Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa

Paul Njom Mobit; Nicholas Ade

doi:doi:10.11648/j.rst.20220802.12

| Peer-Reviewed

Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa

Paul Njom Mobit, Nicholas Ade

Published in Radiation Science and Technology (Volume 8, Issue 2)

Received: 5 May 2022 Accepted: 28 May 2022 Published: 9 June 2022

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

With increasing cancer incidence in Africa, a number of Sub-Saharan African countries have started implementing radiotherapy programs based on linear accelerator (linac) technology. This work summarizes the commissioning experience of a commercially available medical linac installed in a resource-limited oncology centre in Cameroon for the delivery of high-quality radiation treatments to cancer patients in central Africa. Cameroon is a central African country in Sub-Saharan Africa. Using a 2D water phantom and various ionization chambers, we measured commissioning data for a medical linac with 6X and 18X photon beams, and five electron energies ranging from 6–20 MeV. Relative measurements included percent depth doses (PDDs), beam profiles, scatter factors, wedge factors, and electron cone factors. Absolute calibrations of the beam energies were performed using the American Association of Physicist in Medicine Task Group Report 51. Accurate calibrations were checked by irradiating the mailed thermoluminescent dosimeters service offered by MD Anderson Cancer Center. Photon PDDs agreed within 1% of the average of several linacs of the same type at depths between 5 and 20 cm, which are consistent with the data used by the manufacturer for acceptance testing. For electrons, the agreement was within 2 mm for R₅₀, R₉₀, R_p, and d_max. Symmetry and flatness for all photon and electron beams were within 2% for various fields. All absolute calibrations met the MD Anderson Cancer Center criteria within 3%. This work presents the successful implementation and modernization of a radiotherapy program based on linac technology in the central African sub-region in Sub-Saharan Africa. As the first operational medical linac in the sub-region, the commissioning data can provide comparison data to other linacs in the future to ensure high-quality of machine commissioning for clinical use.

Published in	Radiation Science and Technology (Volume 8, Issue 2)
DOI	10.11648/j.rst.20220802.12
Page(s)	30-37
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Radiotherapy, Medical Linac, Commissioning Experience, Cameroon Oncology Center

References

[1]	Organization and training in radiotherapy for developing countries in Africa. (1991). IAEA-TECDOC-614, IAEA, Vienna.
[2]	IAEA International Atomic Energy Agency. (2008). Setting up a radiotherapy program: clinical, medical physics, radiation protection and safety aspect. IAEA, Vienna.
[3]	Ferlay, J., Ervik, M., Lam, F., et al., eds. (2020) Global Cancer Observatory: Cancer Today. International Agency for Research on Cancer. https://gco.iarc.fr/today. Accessed June 30, 2021.
[4]	Soerjomataram, I., & Bray, F. (2021). Planning for tomorrow: global cancer incidence and the role of prevention 2020–2070. Nat Rev Clin Oncol, 18 (10), 663–672.
[5]	IAEA International Atomic Energy Agency. (2016) Accuracy Requirements and Uncertainties in Radiotherapy, IAEA Human Health Series No. 31. IAEA, Vienna.
[6]	IARC, World Health Organization International Agency for Research on Cancer. (2021). GLOBOCAN 2020: Estimated cancer incidence, mortality and prevalence worldwide in 2020. https://gco.iarc.fr/today/fact-sheets-populations. Accessed 13 July 2021.
[7]	Sung, H., Ferlay, J., & Siegel, R. L. (2021). Laversanne M, Soerjomataram I, Jemel A, Bray F. Global Can Statistics 2020: Globocan estimates of incidence and mortality for 36 cancers in 185 countries. CA Cancer J Clin, 71 (3), 209–249.
[8]	Ferlay, J, Ervik M, Lam F, et al. (2018). Cancer today: data visualization tools for exploring the global cancer burden in 2020. Lyon, France: IARC. https://gco.iarc.fr/today.
[9]	WHO World Health Organization. (2020). WHO report on cancer: setting priorities, investing wisely and providing care for all. WHO.
[10]	Abdel-Wahab, M., Bourque, J. M., Pynda, Y., Iżewska, J., Van der Merwe, D., Zubizarreta, E., & Eduardo, R. (2013). Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. Lancet Oncol, 14, e168–e175.
[11]	Yao, Q., Zou, L., Lan, H., Luo, S., Lu, S., Lang, J., & Xu, C. (2020). Initial experience of a tele-radiotherapy system for training radiation oncologists in rural areas. J Canc Educ. doi: 10.1007/s13187-020-01836-9.
[12]	Podgorsak, E. B. (2005). Radiation Oncology Physics: A handbook for teachers and students. IAEA Vienna.
[13]	Gao, S., Balter, P. A., Rose, M., & Simon, W. E. (2016). A comparison of methods for monitoring photon beam energy constancy. J Appl Clin Med Phys, 17 (6), 242–53.
[14]	Lloyd, S. A. M., Zavgorodni, S., & Gagne, I. M. (2015). Comparison of measured Varian Clinac 21EX and TrueBeam accelerator electron field characteristics. J Appl Clin Med Phys, 16 (4), 193–201.
[15]	Almond, P. R., Biggs, P. J., Coursey, B. M., Hanson, W. F., Huq, M. S., Nath, R., & Rogers, D. W. (1999). AAPM’s TG-51 protocol for clinical reference dosimetry of high-energy photon and electron beams. Med Phys, 26 (9), 1847–70.
[16]	Wang, Y., Khan, M. K., Ting, J. Y., & Easterling, S. B. (2012). Surface Dose Investigation of the Flattening Filter-Free Photon Beams. Int J Radiation Oncol Biol Phys, 83 (2), e281–e285.
[17]	Sun, L. M., Huang, C. J., Chen, H. Y, et al. (2016). Evaluating the consistency of location of the most severe acute skin reaction and highest skin dose measured by thermoluminescent dosimeter during radiotherapy for breast cancer. Med Dosim, 41 (3), 216–20.
[18]	McDermott, P. N. (2020). Surface dose and acute skin reactions in external beam breast radiotherapy. Med Dosim, 45 (2), 153–158.
[19]	Lee, N., Chuang, C., Quivery, J. M., et al. (2002). Skin toxicity due to intensity modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys, 53 (3), 630–637.
[20]	Van Kleffens, H., Venselaar, J., Heukelom, S., Jager, N., Mijnheer, B., van der Laarse, R., van Gasteren, H., & Westermann, C. (1999). Dependence of the tray transmission factor on the collimator setting in high-energy photon beams. Med Phys, 27 (9), 2117–2123.
[21]	Glide-Hurst, C., Bellon, M., Foster, R., Altunbas, C., Speiser, M., Altman, M. et al. (2013). Commissioning of the Varian TrueBeam linear accelerator: A multi-institutional study. Med Phys, 40 (3), 031719.

