Radiation Oncology Training Program Guidelines

Revised: 12/07

AMERICAN COLLEGE OF VETERINARY RADIOLOGY RECOGNIZED VETERINARY SPECIALTY OF RADIATION ONCOLOGY TRAINING PROGRAM GUIDELINES

I. INTRODUCTION
II. OBJECTIVES
III. STANDARD PROGRAM
IV. MINIMUM TRAINEE REQUIREMENTS
V. TRAINING PROGRAM DIRECTOR
VI. REQUIRED PROGRAM FACULTY
VII. TRAINING PERIOD
VIII. CLINICAL RESOURCES
IX. FACILITIES
X. MULTIINSTITUTIONAL AGREEMENT
XI. TRAINING CONTENT
XII. FOLLOW-UP INFORMATION
XIII. CONFERENCES
XIV. LITERATURE RESOURCES
XV. EVALUATION OF TRAINEES
XVI. DEFINITION OF ALTERNATIVE PROGRAM
XVII EVALUATION OF PROGRAMS
XVIII. APPLICATION INSTRUCTIONS
XIX. GOVERNANCE

I. INTRODUCTION

This document describes the structure and content of veterinary radiation oncology training programs that will meet the criteria necessary for accreditation by the Recognized Veterinary Specialty of Radiation Oncology of the American College of Veterinary Radiology (ACVR), hereinafter referred to as the Recognized Veterinary Specialty. Institutions offering training in radiation oncology intended to lead to board certification by ACVR must have their training programs evaluated by the Residency Standards Committee of the Recognized Veterinary Specialty with subsequent approval by the Executive Council of the American College of Veterinary Radiology (hereinafter referred to as Executive Council).

There are two meetings of Executive Council each year; a midyear meeting in April, and the Annual Meeting held in conjunction with the Annual meeting of the ACVR. Exact dates of Executive Council meetings are available on the ACVR Calendar which can be viewed on the ACVR Web site and in each issue of Veterinary Radiology & Ultrasound. Applications must be received by the Assistant Executive Director at least 60 days prior to the meeting of Executive Council at which the program will be evaluated. There will be no exceptions to the 60 day lead time requirement.

II. OBJECTIVES

The Radiation Oncology Training Program in veterinary radiation oncology for board certification by ACVR is intended to qualify the trainee in:

  • the therapeutic use of ionizing radiation;
  • a thorough understanding of radiation biology and physics;
  • basic aspects of medical and surgical oncology;
  • imaging techniques that are a critical part of state-of-the-art radiation oncology for:
    • assessing the stage of the disease;
    • planning treatment;
    • determining response to treatment.

Specific objectives of the Radiation Oncology Training Program can be found on the ACVR Web Site; http://www.acvr.org/
A training program in radiation oncology must:

  • offer quality postdoctoral medical educational experience of adequate scope and depth in all aspects of radiation oncology;
  • provide the opportunity for the trainee to obtain information in:
    • radiation biology;
    • cancer biology;
    • radiation physics;
    • diagnostic radiology and other specialized imaging modalities; the indications for use and interpretive skills thereof.

III. STANDARD PROGRAM

A Standard Program is a minimum of two years of continuous training in radiation oncology which meets all requirements defined below (Sections V-XV). The program must be approved by the Executive Council prior to accepting candidates for training. Programs not meeting all requirements for a Standard Program may be submitted for consideration as an Alternative Program.

IV. MINIMUM TRAINEE REQUIREMENTS

Trainees must have a DVM, or equivalent degree. A one-year rotating internship or equivalent practice experience is also required.

V. TRAINING PROGRAM DIRECTOR

The director must be an active Diplomate of the Recognized Veterinary Specialty and, must provide the opportunity for daily interaction with the trainee on the premises at least 45 weeks per calendar year. In addition to supervising and administering the training program in veterinary radiation oncology, the program director should also be actively involved in the training and instruction of trainees.

