DEPARTMENT OF RADIATION ONCOLOGY

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2 Excellence and Leadership in Radiation Medicine Research, Education, and Clinical Practice DEPARTMENT OF RADIATION ONCOLOGY To Advance the Science and Practice of Radiation Medicine 2

3 Table of Contents Chair s Report 5 Faculty List 9 Committees 12 Clinical Programs 15 Education Report 18 Medical Radiation Sciences Program.. 29 Equity Report.31 Research Report 32 Research Grants Publications 57 Peer-reviewed 57 Non Peer-Reviewed. 89 Book Chapters 91 Abstracts 95 Presentations 131 Awards 161 Research Day.164 3

4 Department of Radiation Oncology Executive 2007/08 Chair Mary Gospodarowicz Vice-Chair Vice-Chair Vice-Chair Academic Affairs Clinical Affairs Academic Programs Pam Catton Shun Wong David Jaffray Directors Director Director Director Research Postgraduate Education Fellowship Program Anthony Fyles Barbara-Ann Millar Charles Catton Director Equity Officer Fei-Fei Liu Director Undergraduate May Tsao 4

5 Chair Letter It gives me great pleasure to present to you the University of Toronto, Department of Radiation Oncology (UT DRO) Annual Report for the academic year of The Department continues to strive for excellence and leadership in radiation medicine research, education, and clinical practice. We continue to provide expert clinical care to cancer patients from Toronto, other regions of Ontario, and from across Canada at the Odette Cancer Centre (OCC) and Princess Margaret Hospital (PMH). Both institutions have expanded provincial and international partnerships in clinical care research and education. It is with pride that we announce our new Master of Health Science in Medical Radiation Sciences (MHScMRS) in partnership with the Institute of Medical Sciences at the University of Toronto, which will open in January With the addition of the MHScMRS Program and our new postgraduate program in clinical physics, we now offer a full slate of professional and research training programs. We are also very proud of our large international Clinical Fellowship Program that continues to attract fellows from all over the world. Over the past couple of years, our Medical Radiation Sciences (MRS) Program underwent a major curriculum redesign, which was implemented in September The redesign included several new interprofessional courses that focused on communication professionalized collaborative patient care and leadership in health care research. UT DRO is leading the joint Ontario Ministry of Health and Cancer Care Ontario Advanced Practice in Radiation Therapy Project. The Department continues to thrive under the leadership of its three Vice- Chairs: Professor Pamela Catton, Professor David Jaffray, and Professor Shun Wong. They share their thoughts later in this report. Our management and infrastructure continues to expand. This spring, we welcomed our new Administrative Manager, Effie Slapnicar MBA, who joined us from the Canadian Arthritis Network. Effie s energies will focus on facilitating our departmental programs and innovation in practice. I hope that you will find both our regular report and the new shortened version informative. Mary Gospodarowicz MD FRCPC FRCR(Hon) Professor and Chair 5

6 Vice-Chair Reports Academic Affairs Pamela Catton As Vice-Chair for Academic Affairs, Pam Catton is responsible for the oversight of all education and financial activities in the Department. She works to build strong educational programs that serve the professional and research training needs of all radiation professional disciplines in an environment of fiscal responsibility. The reporting period of July 1, 2007 to June 30, 2008 saw a number of important Departmental initiatives come to fruition. Peter O Brien, the Program Director of the Medical Physics Residency Program and his team were able to fulfill the highest requirements for accreditation by the Commission on Accreditation of Medical Physics Education Programs and were awarded a six-year accreditation. This is a remarkable vote of confidence in this new program s ability to deliver quality physics education. Nicole Harnett, Graduate Program Director, and her team received an outstanding external review for the proposal to start a two-year professional masters program in Radiation Therapy. This MHSc Medical Radiation Sciences is unique to North America and will open in January Given the significant depth and breadth of our education programs, two new leadership positions in Physics and Radiation Biology Education were established to help integrate, coordinate and enhance the teaching of these basic sciences across all programs. Jean-Pierre Bissonette for physics and Bradly Wouters for biology, have assumed these portfolios. It is a stimulating and exciting time as the education programs continue to develop, mature and evolve, informed by the richness of our academic interprofessional environment. 6

7 Vice-Chair Clinical Affairs Shun Wong As Vice-Chair for Clinical Affairs, Shun Wong is responsible for policy and program issues related to relations with clinical sites and clinical faculty. In this portfolio, he oversees the appointment, 3-year review and promotions of members of the Department, and ensures that the recruitment and medical manpower plan at the clinical sites is aligned with the academic plan of the University Department. The past 12 months have witnessed continuing growth of clinical, research and educational activities at Princess Margaret Hospital-University Health Network and Odette Cancer Centre-Sunnybrook Health Sciences Centre. Both centres continued with upgrading of planning and treatment machines as well as state-of-the-art information systems. The program at both sites also benefited from strong philanthropic support by the respective hospital foundations. The Department continued to foster its regional leadership in cancer research and care. Padraig Warde on part time secondment was appointed as Acting Head of Radiation Program at the Southlake Hospital, and Juhu Kamra was appointed as Head of Radiation Oncology of the Royal Victoria Hospital. John Rowlands was appointed the inaugural Director of the Molecular Medicine Research Centre, a clinical research partnership with the Thunder Bay Regional Health Sciences Centre and Lakehead University. In addition, the Department continued to provide education and clinical support to many academic and community hospitals both within and outside the central LHIN. Congratulations are in order to Jim Brierley, Jean-Philippe Pignol and Richard Tsang who were promoted to the rank of Professor, and Joyce Nyhof-Young to the rank of Associate Professor. The following new appointments were made to the department: Arjun Sahgal, Assistant Professor; Shao Hui (Sophie) Huang, Lecturer; Andrew Hope, Assistant Professor; Bradly Wouters, Professor; and Marianne Korizinsky, Assistant Professor. 7

