A national survey of the availability of intensity-modulated radiation therapy and stereotactic radiosurgery in Canada

Eman Z Alduhaiby,Jean-Pierre Bissonnette,Michael Sharpe,Linda Mayhew,Scott Tyldesley,Stephen Breen,Derek R Wilke,David C Hodgson

doi:10.1186/1748-717x-7-18

Abstract

BackgroundThe timely and appropriate adoption of new radiation therapy (RT) technologies is a challenge both in terms of providing of optimal patient care and managing health care resources. Relatively little is known regarding the rate at which new RT technologies are adopted in different jurisdictions, and the barriers to implementation of these technologies.MethodsSurveys were sent to all radiation oncology department heads in Canada regarding the availability of RT equipment from 2006 to 2010. Data were collected concerning the availability and use of Intensity Modulated Radiation Therapy (IMRT) and stereotactic radiosurgery (SRS), and the obstacles to implementation of these technologies.ResultsIMRT was available in 37% of responding centers in 2006, increasing to 87% in 2010. In 2010, 72% of centers reported that IMRT was available for all patients who might benefit, and 37% indicated that they used IMRT for "virtually all" head and neck patients. SRS availability increased from 26% in 2006 to 42.5% in 2010. Eighty-two percent of centers reported that patients had access to SRS either directly or by referral. The main barriers for IMRT implementation included the need to train or hire treatment planning staff, whereas barriers to SRS implementation mostly included the need to purchase and/or upgrade existing planning software and equipment.ConclusionsThe survey showed a growing adoption of IMRT and SRS in Canada, although the latter was available in less than half of responding centers. Barriers to implementation differed for IMRT compared to SRS. Enhancing human resources is an important consideration in the implementation of new RT technologies, due to the multidisciplinary nature of the planning and treatment process.

Highlights

The timely and appropriate adoption of new radiation therapy (RT) technologies is a challenge both in terms of providing of optimal patient care and managing health care resources
The proportion of linear accelerator units (LINAC) used for Intensity Modulated Radiotherapy (IMRT) increased from 23.8% in 2006 to 63.2% in 2010
There is a large body of evidence providing detailed descriptions of the quality assurance (QA) processes suggested by a number of organizations including American Society of Therapeutic Radiation Oncology (ASTRO) and American College of Radiology (ACR) [28], American Association of Physicists in Medicine (AAPM) [27], European Society of Therapeutic Radiation

Summary

Introduction

The timely and appropriate adoption of new radiation therapy (RT) technologies is a challenge both in terms of providing of optimal patient care and managing health care resources. Veldeman conducted a systematic review of the clinical evidence for IMRT in 2008 which included 56 comparative studies, 3 of which were randomized controlled trials (RCTs) [11], and concluded that IMRT reduced treatment-related toxic effects and improved quality of life. Three RCTs reported significant improvement of acute xerostomia with the use of IMRT in head and neck cancers and better quality of life [6,7,9,13], and IMRT for breast cancer was associated with reduced acute and late side effects when compared to 2D RT in three RCTs [4,5,8]. Other non-randomized studies have shown advantages to IMRT for malignancies in other types of cancer, such as prostate, lung and CNS [10,12,14]

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