Radiation Oncology
Introduction
The objectives of this program are to provide graduate veterinarians with advanced clinical education and research experience in accord with the requirements for a radiation oncology residency as defined by the American College of Veterinary Radiology (ACVR). Candidates must have completed a one-year rotating internship or equivalent as required by the ACVR.
The Faculty Committee on House Officer Programs oversees all residency programs at the College. Administration of the radiation oncology program, assignment of clinic duty, and coordination of course work will be done by the residency training supervisor. The radiation oncology residency is a two-year program. At all times, the resident(s) will be under the guidance of the senior faculty and will be expected to participate in all aspects of the professional program.
Twelve days (exclusive of weekends) of paid vacation are provided for each twelve months of training. There are also 10 paid holidays each year, including 5 days at Christmas. Each resident will have a committee to supervise the clinical program and guide their investigative acitivities. Residents will be expected to select a project within the first 6 months of the program. All data should be collected before the end of the first year of the program, and a scientific article submitted by October of the second year.
Clinical training in this program will be gained by providing supervised services in radiation oncology to the Veterinary Teaching Hospital. Within the framework of faculty oncologists and radiologists, and residents in oncology and radiology, direct communication in terms of consultation, observation, demonstration, and constructive criticism will contribute to the resident’s education. The resident will also be expected to pursue independent study with special emphasis on current oncology literature. General oncology rounds will be held daily. Residents will participate in topic discussions. Oncology rounds are also held weekly where patients are reviewed, follow-up information is presented, and treatment decisions are made. Oncology journal club is held weekly. House Officer Rounds are also held weekly, and residents are expected to attend most of the small animal related topics (surgical and non-surgical presentations).
Objectives
The program at North Carolina State University will allow the trainee to have a thorough understanding of:
- the therapeutic use of ionizing radiation;
- radiation biology and physics;
- the biologic behavior and response to therapy of various types of animal cancer;
- imaging techniques which are a critical part of state-of-the-art radiation therapy.
Affiliation Agreement
The primary institution is the College of Veterinary Medicine at North Carolina State University. Additional training in radiation biology and the physics of radiation oncology will take place at either the Schools of Medicine at the University of North Carolina or Duke University Medical Center.
Training Program Faculty
The director of the training program is Donald E. Thrall, DVM, PhD, Diplomate American College of Veterinary Radiology (Radiology, Radiation Oncology). Amy F. Pruitt, DVM, Diplomate American College of Veterinary Radiology (Radiation Oncology) supervises most of the clinical activity in the program.
Clinical Resources
There is an active clinical oncology program in the College of Veterinary Medicine at North Carolina State University. There are typically 4-5 medical oncologists and 3-4 medical oncology residents who participate in this service. The number of patients irradiated annually is substantial, and includes patients treated with definitive and palliative intent.
Facilities and Clinic Operation
Medical oncologists submit a request for radiation therapy when irradiation has been deemed to be appropriate. In most patients the selection of a treatment modality is made by the medical oncologists; this selection is based on prior group discussions regarding standardization of treatment for certain tumor types and locations. At other times there is discussion of treatment options on an individual patient basis. The radiation oncology trainee has the opportunity to participate in the decision-making process.
There are two full-time radiation therapy technologists.
Treatment planning is either manual, or based on CT images. All tumors except for incisions located on extremities or in the rostral oral cavity, or mass lesions located on the manus/pes or rostral oral cavity undergo planning based on CT images.
If CT-based planning is to be performed, the trainee will be involved with obtaining CT images for treatment planning. Being directly involved with patient positioning during CT imaging is critical to implementing the optimal treatment plan. The CT scanner is a Siemens Somatom Sensation 16 slice scanner. Images are sent to the 3-D treatment planning computer via the hospital computer network
CT-based treatment planning is primarily accomplished on PC workstations using PLUNC, standing for Plan UNC, a 3-dimensional treatment planning system developed at the University of North Carolina.
Once the treatment plan has been completed, it will be reviewed with the program director, or other radiation oncology faculty. The trainee and radiation therapy technologist will set-up the patient on the first treatment day. Port films are made of the fields. The setup and port films are reviewed with the program director, or other radiation oncology faculty. Port films are also made on treatment day #7 to assure that the original plan is being implemented. The quality assurance port films will also be reviewed with the program director, or other radiation oncology faculty.
The radiation therapy unit is a Varian Clinac 1800 generating 6MV photons and a variety of electron energies.
Patients are anesthetized for each radiation therapy treatment.
The Veterinary Teaching Hospital at North Carolina State University is a fully equipped medical/surgical facility, with board certified specialists in anesthesiology, cardiology, clinical pharmacology, dermatology, emergency and critical care medicine, laboratory animal medicine, internal medicine, neurology, pathology, clinical pathology, ophthalmology, radiology, radiation oncology, surgery, toxicology, theriogenology, and zoological medicine. These specialists are available for consultation with radiation oncology trainees as needed.
