Introduction
New York University Medical Center is a designated NCI Cancer Center
comprised of New York University School of Medicine, The Tisch Hospital
of New York University, The NYU Cancer Institute, and Bellevue Hospital. Tisch Hospital is
a private voluntary hospital that opened in June 1963. Bellevue
is the principal municipal hospital of the City of New York, located
in a facility that opened in June 1976. The entire Medical Center
complex stretches from 23rd to 34th Streets between First Avenue and
the East River. It is close to Midtown Manhattan, including its
theaters, museums, and department stores.
Approximately 1100 newly diagnosed cancer patients are seen annually in the
Radiation Oncology Department by direct referral, and additional patients are
seen at various interdepartmental conferences. The patient load provides
a balanced and extensive experience in the management of malignant disease.
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Why Two Hospitals?
Although located next to each other, Tisch Hospital and Bellevue Hospital
attract different patient populations and thus provide the radiation oncology
resident with a broader experience in the spectrum of malignant disease than
is generally available at a single institution. All residents receive appointments
to both hospitals and spend time at each institution. The patient population
at Tisch Hospital reflects the population of a tertiary care medical center. Training
includes a wide range of external-beam and brachytherapy techniques. Treatment
planning is carried out with the aid of the department's two simulators: a
conventional simulator with fluoroscopy and a CT-simulator. Both Tisch and
Bellevue Hospital patients are simulated, planned and treated at the Tisch
Hospital location. A full 3-dimensional reconstruction of the CT data set is
loaded into our planning system, Eclipse, for virtual treatment planning. Additional
imaging information such as MR may be registered with the CT and used in the
planning process. There are 12 Eclipse stations located throughout the department
and available for physician planning and review. The department has a varied
treatment armamentarium including 3 linear accelerators (2 with variable photon
energies and a range of electron energies) and a cobalt machine unit. An
Eleckta Gamma Knife is used for stereotactic radiosurgery (SRS). (The
Brainlab treatment planning system is used for both Linac-based SRS and fractionated
stereotactic radiosurgery.) Brachytherpay, both low and high dose rate, is
done with a range of isotopes, using both permanent and temporary techniques. Hyperthermia
is available as well.
Bellevue provides both primary and tertiary care to a broad-based population. The
Bellevue patient population tends to present with more advanced tumors that
permit the resident to see the natural history of untreated disease and challenges
the resident’s resourcefulness in terms of designing and implementing
appropriate treatment plans. All treatment for Bellevue patients is given
at Tisch Hospital. The proximity of the two hospitals enables the resident
to move freely between the two.
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Attending Staff
Silvia Formenti, M.D., is Chairman of the Department of Radiation
Oncology. Ashwatha Narayana, M.D., Associate
Professor and Residency Program
Director. The full-time attending staff physicians are Anurag Chandra, M.D., Nicholas Sanfilippo,
M.D., and Stella Lymberis, M.D. The Physicists are Keith DeWyngaert,
Ph.D., Chief Physicist, Kerry Han, Ph.D., and Gabor Jozsef, Ph.D.
The Radiation Biologist are Barry Rosenstein, Ph.D., Radiation Biology
he directs the radiobiology instruction and Peter Brooks, Ph.D.,Radiation
Biology, heads the department’s radiobiology laboratory. The
attending staff has authored and co-authored a number of books and
many articles dealing with cancer and radiotherapy. Since we
accept a maximum of six residents in all years of training, the
ratio of attendings to house staff is high, and residents have the
opportunity to work closely with the attendings.
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Resident Education
Program Goals
The objective of the residency program in radiation oncology is to educate
and train physicians to be skillful in the practice of radiation oncology and
to be caring and compassionate in the treatment of patients. Residents
spend 36 months in the clinical core curriculum of radiation oncology at NYU
as well as one month in pediatrics and one month in brachytherapy at Memorial
Sloan-Kettering Cancer Center. They receive exposure to oncologic pathology
and are expected to engage in either laboratory or clinical research. Elective
time is allotted to pursue subjects in depth. Residents master the necessary
components of radiation physics and radiobiology, and they learn how to integrate
radiation oncology into the multimodality approach to treatment.
Didactic Training
At the start of each academic year, a series of didactic lectures attended
by Radiation Oncology residents and Medical Oncology fellows introduces the
basic concepts of oncology. These lectures are generally given from 1-2
PM during July and August. Attendance at these sessions is mandatory. The course
covers major oncologic problems facing the oncologist and serves as an introduction
to the natural history of various tumors as it pertains to the evaluation and
treatment of patients. A broad overview of the role of radiation and chemotherapy
in treating each of the tumors is presented. The talks also include practical
information on the evaluation and treatment of common oncologic problems.
