title: Infrastructure of radiation oncology in France: a large survey of evolution of external beam radiotherapy practice.
abstract: OBJECTIVE
  To study the structural characteristics of radiation oncology facilities for France and to examine how technological evolutions had to be taken into account in terms of accessibility and costs. This study was initiated by the three health care financing administrations that cover health care costs for the French population. The needs of the population in terms of the geographic distribution of the facilities were also investigated. The endpoint was to make proposals to enable an evolution of the practice of radiotherapy (RT) in France.
  
  
  METHODS
  A survey designed by a multidisciplinary committee was distributed in all RT facilities to collect data on treatment machines, other equipment, personnel, new patients, and new treatments. Medical advisors ensured site visits in each facility. The data were validated at the regional level and aggregated at the national level for analysis.
  
  
  RESULTS
  A total of 357 machines had been installed in 179 facilities: 270 linear accelerators and 87 cobalt units. The distribution of facilities and megavoltage units per million inhabitants over the country was good, although some disparities existed between areas. It appeared that most megavoltage units had not benefited from technological innovation, because 25% of the cobalt units and 57% of the linear accelerators were between 6 and 15 years old. Computed tomography access for treatment preparation was not sufficient, and complete data management systems were scarce (15% of facilities). Seven centers had no treatment planning system. Electronic portal imaging devices were available in 44.7% of RT centers and in vivo dosimetry in 35%. A lack of physicians and medical physicists was observed; consequently, the workload exceeded the normal standard recommended by the French White Book. Discrepancies were found between the number of patients treated per machine per year in each area (range, 244.5-604). Most treatments were delivered in smaller facilities (61.6%).
  
  
  CONCLUSIONS
  On the basis of the findings of this study, measures were taken to update the infrastructure of RT in France. A first evaluation showed an improvement of care supply in RT in the country.
authors.affiliation: Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Direction Regionale du Sud Est, Marseille 13005, France. sophie.pignon@ersm-sudest.cnamts.fr
authors.forename: Sophie
authors.initials: S
authors.lastname: Ruggieri-Pignon
authors.forename: Thierry
authors.initials: T
authors.lastname: Pignon
authors.forename: Michel
authors.initials: M
authors.lastname: Marty
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Rodde-Dunet
authors.forename: Brigitte
authors.initials: B
authors.lastname: Destembert
authors.forename: Béatrice
authors.initials: B
authors.lastname: Fritsch
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration* / Q000600:supply & distribution; D003035:Cobalt / Q000627:therapeutic use; D003710:Demography; D005602:France; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D010315:Particle Accelerators / Q000592:standards / Q000600:supply & distribution; D011786:Quality Control; D018787:Radiation Oncology / Q000295:instrumentation / Q000458:organization & administration*; D011880:Radiotherapy Planning, Computer-Assisted / Q000706:statistics & numerical data; D011882:Radiotherapy, High-Energy / Q000295:instrumentation / Q000592:standards / Q000706:statistics & numerical data; D013679:Technology, Radiologic / Q000295:instrumentation*; D015898:Tomography Scanners, X-Ray Computed / Q000592:standards / Q000600:supply & distribution; D000078329:Workforce
chemical_list: D003035:Cobalt