Baylor College of Medicine (HDR GYN)

Our Facility:

BCM is the oldest private medical school in the southwest and is one of the foremost research and clinical institutions in the country. It leads all Texas institutions in total NIH research funding and continuously ranks among the top 20 NIH-funded medical schools in the US. The Daniel L Duncan Cancer Center (DLDCC) at BCM, an NCI-designated Cancer Center since 2007, is a matrix-type cancer center with 350 current members that come from virtually every basic science and clinical department at BCM. The DLDCC conducts more than $100 million in total cancer-related research. The Department of Radiation Oncology housed within the DLDCC consists of three participating teaching sites including the Harris Health System/Smith Clinic, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), and Baylor St. Luke’s Medical Center (BSLMC). Residents are required to rotate at all participating locations during their training and the faculty split their time between the affiliate locations.

With its many institutions, diverse patient population, various faculty, other affiliated ACGME oncology programs state-of-the-art equipment, comprehensive didactic curriculum, and clinical and basic science research support, the Baylor radiation oncology program offers a full complement of educational and research opportunities.  Active grants within the department of radiation oncology include R01, CPRIT, Industry-sponsored grants, an investigator-initiated trial, and institutional grants.  The department has 19 full-time faculty slots and includes the physics and dosimetry team and two nurse practitioners and 9 Clinical and 3 Research trainees.  The departmental affiliation with Baylor’s Dan L Duncan Comprehensive Cancer Center offers patients a unique academic care environment because of the collaboration between disease site specialists including radiation oncologists, medical oncologists, surgical oncologists, as well as pathologists and radiologists. This team approach is critical to the DLDCC mission to offer the best care possible and the latest clinical trials. 

Fellowship Description:

The Smith Clinic site is the primary site where residents learn about brachytherapy and receive supervised training for intracavitary tandem and ovoid brachytherapy, vaginal cuff brachytherapy, and interstitial cases.  A smaller number of brachytherapy cases are often performed at Kirby Glen, often for patients who have received external beam within a 200-mile radius of the center, at community facilities that do not offer brachytherapy.  Each individual case is seen as a teaching opportunity for the resident and faculty member. There are a large number of unusual cases at these sites which allows residents the opportunity to apply their practice-based learning skills by looking up articles and going over them with faculty.  The curriculum allows residents an opportunity to improve their communication skills by presenting and discussing individual cases and the role of radiation therapy with residents and faculty in gynecologic oncology and surgical specialties. There is a weekly multidisciplinary Gynecology Oncology Tumor Board that the residents participate in with faculty presence.

The supervision at the Smith Clinic and Kirby Glen Sites is through the attending radiation oncologists.  All patient-related clinical care activities including consults, simulations, weekly on-treatment visits, brachytherapy procedures, and follow-up patients seen by residents are performed with direct faculty supervision. All assessment and treatment plans are developed and approved with an attending faculty member's input. In addition, the faculty provide 24-hr on-call coverage with an assigned on-call resident.   The attending physicians supervise all brachytherapy procedures including all pelvic exams, intracavitary cylinder, tandem, and ovoid brachytherapy, and interstitial procedures.  All the on-site physicians teach the residents regarding quality assurance through pretreatment peer review, weekly chart rounds as well as weekly brachytherapy chart rounds which consists of individual patient case review, with goals of improving patient care and ensuring continuity and timely care. The brachytherapy meeting is attended by the administrator, nursing staff, therapy staff, front desk staff, dosimetry/physics staff, residents, and faculty.

Case volume:

The Harris Health System/Smith Clinic is part of the Harris Health System which cares for medically underserved residents of Harris County.  This site sees on average 1,800 patients per year with an average of 1,300 new starts per year.  This site utilizes one Varisource high dose rate (HDR) afterloader, 1 Elekta Agility, and 2 Elekta Infinity linear accelerators.   The Physics department at the Smith Clinic consists of 2 Ph.D. physicists, 2 master-level physicists, and 5 medical dosimetrists.  Annually, we treat 20-25 patients with gynecologic interstitial brachytherapy, 10-15 with prostate HDR implants, and perform approximately 80 intracavitary tandem and ovoid implants and 70-80 intercavitary vaginal cuff cylinder treatments.   

