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  1. 1. REGIONAL COOPERATIVE AGREEMENT INTERNATIONAL ATOMIC ENERGY AGENCY IAEA/RCA Consultants’ Meeting & Validation Workshop on the Applied Sciences of Radiation Oncology (ASO) Pilot Course RCA PROJECT RAS/6/033 WITH THE PARTICIPATION OF AFRA AND ARCAL Kuala Lumpur, Malaysia 31 January – 3 February 2005 Background This distance learning project was conceived by RCA to address severe shortages in trained radiation oncology personnel, and in particular a lack of teaching resources in the Applied Sciences of Radiation Oncology in many Member States. A project formulation meeting was held in Kuala Lumpur in December 1999 under IAEA Technical Cooperation Project RAS/6/027. Representatives of ARCAL and AFRA attended this meeting, as the concept also had applicability in their regions. The meeting decided that interactive teaching material on the Applied Sciences of Oncology (ASO) would contribute to the solution of the problem. The project coordinating group devised an initial list of eight subjects, comprising 64 modules within those subjects, to cover the most important educational deficiencies. A program to cover seven years was developed. It included: - • Development of English-language materials • Validation by expert review • Piloting of the materials in 3 countries in RCA and countries in AFRA and ARCAL. • Ongoing review • Translation and • Implementation In 2001 this project was approved for continuation under the new project designation RAS/6/033. In June 2003 the 2nd Project Coordinators Meeting (PCM) in Seoul, Republic of Korea, reviewed the development of the course, critically evaluated the content of the teaching materials to that date via a beta-version CD-ROM and planned activities for the 2003/2004 biennium and beyond, including the conduct of the pilot course in 2004. ras6033doc2637.doc Page: 1
  2. 2. PILOT COURSE 2004 The ASO course was piloted in three RCA Member States (MAL, PAK, PHI), two AFRA Member States (EGY, MOR) and two ARCAL Member States (ARG, URU). Twenty-five students participated in the pilot, including two students from Costa Rica who were studying in Argentina. Copies of the Pilot CD were sent direct to the National Course Coordinators (NCCs) of participating countries in January 2004, for distribution to individual students. At the request of the IAEA, supporting reference texts for each host institution were bulk-purchased in Australia and shipped to the relevant UNDP offices in the participating countries in early March. Unfortunately not all the texts reached their intended institutions. In particular, the delivery to Pakistan was mislaid in the UNDP Office in Islamabad and eventually reached the NCC two months late, and then only after considerable effort had been expended to trace it. Some books had been given away by UNDP staff to other Pakistani institutions not involved in project RAS/6/033, and have not so far been recovered. (It appears that the UNDP is not always the most secure supply channel). Egypt also experienced problems with textbook supply. Further revision of the course material was halted at the end of December 2003 to permit the course to be piloted as planned during the 2004 academic year. The module count increased from 68 at the time of the 2nd PCM in 2003 to 71 modules and sub-modules in the Pilot CD-ROM. In part this increase was to achieve a better content layout. As well, certain large modules were split into two so that each part could be completed in a (nominal) one-hour period. A list of the modules on the two CD-ROMs is provided at Appendix 1. The few modules that could not be finalised in time were issued as interim modules on the Pilot CD. In consequence, a Supplementary CD-ROM was issued in November 2004 which updated all but two of the interim modules and incorporated various improvements, including progress tracking and bookmarking, to solve technical problems reported by students during the earlier part of 2004. Assurances had previously been given that each student would have a dedicated IBM-format desktop PC or laptop computer available to them, and consequently the Pilot CDs were configured for single use. However some students were obliged to share equipment and as a result experienced difficulties with automated progress recording. This matter was also addressed in the Supplementary CD, which demonstrated multi-user programming. Monthly progress reports were sought from participants; however the conduct of the course was characterised by poor reporting by a number of students. A contributing factor was the need for many students to study in their own private time due to clinical demands, despite earlier promises of quarantined study time. All students who participated in the workshop in Kuala Lumpur (KL) met the 80 per cent completion prerequisite set for meeting attendance. However not all had fully completed the pilot course by this time. The main reason for this was late starting due to: • the Malaysian academic year beginning in July, and • a very few students replacing initial nominees part way through the year. As well, the use of English language in the pilot course provided an additional level of complexity for the French and Spanish speakers. Despite this challenge, all ARCAL participants completed the course by the time of the meeting in KL. It is noteworthy that the Spanish speaking students in ARG studied as a group, and provided combined progress reports. This may prove a valuable model for those course participants in the future for whom English is a second language. ras6033doc2637.doc Page 2