Cite This Article

Plain Text BibTeX RIS

APA Style

Paul Njom Mobit, Nicholas Ade. (2022). Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiation Science and Technology, 8(2), 30-37. https://doi.org/10.11648/j.rst.20220802.12

Copy | Download

ACS Style

Paul Njom Mobit; Nicholas Ade. Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiat. Sci. Technol. 2022, 8(2), 30-37. doi: 10.11648/j.rst.20220802.12

Copy | Download

AMA Style

Paul Njom Mobit, Nicholas Ade. Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiat Sci Technol. 2022;8(2):30-37. doi: 10.11648/j.rst.20220802.12

Copy | Download

@article{10.11648/j.rst.20220802.12,
  author = {Paul Njom Mobit and Nicholas Ade},
  title = {Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa},
  journal = {Radiation Science and Technology},
  volume = {8},
  number = {2},
  pages = {30-37},
  doi = {10.11648/j.rst.20220802.12},
  url = {https://doi.org/10.11648/j.rst.20220802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.rst.20220802.12},
  abstract = {With increasing cancer incidence in Africa, a number of Sub-Saharan African countries have started implementing radiotherapy programs based on linear accelerator (linac) technology. This work summarizes the commissioning experience of a commercially available medical linac installed in a resource-limited oncology centre in Cameroon for the delivery of high-quality radiation treatments to cancer patients in central Africa. Cameroon is a central African country in Sub-Saharan Africa. Using a 2D water phantom and various ionization chambers, we measured commissioning data for a medical linac with 6X and 18X photon beams, and five electron energies ranging from 6–20 MeV. Relative measurements included percent depth doses (PDDs), beam profiles, scatter factors, wedge factors, and electron cone factors. Absolute calibrations of the beam energies were performed using the American Association of Physicist in Medicine Task Group Report 51. Accurate calibrations were checked by irradiating the mailed thermoluminescent dosimeters service offered by MD Anderson Cancer Center. Photon PDDs agreed within 1% of the average of several linacs of the same type at depths between 5 and 20 cm, which are consistent with the data used by the manufacturer for acceptance testing. For electrons, the agreement was within 2 mm for R50, R90, Rp, and dmax. Symmetry and flatness for all photon and electron beams were within 2% for various fields. All absolute calibrations met the MD Anderson Cancer Center criteria within 3%. This work presents the successful implementation and modernization of a radiotherapy program based on linac technology in the central African sub-region in Sub-Saharan Africa. As the first operational medical linac in the sub-region, the commissioning data can provide comparison data to other linacs in the future to ensure high-quality of machine commissioning for clinical use.},
 year = {2022}
}

