BC Cancer, Vancouver Cancer Center

LDR Prostate and HDR intracavitary and interstitial GYN

Our Facility:

BC Cancer provide comprehensive cancer care for the province of BC and Yukon (approximately 6 million people). In BC, we see about 18,000-20,000 new patients and consults per year. Vancouver sees about 5500-6000 of these, so about 30 percent of the total load in BC.

The University of British Columbia, Department of Radiation Oncology has a current staff of 36 radiation oncologists, and 10 Clinical Associates. The department has a longstanding reputation for clinical excellence and academia. The facility has 10 linear accelerators (including a VERO machine with tumor tracking capability and 2 ETHOS), a Cobalt machine, 2 CT simulators, an operating theater, and a brachytherapy suite. BC Cancer – Vancouver is a full-service cancer center with strong medical oncology, surgical oncology, diagnostic imaging, pathology, oral oncology, supportive care and functional imaging services and an inpatient unit.

Vancouver Fellowship Program has offered fellowship training in brachytherapy for over 20 years at the Vancouver site, for over 10 years at Kelowna, 10 years at Abbotsford/Surrey and 10 years in Victoria. This is a large teaching facility with Residency training Program and fellowship programs.

Teaching Faculty:

Dr. Mira Keyes | Radiation Oncology Vancouver

• Past AFC Director for UBC
• Expertise in LDR prostate brachytherapy and HDR penile brachytherapy

Dr. Ryan Urban | Radiation Oncology Vancouver, AFC Director for UBC

• Expertise in LDR prostate brachytherapy and GYN

Dr. Srini Raman | Radiation Oncology Vancouver

• Expertise in LDR and HDR prostate brachytherapy

Dr. Peter Lim | Radiation Oncology Vancouver, Vancouver Brachytherapy Fellowship Site Director

• Expertise in GYN brachytherapy

Dr. Sarah Hamilton | Radiation Oncology Vancouver

• Expertise in GYN  brachytherapy

Dr. Michael Peacock | Radiation Oncology Vancouver, Residency Training Program Director

• Expertise in LDR prostate brachytherapy

Dr. Tom Pickles | Radiation Oncology Vancouver

• Expertise in LDR prostate brachytherapy

Dr. Iva Kong | Radiation Oncology Vancouver

• Expertise in GYN brachytherapy

Dr. Ingrid Spadinger | Physics Vancouver

• Director of Brachytherapy physics 

Mr. Rustom Dubash | Physics Vancouver

• Expertise in HDR brachytherapy

Mr. Conrad Yuen | Physics Vancouver

• Expertise in LDR and HDR brachytherapy

The teaching program is supported by Department of Radiation Oncology faculty members who have a clinical and academic focus in brachytherapy. All faculty members are highly active clinically and academically productive and offer the required expertise to provide training, supervision and assessments of all competencies.

Number and Variety of Patients: The program has adequate volume and diversity of patients and performs a sufficient number of procedures to provide the full breadth of patient management experience, including ambulatory clinic experience, procedural experiences and planning experiences.

The BC Cancer has one of the largest brachytherapy programs in North America, including the largest prostate LDR brachytherapy program, does unique penile brachytherapy implants, and LDR interstitial breast implants.

Vancouver: 

OR suite for LDR brachytherapy and HDR GYN procedure and separate HDR treatment room.  Procedures: 

• High dose-rate (HDR) brachytherapy after loader,
• Control area,
• Post anesthesia recovery room.
• In-suite imaging equipment consisting of ultrasound, fluoroscopy and MRI on site, and PET on site facilities on site (machine shop and 3D Printer) for creating brachytherapy equipment

Fellowship Description:

1. OR/Brachytherapy Suite. The trainees will maximize the time in the OR which should be a minimum of two days per week, as part of a interprofessional team which includes radiation oncologists, anesthesiologists, medical physicists, nurses, radiation therapists and dosimetrists. The OR/procedure time will also include time for physics and planning if applicable for the site (i.e. HDR prostate, GYN) 
2. Ambulatory Clinic enables trainees to develop skills in consultations and follow up management.  The experience includes performing complete and appropriate consultation and assessments of new patients regarding appropriateness of brachytherapy, discussion of other treatment options, expected brachytherapy side effects, and disease outcomes with or without brachytherapy. The skills would involve creating management plans for new patients, obtaining informed consent, working with multidisciplinary and interprofessional colleagues. The follow-up clinics will include developing skills in managing post-procedural complications and short- and long-term side-effects and counseling. The trainee would spend up to 2 days in an average week in Ambulatory Clinics.  
3. Minimum one-half day per week will be dedicated to Brachytherapy Planning. During Brachytherapy planning the trainee will work closely with medical physicists, dosimetrists and radiation therapists under supervision of the brachytherapy staff physician using several computerized planning systems to process imaging information and generate brachytherapy plans. The planning time may be combined with OR/Brachytherapy Suite schedule. 
4. Up to one day a week, will be dedicated to scholarly activities including Clinical Teaching to radiation oncology residents, medical students, medical physics residents, and other health professionals, on classic brachytherapy systems, interstitial implants, prostate LDR and HDR brachytherapy and gynecological brachytherapy. Trainees will also be involved in research activities and will be expected to complete 1-2 research projects with supervision. Trainees will be required to present their work at the departmental rounds and are encouraged to present their completed projects at national/international conferences and prepare the manuscript for publication. 
5. Trainees will participate in the following rounds:
6. Site specific Multidisciplinary Case Conferences, at which cases are presented at a multidisciplinary forum for discussion regarding treatment recommendations. 
7. Brachytherapy Peer Review and QA Rounds where all brachytherapy cases are presented and reviewed. Brachytherapy plans and post-implant dosimetry on LDR cases are reviewed and evaluated by a multidisciplinary and interdisciplinary team. A decision is made on implant quality and possible need for any remedial action. Trainees will be required to present the cases and discuss the important aspects of planning, contouring, dosimetry and clinical outcomes.

Site specific Peer Review Rounds (GU, GYN) where the radiation treatment plans of all patients undergoing external beam radiotherapy are reviewed and evaluated.

Trainees must:

1. Complete the institution’s radiation safety training. This will be completed as part of their initial orientation.
2. Assess and create management plans for new patients in the Ambulatory Clinic. 

Other Educational Experiences

1. Trainees will perform simulated brachytherapy procedures using an ultrasound compatible prostate phantom to learn ultrasound-based image acquisition, planning and catheter or source placement as an early step in competency development.
2. Trainees will attend a relevant brachytherapy conference e.g. American Brachytherapy Society Annual Scientific Meeting, Canadian Brachytherapy Group Annual Meeting.
3. Trainees will have opportunity to observe and participate in brachytherapy procedures at other disease sites e.g. breast brachytherapy, penile brachytherapy.

Case Volume:

GYN interstitial brachytherapy is now available in Vancouver.

Resident Expectations and Learning Objectives:

Residents are expected to participate in the clinic, OR, brachytherapy planning as outlined above and integrate with Vancouver residency training program.

Please note: U.S. residents will need to obtain an educational license from the College of Physicians in order to participate in this fellowship. To apply for this license, click here.

ABS Fellowship Application: BC Cancer, Vancouver, HDR GYN and LDR Prostate