CERN Accelerating science

A partnership-mentorship approach for global access to radiation therapy
by Virginia Greco (CERN)

An electron linac for conventional treatments with X rays and electrons. Photo from the Clinic of Génolier (Credit: Max Brice, CERN)

On November 2016, CERN hosted a Workshop on Design Characteristics of a Novel Linear Accelerator for Challenging Environments, organized by Norman Coleman and David Pistenmaa from the International Cancer Experts Corps (ICEC) in collaboration with Manjit Dosanjh, from CERN.

The participation to the event was by invitation only and reserved to about 70 internationally-recognized experts in various fields correlated to radiotherapy for cancer treatment. They met to define a strategy for increasing access to radiotherapy to a larger number of people and to discuss possible solutions for geographical areas that present economic and technological challenges as well as a quickly changing political situation.

The idea of designing affordable equipment and developing sustainable infrastructures for delivering radiation treatment for cancer in countries that lack resources and expertise is a core mission of ICEC. Established in 2013 as a non-governmental organization, ICEC has set itself as an international sustainable mentoring network of cancer professionals, whose aim is to establish partnership projects in low- and medium-income countries, as well as in isolated indigenous communities of all countries, oriented at facilitating access to radiotherapy and improving the quality of the treatment offered.

This will be achieved by encouraging and supporting initiatives of local groups, providing mentorship and training, and guiding them through a number of steps to be completed in order to be recognized as high standard cancer care centres.

Leading experts coming from key international organisations, research institutes, universities, medical hospitals, companies producing equipment for conventional x-ray and particle therapy took the stage in turns at the workshop to share their knowledge and expertise and to discuss needs, goals and possible solutions. The key topics of discussion were the technology to be employed, sustainability, and training.

An essential step that ICEC and collaborating experts have to accomplish is designing a linear accelerator and associated instrumentation needed to deliver radiotherapy that would have to be operated in places where general infrastructures are poor of lacking, power outages and water supply fluctuations can occur and whose climatic conditions might be harsh.

The ideal facility should have a modular structure, in order to be easily shipped, assembled in-situ, upgraded and repaired. In order to be easily operated, the equipment also needs to have an intuitive and accessible interface, as a smartphone, even though it is highly technologically advanced.

A critical issue that was also discussed at the meeting at CERN was the treatment system sustainability after its installation. Specialized technical staff is required to maintain the equipment and promptly repair it, if needed, relying on availability of standard spare parts and replacement procedures that will be developed in order to make maintenance as easy as possible.

Difficulties of displacement and communication are also to be taken into account. As a consequence, these centres have to be designed modelled on the philosophy of a space station, where astronauts have spare components available and can easily replace faulty parts as pieces of lego, with remote guidance.

The participants to the workshop agreed that training is fundamental to make this ambitious project possible. ICEC’s strategy consists of setting up a team of mentors to guide local groups throughout the various phases of the programme. In this way, each centre located in a region with cancer treatment disparities and insufficient resources that is aiming at implementing radiotherapy would be associated with a centre in a resource-rich country and eventually become a reference centre for other local groups willing to undertake a similar path.

Professionals in oncology, radiotherapy and radiobiology, medical physicists as well as nurses and ancillary staff, will have to be identified in order to ensure assistance to remote locations. After completion of regular academic training, the personnel of the remote centre would be mentored and trained by ICEC’s experts through face-to-face lectures, periodic on-site visits and consultations via video-connection. This would ensure that, at a later stage, they would be able in turn to train future employees.

At the end of two intense days of debate and exchange of ideas, the participants have got a more precise picture of needs, limits and priorities, as well as a lot of input for further reflection. As a follow up, working groups will be established to address different aspects of the problem and the date for another global meeting fixed. An editorial board will write a report of the workshop, which will also be submitted for publication to medical journals.

The report emerging from the workshop will be published in various media and journals in order to highlight the initiative and obtain further momentum.