Western University Scholarship@Western Oncology Publications Oncology Department 11-11-2016 Radiation Oncology Quality and Safety Considerations in Low Resource Seings: A Medical Physics Perspective Jacob Van Dyk e University of Western Ontario, [email protected]Ahmed Meghzifene Follow this and additional works at: hps://ir.lib.uwo.ca/oncpub Part of the Medical Biophysics Commons , and the Oncology Commons Citation of this paper: Van Dyk, Jacob and Meghzifene, Ahmed, "Radiation Oncology Quality and Safety Considerations in Low Resource Seings: A Medical Physics Perspective" (2016). Oncology Publications. 117. hps://ir.lib.uwo.ca/oncpub/117
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Western UniversityScholarship@Western
Oncology Publications Oncology Department
11-11-2016
Radiation Oncology Quality and SafetyConsiderations in Low Resource Settings: AMedical Physics PerspectiveJacob Van DykThe University of Western Ontario, [email protected]
Ahmed Meghzifene
Follow this and additional works at: https://ir.lib.uwo.ca/oncpub
Part of the Medical Biophysics Commons, and the Oncology Commons
Citation of this paper:Van Dyk, Jacob and Meghzifene, Ahmed, "Radiation Oncology Quality and Safety Considerations in Low Resource Settings: AMedical Physics Perspective" (2016). Oncology Publications. 117.https://ir.lib.uwo.ca/oncpub/117
Cite this article as: Jacob Van Dyk and Ahmed Meghzifene, Radiation OncologyQuality and Safety Considerations in Low Resource Settings: A Medical PhysicsP e r s p e c t i v e , Seminars in Radiation Oncology,http://dx.doi.org/10.1016/j.semradonc.2016.11.004
This is a PDF file of an unedited manuscript that has been accepted forpublication. As a service to our customers we are providing this early version ofthe manuscript. The manuscript will undergo copyediting, typesetting, andreview of the resulting galley proof before it is published in its final citable form.Please note that during the production process errors may be discovered whichcould affect the content, and all legal disclaimers that apply to the journal pertain.
courses provided by national/international organizations74
.
Page 21 of 34
8.4 Partnerships and Peer-to-Peer Collaborations
While the growing cancer divide is becoming increasingly recognized1, 26, 28, 30, 40, 75
the solution
in support of reducing the divide is very complex since it involves multiple social, economic,
cultural and political facets. , Approaches to improving the availability of safe and effective RT
in LMICs, will require collaboration between multiple organizations including local
governments, regional, international as well as non-government organizations40, 41
. Advanced and
coordinated planning by governments, professional and other not-for-profit volunteer
organizations will be essential to the success of these initiatives. The number of organizations
involved is significant as indicated by the 34 examples listed in Table 2. Thus, coordination will
be crucial.
Regarding the involvement of professionals in LMIC contexts, the International Cancer Experts
Corps (ICEC) proposes an altruistic service along with a philosophy that global health becomes
an integral part of the spectrum of academic and professional careers with a goal that 20% of time
be devoted to this activity. Students and residents can also consider this part of their community
service and altruistic efforts76
.
9. Summary and Conclusions
The radiation treatment process is complex involving sophisticated high technology equipment
and multiple professionals including radiation oncologists, medical physicists and radiation
therapists. The complexity, sophistication, high up-front costs and a lack of trained professional
staff have been a deterrent for implementation of RT in many LMICs. However, with appropriate
political and organizational will these barriers can be overcome and indeed are beneficial to both
the healthcare of individuals as well as to a nation’s economic status. The quality, safety and
benefits of radiation treatment are strongly dependent on the quality and safety culture. Strong
Page 22 of 34
partnerships between multiple organizations and countries will enhance the development of safe
and resource-appropriate strategies for advancing the radiation treatment process.
Page 23 of 34
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Figure Captions
Figure 1. Number of publications from PubMed search done in January 2016: (a) with the words
“global” and “cancer” in the title; (b) with the words “global” and (“radiotherapy” or “radiation
therapy” or “radiation oncology”) in the title.
Figure 2. Elements of quality assurance (QA) activities occur at both the programmatic and
individual patient levels. (Adapted from an unpublished figure from M. Milosevic.)
Tables
Table 1. Top cited recommendations20
for patient safety and estimated level of concern in low-
to-middle income countries.
Recommendation Estimated risk level in LMICs * Very low risk
***** Very high risk
Training *****
Staffing *****
Documentation/SOP ***
Incident learning ***
Communication/questioning ***
Check lists ***
QC/PM ****
Dosimetric audit ****
Accreditation ***
Minimizing interruptions ****
Prospective risk assessment **
Safety culture ***
Page 30 of 34
Table 2. Organizations in support of enriching RT capabilities in LMICs.
Organization Web Link Comment
1 Above and Beyond
Cancer
https://aboveandbeyondcancer.org
/
A public charity with a mission to
elevate the lives of those touched
by cancer. Along with getting to
mountaintops, they are devoted to
advocacy and leading an example
for healthy living and cancer
prevention in their communities.
2 Academic Model
Providing Access to
Healthcare (AMPATH)
www.ampathkenya.org Consortium of North American
academic health centers led by
Indiana University working in
partnership with the Government
of Kenya.
3 African Organization for
Research and Training in
Cancer (AORTC)
www.aortic-africa.org AORTC is dedicated to the
promotion of cancer control in
Africa.
