1. Cancer Burden and Infrastructure in Singapore Dr Khoo Tan Hoon Seng National Cancer Centre Singapore

2. 10 Commonest Cancers in Singapore Males Cancer Incidence 1998-2002

3. 10 Commonest Cancers in Singapore Females Cancer Incidence 1998-2002

6. RADIOTHERAPY CENTRES IN SINGAPORE NATIONAL CANCER CENTRE NATIONAL CANCER CENTREPublic1950s MOUNT ELIZABETH HOSP Private1989 GLENEAGLES HOSPITAL Private1995 NATIONAL UNIVERSITY HOSP Public1998 TAN TOCK SENG HOSP Public2003

7. NCC Patient Load 2700 new patients registered for RT yearly 2700 new patients registered for RT yearly 75% are locals including PR 75% are locals including PR 25% foreigners 25% foreigners Malaysia Malaysia Indonesia Indonesia Brunei Brunei Myanmar, Vietnam Myanmar, Vietnam

8. RADIOTHERAPY EQUIPMENT MachinesUnitsRemarks Linacs8 IMRT, SRS Cobalt0AECL Simulators2Varian,Siemens CT1AcQsim TPS5 Eclipse/ CADplan HDR2Gammamed Intravasular Brachy. 1Galileo

9. Staff Qualification  Therapeutic Radiologist: a registered medical practitioner who holds any postgraduate degree, diploma or qualifications in therapeutic Radiology which is approved by the Minister: DMRT, FRCR  Radiation Therapist (Technologist): Required to hold a diploma or degrees in radiotherapy from a recognized institutions  Physicist : No specific legal requirements Administratively required a Min. good honours degree in Physics and with 5 years clinical experiences

10. Organization Chart for Physics QA Physics QA Policy Management Inter-comparison Accountable to HOD Certification of QA daily reports Monthly QA checks Corrective Actions QA Training Daily QA checks Chief Physicist Physicists Radiation Therapists

11. Frequencies of QA checks Description[ On- Treatment DailyMonthlyQuarterlySemi_An. 1Linacyyy 2 CT Simulator yyy 3Simulatoryyy 4 HDR Brachy yyy 5 Stereostatic Rad yyy 6IMRTyyy 7 Treatment Plan yy 8 Intravasacular Brachytherapy yy 9 Measuring Equip y PhysicistsRadiationTherapistsPhysicistsVendors/PhysicistsVendor/Physicists

12. Needs for Improvement Manpower- getting sufficient staff to make the smooth running of the radiotherapy service Manpower- getting sufficient staff to make the smooth running of the radiotherapy service Sub-specialisation- getting staff to undergo further training to upgrade knowledge and skill Sub-specialisation- getting staff to undergo further training to upgrade knowledge and skill Quality Checks- Monitoring the occurrence of mishaps and even near mishaps Quality Checks- Monitoring the occurrence of mishaps and even near mishaps Improving clinical management- evidence based practice and updating practice guidelines Improving clinical management- evidence based practice and updating practice guidelines

13. Manpower Current shortage of RT’s, physicists and dosimetrist and even nurses Current shortage of RT’s, physicists and dosimetrist and even nurses Mulitple causes for shortage Mulitple causes for shortage Slow recruitment Slow recruitment Staff leaving for outer institutions abroad Staff leaving for outer institutions abroad

14. Dosimetrist Whole wide shortage of dosimetrist Whole wide shortage of dosimetrist Training of quality dosimetrist important Training of quality dosimetrist important Allow specialise training in complex techniques eg IMRT, 3D conformal planning so that quality of service can be maintained Allow specialise training in complex techniques eg IMRT, 3D conformal planning so that quality of service can be maintained

15. Quality Control Mishaps are not common in the department but continued vigilance needed Mishaps are not common in the department but continued vigilance needed Recording and audit of radiotherapy related mishaps or near mishaps Recording and audit of radiotherapy related mishaps or near mishaps Device a system whereby we can track such incidents and suggest remedies quickly to prevent Device a system whereby we can track such incidents and suggest remedies quickly to prevent

16. Improvement in Cancer Management- Employment of evidence base practice in radiation oncology Employment of evidence base practice in radiation oncology Updating knowledge with continued medical education Updating knowledge with continued medical education Training in new skills Training in new skills Understanding new treatment techniques Understanding new treatment techniques Participation in clinical trials to test new treatment approaches Participation in clinical trials to test new treatment approaches Re-evaluating and reporting of treatment results Re-evaluating and reporting of treatment results

17. Cancer Management System Multi-Access system (IMPAC) Multi-Access system (IMPAC) Web-based cancer management system Web-based cancer management system Allow access to patient, treatment and machine date via network Allow access to patient, treatment and machine date via network Not just within department but from remote areas eg. other peripheral clinics and from home Not just within department but from remote areas eg. other peripheral clinics and from home Paper less or paperless system Paper less or paperless system