Brachytherapy Clinical Observership Training program

Brachytherapy Clinical Observership Training Program

Program Lead: Prof. Merdan Fayda, MDVenue: Liv Hospital Ulus, Istanbul, TürkiyeTraining Context: Liv Hospital Ulus is a Brachy Academy training center by Elekta and hosts one of the highest-volume brachytherapy clinical practices in Istanbul, Türkiye.Program Format: Observational clinical training only — no hands-on practiceDuration Options: 1 week or 2 weeks

Program Overview

This Brachytherapy Clinical Observership Training Program is designed for radiation oncologists, medical physicists, residents, fellows, radiation therapists, dosimetrists, oncology nurses, and other oncology professionals seeking structured exposure to contemporary brachytherapy practice in a high-volume clinical environment.

The program is conducted at Liv Hospital Ulus, Istanbul, Türkiye, a Brachy Academy training center by Elekta, under the leadership of Prof. Merdan Fayda, MD. The center offers participants the opportunity to observe modern brachytherapy workflows within one of the highest-volume brachytherapy clinical practices in Istanbul, Türkiye.

Participants may choose between two duration options:

• 1-week observership

• 2-week observership

Both options are strictly observational. The program does not include hands-on practice, independent clinical activity, direct patient care, applicator insertion, contouring responsibility, treatment planning execution, equipment operation, or treatment delivery.

The observership follows the clinical brachytherapy pathway from patient selection and multidisciplinary decision-making through applicator selection, imaging, treatment planning review, quality assurance observation, treatment delivery workflow, and follow-up discussion.

Educational Objectives

By the end of the observership, participants should be able to:

• Understand indications and patient selection criteria for contemporary brachytherapy.

• Observe the workflow of high-dose-rate brachytherapy in a high-volume center.

• Recognize key steps in gynecologic, prostate, breast, skin, and other site-specific brachytherapy cases depending on the clinical schedule.

• Understand imaging-based brachytherapy planning principles.

• Observe multidisciplinary coordination among radiation oncologists, physicists, dosimetrists, nurses, anesthesiology, and radiation therapists.

• Appreciate safety, quality assurance, and radiation protection procedures.

• Understand how clinical decision-making is adapted to real-world patient anatomy, disease stage, prior treatments, and institutional workflow.

• Describe the complete clinical workflow of modern HDR brachytherapy.

• Understand site-specific indications and contraindications for brachytherapy.

• Observe patient evaluation, applicator selection, imaging, planning, QA, delivery, and follow-up.

• Understand principles of image-guided adaptive brachytherapy.

• Compare intracavitary, interstitial, surface, and hybrid brachytherapy approaches.

• Recognize common clinical, anatomical, and technical challenges.

• Understand medical physics quality assurance and radiation safety processes.

• Review practical implementation considerations for establishing or expanding brachytherapy services.

• Discuss clinical outcomes, toxicity, patient experience, and follow-up protocols.

Target Participants

This observership is suitable for:

• Radiation oncologists

• Radiation oncology residents or fellows

• Medical physicists

• Brachytherapy fellows

• Radiation therapists

• Dosimetrists

• Oncology nurses with brachytherapy interest

• Clinical program leaders developing brachytherapy services

• International clinicians seeking exposure to Elekta-based brachytherapy workflows

Program Structure

The final schedule is adapted according to clinical case availability, institutional workflow, and patient confidentiality requirements. The following structure outlines the typical observership content.

Core Observership Modules

Module 1 — Orientation, Safety, and Clinical Workflow Introduction

Key topics and activities:

• Welcome and introduction by Prof. Merdan Fayda, MD

• Orientation to Liv Hospital Ulus brachytherapy services

• Overview of Brachy Academy training center environment

• Review of observership rules, patient confidentiality, and professional conduct

• Infection control and radiation safety orientation

• Introduction to Elekta brachytherapy platform and departmental workflow

• Overview of the complete brachytherapy pathway:

  • Consultation

  • Patient selection

  • Simulation

  • Applicator selection

  • Imaging

  • Contouring review

  • Treatment planning

  • Medical physics QA

  • Treatment delivery

  • Post-treatment care

  • Follow-up

Module 2 — Patient Selection and Clinical Decision-Making

Key topics and activities:

• Observation of patient consultation or chart review

• Review of indications and contraindications for brachytherapy

• Discussion of clinical decision-making in common disease sites:

  • Cervical cancer

  • Endometrial and vaginal vault cases

  • Prostate cancer

  • Breast cancer

  • Skin and surface lesions

  • Head and neck cases

  • Re-irradiation scenarios

  • Palliative indications

• Review of staging, prior treatment history, anatomy, performance status, and treatment goals

• Discussion of multidisciplinary coordination and referral pathways

• Case-based discussion with Prof. Fayda or the clinical team

Module 3 — Gynecologic Brachytherapy Observation

Key topics and activities:

• Observation of gynecologic brachytherapy case preparation

• Review of patient evaluation and staging

• Discussion of indications for cervical, endometrial, vaginal, and recurrent gynecologic malignancies

• Review of anesthesia considerations and patient comfort measures

• Observation of applicator selection workflow from an observational standpoint only

• Discussion of intracavitary, interstitial, and hybrid techniques

• Review of challenging anatomy and residual disease scenarios

• Observation of imaging workflow where available

• CT/MRI-based anatomy review

• Discussion of target volumes and organs at risk

• Review of image-guided adaptive brachytherapy principles

Module 4 — Imaging, Contouring, and Treatment Planning Review

Key topics and activities:

• Observation of CT/MRI-based planning workflow

• Imaging review for applicator position and anatomy

• Observation of contouring discussion

• Review of target volume concepts

• Organs-at-risk evaluation

• Discussion of dose prescription and fractionation

• Review of dwell positions, dwell times, and dose optimization principles

• Plan evaluation and approval workflow

• Discussion of common planning challenges and troubleshooting in clinical practice

• Review of selected anonymized cases, if available

Module 5 — Medical Physics, Quality Assurance, and Radiation Safety

Key topics and activities:

• Observation of medical physics planning workflow

• Overview of HDR afterloader principles

• Medical physics quality assurance observation

• Independent checks and treatment plan verification

• Radiation protection and source safety overview

• Emergency procedure overview

• Treatment delivery checklist review

• Team communication and treatment time-out process

• Documentation workflow

• Discussion of safety culture in high-volume brachytherapy practice

Module 6 — Treatment Delivery Workflow Observation

Key topics and activities:

• Observation of treatment delivery preparation

• Review of patient positioning and transfer workflow

• Observation of treatment room workflow

• Review of communication between physician, physicist, therapists, nurses, and anesthesia team

• Observation of treatment delivery process from outside hands-on activity

• Post-treatment documentation review

• Discussion of patient recovery, discharge instructions, and follow-up planning

Module 7 — Site-Specific Brachytherapy Observation

Depending on clinical schedule and institutional availability, participants may observe site-specific brachytherapy cases including:

• Cervical cancer brachytherapy

• Endometrial and vaginal vault brachytherapy

• Interstitial gynecologic brachytherapy

• Hybrid intracavitary/interstitial techniques

• Prostate brachytherapy

• Breast brachytherapy

• Skin and surface brachytherapy

• Head and neck brachytherapy

• Re-irradiation cases

• Palliative brachytherapy

Key topics and activities:

• Review of site-specific patient selection

• Applicator choice and technique selection

• Imaging and anatomy review

• Planning principles by disease site

• Dose constraints and organ-at-risk considerations

• Toxicity prevention and follow-up

• Clinical outcomes discussion

• Case review with Prof. Fayda or clinical team

Module 8 — Advanced Techniques and Complex Case Discussion

This module is especially emphasized during the 2-week observership option.

Key topics and activities:

• Intracavitary versus interstitial decision-making

• Hybrid applicator techniques

• Complex gynecologic brachytherapy cases

• Bulky residual cervical tumors

• Recurrent pelvic disease

• Prior radiation and re-irradiation

• Challenging anatomy

• Organ-at-risk limitations

• Adaptive planning concepts

• Multidisciplinary planning considerations

• Review of complex or anonymized cases, if available

Module 9 — Outcomes, Toxicity, Follow-Up, and Patient Experience

Key topics and activities:

• Observation of follow-up consultations when available

• Review of acute and late toxicity considerations

• Discussion of patient counseling and informed consent

• Follow-up scheduling and surveillance

• Symptom management after brachytherapy

• Functional outcomes and quality-of-life considerations

• Documentation of treatment response and complications

• Patient-centered workflow in a high-volume department

Module 10 — Brachytherapy Service Development and Implementation

This module is particularly relevant for participants seeking to develop or expand brachytherapy services in their own institutions.