8 Academic Programs David Jaffray As Vice-Chair for Academic Programs, David Jaffray is responsible for the oversight of all research activities in the Department and works to build academic pursuits that bridge the faculty, facilities, and programs found within the Department. The reporting period of July 1, 2007 to June 30, 2008 was particularly rich with successes and endeavors. The following items of note demonstrate the scope and depth of this dynamic Department. October saw the long-awaited grand opening of the Spatio-Temporal Targeting and Amplification of Radiation Response (STTARR) Innovation Centre in the MaRS tower a $22M facility with investments from industry, government, and philanthropy all working together to improve our understanding and application of the radiotherapeutic effect. This infrastructure provides an ideal environment for collaboration within the Department and with other fields of medical research. The building of research faculty in the Department and the engagement of other institutions in this activity is a sign of things to come. Bradly Wouters, PhD was recruited to the Department with the support of the Ontario Institute of Cancer Research (OICR) to advance our understanding of radiation response and the microenvironment. David Hodgson, MD received a Level 1 Cancer Care Ontario Research Chair in the first CCO Research Chair competition, for studies of patient and provider characteristics associated with the provision of optimal cancer care, and on identification and quantification of long-term outcomes of cancer treatment, particularly the evaluation of late toxicity among survivors. Kristy Brock, PhD was awarded a Level 2 Cancer Care Ontario Research Chair based on her international reputation for pioneering work in deformable image registration, multi-modality imaging for radiation therapy, quantification and evaluation of organ motion and deformation, and assessment of treatment response. The receipt of dedicated faculty awards creates a platform for further growth in these areas. This is demonstrated in the growth of research grants held by the Department a number that is now approaching $20M per annum ( ). Toronto was host to the combined Canadian Association of Radiation Oncologists (CARO) and Canadian Organization of Medical Physicists (COMP) annual meetings. Many of our faculty participated in administrative, educational, and scientific activities for this meeting. The meeting was a great success with joint sessions that celebrated the collaborations that make Radiation Oncology a dynamic and progressive field. The Department is clearly the place to be. The resources, the strength of our partners, and the culture of collaboration (internal and external) are world-class. 8

9 Faculty Radiation Oncology Professor Pamela Catton Mary Gospodarowicz Fei-Fei Liu Juanita Crook Anthony Fyles Brian O Sullivan Bernard Cummings Gillian Thomas Padraig Warde Shun Wong Associate Professor Ida Ackerman Laura Dawson David Payne Andrea Bezjak David Hodgson Eileen Rakovitch Jim Brierley Robert Bristow Normand Laperriere Charles Catton Robert MacKenzie Rebecca Wong Edward Chow Michael Milosevic Jolie Ringash Cyril Danjoux Lawrence Paszat Richard Tsang Jean Philippe Pignol Assistant Professor Judith Balogh Robert Dinniwell Barbara-Ann Millar Lisa Barbera Mary Doherty Gerard Morton Elizabeth Barnes John Kim Ian Poon Andrew Bayley Anne Koch Arjun Sahgal Anthony Brade Wilfred Levin Alexander Sun Patrick Cheung Andrew Loblaw Ewa Szumacher John Cho Lee Manchul May Tsao Peter Chung Thomas McGowan Yee Ung Gregory Czarnota Michael McLean John Waldron Phillip Davey Cynthia Ménard Woodrow Wells Lecturer Jacqueline Spayne Radiation Physics Professor David Jaffray John Rowlands Assistant Professor Hamideh Alasti Tim Craig Peter O Brien Jean-Pierre Bissonnette Mostafa Heydarian Geordi Pang Stephen Breen Mohammad Islam Thomas Purdie Kristy Brock Harald Keller Michael Sharpe Allison Brown Katherine Mah Douglass Vines Young-Bin Cho Howard Michaels Collins Yeboah James Chow Douglas Moseley Ivan Yeung 9

10 Lecturer Parminder Basran David Beachey Robert Heaton Alexander Lightstone Radiation Therapy Assistant Professor Carol Gillies Lori Holden Tara Rosewall Lecturer Amanda Bolderston Cynthia Eccles Karen Moline Caroline Davey Nicole Harnett Cathryne Palmer Lisa DiProspero Valerie Kelly Instructor Ruth Barker Patricia Charman Jane Higgins Renate Bradley Fiona Cherryman Kari Osmar Angela Cashell Marta Evans Marc Potvin Martin Chai Wendy Flanagan Aisha Sheikh Education Assistant Professor Joyce Nyhof-Young Cross-appointments Professor Richard Hill Michael Rauth David Wiljer Associate Professor Alex Vitkin Assistant Professor Alan Rawlinson Jeff Siewerdsen Milton Woo New Appointments Andrew Hope Marianne Koritzinsky Bradly Wouters Sophie Huang Emily Sinclair 10

11 Departures Juhu Kamra Robert Luke Neil McParland Promotions- Effective July 2008 Professor James Brierley Jean Philippe Pignol Richard Tsang Associate Professor Joyce Nyhof-Young Administrative Staff Administrative Manager Department Secretary Administrative Coordinators: Resident Training Program Physics Residency in Radiation Oncology Fellows Medical Radiation Sciences Program: Associate Registrar Student Services Officer Administrative Assistant Mary Cunningham Rosa Da Silva Kim O Hearn Wanita Lambert Elena Gessas Jeremy Kwan Humberto Rocha Tanya Webb 11

