Global linear accelerator requirements and personalised country recommendations: a cross-sectional, population-based...

Area of Science:

• Oncology
• Medical Physics
• Public Health

Background:

• The Linear Accelerator Shortage Index (LSI) quantifies the ratio of linear accelerator (LINAC) demand to availability for radiotherapy.
• A global assessment of LINAC distribution and radiotherapy needs is crucial for equitable cancer care.
• Disparities in LINAC access significantly impact cancer treatment outcomes worldwide.

Purpose of the Study:

• To utilize the LSI to predict global LINAC requirements.
• To classify countries based on their degree of radiotherapy shortage (LINAC shortage grade).
• To forecast future investment needs for radiotherapy infrastructure.

Main Methods:

• A cross-sectional, population-based study analyzed country-level data for 181 nations.
• LINAC distribution, radiotherapy centers, cancer incidence, GDP, and GNI per capita were sourced from global databases.
• The LSI was calculated (LINAC use / 450 * 100), and countries were graded (0-4) based on shortage severity.

Main Results:

• The global median LSI was 130, indicating a 30% radiotherapy capacity shortage.
• Low-income countries exhibited the most severe shortages (median LSI 1523), with 20% having no LINACs.
• An estimated 30,470 LINACs are needed by 2045, requiring substantial investment, especially in LMICs.

Conclusions:

• The LSI and LINAC shortage grade are effective tools for assessing and forecasting radiotherapy needs.
• Significant global disparities in radiotherapy availability necessitate urgent investment in capacity building.
• Targeted investment in low- and middle-income countries is critical to address radiotherapy deficits.