ISEP/AAPM/IOMP RADIATION THERAPY PHYSICS 2016 Cheng B. Saw, PhD, Harrisonburg, PA

BAPETEN Educational and Training Center

Jakarta, Indonesia • August 22– 26, 2016

A five-day ISEP/AAPM/IOMP Radiation Therapy Physics 2016 course with the theme "Foundation on Theories, Development, and Practices" was held at the Indonesia Badan Pengawas Tenaga Nuklir – BAPETEN (Nuclear Energy Regulatory Agency of Indonesia) Educational and Training Center, Jakarta, Indonesia on August 22th–26th, 2016. This radiotherapy physics course was organized by the BAPETEN Educational and Training Center and University of Indonesia in collaboration with International Scientific Exchange Program (ISEP) of AAPM and International Organization for Medical Physics (IOMP).

The principal objective of this workshop was to improve the quality and knowledge of medical physicists and license evaluators in a radiotherapy facility through a strong medical physics foundation, understanding of the development of radiotherapy programs, and the clinical implementation processes. The radiotherapy physics course 2016 was separated into a radiotherapy physics session in the first four days and a shielding and barrier design session on the last day.

The organizers for this course were Cheng B Saw, PhD serving as Program Director on behalf of the ISEP/AAPM, Lukman Hakim, Ir, MAk, MEng from the Indonesia BAPETEN and Supriyanto A. Pawiro, PhD from University of Indonesia as Co-Host Directors. The faculty members from AAPM who volunteered their times and efforts were:

• Cheng Saw, PhD, Northeast Radiation Oncology Centers, Scranton, PA
• Arthur Boyer, PhD, AAPM, Benton, TX
• Cesar Della Bianca, PhD, Memorial Sloan Kettering, New York, NY
• Sha Chang, PhD, University of North Carolina, Chapel Hill, NC
• Geoffrey Ibbott, PhD, MD Anderson Cancer Center, Houston, TX

The opening ceremony for the radiotherapy physics session commenced on August 22, 2016 with the welcoming address delivered by Dr. Saw. He thanked the Host Directors, Mr. Hakim and Dr. Supriyanto for undertaking this project and conducting the course. Without their support and participation, this course would not be possible. Dr. Saw also thanked the faculty for traveling long distances to volunteer their efforts and times to participate in the project. Also, Dr. Saw indicated that without the participants who had taken their time off to attend, the course would not be possible.

The ceremonial process was conducted by Prof. Dr. Jazi Eko Istiyanto, Chairman of the Nuclear Energy Regulatory Agency. He described the current state and the increasing number of radiotherapy centers in Indonesia. He also assured that his agency, BAPETEN, has strongly supported medical physics programs as a regulator through the regulation and human resources development.

The day one presentations were given by Dr. Ibbott on advances in radiation therapy and in particular, the MRI-Linac. Next, his lectures included discussions on acceptance testing and commissioning of medical linear accelerators. It was followed by reference dosimetry protocols and lastly on in-vivo dosimetry. The presentations on day two were given by Dr. Chang. He covered the in-house treatment planning system, PLUNC, followed by treatment planning strategies. Free copies of PLUNC software were distributed to meeting attendees and basic training was also provided. Compensator-based IMRT, a low cost alternative IMRT approach may be relevant to developing countries, was also discussed. Next, Dr. Chang presented the basics of radiation biology. In the afternoon, Dr. Pawiro and his colleague presented medical linear accelerator quality assurance and patient specific quality assurance. In the morning of day three, Dr. Della Bianca presented 3D planning with HDR followed by brachytherapy quality assurance. Before lunch, Dr. Della Bianca presented advances in IGRT and quality assurance on imaging devices. Dr. Boyer presented the principles of stereotactic radiosurgery. This was followed by the principles of stereotactic body radiation therapy presented by Dr. Saw. The last lecture of the day was given by Dr. Saw on small field dosimetry. On the morning of day four, Dr. Saw presented the treatment planning of Tomotherapy. It was followed by Human Anatomy and then Motion Management by Dr. Boyer, who then continued with non-standard reference dosimetry and patient safety. After lunch, there were discussions on PLUNC software and the non-standard reference dosimetry and then a closing ceremony was held to close the radiotherapy physics session.

The opening ceremony for the shielding and barrier design symposium commenced on August 26, 2016 with the welcoming address delivered by Dr. Saw. Again, Dr. Saw emphasized the volunteer efforts of the Host Directors and the AAPM faculty to hold this course and symposium. In addition, he wanted to recognize the participants for taking time off to attend the radiotherapy physics session and shielding and barrier design symposium. The ceremonial process was conducted by Mr. Zainal Arifin, Director of BAPETEN Authorization for Radiation Safety and Radioactive Sources. He indicated the close collaboration between the regulators, the educators, and the medical physics society fosters faster advancements in the safe use of radiation in Indonesia.

This shielding and barrier design symposium was viewed as very important to BAPETEN Evaluators to further improve their skills and knowledge regarding how to conduct the evaluation of Safety Analysis Report Documents that are being submitted by licensees. It is the hope of the organizers that this symposium will provide insights and improve the quality services provided by BAPETEN.

The first presentation was given by Dr. Boyer on the shielding design for low-dose rate and high-dose rate brachytherapy. He started by examining the shielding design for a patient room and the maximum permissible dose and then continued to the design of the HDR suite. Next, shielding design for medical linear accelerators was presented by Dr. Ibbott. He discussed the principles of shielding including primary beams, radiation leakage, and scattered radiation. In addition, Dr. Ibbott addressed the issue of skyshine and also the presence of neutrons for higher energy machines. The last presentation was given by Dr. Saw on Gamma Knife. Dr. Saw discussed the anisotropic nature of the radiation from the Gamma Knife. Unlike medical linear accelerators, the calculations of shielding barrier for Gamma Knife are done differently. The final hour was left for discussion followed by the closing ceremony. The closing ceremony was conducted by Joni Kadir, from BAPETEN, acknowledging the unique opportunity of having this shielding and barrier symposium for the evaluators in Indonesia. The symposium and discussions during the presentations were invaluable to the audiences.

This ISEP/AAPM/IOMP Radiation Therapy Physics Course 2016, with emphasis on principles of medical physics and shielding, was conducted under the BAPETEN guidelines. The medical physics course and shielding and barrier design symposium were held at the BAPETEN educational and training center which limited the participants to a maximum of 80. In this respect, the participation was at full capacity. In addition, the course was offered to local and international medical physicists without charging registration fees. Besides local medical physicists within Indonesia, the participants were from Singapore, Malaysia, and India. Being a small group, the fact that the sessions were very engaging can be attributed to the interest of the participants in principles of medical physics as applied in the clinics and shielding and barrier design concepts to the evaluators of the BAPETEN.

On behalf of the faculty, the Program Director of ISEP/AAPM (Dr. Saw) wishes to thank the Host Directors, Dr. Hakim of BAPETEN and Dr. Pawiro of University of Indonesia for taking on this project and the hospitality extended to the AAPM faculty in Indonesia. The Host Directors also wish to thank the AAPM faculty for their willingness to travel to Indonesia to participate in this educational project.

Submitted By
Cheng B Saw, PhD (Program Director of ISEP/AAPM)
Mr. Lukman Hakim, Ir, M. Eng (BAPETEN) and
Supriyanto Pawiro, PhD (University of Indonesia)

Opening Ceremony Presentation: [Left to Right: Supriyanto Pawiro, PhD, Cheng Saw, PhD, Prof Dr. Jazi Eko Istiyanto, and Joni Kadir, MSi

Group Photo

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