7. LEARNING CONTENTS 7.1. FCPS Part-I Contents Examination Structure FCPS PART-1 PAPER-I WRITTEN ane Subject No of Questions | Marks 1 | Applied Anatomy 20 ap 2 | Applied Physiology and Biochemistry 10 20 3 | Clinical Pharmacology 20 40 {Toad 50 100 PAPER~ WRITTEN Sl.No. Subject No of Questions | Marks 1 _ | Radiation Physics 25 50 2 | Radiation Biology 25 50 Total 50 100 PAPER -IIT WRITTEN S.No. Subject No of Questions | Marks 1 | Onco-pathology 18 26 2 | Cancer Biology 18 =a ae i Cancer Epidemiology & Medical Statisties 14 28 50 100 2020FCPS Part-I Paper-I 4 Gross Anatomy + Surface Anatomy Regional Vascular, Neural and Lymphatic Supply i ial as Histology Radiological + Clinical Anatomy ‘Name of the Organs Breast Lung, Trachea and Airway System Lip, Cheek, Oral Cavity, Gum, Alveolus, Tongue, Tonsil, Soft Palate, Hard Palate, Pharyny, | Pyriform Fossa Larynx esophagus Naso-pharynx Air Sinuses Salivary Glands including Parotid, Nose and Ear Central Nervous System Base of the Skull Brain Bye Lacrimal Gland Spinal Cord Vertebral Column Skin ‘Musculoskeletal System Bones Cartilage Bone Marrow Skeletal Muscle Smooth muscle GIT and Digestive Glands FCPS Radiotherapy (Curriculum Bsesophagus Stomach Small and Large Intestine Rectum Anal Canal Uterus: Ovary Fallopian Tubes Testes Prostate Urinary Bladder Urethra Peritoneum Endocrine System Lymphatic System1 2 3 4 5 6 r 8 x Cell Physiology and General one Blood Cells Immunity and blood clotting ‘The Circulation Body Fluids and Kidney Respiration. ‘The Nervous System The Special sense ‘The Gastrointestinal Tract ‘Metabolism and Temperature Regulation 10. Endocrinology and Reproduction ‘11. Immune System 12. Physiology of Haemopoiesis 13. Body Fluid 14. Basic BiochemistryCLINICAL, PHARMACOLOGY toxic drugs ’ ’ ee pares reach drug, Discuss the mechanisms of drug resistance, drug resistance Mechanisms of act differs, strategies to optimise efficacy of cytotoxic drugs modifiers, st 2. Drug Design and Development Describes novel therapeutic targets es the process of new drug discovery and development Outline ssessment of candidate compounds Outlines the principles of preclinical a Discusses the role and design of clinical studies (Phase I, 1, Il, 1V) 3. Pharmacokinetics and Pharmacodynamics general principles of pharmacokinetics and interprets pharmacokinetic data Explains the role of the route and timing of administration, Discusses the importance of plasma concentration and its relationship to drug actions, Defines AUC and discusses its importance, Discusses drug activation, metabolism and clearance, Discusses the importance of protein and tissue binding and Describes the importance of drug concentration at target site. Discusses the 4. Clinical Use of Systemic Therapies Describes dose response curves, Explains the concept of dose intensity. Discusses the effects of single agent and combination therapy. Explains the role of adjuvant and neo-adjuvant therapy. Describes the principles of regional therapy. Discusses targeting of drugs Outlines modification of drug resistance. Describes the clinical pharmacology and technology of continuous infusion. Describes the clinical pharmacology of intrathecal treatment. 5. Toxicity of Chemotherapy Describes the dose limiting and common toxicities. Describes dose-related and idiosyncratic toxicity. Defines the concepts of acute and long term toxicity. Discusses the mechanisms of toxicity. Discusses chemical and other factors modifying drug toxicity. Describes safe handling of cytotoxic drugs. Describes strategies to optimise efficacy of cytotoxic therapy.Clinical Pharmacology of Steroids and Anti-emetics se of steroids with chemotherapy Discusses the us ; iscusses their use Lists the classes of anti-emetics and d Drug Interactions in Cancer Treatment Discusses common or important interactions between drugs used in cancer therapy ang commonly used agents Other Endocrine Therapy Describes their mechanisms of action, Describes the mechanism of resistance, Lists the common, side-effects and discusses the effect of combination with other therapies 10, Biological and Novel Therapies anism of action and their combination with standarg i. Discusses biological therapies, their mech therapy Discusses