Impact of High-Dose-Rate Brachytherapy Training via Telehealth in Low- and Middle-Income Countries

Abstract

PURPOSE Our objective was to demonstrate the efficacy of a telehealth training course on high-dose-rate (HDR) brachytherapy for gynecologic cancer treatment for clinicians in low- and middle-income countries (LMICs) METHODS A 12-week course consisting of 16 live video sessions was offered to 10 cancer centers in the Middle East, Africa, and Nepal. A total of 46 participants joined the course, and 22 participants, on average, attended each session. Radiation oncologists and medical physicists from 11 US and international institutions prepared and provided lectures for each topic covered in the course. Confidence surveys of 15 practical competencies were administered to participants before and after the course. Competencies focused on HDR commissioning, shielding, treatment planning, radiobiology, and applicators. Pre- and post-program surveys of provider confidence, measured by 5-point Likert scale, were administered and compared. RESULTS Forty-six participants, including seven chief medical physicists, 16 senior medical physicists, five radiation oncologists, and three dosimetrists, representing nine countries attended education sessions. Reported confidence scores, both aggregate and paired, demonstrated increases in confidence in all 15 competencies. Post-curriculum score improvement was statistically significant ( P < .05) for paired respondents in 11 of 15 domains. Absolute improvements were largest for confidence in applicator commissioning (2.3 to 3.8, P = .009), treatment planning system commissioning (2.2 to 3.9, P = .0055), and commissioning an HDR machine (2.2 to 4.0, P = .0031). Overall confidence in providing HDR brachytherapy services safely and teaching other providers increased from 3.1 to 3.8 and 3.0 to 3.5, respectively. CONCLUSION A 12-week, low-cost telehealth training program on HDR brachytherapy improved confidence in treatment delivery and teaching for clinicians in 10 participating LMICs.

Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study

“…According to our current results, only ~11 – 15% of participants received prior web-based training on SRS/SBRT, which can be seen as an opportunity from an optimistic point of view, yet realistically shows an enormous area of improvement. Including innovative approaches based on online lecturing, interactive learning and artificial intelligence might indeed improve educational outcomes, equating access possibilities for LMIC ( 17 , 18 ). Interestingly, participants from institutions where a pre-course debriefing (4 on-site and 2 on-line) took place had increased adherence to the course, in comparison to those who did not (42.3% vs. 20.8%).…”

The state of gynecologic radiation therapy in low- and middle-income countries

“…Today the professional and resident societies, Asociación Ibero Latinoamericana de Terapia Radiante (ALATRO) and Latin American Residents in Radiation Oncology (LARRO), continue to support the development of radiotherapy throughout the Latin America and Caribbean region through educational, research, networking, mentorship, and political advocacy efforts 34–36. Specifically focused on gynecologic malignancies, Rayos Contra Cancer and BIO Ventures for Global Health have established a gynecologic high-dose-rate brachytherapy training program for physicians and physicists to address fundamental gaps in training required to operate their acquired equipment safely and effectively 36 37. Furthermore, the development of such web-based curricula allows has increased providers exposure to other educational topics, including hypofractionation and stereotactic body radiation therapy 38.…”

“…Rayos Contra Cancer (RCC) conducted a pilot study that administered high-dose-rate brachytherapy training via videoconferencing to radiation oncology clinicians, including those in Africa and the Middle East to be followed by site visits with in-person training. This feasible model could broaden the use of brachytherapy for cervical cancer cases globally 37…”

Global Access to Radiotherapy—Work in Progress

“…Hatcher et al's 6 description of brachytherapy training of professionals in a number of LMIC published in this journal provides an excellent example of that can be done with minimal resources to scale up the capacity for modern radiotherapy delivery in LMIC. 6 The authors provided online training to a group of physicists, radiation oncologists, and dosimetrists from cancer centers located in Egypt, Ghana, Iraq, Jordan, Nepal, Nigeria, Mozambique, and Zambia, showing positive educator and learner experience.…”

“…Hatcher et al's 6 description of brachytherapy training of professionals in a number of LMIC published in this journal provides an excellent example of that can be done with minimal resources to scale up the capacity for modern radiotherapy delivery in LMIC. 6 The authors provided online training to a group of physicists, radiation oncologists, and dosimetrists from cancer centers located in Egypt, Ghana, Iraq, Jordan, Nepal, Nigeria, Mozambique, and Zambia, showing positive educator and learner experience. There is a need for systematic application of online learning opportunities with evaluation of the short-term and long-term outcomes in terms of not only learning outcomes but also translation of this new capacity into improved access to state-of-the-art radiotherapy and improved outcomes in recipients’ environments.…”