[en] The planning and monitoring of national radiotherapy services requires a thorough knowledge of the national cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a realistic future projection of these data. Previous studies have established RTU rates in high income countries. Methods The IAEA conducted a project to investigate the optimal and actual RTU rates in 9 middle-income countries. The aim was to estimate the actual RTU rate and compare it with the optimal RTU in each country to estimate the gaps in service provision. The countries selected for the study were Costa Rica, Ghana, Malaysia, Philippines, Romania, Serbia, Slovenia, Tunisia and Uruguay. Optimal RTU (oRTU) was determined following the epidemiological evidence-based method using cancer incidence data from Globocan-2012 and radiotherapy indication trees from the CCORE group. The actual RTU (aRTU) rates were calculated dividing the total number of new notifiable patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year. An analysis of the characteristics of patients and treatments in a series of 300 consecutive patients receiving RT shed light on the particular patient, diseases profile and techniques used in the participating countries. Results The calculated median oRTU rate for the group of 9 countries was 52%. (author)