Radiotherapy in Nepal: a view from medical physics

In October 2016 a team comprising three Radiation Oncologists and one Medical Physicist made a visit to Kathmandu, Nepal. The purpose of the visit was to deliver a Radiotherapy Treatment Planning course to trainees, Consultant Radiation Oncologists and Physicists. Visits were made to three radiotherapy centres in Kathmandu : Bir Hospital Kathmandu (1 Co60), Kathmandu Cancer Centre(1 linac) and the Nepal Cancer Centre (1 linac). This paper provides a snapshot of the challenges facing the delivery of Radiotherapy services in Nepal. There is a shortage of trained Medical Physicists. Each of the centres visited has only one Physicist for all treatment planning and machine related activities. The staff are enthusiastic, eager to learn and, like physicists worldwide, aspire to deliver high quality treatment using the latest technologies. However, the lack of support in both human and material resources presents significant challenges to delivering safe and timely radiotherapy. This results in a large workload for individuals and limits the process and workflow to a single person environment. Due to a lack of access to healthcare most treatments are palliative and, while cancer incidence is expected to rise, Radiotherapy is not a public health priority in Nepal. The expansion of services are only taking place in the private sector. The course was delivered in two sessions to staff from the three centres. The topics covered included: the physics of photon and electron beams, 3D conformal planning and plan evaluation, planning volumes, contouring (H&N and cervical), breast planning, Quality Assurance, protocols and guidelines. (author)