IB Senior Educational Objectives - UCSF Radiation Oncology

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Rev. 9/14/10 care instructions (including any required prescriptions etc.). The residents are also expected to participate in the management of acute and late toxicities of therapy. 5. CyberKnife: Participate in the simulation, planning, and treatment delivery. They must accompany the attending physician to verify treatment setup of the first treatment fraction (if multiple treatment fractions are given). They are also expected to assist the attending physician with providing patients post-treatment care instructions (including any required prescriptions etc.). The residents are also expected to participate in the management of acute and late toxicities of therapy. 6. Brain Brachytherapy: The resident is responsible for actively participating in the procedure, accompanying attending physician to the operating theatre, assisting in the seed placement, documenting and observing relevant safety protocols, providing patient and family members with post-implant instructions. 7. Read/Study A list of relevant reference articles will be located on the department server for resident download. 8. Maintain service list of patients (current, past, and pending) and continue to update the list to ensure adequate follow-up of pending patient care items. 9. Neurocognitive Clinic (Tuesdays) a. On Tuesday of every week (pending a clinic change), the residents are expected to be in the clinic with Dr. Caroline Racine (in-house neuropsychologist) to learn and observe how to take a cognitive history and how to administer cognitive screening exam (MOCA). They will also be expected to learn the basic brain-behavior relationships and effects of intervention on neuropsychological test results. b. The residents will be supervised on this day by Dr. Racine and are responsible for completing any reading or tasks assigned. 10. New Patients a. Obtain records and prepare for patient prior to their arrival. Present case to attending as indicated. Identify clinical issues and questions raised by a specific case. Make recommendations for patient’s care based on evidence found in literature. Cite relevant literature in summary write-up. Discuss relevant literature with attending. b. Devise and review treatment plan based on patient indications and planning. c. Follow-up on pending surgeries, pathology, medical records, imaging, and other relevant clinical patient information. d. Attend all simulation visits; order relevant simulation studies. e. Be prepared to discuss risks and benefits of radiation therapy with patients when requested by the attending physician. f. Attend all new patient starts and review port films at the treatment machine. g. In treatment planning, the resident is responsible for contouring the following tumor and normal tissue structures: i. Cranial Cases: 1. Tumor (or surgical cavity); GTV, CTV, and PTV (as indicated) 2. Bilateral Eyes 3. Bilateral Optic Nerves 4. Chiasm 5. Bilateral Cochlea and Vestibular Apparatus 6. Pituitary Gland 7. Hypothalamus 8. Bilateral Temporal Lobes 4
Rev. 9/14/10 9. Brainstem (from the cerebral peduncles to the foramen magnum) 10. Bilateral Parotids 11. Spinal Cord (from the foramen magnum to C2) ii. Spine Cases: 1. Tumor (or surgical bed); GTV, CTV, and PTV (as indicated) 2. Spinal cord (two vertebral body levels above and below the target) 3. Relevant, treatment-level specific surrounding normal tissue structures (e.g. small or large bowel, heart, lungs, thyroid, etc.) h. Calculate dose-volume histograms, both differential and cumulative, and understand the relevant thresholds. i. Become familiar with management of acute and late radiation reactions (e.g. radiation necrosis) j. Document in Lantis (or equivalent department medical record system) the following: i. Date of initial diagnosis ii. Date of consultation iii. Treatment site (ICD-9 code) iv. Tumor stage/grade information v. Histology vi. Simulation note, describing simulation position, immobilization devices, type of simulation (PET, CT, MR, or fluoroscopy), specific scan instructions (e.g. scan slice thickness, gap, +/- contrast etc.) vii. Treatment site, modality, energy, dose/fractionation viii. Notify medical physicist(s) if specific pre-treatment checks (e.g. TLDs) are required 11. On-Treatment Patients i. Be aware of issues and status during treatment. ii. Maintain on-treatment list of patients; document on-treatment issues in Lantis (or equivalent electronic medical record system); notify attending of any patient-specific issues/complications iii. Check weekly port films with attending physician; respond to therapist inquiries regarding patient care issues 12. Follow-up Patients i. See follow-up patients with attending physician; document follow-up visits in a clear, concise manner, and communicate with relevant services to ensure proper management and follow-up of patients (e.g. ensure follow-up visits with medical oncology for systemic therapy etc.) ii. Obtain recent test results, imaging and clinical notes on patients in advance of appointments and review with attending; this includes relevant medical records from outside medical facilities. 13. Understand machine- and patient-specific QA practices for external beam treatments. 14. Obtain training in emergency procedures of each treatment modality used (e.g. Gamma knife, Cyberknife, linear accelerator, and brachytherapy) and document proficiency. 15. Final Examination (supervised) <strong>Senior</strong> resident is responsible for overseeing and leading the consultation, simulation, planning, plan evaluation, and treatment delivery of a definitive CNS treatment case (e.g. glioma, meningioma, etc.). The resident will be evaluated on 5
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IB Senior Educational Objectives - UCSF Radiation Oncology

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