  3. 3. CONSULTANTS’ MEETING & VALIDATION WORKSHOP Purpose of the Consultants’ Meeting and Validation Workshop: The main purposes of the meeting were: (1) To review the conduct and efficacy of the ASO distance learning pilot course, (2) To provide pilot students with supplementary training on the ASO, and (3) To provide feedback and recommendations as to improvements in the course material. Pre-meeting student survey A pre-meeting questionnaire was circulated to students in early December 2004 to identify areas where they felt they would personally benefit from additional teaching and discussion on the eight subject areas. They were also asked to rate each subject on ease of use of the course material, relevance of content, and depth of knowledge. Responses from twelve participants (8 individuals and one group of four who studied together) were received in sufficient time for academic faculty to focus their teaching and discussion sessions. Two further responses received shortly prior to the meeting supported the intended emphasis. Pre-workshop feedback (9 responses, 12 students) 3.04.34.0Functional anatomy 3.04.43.9Communications 3.34.03.9Molbiol/pathology 3.44.13.6Systemic therapy 3.64.33.6Patient care 3.65.02.6Radiobiology 3.74.72.5Physics 3.43.92.3Critical appraisal Depth of knowledge Relevance of content Ease of use Ease of use: 1= difficult; 5 = easy Relevance of content: 1 = Irrelevant; 5 = Very relevant Depth of knowledge: 1 = Too superficial, 3 = Just about right, 5 = Too detailed Critical Appraisal, Physics and Radiobiology were felt to be the hardest subjects. This is not surprising as much of the content is unfamiliar to many clinicians. However the overall relevance was rated highly and depth of knowledge was considered appropriate for all subjects. It was encouraging that even though some students found certain subject areas challenging, there was overall satisfaction with both course content and depth. For full details of all 14 responses see Appendix 2. Some quotes from the students offer a qualitative picture of the value of the program. • “(The modules are) an eye opener to us that radiation oncology is not just prescribing radiation but part of a multi disciplinary approach to further research in order to provide better survival to patients and (to emphasise the importance of) primarily prevention.” ras6033doc2637.doc Page 3
  4. 4. • “(We would benefit from supplementary teaching on) communication issues in different cultures, because there is marked difference between the roles that we are sticking to and those mentioned in the module.” • “This (Critical Appraisal) module is very helpful because it helps us analyse journals and studies more objectively. The subjects contained in this module were also not taught formally in our medical school.” • “Would be better if there are more radiological examples (in Functional Anatomy modules) to aid us (to) identify lesions & abnormalities” • “Analgesia is too difficult; the rest (of Patient Care) is easy.” • “I think many of us will benefit from a workshop on the new (Medical Physics) techniques eg. IMRT, SRS & SRT” Meeting organisation Our host Dr Fuad Ismail of Hospital Universiti Kebangsaan Malaysia (HUKM), in cooperation with the Government of Malaysia through the Universiti Kebangsaan Malaysia (UKM), provided coordination, an excellent and cost-effective venue at the Vistana Hotel Kuala Lumpur and all necessary support services. At the initiative of Dr Fuad, each participant was provided with a CD-ROM at the end of the meeting, containing copies of all teaching materials, presentations and official and unofficial meeting photographs. We are sure that this will prove to be a valuable resource for all who attended. Meeting participants The meeting was attended by 23 of the 25 pilot course participants from the seven participating member states in RCA, AFRA and ARCAL, and by their National Coordinators. Technical Experts from Australia, the IAEA Technical Officer and Academic Faculty from the host country Malaysia facilitated the teaching and workshop sessions over the four days. A full list of meeting participants and their affiliations is attached at Appendix 3. Meeting activities Following the welcome by the Academic Consultant, Dr Barton, and the representative of the Host State, Dr Fuad, the Technical Officer Mr Hendry provided an introduction to the role of the IAEA and raised some issues regarding the format of the CD-ROM. The Academic Consultant and Regional Course Coordinator reviewed the project to date. The bulk of the meeting activities were given over to learning and review activities as detailed in the attached program at Appendix 4. A great deal of enthusiasm for the course was shown by meeting participants. They confirmed that the Supplementary CD-ROM issued in November 2004 had provided substantial improvements in functionality over the Pilot CD issued in February 2004, removing many of the technical nuisances that could not be resolved in time to meet the 2004 project deadline for the earlier version. It was very disappointing that the intended Presentation Ceremony to the student participants was not possible, due to the non-arrival of the Certificates of Completion from Vienna. When located and countersigned by the Academic Consultant, these will be posted to students from Sydney. ras6033doc2637.doc Page 4
  5. 5. Findings The following findings were agreed unanimously by the National Coordinators at the conclusion of the Meeting. 1. Students participating in the pilot course were a representative cross-section of trainee radiation oncologists, at a similar educational level both within and between countries. 2. Students showed competent knowledge at Part 1 level, a result due both to the contents of the two CDs and to the reference texts provided by the IAEA. 3. Student feedback was overwhelmingly favourable. Specific items noted include:- a) Overall a good course, suitable for the teaching of others. b) Best undertaken at start of specialist training. c) Some or all of the ASO course was done at home because of time pressures at work, so a set of texts for every participant is desirable. d) An additional text is needed for Critical Appraisal/Epidemiology. e) Translations must include appropriate reference texts in the relevant languages. f) The ASO course should be accompanied and supported by a website. 4. Amendments of both academic and technical nature are needed to the Pilot CD to fill in information gaps, to make specific corrections, and to cull superfluous content. See Appendix 5 for details. 5. There is a need for a limited number of extra course modules (see recommendations below) 6. The representatives of AFRA and ARCAL recommended that the course material should be translated into French and Spanish. National Coordinators also noted that there may be a case for translation into other languages such as Chinese and Russian, and perhaps Korean given the advanced state of electronic learning in the Republic of Korea, but such a recommendation was well beyond the scope of the present meeting and should be taken up at the 3rd PCM later in 2005. 7. The workshop in Kuala Lumpur was useful to the pilot students. 8. Material in the two CDs is already being used to train other students in the pilot countries. 9. Malaysian academic faculty at this meeting found the course material was useful and appropriate. ras6033doc2637.doc Page 5
