Number Of Linear Accelerators Research Articles

Perspectives of Technical Equipment Development for External Radiotherapy in Russian Federation in My View

This article is devoted to problems of radiotherapy technical maintenance development in Russian Federation on next 10–15 years. The next trends of development are discussed:
 1. The composition of equipment included in radiotherapy complexes.
 2. The situation with development of high technology radiotherapy (HTR) on Russia in 2021 year.
 3. The international modes to number of HTR complexes included linear accelerators (LA).
 4. The necessity in future number of LA and HTR complexes in Russia.
 5. how calculate the number of LA and HTR complexes in every separate clinic.
 6. Special possibilities of main Russian clinics.
 7. Where to purchase HTR complexes included LA to other small clinics?
 8. What types of LA is necessary to buy?
 9. What types of LA is necessary produce on Russian plants?
 10.What cost of project will be if it will be accept?
 11.The development of service centers.
 12.The staff maintenance.
 13.The creation of building for disposed new technique or reconstruction of old treatment rooms.
 14.The normative rules limit.
 15.New types of LA.
 16.Metrology maintenance.
 17.Dosimetrical maintenance.
 18.the development of proton accelerators and neutron generators in Russia.
 19.How many years is necessary to wait of production Russian LA beginning?
 The problem the creation of technical equipment maintenance in Russia for modern radiotherapy on
 leading international level is very complex, heterogeneous and expensive. It can’t be realized without
 serious state support. But it is necessary to begin this realization even now. The specialists of necessary
 level are enough in country. It is necessary to create the general conceptual project of it realization, and
 after that create separate but very large problems included in it.

Geographic Density of Linear Accelerators and Receipt of Radiation Therapy for Prostate Cancer

Radiation therapy (RT) is one among several definitive treatments for patients with prostate cancer. Recent analyses have suggested distance from a radiation oncologist influences the likelihood that a patient is to receive RT for their prostate cancer. We aimed to assess if linear accelerator density within healthcare referral regions (HRRs) impacts practice patterns regarding the treatment of prostate cancer patients.Along with the American Society for Radiation Oncology (ASTRO), we identified, and quality checked the location of linear accelerators in the United States as of July 2020, derived from the International Atomic Energy Agency Directory of Radiotherapy Centers (DIRAC) database. The address to each practice was geocoded using the Google Maps API within QGIS 3.12. The number of linear accelerators was determined in each HRR as defined by the Dartmouth Atlas; HRRs represent "regional healthcare markets for tertiary medical care." In 2014, the Dartmouth Atlas published data regarding the management of prostate cancer by HRR based on Medicare data from 2007 - 2011. Linear regression tested the association of linear accelerator density with receipt of prostate cancer radiation therapy.We identified 3,521 linear accelerators in the United States serving a population (as of the most recent US Census in 2010) of 309 million people; this represents approximately 88,000 people per linear accelerator, or 11.4 linear accelerators per million people. Among the 306 HRRs, the mean density of linear accelerators is 11.7 per million (standard deviation 5.2); 5 HRRs do not have a linear accelerator. For 227 HRRs, data regarding the proportion of Medicare beneficiaries over the age of 75 with prostate cancer who received RT was available. For every 1 additional linear accelerator per million, an additional 2.1 prostate cancer patients per 1,000 received RT (95% CI: 0.08 - 4.2; P = 0.04). For 234 HRRs reporting the number of prostatectomies per 1,000 Medicare beneficiaries under 75 with prostate cancer, there was no relationship between prostatectomy rate and number of linear accelerators (P = 0.42).Increasing HRR linear accelerator density is associated with increasing rate of receipt of radiotherapy for prostate cancer in elderly men. These findings need to be explored across other disease sites and age ranges to ascertain the magnitude of this effect and optimize the distribution of linear accelerators to best ensure access to care across the geographic spectrum.

