Radiation therapy is an important cancer treatment in India. The document discusses radiation therapy infrastructure and practices in India, with a focus on the state of Karnataka and the Kidwai Memorial Institute of Oncology in Bangalore. It outlines the services provided at the institute, including teletherapy using linear accelerators and brachytherapy. Medical physics plays a key role in quality assurance and safety. The institute aims to acquire more advanced equipment and improve safety standards and education.

1. Radiation Therapy in India Dr. V. Lokesh M.D Dr. T.R . Arul Ponni Kidwai Memorial Institute of Oncology, Bangalore

2. 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,

3. 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

4. Radiation Therapy - India Teletherapy Cobalt – 60 : 246 Cesium-137 : 09 Linear Accelerator : 44 Brach therapy LDR : 37 HDR : 46 I/C : 76 ISB : 28

5. Radiation Protection Infrastructure Bhabha 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

6. 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

7. Karnataka State

8. 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.

9. Kidwai Memorial Institute of Oncology

10. 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

11. 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

12. 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

13. 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

14. Mould Room Styrofoam Cutter : 2 Thermoplast Water Heater : 1 Perspex Cast Unit : 1 Tissue Compensators : Aluminum Cerrobend Alloy Melting Unit : 1

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. Thank You

22. Acknowledgements IAEA KAERI Dr. Oliver Dr. Lillien Other Participants