1. (National Coordinator) Consultant Radiation Oncologist
Country Report (Pakistan) On Current Status Of Radiotherapy In Pakistan By
Dr. Naseem Begum
(National Coordinator)
Consultant Radiation Oncologist
Institute of Radiotherapy & Nuclear Medicine (IRNUM) Peshawar

2. If I know , I can improve

3. Assessment Of Current Status Of Radiotherapy In Pakistan
As there is no national database, therefore for the situational analysis a nation wide survey was conducted by IRNUM in Feb including all the cancer treatment centers with radiotherapy facilities, both in the public and private sector.
Inputs from the pioneer and senior radiation oncologists & physicists of the country were also sought.

4. Afghanistan

5. Age Wise Proportion of Population of Pakistan (Census 1998)
Age Group (Years)
Total No
Percentage
0-19
53.8%
20-59
40.7%
> 60
5.5%
Median Age = 19.4 Yrs

6. Frequent Cancers In Pakistan
Currently no National tumour Registry exists
The available hospital based tumour registries show a variation in the ranking of 10 common tumours across the country
Breast cancer in females rank No.1 in Pakistan
Head & neck cancers rank No 1 or 02 amongst the males
Oesophageal and Skin cancers are more common in North of Pakistan & adjacent Afghanistan.
Lung and Colorectal cancers are frequent in the south

7. Public Sector Private Sector
Current Status of Radiotherapy Centers In Pakistan (Feb2005) Total No=21
Public Sector Private Sector
PAEC Others 4 10 7
New Cancer Centers in Pipeline: 6+

8. Current Status Of Radiotherapy Centers In Pakistan (Feb2005) N=21
Province
NWFP &
FATA
Islamabad &
Rawalpandi
Punjab
Sindh
Baluchistan
Population Pb Pr
RTH Centers 2 1 7 4
Total 3 8 6
Pb: Public Sector
Pr: Private Sector
RTH: Radiotherapy

9. Current Status Of Radiotherapy Related Human Resource In Pakistan

10. Current Status Of Personnel Working In Radiotherapy Centers In Pakistan ( Feb.2005) (Total Population 149 million)
Personnel No
Radiation Oncologist 69
Radiation Medical Physicists 41
Radiation Technologists
144
Oncology Nurse (need to develop this specialty) ?
Source: Nation wide survey conducted by IRNUM, Feb 2005

11. Current Status Of RTTs In Pakistan
No of RTTs
144
Total No of RTH Equipments 82
Education level
From Matric to M.Sc
Average No. of shifts per therapy machine in Pakistan 02
Current Average Staffing level of RTTs /shift/ machine in Pakistan
0 1
(Minimum recommendations by AFRA-RCA Task Group is
02RTTs/machine/shift)

12. HR related to Repair & Maintenance of Equipment
There is no national database
There is lack of skilled HR

13. Current Status of Radiotherapy Equipment In Pakistan

14. Current Status Of Teletherapy Equipment In Pakistan (Feb. 2005)
Public Sector
Private Sector
Linear Accelerators 11 03
Total = 14
(MLC = (03) Up
Down 04 07
CO 60
Total=22 18
Nil

15. Treatment Planning Computers
Current Status Of Associated Equipment for Quality Assurance In Pakistan (Feb. 2005)
Equipment
Public Sector
Private Sector
Simulator
N=14 11 3
CT simulator
Treatment Planning Computers
N = 14 10 4
Beam Scanning system
N=5 1

16. Current Status of LDR / MDR Facility In Pakistan (Feb 2005)
Institute / Hospital
LDR / MDR facility
Clinical Application
Current status
Mayo Hospital Lahore
226Ra & 137Cs needles & tubes (1957) 198Au (Liquid)
Microselectron (RAL) with 137Cs
I/Implants
I/C (Gynae)
Not in use
NIMRA (Jamshoro)
226Ra needles & tubes, 198Au seeds
137Cs needles & tubes, 192Ir (LDR) (1960)
SMolds
IRNUM (Peshawar)
137Cs needles & tubes, 90Sr, : 1975
137Cs MAL: 1981
Surface Mold &I/Implants
INMOL(Lahore)
137Cs needles: 1984
Gammamed3 (RAL) with 137Cs: 1984
MINAR (Multan)
137Cs Needles & Tubes --
LINAR (Larkana)
226Ra Needles & tubes
Surface molds
CMH (Rawalpindi)
137Cs Selectron
I/C Gynae)

17. Current Status of LDR / MDR Facility In Pakistan (Feb 2005)
Institute / Hospital
LDR / MDR facility
Clinical Application
Current status
CENAR (Quatta)
Curetrone (RAL) with 137Cs
I/C (Gynae)
In use
Zia-ud-Din (Karachi)
Nucleotrone (LDR) with 137Cs
Shaukat Khanum (Lahore)
MAL: 137Cs (LDR)
MAL : 192Ir (LDR)
I/C Gynae
I/Implants

18. Current Status of HDR Brachytherapy Equipment Pakistan
High Dose Rate: 08
Co-60 Source:
Ir-192 Source:
(All the Co-60 sources have completed their two half lives)

19. Current Status Of HDR Equipment in Pakistan (Source: Nationwide Survey Feb.2005)
Institute / Hospital
Year
Equipment
Radioactive Source
Clinical Application
LINAR (Larkana)
1978
Ralstron 20B
(Shimadzu, Japan)
60Co
I/C (Gynae)
MINAR (Multan)
1989
IRNUM (Peshawar)
I/L (Oesophagus& Anorectum)
S. Molds (Skin)
NORI (Islamabad)
1996
Varisoure (Varian)
192Ir
Jinnah Hospital (Lahore)
1993
Model ?
Allied Hospital Fasalabad
BINO (Bahawalpur)
2004
Gammamed plus
KIRAN (Karachi)
HDR Equipment (192Ir source) in Pipeline for: IRNUM Peshawar & INOR Abbottabad

20. Major Needs For Improvement Of Brachytherapy Of Frequent Cancers In Pakistan
Need of additional/ upgraded equipment & QA/QC kits
Need to develop human resource skills in accordance with the changing technology
Replacement of weak Co-60 sources
Development of skills for indigenous production Ir-192
Need to develop treatment protocols
Need to establish comprehensive QA/QC programs
Need for clinical & technical Audits

21. Need For Training Of RTTs In Pakistan
RTTs are an important part of the team of QA Program in RTH
Professional RTTs are required to deliver high quality
radiotherapy
Shortage of professional RTTs is a serious obstacle in improving the quality of radiotherapy
To meet the current and the future needs for well trained RTTs a National Program for the Basic Training as well as the continuing professional development of RTTs is essential 
About 100 RTTs would be required in the next five years  

22. Problems/Needs For Repair & Maintenance Of RTH Equipment In Pakistan
Need to build & improve the capabilities for R and M of RTH units, to ensure proper operation & utilization
Need to promote preventive maintenance
Need to train Human Resource esp. for the R & M of LA
Spare parts have to be purchased from abroad as there is no local resource
Beaurocratic hurdles lead to extensive delays & by the time the required parts are in, the problems with the equipment are multiplied
Need to set up the workshops at medical centers, equipped with skilled HR , standard test equipment and tools for trouble shooting

23. Expected Impact
The successful implementation of the RCA project RAS /6/040 in Pakistan will result in:
Improved quality of radiation therapy by developing the skills of related Human Resource
Improved capability of repair and maintenance of radiation oncology equipment
Improved health care resulting from the better management of frequent cancers

24. If I know where I want to go,
I am likely to get there.