Current Status of Radiotherapy In Myanmar Dr. Thida San Professor / Head Radiotherapy Department Yangon General Hospital Yangon, Myanmar.

Three Radiotherapy Departments in Myanmar 1.Yangon General Hospital (Y.G.H) in Yangon 2.Mandalay General Hospital (M.G.H) in Mandalay 3.Sao San Htun Hospital (S.S.H.H) in Taunggyi with the following facilities

Y.G.H Radiotherapy Department was established in (80 bedded in–patient two storey building was built by Canadian aid.) M.G.H Radiotherapy Department was established in (Government aid) S.S.H.H Radiotherapy Department was established in (by Russian aid)

Y.G.H Radiotherpy Department Man Power Serial No.Staff CategoryAppointed 1Professor/ Head1 2Associate Professor1 3Consultant2 4Assistant Doctor9 5Chief Physicist1 6Senior Physicist- 7Assistant Physicist2 8Technologist9

9Sister1 10Staff Nurse3 11Trained Nurse11 12Nurse Aid2 13Clerk1 14Record Assistant8 15Worker26

Machines and Equipments Treatment Units 1.External Beam Radiotherapy Machines 1.1 Linear Accelerator 6 MV Mitsubishi (Not functioning since 1996 October, failure of Magnetron,Thyratron, and Accrual printed circuit board) 1.2 Cobalt-III, Theratron Elite 100 MDS Nordion (functioning) (installed since 2004) 1.3 Cobalt-II, Theratron -780 AECL (functioning) (installed since 1986) 1.4 Cobalt-I, Picker C-9 JL Shepherd and Associates (functioning) (installed since 1995)

2. Simulator 2.1 Therasim -750 AECL (only Radiotherapy part is useful. The image intensifier tube and monitor unit fluoroscopy is not functioning)

3.Brachytherapy facilities 3.1 Caesium applicators and sources. (WHO/IAEA) 3.2 Curietron Machine (two) (Government) 3.3 Operation theatre for brachytherapy insertion. (Government) 3.4 Simulation and computerized dose calculation. (WHO)

AMRA CURIETRON Manual Afterloading Caesium137

3.5 Brachytherapy wing for patient isolation during treatment. (Six separate rooms with IAEA recommended radiation protection facilities.) 3.6 Computerised Treatment Planning System; Two treatment Planning System: TSG RAD PLAN (WHO) Theraplan Plus (Government)

Mould Room Facilities 4.1 Contour Plotter (IAEA) Head and Neck Immobilisation system (IAEA) MT-RH-1500-EX (Water bath 19”x25”x5”) (IAEA) Breast Board (IAEA) - 2.

Quality Assurance Facilities 1. Dosimetry facilities 1.1 UNIDOS Universal Dosemeter (IAEA) 1.2 Farmer NE 2570/A(Government) 1.3 Victoreen 500(Government)

2. Ionization chamber 2.1 Farmer types(Government/IAEA) 2.2 Victoreen 500 chamber(Government) 2.3 Brachytherapy well chamber HDR (IAEA)

3. Water Phantoms 3. Water Phantoms 3.1 For absolute dose rate measurement 3.1 For absolute dose rate measurement 30x30x30 cm,(Government) 30x30x30 cm,(Government) 3.2 Water Phantom for beam calibration 38x 38 x 38 cm, PMMA walls (IAEA)

4. Survey Meters 4.1 Thyac IV Survey Meter model 290 (WHO) 4.2 Mini Monitor(IAEA) 4.3 PRM 301(WHO)

5. Precision digital barometer, kPa (IAEA) 6. Mechanical barometer (one) (Government) 7. Personal monitor 7.1 TLD badges for all staffs(IAEA) 8. Annual TLD Postal Dose Quality Audit for Co- 60 and Megavoltage X-ray Beams sponsored by IAEA.

Ten Commonest Cancers of Radiotherapy Department Y.G.H (Cancer Statistics, 2000) RankType of CancerNo. of CasesPercent 1Breast, Female % 2Cervix Uteri % 3Lung, Bronchus, Trachea % 4Stomach % 5NHL %

6Oesophagus % 7Larynx802.71% 8Ovary,etc % 9Connective tissue692.33% 10Nasopharynx652.20% 11Others % Total % RankType of CancerNo. of CasesPercent 1Breast, Female % 2Cervix Uteri % 3Lung, Bronchus,Trachea % 4Stomach % 5NHL % Ten Commonest Cancers of Radiotherapy Department Y.G.H (Cancer Statistics, 2000)

Teaching Programme Post-graduate training M. Med. Sc (Radiation Oncology) (Full time training 2 Year Course) 18 Candidates(5 Graduates+13 under-training) M. Med. Sc (Medical Oncology) (Full time training 2 Year Course) 24 Candidates(3 Graduates +21 under-training) M. Med. Sc (Radiology), (Surgery), (OG), (Eye), (Orthopaedics), (Dermatology), (Physical-medicine) & Dr. Med Sc (Chest Surgery) Candidates are trained at Radiotherapy Department according to their syllabus.

Joint Consultation Clinics (JCC) Weekly JCC with -Surgical wards and Maxillofacial Department of Y.G.H -Surgical ward of New Yangon General Hospital -ENT units 1 to 5 of ENT Hospital & Yangon Worker’s Hospital.