the mode of action of interferons, interleukins, growth factors, antibody therapy small molecule inhibitors of signalling pathways, gene therapy and immunotherapy, Describes novel targets for anti-cancer drugs, including vasculature, cell signal control and oncogene. products, Outlines mode of action of bio-reductive drugs and Outlines mode of action of cancer vaccines High Dose Therapy Explains the clinical pharmacology and rationale of high-dose therapy, Describes methods for protection/rescue of stem cells, Lists unusual toxicities due to high dose therapyFCPS PART-I PAPER-IIRADIATION PHYSICS ture, atomic and mag, 1. Physics relevant to radiotherapy : Describes ee sees sn * dese d energy levels. Deseri J _ Describes electron shells and energ; tisation Explains the relationship me E s il gy quant electromagnetic spectrum. Dee ene m4 ‘an x- of gamma-ray beam (quality, energy. of production of x- or gamma-rays, C551) 7, wavelength, frequency and ion, scattering of x-rays spectra, : bsorpti ! intensity, size), Explains the basic principles continuous and discrete. Describes attenuation, al attenuation coefficients and half value layer. 2. Electromagnetic Radiation and its Interaction with Matter + pecans of; following effects and their dependence on the properties of the irradiated material (c.g. deny, atomic number), their variation with energy and their relative importance ee imaging. Elastic scattering, Compton effect, Photoelectric effect, Pair production, *hotonucles interactions. Auger effect, Scattered radiation, Secondary electrons, Linear energy transfer gg Dependence of range of electrons on their energy. 3. Interaction of Sub-atomic Particles with Matter : Ionisation and excitation due to charge Particles, Electrons, collision loss, radiative loss, stopping power due to each and total stopping power, particle range, Bragg peak, bremsstrahlung, Neutrons, elastic and inelastic collision, Protons, ionisation profile, Elementary Knowledge of pions and heavy ions. 4. Radiation Dosimetry : Discusses variation of absorbed dose in different tissues and materials, Concept of exposure and KERMA, The principles of the relationship between exposure, KERMA and absorbed dose, Ionisation in gases. The physical principles underlying radiation dose measurement, Concepts and practice of dose measurement, Relationship between measurement of ionisation and derived measurement of dose, Measurement of exposure, Free air ionisation chamber, Methods of measurement, The advantages and disadvantages of the following: ionisation methods (ionisation chamber, Geiger counter, diodes), chemical methods, primarily films thermoluminescence (TLD), scintillation counters, calorimetry, Calibration methods, intercomparisons, standards (local and national), corrections, constancy checks, Practical dose measurements, introduction to the derivation of isodose curves, central axis depth dose profiles use of phantoms, 5. Physics of Teletherapy Beams ; Describes energy ranges of x-rays used in clinical practice, discusses the dose distribution for therapeutic X-Tays noting the effects on the isodose curve ("% depth dose and beam profile) of energy, FSD (focus to skin distance), beam modifying devices such as wedges, tissue compensators, build-up and skin sparing, Field size, surface obliquity, inhomogeneous media. FCPS Radiotherapy BCS Curriculum 20008, Explains the prin 2. i ist Jectron beams used in clinical + Desoribes the dose distribution of el 6. Dense Bri esetthe isodose curve (% depth dose and beam profiles) of Bs a meting dose at depth (€-g. lung), Field size, Build up and skin sparing, sue ‘otiguity and inomogeneities and Shielding. anning : Explains the principles of ri ilable to optimize patient set-up, tes the methods of tumour volume definition, clinical tional imaging, Explains the concept of Ph adiotherapy treatment me Discusses the effects jotherapy Trea te the techniques aval planning, Diseusses #! 