  6. 6. Actions The following actions were agreed unanimously by the National Coordinators at the conclusion of the Meeting. ACTIONS Responsibility 1. Part 1 pass rates of students who did and did not participate in the course should be compared. RCC, AC, NCCs 2. Existing course material should be revised as specified in the detailed revision sheets that will be published following the KL meeting. RCC, authors, MediWorld 3. Technical problems should be corrected, with functionality at least up to the standard of the Supplementary CD. RCC, MediWorld 4. The list of reference texts should be reviewed with particular attention to texts in other languages. All 5. Existing IAEA reports, TecDocs, etc should be reviewed and incorporated into the CD as appropriate. Kron 6. Web-based resources should be investigated, to determine if/when it might be appropriate for the ASO course to partly or fully migrate to the Internet. Fuad 7. All RCA National Project Coordinators should now receive copies of the two interim version CD-ROMs. RCC Recommendations 1. The Applied Sciences of Radiation Oncology distance learning course should be adopted, disseminated and translated. 2. For the course to be of most benefit, students should be in their first year, or at least no later than their second year of training for the speciality of Radiation Oncology. 3. There should be additional modules added to the existing course content, refer Appendix 6. 4. A web-based resource should be made available. 5. All RCA National Project Coordinators should be invited to the third Project Coordinators Meeting, which should be held in Manila in the second week of November 2005. 6. Member States should be invited to use the existing course material on an interim basis. 7. AFRA and ARCAL should set up projects to translate and implement the CD-ROM based ASO course. 8. Use of the CD in other professions, eg medical physics, should be investigated. ras6033doc2637.doc Page 6
  7. 7. Next meeting The meeting recommended that the 3rd PCM be held in Manila, the Philippines, in the second week of November, namely the week of 7th to 11th November. It was noted that November is a popular time for medical conferences in Manila, so a booking would need to be made as soon as possible. Dr Vega will investigate possible venues and advise with some urgency. Proposed AGENDA for 3rd PCM 1. Review of ASO distance learning program – aims and design 2. Review of pilot course 3. Implementation of the ASO course:- a. In RCA b. In other Regions 4. Possible ASO website 5. Translation(s) 6. Technical considerations (DVD, etc) 7. Maintenance and Update strategy 8. Continuing Professional Development (CPD). The course permits Radiation Oncologists etc to undertake refresher courses, and may represent an avenue for ongoing funding of the course beyond usual IAEA/RCA funding timescales. 9. Incentives for students to participate in and complete the ASO course. This would probably be on a country by country basis, depending on individual circumstances, and might involve the requirement of a completed ASO distance learning course before students would be permitted to sit Part 1. ras6033doc2637.doc Page 7
  8. 8. APPENDICES ras6033doc2637.doc Page 8
  9. 9. Appendix 1 ASO English-language pilot course, 2004 Pilot CD-ROM Subject/module name Supplementary CD-ROM Communications COM-Intro COM-1 Breaking bad news 1 COM-2 Communication with patients 1 COM-3 Communication issues in different cultural settings 1 COM-4 Communication with colleagues 1 Critical Appraisal CRI-Intro CRI-1 Cancer epidemiology 1 CRI-2 Searching for evidence 1 CRI-3 Clinical trial designs 1 CRI-4 Critical appraisal of studies of treatment 1 CRI-5 Survival analysis 1 CRI-6 Patient-based endpoints in clinical trials 1 CRI-7 Systematic review & meta analysis - benefits & pitfalls 1 UPDATED CRI-8 Clinical decision analysis 1 CRI-9 Prognostic indices 1 Functional Anatomy FUN-Intro FUN-1 CNS and peripheral nerves 1 FUN-2 Head and neck I 1 UPDATED FUN-3 Head and neck II 1 UPDATED FUN-4 Lung and thorax 1 FUN-5 Gastrointestinal 1 REPLACED FUN-6 Genitourinary 1 FUN-7 Gynaecological anatomy 1 FUN-8 Anatomy of the breast 1 FUN-9 Lymphatics 1 Molecular Biology, pathology and pathogenesis MOL-Intro MOL-1 Genes and cancer 1 MOL-2 Colorectal and breast cancer 1 UPDATED MOL-3 Pathology: molecular diagnosis and new diagnostic techniques 1 UPDATED MOL-4 Infections associated with malignancy 1 MOL-5 Familiar aspects of cancer 1 ras6033doc2637.doc Page 9
  10. 10. Patient Care PAT-Intro PAT-1 Part 1 Analgesia - Part 1 1 PAT-1 Part 2 Analgesia - Part 2 1 PAT-2 Bones, bisphosphonates and hypercalcemia 1 PAT-3 Symptom control 1 PAT-4 Infections in the cancer patient 1 Physics and radiation technology PHY-Intro PHY-1 Radioactivity 1 PHY-2 Photon generation 1 PHY-3 Photon Interactions with matter 1 PHY-4 Electron beam generation and interactions 1 PHY-5 Dosimetry of ionising radiation 1 PHY-6 Photon beam radiotherapy treatment planning 1 PHY-7 Intensity modulated radiotherapy (IMRT) 1 PHY-8 Computers in radiotherapy 1 PHY-9 Stereotactic radiosurgery (SRS) and radiotherapy (SRT) 1 PHY-10 Brachytherapy techniques 1 PHY-11 Radiation protection 1 PHY-12 Quality assurance 1 REPLACED PHY-13 Dose reporting 1 PHY-14 Intro Introduction - Advanced treatment aids 1 PHY-14a Dynamic wedge 1 PHY-14b Multi-leaf collimators (MLC) 1 PHY-14c Organ motion and patient immobilisation 1 PHY-14d EPIDs 1 PHY-14e Tomotherapy 1 PHY-14f Proton radiotherapy 1 Radiobiology RAD-Intro RAD-1 Principles of X-ray therapy 1 RAD-2 Acute effects 1 RAD-3 Late effects 1 RAD-4 Tumours 1 RAD-5 Fractionation 1 RAD-6 Treatment time effects 1 RAD-7 Dose rate effects 1 RAD-8 Molecular effects and apoptosis 1 RAD-9 Interactions with chemotherapy and chemical modifiers of radiation response 1 ras6033doc2637.doc Page 10
  11. 11. Systemic therapy SYS-Intro SYS-1 Principles of cytotoxic treatment 1 SYS-2 Cytotoxic drugs: mechanisms of action 1 REPLACED SYS-3 Administering chemotherapy 1 SYS-4 Acute complications 1 SYS-5 Late complications 1 SYS-6 Alkylators/platinums/antibiotics 1 REPLACED SYS-7 Antimicrotubule agents and epipodophyllotoxins 1 SYS-8 Anti-metabolites 1 SYS-9 Endocrine therapy 1 SYS-10 Immunomodulators and anti-growth factors 1 SYS-11 Preclinical drug development 1 TOTAL 71 ras6033doc2637.doc Page 11
