With the progress of highly precise radiotherapy such as IMRT, IGRT and charged particle radiotherapy, the number of the patients has markedly increased since the late 20th century. A disproportionate number of radiation oncologists to radiotherapy patients has therefore been a serious problem. To resolve the shortage of radiation oncologists, the departmentalization of radiation oncology is primarily important because professors have administrative rights and powers for education and recruiting of medical students. At present there are only 16 out of 79 medical schools in which department of radiation oncology exists. I do hope that taking every occasion, JASTRO will appeal the importance of department of radiation oncology to the organizations relevant to this subject such as Ministry of Education, Culture, Sports, Science and Technology, Ministry of Health, Labour and Welfare, and medical schools which do not have yet that department. Only when Department of Radiation Oncology is established in every medical school, radiation oncology will be recognized as a distinct medical specialty.

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[in Japanese]

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A national structure survey of radiation oncology in 2007 using questionnaires was conducted from March 2008 to January 2009 by JASTRO. The response rate was 721 out of 765 (94.2%) active radiotherapy institutes. The total number of new cancer patients and the total number of cancer patients (new+repeat) treated with radiation were estimated to be approximately 181,000 and 218,000, respectively. The numbers of linac, telecobalt, Gamma Knife®, 60Co RALS, and 192Ir RALS in actual use were 807, 15, 46, 45, and 123, respectively. The linac has a dual energy function in 539 (66.8%), 3DCRT in 555 (68.8%), and IMRT in 235 (29.1%). The numbers of JASTRO-certified radiation oncologists, full time equivalent (FTE) radiation oncologists, medical physicists, radiotherapy QA personnel, radiation therapists, radiation therapy nurses, and clerks were 477, 826 FTE, 64 FTE, 106 FTE, 1,634 FTE, 494 FTE, and 329, respectively. There were significant increases in the use of 125I for prostate cancer patients by 52% and IMRT by 271% between 2005 and 2007. Geographically, there was still a significant variation in the use of radiotherapy from 0.8 new patients per 1,000 population to 1.8 (average 1.3).

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A national structure survey of radiation oncology in 2007 using questionnaires was conducted from March 2008 to January 2009 by JASTRO. The response rate was 721 out of 765 (94.2%). Annual patient load/FTE (full time equivalent) for radiation oncologists was 248.2. The corresponding data according to the institutional stratification, including more than or equal to 1 FTE radiation oncologist (A) or less than 1 (B), were 212.9 and 157.0 (calculated as FTE=1 to avoid overestimation in B institutions), respectively. More than 300 patients/FTE radiation oncologists (warning level for decline in the quality of care) were treated in one-fourth of the A institutions. The data/radiotherapy technologists were 125.5. In designated cancer care hospitals, larger numbers of cancer patients were treated with more functionally sophisticated linac and CT simulator than in other hospitals. Geographically, there was a significant variation in patient load/FTE radiation oncologists from 130.7 to 391.6. As for radiotherapy technologists, a variation from 87.3 to 258.6 was also observed. The number of cancer patients/ linac exceeded 400/year (warning level) in the institutions with heavy load/FTE radiation oncologists more than or equal to 300/year (A) and in those where the number of new patients was more than or equal to 800/year.

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Purpose: Generally, DRR is evaluated by physical phantom. The CT image is camouflaged by the performance of the radiation treatment planning system and contains a variety of error factors. The CT image (as follows the digital phantom), where an arbitrary CT value is arranged in the matrix, is necessary to evaluate the pure performance of the radiation treatment planning system. In this study, the development of a digital phantom is described, and the utility is discussed. Method: CTport and the radiation treatment planning system are evaluated with the use of a digital phantom as follows: geometrical accuracy evaluation of DRR, consisting of the center position, size of irradiation field, distortion, extension of X-ray, and beam axis, and the image quality evaluation of DRR, which consists of the contrast resolution. Results: As for DRR made with CTport and the treatment planning system, the part that shifted geometrically was confirmed. In the image quality evaluation, there was a remarkable difference. Conclusion: Because the making accuracy and the installation accuracy of the phantom do not influence the digital phantom, the geometrical accuracy of the DRR is reliable. Because the CT conditions and the phantom factor have no influence, the peculiar DRR image quality can be evaluated and used to evaluate the best image processing parameters.