Surveying the Challenges to Improve Linear Accelerator-based Radiation Therapy in Africa: a Unique Collaborative Platform of All 28 African Countries Offering Such Treatment

Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate and service, especially for low- and middle-income countries (LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime.A global initiative was launched in 2016 to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognised that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries.This report presents the method used to conduct this multilevel study of the macro- and microenvironments, the organisation of departments, the technology, the training and the service models that will provide input into the design of a LINAC prototype for a LINAC-based radiation therapy system that will improve access to radiation therapy and thus improve cancer treatment outcomes. It is important to note that new technology should be introduced in a contextual manner so as not to disrupt existing health systems inadvertently, especially with regards to existing staffing, infrastructure and socioeconomic issues. A detailed analysis of data is underway and will be presented in a follow-up report. Selected preliminary results of the study are the observation that LINAC-based facilities in LMICs experience downtime associated with failures in multileaf collimators and vacuum pumps, as well as power instability. Also, that there is a strong association of gross national product per capita with the number of LINACs per population.

Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020.

Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS). The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10years old. The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n=75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate. Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.

ANURIB – Advanced National facility for Unstable and Rare Ion Beams

An ISOL post-accelerator type of RIB facility is being developed at Variable Energy Cyclotron Centre (VECC), Kolkata, India. In this scheme, Rare Ion Beams (RIBs) will be produced using light ion beams (p, α) from the K=130 cyclotron, the RIB of interest will be separated from the other reaction products and accelerated up to about 2 MeV /u using a number of linear accelerators. Recently, a few RIBs have been produced and accelerated using this facility. As an extention of this effort, another RIB facility – ANURIB will be developed in a new campus as a green-field project. ANURIB will have two driver accelerators – a superconducting electron LINAC to produce n-rich RIBs using photofission route and a 50 MeV proton cyclotron for producing p-rich RIBs. In this paper, the status of the RIB facility in the present campus and future plans with the ANURIB facility will be discussed.

Cancer Mortality Based on Income and Radiation Therapy Availability: A Correlation Analysis and Implications for Developing Countries

To analyze mortality rates of common cancers, number of linear accelerators, and gross domestic product per capita (GDPpc) in developing countries in order to determine a relationship between radiation therapy (RT) availability, income, and mortality.

Prostate Cancer and the Hypofractionation Hypothesis

Prostate Cancer and the Hypofractionation Hypothesis

Medical physics aspects of cancer care in the Asia Pacific region: 2011 survey results.

Background:Medical physicists are essential members of the radiation oncology team. Given the increasing complexity of radiotherapy delivery, it is important to ensure adequate training and staffing. The aim of the present study was to update a similar survey from 2008 and assess the situation of medical physicists in the large and diverse Asia Pacific region.Methods:Between March and July 2011, a survey on profession and practice of radiation oncology medical physicists (ROMPs) in the Asia Pacific region was performed. The survey was sent to senior physicists in 22 countries. Replies were received from countries that collectively represent more than half of the world’s population. The survey questions explored five areas: education, staffing, work patterns including research and teaching, resources available, and job satisfaction.Results and discussion:Compared to a data from a similar survey conducted three years ago, the number of medical physicists in participating countries increased by 29% on average. This increase is similar to the increase in the number of linear accelerators, showing that previously identified staff shortages have yet to be substantially addressed. This is also highlighted by the fact that most ROMPs are expected to work overtime often and without adequate compensation. While job satisfaction has stayed similar compared to the previous survey, expectations for education and training have increased somewhat. This is in line with a trend towards certification of ROMPs.Conclusion:As organisations such as the International Labour Organization (ILO) start to recognise medical physics as a profession, it is evident that despite some encouraging signs there is still a lot of work required towards establishing an adequately trained and resourced medical physics workforce in the Asia Pacific region.