Key topics and activities:

• Developing or expanding a brachytherapy service

• Patient referral pathways

• Team composition

• Equipment requirements

• Staff training needs

• Workflow standardization

• Quality assurance culture

• Safety protocols

• Case volume and program sustainability

• Role of structured education through Brachy Academy by Elekta

• Practical discussion of implementation barriers in participants’ home institutions

Module 11 — Final Case Review and Program Wrap-Up

Key topics and activities:

• Consolidated review of observed workflows

• Discussion of key lessons from high-volume brachytherapy practice

• Review of common clinical and technical challenges

• Individual questions and discussion

• Summary teaching session by Prof. Merdan Fayda, MD

• Feedback session

• Certificate of observership attendance, if applicable

• Program closure

Clinical Areas Covered

Depending on patient schedule and institutional availability, the observership may include exposure to:

• Gynecologic brachytherapy

• Cervical cancer intracavitary/interstitial brachytherapy

• Vaginal cuff brachytherapy

• Endometrial brachytherapy

• Prostate brachytherapy

• Breast brachytherapy

• Skin and surface brachytherapy

• Head and neck brachytherapy

• Re-irradiation scenarios

• Palliative brachytherapy

• Image-guided adaptive brachytherapy

• HDR brachytherapy workflow

• Elekta-based planning and delivery systems

• Medical physics QA

• Radiation safety procedures

• Multidisciplinary brachytherapy workflow

Observational Scope

Participants may observe:

• Patient consultation and chart review

• Multidisciplinary case discussion

• Applicator selection rationale

• Imaging workflow

• Contouring review

• Treatment planning discussion

• Medical physics QA

• Treatment delivery workflow

• Post-treatment care and follow-up discussion

• Departmental workflow organization

• Clinical case review sessions

Participants may not:

• Perform patient examination

• Insert, remove, or manipulate applicators

• Create, modify, or approve treatment plans

• Perform contouring as part of clinical care

• Operate treatment equipment

• Approve clinical decisions

• Deliver radiation treatment

• Access patient information outside approved supervision

• Participate in hands-on clinical procedures

• Provide direct patient care

Faculty and Supervision

The program is led by:

Prof. Merdan Fayda, MDRadiation OncologyLiv Hospital Ulus, Istanbul, Türkiye

Training and observational activities are conducted under the supervision of Prof. Fayda and the Liv Hospital Ulus brachytherapy team, including radiation oncologists, medical physicists, dosimetrists, nurses, anesthesiology, and radiation therapists as appropriate.

Program Deliverables

Participants may receive:

• Structured observership schedule

• Clinical workflow orientation

• Case-based discussions

• Exposure to high-volume brachytherapy practice

• Observation of Elekta-based brachytherapy workflows

• Attendance certificate, subject to institutional approval

• Recommendations for further training or implementation planning

Compliance and Confidentiality

All observers must comply with:

• Liv Hospital Ulus institutional policies

• Patient confidentiality and data protection rules

• Infection control procedures

• Radiation safety regulations

• Professional conduct standards

• Observership limitations and non-hands-on requirements

Important Notes

• The program is observational only.

• No hands-on applicator placement, treatment planning, contouring, machine operation, or treatment delivery is permitted.

• Patient privacy, institutional policies, and clinical schedule determine the exact case exposure.

• Program content may be adjusted according to real-time clinical workload.

• Case availability may vary during the selected observership period.

• All activities are subject to approval by Liv Hospital Ulus and relevant clinical teams.

Key Program Message

This Brachytherapy Clinical Observership Training Program offers a structured opportunity to observe contemporary brachytherapy practice at Liv Hospital Ulus, an Elekta Brachy Academy training center, under the leadership of Prof. Merdan Fayda, MD.

The program emphasizes real-world clinical workflow, multidisciplinary teamwork, image-guided planning concepts, quality-focused treatment delivery, radiation safety, and practical decision-making in one of Istanbul’s highest-volume brachytherapy practices. Participants may select either the 1-week or 2-week observership option according to their educational goals and availability.