UMIT Oncological Center of Tomotherapy: how capital doctors succeeded to open a high-tech clinic

This is about the UMIT International Oncological Center of Tomotherapy in Astana, which accepted the first patients on January 1, 2019. The director of the center Yerzhan Shayakhmetov tells about the history of the center:

- The mastermind of the center became the professor Abay Kabatayevich Baigenzhin, head of the National Scientific Medical Center, a prominent Kazakh medical scientist. While in the USA in 2016, he saw a tomotherapy machine and decided to introduce this technology in Kazakhstan. Initially, it was a completely private initiative. Large businessmen financed the purchase of two TomoTherapy HD machines from Accuray company, recognized as the gold standard in oncology field. Simply said, if ordinary device is Mercedes, then ours is Bentley.

There were no problems with the construction of the building: the Development Bank of Kazakhstan and the "Baiterek" NMH participated in the project. The main difficulty during opening the center was finding specialists.

- Radiologists, radiotherapists, medical physicists were gathered from all over Kazakhstan. They completed their primary specialization in India, Delhi, - continues Yerzhan Shayakhmetov.

The chief doctor of the center especially notes the work of medical physicists - these are people of a rare profession, without them even the most modern equipment is just an expensive bunch of metal.

“We make calculations and measurements that are necessary for optimal dose distribution in a patient's body,” explains Tanzhas Shayakhmetov, head of the Department of Medical Physics at the UMIT Center. - We calculate the total and single doses, from what angle, for what duration the target - the tumor will be irradiated.

Tanzhas Shayakhmetov studied his specialty abroad, then have completed a two-year study for master's degree in medical physics in Italy. At the moment, he is the only medical physicist in Kazakhstan who has an international certificate in this specialty.

- Now he is teaching colleagues - graduates of the Faculty of Nuclear Physics of the ENU, - adds Yerzhan Shayakhmetov. - We have 6 medical physicists in our staff, as well as 5 radiotherapists, 10 operators who directly work on the machine. The entire staff is over 60 people.

From 80 to 120 patients can be treated on one tomotherapy machine per day.

- There are only a few centers in the world where two installations are used in parallel. What is it for? Once treatment has begun, it must not be interrupted. Let's say if one machine fails, there is a second one. Plus, due to two installations, we can receive more patients during a day, - the director notes. - In 2019, we treated 205 people, in 2020 - twice as many: 444 patients, in 2021 - more than 500.

In general, 70% of cancer patients need radiation therapy. More than 30,000 new cancer cases are detected annually in Kazakhstan, which means that this technology can help at least 21,000 patients.

The treatment process itself is very complex. First, the patient undergoes computed tomography to determine the tumor borders (the target is what needs to be irradiated) and organs at risk (what needs to be protected from radiation). The target is drawn by radiation oncologist, the second doctor re-checks the work of the first one. Further, the data is transferred to medical physicists. Based on the calculations, a plan is drawn up, which is once again checked by a radiation oncologist. Before starting to treat a patient, medical physicists use special equipment - a phantom, which they irradiate and compare the planned exposure with the produced one. Only having achieved a complete match, the patient is admitted to tomotherapy.

The machine includes a CT scanner and a linear accelerator, so radiation therapy is also carried out in two stages: patient undergoes tomography and, based on the images, his position in the machine is corrected. After that, the radiation therapy session itself begins.

- The source of photon radiation is a generating source, there is no permanent radioactive source, that is, until the device is turned on, it does not produce radiation. Neither the staff nor the patient is at any risk, - Tanzhas Shayakhmetov dispels the fears of patients and their relatives.

The treatment takes 20-30 minutes along with the patient preparation, while the irradiation process itself lasts only 5-7 minutes.

As a result, tomotherapy has far fewer side effects.

- The tomotherapy machine has a narrower irradiation field with modulated intensity. Linear accelerators usually capture 2-3 centimeters of healthy tissue around the tumor. With tomotherapy, only 0.5 cm of healthy tissues are captured, that is, healthy tissues are more protected, - explains Yerzhan Shayakhmetov.

Tomotherapy is the only method of total bone marrow irradiation in children with leukemia before transplantation, which makes it possible to achieve a large irradiation area, about 135 cm in length, and to irradiate the spinal cord and brain according to the same plan.

- In addition, tomotherapy is the only radiation method for patients with pacemakers and defibrillators. In case of tumors of the mediastinum, esophagus, and lungs, it is impossible to irradiate patients with defibrillators on conventional linear installations, since their batteries may fail. The tomo machine makes it possible to reach the tumor without touching the pacemakers, to bypass them, - notes the head physician. - According to the rules, the absorbed dose of more than 2-3 grays should not be allowed on pacemakers. So, our physicists have achieved an impressive result: the total dose that falls on pacemakers reaches only 0.5 Gy.

Treatment on the tomotherapy machine for Kazakhstan citizens is included in the guaranteed volume of free medical care, emphasizes Yerzhan Shayakhmetov. Since March last year, a consultation of a radiation oncologist - both online and offline - is free for all citizens of the Republic of Kazakhstan. All questions can be asked by phone +7 7172 95 44 84, +7 777 201 44 44.

There is also a commercial line for the treatment of oncological diseases, and a medical tourism program has been developed for foreigners, and before the pandemic, patients from the USA, France, Kyrgyzstan, Uzbekistan and other countries were treated at the UMIT.

- We have a four-language web-site: Kazakh, Russian, English and Chinese, - Yerzhan Shayakhmetov gives details. - When we made a presentation about our center at an international online conference in China, they were very interested, and we decided to open the China direction.

In June 2021, the center has passed the international JCI certification "patient and staff safety".

- JCI is a USA-based non-governmental organization that assesses medical organizations for compliance with international quality standards. This commission has already been in existence for 70 years. Today, JCI accreditation is the most prestigious in the world. It is difficult to obtain, and this is an objective recognition of the quality and safety of medical services, - explains an expert in the field of medical services quality management, Zhanat Nurazkhanova. - Experts closely examine every corner of every room, cables and pipes, climb on the roof, go down to the basement, etc.

UMIT is not only tomotherapy, the clinic positions itself as a center for early cancer diagnosis, Yerzhan Shayakhmetov adds.

- For this purpose, we have an outpatient department with the latest generation digital mammograph, fully flexible endoscopy: video fibrogastroscopy, video bronchoscopy, colonoscopy, cystoscopy. We perform all endoscopic operations that can be done on an outpatient basis. We also have laser surgery rooms for benign tumors, we remove papillomas, teratomas. We perform all types of biopsy for neoplasms of the breast, prostate, liver, and other organs available for biopsy.

After treatment at the UMIT, we make a control diagnosis, one and three months after.

- Local oncologists have already seen the difference in the treatment results, they refer patients to our center, - sums up Yerzhan Shayakhmetov.