Radiation oncology in Australia: Workforce, workloads and equipment 1986–1999

Abstract

Regular national surveys of all public and private radiation oncology facilities in Australia have been carried out between 1986 and 1999. Workforce data recorded were numbers of radiation oncologists and trainees, radiation therapists, medical physicists and physics technicians, nursing staff, data managers, social workers and clerical staff. Workloads included treatments with megavoltage beams (linear accelerators, cobalt-60), orthovoltage/superficial X-rays, brachytherapy, total body irradiation and stereotactic radiosurgery. Major equipment recorded included numbers of megavoltage and orthovoltage/superficial X-ray machines, planning simulators, computerized dosimetry systems and brachytherapy equipment. The use of radiotherapy beds and the public-private mix of treatments were also documented. Data were assembled for Australia based on each individual state. Within Australia the number of public and private treatment facilities has increased by 44% from 18 in 1986 to 26 in 1999. The population has increased by 16.4%, cancer incidence by 51.8% and megavoltage workloads (fields) by 102%. The number of radiation therapists and physicists and the number of linear accelerators have, in general, increased with the growth in workloads. The number of radiation oncologists has increased by 60% from 4.5 full-time equivalent (FTE) radiation oncologists per million population in 1986 to 7.2 per million in 1999. There is currently a deficit of at least 40 radiation oncologists to be able to treat the 50% of newly diagnosed cancer patients requiring radiotherapy. In addition, a significant deficiency exists in numbers of radiation therapists, nursing staff, data managers, social workers and clerical staff. Clearly the demands for medical physicists has increased but the data are insufficient to comment on deficiencies. Despite the increases in workloads the proportion of patients with cancer receiving radiotherapy remains below 40%. A positive correlation has been shown between the proportion of newly diagnosed cancer patients treated and the number of FTE radiation oncologists, the number of megavoltage machines and number of radiation therapists. This was shown for Australia as a whole, for each state and for the years 1986 to 1999. This was also the case when total megavoltage fields was used as the dependent variable. Multiple regression analysis using the same independent variables confirmed these positive correlations. It is concluded that the low treatment rate with radiation oncology for cancer patients in Australia is due mainly to the lack of resource allocation. The stated commitment of governments and health departments to a 50% treatment rate can only become a reality if there is a concerted effort to increase the numbers of radiation oncologists, radiation therapists, megavoltage machines and support staff. Otherwise at least one in every 10 newly diagnosed cancer patients will continue to be denied adequate and equitable access to radiotherapy - in 1999 that total figure was 9400 persons.

Effects of Millimetric Shifts in Breast Cancer Radiotherapy on the Radiation Dose Distribution

“…We designed t his study to make the decision making process easier in relation to intrafractional moves in order to decrease the workload of oncology departments (Wigg DR and Morgan GW, 2001). Heart volume dose changes were between 5.2%-7.7.…”

“…Physicians and medical physicist work together during the planning part; the technicians play a big role during its practice. The most important part is the correction implementation of plan and practice (Wigg et al, 2001). The practice must be carried out precisely as it has been planned.…”

Australian radiation therapy: an overview — Part one

“…36 This was mirrored by Bourne 27 who stated that as the treatment planning and delivery became more complex, the number of patients and the number of fields used to deliver the treatment began to increase at a seemingly faster rate than the growth of the population.…”

Medical physics publishing in a changing research environment: the Australasian Physical & Engineering Sciences in Medicine 40th anniversary editorial

“…The number of accelerators in Australia is presented in Fig. 1, using data reported in the 1975 volume of The Radiographer [21][22][23][24][25][26] (assuming no decommissionings prior to 1970), as well as more-recent workforce reports [27,28] and other documents [29][30][31].…”