  12. 12. Appendix 2 ASO Pre-workshop feedback - December 2004 Subject Learning module Ease of use Relevance of content Depth of knowledge Individual comments & topics to emphasise 1= difficult; 5 = easy 1 = Irrelevant; 5 = Very relevant 1 = Too superficial, 3 = Just about right, 5 = Too detailed n Average n Average n Average GENERAL: I really appreciate the modules because it serves as an eye opener to us that radiation oncology is not just prescribing radiation but a part of multi disciplinary approach to further research in order to provide better survival to patients and primarily prevention Number of replies = 11 (14 respondents from all 7 countries; one response from group of four students) Communications 10 3.9 10 4.5 9 3.1 Median = 3.5 Median =5 Median = 3 Range = 2.5 - 5 Range = 3 - 5 Range = 3 - 4 Cultural differences for me is the major obstacle in dealing with a lot of patients specially in the Philippines were there are a lot of nationals (Chinese , Caucasians, Koreans etc).Most of the time especially among Filipinos, the relatives instruct the caregiver and doctors not to inform patients regarding the situation. This module is truly an eye-opener for me because the subjects contained here were not taught to us in medical school. This is very practical. Breaking bad news Communication issues in different cultures, because there is marked difference between the roles that we are sticking to and those mentioned in the module Critical Appraisal 10 2.4 9 4.0 9 3.5 I believe more discussion about evidence based medicine would be very beneficial Median = 2.5 Median =4 Median = 3 Range = 1 - 4 Range = 3 - 5 Range = 3 - 5 ras6033doc2637.doc Page 12
  13. 13. During our training clinical epidemiology was the least of our priority which is supposed to be emphasized considering that treating cancer patients is based all on clinical trials. Sir, if you can emphasized on all these aspects. This module is very helpful because it helps us analyse journals and studies more objectively. The subjects contained in this module were also not taught formally in our medical school. Clinical trial designs Survival analysis Systematic review & meta analysis - benefits & pitfalls Functional Anatomy 9 4.1 9 4.4 10 3.1 Would be better if there are more radiological examples to aid us identify lesions & abnormalities? Median = 4 Median = 5 Median = 3 Everything is OK, no need for supplement. Range = 3 - 5 Range = 3 - 5 Range = 1 - 4 Head and neck I Head and neck II Genitourinary Gynaecological anatomy Molecular Biology, pathology and pathogenesis 9 3.9 9 4.2 8 3.3 All modules in subject (request by one participant) Median = 4 Median = 4 Median = 3 Range = 3 - 5 Range = 3 - 5 Range = 3 - 4 Patient Care 10 3.6 9 4.4 8 3.5 (Ease) Analgesia is too difficult, the rest is easy Median = 3.5 Median = 4 Median = 4 Range = 1 - 5 Range = 3 - 5 Range = 3 - 4 Patient and doctor’s education are the most important to emphasized especially in giving central acting drugs. Hearing the word Morphine from the doctor has a very high resistance from the patient because they think its addicting and they are terminal already. In the Philippines the usage of Morphine is very low because of lack of education and fear, sad to say both for the doctors and the patient. ras6033doc2637.doc Page 13
  14. 14. Physics and radiation technology 9 2.8 9 4.8 9 3.6 All modules (one participant) Median = 3 Median = 5 Median = 3 Dosimetry of ionising radiation Range = 1 - 5 Range = 4 - 5 Range = 3 - 5 Quality assurance I think many of us will benefit from a workshop on the new techniques eg. IMRT, SRS & SRT Radiobiology 9 2.8 9 5.0 9 3.4 Fractionation Median = 2 Median = 5 Median = 3 Treatment time effects Range = 2 - 4 Range = 5 - 5 Range = 3 - 5 Dose rate effects Systemic therapy 9 3.6 9 4.3 9 3.3 Median = 4 Median = 4 Median = 3 Range = 2 - 5 Range = 3 - 5 Range = 3 - 5 ras6033doc2637.doc Page 14
  15. 15. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Appendix 3 Consultants' Meeting and Validation Workshop Malaysia, Kuala Lumpur 2005-01-31 - 2005-02-03 List of Participants (as of 2004-12-06) 1 Australia Mr Barton, Michael Bernard Liverpool Health Service CCORE (Collaboration for Cancer Outcomes Research and Evaluation) Locked Bag 7103 Liverpool 1871 NSW Australia Tel.: +61 2 98286541 Fax: +61 2 98286670 Email: michael.barton@swahs.nsw.gov.au Mobile: +61 0409 466 255 2 Australia Mr Thode, Richard Liverpool Health Service CCORE (Collaboration for Cancer Outcomes Research and Evaluation) Locked Bag 7103 Liverpool 1871 NSW Australia Tel.: +612 98286669 Fax: +612 98286670 Email: Richard.Thode@swsahs.nsw.gov.au 3 IAEA Hendry, Jolyon Hindson , IAEA, NAHU 4 Argentina Mr Ferraris, Alfredo Enrique Instituto Municipal de Oncologia "Angel H. Roffo" Avenida San Martin 5481 1417 Buenos Aires Argentina Tel.: +54 11 45010091 Fax: +54 11 45013039 Email: aferraris@intramed.net.ar 5 Argentina Dr Lemoine, Gaston Instituto Municipal de Oncologia "Angel H. Roffo" Avenida San Martin 5481 ras6033doc2637.doc Page: 15
  16. 16. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology 1417 Buenos Aires Argentina Tel.: +54 11 45802805 Email: gaslemoine@hotmail.com 6 Argentina Dr Roth, Berta Maria Cristina Instituto Municipal de Oncologia "Angel H. Roffo" Avenida San Martin 5481 1417 Buenos Aires Argentina Tel.: +54 11 45802800 Fax: +54 11 47889984 Email: bertaroth@intramed.net.ar 7 Argentina Mr Blanco Saborio, Alejandro Jose Instituto Municipal de Oncologia "Angel H. Roffo" Avenida San Martin 5481 1417 Buenos Aires Argentina Tel.: +54 11 45029979 Email: a_blancos@hotmail.com 8 Argentina Dr Cordero, Johaksho Jose Instituto Municipal de Oncologia "Angel H. Roffo" Avenida San Martin 5481 1417 Buenos Aires Argentina Tel.: +54 11 45802805 Email: johaksho@msn.com 9 Egypt Mr Boutrus, Rimoun Cairo University National Cancer Institute Kasr El Ani Street Fom El Khalig Cairo 11796 Egypt Tel.: +202 364 5641 Fax: +202 364 4720 Email: remon99@yahoo.com 10 Egypt Ms Eissa, Heba Cairo University National Cancer Institute ras6033doc2637.doc Page: 16