At the beginning of the academic year there is also a short series of lectures
in medical physics, which serves to introduce the residents to this important
aspect of training.
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Physics Training (Faculty: Keith DeWyngaert, Ph.D.)
Satisfactory completion of a formal course in physics is expected of all residents. The
physics staff conducts a series of lectures and laboratory experiences
to give the resident an understanding of the physics of radiation oncology. Lecture
notes are distributed and there are tests of residents’ performance
during this course. There are homework assignments, and the residents’
performance during this course is evaluated. Residents take the RAPHEX exam
annually.
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Radiobiology (Faculty: Barry Rosenstein, Ph.D.)
Satisfactory completion of a formal course in radiobiology is required for
all residents. Lecture notes are distributed, and there are tests of residents’
performance during this course.
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Multidisciplinary Conferences & Tumor Boards
A variety of interdisciplinary clinical conferences of value to the resident
are held at frequent intervals at the Medical Center. Attendance at these
conferences aids the resident in learning the value of other treatment modalities
in the care of the patient with cancer. To assure a broad and equitable
exposure to these conferences, a schedule of mandatory attendance is created
for the residents and distributed by the chief resident. During the full
course of training, residents have the opportunity to attend each of the conferences.
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Clinical Lectures
The attending staff present didactic material to the residents throughout the
academic year. Attendance is mandatory. Residents are also encouraged to utilize
the "Practical Reviews in Oncology" for self study and self assessment.
Review of these examinations in study groups organized by the residents is
encouraged.
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Resident Presentations
During the academic year, residents are assigned to prepare conferences.
These cover a specific oncology problem, and residents are assigned
a preceptor with whom they should review their topic outlines. The nature
of the topic, site of disease and expected depth of the presentation are in
keeping with the level of the residents training. The resident is required
to discuss his/her topic during preparation of his/her presentation with members
of the attending staff to gain guidance and advice about the material to be
covered and format of the presentation. A formal evaluation of the presentation
is done.
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Electives
Time is available for electives in various oncology specialties, and additional
time is available for rotations in medical physics. Residents are required
to take 1-month "mandatory electives" in pediatrics and brachytherapy
at Memorial Sloan-Kettering Cancer Center. Under some circumstances,
residents may pursue other special training outside of the Medical Center. Such
an elective must have a clearly defined educational goal that cannot be provided
“in house.” All electives must be approved by the director
of the program and the chairman of the Department.
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In-Service Examination
The In-Service examination for residents in radiation oncology is given in
March of each year. All residents are urged to take the test. The
Department pays for each resident to do so and provides time during the course
of the regular work week to take the test.
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Pathology Rounds
Each academic year, the chief resident coordinates a series of pathology rounds. These
are held monthly, beginning at 7:30 AM, for the purpose of reviewing general
oncologic pathology specimens. Residents also attend a monthly pathology
lecture jointly with the Pathology residents. In addition, tumor specimen histology
is presented by the Pathology staff at the various multi-disciplinary tumor
boards. It is expected that the residents will review the individual specimens
on each case they see with a member of the Pathology Department.
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Research
The American Committee on Graduate Medical Education (ACGME) requires residents
in Radiation Oncology to engage in a research project during the course of
training. The research project may involve a basic science or clinical study
or may be directed to a physics or radiobiology question. Residents are encouraged
to develop their own research proposal. Once the resident has selected
his/her topic for research, the idea must be written out in the form of a proposal
with accompanying supporting information: a summary of other work in the field,
the relevance of the idea to oncology and a time table for completion. To
allow sufficient time to complete the required project, residents are urged
to select a topic during the first year of their training. This will allow
time to conduct the research, analyze the data, prepare a manuscript and submit
it for presentation at a national meeting and/or submit it for publication. Residents
work closely with a faculty mentor during all steps of the research process.
The trainee is encouraged to participate in more than one research project
although quality is stressed rather than quantity. The resident will be
sent (with expenses paid by the program) to any meeting at which his/her work
is accepted so that he/she may present the work.
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Attendance at Meetings Outside of the Medical Center
During the course of the academic year a variety of oncology-related meetings
are held in the New York metropolitan area. These include monthly meetings
of the New York Roentgen Society, the New York Cancer Society and the Metropolitan
Breast Society. Attendance at the monthly Monday evening meeting of the
New York Roentgen Society is required. The Department pays for membership
in this society. Residents are provided time to attend the Spring Meeting
of the NYRS. Residents are sent to any meeting at which they have an abstract
accepted. Residents in their last year of training are sent to the American
Society for Therapeutic Radiology and Oncology meeting as a matter of course.
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