Implementation of a Novel Cloud-based Platform for Facilitating Remote Radiotherapy Peer Review and Training in Resource-Limited Settings: Results of Feasibility Assessments in 4 Radiotherapy Centers in Botswana, Ghana and Tanzania

Abstract

A major challenge for radiotherapy (RT) centers in low- and middle-income countries (LMICs) is to ensure that they deliver consistently high-quality treatment. The RT multi-disciplinary team requires adequate training in RT planning and access to ongoing expert input and peer review to achieve this. Cloud-based technology may function as a tool for facilitating remote peer review and training for RT centers in LMICs. We undertook a feasibility study of a cloud-based peer review and training software program in 4 RT centers in sub-Saharan Africa, to assess center-specific requirements for such a platform, and the existing technological infrastructure to support this. We carried out 5 site visits at 4 RT centers in Ghana, Tanzania and Botswana over 18 months. We reviewed existing RT treatment facilities, assessed the informatics infrastructure and interviewed RT staff to ascertain center-specific needs and the potential for incorporating cloud technology into their existing workflow. We attempted installation of the software in each center and tested its functionality to perform a full external peer review ‘feedback loop’. The feasibility study revealed a range of capabilities between the centers, and highlighted a lack of formal peer review practice amongst clinicians delivering 3D conformal RT. Installation of cloud software was achieved in 3 sites, however, it only demonstrated full functionality in 1 center. At this center, a full feedback loop with external peer review of RT volumes was achieved. The main barriers to implementation of cloud-based peer review were low internet bandwidth with poor or variable connection speeds, and insufficient IT facilities and expertise. Lack of dedicated time for formal peer review due to high clinical workloads compounded these issues. Where it is technically feasible, cloud software may offer great potential for the implementation of regular peer review and training in radiotherapy planning in LMICs. However, the extra work burden it puts upon staff and need for further training to use the software, along with sub-optimal internet capabilities, means that further work is required to embed routine peer review into practice, and to optimize the appropriate platform for achieving this.Tabled 1Abstract 2881; TableKomfo Anokye Teaching Hospital, Kumasi, GhanaSweden Ghana Medical Centre, Accra, GhanaOcean Road Cancer Institute, Dar Es Salaam, TanzaniaGaborone Private Hospital, Gaborone, BotswanaIs the internet capability sufficient for download of software?NoYesYesYesCan user accounts be created?NoYesYesYesCan DICOM files be exported from treatment planning system?NoYesNoYesCan DICOM data be imported to cloud platform?N/AYesNoNoAre imported images adequately rendered?N/AYesN/ANoIs upload of data to cloud supported?NoYesNoNoIs uploaded data anonymized?NoYesN/AN/AIs cloud platform functioning sufficient to allow completion of a ‘feedback loop’?NoYesNoNo Open table in a new tab