Glimpses of Radiotherapy in Nepal : It will be updated....

TRUEBEAM Machine @ Nepal Cancer Hospital and Research Center

      

Physicists Commissioning TOMOTHERAPY Machine @ NAMS

HYPERARC Treating Patient @ Chitwan Medical College

     

Physics Team @BPKMCH TRUEBEAM Control Console

Birat Cancer Institute Team @ TRUEBEAM Control Console

A successful episode of SCMPCR hands-on training program: This time at BPKMCH, Bharatpur, Chitwan, Nepal

South Asia Center for Medical Physics and Cancer Research (SCMPCR), Dhaka, Bangladesh under the leadership of Prof. Dr. Golam Abu Zakaria and management of Prof. Dr. Hasin Anupama Azhari has made its place as a successful organization for organizing various scientific activities, e-learning program, Hands-on workshops on regular basis etc. It has gathered wide appreciation from different societies and organization for its causes.

As SCMPCR is taking off its activities beyond Bangladesh, and after successful organization of SCMPCR HW-07, in February 2024, at Kolkota, India; this time SCMPCR hands-on workshop (SCMPCR-HW08) was held between 13^th to 16^th March, 2025 at B P Koirala Memorial Cancer Hospital(BPKMCH), Bharatpur, Chitwan, Nepal. It was an episode of a series of hands-on workshop SCMPCR organizes each year in different countries in South Asia. The program was a wonderful example of collaborative effort of SCMPCR and BPKMCH in co-operation with Nepalese Association of Medical Physicists (NAMP), which catered the need of international and national participants and satisfied trainers with great honor and hospitality. The title of the workshop was “Clinical Implementation of SRS, SRT and SBRT for Medical Physicists and Radiation Oncologists”. It was an EBAMP accredited course for 38 CPD points.

BPKMCH is the largest government funded comprehensive cancer hospital in Nepal. It is equipped with three medical linear accelerators (Varian Truebeam, Clinac iX and 600 CD), a HDR brachytherapy unit and a CT simulator. There are seven radiation oncologists, six medical physicists, thirteen technicians, and two onco-nurses in department of radiation oncology, of which the current head of department is Dr. Ranjanbhakta Bhandari and Mr. Surendra Bahadur Chand is incharge of medical physicists. It offers a range of treatment services like 3DCRT, IMRT, VMAT and IGRT. It treats 200 patients each month, and its staff members are trained in different countries and dedicated in patient services. Also BPKMCH is known for hosting different national and international seminars, conferences, and has praiseworthy amenity and ambiences.

The four-day workshop was a well organized effort of the organizers, which had both the theoretical and practical components, delivered by eminent speakers from six different countries (Germany, Belgium, Netherlands, Switzerland, Bangladesh and India) and two medical product vendors (Seimen healthliners and PTW). Forty-two participants (Medical Physicists, Radiation Oncologists and RTTs) from three different countries (Bangladesh, India and Nepal) attended the program with great enthusiasm. There were participants from almost every cancer hospital in Nepal. As new machines with advanced features are being installed in Nepal, this particular training program was important to shed knowledge on SRS, SRT and SBRT to local participants, and empower with wider knowledge and skills to foreign participants. Before the formal program begun, some physicist colleagues from Kathmandu displayed their hospitality by welcoming speakers at Tribhuwan International Airport in Kathmandu and accompanying them to their hotel in Chitwan.

On 13^th March, the first day of the program, the event started with a registration process at 8:30 am at Hall Room, BPKMCH, while the formal training program begun at 10:30 am with the introductory lecture on SRS, SRT and SBRT by Dr. Raju Srivastava, Belgium. This was followed by lecture by Prof. Dr. Sarbani Ghosh Laskar, India on Head and Neck delineation and associated issues, while Dr. Robert Semrau, radiation oncologist from Germany discussed on impact of contouring on quality of treatment plans. A lunch at Chitwan Garden Resort offered with traditional Nepalese cuisine to participants and speakers was a nice opportunity to everyone to get introduced to each other. It was further followed by a follow-up lecture by Dr Semrau on imaging modalities, image registration and pitfalls. Additionally, two online lectures- hypofractionation for breast cancer by Dr. Janine Simons (Netherlands) and hypofractionation for prostrate cancer by Prof. Luca Incrocci ( Netherlands) added a flavor to novel purpose of the event.

