A Balanced Approach to Radiotherapy: Integrating Cobalt-60 Machines and Linear Accelerators Treatment

Speakers and participants at “How to maximize the efficiency of radiation treatment: intergrating cobalt-60 machines and linear accelerators”, an IAEA 60th General Conference side event. (Photo: E. Izewski/IAEA)

Thanks to recent advances in technology, health authorities are able to select from among a variety of radiotherapy technologies. An IAEA General Conference side event held today provided guidance on the most important factors to be considered when deciding on the type of radiotherapy equipment to invest in for cancer treatment.

“It is important to evaluate each aspect of the equipment choice, first of all the anticipated clinical benefits to patients but also the management of the technology over time to ensure that it will deliver consistently safe and effective treatment,” said Ahmed Meghzifene, Head of the Dosimetry and Medical Radiation Physics Section at the IAEA. “If not correctly handled and maintained, radiotherapy equipment may deliver non-optimal treatments to patients and in extreme situations may cause harm.”

The side event ‘How to maximize the efficiency of radiation treatment – integrating cobalt-60 machines and linear accelerators’, provided a balanced perspective on these two technologies to help Member States make informed decisions based on their specific needs and conditions. Linear accelerators (linacs) and cobalt-60 (Co-60) machines are two of the most commonly used machines for external beam radiotherapy, a procedure in which high-energy beams are used to kill tumour cells.

Extra costs to consider

The total cost of operating a teletherapy machine far exceeds the price tag of the equipment itself. “It’s much more than Cobalt versus linacs, you need all the other things to go along with it,” said Jake Van Dyk, Professor Emeritus of Oncology and Medical Biophysics at Western University in Canada. “For a therapy to work, you need patient treatment planning which requires diagnostic equipment, CT scanners, patient set-up devices, computers and then, finally, the machines.”

In fact, capital equipment makes up only 30% of the overall cost of teletherapy in developed countries. “The biggest component is paying salaries for the staff, which is about 60%,” Van Dyk said. “But in low-income countries it’s the opposite, with almost 80% of the costs go towards buying the equipment. And that upfront capital investment is what scares a lot of people off.”

Although a considerable investment, proper radiation therapy brings many economic benefits in the long run, he said. “People are living longer and therefore contributing to the economy of their countries.”

Personnel requirements

Due to the high level of sophistication of the machines, medical physicists and operating personnel must be properly-trained before they can handle radiotherapy machines. “If they are not properly trained, there could be significant damage done to patients and compromise patient outcomes” said Virginia Tsapaki, Secretary General of International Organization for Medical Physics and Director of Medical Physics Department at Konstantopoulio General Hospital in Athens, Greece.

The key is advanced planning, especially for low income countries with no existing training program for radiotherapy personnel, she said. “Whether to set up training programs locally or sending them abroad, these are all challenges governments need to consider.”

When it comes to the choices for radiotherapy there is no standard answer. An equipment choice should be the result of careful analysis that includes not just the technological characteristics of the machines but also the local infrastructure, the evaluation of maintenance requirements, affordability and the availability of well-trained personnel, according to May Abdel-Wahab, the Director for the Division of Human Health at IAEA.

“We want our Member States to be fully aware about different infrastructure needs for its effective utilisation before purchasing a particular equipment,” she said.

Investments in radiotherapy can be maximized by strengthening health systems to deliver affordable and effective preventative, diagnostic, treatment and palliative care services, said Nelly Enwerem-Bromson, Director of the IAEA's Programme of Action for Cancer Therapy. “Greater international collaboration and continued innovations in technology and financing are needed to address the numerous challenges that limit access to radiotherapy,” she said.

Directory of Radiotherapy Centres

The event was followed by the launch of the new Directory of Radiotherapy Centres (DIRAC). DIRAC encompasses data on teletherapy machines, devices and sources used in brachytherapy, equipment for dosimetry, patient dose calculations and quality assurance. The first upgrade in 10 years, the relaunched database not only redesigned the interface but also added in new tools for data analysis and visualisation that enable users to review and compare radiotherapy facilities in any specific country or region in the world. See this press release for more information.