The Kirby Glen center is part of the Baylor St Luke’s Medical Center and this site sees between 600 -700 patients a year with an average of 370 new starts per year.  It is equipped with a Varian Trilogy, 21ex, CyberKnife, 4D CT simulator, and a Varian HDR varisource afterloader.  The physics department at Kirby Glen consists of a Ph.D. physicist, a masters-level physicist, and a medical dosimetrist.  Annually, we perform approximately 20-25 intracavitary tandem and ovoid implants and 15-20 intracavitary vaginal cuff cylinder treatments. 

Currently, our prostate HDR program is on hold during the Covid-19 pandemic due to the limited OR time available from nursing staffing shortages.

Resident Expectations and Learning Objectives:

Goals and Objectives – Brachytherapy service


GOAL:  To obtain the experience necessary to be competent in brachytherapy through a high volume of cases


1.  MEDICAL KNOWLEDGE: At the end of this rotation, the resident should be able to:

  1. Determine appropriate brachytherapy technique, including knowledge of appropriate volume and treatment fractionation and doses in genitourinary and gynecologic, cancer patients
  2. Determine the tolerance doses of critical structures next to target volumes and analyze dose-volume histograms (DVH) for brachytherapy
  3. Determine optimal doses and techniques for brachytherapy of gynecological and genitourinary malignancies


2.  PATIENT CARE: At the end of this rotation, the resident should be able to:

  1. Manage oncologic and treatment-related side effects in patients receiving brachytherapy
  2. Observe and plan their own HDR brachytherapy cases with the aid of a medical physicist

3.   INTERPERSONAL/COMMUNICATION SKILLS: At the end of the rotation, the resident should be able to:

  1. Communicate plan of treatment to the attending and referring physician as well as nurses, dosimetrists, physicists, and therapists involved in the care of the patient
  2. Write a brachytherapy prescription for approval by the attending radiation oncologist with regard to the treatment plan for the patient
  3. Communicate with physicians in the multidisciplinary treatment of cancer the role of brachytherapy including results and side effects in a tumor board or working group setting


?4.   PRACTICE BASED LEARNING: At the end of this rotation, the resident should be able to:

  1. Prepare for brachytherapy conference by review of existing literature in the treatment of a particular type of disease. He or she should be able to defend treatment plan through evidence-based medicine
  2. Attend multidisciplinary tumor boards (gynecologic oncology, genitourinary), to discuss the role of brachytherapy to the presented cases


5.   SYSTEM BASED PRACTICE: At the end of this rotation, the resident should be able to:

  1. See all patients on treatment and review treatment records on a weekly basis to determine if the treatment to assure that the right treatment is being delivered and tolerance of certain organs to irradiation is not exceeded
  2. Review treatment-related complications after brachytherapy and present findings in the monthly morbidity and mortality conference. The resident should find ways of how the complication can be minimized or avoided in the future through review of the existing literature and methods to treatment delivery


6.   PROFESSIONALISM: At the end of this rotation, the resident should be able to:

  1. Maintain high ethical behavior in all professional activities
  2. Demonstrate commitment to continuity of care by carrying out his/her own responsibilities or by assuring that those responsibilities are fully and accurately conveyed to others acting in his/her behave
  3. Demonstrate sensitivity to issues of age, race, gender, sexual orientation, and religion with patients, families, and all members of the health care team


BCM Resident Fees for Radiation Oncology 2-month elective:

$131 (PIT= Physicians in Training), plus $83.75 (background check).

ABS Fellowship Application: Baylor College of Medicine, HDR GYN

Accepting Applications