Setting up a radiotherapy programme: Clinical, medical physics, radiation protection and safety aspects

The incidence of cancer is increasing, particularly because of the increase in life expectancy arising from worldwide improvements in standards of living. According to recent estimates of the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO), approximately ten million new cases of cancer are being detected per year worldwide, with slightly more than half of the cases occurring in developing countries. By the year 2015 this number is expected to increase to about 15 million cases, of which two thirds will occur in developing countries. About half of all cancer patients receive radiotherapy, either as part of their primary treatment or in connection with recurrences or palliative treatment. Radiotherapy is a multidisciplinary specialty which uses complex equipment and radiation sources for the delivery of treatment. It is estimated that approximately 3300 teletherapy machines are currently installed in developing countries. This figure is significantly below the estimated needs, of almost 5000 machines at present and about 10 000 machines by the year 2015. Taking this into account, in addition to the great need for qualified professionals (radiation oncologists, medical radiotherapy physicists, radiotherapy technicians, radiation protection officers, maintenance engineers, etc.), the future development of the medical infrastructure for cancer treatment appears to be a substantial undertaking. While the present publication discusses radiation treatment programmes alone, it is recognized that other components of comprehensive cancer management programmes, such as cancer prevention and diagnosis, also need to be addressed. It is widely acknowledged that the clinical aspects (diagnosis, treatment decision making, indication for treatment and follow-up), as well as the procedures related to the physical and technical aspects of patient treatment, must be subjected to careful control and planning in order to ensure safe, high quality, radiotherapy. While it has long been recognized that the physical aspects of quality assurance in radiotherapy are vital to achieving effective and safe treatment, it has been increasingly acknowledged that a systematic approach is necessary for all the steps within the clinical and technical aspects of radiotherapy programmes as well. The need to establish general guidelines at the IAEA, taking into account the clinical, medical physics, radiation protection and safety considerations for designing and implementing radiotherapy programmes in Member States, has been identified through the increased interest of Member States in the efficient and safe application of radiation in health care. To satisfy this need, the IAEA has convened several consultant and advisory group meetings to prepare a publication providing a basis for establishing a programme in radiotherapy. The external expertise has been substantially complemented by the contributions of a large number of IAEA staff members. The present publication supersedes IAEA-TECDOC-1040 (Design and Implementation of a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects) published in 1998. It is addressed to professionals and administrators involved in the development, implementation and management of a radiotherapy programme, in order to establish a common and consistent framework in which all the steps and procedures in radiotherapy are taken into account. The present publication has been expanded to include orthovoltage X rays and linear accelerators.