Copy | Download

TY - JOUR
T1 - Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa
AU - Paul Njom Mobit
AU - Nicholas Ade
Y1 - 2022/06/09
PY - 2022
N1 - https://doi.org/10.11648/j.rst.20220802.12
DO - 10.11648/j.rst.20220802.12
T2 - Radiation Science and Technology
JF - Radiation Science and Technology
JO - Radiation Science and Technology
SP - 30
EP - 37
PB - Science Publishing Group
SN - 2575-5943
UR - https://doi.org/10.11648/j.rst.20220802.12
AB - With increasing cancer incidence in Africa, a number of Sub-Saharan African countries have started implementing radiotherapy programs based on linear accelerator (linac) technology. This work summarizes the commissioning experience of a commercially available medical linac installed in a resource-limited oncology centre in Cameroon for the delivery of high-quality radiation treatments to cancer patients in central Africa. Cameroon is a central African country in Sub-Saharan Africa. Using a 2D water phantom and various ionization chambers, we measured commissioning data for a medical linac with 6X and 18X photon beams, and five electron energies ranging from 6–20 MeV. Relative measurements included percent depth doses (PDDs), beam profiles, scatter factors, wedge factors, and electron cone factors. Absolute calibrations of the beam energies were performed using the American Association of Physicist in Medicine Task Group Report 51. Accurate calibrations were checked by irradiating the mailed thermoluminescent dosimeters service offered by MD Anderson Cancer Center. Photon PDDs agreed within 1% of the average of several linacs of the same type at depths between 5 and 20 cm, which are consistent with the data used by the manufacturer for acceptance testing. For electrons, the agreement was within 2 mm for R50, R90, Rp, and dmax. Symmetry and flatness for all photon and electron beams were within 2% for various fields. All absolute calibrations met the MD Anderson Cancer Center criteria within 3%. This work presents the successful implementation and modernization of a radiotherapy program based on linac technology in the central African sub-region in Sub-Saharan Africa. As the first operational medical linac in the sub-region, the commissioning data can provide comparison data to other linacs in the future to ensure high-quality of machine commissioning for clinical use.
VL - 8
IS - 2
ER -

Copy | Download

Author Information

Paul Njom Mobit

Department of Radiation Oncology, Cameroon Oncology Center, Douala, Cameroon
Nicholas Ade

Department of Radiation Oncology, Cameroon Oncology Center, Douala, Cameroon

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Paul Njom Mobit, Nicholas Ade. (2022). Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiation Science and Technology, 8(2), 30-37. https://doi.org/10.11648/j.rst.20220802.12

Copy | Download

ACS Style

Paul Njom Mobit; Nicholas Ade. Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiat. Sci. Technol. 2022, 8(2), 30-37. doi: 10.11648/j.rst.20220802.12

Copy | Download

AMA Style

Paul Njom Mobit, Nicholas Ade. Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa. Radiat Sci Technol. 2022;8(2):30-37. doi: 10.11648/j.rst.20220802.12

Copy | Download

@article{10.11648/j.rst.20220802.12,
  author = {Paul Njom Mobit and Nicholas Ade},
  title = {Commissioning Experience of a Medical Linear Accelerator in a Low-Resource Setting in Sub-Saharan Africa},
  journal = {Radiation Science and Technology},
  volume = {8},
  number = {2},
  pages = {30-37},
  doi = {10.11648/j.rst.20220802.12},
  url = {https://doi.org/10.11648/j.rst.20220802.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.rst.20220802.12},
  abstract = {With increasing cancer incidence in Africa, a number of Sub-Saharan African countries have started implementing radiotherapy programs based on linear accelerator (linac) technology. This work summarizes the commissioning experience of a commercially available medical linac installed in a resource-limited oncology centre in Cameroon for the delivery of high-quality radiation treatments to cancer patients in central Africa. Cameroon is a central African country in Sub-Saharan Africa. Using a 2D water phantom and various ionization chambers, we measured commissioning data for a medical linac with 6X and 18X photon beams, and five electron energies ranging from 6–20 MeV. Relative measurements included percent depth doses (PDDs), beam profiles, scatter factors, wedge factors, and electron cone factors. Absolute calibrations of the beam energies were performed using the American Association of Physicist in Medicine Task Group Report 51. Accurate calibrations were checked by irradiating the mailed thermoluminescent dosimeters service offered by MD Anderson Cancer Center. Photon PDDs agreed within 1% of the average of several linacs of the same type at depths between 5 and 20 cm, which are consistent with the data used by the manufacturer for acceptance testing. For electrons, the agreement was within 2 mm for R50, R90, Rp, and dmax. Symmetry and flatness for all photon and electron beams were within 2% for various fields. All absolute calibrations met the MD Anderson Cancer Center criteria within 3%. This work presents the successful implementation and modernization of a radiotherapy program based on linac technology in the central African sub-region in Sub-Saharan Africa. As the first operational medical linac in the sub-region, the commissioning data can provide comparison data to other linacs in the future to ensure high-quality of machine commissioning for clinical use.},
 year = {2022}
}

Copy | Download