRT and 3D CRT) and Brachytherapy. Future ProposalChemotherapy unit, Surgical unit, Image Guided Radiotherapy.
No. of Pathological test done 200 180 160 140 120 Average 100 80 60 40 Total Pathological test done- 1696, 20 Avg Pathological test -106 per mth 0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 nav-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 No of PathoTest 10 61 74 98 138 114 93 184 124 117 151 109 112 104 122 85
Therapeutic Units External Beam Radiotherapy. Linear Accelerator from Varian Medical System (Clinac iX)Total no patients treated till date –396No of Patients on Radiotherapy -35Total patients in planning process –16 Total =447 Brachytherapy Unit (Nucleotron’s Microselectron)Total no. of patients treated- 32Total no. of session of Brachy- 92
External Beam Radiation Therapy unit Head Gantry Couch
Bending magnate Tungsten target Electron gunBeam flattening device Ion chamber Asymmetrical jaws Multileaf collimator Electron Acceleration tube
Case Sheet- Page 1 page 569 "BA" Smt L. C. Parikh Cancer Centre, Navsari, Gujarat-396445 Date 25/04/2012 Reg.No. LCA1049 RT No. Patients Name Anarsingh Ratiramsingh Tevatia Father/Husbands Name Ratiramsingh Tevatia Age & Sex 76 Years Male Birth Date. Address Opp. Police head Quarter AbramaVAlsad Religion Hindu Marital Status Married Citizenship Indian Birth Country Mobile self 9820134043 Passport No. First Name of Contact(Mobile) 9724902926 contact/Relationship E-mail ID. Reffered From Dr. Parimal Lad Original Complaints :- Pt is K/ case of CA Past History :- No H/O HTN, DM rectum Post op , new developed brain mets First O/E - DR Parimal Lad - 24/03/2012, P/A - growth in rectum lower Examination with margine in 3.5 - 4cm from anal verge, post wall margin high Dig. Previous CT Abdomen ( 17/03/2011) - 6-7cm of lower rectum shows Investigations diffusecircumferential heterogeneous thickening max thickening - 17 done (Imaging) mm, paracolic infiltration with multipale Nodes. Biopsy with Date Bx - 21/803/2011 => well diff adenocarcinoma ICM Codes (description) Previous Sx - 26/03/2011 => Dr. Parimal Lad - abdomino perineal resection. Treatment Per op - circumferential growth of lower rectum 3-5cm from anal Recived. verge. Extending 5cm, adviced adjuvant EBRT + chemo. Pt had not taken. In Apr 2012 C/O. severe headache walking difficulty, left side weakness, MRI Brain - 11/04/2012 - multiple lung mets, tru cut biopsy from lung - 21/04/2012 - metastatic adenocarcinoma.Actual File EMR Sheet
Case Sheet page 2 Histopatho Report well diff adenocarcinoma recutam with date :- Site tumor involve full thickness of wall to external fat 31/03/2011 Desai lab Tumor Surat Size Margin Status cut margine free Invasion LVI - 1 Nodal Examined 7/10 Level Involvem Largest ent (cm) ECE Comment s Post Present status treatment days Present Complaints Present Examination :- GC stable pallor - ve, No neurological deficiency, P/A soft colostomy by on left side abdomen. Final Diagnosis Ca rectum with brain mets T3N2M0post op Stage IV RT Decision palliative EBRT Plan Dose/Site 30 Gy / 10 # Planning Technique Conv Time Period 2 weeks Indications for Radiation Therapy Brain metastasis Expected Reaction Alopacia Comments Advices :- to be taken for EBRT. CT Scan for RT planning(27/04/2012) --> 3.6x2.2cm lesion in right high frontal region with surrounding edema,. 1.7x1.6 cm nodular lesion in right temporal region . S/O - metastasis. Consent For RT Taken/Not Taken Dr Surendra Singh Solanki MD Consultant, Radiation OncologyActual File EMR Sheet
Files on Desktop for RecordFiles on Desktop for Record Daily Backup of files into hospital’s Gmail Account
OPD 2 All patients recordOPD 2 All patients record
Good Immobilization Practice Immobilization is a team effort involving Radiation technologist, CT technician, Nursing staff, ward boys Supervised by medical physicist and radiation oncologist.