A Systematic Scoping Literature Review of Incorporating a Total Quality Culture Within Radiotherapy Staffing Models: A Management Strategy to Improve Patient Safety and Quality of Care in Radiation Therapy Departments

Background Radiation therapy (RT) staffing models have traditionally been based on the number of linear accelerators available at cancer centers (i.e., task-focused). RT treatments are becoming increasingly complex and a novel staffing model should be established that incorporates a total quality culture (TQC) to promote process-focused performance by using a patient-centered approach throughout the entire organization. Objectives The objective of this article was to conduct a systematic scoping literature review of publications that study TQC within hospitals. The second objective was to specifically identify the publications that report on the relationship between TQC and their current RT staffing model. Methods and Results A systematic scoping literature review was conducted in July 2010 using the Web of Science, Pub Med, and Google Scholar databases. Nine studies were identified that discussed TQC in hospitals. Five of the nine studies found that a TQC is positively correlated with patient satisfaction in hospitals. The remaining four studies discussed RT staffing based on the number of linear accelerators and did not mention a TQC. Conclusions There are few studies that focus on the incorporation of a TQC in hospitals and RT staffing models. RT staffing models should be updated with an emphasis on “process-oriented” results. A novel RT model that includes a TQC strategy should allow radiation therapists within RT departments to be more autonomous in patient care and allowed to make more decisions in the treatment of patients.

Resources and management strategies for the use of radiotherapy in the treatment of lung cancer in Central and Eastern European countries: Results of an International Atomic Energy Agency (IAEA) survey

To assess resources and management strategies for the use of radiotherapy (RT) in the treatment of lung cancer in developing Central and Eastern European countries. Questionnaires on patterns of care of NSCLC and SCLC were sent to radiation oncologists of Central and Eastern Europe. Comparisons were made between two groups of countries-ex-USSR states and other Eastern and Central European countries. Twenty-four out of twenty-eight surveyed countries responded. There were significant differences in access to modern treatment facilities (3D planning systems, number of linear accelerators), percentage of patients with lung cancer receiving radiotherapy, schedules of palliative RT, use of postoperative RT for early stages between both analysed groups of countries. 3D systems were in use in 25% of centres for an entire treatment, in 28% for a part of the treatment, and in 47% curative RT was 2D planned. Sequential chemo-RT was the most common approach to radical management of NSCLC, followed by RT alone and concomitant chemo-RT; median percentages of patients receiving respective treatments per centre were 57%, 30%, and 10%. For SCLC, the concurrent approach was declared by 56%, and the sequential approach by 42% of responders. Patterns of care of lung cancer in the analysed countries differed in some part from existing, evidence-based data on lung cancer. In particular, this difference was observed between ex-USSR countries and the rest of European developing countries in the equipment available and specific diagnostic and treatment parameters in radiotherapy of lung cancer, the latter group's practices more resembling those of developed European countries.

Radiotherapy services in countries in transition: gross national income per capita as a significant factor

Background and purpose: The acquisition of radiotherapy by countries in transition (CITs) is an evolutionary process from having no resources whatsoever, to meeting the standards adopted by well-developed countries. The influence of the economic ability of a country to acquire and sustain this technology has intuitively been accepted as a major factor but has not before been subjected to analysis for a large group of countries. This information has been analysed to provide guidance to countries commencing and expanding radiotherapy services. Material and methods: The number of linear accelerators and 60Co megavoltage teletherapy machines in 72 CITs, those with gross national income per capita (GNI/cap)<$12 000 per annum (pa) and a sample of 12 countries with GNI/cap>$12 000 pa were expressed as machines per million population (MEV/mil) and used as an index of the ability of the country to provide a service. This figure was related to GNI/cap. The average populations of 24 further countries without radiotherapy were compared with 21 countries with radiotherapy facilities having the same range of GNI/cap. Results: The relationship log 10 MEV/mil=−2.90+0.85 log 10 GNI/cap was identified between the machines and income. Also verified was that small low income countries were less likely to have the technology than those with large populations. Conclusions: The increase in the number of teletherapy machines is closely linked to the GNI/cap of a country. Our sample of well developed countries failed to demonstrate a levelling off of equipment acquisition with income. In the lower income group, smaller countries were less likely to have radiotherapy services than those with large populations.

Radiation oncology in Australia: workforce, workloads and equipment 1986-1999.