Chest conference with chest medical, chest surgical, radiology and pathology departments every two weeks. Combined clinical meeting monthly with all departments of Y.G.H. X-ray conference with Orthopaedics- Surgeons, Radiologists, Pathologists, and Physical Medicine Physicians monthly.

Tumour Board with Obstetrician and Gynaecologists, Pathologists, Radiologists of Central Women Hospital monthly. Paediatric Tumour Board with Paediatricians, Medical Oncologists, Pathologists, Radiologists at Yangon Children Hospital monthly.

We have submitted 2 TC programmes for since July 2003 namely, 1.To achieve improvement in the management of the Cervical Cancer by implementing QA for Brachytherapy. 2.To improve the knowledge and skill of Medical Physicists through education and training.

Mandalay General Hospital Radiotherapy department Manpower of M.G.H Serial No.Staff CategoryAppointed 1Lecturer/ Consultant1 2Assistant Doctor2 3Senior Physicist1 4Assistant Physicist1 5Technologist7

6Sister1 7Staff Nurse1 8Trained Nurse3 9Clerk1 10Record Assistant1 11Worker5

Machines and equipments Treatment Units 1. External Beam Radiotherapy Machines 1.1 Cobalt -60 machines (two) (Government) 1.2 Superficial X- ray machine (one) (Government) 2. Simulator (one) – (IAEA) 3. Brachytherapy Facilities 3.1Caesium Applicators and Sources(IAEA)

Sao San Htun Hospital Manpower Serial No.Staff CategoryAppointed 1Lecturer1 2Assistant Doctor1 3Senior Physicist- 4Assistant Physicist1 5Technologist2

Sao San Htun Hospital Manpower 6Sister1 7Staff Nurse1 8Trained Nurse3 9Clerk- 10Record Assistant- 11Worker5

Sao San Htun Hospital Machines and Equipment Treatment Units 1. External Beam Radiotherapy Machine 1.1 Cobalt -60 machines (one)(Government) 1.2 Deep X- ray machine (one) – Not functioning (Government) 1.3 Superficial X- ray machine (one)(Government)

Future Plan 1.To upgrade the Radiotherapy Departments of Myanmar by trying to get more machines and equipments by IAEA support. 2.To upgrade Cancer Registry Unit of Radiotherapy Dept 2.To send more doctors, physicists, technologists and nurses for capacity building and proper training abroad by IAEA projects. 3.To request to send IAEA experts to Myanmar to assess our problems and requirements. 4.To get proper maintenance and repair on radiotherapy-related equipments

Present Requirements for three Radiotherapy Departments in Myanmar 1.Proper maintenance and repair on radiotherapy- related equipments. At present, maintenance and repair of radiotherapy- related equipments are performed by engineers and physicists of YGH, MGH and SSGH. It will be better if these people can get fellowship training in equipment repair work.

2.Education and training of Radiotherapy Radiographers (RTTs). One proper education and training of RTTs was conducted at RT department, YGH for twelve weeks from to for 9 Radiographers from YGH, MGH and SSGH. It will be more beneficial if we can arrange training courses at abroad or locally.

3. Clinical QA in the treatment of common cancers by teletherapy and brachytherapy. Teletherapy machines---Daily QA checks are performed before starting treatment by technologists & weekly, monthly and annually QA checks are performed by physicists Brachytherapy---- contamination tests are performed by physicists together with Department of Atomic Energy officials and IAEA experts.

For better performance of QA, we need the following machines and equipments: 1..Linear accelerator (Different energies for photon and electron.) 1 (for YGH ) 2.Simulator machine 1 (for YGH) 3. Cobalt 60 machine 3 (for 3 centre) 4. Dosemeter (For absolute dose rate measurement) 2(for MGH &SSHH) 5. Water Phantom (30 x 30 x 30 cm) 2 (MGH&S.S.H.H) 6. RMI Solid water Phantom1 (for YGH)

7. Survey meter 3 (for three centres) 8. T L D Read out system 1 (for YGH) 9. Computerised Dosimetry system 1 (for YGH) 10. Low dose rate After Loading system for Brachytherapy 3 (for three centres) 11. High dose rate Remote After Loading System 1 (YGH) 12. Treatment Planning system 2 (forMGH&SSHH) 13. Personal radiation Monitors for 3 centres 26

14. BEAM CHECK (Light and Radiation field Analyzer) 1 (foe YGH) 15. Multi- Channel Analyzer 1 (for YGH) 16. GARD (Geometric Accuracy Radiation Device) 1 (for YGH) 17. PC – Rainbow(12 Channel patient dose verification and QC beam analyzer) 1 (for YGH) 18. Trusted, versatile (QA alignment system) (for YGH) -1

19. DPD-510(Direct Patient Dosimetry) - 1 (for YGH) 20. MAMMORX Breast treatment system - 6 (for 3 centres) 21. Precision Patient Positioning laser light (2 Lateral, 1 Ceiling and 1 Saggital) - 1(for M.G.H) 22. L.C.D Projector - 1 (for YGH) 23. Overhead Projector - 1 (for YGH)

24. MT-2200C-EX laser, Apex, Crross hair 220V - 2 (for MGH) 25. MT-2200C-EX laser, Apex, Sagittal 220V - 2 (for MGH) 26. Rolling Radiation Protection Shields for brachhtherapy (Model MT-RPD ) - 6 (for MGH) 27. Superficial X ray Machine - 2 (for YGH&MGH)