Good Immobilization Practice Multiple hand support Siemens’ Somatom SpiritLAP LASERs All in one Base plate
Good Immobilization Practice Proper laser Alignment Blue marking- CT marks Red marking- treat marks at LA Indexed Carbon Couch
Good Immobilization PracticeSelf Designed Vac-Lok Support (by Amol) Vac-Lok for Pelvis and abdomen cases
2nd Step- CT images in TPS Treatment planning system
3rd step Precise Target marking and field Placement. Conventional Radiotherapy - square or rectangle fields 2 or 3 fields 3Dimentional Conformal Radiotherapy- MLC based Multiple Fields to conform target IMRT- Intensity modulate during movement of MLCs with 7-9 fields optimize the doses to target
First Day –Set up Verification Marking on Orfit CT scan by blue pen= Set up origin in 3 D coordinates(x=0,y=0,z=0) Field centre = Isocentre (new point in CT scan images) The shift from set up origin to isocentre is called isocentre shift. After that shift we mark new point with red ink
Average No. of Patients on LA 30 0 35 40 45 5 50 10 20 15 25 Jan-11Feb-11Mar-11Apr-11May-11Jun-11 Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12 Conv IMRT 3DCRT Diff. RT Practices + Avg Pt on LA Palliative Average pT
Average Patients on Linac Avg Patient per month Average No. of Patients on LA 50 40 30 20 10 0 Aug-11 Jan-12 Jul-11 Feb-12 Jan-11 Feb-11 Jun-11 Dec-11 Oct-11 Apr-12 Apr-11 Sep-11 Nov-11 Mar-12 May-12 Mar-11 May-11 Jan- Feb Mar Apr May Jun- Jul- Aug Sep Oct Nov Dec Jan- Feb Mar Apr May 11 -11 -11 -11 -11 11 11 -11 -11 -11 -11 -11 12 -12 -12 -12 -12Avg Patient per month 4.6 22. 37. 36. 36. 36. 32. 44. 39. 44. 40. 34. 28. 31. 31. 28. 36
Side Effect analysis During weekly review patients in quantify for side effects of radiation therapy and its recording. 27 side effects are being investigated Also taking their picture of radiation side effects esp skin
S.S. Solanki1 , M. Loganathan1, R. Swathika’ 1 ,Amol Palaskar1 , Boniface Chettri1 , Jyoti Pokale 1 , P.B. Lad2 1Department of Radiation Oncology, 2Department of Onco-Surgery, “BA” Lilaben Chimanlal Parikh Cancer Centre, Navsari , Guj
Introduction Computerization of medical record of patients is one of the key to access the information in least time. To keep patient’s data at par with good institutes, we use our own self developed Electronic Medical Record System in form of Microsoft’s Excel sheets in our day to day activities. This study is being conducted to show how the medical data is recorded and analyzed at our centre for the year 2011.
Objectives To find number of patients treated for curative and palliative intent. To find how many patients completed radiation therapy for their prescribed doses. To find present status of patients in terms of alive and lost to follow up through record search and phone calls. To find overall survival in months for Radiotherapy in year 2011.
