ACVR - RO New Residency Program Application

Please review the Radiation Oncology (RO) Residency Program Essentials Training Standards and Requirements document prior to completing this form.

The following documents will be needed to complete the application:

CVs (current within 1 year and a maximum of 2 pages each) for radiation oncology, diagnostic imaging, and medical oncology Diplomates involved in the training program
- As a reminder, CVs will be publicly available on ACVR's website. We encourage you to NOT include personal information on the CVs that are uploaded with your application.
Syllabi for coursework in medical physics, cancer biology, and radiation biology (including internal and external courses)
Letters of agreement from cooperating institutions
Letter of agreement from medical physics support for clinical training
Resident calendar that includes the following:
- 24 months of RO-specific activities (primary case responsibility, treatment planning, 1 week/year of radiation therapist activities)
- 8 weeks of medical oncology
- 4 weeks of diagnostic imaging
- 40 hours of medical physics
- 40 hours of clinical pathology
- 80 hours of anesthesia in minimum 1-week blocks
- 2 weeks of neurology
- 2-week minimum off-clinic time per year (study, research, etc) not including vacation
- Vacation time as mandated by state/institution
- Required outrotations at cooperating institutions
Resident evaluation forms

Submission Date

Date

Your Name

First NameMiddle NameLast Name

Your Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Your Email Address

example@example.com

Radiation Oncologists in support of the program (Must be Diplomate(s) of the ACVR):*

*Resident supervision is defined as being available on-site 40 hours/week (defined as a 4- or 5-day work week to equal a minimum of 40 hours) to support the resident in radiation oncology-related activities including patient consultation/management, review of treatment plans, position verification and participation in daily case-based rounds.

Which of the Radiation Oncology Diplomates listed above will serve as the Residency Director? This individual will be the primary contact for the residency program and will be responsible for completing all necessary forms/reviews and notifying the RO RSEC of any changes to the program. The Residency Director must be a Diplomate of the ACVR and must be located at the primary training institution.

Please confirm that during the minimum 24 months of RO-specific activities, a Supervising Diplomate will be present on site to supervise the resident as defined above for 40 hours/week (4-5 days).

YesNo

Comments:

A standard residency program is one that meets all of the residency program requirements set forth in the ACVR-RO Residency Essentials Training Standards document. An alternative or amended program is designed for one specific individual/resident and satisfactorily meets all of the residency program requirements, but is completed in an extended timeline (more than 3 years but fewer than 5 years).

This application is made for (check one):

Standard ProgramAlternative Program

Comments:

What is the total length of the training program?

Number of months dedicated solely to radiation oncology-specific activities as defined in the ACVR-RO Residency Essentials Training Standards document (RO-specific activities include primary case responsibility, treatment planning, 1 week/yr of therapist activities):

Primary Site:

Hospital/University:

Department:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cooperating Institution(s) (if applicable)

Advanced Degree and Research/Publication Requirement

	Yes	No	Optional
Masters
PhD
Research Project
Publication

Documentation of residency completion is required to obtain Diplomate status. Is receipt of residency certificate dependent on completion of advanced degree/research/publication?

YesNo

It is required that a residency in veterinary radiation oncology provide the trainee with experience in formulation of radiation treatment plans, dose calculation, and treatment administration for veterinary patients with cancer. This includes generation of both manual and computer-based treatment plans for megavoltage external beam irradiation. External beam planning experience must include both forward and inverse planning, even if only one of those types is utilized for treatment at the primary facility. Does the program fulfill these requirements?

YesNo

Comments:

It is required that a residency in veterinary radiation oncology provide the trainee with experience in primary case responsibility, including new referrals, ongoing radiation patients, and follow-up visits. This includes receiving patients, clinical rounds, client/referring DVM communications, and medical records keeping. Does the program fulfill these requirements as described on page 12 of the RO Essentials document?

YesNo

Comments:

It is required that a residency in veterinary radiation oncology provide the trainee with a minimum of 1 week per year of radiation therapist activities to include daily linear accelerator quality assurance and warm up, patient positioning for treatment planning CT and therapy, radiation delivery (as allowed by the state/province), and acquisition of position verification imaging. Does the program fulfill these requirements?

YesNo

Comments:

How will the resident be trained in radiation biology? Please provide a description of formal and informal training experiences, or indicate time allotted for self-study.

Please provide instructors’ names and credentials for radiation biology formal and informal training:

How will the resident be trained in cancer biology? Please provide a description of formal and informal training experiences, or indicate time allotted for self-study.

Please provide instructors’ names and credentials for cancer biology formal and informal training:

How will the resident be trained in medical physics? Please provide a description of formal and informal didactic (non-clinical) experiences, or indicate time allotted for self-study.

Please provide instructors’ names and credentials for didactic (non-clinical) medical physics formal and informal training:

Medical physics training requires 1 week or 40 hours of clinical contact with a qualified medical physicist. Please provide a description of the training experience.

Medical Physicist(s) in support of clinical training in the residency program

A minimum of 1 hour of medical literature review with an ACVR-RO Diplomate is required monthly. Please describe this experience, and any additional formal or informal conferences available to the resident (including journal clubs, seminars, book reviews, etc.) that are not already listed above:

The resident is required to present at least 2 lectures or scientific presentations during the course of the residency. Please describe how the program will fulfill this requirement:

The program must include an external beam radiation therapy machine in the megavoltage range and 3D computerized radiation treatment-planning capabilities to create treatment plans used for treatment delivery. Residents must have on-site access to treatment planning systems capable of forward and inverse planning even if both types of planning techniques are not deliverable at that institution.

