1. Dr S.S. Solanki MD (Radiation Oncology )Consultant , Radiation OncologyBA Lilaben Chimanlal Parikh Cancer Centre,Navsari , Gujrat

2. 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. 3. Facilities to offer At PresentDiagnostic- CT Scan, X Ray facility, USGLaboratory- Simple lab testTherapeutic- Radiation Oncology includingExternal Beam Radiotherapy (IMRT and 3D CRT) andBrachytherapy. Future ProposalChemotherapy unit, Surgical unit, Image GuidedRadiotherapy. 4. CT scanSimens Somatom Sprit Dual slice 5. Data of CT ScansChart TitleTotal RT scans - 486120Total CT Diag. - 481100Total Brachy - 5780 Total no of scans- 8456040200Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12RT Scan19 31 36 34 23 23 42 34 36 33 35 30 322120 37Daignostic Scan36 32 64 70 35 24 30 28 35 25 29 18 19 16713Brachy Scan0 005527392732462Total Monthly Scan 55 63 10010963 49 79 65 80 60 7151534133 52 6. Siemens Digital X ray unitX ray 7. Ultrasonography unit 8. Data for X-ray and USGChart Title 70Total X-Rays - 381Total USG - 210 60 50No. of scans 40 30 20 10 0Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 X-Ray 12 24 3965 20 1916 322126 2322 16 17 19 10 Sonogrphy 412 1832 11 1312 12 2511 12 912 515 7 9. Laboratory services 10. No. of Pathological test done 200180160140120 Average100806040Total Pathological test done- 1696,20Avg 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 PathoTest10 61 74 98 13811493 18412411715110911210412285 11. Therapeutic Units External Beam Radiotherapy. Linear Accelerator from Varian Medical System (Clinac iX)Total no patients treated till date396No of Patients on Radiotherapy -35Total patients in planning process 16Total =447 Brachytherapy Unit (Nucleotrons Microselectron)Total no. of patients treated- 32Total no. of session of Brachy-92 12. External Beam Radiation Therapy unit Head GantryCouch 13. Bending magnate Tungsten targetElectrongunBeam flatteningdevice Ion chamberAsymmetricaljawsMultileaf collimator ElectronAcceleration tube 14. Blue phantom for measuring Beam parameters 15. Nucelotrons Microselectron Brachytherapy Unit 16. Brachytherapy instrumentsCentral Vaginal SourceIntracavitary Applicators 17. Data from Brachytherapy No. ofNo ofBrachytherapy Patients fractionCVS 23 66 ICRT7 22 Intraluminal Rectum12 Esophageal12Total 32 92 18. Electronic Medical Record self developed excel sheets. 19. Electronic Medical Record 20. Electronic Medical Record 21. Electronic Medical Record 22. Case Sheet- Page 1page 569 "BA" Smt L. C. Parikh Cancer Centre, Navsari, Gujarat-396445Date 25/04/2012 Reg.No. LCA1049 RT No.Patients Name Anarsingh Ratiramsingh TevatiaFather/HusbandsNameRatiramsingh TevatiaAge & Sex76 Years Male Birth Date.AddressOpp. Police head Quarter AbramaVAlsadReligion Hindu Marital Status MarriedCitizenshipIndianBirth CountryMobile self9820134043 Passport No.FirstName ofContact(Mobile) 9724902926 contact/RelationshipE-mail ID.Reffered FromDr. Parimal LadOriginal Complaints :- Pt is K/ case of CA Past History :- No H/O HTN, DMrectum Post op , new developed brain mets First O/E - DR Parimal Lad - 24/03/2012, P/A - growth in rectum lowerExamination with margine in 3.5 - 4cm from anal verge, post wall margin highDig.Previous CT Abdomen ( 17/03/2011) - 6-7cm of lower rectum showsInvestigations diffusecircumferential heterogeneous thickening max thickening - 17done (Imaging) mm, paracolic infiltration with multipale Nodes.Biopsy with Date Bx - 21/803/2011 => well diff adenocarcinomaICM Codes(description)Previous Sx - 26/03/2011 => Dr. Parimal Lad - abdomino perineal resection.TreatmentPer op - circumferential growth of lower rectum 3-5cm from analRecived. 