12 Department of Radiation Oncology Committees Executive Committee Mary Gospodarowicz Chair Mary Cunningham Pamela Catton Peter Chung Anthony Fyles Nicole Harnett David Jaffray Barbara -Ann Millar Finance Committee Pamela Catton Chair Mary Cunningham Bernard Cummings Appointments Committee Shun Wong Chair Pamela Catton Anthony Fyles Carol Gillies External Relations Committee Anthony Brade Chair Kristy Brock Mary Cunningham Gregory Czarnota Rosa DaSilva Robert Dinniwell Academic Promotions Committee Shun Wong Chair Pamela Catton Anthony Fyles Mary Gospodarowicz Research Advisory Committee Anthony Fyles Chair Charles Catton David Jaffray Fei-Fei Liu Fei-Fei Liu Peter O Brien Cathryne Palmer John Rowlands Jacqueline Spayne Padraig Warde Shun Wong Mary Gospodarowicz David Jaffray Shun Wong Mary Gospodarowicz David Jaffray Fei-Fei Liu John Rowlands Zahra Kassam Kim O Hearn Sarah Rauth Tanya Webb David Wiljer David Jaffray Fei-Fei Liu John Rowlands Gillian Thomas Michael Milosevic Jean-Philippe Pignol John Rowlands 12

13 Teaching Effectiveness Committee Pam Catton Chair Ida Ackerman Jean-Pierre Bissonnette Cathryne Palmer Education Committees Undergraduate Medical Education Juhu Kamra Chair Lee Manchul Joyce Nyhof-Young Postgraduate Education Pam Catton / Barbera-Ann Millar Chair Ida Ackerman Robert Bristow Charles Cho William Cho William Chu Meredith Giuliani Adrian Ishkanian Stanley Liu Fellowship Charles Catton Chair Anthony Fyles Mary Gospodarowicz Michael Milosevic Ewa Szumacher May Tsao Woodrow Wells Sten Myrenhaug Peter O Brien Kim O Hearn Jean-Philippe Pignol Hany Soliman Eileen Rakovitch Woodrow Wells Rebecca Wong Gerard Morton Woodrow Wells Shun Wong 13

14 Department of Radiation Oncology Representation On University of Toronto Committees Catton, P Faculty of Medicine Education Committee, Member IMS Admissions Committee, Member Gospodarowicz, M Clinical Relations Committee, Faculty of Medicine, Member Medical Radiation Science Board of Examiners, Member Faculty Council, Faculty of Medicine, Member Harnett, N Faculty Council, Faculty of Medicine, Member Manchul, L Continuing Education Council, Faculty of Medicine, Chair Nyhof-Young, J Dean s Advisory Committee on Gender Issues, Faculty of Medicine, Member Ringash, J Academic Board of the Governing Council, Member Faculty Council, Faculty of Medicine, Member Faculty of Medicine Research Grants Committee, Member 14

15 Clinical Programs Princess Margaret Hospital Mary Gospodarowicz The Princess Margaret Hospital Radiation Medicine Program (RMP) is one of the largest in the world. With modern facilities equipped with 16 linear accelerators, all IMRT and IGRT enabled, Leksell Gamma Knife 4C and Perfexxion, HDR and PDR brachytherapy programs, it is capable to handle any radiation therapy situations. The clinical expertise spans all cancer sites with large breast, lung, genitourinary, upper and lower gastrointestinal, gynecologic, head and neck, central nervous system, ocular, lymphoma, sarcoma, skin, endocrine and pediatric radiation oncology groups. In , PMH RMP continued to expand its clinical and academic programs. RMP faculty provided consultations in many collaborating institutions including St Michael s and St. Joseph s Hospitals in Toronto and the Southlake Cancer Centre in Newmarket. The research programs in CT PET simulation, MR simulation and Image Guided radiation therapy continued to make excellent progress with a very successful symposium Magnetic Resonance Comes of Age at the combined 2007 Annual Scientific Meeting of the Canadian Association of Radiation Oncology and the Canadian Organization of Medical Physicists led by Cynthia Menard. RMP PMH leadership extends well beyond radiation oncology and Toronto. Brian O Sullivan developed the strategic plan for Princess Margaret Hospital Cancer Program. The partnership with the Aviano Cancer Centre in Italy saw faculty from Italy visit PMH. Mary Gospodarowicz joined the Aviano s International Scientific Advisory Board led by Prof Dalla Favera from the Columbia University in New York City. Padraig Warde was appointed as Acting Head of the Radiation Medicine Program in the Southlake Cancer Centre. He has also been appointed as Chair of the Radiation Oncology Provincial Advisory Committee. Michael Milosevic became the President of the Canadian Association of Radiation Oncology for the term of office. Bernard Cummings, Mary Gospodarowicz, and Brian O Sullivan were named Fellows of the American Society of Therapeutic Radiology and Oncology (FASTRO). FASTRO designation is based upon meritorious service to ASTRO and to the field of radiation oncology including leadership/service, research, patient care and education. The research programs continued to expand. Last year witnessed the formal opening of the STTARR Innovation Centre in the MaRS (Medical and Related Sciences) complex in the University Health Network. Funded by the 15