VI. REQUIRED PROGRAM FACULTY

In addition to the Training Program Director, the faculty of the program must include Diplomates of the:

  1. American College of Veterinary Radiology (imaging),
  2. American College of Veterinary Internal Medicine, Specialty of Medical Oncology,
  3. American College of Veterinary Pathology,
  4. American College of Veterinary Surgery.

Exposure to other specialty disciplines (such as cardiology, neurology, ophthalmology, etc.) is also highly desirable.

One individual can fulfill the requirements of only one required faculty. For example, an individual who is a Diplomate of ACVIM and ACVR-RO may only fulfill the requirement of one of those required faculty positions. Likewise, a Diplomate of the ACVR in imaging and radiation oncology can only fill the requirements of one of the ACVR faculty. Medical Oncology and Radiology Consultation for the trainee, provided by a Diplomate or Diplomates in these specialties, must be available to the trainee on the premises on a daily basis for at least 45 weeks per calendar year. This consultation may be provided by a single individual, in each specialty, or by multiple individuals, in each specialty, on a rotating basis. Faculty resources are not limited to those in the primary institution; faculty requirements can be filled by consideration of resources available at cooperating institutions (see Section X).

VII. TRAINING PERIOD

The training period shall consist of a minimum of 24 continuous months of post-DVM supervised clinical education and experience in veterinary radiation oncology. The 24-month training period must include but not be restricted to:

  • pretreatment evaluation of cancer patients;
  • formulation of treatment plans;
  • administration of treatments;
  • assessment of tumor and normal tissue response;
  • exposure to a variety of tumors, associated syndromes, and conditions;
  • sufficient courses, journal clubs and seminars to allow the candidate to become competent in those subjects likely to be included on the certification examination;
  • continued assessment of long-term tumor and normal tissue response in patients the trainee has treated with radiation therapy.

VIII. CLINICAL RESOURCES

The program must provide a sufficient volume and variety of patients for instruction. Although exact numbers will not be specified, it is expected that the trainee will be exposed to a sufficient number of new cancer patients ultimately treated with ionizing radiation over the course of the training program to provide: (1) the material necessary to expose trainees to the majority of situations likely to be encountered in the practice of radiation oncology; and (2) the opportunity for reinforcement of important radiation oncology principles. Specific program content is detailed in Section XI, “Training Content.”

IX. FACILITIES

The program must provide adequate space, equipment, and other pertinent facilities to ensure an effective educational experience for trainees in veterinary radiation oncology. Facilities must include an external beam radiation therapy machine in the megavoltage range and computerized radiation treatment-planning capabilities. Although facilities for brachytherapy are not required, exposure to brachytherapy treatment planning and techniques is recommended. These resources are not limited to those in the primary training institution; requirements can be filled by consideration of resources available at cooperating institutions.

X. MULTIINSTITUTIONAL AGREEMENT

When the resources of two or more institutions are used for the clinical education of a trainee in veterinary radiation oncology, one institution must be designated as the primary institution. Typically, the primary institution will be a School or College of Veterinary Medicine but applications where the primary institution is a private veterinary practice or organization will also be considered. Cooperating institutions are not limited to veterinary institutions and may include Colleges or Schools of Medicine. Letters of agreement, signed on behalf of the institution by the appropriate individual, must be provided from the cooperating institution(s). The resources of the cooperating institution must be readily available to trainees and this must be specified in the letter of agreement.

XI. TRAINING CONTENT

Clinical rotations must be a directed educational process. Unsupervised clinical responsibility alone does not constitute a suitable educational experience. The candidate must generate and provide complete and accurate records documenting the radiation treatment details for all patients. These records must be reviewed by the faculty responsible for training.

The program must:

  • ensure the supervised trainee performs those types of radiation treatments commonly accepted in all aspects of therapeutic radiology;
  • include planning and administration of radiation for treatment of tumors in animals by teletherapy;
  • include regular chart rounds to review patient treatment plans, current patient status including side effects and their management
  • provide for gaining experience in the behavior of various types of animal cancer;
  • provide an understanding of the principles of tumor biology;
  • provide supervised, progressive responsibility for interpretation of certain imaging studies;
  • ensure that trainees generate timely written reports from these imaging studies;
  • ensure that these reports generated by the trainee are reviewed by the faculty responsible for training in that area;
  • ensure that trainees are given the opportunity to attend pathology rounds or have access to written pathology reports generated from radiation oncology patients.