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 23. Case Sheet page 2Histopatho Reportwell diff adenocarcinoma recutamwith date :- Sitetumor involve full thickness of wall to external fat31/03/2011 Desai lab TumorSurat Size Margin Statuscut margine free InvasionLVI - 1 Nodal Examined 7/10 Level Involvem Largest ent (cm)ECE Comment s PostPresent status treatment daysPresent Complaints Present Examination :- GC stable pallor - ve, No neurological deficiency, P/A soft colostomy by on left side abdomen.Final DiagnosisCa rectum with brain mets T3N2M0post op Stage IVRT Decisionpalliative EBRTPlan Dose/Site 30 Gy / 10 #Planning Technique ConvTime Period 2 weeks Indications forRadiation Therapy Brain metastasisExpected Reaction AlopaciaCommentsAdvices :- to be taken for EBRT. CT Scan for RTplanning(27/04/2012) --> 3.6x2.2cm lesion in right highfrontal region with surrounding edema,. 1.7x1.6 cm nodularlesion in right temporal region . S/O - metastasis. Consent For RT Taken/Not TakenDr Surendra Singh Solanki MD Consultant, Radiation OncologyActual FileEMR Sheet 24. Files on Desktop for RecordFiles on Desktop for RecordDaily Backup of files intohospitals Gmail Account 25. OPD 2 All patients recordOPD 2 All patients record 26. RT list- Patient enrolledRT list- Patient enrolled 27. Pt seen in OPD and RT enrolled Avg new pts per month = 35.87 Range(64-21) Total 598Chart Title70 Avg new pts enrolled = 26.68 Range(37-18) Total 44760No of Patients5040302010 0 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12May-12 Mar-May- Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12Apr-121212 New Pt Seen in OPD 64 47 40 35 24 27 55 45 38 36 28 25 33 21 2333 24 CT scan done for EBRT19 29 34 30 18 22 37 31 32 30 24 19 29 20 19 3420 28. 1st Step - Radiation planning1st Step - Radiation planning CT scan + immobilization CT scan + immobilization 29. Good Immobilization Practice Immobilization is a team effort involving Radiation technologist, CT technician, Nursing staff, ward boys Supervised by medical physicist and radiation oncologist. 30. Good Immobilization Practice Multiple hand supportSiemens Somatom SpiritLAP LASERs All in one Base plate 31. Good Immobilization Practice Proper laser AlignmentBlue marking- CT marksRed marking- treat marks at LA Indexed Carbon Couch 32. Good Immobilization PracticeSelf Designed Vac-Lok Support (by Amol) Vac-Lok for Pelvis and abdomen cases 33. 2nd Step- CT images in TPS Treatmentplanning system 34. 3rd step Precise Target markingand field Placement. Conventional Radiotherapy - square or rectanglefields 2 or 3 fields 3Dimentional Conformal Radiotherapy- MLC basedMultiple Fields to conform target IMRT- Intensity modulate during movement of MLCswith 7-9 fields optimize the doses to target 35. Conventional Radiotherapy 36. Three Dimensional ConformalRadiotherapy 37. Pain in wrist due to excessive contouring 38. Pen Tablet- a good solution Smooth workingFaster speed in marking 39. Intensity Modulated Radiotherapy 40. 95 % ofPTV toreceive 100 %of dose 41. Page 32 "BA" Smt L. C. Parikh Cancer Centre, Navsari, Gujarat-396445Date of Reg. 01-12-2011Reg.No.LCA694RT No. RT2011309Patients NameNitinbhai Bhagubhai Patel Age/Sex50 / MDiagnosisCa tongue T4N2MOTreatment period From 14-12-2011To25-01-2012DaysEBRTIMRT SIB/Phase treatmentPTVs Prescription VolD95%D98%D2%PTV1 6600cGy/30#213 cc642863666806PTV2 6000cGy/30#600.55 cc 593358416620PTV3 5400cGy/30#333 cc503849355746OARDose PrescriptionDose tye Dose AchiveapprovalcommentSpinal Cord