Corrigendum to "Comparative Analysis of Radiotherapy Linear Accelerator Downtime and Failure Modes in the UK, Nigeria and Botswana" [Clinical Oncology 32 (2020) e111-e118].
Clinical oncology (Royal College of Radiologists (Great Britain)) 35:5 (2023) e347
Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa.
Journal of cancer policy 35 (2023) 100372
Abstract:
Background
Access to high quality radiotherapy (RT) continues to be a major issue across Africa with Africa having just 34% of its optimal capacity.Methods
We co-developed a survey with clinical, academic and policy stakeholders designed to provide a structured assessment of the barriers and enablers to RT capacity building in Africa. The survey covered nine key themes including funding, procurement, education and training. The survey was sent to RT professionals in 28 countries and the responses underwent qualitative and quantitative assessment.Results
We received completed questionnaires from 26 African countries. Funding was considered a major issue, specifically the lack of a ring fenced funds from the Ministry of Health for radiotherapy and the consistency of revenue streams which relates to a lack of prioritisation for RT. In addition to a significant shortfall in RT workforce disciplines, there is a general lack of formal education and training programmes. 13/26 countries reported having some IAEA support for RT for education and training. Solutions identified to improve access to RT include a) increasing public awareness of its essential role in cancer treatment; b) encouraging governments to simplify procurement and provide adequate funding for equipment; c) increasing training opportunities for all radiotherapy disciplines and d) incentivizing staff retention.Conclusion
This survey provides unique information on challenges to delivering and expanding radiotherapy services in Africa. The reasons are heterogonous across countries but one key recommendation would be for national Cancer Control plans to directly consider radiotherapy and specifically issues of funding, equipment procurement, servicing and training.Policy summary
The study demonstrates the importance of mixed methods research to inform policy and overcome barriers to radiotherapy capacity and capability in LMICs.Beam optics study for a potential VHEE beam delivery system
Journal of Physics: Conference Series IOP Publishing 2420:1 (2023)
Abstract:
VHEE (Very High Energy Electron) therapy can be superior to conventional radiotherapy for the treatment of deep seated tumours, whilst not necessarily requiring the space and cost of proton or heavy ion facilities. Developments in high gradient RF technology have allowed electrons to be accelerated to VHEE energies in a compact space, meaning that treatment could be possible with a shorter linac. A crucial component of VHEE treatment is the transfer of the beam from accelerator to patient. This is required to magnify the beam to cover the transverse extent of the tumour, whilst ensuring a uniform beam distribution. Two principle methodologies for the design of a compact transfer line are presented. The first of these is based upon a quadrupole lattice and optical magnification of beam size. A minimisation algorithm is used to enforce certain criteria on the beam distribution at the patient, defining the lattice through an automated routine. Separately, a dual scattering-foil based system is also presented, which uses similar algorithms for the optimisation of the foil geometry in order to achieve the desired beam shape at the patient location.Collaboration: The Force That Makes the Impossible Possible.
Advances in radiation oncology 7:6 (2022) 100966
Abstract:
Over the last three decades, the landscape of cancer treatment with radiotherapy has never stopped improving. ENLIGHT - the European Network for Light Ion Hadron Therapy - has been an active participant in the huge changes that have taken place, in particular in Europe. At the end of the 90s when I arrived at CERN, it appeared clear that an improvement in communication, sharing and exchange, while keeping a common goal, was needed to bring together international experts from accelerator physics, imaging, medical physics, radiobiology and clinical medicine. ENLIGHT network was most aptly launched at CERN, since CERN is renowned as a place for global collaboration. The network has come a long way since the kick-off meeting at CERN in 2002 when only about 70 specialists from different disciplines took part and continues to grow and flourish with now over 1000 participants, accounting for over 100 institutions, from around 40 countries around the globe.Clinical use and future requirements of relative biological effectiveness: Survey among all European proton therapy centres.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology 172 (2022) 134-139