It is expected that a 24-month period of clinical training in veterinary radiation oncology will result in the trainee being involved in the following:

  1. Formulation of treatment plans, calculation of dose, and administration of treatment for patients with solid tumors. This should include experience in generating treatment plans (both by hand calculation and treatment-planning computer) for external beam irradiation with orthovoltage and megavoltage photons as well as treatment plans for patients treated with brachytherapy. External beam planning experience must include treatment with multiple beams, arranged in configurations other than parallel opposed, and modified by wedges and beam-shaping blocks. A minimum number of patients treated during the training program is unnecessary since the overall quality of the training program must focus on the intensity of training rather than sheer numbers of patients treated.
  2. Four weeks of formal training in interpretation of diagnostic radiographs and images from other more specialized techniques (such as CT, MR, gamma scintigraphy, and diagnostic ultrasound) are a required segment of the residency program. This should be fulfilled by rotation of the trainee through a dedicated imaging facility/service under the direct supervision of a Diplomate of the ACVR-Imaging. Additional expertise in interpreting these images will be obtained in the process of pretreatment and posttreatment evaluation of patients receiving radiation therapy. The association of a Diplomate of the American College of Veterinary Radiology with the radiation oncology program will facilitate this learning process.
  3. An environment which encourages the interchange of knowledge and experience among trainees and faculty in the program, as well as with residents in other major clinical specialties located in those institutions participating in the program. Formal didactic classes or organized self-study opportunities must be offered in principles of general oncology, radiation oncology, and radiation biology. An understanding of the basic principles of the physics of diagnostic radiology, CT, MRI, gamma scintigraphy, PET scanning, and diagnostic ultrasound are also expected. It is not the goal of the training program to provide detailed training in the physics of these imaging modalities or in rigorous interpretation of the images. However, trainees should have some appreciation for basic physical principles, indications for use, and basic interpretation of specialized imaging techniques in cancer patients. The trainee is also expected to develop adequate knowledge regarding normal and pathologic anatomy and physiology. Trainees should also be provided ample opportunity to present formal lectures. It is expected that each trainee will prepare and present lectures or scientific presentations during the course of the training program.
  4. Of the 24 month training period in radiation oncology, there must be at least 18 months (75%) devoted solely to activities in radiation oncology. Suitable activities include involvement in steps necessary for identification of suitable patients, treatment planning and administration of treatment to patients. Activities limited to a primary-care service, such as medical (clinical) oncology, would not be considered to meet this requirement even if the trainee’s involvement was limited to assessment and clinical management of radiation therapy patients.
  5. The ACVR recognizes the value of radiation oncologists to have some knowledge in medical and clinical oncology. Thus, at least 2 months of the 24 month training period must be spent in medical oncology, with training under the direction of a Diplomate of ACVIM, Specialty of Medical Oncology. It is expected that the trainee would function as a clinician in the service, examining patients, consulting with pet owners and veterinarians, administering chemotherapy and participating in decision-making as it pertains to patient management.
  6. Current examination guidelines can be found on the ACVR Web site.

XII. FOLLOW-UP INFORMATION

A system must be in place at the trainee's institution whereby response of all treated patients is monitored on a regular basis with the results compiled into organized reports. These reports should be indexed, coded, and currently maintained.

XIII. CONFERENCES

Conferences, oncology journal club and teaching rounds must be correlated and provide for progressive trainee participation. These should be intradepartmental conferences, and also should involve each major clinical department. They should be of sufficient frequency and include both trainees and faculty participation on a regular basis.

XIV. LITERATURE RESOURCES

The program shall provide a sufficient variety of journals, references, and resource materials pertinent to progressive levels of education in radiation oncology and associated fields all of which should be readily accessible for trainee study.

XV. EVALUATION OF TRAINEES

The in-training evaluation of trainee performance and progress must be documented at least yearly through appropriate techniques, including faculty appraisal, oral or written examinations, or a combination of these. A copy of the form used in trainee evaluation must be attached to the application.

