Radiation Therapy Physics Quality Assurance and Management Practices in Low- and Middle-Income Countries: An Initial Pilot Survey in Six Countries and Validation Through a Site Visit.

Purpose: Our purpose was to assess physics quality assurance (QA) practices in less resourced radiation therapy (RT) centers to improve quality of care. Methods and Materials: A preliminary study was conducted in 2020 of 13 select RT centers in 6 countries, and in 2021, our team conducted onsite visits to all the RT centers in Ghana, one of the countries from the initial survey. The RT centers included 1 private and 2 public institutions (denoted as Public-1 and Public-2). Follow-up surveys were sent to 17 medical physicists from the site visit. Questions centered on the topics of equipment, institutional practice, physics quality assurance, management, and safety practices. Qualitative and descriptive methods were used for data analysis. Questions regarding operational challenges (machine downtime, patient-related issues, power outages, and staffing) were asked on a 5-point Likert scale. Results: The preliminary survey from 2020 had a 92% response rate. One key result showed that for RT centers in lower gross national income per capita countries there was a direct correlation between QA needs and the gross national income per capita of the country. The needs identified included film/array detectors, independent dose calculation software, calibration of ion chambers, diodes, thermoluminiscence diodes (TLDs), phantoms for verification, Treatment Planning System (TPS) test phantoms, imaging test phantoms and film dosimeters, education, and training. For the post survey after the site visit in 2021, we received a 100% response rate. The private and the Public-1 institutions each have computed tomography simulators located in their RT center. The average daily patient external beam workload for each clinic on a linear accelerator was: private = 25, Public-1 = 55, Public-2 = 40. The Co-60 workload was: Public-1 = 45, Public-2 = 25 (there was no Co-60 at the private hospital). Public-1 and -2 lacked the equipment necessary to conform to best practices in Task Group reports (TG) 142 and 198. Public-2 reported significant operational challenges. Notably, Public-1 and -2 have peer review chart rounds, which are attended by clinical oncologists, medical physicists, physicians, and physics trainees. All 17 physicists who responded to the post site visit survey indicated they had a system of documenting, tracking, and trending patient-related safety incidents, but only 1 physicist reported using International Atomic Energy Agency Safety in Radiation Oncology. Conclusions: The preliminary study showed a direct correlation between QA needs and the development index of a country, and the follow-up survey examines operational and physics QA practices in the RT clinics in Ghana, one of the initial countries surveyed. This will form the basis of a planned continent-wide survey in Africa intended to spotlight QA practices in low- and middle-income countries, the challenges faced, and lessons learned to help understand the gaps and needs to support local physics QA and management programs. Audits during the site visit show education and training remain the most important needs in operating successful QA programs.

Reimagining Education in Global Radiotherapy: The Experiences and Contribution of Rayos Contra Cancer.

PURPOSE: Technology advancements ushered in a new era of how we reimagine our human interaction, with videoconferencing becoming commonplace in educational, professional, and social settings. These tools became the new paradigm in online/virtual education for all institutions around the world. Particularly in global health, where the traditional norm for support relied on traveling and onsite visits, we face a ripe opportunity for innovation. METHODS: From 2019 to present, Rayos Contra Cancer has conducted remote operations by organizing the efforts of volunteer educators and moderators who are radiotherapy professionals or trainees from across the United States and other parts of the world. On average, each program consists of 17 virtual sessions. The hour-long sessions are conducted over Zoom and include didactics, question-and-answer dialogue with participants, and sample cases. The educators are seasoned and accomplished radiation oncologists, physicists, dosimetrists, and radiation therapists who teach single or multiple topics in a program. Participants are radiotherapy professionals or trainees affiliated with a radiotherapy clinic in a low- and middle-income country. RESULTS: The number of participant clinics ranged from 2 to 120 per program. Our combined programs have resulted in over 2,000 unique participants spanning approximately 500 unique centers in 54 countries with the support of over 200 unique educators and moderators from centers in 18 countries. CONCLUSION: When the world shut down, we were forced to reimagine how we approached global health education. Our data show tremendous growth year to year and from one curriculum to another. The feedback from our participants demonstrates that our approach is an effective way to engage practitioners in radiotherapy centers with fewer resources.

WeWhoCurie: An Initiative to Advocate for Those Underrepresented in Radiation Oncology.

Purpose: An initiative to advocate for those underrepresented in radiation oncology. Methods and Materials: Inspired by the success of the #ILookLikeAnEngineer and #ILookLikeASurgeon campaigns, this initiative aimed to break down stereotypes in traditionally male-dominated fields. In honor of Marie Curie's birthday, on November 7, 2018, the Society for Women in Radiation Oncology launched a social media campaign called #WomenWhoCurie day. However, as the popularity of the social media campaign increased, it become evident that members of the wider radiation community, in particular women of color, nonbinary and transgender people did not feel supported by the #WomenWhoCurie movement. In November 2021, after consultation with diversity and inclusion leaders and members of other national radiation oncology organizations, Society for Women in Radiation Oncology launched #WeWhoCurie alongside the #WomenWhoCurie campaign for women and gender minorities in radiation oncology. Radiation oncologists, physicists, dosimetrist, therapists, nurses, and other professionals from around the world gathered and shared photos and social media posts throughout the day on multiple platforms including Facebook, Instagram, and Twitter. Results: In the year #WeWhoCurie, #WomenWhoCurie, #_______ WhoCurie campaign launched, we saw an increase in participation across the globe from 9 countries: the United States, Canada, Mexico, Brazil, Italy, Spain, China, New Zealand, and Australia. There were over 720 tweets contributing to the campaign with over 2000 messages, representing 3,365,444 "potential impacts", or the number of times someone saw the hashtag. Conclusions: Through this campaign we aim to celebrate the incredible women, gender minorities, and allies who are "Curie-ing" patients with cancer and conducting cutting edge research to improve cancer care across the globe. As an organization we believe adding our voices to the masses will foster a culture of inclusion for everyone. Afterall, what good is the practice of radiation oncology if all are not equally welcome?