title: A framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries.
abstract: We present a practical, generic, easy-to-use framework for the implementation of new radiation therapy technologies and treatment techniques in low-income countries. The framework is intended to standardize the implementation process, reduce the effort involved in generating an implementation strategy, and provide improved patient safety by reducing the likelihood that steps are missed during the implementation process. The 10 steps in the framework provide a practical approach to implementation. The steps are, 1) Site and resource assessment, 2) Evaluation of equipment and funding, 3) Establishing timelines, 4) Defining the treatment process, 5) Equipment commissioning, 6) Training and competency assessment, 7) Prospective risk analysis, 8) System testing, 9) External dosimetric audit and incident learning, and 10) Support and follow-up. For each step, practical advice for completing the step is provided, as well as links to helpful supplementary material. An associated checklist is provided that can be used to track progress through the steps in the framework. While the emphasis of this paper is on addressing the needs of low-income countries, the concepts also apply in high-income countries.
authors.affiliation: University of Calgary, Depts of Oncology and Physics and Astronomy, Tom Baker Cancer Centre, Calgary, AB, Canada. Electronic address: brown.derekw@gmail.com.
authors.forename: Derek W
authors.initials: DW
authors.lastname: Brown
authors.affiliation: Overlook Medical Center, Summit, NJ, USA. Electronic address: adam@radiatinghope.org.
authors.forename: Adam
authors.initials: A
authors.lastname: Shulman
authors.affiliation: Tom Baker Cancer Centre, Calgary, AB, Canada. Electronic address: alana.hudson@albertahealthservices.ca.
authors.forename: Alana
authors.initials: A
authors.lastname: Hudson
authors.affiliation: University of Calgary, Depts of Oncology and Physics and Astronomy, Tom Baker Cancer Centre, Calgary, AB, Canada. Electronic address: wendy.smith@albertahealthservices.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Smith
authors.affiliation: Gamma West Cancer Services, Layton, UT, USA. Electronic address: bjfisher7@gmail.com.
authors.forename: Brandon
authors.initials: B
authors.lastname: Fisher
authors.affiliation: Varian Medical Systems, Palo Alto, CA, USA. Electronic address: jon.hollon@varian.com.
authors.forename: Jon
authors.initials: J
authors.lastname: Hollon
authors.affiliation: International Educational Activities Committee, American Association of Physicists in Medicine, USA. Electronic address: ypipman@yahoo.com.
authors.forename: Yakov
authors.initials: Y
authors.lastname: Pipman
authors.affiliation: Dept of Medical Biophysics, Western University, London, ON, Canada. Electronic address: vandyk@uwo.ca.
authors.forename: Jacob
authors.initials: J
authors.lastname: Van Dyk
authors.affiliation: Dept of Oncology, Moores Cancer Center, San Diego, CA, USA. Electronic address: jeinck@ucsd.edu.
authors.forename: John
authors.initials: J
authors.lastname: Einck
mesh_terms: D054869:Clinical Audit; D003906:Developing Countries; D006295:Health Resources; D017410:Practice Guidelines as Topic; D011361:Professional Competence; D011785:Quality Assurance, Health Care; D011874:Radiometry; D011878:Radiotherapy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D018570:Risk Assessment; D012449:Safety
keywords: Efficiency; Implementing new treatment techniques; Patient safety