7 nt, Descril of patient and organ moveme! examination, radiograph, CT, MRI, ultrasound, fun aging. Explins he coe of Tanning volumes CCK Sty 82), char Te a Volume (GTV), Clinical Targ planning ~ ee Volunae (PTY), Planning organ at Risk Volume (PRV), Internal Target vat Se Min ‘ao, Treated Volume, Irradiated Volume, Organs at risk (OAR), Explains the methods of planning volume localization, Clinical mark-up, CT, MRI or PET er ation, Ultrasound, Compares fixed FSD versus isocentric planning, Deseribes isodose d critical assessment in each of the following situations. Single field, distributions, their uses an‘ I Multi field (coplanar and non-coplanar), Arc and rotational therapy, Weighting, Outlines the principles of beam shaping including conformal therapy and IMRT, Outlines the principles of forward and inverse planning, Discusses dose prescription including ICRU 50, 62.83, Ouilines the principles of dose calculations in the presence of extensive shielding, Explains the principles Of field matching, Describes the principles of plan evaluation and verification using isodose display, dose volume histogram (DVH, cumulative and frequency) and digitally reconstructed radiographs (DRR). les of beam therapy equipment : Beam Therapy Equipment. Outlines the principles of superficial and orthovoltage x-ray production. Outlines the prineiples of the linear acceleration, including: Electron beam production, X-ray production, beam control and, stability, Output, IMRT, Describes the concept and definition of the isocentre, Describes techniques for defining the beam geometry, Collimators, Applicators, Multi leaf collimators, Explains the factors influencing pernumbra Defines beam quality, Describes the shielding techniques available and the materials used in their construction, Explains the concepts of transmission, scatter and doses under shields. Discusses the factors involved in accurately irradiating the target. The treatment couch, Positioning the patient, Lasers, Light fields and Monitoring radiation output, Describes the functioning of multi leaf collimators: Edge definition, Leaf leakage, Influence of leaf size and Outlines the principles of stereotactic equipment. 5 Quality Assurance in radiotherapy : Defines quality assurance and quality c i ae eee Parameters that should be included when siting ee a i a ; ea the ‘Processes that are undertaken to ensure that the prescription is ct computer verification, Manual checking, Monitoring c films, mega-voltage imaging, aware of IGRT, fields, mechanical pointers, tolerances), field flatness (tolerances) and In vivo Page 29jation output, Symmetry and Fig, f; Radiation 01 i 4 flatness, Beam energy, Field size, luding the legal requirements. oi radioactivity inch including the lege ibes the basic principles of 'y includin, concepts, definitions and units of actin, er decay series, Definitions and yn : Desert yy, isotopes, 10. adioactive Sources in Therapy parent and daught types of radiation and radioactive deca and half-life, characteristics of radiation, Thal life, radioactive equi : , ica of activity and half-life including Dept construction (wits, hating seed sealed and unsealed sources, Types of soures and they SoS TTT Bsr eee tubes, needles, ovoids etc.) specific forms sion Doce eeations of rourcs sicaglh, Sti, as) Haters Hitare ee, dose striations around standard = a source, KERMA rate, calculation of absorbed dose from a source, dose isttPailons Mou sand 5 sources, hazards with sealed sources, control and testing ethods of measurement of activity, principles of storage and movement ano chil of —_ handling, aware of leak testing and inspection of sources, safety de' ee and contrasts use of teletherapy and brachytherapy methods ohare pee Explains the principles of after loading, Explains principles of brachy' rent planning, 11, Brachytherapy : Discusses the principles of brachytherapy, Outlines the principles of clinical use, Describes the distribution rules and dose calculation basis for Paris system, Describes the gynaecological intracavitary brachytherapy systems, Describes the sources used and the dose distributions, Describes how the dose is specified, Explains the principles of after loading, Discusses the types of after loading, including manual, remote, low, intermediate and high dose rate and Discusses use of imaging in brachytherapy. 