Radiation Oncology Residency

Training Program Director
Donald E. Thrall, Don_Thrall@ncsu.edu or by phone at (919) 513-6292

Introduction
The objectives of this program are to provide graduate veterinarians with advanced clinical education and investigational 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 House Officer Training 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. The resident(s) will be under the guidance of the senior faculty at all times and will be expected to participate in all aspects of the professional program.

The radiation oncology training program has been structured to ensure that all aspects of the ACVR requirements are met. Supervised Clinical Training, Independent Study and various seminar courses provide the required clinical training. Each resident will have a committee to supervise the program. It is expected that a prospective investigational project will be completed. Residents will be expected to identify their 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 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 weekly. 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). One presentation per year in the House Officer Seminar Series is required.


Objectives
The program at North Carolina State University will allow the trainee to have a thorough understanding of:


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 the Schools of Medicine at the University of North Carolina and Duke University Medical Center. Letters attesting to this Affiliation are available.


Clinical Resources
There is an active clinical oncology program in the College of Veterinary Medicine at North Carolina State University. The oncologists who participate in this service are:

  1. Marlene L. Hauck, DVM, PhD, Diplomate ACVIM, Oncology
  2. Amy F. Pruitt, DVM, Diplomate ACVR, Radiation Oncology
  3. Steven Suter, DVM, PhD, Diplomate ACVIM, Oncology
  4. Donald E. Thrall, DVM, PhD, Diplomate ACVR (Radiology, Radiation Oncology)
  5. Laurel Williams, DVM, Diplomate ACVIM, Oncology

There are three medical oncology residents.


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 or MR 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 or MR 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 General Electric Sytec SRI helical scanner. Images are sent to the 3-D treatment planning computer via the hospital computer network

CT-based treatment planning is primarily accomplished on a PC computer using PLUNC, developed at the University of North Carolina, Chapel Hill

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 Clinic 1800 linear accelerator capable of delivering 6MV photons and electrons of 5 energies.

Patients are anesthetized for each radiation therapy treatment using either isoflurane or halothane administered via mask followed by orotracheal intubation.

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.


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:

  1. Daily oncology ward rounds where progress and toxicities of current patients are reviewed - treatment options are also discussed at this meeting;
  2. 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;
  3. Weekly oncology journal club.

The following conferences are available for attendance by trainees in radiation oncology:

  1. Weekly NCSU house-officer seminar - presentations on various topics by house officers;
  2. Twice-weekly morning radiation oncology conference at Duke University Medical Center special seminars at Duke University Medical Center and the University of North Carolina;
  3. Morning radiology rounds attended by two board certified radiologists and three radiology residents;
  4. 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 from the medical school libraries at Duke University Medical Center and the University of North Carolina.

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 Academic Affairs 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
The following individuals have received training in radiation oncology at North Carolina State University and are board certified in radiation oncology by the ACVR attesting to the program being able to provide training of high quality:

  1. Deborah M. Prescott, DVM, PhD, Diplomate ACVR (Radiation Oncology)
  2. Margaret McEntee, DVM, Diplomate ACVIM (Oncology), Diplomate ACVR (Radiation Oncology)
  3. Sheri Siegel, DVM, Diplomate ACVR (Radiation Oncology)
  4. Chieko Azuma, DVM, Diplomate ACVR (Radiation Oncology)
  5. Amy F. Pruitt, DVM, Diplomate ACVR (Radiation Oncology)
  6. Miriam Kleiter, DVM, Diplomate ACVR (Radiation Oncology)
  7. Jayme Looper, DVM, Diplomate ACVR (Radiation Oncology)

Application Process
This residency participates in the American Association of Veterinary Clinicians’ (AAVC) Veterinary Internship and Residency Matching Program (VIRMP) when a position is available. Application information and procedures are available at www.virmp.org

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):

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
Ph. (919) 513-6292
4700 Hillsborough St.
Raleigh, NC 27606