XVI. ALTERNATIVE PROGRAM

The following conditions define an Alternative Program:

  1. If the program is not a minimum two years of continuous radiation oncology training which fulfills all of the requirements defined in Sections V-XV, it will be defined as an Alternative Program.
  2. If exemption from any requirement for a Standard program is requested in the application, the program must be submitted as an Alternative Program.

Radiation oncology training in an Alternative program must entail training equivalent to that received in a Standard two-year training program. Alternative programs will be considered without having a specific candidate identified. This provides flexibility and could allow the trainee to be identified using the matching program mechanism. If the program is a combined program with another discipline, the program must be evaluated and considered by Council before the trainee begins the radiation oncology portion of training. Once an Alternative Program is approved and a candidate completes training, the program must be re-evaluated and reapproved prior to accepting another trainee.

Approval of Alternative programs is limited to 3 years. Those programs that do not accept a resident for training within a 3 year period must resubmit an application for program approval.

Trainees in Alternative Programs must keep a log of the patients for which the candidate was the primary person responsible for planning and administration of treatment during the training period. This log must include:

  • descriptions of the tumor (site, type, volume);
  • treatment (modality, plan description, time-dose scheme);
  • current follow-up information on each patient on the log; and
  • follow-up information on normal tissue and tumor response.

XVII. EVALUATION OF PROGRAMS

The Recognized Veterinary Specialty will undertake regular evaluation of all training programs. This will be accomplished by questionnaires sent to training program coordinators, and comprehensive re-evaluation every 3 years accomplished by completion of a detailed program description as specified on the ACVR Web site. The quality and effectiveness of a training program may also be assessed by monitoring the performance and success of its trainees in the certification examination.

XVIII. APPLICATION INSTRUCTIONS

Training program directors wishing to have their programs evaluated should submit a detailed description of the program (4 copies) based on information contained in this document, to the Assistant Executive Director of the ACVR. The application form is available on the ACVR Web site; http://www.acvr.ucdavis.edu. The application must be received at least 60 days before the meeting of Executive Council at which the program will be evaluated. There are two meetings of Executive Council each year; a midyear meeting in April, and the Annual Meeting held in conjunction with the Annual meeting of the ACVR. Exact dates of Executive Council meetings are available on the ACVR Calendar which can be viewed on the ACVR Web site, and which is also printed in each issue of Veterinary Radiology & Ultrasound. There will be no exceptions to the 60 day lead time requirement. The Executive Director will forward copies to the Residency Standards Committee of the Recognized Veterinary Specialty for evaluation. The committee will evaluate the application, a vote will be taken, and the results of the vote and the majority recommendation of the committee forwarded to the President of the Recognized Veterinary Specialty for consideration at Executive Council at one of the two annual meetings.

For Diplomates providing consultation in medical oncology and imaging, please provide a brief 2-page curriculum vitae and specify the number of weeks each year that the individual will be available to actively support the radiation oncology trainee.

If courses are part of the training program, a syllabus for each course and the instructors credentials should be included with the application.

A calendar must be included with the application indicating the rotations of the resident per unit time (preferably monthly). For each subject area specified in the calendar, e.g. radiation oncology, medical oncology, anesthesia, imaging, etc., there must be a description of the specific activities of the trainee during that time. For Alternative programs, a calendar for the entire training program must be provided, and for each time period it must be stated whether the activity for that period applied to radiation oncology training, medical oncology training, graduate school, etc., or some combination of disciplines.

XIX: GOVERNANCE

The requirements for Standard and Alternative Training Programs, evaluation of applications for program approval, and evaluation of applications from trainees to take the Certifying Examination of the Recognized Veterinary Specialty will be the responsibility of the Residency Standards Committee of the Recognized Veterinary Specialty. Committee makes recommendations to Executive Council of the ACVR for final decisions. The Residency Standards Committee may also be called upon to make recommendations regarding other matters pertaining to training programs or trainees at the discretion of the President of the Recognized Veterinary Specialty.