About the Conference

Outset

Radiation therapy technology is evolving at an unprecedented speed in developed countries as a result of vast financial and intellectual investments in the previous decades.The standard of care in such countries are generally dynamically improved to match the complexity of the latest technology such that maximum safety of the staff and patients is guaranteed while the new technology is used as efficiently as possible to best pay off for its costs. Technical training and information are easily transferred to the end-users in clinics and experiences are generally constructively shared and absorbed by the community of clinical experts in these countries. Dynamic and well-developed regulatory mandates as well as the industrial work culture minimize potential misuse of the technology or mistakes in delivering treatments. In developing countries on the other hand, even though the outpouring of modern radiotherapy technology occurs at a slower speed, the standard of care and regulatory mandates still lag behind. It is not yet fully appreciated that modern technology by itself does not guarantee a better treatment unless resources are allocated to acquire expertise of correctly using the technology and a spirit of vigorous effective teamwork for modern treatment techniques is developed. As best described by International Commission on Radiation Protection report 112, “purchasing new equipment without a concomitant effort on education and training and on a program of quality assurance can be dangerous” (ICRP112,2009). As an attempt to advocate and raise awareness of the importance of proper training, proper use and developing adequate quality control procedures for new radiotherapy techniques, the Iranian Society of Clinical Oncology (ISCO) and Iranian Association of Medical Physicists (IAMP) are considering hosting a series of events and conferences aimed primarily at clinical Radiation Oncology professionals who share common interests and concerns in implementing modern radiotherapy technologies in developing countries. The scope goes beyond the borders of the hosting country and attempts to address clinical settings where resources are more restricted than developed countries and technical knowhow is currently not adequate. These series of events would also seek developing simplified and minimal solution packages to locally optimize the use of modern technologies without compromising patient safety and treatment quality. This can be of use to many countries and clinics with inadequate resources to develop local research teams or overwhelming quality assurance procedures. Through this program, ISCO and IAMP seek both to help promoting recognition of the complexity of modern techniques among professionals in the field and to provide a debate field where locally specific issues could be itemized and discussed together with potential solutions and answers. To serve this goal, the first conference is programmed as a short Quality Control refresher/reminder course for radiation oncology experts in Iran along which management, cultural and technical issues impeding proper implementation of advanced technologies will be propounded and discussed. Therefore, the proposed format of the conference will be a mix of courses, talks and discussion panels. Below, the conference is outlined in detail.

Conference overview:

Almost all cobalt teletherapy units in Iran have been decommissioned within the past 6 years due to restrictions in radioactive source replenishment.Meanwhile, the number of operating medical linear accelerators has almost doubled; i.e. , currently 1 linac operates in the country per million citizens. There is room for this figure to increase 8 folds, should this be comparable to a European average of 8.6 linacs per million (Rodin D, 2014). New radiotherapy facilities are being constructed for higher energy machines. This increasing trend of radiotherapy facilities and machines in Iran is expected to continue in the upcoming years as several new radiotherapy centers are either under construction or under consideration to be constructed or expanded. The diversity of treatment techniques is also expected to increase as new technology is, in principle, capable of delivering more complex treatments. Although the increase in the number of MLC-equipped linacs has created the enthusiasm for Intensity Modulated RadioTherapy (IMRT), not more than one or two clinics in the country have yet embarked on developing the technique. Factors hindering the development of IMRT are manifold, ranging from misperceptions about its cost and complexity to real budgetary restrictions, lack of treatment insurance recognition, shortages in equipment, sluggishness in aftersales support and services, management incompetence, lack of technical training and so on.The conference aims at bringing internal and international professionals in the field together to discuss these encumbrances and encourage Iranian professionals to embark on developing IMRT techniques where possible, while discussing its relevance, justifications or limits; the aim is to give the audience practical hints on where and how to start building up their skills and expertise for a safe and effective radiotherapy practice and development. The conference would be focused on commissioning and quality control procedures which need to be correctly understood, developed and practiced routinely with ease and confidence. Radiation oncologists and clinical physicists will be presented with materials to further familiarize themselves with examples of intricacies along the treatment chain, where major pitfalls or potential dangers may conceal. Along with each ring in the treatment chain, there are rings of hindrances which need to be recognized and addressed. Either local or collaborative resolutions should be developed for each hindrance to serve the quality of RT services nationwide. Speakers are requested to actively address these issues and come up with suggestions of resolutions. Discussions would be recapped and published on the ISCO website for further access and continued evaluation by experts. The organizing committee will prepare a report of the main points discussed to be presented to the national regulatory agencies for their perusal.

Regional coverage:

As the topic of the conference could be of interest to medical physicists and radiation oncologists of countries with proportional radiotherapy status, invitation letters will be sent to regional medical physics and radio-oncology societies of Turkey, Iraq, Pakistan, Uzbekistan, Georgia, Azerbaijan, Armenia, Tajikistan, India, Turkmenistan, Kuwait, Oman, UAE, Kyrgyzstan and Kazakhstan. About one third of the capacity of the conference can be allocated to regional participants.

Target audience:

National and regional radio-oncologists (MDs); clinical medical physicists (MPs); national regulatory agencies delegates; delegates from regional medical physics and radio-oncology societies.

Conference language:

The aim of the conference is both to address Iranian national professionals in the field of radiotherapy and international experts about the challenges of implementing advanced radiotherapy technology in a situation with specific restrictions such as the Iranian workspace. To better communicate this message, to seek contributions from international community and to set the ground for broader discussions and collaborations which may help developing a new concept in radiotherapy marketing, the official language of the conference will be English. All materials will be presented and published online in English. However, the executive committee will prepare specific summaries in Farsi to be presented to the national regulatory authorities as these could be of use to improve their policy making. Reports or summaries may also be prepared and published in Farsi in IAMP or ISCO newsletters.

Benefits for participants:

The participants are expected to:
– acquire a clearer view about the perspective of radiotherapy developments in Iran or a country with similar status;
– be motivated to review their current radiotherapy QA procedures and improve them if necessary;
– be encouraged to think actively about possible sources of error in their current workflow;
– obtain ideas on how and where to start taking further steps towards new techniques, if the infrastructure permits;
– examine the possibilities of collaboration with other clinics for knowledge transfer;
– be encouraged to participate in further debates and providing input to enrich the discussions.

Conference outcomes:

ISCO would recap the experts’ panel discussions and publish them on the ISCO website for public access; the discussions are expected to help forming an Iranian perspective on proper approach to implementing and developing modern radiotherapy techniques. Both government regulatory delegates or public service clinics and private sector can benefit from the sketches of this perspective and can contribute to forming it. Major hindrances in education and training, together with technical and regulatory issues would be prioritized based on the outcome of the panel discussions for future reference and further pursuit.

Conference outline:

The conference is scheduled to contain 55 sessions in three days. It is estimated that about 150 participants will attend the conference and the hosting capacity is set to about the same number of Iranian attendees; however, if the executive committee can obtain international recognition for this conference, the content and the number of attendees may be modified accordingly.