Typical Program Structure
The resident’s schedule will follow the guidelines of the American College of Veterinary Radiology, available at www.acvr.org.
Follow-up Information
There is a detailed follow-up system in place. Data regarding all patients receiving radiation therapy is archived in a computer database. The database generates follow-up letters for all patients where contact has not been made within the past 6 months. The follow-up letter, which is sent to the owner of the patient, is accompanied by a questionnaire regarding the status of the animal. If these questionnaires are not returned by the owner in a timely fashion, the owner is contacted by telephone. This follow-up information is used in the generation of manuscripts and in assessing the response of various tumor types to currently-used protocols.
Research Environment
There is an ongoing and active investigational component to the oncology area at North Carolina State University. Current areas of radiation therapy-related investigation include the combination of radiation and hyperthermia, and assessment of factors such as proliferation and hypoxia which may limit the response of tumors to radiation. This investigational activity involves collaboration with Duke University Medical Center, and the University of North Carolina
Conferences
The following conferences are attended regularly by trainees in radiation oncology: daily oncology ward rounds where progress and toxicities of current patients are reviewed - treatment options are also discussed at this meeting; weekly oncology conference where all current oncology patients are discussed, recent port films are scrutinized', and treatment plans for new patients are considered - follow-up information is also reviewed at this meeting; weekly oncology journal club.
The following conferences are available for attendance by trainees in radiation oncology: weekly NCSU house-officer seminar - presentations on various topics by house officers; morning radiology rounds attended by a board certified radiologist and 3-4 radiology residents;weekly gross pathology rounds, given by the duty pathologist and resident.
Literature Resources
The library in the College of Veterinary Medicine subscribes to a large number of journals dealing with veterinary medicine as well as human disease. Titles not in the collection at the Veterinary College can be readily obtained electronically.
Evaluation of Trainees
All clinical trainees at North Carolina State University are evaluated two times each year; by Dec 1 and Apr 1. There is a standard evaluation form. A copy of the form is submitted to the Associate Dean for Services and one is placed in the trainee's file.
Training Period
The length of training will be 24 months. This training period may be a part of a training program in another discipline, but 24 months of training will be devoted to radiation oncology.
Prior Trainees
Every trainee completing a program in radiation oncology at North Carolina State University, listed below, is now board certified in radiation oncology by the ACVR, attesting to the program being able to provide training of high quality.
Deborah Prescott, DVM, PhD, 1986-1990. Diplomate ACVR, Private Practice, Dayton OH.
Margaret McEntee, DVM, 1991-1993. Diplomate ACVR (Radiation Oncology), Cornell University, Ithaca, NY.
Sheri Siegel, DVM, 1994-1996. Diplomate ACVR (Radiation Oncology), Private Practice Boston, MA
Chieko Azuma, DVM,PhD, 1995-2000. Diplomate ACVR (radiation oncology), Tufts School of Veterinary Medicine, North Grafton, MA
Amy Pruitt, DVM, 1999-2001. Diplomate ACVR (Radiation Oncology). Assistant Professor of Radiation Onclogy, North Carolina State University.
Miriam Kleiter, DVM, 2001-2003. Diplomate ACVR (Radiation Oncology). Radiation Oncologist, School of Veterinary Medicine Vienna, Vienna, Austria.
Jayme Looper, DVM, 2002-2004. Diplomate ACVR (Radiation Oncology) Private practice, Chicago, IL.
David Proulx, DVM, 2003-2005. Diplomate ACVIM (Oncology, ACVR (Radiation Oncology) Private Practice, San Diego, CA.
Jarrod Lyons, DVM, 2004-2006. Diplomate ACVR (Radiation Oncology) Private Practice, Los Angeles, CA
Application
If a position is available, it will be filled through the American Association of Veterinary Clinicians Matching Program, or advertised in National outlets, such as the ACVR Web site.
It is expected that the NCSU Radiation Oncology program will receive a large number of applications from candidates with a wide range of experiences. To assist candidates in preparing their application, they should consider their strengths in the various areas outlined below.
Aspects of an application that are considered in the selection process include (but are not limited to):
- DVM GPA / Class Rank
- Awards and Honors related to Oncology
- Completion of a rotating medicine/surgery internship or similar post-graduate experience
- Ability of the letter of intent to convey the candidates interest in the position and future goals
- References from Diplomates of ACVIM or ACVR and other specialty Colleges that attest to your abilities
General questions pertaining to the residency program should be directed to:
Donald E. Thrall, DVM, PhD
Professor of Radiology
College of Veterinary Medicine
North Carolina State University
4700 Hillsborough St.
Raleigh, NC 27606
Ph. (919) 513-6292
Email: don_thrall@ncsu.edu