Methodology for acquisition of appropriate technology for radiation therapy in developing countries

Introduction It has been estimated that about 60 % of all cancer patients in the world can benefit from radiotherapy treatment. Unfortunately, not all patients can get access to this effective treatment modality because of lack of radiotherapy facilities and associated resources. Driven by improving economy and with supports provided by international and professional organizations in recent years, radiotherapy services are becoming more accessible to patients in the developing countries. At the same time, major advances in technologies and treatment techniques have taken place in the field of radiation oncology. A full range of innovative and effective new treatment modalities such as IMRT, IGRT, SRS, helical Tomotherapy, particle therapy, etc. have been developed and becoming standard treatments in the clinics in some countries. Such sophisticated treatment modalities are also gradually being introduced in developing countries. Implementing advanced radiotherapy treatment service in the public hospital system can be costly and hard to sustain. Furthermore, such investments may not always achieve the expected clinical outcomes for various reasons. The common reasons may include inadequate QA due to lack of staff, inadequate staff training, service bottle neck due to inconsistence in standard of service amongst the supporting clinical services, inadequate supporting infrastructure needed for proper and efficient implementation and operation of advanced treatment service. Implementation of a cost effective and sustainable radiation therapy service, particularly in public healthcare system requires careful planning & implementation of appropriate technologies. The latter should be determined and selected based on a set of country specific criteria and conditions such that service capacity & quality can be maximized to meet service needs with limited resources. A methodology is described which may be used to develop a set criteria for technology acquisition.