Setting up

A Radiotherapy Program
Sebuah Panduan IAEA dalam
Menyiapkan Suatu Pelayanan Radioterapi

Oleh: Iwan Heryawan, SST

Radioterapis RSCM Jakarta
 Backgrounds :
 According to estimates made by the International Agency
for Research on Cancer (IARC), there are currently
(2002 estimate) approximately ten million new cancer
cases per year worldwide, with slightly more than half of
the cases occurring in developing countries. By the year
2015, this number is expected to increase to about 15
million cases, of which two thirds will occur in developing
countries.
 By the year 2015, excluding the possibility of a dramatic and
unforeseen cure for cancer, a total of 10 000 machines will be
needed to provide treatment for an estimated ten million new
cancer cases per year in developing countries.
BACKGROUNDS :
 Menurut prakiraan ( pada tahun 2002) yang dibuat
oleh IARC ( International Agency for Research on
Cancer ) diperkirakan akan terjadi sekitar 10 juta
kasus kanker baru setiap tahun diseluruh bagian
dunia. Hingga tahun 2015, jumlah kasus tersebut
akan bertambah sekitar 15 juta kasus, dimana 2/3
nya terjadi di negara-negara berkembang.
 Hingga tahun 2015, diluar kemungkinan adanya
suatu cara pengobatan yang dramatis, maka 10
ribu pesawat radioterapi perlu disediakan untuk
melayani pengobatan 10 juta pasen kanker per
tahun di negara-negara berkembang
 Backgrounds…
 Pelayanan Radioterapi akan semakin dibutuhkan
keberadaannya di tiap-tiap negara tidak terkecuali di
Indonesia.
 Penyediaan layanan radioterapi memerlukan dukungan dari
berbagai aspek: kebijakan pemerintah yang terkait, sarana
dan prasarana ( infrastruktur),ketersediaan sumber daya
manusia, peralatan yang memadai, dan lain sebagainya.
 Perlu adanya suatu panduan dalam penyelenggaraan
pelayanan radioterapi yang harus memenuhi standar mutu
dan keamanan dalam pemanfaatan sumber radiasi (nuklir)
 International Atomic Energy Agency (IAEA) membuat
panduan untuk suatu penyelengaraan pelayanan radioterapi
sehingga dapat memenuhi standar mutu dan keamanan
dalam pemanfaatan radiasi di bidang kedokteran.
IAEA’s Publication ( 2008):
Setting up A Radiotherapy Programme :
Clinical, medical physiscs, radiation
protection and safety aspects.
1. PROGRAMME DESIGN
AND IMPLEMENTATION FLOW
 Programme design
1. Assessment of national needs and contrywide distribution of radiotherapy
facilities
2. Assessment of institution’s clinical needs
3. Basic clinical essentials
4. Assessment of institution’s infrastructure and resources
5. Formulation of radiotherapy programmes
 Programme implementation
1. Staff training
2. Equipment specification
3. Planning and construction of facilities.
4. Delivery of equipment.
5. Planning and initiation of treatment
 Follow-up and assessment mission
2. STAFF REQUIREMENTS FOR A
RADIATION THERAPY PROGRAMME.
 Hospital administrators
 Radiotherapy staffing.
1. Patient throughput assessment
2. Staff
 Internal staff organization
1. Combined assessment clinic
2. Radiation safety
3. RADIOTHERAPY FACILITY DESIGN
 External beam therapy
1. Examination rooms
2. Simulator room
3. Treatment planning room
4. Mould room
5. Treatment room
6. Waiting areas

 Brachytherapi
1. Source storage and preparation room
2. Operating theatre/treatment room
3. Treatment planning room.
4. Patient rooms
5. Additional requirements for LDR remote afterloading.
4. EQUIPMENT
 Equipment for external beam radiotherapy
1. Simulator and computed tomography simulators
2. Treatment planning equipment
3. Teletherapy unit
4. Quality assurance equipment
5. Radiation safety equipment
 Equipment for brachytherapy.
1. Imaging equipment
2. Equipment for treatment planning
3. Treatment delivery equipment
4. Quality assurance equipment
5. Equipment for radiation safety and source handling.
5. QUALITY ASSURANCE OF THE
RADIOTHERAPY PROGRAMME AND
RADIATION PROTECTION OF THE PATIENT
 Clinical aspects of quality assurance programme
1. Treatment policies
2. Clinical case conferences for review of proposed/recent patient
treatments.
3. Clinical follow-up and statistical review .

 Physical aspects of the quality assurance programme

 Radiotherapy planning and delivery

1. Initial evaluation
2. Therapeutic decisions
3. External beam radiotherapy.
4. Brachytherapy
……QUALITY ASSURANCE OF THE
RADIOTHERAPY PROGRAMME AND RADIATION
PROTECTION OF THE PATIENT
 Maintenance programme.
1. Preventive maintenance
2. Repairs
3. Spare parts
 Investigation of accidental medical exposures
 Quality audits
6. RADIATION PROTECTION AND
SAFETY OF SOURCES
1. Authorization
2. Organization and managerial measures.
 Management policy .
 Organization and responsibilities.
 Staffing and training .
 Reassessment of training needs

3. Safety in equipment and sources

4. Facility layout, shielding and interlocks
 External beams.
 Brachytherapy
 …RADIATION PROTECTION AND
SAFETY OF SOURCES
5. Occupational protection
 Investigation levels for staff exposures in radiotherapy
 Pregnant workers
 Classification of areas
 Individual monitoring and exposure assessment
 Monitoring of the workplace
 Rules and supervision
 Procedures for external beam therapy
 Procedures for brachytherapy
 Supervision
 Health surveillance
 Records
…RADIATION PROTECTION AND
SAFETY OF SOURCES
6. Protection against medical exposure
 Responsibilities
 Justification
 Optimization
 Calibration
 Clinical dosimetry
 Quality assurance for medical exposures
 Investigation of accidental medical exposures
 Prevention of accidental medical exposures
7. Prevention of accidental medical exposures
8. Public exposures.
…RADIATION PROTECTION AND
SAFETY OF SOURCES

9. Safety during the transport of radioactive materials

10. Emergency plans

 Lost sources
 Stuck sources .
 Contamination .
 Accidental exposures of patients
Terima Kasih