12, Unsealed Sources in Therapy: Discusses the principles of the use of unsealed sources in Defines the difference between therapy. Describes the concepts of stability and shelf life. physical and biological half life Lists the radiopharmaceuticals in common clinical use in oncology. Describes their therapeutic applications. Explains methods for dose calculation 13. Radiation Protection Discusses the principles of radiation protection, Discusses the risks of radiation, Describes the effects of total body irradiation at different dose levels, Compares Discusses quality factors and dose equivalent, classification of staff, designated areas, Outlines lonising Radiation regulations (IRR) 1999, Outlines Ionising Radiation (Medical Exposure) Regulations 2000, Outlines Administration of radioactive Substances Advisory Committee (ARSAC), Outlines Radioactive Substances Act 1993, Discusses local rules, Nuclear Safety & radiation Control (NSRC) Act, 1993, Bangladesh Atomic Energy Regulatory Authority (BAERA) Act, 2012, Defines controlled areas Explains Protection mechanisms, including time, distance, shielding Explains the design of treatment rooms: Primary/secondary barriers, Transmission through barriers, elementary calculations, Mazes, coors and interlocks, Leakage and Scattered radiation Describes the monitoring of personnel: Construction and Operating of film badge, TLD badge and direct reading dosemeter. FCPS Radiotherapy Curricutum be| jular systems (hierarchical, flexible) and Outlines the principles of cell ce of Linear Energy RADIATION BIOLOGY [ 1. General Principles 0 diobiology : Deseribes cell f Rat ‘Contrasts parallel and serial systems, i e to radiation, ee to radi curves, clonogenic assay, Describes the relevan ri Eades oar Describes radiation damage at the cellular level (including ‘Compares bystander with ular damage, Trans ) to cell outcome phenotypes: ¢ of radiation, ns between sys! Frromosome damage and cell radio sensitivity), d Compares the effects of low and high dose rate radiation and ‘temic anti-cancer therapies and radiotherapy. nteraction and Repair : Describes the basies of experimental 1s, Explains the molecular processes involved in « involved in radiation damage repair, Discusses perimental DNA damage zy of Radiation Damag vy, including sensiti ins the molecular processes \d Describes laboratory &x . Molecular Biolo} molecular radiobiolog: radiation damage, Exp joteraction between radiation and other agents an and repair. ¢ cellular level, including biology : Describes radiation damage at th Defines cellular systems outcome phenotypes, chromosome damage and cell radio sensitivity, (hierarchical and flexible) and describes their response to radiation, Describes normal tissue damage (early and late), Discusses the concept of normal tissue tolerance, Discusses the factors snfluencing tolerance, Describes the effects of radiation on different tissues and organs including tinplanned whole body exposure and Discusses Equivalent Uniform Dose (EUD), Discusses the genetic factors and co-morbidities, including auto-immune factors, which influence tolerance, Liss the tolerance levels for different tissues and organs, Discusses organ tolerance to retreatment with radiation, Describes the schemes for reporting normal tissue damage. 3, Normal Tissue Radi 4. Radiobiology: Discuss population radiobiology, Explains the production of the cell survival curve, Describes descriptive models, e.g. linear quadratic model, Discusses the concept of damage (lethal, sub-lethal, potentially lethal), Discusses the concept of repair (early and late), Describes the effect of cell cycle on radiation sensitivity, Discusses repopulation, Explains the role of the cell survival curve as a basis for fractionation, Defines terms describing cellular sensitivity (SF2, a, B, mean inactivation dose), Discusses the o/ ratio and its relevance to acute and late responding tissues, Describes iso-effect curves (various forms) and formulae, including BED, Discusses fractionation and its influence on outcome with varying w/f: ratio, Defines hyperfractionation, accelerated fractionation and hypofractionation and Discusses he infiuence of gaps in radiotherapy and their management, Discusses radiation protectors, Describes low dose hyper-radio sensitivity and Describes effects of total body irradiation. : 5. inert Betray and Other Agents: Discusses the interaction between radiation l other n a the interaction with chemotherapy (before, during or princip les of the interaction with hyperthermia. BCPSFCPS PART-I PAPER-ITI Page 32 FCPS Radiotherapy Curriculum Ee(CO-PATHOLOGY AND CANCER BIOLOGY ‘| a a iecusses the general principles of tumour biology. Defines ysplasia and carcinoma 1. Principles of and can distinguish ‘situ, Describes the cell cycle, Desccibes fie of spread, local invasion/migration, focal (e.g. pressure), distant (metastat'> and non- metastatic} Describes mechanisms of DNA damage and repair:Single strand vasculature and angiogenes DNA breaks:Base excision repair(BER), Nucleotide excision repair (NER), Mismatch repair (MMR); Double strand DNA Hreaks:Non-homologous end joining (NHEJ) and Homologous recombination, Described the potential role of cancer stem cells, Describes mechanism of cell sean, eg. apoptosis, autophagy and Describes the molecular targets for anti-cancer therapy: jecular Biology : Describes the principles and use of techniques in molecular including electrophoresis, ‘and use of nucleic acid analyses, Describes the principles and use of f transgenic model metastasis, Describes the effects of tumours: ), Discusses the importance of tumour mechanisms 2. Techniques in Mol biology Describes the principles hybridisation, blotting, PCR, sequencing, transfection, Describes the principles and use of microarray techniques, eral principles of tumour biology, Genetics of | ‘Normal and Malignant Cells : Discusses the gent Deseribes normal chromosomal structure and funtion, normal gene transcription and its control, Deseribes normal DNA repair mechanisms, Describes polymorphisms, SEM and microsatellites, Discusses chromosomal Describes chromatin structure and function, Describes methylation, ees in malignancy, point mutations, translocations, deletions, gene and genetic chan; amplification and over-expression, Discusses oncogenes proto-oncogenes, tumour suppressor genes and their mode of action, describing well established examples in each class Describes protein-protein interactions. nisms of Cell growth Control : Discusses the normal and th control Discusses the control of normal cell growth and behavior, Contrasts autocrine, paracrine and endocrine growth factors, Discusses altered expression, function and control of these mechanisms in malignancy, Describes signal transduction (MAP kinases), Describes the role of cyclin kinases and Describes gene promoters and their activity in normal and malignant cells 4. Normal and aberrant Mecha' aberrant mechanisms of cell growtl Causation of Human cancers : Discusses the causation of human cancers Describes environmental factors and influences, Discusses carcinogenesis in vitro and in vivo, Describes viral carcinogenesis and viruses firmly associated with cancer (HPV, EBV etc.), Discusses radiation carcinogenesis including:Ionising and non-ionising radiation associated with carcinogenesis, DNA damage and repair (differing effects with various radiation types) 5. Page 33 Bg4 Symptoms Discusses the each tumour : Epidemiology and actiot nn, Characteristic imaging findings, LAbor™iory diagnos mnee of tumour compared with normal Gal ems in use, Immunohistochemis verview) and The candidate shoulq stic and predictive factors 6. Oncological Signs an and natural history Clinical presen croscopic appeara of disease: Macroscopic and mict oforigin and differential diagnosis Grading and staging sySt Tumour markers, Molecular techniques available (brief ov beable to interpret a pathological report including pathologic progno* romes Discusses the each tumour, Pain, Nauseq Physiology of Oncologie symptoms and syndi and vomiting heES (CANCER EPIDEMIOLOGY AND MEDICAL STATISTICS 1. Types of Data 2, Sampling 4, Statistical inference 14, Test Used to Compare Two or More Groups ‘5, Association Between Variables 6. Screening Test 7, Survival Analysis & Design and analysis of clinical trials 9. Collection and use of Epidemiological Data 10. Medical Ethics and Confidentiality 1, Medical ethics and conflict of duty 12. Medical ethics and autonomy and capacity 13. Medical ethics and end of life issues 14, Ethical research 15, Evidence and Guidelines 16. Audit