4 Alliance des Ligues
Francophones Africaines
& Mediteraneennes
(ALIAM ) ("Alliance of
African & Mediteranean
French Speaking
Leagues")
www.aliam.org ALIAM was founded by common
agreement between the
representatives of multiple
associations from multiple
Francophone countries to fight
against cancer.
5 American Association of
Physicists in Medicine
(AAPM)
www.AAPM.org Through various international
committees and on-line
educational resources for
developing countries.
6 American Society for
Radiation Oncology
(ASTRO)
www.ASTRO.org Through its International
Education Subcommittee (IES)
7 American Society of
Radiological
Technologists Foundation
http://foundation.asrt.org/ It invests money raised in medical
imaging technologists and
radiation therapists who want to
deliver the safest and highest-
quality patient care possible
around the world and more.
8 Association
Cancérologues sans
Frontières (“Oncologists
Without Borders”)
www.cancerologuesansfrontieres.
com
"Oncologists Without Borders"
was created in 1998 to promote
oncology in developing countries.
It is a non-profit organization.
9 BOTSwana Oncology
Global Outreach Program
(BOTSOGO)
www.botsogo.org Works to improve access to quality
cancer care in Botswana
Page 31 of 34
1
0
ChartRounds www.chartrounds.com ChartRounds brings together
academic disease site specialists
from leading cancer treatment
institutions and connects them
with the Chartrounds network of
over 1300 physicians and medical
physicists.
1
1
Cure4kids www.cure4kids.org Cure4Kids is an online resource
for healthcare professionals
dedicated to enhancing the care of
children who have cancer and
other life-threatening diseases in
countries around the globe.
1
2
European Society for
Radiotherapy and
Oncology
www.estro.org Advances all aspects of Radiation
Oncology through a range of
activities, including teaching
courses in Europe and beyond.
1
3
Foundation for Cancer
Care in Tanzania
www.tanzaniacancercare.org The Foundation for Cancer Care in
Tanzania enhances cancer care to
improve the lives of the citizens of
Tanzania through education,
programs for prevention and
screening, and services providing
treatment and palliation.
1
4
Global Oncology www.globalonc.org Global Oncology is a volunteer
community of physicians,
scientists, designers, engineers,
public health experts, policy
makers, nurses, lawyers, students,
and other professionals working in
teams to help people throughout
the world who are treating cancer
and its related pain.
1
5
Global RT http://globalrt.org GlobalRT is a movement to turn
radiotherapy into a global health
priority. It provides a virtual
platform for education, exchange,
and action around the essential
nature of radiotherapy for cancer
care.
1
6
International Agency for
Research on Cancer
(IARC)
www.iarc.fr IARC is the specialized cancer
agency of the World Health
Organization to promote
international collaboration in
cancer research.
1
7
International Atomic
Energy Agency (IAEA)
(a) Programme of Action
for Cancer Therapy
(PACT)
http://cancer.iaea.org/mission.asp
PACT strives for global
partnerships to confront the cancer
crisis in developing countries, with
Page 32 of 34
(b) Human Health
Campus
(c) Technical Cooperation
https://nucleus.iaea.org/HHW/
https://www.iaea.org/technicalcoo
peration/
WHO, and the Joint Programme
on Cancer Control established in
2009.
Online information resource for
health professionals working in
nuclear medicine, radiation
oncology, medical physics, and
nutrition.
Supports human resource capacity
building, networking, knowledge
sharing, partnership facilitation
and procurement of equipment.
1
8
International Campaign
for Establishment and
Development of Oncology
Centers (ICEDOC)
www.icedoc.org A non-governmental organization
which aims to lessen the human
suffering from cancer all over the
world.
1
9
International Cancer
Experts Corps (ICEC)
www.iceccancer.org "Partnering to transform global
cancer care"
2
0
International Cancer
Research Partnership
(ICRP)
https://www.icrpartnership.org/ ICRP is a unique alliance of cancer
organizations working together to
enhance global collaboration and
strategic coordination of research.
2
1
International Network for
Cancer Treatment and
Research (INCTR)
www.inctr.org A not-for-profit organization
dedicated to helping build capacity
for cancer research and treatment
in developing countries.
2
2
International Organization
for Medical Physics
(IOMP)
www.iomp.org Advances medical physics practice
worldwide by disseminating
scientific and technical
information, fostering educational
and professional development of
medical physics and promoting the
highest quality medical services
for patients.
2
3
Medical Physicists
Without Borders (MPWB)
www.mpwb.org MPWB is a not for profit,
membership-based volunteer
organization to support the
effective and safe use of physics
and technologies in medicine
through advising, training,
demonstrating and/or participating
in medical physics-related
activities, especially in LMICs.
2
4
Mephida www.okonmedphys.com Mephida is an independent NGO
with a novel approach to improve
cancer care in Africa through
medical physics services.
2
5
Physicien Médical Sans
Frontière
www.pmsf.asso.fr French-based non-government
organization with expertise in
Medical Physics and devoted to
Page 33 of 34
the fight against cancer.
2
6
Pink Ribbon Red Ribbon http://pinkribbonredribbon.org A global organization powered by
partnerships, Pink Ribbon Red
Ribbon saves lives from cancer in
countries where the need is
greatest.
2
7
Rad-Aid www.rad-aid.org Its mission is to improve and