Regular national surveys of all public and private radiation oncology facilities in Australia have been carried out between 1986 and 1999. Workforce data recorded were numbers of radiation oncologists and trainees, radiation therapists, medical physicists and physics technicians, nursing staff, data managers, social workers and clerical staff. Workloads included treatments with megavoltage beams (linear accelerators, cobalt-60), orthovoltage/superficial X-rays, brachytherapy, total body irradiation and stereotactic radiosurgery. Major equipment recorded included numbers of megavoltage and orthovoltage/superficial X-ray machines, planning simulators, computerized dosimetry systems and brachytherapy equipment. The use of radiotherapy beds and the public-private mix of treatments were also documented. Data were assembled for Australia based on each individual state. Within Australia the number of public and private treatment facilities has increased by 44% from 18 in 1986 to 26 in 1999. The population has increased by 16.4%, cancer incidence by 51.8% and megavoltage workloads (fields) by 102%. The number of radiation therapists and physicists and the number of linear accelerators have, in general, increased with the growth in workloads. The number of radiation oncologists has increased by 60% from 4.5 full-time equivalent (FTE) radiation oncologists per million population in 1986 to 7.2 per million in 1999. There is currently a deficit of at least 40 radiation oncologists to be able to treat the 50% of newly diagnosed cancer patients requiring radiotherapy. In addition, a significant deficiency exists in numbers of radiation therapists, nursing staff, data managers, social workers and clerical staff. Clearly the demands for medical physicists has increased but the data are insufficient to comment on deficiencies. Despite the increases in workloads the proportion of patients with cancer receiving radiotherapy remains below 40%. A positive correlation has been shown between the proportion of newly diagnosed cancer patients treated and the number of FTE radiation oncologists, the number of megavoltage machines and number of radiation therapists. This was shown for Australia as a whole, for each state and for the years 1986 to 1999. This was also the case when total megavoltage fields was used as the dependent variable. Multiple regression analysis using the same independent variables confirmed these positive correlations. It is concluded that the low treatment rate with radiation oncology for cancer patients in Australia is due mainly to the lack of resource allocation. The stated commitment of governments and health departments to a 50% treatment rate can only become a reality if there is a concerted effort to increase the numbers of radiation oncologists, radiation therapists, megavoltage machines and support staff. Otherwise at least one in every 10 newly diagnosed cancer patients will continue to be denied adequate and equitable access to radiotherapy - in 1999 that total figure was 9400 persons.

A Quality Assurance Network in Central European Countries: Radiotherapy Infrastructure

A survey of the infrastructure in radiotherapy centres in three Central European countries has been performed as a first step in the development of a quality assurance network. Data concerning radiotherapy equipment, staff and number of patients treated in most of the radiotherapy centres from Czech Republic, Poland and Hungary were collected at the beginning of 1994. Equipment data have shown that 35% of 182 treatment units are conventional x-ray units, 35% 60Co units, 19% linear accelerators, 7% 137</supCs units and 4% betatrons. About 47% of high energy units are older than 12 years and about 20% older than 21 years. An important number of centres still have no simulator which would constitute an important handicap to carry out adequate radiotherapy. The number of treatment planning systems has also been registered; 44% being PC-based systems with locally developed software. Large variations are observed in the number of patients treated per year, per high energy unit, but 12/47 centres treat more than 700 patients per year and unit. On the average, staffing seems adequate in numbers though there are wide variations. The main limitation of radiotherapy infrastructure in the Central European countries is the low number of linear accelerators and simulators and the advanced age of therapy units. </abs>

Economic Incentives and the Distribution of Extracorporeal Shock wave Lithotripters and Linear Accelerators in Spain

We studied the role of economic incentives for private providers in explaining Spain's disproportionately large number of extracorporeal shock wave lithotripters (ESWLs) and low number of linear accelerators (linacs) per million population (pmp) in comparison to other countries of the Organization for Economic Cooperation and Development (OECD). We found that the reimbursement policy for 1990 allowed an average profit per private ESWL of $732,000, but no profit for linacs. Regional per-capita income was positively correlated with ESWLs pmp in Spain (R2 = 0.49; p = .001), but not with linacs. Sixty-nine percent of ESWLs were privately held versus only 16% of linacs. To avoid these types of distortions, financial incentives should be based on a reasonable relationship between cost and charges and should be associated with the appropriateness of medical care.