16 Canadian Foundation for Innovation STTARR is the heart of the translational biology and technology research programs of RMP. Led by David Jaffray, Robert Bristow and Michael Milosevic, this collaborative program extends its reach well beyond radiation oncology engaging surgery, pathology, imaging, and others in collaborative research. David Hodgson was awarded a level 1 Cancer Care Ontario Research Chair in Patterns of Care, and Kristy Brock, a level 2 Cancer Care Ontario Research Chair in Cancer Imaging, in the first CCO Research Chairs competition. RMP supported unprecedented number of undergraduate MRS students (23), clinical fellows (20), and hosted 5 international IGRT courses with participants from Europe, Australia, Asia, and North America. RMP PMH was awarded a grant from Cancer Care Ontario to organize a comprehensive IMRT Course for the province to run four times over the next two years. Michael Sharpe PhD, the Course Director will lead this initiative. We welcomed many new staff to the program including Catherine Coolens PhD who joined us from the Institute of Cancer research and Royal Marsden NHS Trust and Andrew Hope MD who joined us from Washington University in St Louis. Bradly Wouters PhD joined the Ontario Cancer Institute and PMH RMP from the Department of Radiation Oncology (Maastro Lab), GROW Research Institute and Maastricht University in Netherlands. With the best staff, clinical infrastructure, education and research programs, while the Princess Margaret Hospital Cancer Program aspires to be one of the five top comprehensive cancer programs, the Radiation Medicine Program aspires to be the best. Toronto-Sunnybrook Regional Cancer Centre Shun Wong The past twelve months have witnessed continuing growth of the clinical, research and educational activities of the Radiation Treatment Program at Sunnybrook Health Sciences Centre. Just over 6100 new radiation oncology patients were seen in fiscal year 07-08, an increase of 6.5% from 06-07, and about 100,000 fractions of radiation treatment were delivered. Upgrades to the existing clinical infrastructure continued with the installation of two new linacs with image-guided radiation treatments (IGRT) capability. A CT simulator replaced the conventional simulator. Many specialized programs including Tomotherapy, IGRT using cone-beam and brachytherapy continued to expand. Stereotactic body radiation therapy was implemented, and other upgrades in technology continued. The Radiation Treatment Program benefited form a large philanthropic support from Mr. Edmond 16

17 Odette to enhance its academic objectives, specifically in imaging research and image-guided radiation treatments. Juhu Kamra was appointed as Head of Radiation Oncology of Royal Victoria Hospital, but will remain as consultant staff at Sunnybrook. Four radiation oncologists were successfully recruited to start over the next two academic years. The Program continued to foster its regional leadership role in cancer care. A temporary radiation treatment facility, a partnership between the Royal Victoria Hospital (RVH) and the Radiation Treatment Program at Sunnybrook began operation in April 2008.Radiation Oncologists continued to participate in peripheral clinics at RVH, Toronto East General Hospital and North York General Hospital. The Program continued to provide multidisciplinary cancer conference support to a number of community hospitals within and outside of the Toronto Central LIHN. Faculty members were successful in securing a number of multi-year external peer-reviewed grants. These research grants including a number of large awards (Poon, OICR; Czarnota, US Army; Pignol, CBCF) are detailed elsewhere in the annual report. The Rapid Response Radiation Program (Chow) was awarded the Co-op student of the year Employer Award by Education at Work Ontario for education leadership. 17

18 Education Report In , the UT DRO continued its strong commitment to high quality health professional education and research training and a number of important Departmental initiatives came to fruition. Peter O Brien, the Program Director of the Medical Physics Residency Program and his team were able to fulfill the highest requirements for accreditation by the Commission on Accreditation of Medical Physics Education Programs and were awarded a five-year accreditation. This is a remarkable vote of confidence in this new program s ability to deliver quality physics education. Nicole Harnett, Graduate Program Director, and her team, received an outstanding external review for their proposal to start a two-year professional masters program in Radiation Therapy. This MHSc Medical Radiation Sciences is unique to North America and will open in January A number of leadership positions changed hands in the academic year. Barbara-Ann Millar became the Program Director of the Radiation Oncology Residency Program, assisted by Woodrow Wells, Associate Program Director. Pamela Catton served as Acting Program Director during Barbara-Ann Millar s maternity leave. Juhu Kamra stepped down from the Undergraduate Medical Education portfolio in April, to be succeeded by May Tsao as Director, and Joyce Nyhof-Young as Associate Director. Given the significant depth and breadth of our education programs, two new leadership positions in Physics and Radiation Biology Education were established to help integrate, coordinate and enhance the teaching of these basic sciences across all programs. Jean-Pierre Bissonette for Physics and Bradly Wouters for biology assumed these portfolios. Graduate Education Introduction In , efforts to enhance our involvement in graduate education at the University of Toronto continued. Master s of Health Science, Medical Radiation Sciences In January 2009, the Institute of Medical Science (in collaboration with UT DRO) will launch the very first radiation therapy focused master s program in North America. After several years of development and collaboration, the program received final approval from both the University of Toronto and the Ontario government in Spring

19 For many years, radiation therapists interested in pursuing discipline specific graduate education were forced to go abroad and study primarily through distance learning formats completing module or research-based programs. This professional master s is unique in that it prepares radiation therapists, interested in continuing their clinical work, for an academic and advanced practice. The eight credits, full time program provides an excellent complement to the research master s program already offered through IMS to qualified radiation therapists. Curriculum development is currently underway for the nine new radiation medicine-focused courses and will draw heavily on our local expert faculty at Odette Cancer Centre and Princess Margaret Hospital. The program also requires students to complete the existing IMS courses in radiation oncology including Translation Biology applied to Radiation Science, Frontiers in Radiation Medicine Research, and Advanced Radiotherapy and Medical Physics. This will allow students to study in a more multidisciplinary environment and learn from their fellow students. With initial registration set at five students per year, it is hoped that over the following 5 years, the program will expand to accept at least ten radiation therapists annually. It is hoped that this program will become the gold standard for advanced academic preparation for expert radiation therapists around the country and beyond. In the following UT DRO graduate students were enrolled in the MSc/PhD stream in the Institute for Medical Sciences: Name Degree Program Supervisor Chan, Phillip MSc A. Fyles Dinniwell, Robert MSc M. Milosevic Bachtiary, Barbara MSc A. Fyles Keller. Brian PhD J.P. Pignol Letourneau, Daniel PhD D. Jaffray Franks, Kevin MSc D. Jaffray Koh, Eng-Siew MSc P. Catton Case, Robert MSc L. Dawson Christiansen, Eva MSc R. Bristow Lim, Karen MSc M. Milosevic Mehdizadeh, Hany MSc J. Siewerdsen 19

