Division of Radiation Oncology
Department of Interdisciplinary Oncology
H. Lee Moffitt Cancer Center & Research Institute
at the University of South Florida (USF)
Introduction
The goals of the training program are to provide interdisciplinary care for new and established patients, develop and conduct clinical research trials that focus on radiation as the modality of treatment, establish collaborative links with appropriate basic science programs, and provide educational programs and training. In addition, it will provide comprehensive, patient-oriented care for all types and stages of cancer using the most technically advanced equipment with concern for quality of life and education. Physicians and staff provide state-of-the art patient care while striving to blend compassion, technology and advanced techniques.
The program will provide a scholarly environment for acquiring cognitive and technical skills, and to provide extensive supervised training and education so residents can acquire special skill and knowledge while encompassing the newest techniques with focus on a multidisciplinary approach to patient care. Scholarly attributes of self-instruction, teaching, skilled clinical analysis, sound judgment and research creativity is strongly emphasized. Training faculty will inspire all residents to develop and maintain a lifetime commitment to continued learning and expansion of their knowledge and wisdom, and to disseminate their knowledge and wisdom to other physicians, non-physician health care professionals and patients through maintenance of personal outcome data.
Clinical Structure
No fewer than 36 months of the four‑year program will be spent in the core curriculum in Radiation Oncology. During each clinical rotation at each of the training institutions, residents will be supervised and instructed on a one-to-one basis by a faculty member who is responsible for both resident teaching and evaluation of resident performance during that rotation. Residents will participate in all aspects of Radiation Oncology in all disease-sites, and in pediatric radiation oncology. Residents will receive training in the clinical treatment planning of benign and malignant disease, treatment delivery, multidisciplinary approach to patient care, supportive care, medical physics, dosimetry, brachytherapy, simulation, port film evaluation, radiation safety, and radiobiology. Throughout the duration of the residency program, residents will receive cumulative experience in adult medical oncology, pathology and radiology through exposure to multidisciplinary treatment conferences, weekly radiology case conferences, and combined modality treatment protocols.
The resident’s initial training will focus on the area of clinical evaluation, history and physical, staging, and patient management. Individual mentoring from staff radiation oncologists through didactic curriculum, clinical rounds, tumor conferences and clinical presentations will be provided. Consultations will be evaluated by the resident and presented to the attending staff physician. The resident and attending staff physician will discuss the evaluation and treatment recommendations. Following the consultation, the resident will be responsible, with staff supervision, for directing the treatment of the patient, including treatment planning, evaluation of the dosimetry, and on-treatment visits. Staging and treatment recommendations will be discussed in a didactic session between attending physicians and residents for each patient including simulation, planning CT, verification, or brachytherapy at a later time. During the course of treatment planning, the indications and techniques of treatments will be discussed between the attending and resident physician. In addition, patient cases will be discussed at the weekly chart review meeting.
Senior residents (chiefs) will also be responsible for accepting referral consultations when called in by the residents from the medicine and surgical services. This process will increase the interactions between the services at the resident level, and teaches or provides learning experience in the consultation and referral process. This will also apply when radiation oncology residents are assigned to obtain a consultation or referral evaluation with another service on a patient whom they are responsible for following or during radiotherapy treatment.
Residents will benefit from interactions with other residents from programs such as Otolaryngology, Pathology, Medical Oncology, Surgical Oncology and Radiology. Radiation Oncology resident physicians will interact daily with resident and attending physicians from other departments and services in the day-to-day practice of clinical patient care.
Treatment Modalities
Resident will receive training in all aspects of Radiation Oncology technology, including but not limited to the following:
Ø Three Dimensional Computerized Radiation Therapy (3D CRT)
Ø Intensity Modulated Radiation Therapy (IMRT)
Ø Image Guided Radiation Therapy (IGRT)
Ø Tomotherapy
Ø Stereotactic Radiotherapy (SRT) and Stereotactic Radiosurgery (SRS) - The Novalis Brainlab
Ø Intracavitary Brachytherapy - High Dose Rate (HDR) and Low Dose Rate (LDR)
Ø Intersititial Brachytherapy - High Dose Rate (HDR) and Low Dose Rate (LDR)
Ø Oral I-131.
Ø Radiolabeled Monoclonal Antibody Therapy of Lymphoma - Zevalin and Bexxar
Technical Training
Residents will benefit from technical training with a wide array of equipment within the training institutions. The Moffitt Cancer Center Division of Radiation Oncology equipment consists of 3 Megavoltage Units, 1 Radiosurgery unit, 1 Tomotherapy unit, 1 Fluroscopic Simulator, 2 CT Simulators, 14 3-Dimensional planning computers, 13 IMRT capability, 1 3D Water Phantom, 1 PET CT, and 1 3TMRI unit. The James A. Haley Veterans Administration Hospital equipment consists of 3 Megavoltage Units, 2 units with electron capability, CT Simulator, 3-Dimensional planning computers, and IMRT techniques.
