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Klik om de stijl te bewerkenVUmc
Guidelines for radiotherapy staffing and infrastructure in Europe
“QUARTS”
Ben Slotman, MD,PhD
Professor & Chair
VU University medical center
Amsterdam, The Netherlands
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Klik om de stijl te bewerkenVUmc Methods
• 2003 Q1: Questionnaires on guidelines for equipment and personnel and on reimbursment system
• 2003 Q1-2: Contact by phone, fax, mail, e-mail
• 3 groups of countries based on GDP/capita:– High resource >10 K USD (n=23)– Medium resource 3-10 K USD (n= 9)– Low resource <3 K USD (n=12)
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Klik om de stijl te bewerkenVUmc Results
• Response– 41/44 countries (93.2%)
• excl. Iceland, Monaco and Moldova– Representing 805/809 M inhabitants (99.4%)
Where applicable, guidelines were recalculated from patients to population size using 2.500 new radiotherapy patients / 1.000.000 inhabitants
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Klik om de stijl te bewerkenVUmc Guidelines linacs available: 17/41 (42%)
Population
High resources Medium resources Low resources
Countries
1 linac per ….2.500
NP
1.500NP
500NP
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Klik om de stijl te bewerkenVUmc Guidelines linacs
CountryAverage(popul.)
Range(popul.)
Average(patients)
Range(patients)
High resources 1:183.000 80-250.000 1: 458 200-625
Medium resources 1:284.000 200-400.000 1: 710 500-1.000
Low resources 1:500.000 250-1.000.00 1:1.250 625-2.500
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Klik om de stijl te bewerkenVUmc Radiation oncologists
• Guidelines available: 17 (42%)• High 43%• Med 44%• Low 36%
• In general: 1 per 250 patients (range 150-400)
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Klik om de stijl te bewerkenVUmc Radiation oncologists
Patients
Countries
High resources Medium resources Low resources
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Klik om de stijl te bewerkenVUmc Physicists
• Guidelines available: 18 (43.9%)• High 52%• Med 33%• Low 36%
• In general 1 per 565 patients (range 300-1.250)
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Klik om de stijl te bewerkenVUmc Physicists
Patients
Countries
High resources Medium resources Low resources
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Klik om de stijl te bewerkenVUmc Technologists
• Guidelines available: 18 (44%)• High 43%• Med 56%• Low 36%
• Great diversity: in general 2 per linac + for other tasks
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Klik om de stijl te bewerkenVUmc Treatment planning perfomed by
High Med-Low
Technologist/dosimetrist 42.8% 0.0%Physicists 42.8% 85.0%Both 14.4% 15.0%
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Klik om de stijl te bewerkenVUmc Quality assurance performed by
High Med-Low
Technologist/Assistant 14.3% 0.0%Physicists 66.7% 90.0%Both 19.0% 10.0%
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Klik om de stijl te bewerkenVUmc Re-imbursement
• Great diversity• Often more than one system
High resource Medium resource Low resource
Budget-based 48% 44% 91%
Case-based 24% 33% 46%
Fee for service 81% 50% 18%
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Klik om de stijl te bewerkenVUmc Special re-imbursement
High resource Medium resource Low resource
Intensive/CRT 62% 33% 27%
IMRT 24% 33% 9%
SRT 48% 56% 9%
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Klik om de stijl te bewerkenVUmc General guidelines
• Linacs: 1 per 450 patients (1 per 180.000 population); with increasing complexicity 1 per 400-450 patients
• Radiation oncologist: 1 per 250 patientswith increasing complexity 1 per 200-250 patients
• Physicists: 1 per 500 patients or 1 per linac
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Klik om de stijl te bewerkenVUmc CAUTION !
• These are only crude guidelines, which do not take into account the specific structure of the population, differences in cancer incidence and treatment strategies, etc.
• Better approaches to determine the real needs within a country or region are warranted !
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Klik om de stijl te bewerkenVUmc Evidence-based guidelines
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Klik om de stijl te bewerkenVUmc
• Differences in crude cancer incidences in Europe, due to differences in exposure to risk factors and differences in age structure
• Use evidence-based indications to calculate needs (SBU, CCORE, QCRI)
Evidence-based guidelines
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Klik om de stijl te bewerkenVUmc Estimated # of linacs per 1.000.000
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Klik om de stijl te bewerkenVUmc Linacs realized and required
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Klik om de stijl te bewerkenVUmc Conclusions
• Large difference in guidelines among Europe and large difference in cancer incidences
• National incidence rates for various cancers as basis
• Use evidence based guidelines for use of radiotherapy in these tumors to detemine total number of patients requiring radiotherapy (= number of treatments)
• On average 450 treatments per linac