20 EIRR 21 Research Training Program The Excellence in Radiation Research for the 21 st Century (EIRR21) Training Program entered its fifth year (Funded by the Canadian Institute of Health Research. It has graduated six trainees, four of whom hold academic research positions either at the Princess Margaret Hospital or Europe. Currently, there are 30 active trainees in EIRR21, including four MDs, many hail from other countries such as Australia, India, Germany, and the United Kingdom. The research domains cross several disciplines, ranging from basic genetic and molecular studies on radiation response, molecular imaging, bio-informatics, novel therapeutic approaches, technical improvements in radiation delivery, and biomarker evaluations for radiation response and toxicity in cancer patients. Hence, the trainees are nurtured in an environment, which facilitates cross-pollination of scientific ideas and approaches. The EIRR21 trainees continue to be highly productive, with a total of 62 peer-reviewed publications, one research grant, and four patent-filings. There have been several significant achievements of many EIRR21 trainees, including receipt of external competitive training awards such as NCIC, NSERC, and CIHR. Nadine Kolas (supervisor Dan Durocher) published a paper in Science (Kolas et al; Science 318:1637, 2007) on the novel role of RNF8 ubiquitin ligase in mediating DNA damage response. Naomi Matsuura (supervisor John Rowlands) was awarded the John Charles Polanyi Prize from the Ontario Government, in recognition of young talented researchers in the province. Hence, this research-training program fulfils the CIHR mandate to build capacity, innovate, conduct trans-disciplinary science, and be internationally competitive. The trainees enrolled in the Program in include: Trainee Status Supervisor(s) Mocanu, Joe PhD F.F. Liu Bailey, Kristy MSc K. Vallis/ R. Reilly Boutros, Paul PhD I. Jurisica/L. Penn Costantini, Danny PhD R. Reilly/K. Vallis Cai, Zhongli PDF K. Vallis Kolas, Nadine PDF D. Durocher Macrae, Chloe MSc A. Koch Matsuura, Naomi PDF J. Rowlands Moniz, Larissa PhD V. Stambolic Vlad, Roxana PhD G. Czarnota 20

21 Zhang, Wei PhD D. Durocher Zheng, Jinzi MSc D. Jaffray Jacks, Kellie PhD A. Koch Kumareswaran, Ramya MSc R. Bristow Lau, Priscilla PhD P. Cheung Clending, James PhD L. Penn Christensen, Eva MSc R. Bristow Franks, Kevin MD A. Bezjak/D. Jaffray McLarty, Kristen PhD R. Reilly Li, Michelle MSc B. Derry Para, Andrea MSc R.P. Hill Stroian, Gabriela PDF J. Seuntjens Medical Education Undergraduate Medical Education Program Director: May Tsao The Department of Radiation Oncology continued to provide teaching to pre-clerkship (years 1 and 2) and clerkship (years 3 and 4) medical students. Pre-clerkship teaching included tutoring students in the Determinants of Community Health (DOCH) I course and providing lectures for the Foundations of Medical Practice and Pathobiology of Disease courses. Furthermore, a few University of Toronto radiation oncologists participated in teaching the DOCH II course. Twenty-four elective students, seven ambulatory Community Experience (ACE) students and four Ivan Smith awardees rotated through the Department. Postgraduate Medical Education Radiation Oncology Residency Program Director: Barbara-Ann Millar The UT DRO had 26 residents participating in its five-year training program. PGY1 s spent most of their first year off service in a basic clinical year comprised of surgical, medical and gynecological oncology, radiology, emergency medicine, general internal medicine, pediatrics, urology, and an elective. During January and February the Academic Block was offered, consisting of eight weeks of classroom based interprofessional teaching. Modules in CanMEDS, the Fundamentals of Research, the Fundamentals of 21

22 Radiation Therapy and Introductory Oncology complemented the basic science teaching Radiation Oncology residents from Queen s University Program and University of Toronto physics residents also attended. The PGY2 s spent six months off service in medicine and medical oncology and 6 months rotating in radiation oncology. PGY3 residents were based at the Odette Cancer Centre (OCC), under the supervision of Ida Ackerman, Site Residency Coordinator. Basic physics knowledge and its application in clinic are emphasized. PGY4 and PGY5 residents continued to improve sitespecific knowledge and radiation practice competencies at both the Odette Cancer Centre and the Princess Margaret Hospital. The Annual Research Day was held at the Faculty Club this year on May 10, Given the large number of radiation oncology residents, fellows, physics residents and graduate students, we accepted 49 abstracts by peer review. Eleven residents presented research projects, nine as podium presentations. Adrian Ishkanian won the W.J. Simpson Award for Academic Excellence in Research by a Resident (Supervisor: Robert Bristow) for his work High-resolution Array CGH Identifies Novel Regions of Genomic Alteration in Intermediate-risk Prostate Cancer. A New Award was introduced this year for overall excellence and this award went to Adrian Ishkanian, PGY2, Radiation Oncology Resident and clinician-scientist at the University of Toronto, He was also awarded a 2008 Novartis Oncology Young Investigator Award for this year's ASCO meeting in Chicago June At CARO in 2007, nine residents had their abstracts accepted for the Resident Competition. All PGY5 residents successfully passed the RCPSC national certification examination in June, Residents PGY1 Eman AlDuhaiby Amanda Caissie Meredith Giuliani Eric Leung Eve-Lyne Marchand Fazilat Mohammed PGY2 Adrian Ishkanian Kathy Han Elisa Chan Ameen Al-Omair 22