The second day program kicked off with an enlightening lecture by Dr. Sarbani on radiological challenges in SRS, SRT and SBRT, which was followed by a motivating lecture by Prof. Dr. Golam Abu Zakaria on Physics Quality Assurance, while after a short tea break, Ms. Tanya Bahl ( Varian) shared ideas on 4D CT scanning, MR fusion and RGSC for Advanced treatment planning, and Dr. Binay Shrestha ( Switzerland) through his online lecture discussed plan evaluation and clinical protocols in relation to SRS, SRT and SBRT. After the lunch at traditional Thakali Kitchen, once again Ms Bahl spoke on plan optimization and algorithms for SRS, SRT and SBRT dose calculation. The final lecture for the day was delivered by Dr. K Kanakavel (PTW), who shed light on patient specific QA with various QA devices. The scientific program ended at 4:30 pm, while everyone would attend the formal inauguration session at Chitwan Garden Resort at 6:30 pm.

The inauguration session started sharply at 6:30 pm, with the glorious presence of the chief guest Prof. Dr. Anjani Kumar Jha, vice chairperson of Nepal Medical Council, the apex body of medical education in Nepal. Also Dr. Bijay Raj Neupane, Chairman, BPKMCH, Board of Directors, Dr. Shivaji Poudel ( Executive Director, BPKMCH), formor BODs, Deputy director, HoDs (BPKMCH), other staff members, invitees, and media personnels added to the glory of the session. Dr. Jha praised the role of medical physics in health care setttings, and emphasis on necessity of medical physics education in Nepal was praiseworthy. His appreciation to SCMPCR, BPKMCH and NAMP to organize such events in Nepal was noteworthy. Similarly, Prof. Golam Abu Zakaria (Chairman SCMPCR) during his speech emphasized his interest to extend SCMPCR programs in other countries in South Asia, also asked participants to write on SCMPCR newsletter-which has grown as a nice platform to express on various issues related to medical physics and radiation oncology for global visibility of their write ups, and more importantly he assured that SCMPCR will support for clinical implementation of new techniques at BPKMCH in future as well. Other speakers highlighted the importance of such collaborative efforts to uplift the radiation services in Nepal. Prof. Dr. Hasin Anupama Azhari shared the success of SCMPCR in various arena of its effort to realize the novel dream of strengthening medical physics education for quality health services in South Asia.

On the third day, the participants were gathered at Radiotherapy building and as it was dedicated for the practical sessions, so the participants were divided into two groups- the first group of radiation oncologists was led by Dr. Laskar and Dr. Semrau and the second group of medical physicists and RTTs wasw led by Dr. Raju Srivastava, Dr. K Kanakaval  and Ms. Tanya Bahl. The first group polished their skills on contouring, plan evaluation, image fusion and countouring on 4DCT while the second group performed practicals on patient specific QA with particular focus on isocenter verification through Wintson Lutz test using ball bearing and PTW software and learned various data analysis techniques. Of course there was Coffee breaks and lunch break in between. The day ended with a general discussion on role of medical physicists on clinical context. The day was actually fruitful as the participants had opportunity to learn things practically.

On the final day, at Hall Room, two separate groups (of radiation oncologists and medical physicists &RTTs) were formed to whom two different sets of question papers were administered to evaluate learning outcomes. Except few participants, almost everyone passed the exam to gather EBAMP CPD points. This reflects the success of the training program, which the implementation of SRS, SRT and SBRT at their respective hospital will truly make the event successful. SCMPCR will remain in contact to them to get the regular feedback even after the event.

