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A Radiologist in The Radiotherapy Department

For the British Institute of Radiology, November 2014. A history of radiation oncology and how it has (unwisely) divorced itself from its' historical origins in diagnostic imaging.
by

Richard Simcock

on 25 January 2015

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Transcript of A Radiologist in The Radiotherapy Department

A Radiologist in the Radiotherapy Department
Dr Richard Simcock
Consultant Clinical Oncologist
FRCR

@BreastDocUK


Presented at The British Institute of
Radiology, November 2014
1895
1896
Despeignes
France
Hygienist / Physician

Gastric cancer
Freund (with Schiff)
Austria
Physician


Hairy naevus
1903: Textbook on Radiotherapy
Emil Grubbe
America
Medical student

Breast cancer
Thor Stenbeck
Sweden
Physician


Radiologist
and
Radiotherapist

1898
French Radium from Latin 'radius' meaning ray



The 'Bequerel Burn'

Henri-Alexander Danlos

France
Dermatologist

Lupus
1904
Howard Atwood Kelly
America (Johns Hopkins)
Gynaecologist
1901
Ralston Patterson
1897-1981

1915-17
Soldier
Ernest Rutherford
Manchester
Physicist
purchases 200mg
Radium
1923
University of Edinburgh
Medical Student
1924
Cambridge
Radiologist

Abderdeen
South Africa


Geoffrey Keynes
London
Surgeon
Uses radium in breast cancer


1925
FRCS


1926
Mayo Clinic Rochester

"By far the best man that has come
through the service of Fellowship"


Mayo Clinic

Three Departments:
Diagnostic Roentgenology
Therapeutic Roentgenology
Radium Therapy




1927-1930
University of Chicago
Private Practice Toronto




1930
Edinburgh
FRCP
Physician




1921
Death of Dr Ironside Bruce
Charing Cross Hospital
British XRay and Protection Committee formed
1931
The Christie forms collaboration
with Holt Radium Institute




1931
Becomes Director of Holt Institute

Travels to France, Sweden, Brussels




1934
The British Association of Radiologists
established




1929
National Radium Commission
Radium Officers
'Radiotherapist Visiting Club'




1932
Radiation Oncologist
The Manchester Method




1935
Society of Radiotherapists GB and Ireland
established




1939
Amalgamated as Faculty of Radiologists
"From Rays, Health"




1943
Travels to Australia
Organises Regional Centres




1944-
Faculty of Radiologists housed in
Royal College of Surgeons





1947
Textbook
"The Treatment of Malignant Disease by
Radium and X Rays"




1950
6th International Congress of Radiology - England
39 Countries
Diagnostic Radiology
Radiation Physics
Therapeutic Radiology
Radiobiology






Becomes President




1953
7th International Congress of Radiology - Copenhagen

International Club of Radiotherapists

Royal Charter granted to Faculty of Radiologists





1958
American Club of Therapeutic Radiologists

(later to become ASTRO in 1966)





1974
Meet for last time

1897
The Röntgen Society
1917

The British Association for the Advancement of Radiology and Physiotherapy
1927
British Institute of Radiology and the Röntgen Society amalgamted
2014

Multiple techniques
Multiple applications
Increasing specialisation


M. Dimigen, S.K. Vinod, K. Lim 
Clinical Oncology 
Volume 26, Issue 10, Pages 630-635 (October 2014)

Is this good radiology or poor radiation oncology?
The impact of introducing intensity modulated radiotherapy into routine clinical practice 
Elizabeth A. Miles et al
Radiotherapy and Oncology 2005
Volume 77, Issue 3, Pages 241-246

(a) prostate and pelvic lymph node

(b) head and neck cancer IMRT
(c) conventional head and neck cancer, two phase and three phase (patients 1, 2, 4 and 8)
“For clinicians
the challenge of IMRT
is in the selection and delineation
of target volumes in addition to
defining organs at risk
and non involved issue to be spared”
A Multicentre Timing Study of IMRT Planning
and Delivery
S.J Thomas et al
Clinical Oncology 2012
Volume 22, Pages 658-665

Change in practice in 45% of cases
Definition of gross tumor volume in lung cancer: inter-observer variability VanDeSteene et al
Radiotherapy & Oncology 2002
Volume 62, Issue 1,Pages 37–49
Problems
:
It takes time
It takes expertise
It takes training

...and things keep changing

Radiotherapy Planning
New challenges for Clinical Oncologists

2012





Time Problem
Job Planning

Target Volume Definition
Go on a course (or play at home or at the COAST)
"There must be comprehensive teaching of
radiotherapy planning that is appropriate to the stage of training, including
simulation, virtual simulation, 3-D conformal planning, image fusion and IMRT"
"The program must educate resident physicians in adult medical oncology, pediatric medical oncology, oncologic pathology, and diagnostic imaging in a way that is applicable to the practice of radiation oncology. (Core)"
Thanks to Matthew Katz
@subatomicdoc
The Oncology Sciences section comprises the subjects considered fundamental to the clinical practice of Radiation Oncology, namely:

• Radiation Oncology Physics
• Radiation and Cancer Biology

Anatomy
• Pathology
Thanks to Sandra Turner
@sandraturner49
3 month rotation in CT and MRI
No exams
Thanks to Tere Miguelanez
@MsConcu
Hip Fracture
NICE Guidance

From admission, offer patients a formal, acute, orthogeriatric ward-based Hip Fracture Programme that includes all of the following:

orthogeriatric assessment
continued, coordinated, orthogeriatric and multidisciplinary review


Giuliani M et al
IJORBP 2014:88(4);pages 961-6
Determining an imaging literacy curriculum
for radiation oncologists
263 potential imaging competencies
Ranked by 32 Oncologists from 24 centres in 6 countries
84 compentencies indentified:
Imaging Fundamentals (42 items)
Clinical Applications (27 items)
Clinical Management (5 items)
Professional Practice (10 items)



A Radiologist can't do my work.
They don't understand
Radiotherapy
Physics concepts
It would be nice to have a
Radiologist to help,
but they're too busy / we
can't afford them.
We can just let the software
do it.
They can't work just
from a CT
What will
I
do?
Radiation Oncologist
Radiologist
Diagnosis
Biopsy
Staging
Response

Clinical review
Treatment
CTV
PTV

GTV
OARs


"Two are better than one": a pilot study of how radiologist and oncologists can collaborate in target volume definition.
Horan G et al
Cancer Imaging
2006;6:16-9
Working Together
If radiologists and oncologists contour separately there will be mismatch

Concordance develops through closer working
Silvanus Thompson
Physicist
A minimum of 18 blocks of foundational clinical training that must include:
5 of medical specialty/subspecialty training;
4 blocks of surgical specialties/subspecialties;
1 block of diagnostic imaging
1 block of anatomical pathology
3 blocks of medical oncology
1 block of palliative care
3 blocks of elective opportunities
Thanks to Jay Detsky
@jaydetsky
This is multidisciplinary working

When we stopped expecting the
orthopaedic surgeons to be good
at geriatric medicine we started saving lives.

West of Scotland

2 month block in radiology
Thanks to Mohammed Alfayez
@alfayezmo
Full transcript