23 PGY3 Matthew Follwell Sten Myrehaug Hany Soliman Fred Yoon PGY4 Iwa Kong Louis Fenkell Behzad Banihashemi Stanley Liu Sarah Rauth PGY5 William Chu Charles Cho Christiaan Stevens Alina Sturdza Moji Taremi Yongjin Wang Jason Wong Residency Program in Radiation Oncology Physics Program Director: Peter O Brien Site Coordinators: Jean-Pierre Bissonnette (PMH); Milton Woo (OCC) The Residency Program in Radiation Oncology Physics started in July 2007 by combining existing long-standing medical physics residency programs at the Princess Margaret Hospital and the Odette Cancer Centre. The goal of the new joint program is to produce highly competent medical physicists who combine a comprehensive understanding of clinical radiation physics and specific knowledge of radiation therapy and radiation oncology principles and practice with enhanced leadership, research and teaching skills. The program accepts applications from qualified and highly motivated candidates with a post-graduate degree in medical physics or a related discipline. The minimum program length is 2 years and includes a mix of didactic instruction, clinical rotations and clinical projects. Each resident is assigned a mentor to act as a guide throughout the program. During the first year the residents have didactic training in Radiation Biology, Radiation Safety, Clinical Radiation Physics and Dosimetry and the Principles of Treatment Planning. There are rotations in Instrumentation, Treatment Planning and Quality Management. In the second year there are rotations in 23

24 Brachytherapy and Imaging Physics, Advanced Treatment Planning and a continuation of Quality Management. Residents interact with radiation oncologists and radiation therapists during the Applied Physics tutorials and the Interdisciplinary Rotation that follows specific patients from first clinic to treatment. Resident knowledge is evaluated at regular, topical resident question and answer sessions based upon the program syllabus. To complete the program the resident must successfully pass the Peer Review A oral examination, organized by a standing provincial committee of Cancer Care Ontario. Jean-Pierre Bissonnette is a member of the Peer Review A examination committee. Throughout the 2-year program the resident is expected to work one or more clinical physics projects under the supervision of a staff medical physicist. The results of this work were presented as posters during the UT DRO Research Day and also as posters and oral presentations at the meetings of the Canadian Organization of Medical Physicists, and the American Association of Physicists in Medicine. The winner of the J.R. Cunningham award for academic excellence in research by a medical physics resident was Aaron Vandermeer. In the summer of 2007 the program committee applied for accreditation from the Committee on Accreditation of Medical Physics Education Programs (CAMPEP). A self study and site-evaluation by a CAMPEP team were completed in the fall of 2007 leading to a full 5-year accreditation. The first graduates on the new CAMPEP accredited program were Xia Wu in December 2007, Lee Chin and Aaron Vandermeer in June The other residents, with clinical site and expected completion dates are Dylan Hunt, Rick Holly (October, 2008), Alex Karotki (September, 2009), Shahin Fattahi (January, 2010), Andrea McNiven (September, 2009, Claire McCann (February, 2010) and Alexandra Rink (January, 2010). Radiation Oncology Fellowship Programmes Program Director: Charles Catton The UT DRO Fellowship program is one of the largest in the world. Fellows spend one or two years in a Research Fellowship or a Clinical Research Fellowship. This past year 22 Fellows were involved in the program at both sites, coming from Australia (5); Canada (4); India (4), Ireland (2), UK (7). Three Fellows won travel awards to present their work, and another won second prize for best presentation at an international meeting. Five Fellows received directly to themselves over $374,000 in peerreviewed funding. This program remains successful and internationally highly regarded based upon the Fellows presentation and publication 24

25 record, positive exit interviews, and most importantly, a steadily increasing annual application rate as a consequence of referrals and recommendations from previous Fellows. Quality measures Abstracts presented: 72 Manuscripts published: 9 Manuscripts in preparation: 9 Grants: PI (n=5) $374,400 Awards: 1 ASTRO Travel award 1 Swiss League Against Cancer Travel Award 1 ISMRM Travel Award Second prize, best presentation at 4 th ISV International Conference on Cancer Therapeutics Fellows Supervisors Gaurav Bahl Debashis Biswas Supriya Chopra Max Dahele David Fitzpatrick Jayant Goda Asim Kamran Zahra Kassam Justin Lee Mark Lee Gerald Lim Karen Lim Chen Liu Orla McArdle Nikhilesh Patil Paul Sanghera Colin Tang Shaun Tolan Danny Vesprini Jonathan Wan Deborah Williamson Karen Wong Normand Laperriere/David Hodgson Anthony Fyles Cynthia Menard Mary Gospodarowicz/Andrea Bezjak Rebecca Wong Richard Tsang/Peter Chung Gerard Morton Jolie Ringash Gregory Czarnota Laura Dawson Andrea Bezjak Michael Milosevic/Anthony Fyles John Kim/John Waldron David Hodgson/Pamela Catton Juanita Crook Philip Davey/May Tsao Andrew Loblaw Michael Milosevic CharlesCatton/PadraigWarde/Robert Bristow Anthony Brade Anthony Fyles/Robert Dinniwell Jolie Ringash/John Waldron Continuing Education The Departmental CE activities were led by individual course directors, with oversight provided by Pamela Catton. 25