Please list the manufacturer and model of the on-site external beam radiation therapy delivery system:

Please list the manufacturer and model of the on-site radiation therapy treatment planning system(s). Please indicate whether they are capable of forward or inverse planning, or both, and whether or not they are used clinically to deliver treatments:

The clinical training requirements in the following six questions, described on pages 15 and 16 of the RO Essentials document can be fulfilled at a cooperating institution if the primary institution lacks resources to accomplish them. Training at cooperating institutions must be supervised by a Supervising or Supporting ACVR-RO Diplomate and a letter of agreement from the cooperating institution is required. The training requirements can be combined into a single minimum 2-week learning experience at the cooperating institution.

The residency program requires hands-on clinical experience to develop expertise and self-sufficiency in manual setups and manual treatment planning with photons. How does the program fulfill this requirement?

The residency program requires hands-on clinical experience to develop expertise and self-sufficiency in manual setups and manual treatment planning with electrons. How does the program fulfill this requirement?

The residency program requires hands-on clinical experience with forward planning for 3D conformal radiotherapy (non-IMRT). How does the program fulfill this requirement?

The residency program requires hands-on clinical experience with inverse planning for IMRT. How does the program fulfill this requirement?

The residency program requires hands-on clinical experience in on-board imaging verification with MV or KV CT. How does the program fulfill this requirement?

The residency program requires hands-on clinical experience in on-board imaging verification with kV digital radiographs. How does the program fulfill this requirement?

The residency program requires hands-on clinical experience in on-board imaging verification with MV portal imaging. How does the program fulfill this requirement?

Radiologist(s) in support of the residency program [Must be Diplomate(s) of the ACVR or ECVDI]

The residency program requires at least 26 weeks/year of on-site diagnostic imaging support from a ACVR or ECVDI Diplomate and availability for remote support for at least 45 weeks/year. How will the institution fulfill this requirement?

How will the resident be trained in diagnostic imaging? Please provide a description of formal and informal training experiences as well as a description of the resident's role while rotating on a diagnostic imaging service:

The program must have on-site access to modern radiographic equipment, including digital or computed radiography, ultrasound, and CT. Does the institution fulfill this requirement?

Medical Oncologist(s) in support of the residency program [Must be Diplomate(s) of the ACVIM, Specialty of Oncology]

The residency program requires at least 26 weeks/year of on-site medical oncology support from an ACVIM (Oncology) Diplomate. How will the institution fulfill this requirement?

How will the resident receive training in medical oncology? Please provide a description of formal and informal training experiences as well as a description of the resident's role while rotating on a medical oncology service:

Surgeon(s) in support of the residency program [Must be Diplomate(s) of the ACVS]

The residency program requires at least 26 weeks/year of on-site surgical support from an ACVS Diplomate. How will the institution fulfill this requirement?

Pathologist(s) in support of the residency program [Must be Diplomate(s) of the ACVP (Anatomic or Clinical Pathology) or ECVP (Clinical Pathology)]

The residency program requires at least 45 weeks/year of anatomic and clinical pathology support by ACVP Diplomates. If not on-site, a letter of support must be submitted. How will the institution fulfill this requirement?

At least 1 week or 40 hours in a clinical rotation or rounds with a clinical pathologist are required during the residency program. If off-site, a letter of agreement must be submitted. How will the institution fulfill this requirement?

Anesthesia Specialists in support of the residency program [Must be Diplomate(s) of the ACVAA or ECVAA, or Veterinary Technician Specialists (VTS)]

The residency program requires two 1-week (40-hour per week) clinical rotations (80 hours in total) in anesthesia with an Anesthesia Specialist, as defined above. Please provide a description of this training experience and the resident’s role on this rotation.

Neurologist(s) in support of the residency program [Must be Diplomate(s) of the ACVIM, Specialty of Neurology or ECVN]

The residency program requires a 2-week clinical rotation supervised by a Diplomate of the ACVIM (Neurology) or ECVN. Please provide a description of the training experience and resident’s role on this rotation.

Please list all additional board certified specialists in direct support of the residency program. If offsite, please explain relationship:

Evaluation of resident performance and progress must be documented every 6 months through appropriate techniques, including faculty appraisal, or oral or written tests, or a combination of these. Institutional resident evaluation forms should be submitted as part of the residency application. How will the program fulfill this requirement?

If applicable, please list the residents who have completed the training program within the last five years, including the year that each individual's training program ended. If possible, provide the status of each individual with respect to the board certification process.

Please list any additional information of interest in support of this residency application.

CVs (current within 1 year and maximum of 2 pages) for each radiation oncologist, radiologist and medical oncologist involved in the training program
Resident calendar that includes the following:
- 24 months of RO-specific activities (primary case responsibility, treatment planning, 1 week/year of radiation therapist activities)
- 8 weeks of medical oncology
- 4 weeks of diagnostic imaging
- 40 hours of medical physics
- 40 hours of clinical pathology
- 80 hours of anesthesia in minimum 1-week blocks
- 2 weeks of neurology
- 2-week minimum off-clinic time per year (study, research, etc) not including vacation
- Vacation time as mandated by state/institution
- Required outrotations at cooperating institution(s)
Letters of agreement from cooperating institutions
Letter of agreement from medical physics support for clinical training
Residency evaluation forms
Syllabi for any formal or informal coursework

CVs

Browse Files

Resident Calendar

Browse Files

Letters of Agreement From Cooperating Institutions

Browse Files

Letter of Agreement from Medical Physics Support for Clinical Training

Browse Files

Residency Evaluation Forms

Browse Files

Syllabi for Coursework

Browse Files

ACVR - RO New Residency Program Application

Upload the following information