Global radiation therapyChanging the global radiation therapy paradigm
Section snippets
The magnitude of the problem
It is estimated that the annual global cancer incidence will rise from 15 million cases in 2015 to as many as 25 million cases in 2035, 65–70% of which will occur in low- and middle-income countries (LMICs) [4] where there is a severe shortfall in radiation treatment capacity. Cancer care is multi-modal, including pathology, imaging, the range of oncology expertise, nursing and support staff, with at least 50% of cancer patients benefiting from radiotherapy regardless of their geographic
Focusing on the machine alone will not solve the problem
Numerous national scientific societies and non-governmental organizations (NGOs) provide training globally on a limited scale for radiotherapy professionals and allied health personnel. Radiating Hope, a US-based NGO, provides radiotherapy equipment, often refurbished, on a limited scale to regions that have limited or no capacity [13]. Successful approaches to peer-supported case-based education including pioneering work by Hardenburgh via Chartrounds [14] and the potential for use of highly
Moving ahead
The medium-term goal for technology development is to ‘bury the complexity’ [27] of radiotherapy by taking advantage of software to incorporate automation to affect ease of use and, in conjunction with excellent diagnostic imaging, to insure high quality treatment. In addition, examples of the emerging role of software to lower the cost of radiotherapy through new software tools (optimization and automation) demonstrated that software can compensate for machine “weakness” and can eliminate
Actions
Three tasks forces are at work.
Summary and conclusion
The magnitude of the global shortfall in cancer care, especially radiation oncology, is a crisis that cannot be ignored and presents an opportunity for innovative systems solutions to include developments in technology, capacity, expertise, advanced treatment capability and sustainable mentorship and education. Detailed definition and documentation of the problem provides essential metrics upon which to make improvements, but action is required to begin to implement solutions to the urgent need
Disclaimer
The information in this paper and the presentations at the Workshop and subsequent meetings are personal opinions of the individuals and do not represent opinions or policy statements of the institutions or organizations in which they work. Presentations from the CERN workshop are posted on the meeting website with permission of the presenters.
Conflict of interest
AD – ADAM S.A.
MEG – Board of Directors, IBA.
PH – CEO, Chartrounds, LLC.
DAJ – Inventor of cone-beam CT for image-guided radiotherapy; Active-breathing control; Integrated Quality Monitor; Elekta Image-guided Perfexion; AQUA – Co-founder Acumyn Inc.; MORFEUS Deformation System; Pentaguide – Modus Medical; Inventor Cx225 small animal irradiator; Owner – Nanovista Inc.; Board member–CanProbe; Existing or Complete sponsored research/development agreements with Elekta, GE, Varian, Raysearch Labs,
Contributions
Preparation of the manuscript: DAP, CNC, MD, DAJ.
Submission of component of meeting summary and review of manuscript: all other authors.
Names and degrees
David A. Pistenmaa, MD, PhDa,t, Manjit Dosanjh, PhDb,t, Ugo Amaldi, PhDc, David Jaffray, PhDd, Mary Gospodarowicz, MDd, Maurizio Vretenar, PhDb, Alberto Degiovanni, PhDe, Katherine Holtf, Miles Pomperg, Yakov Pipman, PhDh, Eduardo Zubizarreta, MDi, Surbhi Grover, MD, MPHj, Danielle Rodin, MD, MPHd, Onyinye Balogun, MDk, Ahmed Meghzifene, PhDi, Yolande Lievens, MDl, Ronald Cobbsm, Jacques Bernier, MDn, Bhadrasain Vikram, MDo, Patricia Hardenbergh, MDp, Steve Myers, PhDb, Bruce Curranq, Richard
Acknowledgments
The ICEC-CERN workshop would not have been possible without the generosity of CERN and support from the International Cancer Expert Corps (ICEC), the International Conference for Translational Research in Radiation Oncology- Physics for Health in Europe (ICTR-PHE) leadership and the sponsors listed on the website. Editorial comments included Donna O’Brien, Monique Mansoura and Larry Roth from the ICEC. Assistance with photography and videography from Roger Spottiswoode and CERN Communication
Funding
No funds were provided from the National Institutes of Health or any other funding agency. The following are employed by NIH: BV and CNC, however, for CNC this is a formal Outside Activity unrelated to NIH employment.
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2019, World NeurosurgeryCitation Excerpt :For example, a CyberKnife generally is priced at a capital cost of $3.2 million plus $0.5–$0.75 million for site setup.18-20 The cost for a concrete bunker for housing a radiosurgery device in a developing country has been calculated to be much less overall because space is often relatively inexpensive; however, shielding costs can remain high.21 Similar to Gamma Knife, additional expenses may include costs of service and repair.
- 1
Co-authors Drs. Pistenmaa, Dosanjh and Coleman contributed equally to this manuscript preparation.
- 2
Participants in Appendix 1.