National Project Document (Category A)

Country Name: Bangladesh

Project Title: Up gradation of Radiotherapy Treatment Facilities

with Implementation of IMRT & SBRT Treatment at National
Institute of Cancer Research & Hospital, Dhaka, Bangladesh.
Field of Activity: Radiation therapy in the treatment of cancer
patients.
Name and contact details of Counterpart:
Professor (Dr.) Md. Moarraf Hossen
Director cum Professor of Radiotherapy
National Institute of Cancer Research & Hospital,
Mohakhali, Dhaka-1213, Bangladesh
Phone: +88 02 8826561-5
E-mail: nicrh@hospi.dghs.gov.bd

Section-1: Project Background and Justification

Gap/ Problem / Need Analysis:

Bangladesh is a small developing country with more than 160
million population where cancer is increasing day by day.
According to the International Agency for Research on Cancer
(IARC) report 2012 the incidence rates are around 122000 though
it is underestimate as there is no population based cancer
registry. The National Institute of Cancer Research and Hospital
(NICRH), Bangladesh which is the only tertiary level hospital for
the country has reported that in 2008 total new diagnosed cancer
patients was 7458 and in 2014 it was 11108 which indicate rapid
rise of the disease.
This country has widely varying cultures, habits, languages and
many different ethnic groups. The pattern of cancer, therefore,
mainly depends on their habits and life styles rather than other
risk factors. Lung, Head, Neck & Esophagus cancers in the male
and cervix and breast, Head, Neck cancers in the females are the
main cancers. All together they form nearly 60% of all cancers.
Like other third World countries Bangladesh also has poverty,
illiteracy, less life expectancy. Moreover due to lack of awareness
and routine cancer screening facilities it is critical to early cancer
detection and most of the cancer patients present in very
advance stage of their diseases.
The facilities for cancer diagnosis and treatment vary widely from
metropolitan cities to rural areas where around 70% of the
Bangladeshi population lives. In major cities, good to excellent
treatment facilities exist but in the rural setting the facilities are
very few or non-existent at all. Therefore almost all cancer
patients need to come to cities for treatment. The people do not

have health insurance. The cost of treatment, therefore, is borne

by the entire family which is quite high.
The Government of Bangladesh through Ministry of Health has
address the problem and establish the National Institute of Cancer
Research and Hospital with comprehensive multidisciplinary
facilities with very low cost. It has largest radiation treatment
facilities with two telecobalt for conventional treatment with
conventional Simulator, high dose rate Brachytherapy and four
Linear Accelerator machine with CT Simulator for modern Three
Dimensional Conformal Radiotherapy (3DCRT) technique for both
curative and palliative purpose. Under the guidance of IAEA we
have already reached in Level II, which is transition from 2D to
3DCRT. Now we are trying to adopt Intensity Modulated Radiation
Therapy (IMRT) and Stereotactic Body Irradiation (SBRT) in our
centre which would be more beneficial for our poor cancer patient
with very low price. Two RCA project of IAEA is ongoing for
strengthening IMRT and SBRT in the Region. To establish IMRT and
SBRT in our centre we need few supports from IAEA so that we
can offer higher Radiation Therapy technique to our cancer
patient with more survival benefit and less toxicities.

Stakeholder Analysis and Partnerships: Cancer Patients, Radiation

Oncologists, Medical Physicists, Radiation Technologists, Vendor,
Bangladesh Atomic Energy Commission, Ministry of Health &
Family Welfare.

Overall Objective: To improve the survival and Quality of Life

(QoL) for cancer patients through implementation of IMRT and
SBRT.

Objective Analysis:

I.
II.
III.
IV.

State of the art knowledge acquirement in IMRT and

SBRT techniques.
Procurement of necessary logistics.
Obtaining permission from concerned authority.
Training of service providers.

Role of nuclear technology and IAEA:

The IAEA is expected to provide us with
I.
II.
III.
IV.

Guidelines for implementation of IMRT and SBRT

Necessary
software
preferably
Rapid
Arc,
immobilization devices and QA tools
Human Resource (HR) development
Logistic and advisory supports to make the project
viable and sustainable

Section-2: Project Description

Outcome: Improvement of Radiation therapy services at NICRH

Performance Indicators:
IMRT and SBRT facilities fully functional by the end of 2019.
Training of five Radiation Oncologists, three Medical Physicists &
four Radiation Technologists completed by mid 2018.
Adaptation of the standard treatment protocol at the end of the
project.

Physical Infrastructure and Human Resource: At present we have

two Linear accelerator machine for IMRT and SBRT up gradation.
We have 25 qualified Radiation Oncologists, 4 Medical physicists

and 18 Radiation technologists working at NICRH. Bangladesh

Atomic Energy Commission will support to establish such facility.

Safety and Regulatory Infrastructure: Our center is well equipped

in respect of radiation safety as per international standard.

Other considerations: No visible threat to environment at present.

All the radiation premises are restricted and appropriate signs on
radiation hazards are shown. Both male and female will get equal
opportunity in terms of training or treatment.

Project duration: Proposed starting date January 2018. It will be

completed by December 2019.

Funding and project budget: The Government of Bangladesh will

provide necessary land, building, machines, man power through
NICRH.
IAEA will provide software preferably Rapid Arc, training of the
concerned personnel and logistics.

Section-3: Implementation Aspects

Implementation strategy: NICRH is the centre of excellence for

cancer treatment in Bangladesh. We have been working with
committed and devoted Oncology team since 1992. We have
started 3DCRT since 2009. At present we have all the necessary
infrastructure installed in our premises for commissioning of IMRT
and SBRT but necessary software and logistic supports is
necessary.

Monitoring and Reporting: Project implementation team will seat

and evaluate the progression of ongoing project quarterly and
send their expert report to IAEA through proper channel. As
Director of NICRH is the Coordinator of this project will be
responsible for the report.

Risk Management: Reallocation of resources specially human

resources is one of the major barriers for success and
sustainability of the project. Authority will be requested not to
transfer trained personnel in SBRT and IMRT to other places until
completion of the project.Multi-phase electricity supply will be
ensured for smooth running of the machines. By organizing local
trainings on SBRT and IMRT we will help to develop alternate
human resources to make this project sustainable.

Section-4: Work plan

January 2018-December 2019

ACTIVITY

RESPONSIBLE

DEADLINE

Preparation of action plan ,

Formulation of a project
team, Inventory analysis

Project Coordinator

First Quarter

Acquirement of
Knowledge,Acquirement of
license

Project Coordinator

Second Quarter

HR development

Project Coordinator

Third Quarter

Installation of equipment
and QA,IMRT and SBRT
implementation

Project Coordinator

Fourth Quarter

Continue Treatment

Project Coordinator

Fifth Quarter

Development of Protocol

Project Coordinator

Circulation and organize

local Training

Project Coordinator

Seventh Quarter

Evaluation and Reporting

Project Coordinator

Eighth Quarter

Sixth Quarter