Training, Education, & Staffing: Focus on low & m - PowerPoint PPT Presentation

Training, Education, & Staffing: Focus on low & m iddle-incom e countries ( I ndia as a case exam ple) KA Dinshaw , T.Gupta & S K Shrivastava Professor & Head, Departm ent of Radiation Oncology Tata Mem orial Centre, Mum bai, I NDI A

Introduction Cancer in India : Current scenario (2000-2008) Assuming a population of 1.2 billion people � 1 million new cases; 2.5 million prevalent cases; 0.6 million deaths (IARC) � Relatively young cancer population as per the existent age pyramid (NCRP) � Tobacco-related cancers – large burden (40% in men & 25% in women) (ATLAS) � Cervix still the leading cancer in women across the country (ICMR; NCRP) � Breast cancer has overtaken cervix in urban metropolitan registries (ICMR) � Less than 400 teletherapy units in the entire country presently (RP&AD, BARC) � 2/3 rd of cancer patients need RT i.e. 650,000 patients / year � Only 1/3 rd of these estimated patients actually receive RT (major shortfall)

Projections for future (2015-2020) � Doubling of the cancer incidence in next 15 years (WHO) � Ageing population with consequent increase in cancer incidence & prevalence (WHO; ICMR; NCRP) � Huge shortage of RT infrastructure (equipment and human resource) to meet recommended norms (IAEA; WHO)

Growth of teletherapy infrastructure in India over the years 300 250 Co-60 : 2 7 9 200 U N 150 I T S 100 LA: 1 1 4 50 0 1960 1980 1985 1990 1995 2000 2005 2008 Co-60 LA

Barton et al, Lancet Oncol 2004

Radiation Oncology Infrastructure Gap between demand and supply Parameter Current Existing Ideal Scenario* Practical Shortfall (international norms) Recommendation Equipment Tele-density 0.33 per million 2 per million population 0.5 per million 0.17 per million population population Tele-units 393 teletherapy 2400 600 207 units units Personnel Radiation 800 (1 per 825 2640 (1 per 250 patients 1320 (1 per 500 520 Oncologist patients annually) annually) patients annually Medical 550 (1 per 1200 1650 (1 per 400 patients 1320 (1 per 500 770 Physicist patients annually) annually) patients annually) Dosimetrist Nil 660 (1 per 1000 patients 1 per RT centre 660 annually) RT 750 (2 per MV 9600 (4 per MV units) 1800 (3 per MV unit) 1050 Technologist unit) * I deal scenario ( ACR guidelines) 8 w orking hours per day; 2 5 -3 0 patients per day per teletherapy unit Average: 5 w eeks of XRT treatm ent ( radical & palliative) ; 5 0 w orking w eeks/ year 2 5 0 -3 0 0 patients per teletherapy unit per year; 6 6 0 ,0 0 0 patients need RT every year

Current RT training infrastructure in India • Number of recognized MD (Radiation Oncology) seats: 52 per year • Total number of active/practising Radiation Oncologists: 800 approximately • Number of Diploma in Radiological Physics pass-outs: 16 per year (average) • Number of MSc in Medical Physics pass-outs: 17 per year (average) • Total number of practising medical physicists: 550 only • Number of seats for training in RT technology: 60 per year • Number of seats for RT dosimetrists; NIL • Total number of practising RT Techs: 750 approximately

Manpower: Capacity Building Radiation Oncologists � Increase number of centres offering MD-Radiotherapy (secondary & tertiary level) � Increase the number of MD-Radiotherapy seats in existing tertiary referral centres � Stop running MD-Radiotherapy courses in centres not fully equipped Medical Physicists � Increase post MSc DRP seats � Mandatory 6-month internship for DRP students in tertiary referral centres � Introduce and promote PhD courses at tertiary referral centres Radiotherapy Dosimetrists/Technologists � Increase number of seats in exclusive training courses for RT technologists � Introduce training courses for dosimetrists � Mandatory 3 mth internship for all RT technologists/dosimetrists in clinical radiotherapy department at either a secondary or tertiary level centre

Equipment/Infrastructure Proposed 3-Tier Network Prim ary Referral RT centre Secondary Referral RT centre Tertiary Referral RT centre Networking via Tele-Medicine

Summary for improving radiotherapy infrastructure

Thank You Look at the middle column! Where does it end?