Moreover, participants and speakers enjoyed the natural beauty of Chitwan, and many of them took opportunity to visit Royal Chitwan National Park and could observe Elephant Breeding center there, one-horned rhinos, alligators, deers, peacocks and other wild animals. To sum up, participants and speakers experienced the true blend of scientific activity and natural beauty of Chitwan alongside the hospitality provided by BPKMCH, particularly by the Dr. Shivaji Poudel, Dr. Ranjanbhakta Bhandari (HOD, Radiation Oncology), Mr. Surendra Bahadur Chand (RSO), radiation oncologists, medical physicists and other staffs, during the program and beyond was extraordinary.  

 

 Barn Sallow (गौंथली ) !

Why would you build your home?

if you forage the whole year;

in cruel summer and in harsh winter

partly collecting food, for your survival

and partly collecting mud and husks

 to build your home

Futile is your efforts, and stubborn is your approach

to build tiny home;

not knowing, if your dream home

built on a man's house

Perhaps itself build without sufficing

legal order

Chances of being demolished 

with the man's fate for not sufficing legal order

Barn sallow! Rather learn from a jolly sparrow

living to its fullest, blessed as erotic freak,

still would have home at bushes and forest

escaping cruel summer, or harsh winter

आच्कल् बासुरि बज्दैन

मेरो देश् मा
आच्कल् बासुरि बज्दैन
तेस्ले हृद् य् को छेउबाट्
बग्ने तरङ बोक्थ्यो
मधुर् हुन्थियो
बेचैन् मन् को भाका बोल्थ्यो
दुनिया बिउझ्अ उथ्यो
भिर् पाखा, गाउ घर् गुन्झ्अ उथ्यो
तर, आच्कल् बासुरि बझ्दैनन्
बरु डम्फु बज्छन्
अर्कै लय हाल्छन्
ठुल डम्फु हुन् भने
ठुलो कोकोहोलो
साना हुन् भने सानै
आफु भित्र भरिय्एको
हावा को आयतन् को सापेछ् मा
डम्फु बज्छन्
कोकोहोलो मच् उन्छन्
मधुर् बसुरि को धुन् बिर्सौन्छन् (2)

Creating Scopes for Science Graduates in Nation Building: Some Suggestions

In recent years, the number of science graduates has noticeably increased. Nevertheless, neither the job market for them, nor the research activities are rising proportionately. This has led to larger dissatisfaction among the graduates as they get the rare opportunity to serve the nation and make the proper livelihood inside the country. Ultimately there is a forced exodus of bright minds in search of livelihood in foreign countries. Surprisingly, many of such science graduates have done significant progress in the field of study and research there. But their intense desire to serve their motherland and live happily with their families and friends has rarely been met, because they hardly get any opportunity to utilize their skills and knowledge inside Nepal even if they want to come back after study and this situation frustrates them in many instances.

From country’s prospective, it’s a huge loss for Nepal, for not being able to accommodate or welcome its own citizens to serve the nation, by utilizing their skills, knowledge and innovative outcomes. To be more precise, it is a huge economic loss to lose a highly skilled and trained human resource, on which the nation invest for two decades or more. Neither the country has been able to utilize them as semi-skilled workforce, rather than pushing them to abroad form higher education.

Government can develop petty projects to ensure jobs for science graduates, which may help the government and the graduates in many ways- engage the graduates to serve the nation, job creation and redistribution of income, help bridging the gaps in knowledge, give the workforce to modernize the country, innovations etc. How such things could happen, may be a question, so few examples are given below about how the science graduates could be used for developing the country.

There is a rampant cheating of passengers by the taxi-drivers or transportation operators or the customers by the petrol pumps or businessmen by mis-calibrating the meters or weighing machines. In such scenario, if a physicist, who is generally the expert in calibrating the instruments, is deployed in the market, as a market supervisor, who would check and verify the instruments in regular basis, would help to control the cheating. And by doing so, hundreds of jobs for physicists could be created on one hand and the cheating of customers could be minimized. Proper calibration of measurement devices and vending machines helps to curb black marketing. This will keep society in checks and balance. On the other hand, diversification of the nature of job helps physicists to enjoy his/her undertaking of jobs.