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Purpose/Objective: To establish an experimental rat model and examine the efficacy of polaprezinc suppositories against radiation-induced rectal disorders. Materials/Methods: Female Wister rats (6 weeks old) were used in the present study. The rats were divided into three groups. Group A was irradiated and medicated with polaprezinc suppositories. Group B was irradiated without any medication. Group C had no irradiation or medication. The rat was taped by the tail in the vertical position under anesthesia. Lead shielding was used to cover the rats except the area of the lower pelvis. They were irradiated at 22 Gy by a single fraction. Polaprezinc suppositories were inserted daily into the rat anus for 7 days after irradiation. All rats were evaluated by colonoscopy on the 7th day after irradiation, sacrificed on the 10th day, and evaluated for mucosal damage. Results: In the clinical findings, the endoscopic findings, and the histological findings, the rats not administered polaprezinc suppositories tended to show more severe mucosal damage but there were no significant differences. Conclusion: Our study showed that this model was a useful experimental rat model for radiation-induced rectal disorders and polaprezinc suppositories demonstrated good efficacy against radiation proctitis.

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We report a case of multiple bone metastases from breast cancer with femoral head replacement due to pathological fracture of the femoral head 81 days after injection of strontium chloride (Sr-89), radiopharmaceutical for bone pain palliation. Before replacement, the external radiation dose was estimated, and careful attention was paid to reducing the radiation from the exposed bones containing Sr-89 during the surgery. The calculated dose and measured dose with the portable dose rate meter were far below the exposure limits. We think this report will be informative for future occasions of such plastic surgeries.

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The Japanese Society of Palliative Medicine (JSPM) published guidelines for treatment of cancer pain conforming to evidence-based medicine in 2000. In 2005, JSPM planned an update to the guidelines, and a working group was formed for the update under the direction of Prof. T. Dokiya as the chief president of the Japanese Society of Therapeutic Radiation Oncology at that time. We show the process of tasks, including the establishment of guideline questions and the creation of structured abstracts, for the proposal to develop guidelines on radiation for cancer pain limited to metastatic bone pain. The guidelines appear to be useful for clarifying the validity of irradiation for painful osseous metastases. In spite of being limited to radiotherapy for painful osseous metastases, which seems to have the most evidence in the domain of palliative irradiation, developing guidelines was an enormous task. We need to establish a standing working group to make useful guidelines available for related specialists and for adequate updating.

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Purpose: Environmental pollution induced by lost radioactive seeds is an important social problem. The purpose of this paper is to evaluate the time and place where lost seeds were found and to develop a method to prevent the loss of seeds from the time of insertion to the discharge of the patient from the hospital. Materials and Method: A total of 121 cases (7718 seeds) who received permanent insertion treatment from July 2006 to Dec 2007 were evaluated. During this period, the time and place of lost seeds was estimated from the place where the seeds were found. Results: A total of 43 seeds were found before discharge for a rate of 0.56% (43/7718). Four seeds were found in the operating room. Two seeds were found in the in-patient room before the balloon catheter was removed. Five seeds were removed from the bladder by surgery using cystoscopy. In addition, 32 seeds were found in the room when surveying the room for patient discharge. Five seeds were brought from the patient’s house after discharge. Conclusion: To prevent the loss of seeds from the patients’ room, which is the best way prevent environmental pollution, careful monitoring and careful surveys of the room are needed.

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Purpose: We applied patient’s self-breath hold irradiation system to a device to declare the patient’s intentions (SOS switch system: SSS) in the radiation room and examined a utility for problem recognition and improvement of risk management during radiation therapy by induction of SSS. Materials and Methods: Between May 2005 and October 2006, we used SSS with 65 patients. The study involved 32 men and 33 women with a median age of 65 (range, 26 88)years. The reason for using SSS was as a shell in 57, a history of laryngectomy in 2, a cough in 6, convulsions in 1, and anxiety in 3. Results: The treatment with SSS was performed 1,120 times. The hand switch was pushed 11 times. The reasons the switch was pushed were for nausea, aspiration, pain, and cough one time each. For the others, the reasons were unclear, and it was thought due to the clouding of consciousness from brain metastases. No problems were observed with the use of SSS. Conclusion: SSS was a useful device for improvement of risk management during the radiation therapy.

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