26 CEI³ Core Curriculum The UT DRO CEI³ is made up of a curriculum comprised of a fixed core of annual elements including UT DRO Rounds, and the Kingbrige Conference, in addition to a variable program hosted by UT DRO faculty. CEI³ complements a comprehensive continuing professional development program that takes place at PMH and TSRCC. Each program element has a Course Director, an interprofessional program and planning committee, is based on educational needs, is eligible for CE credits, intends to achieve an international profile and innovative elements, and is evaluated by standard educational criteria. UT DRO Rounds Coordinator: Anthony Fyles These twice-yearly symposia profile the academic programs of the UT DRO, share information and ideas between the two campuses, foster new research collaborations, and stimulate inquiry. Second Cancers Following Radiation. Moderator: Anthony Fyles David Hodgson - learning from the fat man: modeling second cancer risk for clinical use Fei- Fei Liu - Thinking outside the box... how does breast RT induce saml? Jean- Philippe Pignol - Second cancers following breast radiation - physics and solutions Robert Bristow - DNA repair as a chemoprevention target following radiotherapy?" Other Continuing Education Activities All Department of Radiation Oncology faculty continued their active involvement in continuing education endeavours in a variety of capacities: course directors and invited speakers at local University of Toronto, national and international conferences, and as visiting professors. A number of faculty were involved in innovative continuing education initiatives including workshops, web-based and CD-ROM formats. For example, Ida Ackerman has developed a distance web-based collaboration with physics to teach clinical applied physics to radiation oncology residents in Australia. Patient-Centered Radiotherapy at Kingbridge April 26 27, 2008: King City, Ontario Course Directors: Amanda Bolderston and Ruth Barker 26

27 The 5 th Annual Conference entitled Global Perspectives, Local Outcomes was held at the Kingbridge Conference Centre. Over the two days approximately 110 attendees from radiation therapy, radiation oncology, physics and pharmacy enjoyed a blend of topics in plenary, workshop and poster sessions. The program included a keynote speaker on Saturday - Gail Tomblin Murphy, Nurse and Professor at Dalhousie University, School of Nursing and Community Health and Epidemiology, who discussed driving forces and environment realities and how these impact our community of healthcare providers. Sunday s keynote speaker was Marilyn Hammick, Radiation Therapist and Visiting Professor at the University of Central England and Anglia Ruskin University, and Chair of the UK Centre for Advancement in Interprofessional Education. Marylin Hammick s lecture was also attended by a number of her interprofessional colleagues from George Brown College. The keynote speakers were followed by plenary sessions with afternoon concurrent workshops and oral abstract presentations. Posters were displayed throughout the conference with a formal presentation at a wine and cheese event on Saturday evening. Snapshot of evaluations: Evaluation of the overall impression of the conference o 78% of attendees who completed the evaluation rated the conference either good or excellent. Do you think this event will change your practice? o 61% of attendees who completed the evaluation said yes. Would you recommend this conference to others? o 91% of attendees who completed the evaluation said yes. Next year s conference will be held at the Old Mill, Toronto on March 6 th and 7 th. The conference will also incorporate the Radiation Therapist Research Symposium for the first time. The merging of these two successful events will provide a wider variety of concurrent research presentations in one convenient venue whilst also increasing the potential number of attendees. 27

28 IGRT Education Course The Image Guided Radiation Therapy (IGRT) Education Course is a collaborative educational course operated jointly by the UT DRO and the Radiation Medicine Program at PMH. Since its inception, 420 registrants have attended the course including 221 RMP staff and UT DRO students, residents and fellows. It is offered five times a year. The course engages over 30 faculty members, the majority of whom are UT DRO appointed faculty, and invited guest faculty from the broader radiation therapy community. This year Lei Dong, from MD Anderson in Houston, participated as a guest faculty member. The course continues to attract international participants from Europe, Asia and Australia, and many points throughout the US. It continues to be seen as the gold standard for IGRT education in radiation medicine circles. IMRT Education Course Intensity-modulated radiation therapy (IMRT) has emerged as the contemporary standard of care for patients with many forms of cancer. Given UT DRO s reputation as a leader in radiation medicine and the academic home of many IMRT experts, CCO has sponsored the development of an IMRT Education Course in partnership with PMH and UT DRO. This course will give radiation medicine practitioners from around Ontario an opportunity to enhance their knowledge and skills in this area. The first internal offering was delivered in June 2008 to 30 internal attendees. The course and the 14 faculty members received high praise from participants. The new two-day educational program will consist of both theoretical and practical sessions to assist registrants prepare for IMRT implementation in their own centres. The course will begin in the fall of 2008 and will be run four times over the next two years. UT DRO Faculty in Continuing Education Leadership Several faculty continued to play a leadership role in the area of education administration as chairs of local and national continuing education committees and international organizations. Lee Manchul served as Chair of the Continuing Medical Education section of the Group on Educational Affairs within the American Association of Medical Colleges, Chair of the Continuing Education Council Faculty of Medicine, University of Toronto and Chair of the Education Committee for the Canadian Association of Radiation Oncology. 28