Material and Methods:In the year 2011, a total of 325 patients were enrolled for Radiotherapy. All information about patients details were first written on case sheet then typed on Microsoft’s excel sheet specially prepared for medical records. (Fig 1& 2- excel sheet for data). Treatment decisions were taken to treat patient for radiation therapy on clinical grounds for curative intent (radical, post op or Adjuvant EBRT) or for palliative intent( bone metastasis, brain metastasis, or haemostatic EBRT). All Patients were immobilized with Thermoplastic Cast (ORFIT Industries) and CT scans done (Siemens Emotion Sprit) for planning purpose on flat indexed Carbon Couch (Civco) with help of All in one Base plate (POCL). (Fig 3)
Material and Methods: Patients were planned on Eclipse treatment planning system (version 8.9) (Fig. 4) All patients were treated on Varian’s Clinac iX Linear Accelerator daily for 5 days a week. (Fig.5) Weekly OPD review for side effect analysis and adequate treatment was offered for their problems. (Fig 6.)All Patients were given treatment summary after their completion of EBRT from the record.Patients are advised to come on follow up every 2-4 monthly in first year.
Material and Methods:To find present status of patients , they were called on mobilein the month of March and Apr 2012 and their status regardingalive with disease free or with disease progression was noted.The analysis was done only for those patients who havecompleted radiotherapy as per prescribed doses.The data was analyzed for treatment completion, overallsurvival and average survival in alive.For Overall survival months were found between date ofevaluation to date of registration.
Results-Major groupsTable 1. EBRT Data Survival Figures Incomp Complete Complet Alive Median No RT Alive Alive Lost toMajor Groups Enrolled lete d ed (dis. survival started ( with dis.) (Total) Follow up EBRT EBRT EBRT Free) (months) 288 8.35 (1.36-Curative intent- 6 25 257 257 177 25 202 55 (88.61%) 14.63) 37 7.90 (3.60-Palliative intent 1 1 35 35 0 12 12 23 (11.38%) 13.90) 325 7 26 292 292 177 214 8.32 (1.36- 78 Total 37 (12.67%) (100%) (2.1%) (8%) (89.8%) (100%) (60.6%) (73.28%) 14.63) (26.7%)
Results- Soft Tissue Sarcoma Table 13 EBRT Data Survival FiguresSarcomas- Median No RT Incomp. Complete Complete Alive(Ds. Alive (with Alive Lost to Bone and Enroll. survival started EBRT EBRT EBRT Free) Dis) (Total) Follow upSoft Tissue (months)Soft tissue 2 10.56 (8.6- 0 0 2 2 2 0 2 0 sarcoma (100%) 12.53) 2 2 2 2 10.56 (8.6- Total 0 0 2 (100%) 0 0 (100%) (100%) (100%) (100%) 12.53) Results- Pediatric tumors Table 14 EBRT Data Survival Figures Median Pediatric No RT Incomp. Complete Complete Alive(Ds. Alive (with Alive Lost to Enroll. survival Tumors started EBRT EBRT EBRT Free) Dis) (Total) Follow up (months) Ewing 1 0 0 1 1 1 0 1 6.33 0 sarcoma (50%) CNS- 1 pediatric 1 0 0 0 0 0 0 0 0 (50%) tumor 2 1 1 1 1 Total 0 1 (100%) 0 6.33 0 (100%) (50%) (50%) (100%) (100%)
ConclusionsIn one year of Radiation practice at Ba Cancer Centre wehave tried our level best to ensure good radiation practice forour patients. Overall 292/325 (89.8% ) of patients were able to completetheir radiotherapy as per prescribed doses.From curative intent group 214/325 (78.3%) patients are stillalive.Median survival of all alive Patients were 8.32 months (range1.36-14.63)
Charges at present Ba Cancer Centre Any Pvt centreConventional 26,000/- 50,000/- toRadiotherapy 80,000/-3D Conformal 31,000/- 75,000/-toRadiotherapy 1,00,000/- Intensity 51,000/- 1,15,000/- to Modulated 1,50,000/-Radiotherapy Palliative 10,000/-,15,000/- 30,000/-,45,000/-Radiotherapy
Take home message Option of a Good Radiation therapy centre is opened for the people of Surat and nearby areas in form of Ba Cancer Centre, Navsari Electronic Medical Record System makes this centre working smoothly. We offer world class Immobilization, radiation Planning and Delivery methods. Economically less burden to patients