  17. 17. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Kasr El Ani Street Fom El Khalig Cairo 11796 Egypt Tel.: +20 2 3645641 Fax: +20 2 3644720 Email: beba_eisa@yahoo.com 11 Egypt Mr Mostafa, Samy Cairo University National Cancer Institute Kasr El Ani Street Fom El Khalig Cairo 11796 Egypt Tel.: +202 364 5641 Fax: +202 364 4720 Email: elbadawy@hotmail.com 12 Australia Mr Kron, Tomas Peter MacCallum Cancer Institute Department of Physical Sciences Locked Bag 1, A’Beckett Street Melbourne VIC 8006 Australia Tel.: +61 3 9656 1907 Fax: +61 3 9650 4870 Email: Tomas.Kron@petermac.org 13 Malaysia Ms Abdul Malik, Rozita Jalan Universiti Universiti Malaya Medical Center Clinical Oncology Unit Kuala Lumpur 50603 Malaysia Tel.: +60 3 7950 2185 Fax: +60 3 7956 3072 Email: rozita@ummc.edu.my 14 Malaysia Mr Ismail, Fuad National University of Malaysia University Hospital Department of Radiotherapy and Oncology Jalan Yaacob Latif 56000 Kuala Lumpur ras6033doc2637.doc Page: 17
  18. 18. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Malaysia Tel.: +60 3 9702630 Fax: +60 3 9738908 Email: fuad@mail.hukm.ukm.my 15 Malaysia Dr Lee Wei Luen, Fabian Jalan Universiti Universiti Malaya Medical Center Clinical Oncology Unit Kuala Lumpur 50603 Malaysia Tel.: +60 3 7950 2185 Fax: +60 3 7956 3072 Email: flwl74@streamyx.com 16 Malaysia Dr Rashidi, Yang Jalan Universiti Universiti Malaya Medical Center Clinical Oncology Unit Kuala Lumpur 50603 Malaysia Tel.: +60 3 7950 2185 Fax: +60 3 7956 3072 Email: kid_creole71@yahoo.com 17 Malaysia Dr Wan Ishak, Wan Zamaniah Jalan Universiti Universiti Malaya Medical Center Clinical Oncology Unit Kuala Lumpur 50603 Malaysia Tel.: +60 3 7950 2185 Fax: +60 3 7956 3072 Email: zamachi@hotmail.com 18 Morocco Prof. El Gueddari, Brahim El Khalil Institut national d'oncologie Sidi Mohamed Ben Abdellah B.P. 6213 Rabat 10101 Morocco Tel.: +212 37 712484 Fax: +212 37 712469 Email: gued.ino@sante.gov.ma ras6033doc2637.doc Page: 18
  19. 19. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology 19 Morocco Ms Mesbah, Latifa Institut national d'oncologie Avenue Allal Al Fassi - Madinat Al Irfane Hay Ryad B.P. 6213 RI Rabat 10101 Morocco Tel.: +212 37 712484 Fax: +212 37 712469 Email: latifa.mesbah.1@caramail.com 20 Morocco Dr Nejjar, Ikrame Institut national d'oncologie Avenue Allal Al Fassi - Madinat Al Irfane Hay Ryad B.P. 6213 RI Rabat 10101 Morocco Tel.: +212 6207 3253 Fax: +212 3771 2469 Email: inejjar@caramail.com 21 Pakistan Dr Basit, Muhammad KRL Hospital Mauve Aiwane Sanato, Tijarat G-9/1 Islamabad Pakistan Tel.: +92 51 9261150 Fax: +92 51 9260616 Email: basitsaadia@yahoo.com 22 Pakistan Ms Javed, Nabeela Nuclear Medicine, Oncology & Radiotherapy Institute G-8/3 P.O. Box 1590 44000 Islamabad Pakistan Tel.: +92 91 9260115 Fax: +92 91 9260616 Email: Nabila_Javed@hotmail.com 23 Pakistan Dr Khan, Khurshid Ahmad Nuclear Medicine, Oncology & Radiotherapy Institute G-8/3 P.O. Box 1590 ras6033doc2637.doc Page: 19
  20. 20. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology 44000 Islamabad Pakistan Tel.: +92 51 9260615 Fax: +92 51 9260616 Email: khdajk123@yahoo.com 24 Pakistan Ms Mahmood, Humera Pakistan Atomic Energy Commission Nuclear Medicine, Oncology and Radiotherapy Institute (NORI) P.O. Box 1590 Islamabad 44000 Pakistan Tel.: +92 51 9260611 5 Fax: +92 51 9260616 Email: nori@isb.paknet.com.pk 25 Pakistan Dr Maken, Rab Nawaz Nuclear Medicine, Oncology & Radiotherapy Institute G-8/3 P.O. Box 1590 44000 Islamabad Pakistan Tel.: +92 51 9260615 Email: rnmaken@hotmail.com 26 Pakistan Dr Muhammad, Aun Nuclear Medicine, Oncology & Radiotherapy Institute Oncology Department G-8/3 P.O. Box 1590 44000 Islamabad Pakistan Tel.: +92 51 56133726 Email: doc_aun@hotmail.com 27 Philippines Dr Bagis, Faiqha Philippines General Hospital Taft Avenue Manila 1001 Philippines Tel.: +63 2 5234372 Fax: +63 2 5234372 Email: faiqhabagis@yahoo.com ras6033doc2637.doc Page: 20
  21. 21. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology 28 Philippines Dr Legaspi-Chavez, Lorelei Philippines General Hospital Department of Radiology Taft Avenue Manila 1001 Philippines Tel.: +63 2 5234372 Fax: +63 2 5234372 Email: iamelei@yahoo.com 29 Philippines Dr Malabanan, Michael Martin Makati Medical Center 2 Amorsolo Street Legaspi Village Makati City 1200 Philippines Tel.: +63 2 8933792 Fax: +63 2 8933792 Email: michaelmartinmalabanan@yahoo.com 30 Philippines Mr Rivera, Jesus Randy Jose Reyes Memorial Medical Center Rizal Avenue, San Lazaro Compound Tayuman, Santa Cruz Manila 1003 Philippines Tel.: +63 2 711 6939 Email: jrcrivera@yahoo.com 31 Philippines Dr Uy, Charito Saint Luke's Medical Center Radiation Oncology Department 279 E. Rodriguez Sr. Blvd. Cathedral Heights P. O. Box 700 Quezon City 1102 Philippines Tel.: +63 2 7275410 Fax: +63 2 7275410 Email: chuchieuy@yahoo.com 32 Philippines Dr Vega, Gaudencio P. University of the Philippines College of Medicine Philippine General Hospital ras6033doc2637.doc Page: 21
  22. 22. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Radiation Oncology Section, Department of Radiology Taft Avenue, Ermita 1000 Manila Philippines Tel.: +632 3723439 Fax: +632 5234372 Email: gvega@info.com.ph 33 Uruguay Mr Aguiar Vitacca, Sergio Andres Hospital "Pereira Rossell" Instituto de Radiologia y Centro de Lucha Contra el Cancer Bv. Artigas 1550 P.O. Box 6571 Montevideo 11600 Uruguay Tel.: +598 2 9004480 Fax: +598 2 5074042 Email: saguiar@adinet.com.uy 34 Uruguay Mr Leborgne Deus, Jose Honorio Centro Hospitalario Pereira Rossell H. Gutierrez Ruiz 1210 Montevideo, Centro 11100 Uruguay Tel.: +598 2 9003333 Fax: +598 2 9002111 Email: jleborgnedeus@adinet.com.uy ras6033doc2637.doc Page: 22
  23. 23. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Appendix 4 IAEA/RCA Consultants’ Meeting & Validation Workshop LOCATION: Kuala Lumpur, MALAYSIA DATES: 31 January to 3 February 2005 PARTICIPANTS: Overseas students 19 National Coordinators (excl MAL) 5 IAEA TC Officer/Radiobiology expert 1 Physics expert (T Kron) 1 Academic Consultant 1 Regional Course Coordinator 1 Subtotal (core participants) 28 PLUS: Local students 4 MAL National Coordinator (Fuad) 1 Local teaching faculty 5 TOTAL: 38 VENUE: VISTANA HOTEL No. 9, Jalan Lumut, Off Jalan Ipoh, 50400 Kuala Lumpur Tel. No.: +60-3-40428000 Fax No. : +60-3-40411400 Info: http://www.holidaycity.com/vistana-kl/ Map: http://www.holidaycity.com/vistana-kl/map.html <Hyperlinks checked 25 January 2005> ras6033doc2637.doc Page: 23
