title: Radiotherapy equipment and departments in the European countries: final results from the ESTRO-HERO survey.
abstract: BACKGROUND
  Documenting the distribution of radiotherapy departments and the availability of radiotherapy equipment in the European countries is an important part of HERO - the ESTRO Health Economics in Radiation Oncology project. HERO has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The aim of the current report is to describe the distribution of radiotherapy equipment in European countries.
  
  
  METHODS
  An 84-item questionnaire was sent out to European countries, principally through their national societies. The current report includes a detailed analysis of radiotherapy departments and equipment (questionnaire items 26-29), analyzed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis is based on validated responses from 28 of the 40 European countries defined by the European Cancer Observatory (ECO).
  
  
  RESULTS
  A large variation between countries was found for most parameters studied. There were 2192 linear accelerators, 96 dedicated stereotactic machines, and 77 cobalt machines reported in the 27 countries where this information was available. A total of 12 countries had at least one cobalt machine in use. There was a median of 0.5 simulator per MV unit (range 0.3-1.5) and 1.4 (range 0.4-4.4) simulators per department. Of the 874 simulators, a total of 654 (75%) were capable of 3D imaging (CT-scanner or CBCT-option). The number of MV machines (cobalt, linear accelerators, and dedicated stereotactic machines) per million inhabitants ranged from 1.4 to 9.5 (median 5.3) and the average number of MV machines per department from 0.9 to 8.2 (median 2.6). The average number of treatment courses per year per MV machine varied from 262 to 1061 (median 419). While 69% of MV units were capable of IMRT only 49% were equipped for image guidance (IGRT). There was a clear relation between socio-economic status, as measured by GNI per capita, and availability of radiotherapy equipment in the countries. In many low income countries in Southern and Central-Eastern Europe there was very limited access to radiotherapy and especially to equipment for IMRT or IGRT.
  
  
  CONCLUSIONS
  The European average number of MV machines per million inhabitants and per department is now better in line with QUARTS recommendations from 2005, but the survey also showed a significant heterogeneity in the access to modern radiotherapy equipment in Europe. High income countries especially in Northern-Western Europe are well-served with radiotherapy resources, other countries are facing important shortages of both equipment in general and especially machines capable of delivering high precision conformal treatments (IMRT, IGRT).
authors.affiliation: Aarhus University Hospital, Denmark. Electronic address: caigrau@dadlnet.dk.
authors.forename: Cai
authors.initials: C
authors.lastname: Grau
authors.affiliation: European Society for Radiotherapy and Oncology, Brussels, Belgium.
authors.forename: Noémie
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authors.lastname: Defourny
authors.affiliation: University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland.
authors.forename: Julian
authors.initials: J
authors.lastname: Malicki
authors.affiliation: University of Calgary, Canada.
authors.forename: Peter
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authors.lastname: Dunscombe
authors.affiliation: University of Barcelona, Spain.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Borras
authors.affiliation: Trinity College Dublin, Ireland.
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authors.lastname: Coffey
authors.affiliation: VU Medical Center, Amsterdam, The Netherlands.
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authors.lastname: Slotman
authors.affiliation: Cancer Diagnosis and Treatment Center, Katowice, Poland.
authors.forename: Marta
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authors.lastname: Bogusz
authors.affiliation: European Society for Radiotherapy and Oncology, Brussels, Belgium.
authors.forename: Chiara
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authors.affiliation: Ghent University Hospital, Belgium.
authors.forename: Yolande
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authors.lastname: Polgar
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authors.forename: Moya
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authors.forename: Stefano
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authors.lastname: Magrini
authors.forename: Vydmantas
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authors.lastname: Atkocius
authors.forename: Michel
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authors.lastname: Untereiner
authors.forename: Martin
authors.initials: M
authors.lastname: Pirotta
authors.forename: Vanja
authors.initials: V
authors.lastname: Karadjinovic
authors.forename: Sverre
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authors.lastname: Levernes
authors.forename: Krystol
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authors.lastname: Sladowski
authors.forename: Maria
authors.initials: M
authors.lastname: Lurdes Trigo
authors.forename: Barbara
authors.initials: B
authors.lastname: Šegedin
authors.forename: Aurora
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Magnus
authors.initials: M
authors.lastname: Lagerlund
authors.forename: Bert
authors.initials: B
authors.lastname: Pastoors
authors.forename: Peter
authors.initials: P
authors.lastname: Hoskin
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mesh_terms: D003625:Data Collection; D005060:Europe; D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy; D010315:Particle Accelerators; D018787:Radiation Oncology / Q000295:instrumentation* / Q000706:statistics & numerical data*; D011878:Radiotherapy / Q000191:economics / Q000295:instrumentation* / Q000706:statistics & numerical data*
keywords: Health economics; Radiotherapy equipment