1. Klik om de stijl te bewerken VUmc Guidelines for radiotherapy staffing and infrastructure in Europe “QUARTS” Ben Slotman, MD,PhD Professor & Chair VU University medical center Amsterdam, The Netherlands

2. Klik om de stijl te bewerken VUmc 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 resource3-10 K USD(n= 9) –Low resource <3 K USD(n=12)

3. Klik om de stijl te bewerken VUmc 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

4. Klik om de stijl te bewerken VUmc Guidelines linacs available: 17/41 (42%) Population High resources Medium resources Low resources Countries 1 linac per …. 2.500 NP 1.500 NP 500 NP

5. Klik om de stijl te bewerken VUmc Guidelines linacs Country Average (popul.) Range (popul.) Average (patients) Range (patients) High resources1:183.000 80-250.000 1: 458 200-625 Medium resources1:284.000 200-400.000 1: 710 500-1.000 Low resources1:500.000 250-1.000.00 1:1.250 625-2.500

6. Klik om de stijl te bewerken VUmc Radiation oncologists Guidelines available:17 (42%) High43% Med44% Low36% In general: 1 per 250 patients (range 150-400)

7. Klik om de stijl te bewerken VUmc Radiation oncologists Patients Countries High resources Medium resources Low resources

8. Klik om de stijl te bewerken VUmc Physicists Guidelines available:18 (43.9%) High52% Med 33% Low 36% In general 1 per 565 patients (range 300-1.250)

9. Klik om de stijl te bewerken VUmc Physicists Patients Countries High resources Medium resources Low resources

10. Klik om de stijl te bewerken VUmc Technologists Guidelines available:18 (44%) High43% Med56% Low36% Great diversity: in general 2 per linac + for other tasks

11. Klik om de stijl te bewerken VUmc Treatment planning perfomed by HighMed-Low Technologist/dosimetrist42.8% 0.0% Physicists42.8%85.0% Both14.4%15.0%

12. Klik om de stijl te bewerken VUmc Quality assurance performed by HighMed-Low Technologist/Assistant14.3% 0.0% Physicists66.7%90.0% Both19.0%10.0%

13. Klik om de stijl te bewerken VUmc Re-imbursement Great diversity Often more than one system High resourceMedium resourceLow resource Budget-based48%44%91% Case-based24%33%46% Fee for service81%50%18%

14. Klik om de stijl te bewerken VUmc Special re-imbursement High resourceMedium resourceLow resource Intensive/CRT62%33%27% IMRT24%33%9% SRT48%56%9%

15. Klik om de stijl te bewerken VUmc 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 patients with increasing complexity 1 per 200-250 patients Physicists: 1 per 500 patients or 1 per linac

16. Klik om de stijl te bewerken VUmc 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 !

17. Klik om de stijl te bewerken VUmc Evidence-based guidelines

18. Klik om de stijl te bewerken VUmc 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

19. Klik om de stijl te bewerken VUmc Estimated # of linacs per 1.000.000

20. Klik om de stijl te bewerken VUmc Linacs realized and required

21. Klik om de stijl te bewerken VUmc 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