  24. 24. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Validation Workshop Sunday 30th Jan TIME MONDAY 31st Jan TUESDAY 1st Feb WEDNESDAY 2nd Feb THURS 3rd Feb Arrival of participants 0900 Welcome MBB Housekeeping Fuad Introduction to IAEA JHH SESSION - FUN Fuad SESSION - RAD-2 JHH SESSION – PHY-3 TK (Whole day) 1000 Pilot process RJT Discussion - FUN Fuad SESSION – CRI MBB Discussion - Additional modules & additional subjects MBB/TK 1030 BREAK BREAK BREAK BREAK 1100 SESSION - RAD-1 JHH SESSION – FUN (CT anatomy) AAR Course & CD-ROM feedback – RCC and pilot students RJT Presentation of Certificates of Completion JHH/Fuad SUMMARY & CLOSING 1200 Discussion - RAD JHH SESSION – SYS-1 GL SESSION – COM MBB/WS MEETING REPORT (National coordinators) 1300 LUNCH LUNCH LUNCH LUNCH 1400 SESSION - PHY-1 TK SESSION – SYS-2 GS Discussion- COM/CRI MBB / WS (incl non-Western approaches) 1500 Discussion - PHY TK Discussion - SYS GS/GL SESSION – PHY-2TK 1530 BREAK BREAK BREAK 1600 SESSION - PAT EH SESSION – MOL MRH SESSION – RAD-3 JHH Official Dinner - Vistana ras6033doc2637.doc Page: 24
  25. 25. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology SESSION AREA(S) OF EMPHASIS FACILITATOR 1. Radiobiology 1 Dose/treatment time/fractionation JHH 2. Discussion - RAD Feedback on Pilot CD modules Interaction/supplementary teaching as necessary JHH 3. Physics 1 Theory: Sources of radiation and interaction with matter TK 4. Discussion - PHY Feedback on Pilot CD modules Interaction/supplementary teaching as necessary TK 5. Patient care Analgesia; management of acute conditions MAL 6. Functional anatomy Cross-sectional anatomy CT/MRI/X-ray including abnormalities MAL 7. Discussion - FUN Feedback on Pilot CD modules Interaction/supplementary teaching as necessary MAL 8. Functional anatomy CT anatomy MAL 9. Systemic Therapy 1 General review MAL 10. Systemic Therapy 2 General review MAL 11. Discussion - SYS Feedback on Pilot CD modules Interaction/supplementary teaching as necessary MAL 12. Molecular biology General review MAL 13. Radiobiology 2 Dose-time-fractionation (continued) Tumour radiosensitisers JHH 14. Critical Appraisal Evidence-based medicine (hand out papers for appraisal on Monday) • Survival analysis • Meta-analysis • Decision analysis MBB 15. Course & CD-ROM feedback General discussion – Regional Course Coordinator and pilot students RJT 16. Communications Informed consent Communication with patients (Singapore medicolegal paper as pre-reading) MBB 17. Physics 2 Applied Medical Techniques: From brain to prostate TK ras6033doc2637.doc Page: 25
  26. 26. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology 18. Discussion – COM/CRI (incl non-Western approaches) Feedback on Pilot CD modules Interaction/supplementary teaching as necessary MBB/WS 19. Radiobiology 3 Normal tissue injury JHH 20. Physics 3 Advanced Techniques: Images & IMRT TK 21. Discussion - Additional modules & additional subjects What additional topics/subjects are needed in course? MBB/TK 22. Presentation of Certificates of Completion SUMMARY & CLOSING JHH/Fuad 23. MEETING REPORT National coordinators List of FACULTY LECTURER TITLE MODULE(S) MBB Michael BARTON Academic Consultant Critical appraisal Communications TK Thomas KRON Radiation Oncology Physicist Physics JHH Jolyon HENDRY IAEA Consultant Radiobiologist Radiobiology AH ABDUL HAMID Abdul Rashid Professor in Anatomy Functional anatomy GS G. SELVARATNAM Consultant Oncologist Systemic therapy WS WAN SALWINA Wan Consultant Psychiatrist Communication EH EDNIN Hamzah Palliative care consultant Patient care AAR AMRAN Abdul Rahman Consultant Radiologist Functional anatomy GL Gerard LIM Consultant Oncologist Systemic therapy MRH Mohd ROSLAN Harun Consultant Physician Molecular biology ras6033doc2637.doc Page: 26
  27. 27. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Appendix 5 ras6033doc2637.doc (Changes required in addition to simple corrections) Pilot CD-ROM Subject/module name Proposed amendments Communications COM General The Communications modules caused quite a lot of discussion during the 2nd PCM in Seoul in 2003, in particular the two modules on communications with patients. While an understanding of best practice communications in a “Western” context was considered useful and educative for RadOnc students, some country coordinators were concerned that such approaches were culturally and practically inappropriate in an “Asian” context. It also became apparent that there were differences in approach between different countries. It was proposed that after the pilot course in 2004, additional module(s) should be added that dealt with the different approaches of “Western” and non-Western cultures. During the pilot course itself, students showed interest in knowing about alternative communications approaches, although some felt that generally it might not be possible to adopt such practices in their own countries. One student comment in the pre-meeting survey was “Cultural difference for me is the major obstacle in dealing with a lot of patients especially in the Philippines where there are a lot of nationalities (Chinese, Caucasians, Koreans etc). Most of the time especially among Filipinos, the relatives instruct the caregiver and doctors not to inform patients regarding the situation.” Dr Wan Salwina, a Malaysian psychologist who presented to the KL meeting on Communicating Bad News, felt that the CD is very useful to raise awareness of issues including cultural stereotypes, and differences between persons from the same culture in different settings eg Chinese living in the USA compared to Chinese living in China. ras6033doc2637.doc Page: 27
  28. 28. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology COM-1 Breaking bad news 1 The WHO guidelines on Communicating Bad News (1993) handed out by Dr Wan Salwina talk about three models of communication:- • No disclosure • All disclosure • Individualised disclosure QUERY: Is this document a possible additional resource? Subsequent to the KL meeting, we have learned that these guidelines have not been updated since their release in 1993. The guideline document is part of a series of WHO Behavioural Science Learning modules that are no longer being issued. Therefore, the use of other more recent resources should be examined. COM-2 Communication with patients 1 The meeting discussed cultural and educational differences, as the current modules are quite “Western” oriented  decision that additional module(s) are NOT required; ADD explanation that module discusses various examples etc in different settings. The intent is to sensitise students to cultural differences/issues. There are many variations within cultures, including different levels of education, as well as between cultures ADD section on use of interpreters to cultural module – interpretation is a potential problem for satisfactory communications, especially when translation is by family members. DISCUSS relatives desire to protect patient from bad news. NB It is always possible to ask patients how much they WANT to know. COM-3 Communication issues in different cultural settings 1 COM-4 Communication with colleagues 1 Additional COM material ADD pre-reading to Communications modules? • Michael Barton noted that there is a new emphasis on legal, regulatory and ethical concepts, including informed consent, and practitioners need to be suitably trained. A new module is proposed, which should include medico-legal issues related to informed consent (see separate list of proposed additional modules) • A second new COM module, targeted at junior doctors is proposed, addressing practical skills needed to control workload and prevent burnout, and on how to cope with death & dying, including an understanding of the concept of stages of grief. ras6033doc2637.doc Page: 28
  29. 29. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Critical Appraisal CRI General Many students had only limited exposure to epidemiology & Evidence Based Medicine in Medical School, and found this subject area fairly hard going but valuable. An additional module on medical writing was proposed (under COM, not CRI), which should also serve to enhance students’ understanding of and competence to appraise journal articles, guidelines, etc. CRI-1 Cancer epidemiology 1 CRI-2 Searching for evidence 1 CRI-3 Clinical trial designs 1 Pre-meeting feedback requested additional teaching in KL on clinical trial design CRI-4 Critical appraisal of studies of treatment 1 CRI-5 Survival analysis 1 Pre-meeting feedback requested additional teaching in KL on survival analysis CRI-6 Patient-based endpoints in clinical trials 1 CRI-7 Systematic review & meta analysis - benefits & pitfalls 1 Pre-meeting feedback found this module difficult, requested additional teaching in KL CRI-8 Clinical decision analysis 1 Pre-meeting feedback found this module difficult, requested additional teaching in KL. CRI-9 Prognostic indices 1 Functional Anatomy FUN All modules Pre-meeting feedback requested extra teaching in KL, covering cross-sectional anatomy and radiographic imaging (CT/MRI/X-ray). Additional modules on imaging were proposed (see under Physics). General need for some restructuring of anatomy modules. • Greater emphasis on radiographic images, in particular CT; possibly fewer diagrams • Arrows: improve accuracy of interactive arrow placement (?as CT instead of diagram?); should labels be listed alphabetically, or remain random?; • Consider placing diagram and CT next to each other on a single screen; then zooming image of interest • More landmarks for planning, incl surface anatomy (skin) • Provide markers on radiographic images (R, L) • MCQ answer “The author disagrees” bothered at least some students, as there was no explanation WHY the author disagreed (also see RAD). ras6033doc2637.doc Page: 29
  30. 30. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology • Berta Roth: ESTRO site has many good anatomical images available • Amran Rahman would be happy to make his extensive slide-sets on cross-sectional anatomy available for any future module(s) on normal vs pathological states. FUN-1 CNS and peripheral nerves 1 FUN-2 Head and neck I 1 Considered too complex by some students (eg all the branches of facial nerves); more emphasis requested on H&N lymphatics (here or in FUN-9?) Perhaps provide hyperlink to RTOG atlas of H&N. FUN-3 Head and neck II 1 FUN-4 Lung and thorax 1 FUN-5 Gastrointestinal 1 FUN-6 Genitourinary 1 FUN-7 Gynaecological anatomy 1 FUN-8 Anatomy of the breast 1 FUN-9 Lymphatics 1 Still an INTERIM module, needs to be completed (Need more H&N lymphatics, here or in FUN-2&3) Molecular Biology, pathology and pathogenesis Overall depth & breadth is OK, according to A/Prof Roslan Harun, who conducted teaching session on MOL. He would like to see more diagrams in some modules. MOL-1 Genes and cancer 1 Still an INTERIM module, needs to be completed MOL-2 Colorectal and breast cancer 1 MOL-3 Pathology: molecular diagnosis and new diagnostic techniques 1 Harun would like more basic pathology eg H&E stains, epithelial, LCA etc. Asks would it be useful to have a guide to diagnosis of undifferentiated tumours? What is clinical relevance of test(s)? eg HER_2 for treatment, E6 and E7 proteins confer resistance to radiation, etc MOL-4 Infections associated with malignancy 1 MOL-5 Familiar aspects of cancer 1 When reviewing familial cancer module prior to his presentation in KL, Harun found it quite difficult to understand. He notes that a few examples are laid out poorly within the CD, and it would be much better to have family tree graphs beside text on SAME screen. ras6033doc2637.doc Page: 30
  31. 31. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Patient Care PAT-1 Part 1 Analgesia - Part 1 1 Need to simplify module on analgesia. Opioid-responsive and opioid-resistant. Address opioid-“phobia” especially in some developing countries Address availability & cost of drugs eg morphine not available in some locations (in India?) Compliance. [Add neuropathic pain ladder? To match WHO opioid ladder] PAT-1 Part 2 Analgesia - Part 2 1 PAT-2 Bones, bisphosphonates and hypercalcemia 1 PAT-3 Symptom control 1 PAT-4 Infections in the cancer patient 1 Physics and radiation technology PHY-1 Radioactivity 1 PHY-2 Photon generation 1 PHY-3 Photon Interactions with matter 1 PHY-4 Electron beam generation and interactions 1 PHY-5 Dosimetry of ionising radiation 1 Pre-meeting feedback from pilot students requested additional teaching in KL on dosimetry. PHY-6 Photon beam radiotherapy treatment planning 1 NB: 50 % to 60% of meeting delegates have routine access to CT for planning PHY-7 Intensity modulated radiotherapy (IMRT) 1 Discussion of IMRT “bandwagon”. Pushed too hard too early by equipment manufacturers prior to EBM studies. Comment from Brahim El-Gueddari: need to go slowly in developing world, until have good QA culture, etc, else can do WORSE using high tech equipment. NB Need for back-up/alternatives in case of linac breakdown. PHY-8 Computers in radiotherapy 1 PHY-9 Stereotactic radiosurgery (SRS) and radiotherapy (SRT) 1 PHY-10 Brachytherapy techniques 1 ras6033doc2637.doc Page: 31
