Department of Physics, University of Oxford, Oxford, UK.
National Hospital Abuja, Abuja, Nigeria.
Clin Oncol (R Coll Radiol). 2020 Apr;32(4):e111-e118. doi: 10.1016/j.clon.2019.10.010. Epub 2019 Nov 19.
The lack of radiotherapy linear accelerators (linacs) in low- and middle-income countries (LMICs) has been recognised as a major barrier to providing quality cancer care in these regions, together with a shortfall in the number of highly qualified personnel. It is expected that additional challenges will be faced in operating precise, high-technology radiotherapy equipment in these environments, and anecdotal evidence suggests that linacs have greater downtime and higher failure rates of components than their counterparts in high-income countries. To guide future developments, such as the design of a linac tailored for use in LMIC environments, it is important to take a data-driven approach to any re-engineering of the technology. However, no detailed statistical data on linac downtime and failure modes have been previously collected or presented in the literature. This work presents the first known comparative analysis of failure modes and downtime of current generation linacs in radiotherapy centres, with the aim of determining any correlations between linac environment and performance. Logbooks kept by radiotherapy personnel on the operation of their linac were obtained and analysed from centres in Oxford (UK), Abuja, Benin, Enugu, Lagos, Sokoto (Nigeria) and Gaborone (Botswana). By deconstructing the linac into 12 different subsystems, it was found that the vacuum subsystem only failed in the LMIC centres and the failure rate in an LMIC environment was more than twice as large in six of the 12 subsystems compared with the high-income country. Additionally, it was shown that despite accounting for only 3.4% of the total number of faults, linac faults that took more than 1 h to repair accounted for 74.6% of the total downtime. The results of this study inform future attempts to mitigate the problems affecting linacs in LMIC environments.
低中等收入国家（LMICs）缺乏放射治疗直线加速器（linacs），这被认为是在这些地区提供高质量癌症治疗的主要障碍，加上高素质人员短缺。预计在这些环境中操作精确、高科技的放射治疗设备将面临更多挑战，并且有传闻证据表明，与高收入国家的同类设备相比，linacs 的停机时间更长，部件故障更高。为了指导未来的发展，例如设计专门用于 LMIC 环境的 linac，重要的是对技术进行数据驱动的改进。然而，以前没有在文献中收集或提出有关 linac 停机时间和故障模式的详细统计数据。这项工作首次对放射治疗中心当前一代 linac 的故障模式和停机时间进行了比较分析，目的是确定 linac 环境和性能之间的任何相关性。从牛津（英国）、阿布贾、贝宁、埃努古、拉各斯、索科托（尼日利亚）和哈博罗内（博茨瓦纳）的中心获取并分析了放射治疗人员关于其 linac 运行的日志。通过将 linac 分解为 12 个不同的子系统，发现只有在 LMIC 中心才会出现真空子系统故障，并且在 12 个子系统中有 6 个的故障发生率是高收入国家的两倍多。此外，结果表明，尽管仅占总故障数的 3.4％，但需要超过 1 小时才能修复的 linac 故障占总停机时间的 74.6％。这项研究的结果为未来减轻影响 LMIC 环境中 linac 的问题提供了参考。