Similarly, food technologists can be used as food quality internal and external auditors. As in financial auditing, they will check if the vendor machines are properly vending the supposed amount or quantity of substances. This will help discourage the adulteration of consumables.

Likewise, if laboratories could be set up for chemists who are deployed to check and verify adulteration, quality of chemical and physical materials, etc, would help the nation and its citizens to live a quality and secure life. Same for the biologists, microbiologists, environmentalist and any science graduates.

To conclude, science graduates can be absorbed in the market if enough scopes for job is created in the country. There should be the diversification of jobs which they take. These graduates could be utilized by the society for nation building. Nevertheless government should build the proper mechanisms to finance such activities and hence sustain it.

 Mr. Suresh Poudel is a DAAD Research Scholar.

Development of Use of Radiation in Medicine

New Radiotherapy Centers and Infrastructural Needs

Year 2016 has been a significant year for cancer treatment in Nepal. Nepal Cancer Hospital and research center (NCHRC) in Lalitpur will soon start radiotherapy services with Varian Truebeam machine while Kathmandu Cancer Care and Research Center (KCCRC) in Bhaktapur has already started radiotherapy services with Elekta Synergy machine recently. Both of these machines are modern medical linear accelerators from two different companies. Previously, only BPKCH in Bharatpur and Manipal hospital in Pokhara had medical LINACS. NCHRC is also going to start High Dose Rate Brachytherapy with 24 Channel Gammamed ix plus machines to treat gynecological malignancies.  With the addition of these two new external beam radiotherapy machines in Nepalese Health Care system and one HDR Brachytherapy machines, we are now capable of performing modern cancer treatment techniques like 3DCRT, IMRT, VMAT/Rapid Arc, Stereotatic Radiosurgery & Stereotatic Body Radiotherapy,Total Body Irradiation in the country.

Previously, Cancer patients who had indication for such treatment techniques had to go abroad to receive such treatments. There used to be tremendous financial, psychological and practical difficulties for cancer patients and their families to receive such treatment in abroad. With these new medical facilities in the country, cancer patients and their near ones will surely be relieved with such pressures.

However, with the addition of new facilities in diagnostic radiology and radiation therapy, there is a rising challenges in the part of the service providers and government of Nepal to establish adequate radiation infrastructure for smooth functioning of such facilities in the country.

 Firstly, since radiation therapy machine produces ionizing radiation to cure malignancies, proper handling of such equipment is important. There should be a quality assurance mechanism to ensure quality treatment with these machines. Proper treatment outcome of radiotherapy requires the joint effort of Radiation Oncologists, Medical Physicists, Radiation Technologist, Oncology Nurses and others involved. Nevertheless, Medical Physics, Radiation Technology and Oncology Nursing courses are not offered in the country. So there is a shortage of these professionals in the country. GoN should take actions to prepare such human resources in the country.

Secondly, radiation monitoring is an important aspect of radiation safety. But due to the lack of radiation law, radiation regulatory body and infrastructural arrangement, there is difficulty in adopting proper guidelines and dose audits. So it is important to draft radiation law, establish regulatory body and make infrastructural arrangement as soon as possible. Drafting radiation law and establishing radiation regulatory body with give basic guidelines in operating radiation facility and help to move further to prepare necessary documents to ensure quality treatment.

Thirdly, most radiotherapy machines and related equipments are specially designed highly advanced machine. Establishing radiotherapy facilities requires huge investment. So GoN should facilitate in all possible ways to encourage health service entrepreneurs and hence increase access to specialized health services for cancer patients within the country. This will ultimately appease cancer patients and their near ones by minimizing their financial burden, psychological pressure etc. In addition, millions of rupees is retained in the country which would otherwise be spent aboard to get the radiotherapy services there.

In conclusion, with the rise in number of radiation facilities, particularly megavoltage radiotherapy facility, there is an urgent need to prepare basic and additional infrastructures for quality radiotherapy services for cancer patients.

By Suresh Poudel, Medical Physicist, Nepal Cancer Hospital and Research Center, Harisiddhi, Lalitpur