BANGLADESH MEDICAL PHYSICS SOCIETY (BMPS) Nupur Karmaker, Abu Kausar, Kumaresh Chandra Paul, Hasin Anupama Azhari, Department of Medical Physics and Biomedical Engineering, Gono Bishwabidyalay (University), Savar, Dhaka

Hands on Training of Radiotherapy Treatment Planning and Quality Control of X-ray Imaging

Introduction

The Medical Physics situation is improving step by step in a very organized way to fulfill the demand of medical physicists in Bangladesh. Bangladesh Medical Physics Society (BMPS) has started a journey from 2009 with various dimensions to improve the status of medical physics in the country. Also the Department of Medical Physics and Biomedical Engineering (MPBME), Gono Bishwabidyalay (University) has been playing the major role by providing medical physicists (MSc in Medical Physics) to different government and private hospitals since 2001.

This year special emphasis is given on the quality of radiotherapy treatment and quality control of diagnostic imaging equipment. In this aspect MPBME, GB and BMPS has started a practical training workshop on treatment planning in MPBME, GB and on Quality Control (QC) of X-ray Imaging devices (X-ray, Mamography and Fluroscopy) in different diagnostic centers.

At present for cancer treatment, updated and high technology machines are purchased by different public and private hospitals. The purpose of this training program was to gain knowledge on new methods of treatment planning and to introduce the quality control tests of imaging equipment. In our there is still no protocol for maintenance and quality of these imaging techniques. Also these QC kit are imported for first time in Bangladesh and TPS are installed for the first time to serve the academic purpose (MPBME, GB). The department will liaison with different diagnostic centers and Bangladesh Atomic energy Commission (BAEC) to establish quality control protocol in our country by following international recommended guidelines. Thereby we can assure diagnostic accuracy as well as protect the public from radiation hazards.

This training program was conducted by Prof. Dr. Golam Abu Zakaria, Chairman, Department of Medical Radiation Physics, Gummarsbach Academic Teaching Hospital of Cologne, Germany and Akhtaruzzaman, MD, Medical Physicist, The Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland.

In general, based on the interest of participants, two groups are formed having 15 persons each for training purpose. This training program was divided into different parts such as theoretical, practical, group discussion, examination and certification.

These training activities were arranged into two parts: Pre-training and Final Training. In pre-training two groups (one for TPS and another for QC of imaging) are assigned for two weeks before final training. Each group comprises of faculty members, students, hospital physicists and technicians. For TPS, group coordinator was Abu Kausar, MD, and included the following team members: Mr. Safayet Zaman, Ms. Nupur Karmaker, Mrs. Towmim Afrin Supti and Ms. Naima Jannat. For QC of Imaging, the group coordinator was Dr. Kumaresh Chandra Paul, and included the following team members: Mr. Rashed Al Amin, Atiqur Rahman, MD, Sajon Hossain, MD, Jobairul Isalm, MD, Abu Saif, MD, Mr. Hasib Ahmed Omeo. In addition 15 students were selected for each group for the final two days of training.

Pre-Training

Pre-Training on TPS

The coordinator and his group did their planning in Eclipse (AREA 13.6 version) planning system on different cases in advance of a real training period through social media like WHAT'S app and Skype. Also, the trainer sent different reading materials in this regard. In this way the group had shared the knowledge and performed the activities (Fig: 1a).

The main goal to train the core members was, they will train the large group members later by using local facilities. Another concern was to use potentials of Bangladeshi people who have a wide range of knowledge in medical physics and are willing to disseminate their knowledge to the young generation.

Pre-Training on QC of Imaging Equipment

For the pre-training program a 'QC team-Discussion' was formulated in WHAT'S and Skype social media. Training on QC of X-ray, Mammography, Fluroscopy had been organized in different hospitals (28 December 2017: Padma Diagnostic Center; 5 January 2017: Gonoshasthaya Samaj Vittik Medical College & Hospital, Savar; 9 January 2017: Gonoshasthaya hospital Barobaria, Dhamrai; 14 January: Gonoshasthaya Nagar Hospital, Savar). During the training procedure the real- time problems were posted by the team from the clinic and discussion was carried out on the topic accordingly for the solutions. Also through e-learning method Prof. Zakaria shows all the procedures (Fig: 1b) and at the same time the team members do the same according to the protocol. It gave the field level personnel confident on the QC procedure. After that results were sent to the trainer for further follow up. After a visit of each center, detailed discussion regarding their experiences, strengths, weaknesses and tentative solutions had been carried out by the QC team members, the training of participants and the trainer was proposed. Then a QC sheet was sent to the trainer.

Final Training

Opening ceremony

On January 30, 2017 an opening ceremony of main training (Fig: 02) was held with all the students, trainers. There was a formal discussion about the training goal and outcome which was clearly elaborated by the team coordinators. Then whole procedure of the program was defined by the trainers. After that assigned students were divided for each program.

TPS Training

On January 30–31, 2017 at MPBME, Gono Bishwabidyalay (University), TPS training was organized. Trainers delivered their valuable presentation about basic treatment planning systems and different cases studies such as breast, lung and prostate. Students discussed and shared their knowledge with one another.

Fifteen students from MPBME, University of Dhaka, Nepal were divided into five small groups having three members in each group for the workshop (Fig: 3a). In each small group, the leading member sat in front of the treatment planning system and made 3DCRT, IMRT treatment plans with their hands for the above-mentioned cases. Participants learnt how to import patients, make treatment plans and plan evaluation. In addition, attendees also learnt about contouring. After planning of each treatment case, there was an interactive session conducted by experts for plan evaluation and QA. Trainers discussed all cases individually with the participants.

On the last day, participants exchanged their views, knowledge, experience and ideas among themselves. Then participants attended a short examination for the assessment followed by distribution of the certificate.

Training on Quality Control of X-ray, Fluoroscopy and Mammography

There was a formal training program inaugurated at MPBME on January 30 and on January 31 a practical session on QC took place at Emam Medical College and Hospital, Savar Dhaka (Fig: 3b). Then on February 4 at Ibna sina Diagnostic center a second training was carried out. IBA diagnostic QC complete kit was used for the whole procedure. Finally, all trainees and participants were given the certificates issued by the Chairman of MPBME, Prof G A Zakaria and President of Bangladesh Medical Physics Society (BMPS) Dr. Kumaresh Chandra Paul

Outcome of the Training

Participants gained theoretical and practical knowledge on treatment planning and on QC of X-ray, Fluoroscopy and Mammography through this workshop that made them motivated and confident. This will definitely enhance their conceptual skills that could be implemented in clinical practice. All participants completed a short examination and they achieved very good scores. In this way these students will disseminate their knowledge to others. In a broader sense, they gathered competence and knowledge that will help to establish QC protocol in Bangladesh through BMPS. Also this type of workshop will improve quality of work force, enhance employee growth and increase both theoretical and clinical knowledge.

Closing Ceremony

Acknowledgement

We are thankful to our colleagues, contributors, coordinator, team members, students and all other people who provided expertise for their assistance in the training program. Special thanks to University Grant Commission (UGC), World Bank and Bangladesh Government, through which MPBME purchased the TPS and QC kits of imaging equipment.

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