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    Clinical Activities

    Residents will participate in the full spectrum of radiation oncology practice. This includes both inpatient and outpatient evaluations and consultations. Residents will be involved in CT assisted simulation procedures as well as treatment planning procedures including three-dimensional conformal radiation procedures as well as intensity modulated radiation treatment procedures (IMRT) and stereotactic radiation treatment procedures.

    A separate treatment planning system is used for stereotactic radiation treatments.

    Patients seen in the program represent the broad diversity of patients from the San Francisco Bay Area and include those diagnosed at both early and late stages of illness. Because of our integrated programs residents see a variety of approaches employed by a number of clinical faculty at different hospitals (which incorporate radiation oncology nurses, radiation physicists, radiation dosimetrists, nutritionists, social workers, psycho-social therapists. Residents also actively participate in site-oriented multi-disciplinary tumor boards at each facility. Tumor boards include: general tumor boards, pediatric, gynecologic, neurologic, genito-urinary, otolaryngology and gastrointestinal tumor sites.

    Residents also have a 4 month brachytherapy rotation. Patients rotate 1 on 1 with a radiation oncologist and carry out under direct supervision low- and high-dose-rate brachytherapy. Brachytherapy services are provided to selected patients in multiple tumor sites, including; prostate, breast, lung, GI, GU, GYN and interstitial tumor sites. A Varian Gamma-MED plus treatment afterloading Ir-192 unit is employed for HDR brachytherapy treatments in prostate, GYN and other interstitial tumor sites. Residents will become proficient in Flectcher-Suit low-dose and high dose rate applications, vaginal cylinders and interstitial gynecological implants. Esophageal and endobrochial high dose rate applications are also performed in addition to endorectal, biliary tree, nasopharyngeal and intracavitary breast implants (Mammosite, SAVI, Contura) applications. CPMC also has an IORT Intrabeam unit that allows for breast IORT treatments.

    For low-dose rate prostate brachytherapy patients, residents will become proficient in carrying out ultrasound volume studies, transperineal ultrasound guided preloaded interstitial prostate permanent seed implants, interpretation of brachytherapy preplans & post-implant CT scans. Treatment planning is carried out using Variseed and Brachyvision planning systems. Residents will have experience in the placement of transrectal ultrasound guided fudicial marker placement for prostate cancer patients for IGRT (intensity modulated guided radiation therapy.

    Resident Responsibilities

    In all rotations at each of the four departments, the radiation oncology team is made up of at least 1 faculty member, the resident and other health professionals. Residents are directly involved in the diagnosis, treatment planning, simulation and follow-up of oncology patients. The resident gradually assumes increased responsibility for patient care as he or she gains experience.