Needs and Strengths Assessment for Radiotherapy Centers in Africa Transitioning to IMRT

Abstract

Multiple centers globally are interested in implementing intensity-modulated radiotherapy (IMRT) programs, however little data exists comparing granular center-specific needs and strengths of radiotherapy (RT) centers interested in establishing an IMRT program, in low-resource countries in this position. In conjunction with up-scaling training, methods are needed to assess multiple centers efficiently. Using a novel approach, we assess centers' needs and strengths to tailor a multi-institutional remote training program.To assess strengths and needs of centers interested in establishing an IMRT program. Core RT leaders from 16 RT centers in 7 African countries (Ghana, Ivory Coast, Kenya, Nigeria, Senegal, Morocco, Zambia and one sister center in Pakistan) were individually invited to complete a 30-minute, 55-question electronic survey followed by 60-75-minute video conference with 2-4 lead members of a non-profit global health radiation oncology organization prior to participating in a remote IMRT training program.14 centers responded and were surveyed, and interviewed, including 11 public, 3 private and 1 hybrid institutions. Among centers 4 (28.6%) and 1 (7.1%) are currently treating patients with IMRT and both, IMRT and VMAT, respectively. In terms of strengths all 14 (100%) centers emphasized high energy and commitment to learning potential research collaboration, 1 (7.1%) center is a designated International Atomic Energy Agency training center and 1 (7.1%) is the only center in East Africa with Joint Commission International Accreditation. All 14 (100%) centers emphasized the need for education and training in advanced treatment planning procedures and techniques, 4 (28.6%) centers reported major gaps (including CT simulators, linear accelerator) in equipment, 5 (35.5%) minor gaps (including in-room image guidance, multi-leaf collimator) in equipment, and 5 (35.7%) gaps in physics QA devices (including film/array detectors, dose calculation software, phantoms for machine output checks). Using benchmark recommended staffing levels from Health Economics in Radiation Oncology data (HERO), 14 (100%) centers were well-staffed with physicists, 8 (57%) well-staffed with radiation oncologists and 8 (57%) well-staffed with radiation therapists.Among a motivated group of African RT centers with demonstrated interest in commissioning an IMRT program, we noted gaps in equipment for safe IMRT treatment delivery. Staffing met recommendation for physicists but not radiation oncologists and therapists. Combined survey and video interview assessment can help guide curriculum design for training programs and other areas for improvement.