Training for use of Unsealed Byproduct Material
The American Board of Radiology (ABR) requires that resident training and experience and the materials on which the ABR examines match the United States Nuclear Regulatory Commission (NRC) regulations. The Residency Training Program will adhere to the training guidelines set forth by the NRC. The NRC requires that specialty boards shall require all candidates for certification to successfully complete residency training in a radiation therapy or nuclear medicine training program or a program related medical specialty. The training must include 700 hours of training and experience in classroom and laboratory training in radiation physics and instrumentation, radiation protection, mathematics pertaining to the use and measurement of radioactivity, chemistry of byproduct materials for medical use, radiation biology and work experience under the supervision of an authorized user who meets state requirements. The NRC regulations pertain to training and experience in the therapeutic administration of unsealed byproduct materials as well as the use of manual brachytherapy sources and remote afterloader units, teletherapy units and gamma stereotactic radiosurgery unit. The Residency Program will provide training as mandated by the NRC and the ABR and will adhere to all training requirements, including required number of experiences.
Resident Supervision
All clinical patient care activities are conducted under direct supervision of the assigned attending faculty member at each of the participating training institutions.
Resident Evaluation
Resident performance will be carefully monitored during the course of the training program to ensure residents receive adequate training. Formal evaluation completed by training faculty, staff and patients will be conducted following each formal rotation and become part of the resident’s permanent file. Residents will evaluate the training faculty, staff and the rotation experience following each formal rotation which will become part of the resident’s permanent file. Resident’s will meet with the Program Director semi-annually to review both resident and program performance. Evaluations are based on the ACGME core competencies.
Education/Multidisciplinary Conferences
Residents will be provided with significant opportunity to enhance their training experience through a multitude of educational conferences. Residents will participate in multidisciplinary tumor conferences with case presentations and discussion of treatment options. Faculty members from each of the respective disciplines will be present at each of the conferences. Residents will have considerable responsibility for the presentation of patient history and laboratory results with interpretation of the diagnostic findings. Residents will also gain knowledge, experience, and interaction in journal clubs, chart reviews, grand rounds, symposiums, CME conferences, guest lecture series, scientific meetings, and other educational programs. Detailed didactic training will focus on but not be limited to radiation biology, cancer biology, radiation physics, radiation safety, brachytherapy, medical statistics, population sciences, and diversity.
Physics
The faculty in Radiation Oncology is supported by a strong physics faculty and staff whose focus is the support of an excellent quality assurance program for the accurate calculation and delivery of radiation dose and brachytherapy sources. Members of the physics and dosimetry section will actively participate in the teaching of the residents, offering a broad experience in clinical radiotherapy physics and special areas of radiotherapy and treatment planning expertise.
The objective of the Physics rotation will be to provide the residents with an understanding of the physics concepts related to radiation oncology treatments. Radiation Oncology is based on the physical properties of the radiations used. The radiation oncologist must understand the physics concepts to properly understand the treatment parameters.
The ASTRO guidelines for resident instruction (Eric Klein et al), which sets very high standards for the instruction of radiation oncology residents, will be adopted by the faculty when teaching radiation physics to the residents.
The following will be covered in training the radiation oncology residents:
1. Radiation Safety (linear accelerators, brachytherapy)
2. Quality Assurance (linear accelerators, brachytherapy, charting/information management)
3. Simulation
4. Dosimetry Planning (external beam, brachytherapy)
Clinical rotations will include:
- Simulation
- Dosimetry Planning – conventional
- Dosimetry Planning – IMRT/IGRT/tomotherapy
- HDR/LDR Brachytherapy
- Stereotactic radiosurgery/radiotherapy for CNS and body parts
- Therapeutic Nuclear Medicine
Radiation Biology
The Division of Radiation Biology provides lab space and mentoring for residents to address basic and translational research projects. Emphasis is placed on delineating the fundamental processes that regulate radiosensitivity and the development of molecularly targeted radiosensitizers. Equipment and facilities are available for molecular, cellular and animal studies. In addition, there is access to microscopy, microarray gene expression and proteomic technology.
Electives
In order to achieve intensified knowledge in a specialty of interest, residents will be given the opportunity to select an elective rotation in the PGY-4 and PGY-5 residency years. Electives will be three months in duration and conducted in disciplines such as hematology, pathology, molecular biology and research. Electives will be considered on a case-by-case basis and approved by the Program Director.