Medical Physics

The department provides highest standard, quality assured services to accomplish multi-disciplinary goal of achieving accurate diagnosis and safe, precise and effective treatment of patient using radiation.

The department is structured to provide unique service, tailored to individual patient’s need, through evidence based scientific approach, established protocols, education and innovative research. The department looks after the regulatory compliance for clinical usage of ionizing radiation across various departments in the hospital.

Medical treatment delivery includes: chemotherapy, hormone therapy, targeted therapy, biological therapy and immunotherapy. It’s used primarily in the following scenarios:

• Concurrent partner to radiotherapy to increase the efficacy of radiation.
• Neoadjuvant therapy: Given before definitive therapy which could be chemo-radiotherapy or surgery. This is also given to make inoperable cancers
  operable by reducing the size in some patients.
• Adjuvant Therapy: This is given post-surgery to decrease the risk of recurrence.
• Palliative Therapy: To control advanced cancers (cancer which has spread beyond the site of origin) or locally advanced cancer not amenable to surgery or radiotherapy.

Uniqueness of the department

The first team in South-East-Asia to clinically commission state-of-the-art pencil beam scanning proton therapy facility. The team has successfully implemented latest contemporary proton therapy techniques for various clinical sites including the most challenging cases.

The strength of the department lies with the cohesive service delivered by a group of medical physicists specialized in specific areas with the ultimate goal of providing the best possible care to patient.

Medical Physicist Profile

Medical physicists are health professionals with education and specialized training in the concepts and techniques of applying physics in medicine. All medical physicist in the team have enriched experience in high precision radiation therapy and multi-modality imaging techniques, characterization, calibration and quality assurance of latest state-of-art radiotherapy and diagnostic equipment using advanced radiation detectors, phantoms and instruments.

The team members have acquired specialized training in proton beam therapy from reputed institutes across the world.

• Dr. Dayananda Sharma Shamurailatpam, PhD, DipRP, MCMPI – (Head, Department of Medical Physics)
• Dr. M.P. Noufal, PhD, DipRP, MCMPI, MS – (Senior Medical Physicist)
• Mr. Kartikeswar Patro, M.Sc., DipRP – (Senior Medical Physicist)
• Dr. K. Ganapathy, PhD – (Senior Medical Physicist)
• Dr. A. Manikandan, PhD, DipRP – (Senior Medical Physicist)
• Dr. T. Rajesh, PhD, MCMPI – (Senior Medical Physicist)
• Mr. Mayur Sawant, M.Sc., DipRP – (Medical Physicist)
• Mr. Suryakant Kaushik, M.Sc., DipRP – (Junior Medical Physicist)

Proton treatment technology at APCC

Photon treatment technology at APCC

Clinical Services

The department provides quality assured medical physics services ranging from the initial commissioning to day-to-day clinical services and critical analysis to various specialities within the hospital primarily in Radiation Oncology, Diagnostic radiology and Nuclear Medicine.

Commissioning: The performance characteristics of any new radiation generating equipment, associated software and ancillary devices are measured and evaluated meticulously following various national and international standards and protocols. The successful commissioning ensures clearance from national regulatory body and safe use of the equipment for patient treatment. At APCC, PROTEUS-PLUS and RadiXact-X9 HT system along with associated RayStation (RaySearch Lab, Sweden) and Precision (Accuray, USA) TPS have been commissioned to treat patients using high precision radiotherapy employing photon and proton. Our team continuously develops new treatment techniques and clinical implemented after extensive validation. Besides, the team has also commissioned various radiation generating imaging equipments including Aquilion-LB Wide bore CT (Toshiba, Japan) and Biograph Vision Digital PET-CT (Siemens, Germany).

Calibration: Medical Physicists quantify and calibrate the radiation dose delivery by different radiation generating equipments following international formalism and ensure that it is traceable up to the primary standard.

Quality assurance: To ensure safe and accurate delivery of the prescribed radiation dose to patient, the department conducts numerous periodical quality assurance checks of the treatment delivery machines (PROTEUS-PLUS and RadiXact-X9 HT) and associated components at the daily, weekly, monthly and annual intervals. The department also ensures proper functioning of imaging equipment installed in the proton/photon therapy machine (for pre-treatment verification of patient positioning) and other diagnostic machines.

Treatment planning: Patients enrolled for any form of radiation therapy has to undergo an extensive pre- treatment step-by-step preparation following departmental SOP. It starts with the preparation of customized immobilization devices followed by delineation of tumour and critical organs using multi-modality volumetric image sets (CT, MRI, PET). Intended treatment is simulated on the TPS using patient and machine model. The dose distribution within the patient is computed using highly sophisticated and accurate Monte- Carlo/convolution superposition algorithms. The treatment plan thus generated is evaluated by a team of Radiation oncologist and Medical Physicist to ensure the fulfilment of pre-defined clinical goal.

Proton Treatment planning: The technological advancement of PROTEUS-PLUS enable us to plan and treat our patient with the most sophisticated technique of Intensity Modulated Proton Therapy (IMPT). Treatment planning for IMPT is carried out in RayStation TPS. It involves complex iterative optimization of multiple proton energy staking with several thousand proton spots, their positions, spacing and weights to achieve a highly conformal dose to the tumour and sparing adjacent normal tissues. We adopt SFO, MFO, Hybrid and Robust optimization depending on the complexities and requirement for the clinical case. 4D robust optimization, Layer and volumetric re-painting IMPT are used for dynamic tumour. Adaptive IMPT is routinely carried out for indicative clinical sites.

Photon/High Energy X-ray Treatment planning: Photon radiation therapy treatment plans are performed on Precision TPS using helical intensity modulated radiotherapy (IMRT) of all clinical sites. SBRT, frameless SRS, SRT and adaptive radiotherapy are also routinely practiced for indicated cases. Besides treating many complicated clinical sites, we have also started Total marrow irradiation (TMI)/Total marrow and lymphoid irradiation (TMLI) for the first time in India.

Research

Medical Physics department at APCC is actively engaged with innovative research works related to multi- modality imaging and high precision radiotherapy utilizing both proton and photon beam.

Our current research interests include, in-house software development, investigation of new treatment technique, artificial intelligence and machine learning, in-vivo and in-vitro cell-line study, addressing unaddressed questions, big-data from machine log-file etc.

The department has many ongoing intramural projects and collaborative project with reputed institutions in India and abroad. The department is also actively engaged in clinical trials and research projects exploring the delivery of ionizing and non-ionizing radiation to patients for diagnostic and therapeutic purposes.

The outcome of our innovative continuing research are available in the Recent Publication Section