New guidance from the World Health Organization (WHO) and the International Atomic Energy Agency (IAEA) on the procurement of radiotherapy equipment could improve access to this life-saving cancer treatment option across the world. The new technical guidance aims to ensure that the selection of radiotherapy equipment is appropriate to country and health facility contexts, that treatment is delivered safely, that quality is maintained, and that services are sustainable.
The new specifications are an update of a previous version issued by the IAEA, published in 2008. The publication is intended for medical physicists, biomedical and clinical engineers, radiation oncologists, oncologists, and anyone else with responsibility for manufacturing, planning, selecting, procuring, regulating, installing, or using radiotherapy equipment. It was developed as part of the ongoing collaboration between WHO and the IAEA to foster safety and quality in the medical use of radiation technology.
More than 50% of patients with cancer require radiotherapy as part of their care, and it is frequently used to treat the most common types of cancer, such as breast, cervical, colorectal, and lung cancers. Yet access to radiotherapy is inadequate—particularly in low- and middle-income countries.
“IAEA data show that around one-third of countries still do not have radiotherapy available, out of which 28 are in Africa,” said May Abdel-Wahab, MD, PhD, FACR, Director of the IAEA’s Division of Human Health. “Many of them would benefit from increased access to radiotherapy services. The key is tailoring radiation oncology solutions to the situation on the ground, underpinned by appropriate safety infrastructure.”
Guide Details
Types of radiotherapy equipment covered by the guide include external-beam radiotherapy machines (both cobalt-60 and linear accelerators), brachytherapy devices that apply radiation sources directly to tumors, and complementary imaging devices such as conventional or computed tomography (CT) simulators, as well as other tools essential for safe operation and quality control. Depending on the type of radiotherapy machine, the need for specialized professionals and infrastructure, as well as quality assurance and maintenance, may vary.
Safety is also covered extensively, with information provided on planning for bunkers to house radiotherapy equipment; shielding for walls, floor, and ceilings; and emergency buttons for treatment and control rooms. In addition, clear guidance is provided on what is required to ensure functionality of equipment for an optimal equipment lifespan, usually a period of 10 to 15 years.
Selecting radiotherapy systems appropriate for given settings and matched to the existing workforce help ensure the delivery of safe radiotherapy. It contributes to the improvement of access to life-saving treatment by minimizing service interruptions because of machine downtime and builds a solid foundation for further expansion of services when the health-care system is ready for adoption of more complex radiotherapy systems.
“While interruptions of radiotherapy equipment predate COVID-19, they have been exacerbated during the pandemic because of breakdowns in global supply chains and barriers to the free movement of technical service personnel. Any improvement that reduces interruptions can make the difference between life and death for patients whose tumors continue growing while they await treatment,” said Bente Mikkelsen, MD, MHA, Director of the Department of Noncommunicable Diseases at WHO.
Radiotherapy is also an integral part of breast and childhood cancer control, two other major WHO global cancer initiatives. The changes that will be facilitated by the new guidance will also benefit millions of patients with cancer globally, including women seeking treatment for breast cancer, now the most commonly diagnosed form of cancer worldwide.