  32. 32. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology PHY-11 Radiation protection 1 PHY-12 Quality assurance 1 Pre-meeting feedback requested additional teaching in KL on QA and verification. Tomas Kron canvassed four different approaches to a useful QA module:- • General overview of QA principles (ISO approach, used in current ASO module) • General overview of QA in XRT (ESTRO approach) • Accident prevention and dosimetry (IAEA approach) • Examples of specific QA activities (AAPM approach) A chain of quality is needed throughout a department, equipment QA is not enough. Discussion as to whether an additional QA module was needed. At some point we go beyond the Applied Sciences and start addressing clinical practice, which is NOT the purpose of this course  NO to additional module, make ADDITIONS to existing one, incl:- • Training & qualifications, and HR issues • External audit of clinicians’ performance • Module should summarise info in embedded IAEA TecDoc ADDITIONAL RESOURCE: Jolyon Hendry advises that the IAEA is planning a QA Symposium in Radiation Medicine for November 2006, and its Proceedings will be a useful extra QA text/resource that can be added during a future update of the ASO CD. PHY-13 Dose reporting 1 PHY-14 Intro Introduction - Advanced treatment aids 1 Pre-meeting feedback requested additional teaching in KL in new techniques (valid also for modules on IMRT and SRS/SRT) All modules on advanced techniques need to be reviewed by authors, as most were written in 2001 or 2002. PHY-14a Dynamic wedge 1 PHY-14b Multi-leaf collimators (MLC) 1 PHY-14c Organ motion and patient immobilisation 1 PHY-14d EPIDs 1 PHY-14e Tomotherapy 1 PHY-14f Proton radiotherapy 1 ras6033doc2637.doc Page: 32
  33. 33. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Radiobiology Student feedback is that because of a lack of teachers in developing world, this is a particularly important subject area. Needs to be simplified but contain more content. ARG student commented that CD helped considerably as background to recent IAEA Teaching course on Radiobiology in Buenos Aires. REFERENCE TEXT: There was a discussion on Hall vs Steel as the more appropriate reference text for radiobiology. This was not resolved, and will be raised again in Manila. Hall is comprehensive and covers radiobiological aspects of radiology and protection, as well as radiation oncology. Steel is directed solely to radiation oncologists, and is written by teachers on the ESTRO radiobiology course. Steel is more recent (2002) than Hall (2000), slimmer, and cheaper. Both have particular attributes, and perhaps both could be recommended. Other books, more introductory in nature e.g. Nias, are now getting somewhat out of date (pre 2000). General agreement that a new module to provide a mathematics refresher including aspects needed for LQ modelling would be helpful; (see under Physics). MCQs: answer “False” or “The author disagrees” bothered at least some students, as often there was no explanation WHY the author disagreed (also see FUN). Regarding techniques and methodologies, it was recommended to study these in the textbooks rather than to extend or plan new modules. RAD-1 Principles of X-ray therapy 1 RAD-2 Acute effects 1 RAD-3 Late effects 1 Should include that some agents now available that alleviate late effects, at least in pre- clinical models eg ACE inhibitors, AII blockers, PUFAs, PTX. It should be noted that late effects do not stop appearing at 5 years. ADD: Retreatment. RAD-4 Tumours 1 Add info on some new radiosensitisers e.g. EGFR blockers, Cox-2 inhibitors. RAD-5 Fractionation 1 In Pre-meeting feedback, pilot students advised that they found this module difficult and requested additional teaching in KL. Jolyon Hendry believes this module needs extra material, and examples of fractionation calculations would be useful. RAD-6 Treatment time effects 1 Pre-meeting feedback requested additional teaching in KL on treatment time effects ras6033doc2637.doc Page: 33
  34. 34. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology RAD-7 Dose rate effects 1 Pre-meeting feedback requested additional teaching in KL on dose rate effects RAD-8 Molecular effects and apoptosis 1 Pre-meeting feedback requested additional teaching in KL on molecular effects. Suggestion that this module needs additional info on apoptosis, and /or glossary entries with diagrams to cover apoptosis, necrosis, reproductive/mitotic cell death. RAD-9 Interactions with chemotherapy and chemical modifiers of radiation response 1 Systemic therapy Too detailed for some students  ACTION: separate or identify high-level content, incl pre- clinical drug development (module SYS-11). More consideration of interactions with XRT SYS-1 Principles of cytotoxic treatment 1 More drug interactions and interactions with ?chemotherapy SYS-2 Cytotoxic drugs: mechanisms of action 1 SYS-3 Administering chemotherapy 1 SYS-4 Acute complications 1 Craig Lewis wishes to update this module as there are several new developments in clinical management (e-mail 30 July 2004) SYS-5 Late complications 1 SYS-6 Alkylators/platinums/antibiotics 1 ?Diagrams in wrong sequence? SYS-7 Antimicrotubule agents and epipodophyllotoxins 1 SYS-8 Anti-metabolites 1 SYS-9 Endocrine therapy 1 SYS-10 Immunomodulators and anti-growth factors 1 SYS-11 Preclinical drug development 1 TOTAL FOR REWORK ras6033doc2637.doc Page: 34
  35. 35. IAEA/RCA Distance Learning Project: Applied Sciences of Oncology Appendix 6 ASO additional modules - proposed KL, 3 Feb 2005.doc Subject/module name Proposed content Communications COM-5 Informed consent 1 COM-6 Burnout (& coping with dying) 1 Burnout of RadOncs and its impact; coping with dying COM-7 Medical writing 1 Medical writing for journals Critical Appraisal CRI-10 Economic analysis 1 Basic economic analysis, including equipment decisions Functional Anatomy No additions requested Molecular biology, pathology and pathogenesis No additions requested Patient Care PAT-5 Nutrition/cachexia/fatigue 1 Physics and radiation technology PHY-15 Imaging using ionising radiation 1 CT/PET PHY-16 Imaging using non-ionising radiation 1 MRI/ultrasound PHY-17 Image handling 1 Image fusion, window levels, DRRs PHY-18 Maths for the maths-phobic 1 Basics of physics, radiobiology, statistics and error (uncertainty) Radiobiology RAD-10 Second cancers 1 Especially protection aspects <link from radiation safety module> Systemic therapy No additions requested TOTAL 10 ras6033doc2637.doc Page: 35

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