M. P. Dykstra1, T. Netherton2, B. A. Mohammed3, N. Lasebikan Sr4, S. Kibudde5, A. Mallum6,7, D. A. Ndoli8,9, J. L. Shah1, A. K. Waweru10, M. N. Kitonyi11, G. L. Lazarus12, S. Hawley13, L. E. Court2,14, and L. Wallner15,16; 1Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 3National Hospital Abuja, Abuja, Nigeria, 4University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria, 5Uganda Cancer Institute, Kampala, Uganda, 6Department of Radiotherapy and Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa, 7Department of Radiotherapy and Oncology, College of Health Sciences University of KwaZulu Natal, Durban, South Africa, 8Rwanda Military Hospital, Kigali, Rwanda, 9University of Rwanda, Kigali, Rwanda, 10Aga Khan University Hospital, Nairobi, Kenya, 11Department of Radiation Oncology, Mayo Clinic, Rochester, MN, 12Department of Medical Physics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa, 13Division of General Internal Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, 14The University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences, Houston, TX, 15Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, 16Department of Internal Medicine, University of Michigan, Ann Arbor, MI
Purpose/Objective(s): African radiotherapy access is insufficient to meet population needs. Inadequate staffing for contouring and treatment planning is one key barrier to meeting the radiotherapy demand. One possible solution to augment the existing workforce is the Radiation Planning Assistant (RPA), an automated contouring and planning web-based platform being offered without cost for breast, cervix, head and neck and whole brain radiotherapy. We sought to characterize 1) current allocation of skilled workers for contouring and treatment planning, and 2) perceptions regarding barriers and facilitators to RPA implementation. Materials/
Methods: A survey captured information about demographics, current clinic workflow, perceptions of barriers and facilitators about the RPA, and an abridged version of the Organizational Readiness for Change Assessment (ORCA). It was distributed at the African Organisation for Research and Training in Cancer (AORTIC) Conference in November 2023. Electronic surveys were distributed via networking at the conference and a QR code after a relevant oral presentation. The survey link was also sent through existing collaborative networks on the African continent. Results: A total of 24 respondents practicing in 15 radiotherapy centers across 9 African countries completed the survey. Most respondents were practicing in public centers (n = 16, 67%). Twelve (50%) respondents were consultant physicians, three (13%) were physician trainees, six (25%) were physicists, and three (13%) were radiation therapists. Providers involved in contouring under routine conditions were physicians (100%), physicists (22%), radiation therapists (17%), and automated software (13%). Treatment planning was performed by physicists (87%), radiation therapists (30%), physicians (17%), and dosimetrists (13%). At least 85% (n = 21) of providers identified decreased workload, decreased planning time, improved treatment plans, and increased consistency as facilitating factors for implementation. Two thirds of respondents agreed or strongly agreed that internet connection and a paid subscription would be significant barriers to implementation. Other barriers included power outages (46%), need for additional training (46%), and need for contouring/planning of other disease sites (46%). All respondents (100%) wanted to use the RPA and most (88%) believed they could implement the RPA in their center in the next 6 months. On abbreviated ORCA questionnaire, 92% agreed or strongly agreed that there was sufficient evidence for the RPA to be used clinically. Conclusion: Among a diverse set of providers from across Africa, most contours are done by physicians and most treatment plans are made by physicists. There is enthusiasm about the potential for automated contouring and planning among African providers, though key barriers must be overcome.