29 Medical Radiation Sciences Program After receiving all levels of approval at the Michener Institute and University of Toronto, the Medical Radiation Sciences Program has been actively developing and redesigning the curriculum. The first intake of students into the new curriculum commenced in September The MRS curriculum has been redesigned to include several courses that are interprofessional in nature, so that MRS students can learn with, from and about other healthcare professional students. Students entering the MRS Program in September will undertake a number of interprofessional education courses; specifically courses that focus on communication, professionalism, collaborative patient care, leadership in healthcare and research. Several of the discipline specific courses have been revised with some courses incorporating new material based on current clinical practice. For example students in all three disciplines will have as a component of their core curriculum a full course entitled Integrated CT Imaging Theory & Practice. No other programs in Ontario are educating their students to this level of practice. In addition, a clinical simulation semester, both interprofessional and discipline specific, will be implemented in the summer of Currently course development and approvals are underway for the academic year 2008/2009. There is representation from the MRS Program on several working committees organized through the Office of Interprofessional Education. As directed by the Council of Health Sciences Deans (CHSD), UT health professional students will participate in a longitudinal curriculum to acquire core competencies needed to provide patient-centered care, focusing on an interprofessional collaborative team approach. Program Quality: National Certification Results Radiological Nuclear Radiation Technology Medicine Therapy (88.7) 68.4 (64.0) 98.3 (98.8) (92.5) 78.9 (93.8) 96.9 (97.0) (95.0) 89.3 (87.1) 87.5 (87.0) (88.1) 90.6 (89.5) 97.1 (90.4) (94.2) 83.9 (82.8) 98.2 (89.2) Percent of students successful on the first write of the exam. National averages in brackets. 29

30 Each year, the Ontario Association of Medical Radiation Technologists (a provincial member of the national professional association) awards the T.B. Hurst award to the graduate who achieves the highest score on the Canadian Association of Medical Radiation Technologists certification examination in each of the disciplines. In 2007, UT/TMI Medical Radiation Sciences students, won in the disciplines of: Radiation Therapy: Iris Wong Nuclear Medicine: Melissa Roza Student Statistics: Enrolment Radiological Nuclear Radiation Total Technology Medicine Therapy Class Class Graduation Numbers: (eligible to graduate November 2008) Graduation Radiological Nuclear Radiation Total Technology Medicine Therapy Class Student Academic Awards: Overall Highest Academic Standing: Gold, Silver and Bronze awards are given to the graduates attaining the highest overall gap at the November 2007 Convocation Ceremony Gold Medallist: Silver Medallist: Bronze Medallists: Pavlo Ohorodnyk - Radiological Technology Daphne Chan - Radiation Therapy Jin Huang - Nuclear Medicine Research Awards: University of Toronto/Michener Institute Award for Excellence in Research by a Final Year Medical Radiation Sciences Student. Winner: Jaclyn Gouin - Radiation Therapy Title: The impact of daily travel on fatigue scores in a prostate cancer population at the Windsor Regional Cancer Centre Co-Supervisors: Colvin Springer & Siobhan Ozard Honourable Mention: Title: Caitlin Gillan - Radiation Therapy Radiation therapy students' teaching 30

31 Supervisor: Honourable Mention: Title: Supervisor: expectations of therapists over the course of clinical practicums: a longitudinal study Cate Palmer Peter Geu Machar - Nuclear Medicine PET/CT and the Attenuation Correction of PET Studies R. Glenn Wells & Donald Kuhl Clinical Project Awards: In each discipline the students who have the highest combined marks for Clinical Project I & II are recognized for their achievements. Radiological Technology: Outstanding achievement in clinical project: Honourable mention: Honourable mention: Nuclear Medicine Outstanding achievement in clinical project: Honourable mention: Radiation Therapy Outstanding achievement in clinical project: Honourable mention: Navindra Johnie Rachel Au Dong Xu Roxana Fung Avelene De Souza Allison Michelle Mills Erin Elizabeth Dwyer Equity Report Program Director: Fei-Fei Liu A new appointment has been made in 2007, for an Equity Officer in the UT DRO. The responsibilities for this position include developing, implementing and evaluating programs to maintain an inclusive learning environment, and ensuring an atmosphere of sensitivity for cultural, ethnic, and diversity issues, along with gender equality. Given the extensive intersections of UT DRO faculty and trainees with many other host institutions including hospitals, research institutes, training programs, and other schools within the larger UT environment, the Equity Officer will minimize duplication of efforts and programs, and instead, will be playing a major role in facilitating resolution of potential conflicts, and access to relevant resources at the host institutions. 31

32 Research Report The UT DRO research program continues to grow and consolidate its profile as one of the pre-eminent multidisciplinary radiation medicine research programs in the world. The following report summarizes the areas of progress, new initiatives, and benchmarks of success in Research in UT DRO is conducted in all domains of radiation medicine; including radiation physics, therapy and nursing. The scope includes clinical research, quality of life and health services and outcomes research, basic and translational studies related to radiation response, and advanced highprecision radiation and imaging. Research is performed in collaboration with the other clinical and basic science departments, extra-departmental units including hospital research institutes, both within and outside of the University of Toronto. The UT DRO Research Committee advises regarding research priorities in DRO, fosters collaboration between research units and hospitals, advises regarding resident and fellowship research training programs, identifies mechanisms for funding, and monitors departmental research output and benchmarks. Research Highlights David Hodgson was awarded a Level 1 Cancer Care Ontario Research Chair in the first CCO Research Chair competition, for studies of patient and provider characteristics associated with the provision of optimal cancer care, and on identification and quantification of longterm outcomes of cancer treatment, particularly the evaluation of late toxicity among survivors. Kristy Brock was awarded a Level 2 Cancer Care Ontario Research Chair based on her international reputation for pioneering work in deformable image registration, multi-modality imaging for radiation therapy, quantification and evaluation of organ motion and deformation, and assessment of treatment response. Barbara Bachtiary was awarded the Whiteside Award, given annually to a graduating IMS Master of Science student who has made outstanding scholarly contributions. Barbara Bachtiary is a PMH and UT DRO Research Fellow, and a trainee with the EIRR21 (Excellence in Radiation Research for the 21st Century) Training Program, supervised by Anthony Fyles and Fei-Fei Liu. 32