Overview

Following adoption of resolutions WHA60.29 on health technologies and WHA70.12 (1,2) on cancer prevention and control, the World Health Organization (WHO) published List of priority medical devices for cancer management in 2017 to assist countries in prioritizing inclusion of medical devices into their health-care systems (3). WHO and the International Atomic Energy Agency (IAEA) published detailed technical specifications of the radiotherapy equipment required for cancer treatment (4). It was observed, however, that, once the appropriate radiotherapy equipment had been procured, many radiotherapy departments found difficulty in managing the equipment and facilities. The aim of this document is to provide guidance on sustainable management of the equipment and facilities to ensure that cancer patients are treated safely and accurately, with minimum gaps in their treatment. The guidance is intended for a committee of clinical radiation oncologists, medical physicists, radiation therapists and biomedical engineers and financial and planning officers to manage sustainable operation of all the radiotherapy equipment necessary to treat cancer patients, from pre-treatment imaging through to treatment and the facilities to house equipment. Therefore, recommendations are given on sustaining operation of the equipment and facilities, from procurement to replacement of equipment at the end of its life-cycle.

Section 1 lists the elements necessary to sustain: radiotherapy equipment, facility infrastructure, management and well-trained staff. The latter are not, however, covered in this document as the topic has been well documented in other IAEA and WHO publications. Section 2 covers the elements necessary to sustain radiotherapy, consisting of the equipment, facilities and funding, and also both preventive and corrective maintenance. Section 3 outlines the duties of those responsible for the sustainability of radiotherapy service. Section 4 discusses the maintenance of radiotherapy equipment and facilities, from procurement to replacement of the equipment at the end of its life. This includes various options for service contracts, depending on the type of equipment and facility, and penalties to be included in service contracts to ensure a reliable service from the maintenance provider. The annexes give examples for calculating the uptime of equipment, details of machine log books, items to be included in a service contract and negotiation of a service contract.