The number of people per radiotherapy machine per African country

Designing new radiotherapy technologies to treat cancer in low and middle-income countries

June 11, 2020

Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity (ITAR)

A new project, “Innovative Technologies towards building Affordable and equitable global Radiotherapy capacity” (ITAR), supported by the Science and Technology Facilities Council (STFC), aims to design and develop new radiotherapy technologies to give more cancer patients in Sub-Saharan Africa access to treatment and to save lives. The project will contribute to the development of novel radiotherapy machines, specifically designed to meet the needs of African hospitals. The challenge brings together an international team of accelerator physicists and engineers, medical physicists, radiobiologists, radiation oncologists, radiologists, IT experts, and health system researchers.

The state of cancer care

The number of people per radiotherapy machine per African country

The annual global incidence of cancer is projected to rise to 27.5 million cases by 2040, leading to more than 13 million deaths. Up to 70 percent of these will occur in low and middle-income countries (LMICs). Radiotherapy is an essential component of cancer care being a very effective means of curing the disease, as well as palliative treatment, and where available, is used to treat more than half of patients.

Many low and middle-income countries in Africa have acute shortages of radiotherapy machines. In the lowest-income countries, only four percent of cancer patients that need radiotherapy treatment are able to be treated. There are currently only 385 radiotherapy machines in the region, and 60 percent of those are located in just three countries – South Africa, Egypt and Morocco.

A report by the Lancet Oncology Commission – Global Task Force on Radiotherapy for Cancer Control (GTFRCC) of the Union for International Cancer Control (UICC) recently estimated that by 2035 at least 5,000 additional megavolt-class treatment machines would be needed to meet radiotherapy demands in low-and middle-income African countries.

A collaborative effort

The ITAR project, a critical part of a larger international project that includes the International Cancer Expert Corps (ICEC), CERN, STFC (Daresbury Laboratory), and Lancaster University, is led by Lancaster University and Oxford University and will bring together partners from the Cockcroft Institute, STFC’s Accelerator Science and Technology Centre (ASTeC), John Adams Institute, Swansea University, King’s College London, ICEC and CERN.

In ITAR’s first phase, the project will define the persistent shortfalls in basic infrastructure, equipment and specialist workforce which remain barriers to effective radiotherapy delivery, and develop novel solutions leading to a detailed specification and conceptual design. The project will then progress to a prototype development phase at STFC’s Daresbury Laboratory.

Professor Manjit Dosanjh, from CERN and Oxford University, and member of the ICEC Board of Directors, and who leads the overall international project, said: “I am really excited that the idea, first presented by Dr Norman Coleman of the International Cancer Expert Corps at the 2014 ICTR-PHE meeting held in Geneva, continues to flourish. Having Lancaster and Oxford Universities, along with Daresbury Laboratory and others working on this with STFC’s critical support and ICEC’s expertise, is a significant step in addressing the need for a novel medical linear particle accelerator to generate the radiation for LMICs and other challenging environments.”

Local stakeholder participation is vital to the project’s success

Dr. Taofeeq Ige (National Hospital Abuja, Nigeria) in front of one of the hospitals radiotherapy LINACs

Dr. Taofeeq Ige (National Hospital Abuja, Nigeria) in front of one of the hospital’s radiotherapy LINACs.

A critical aspect of the project’s challenge cluster is the involvement of the international partners. Dr. Taofeeq Ige and Dr. Simeon Aruah, of the National Hospital Abuja, Nigeria, and Dr. Surbhi Grover, of the Botswana-UPENN Partnership and Princess Marina Hospital, are key partners working in African hospitals. They will gather information from a network of other hospitals in Botswana, Ghana, Kenya, Nigeria, South Africa, Tanzania, Zambia and Zimbabwe and play a key role in the definition of the specification for the new machines.

In addition, ICEC provides a network of international oncologists, medical physicists, and engineers working in radiotherapy systems. They are already providing training and mentorship in lower- and middle-income countries and will continue with their assistance in the development of the radiotherapy system in this project.

Professor Graeme Burt, of Lancaster University and the Cockcroft Institute, and who is leading the phase 1 project said: “Current radiotherapy machines are optimised for use in western countries. The ITAR project aims to design specifically for use in Africa making it far more tolerant to the local environment, which will greatly increase the capacity for more lives to be saved.”

Professor Deepa Angal-Kalinin, of STFC and the Cockcroft Institute, University of Manchester, and who is leading the accelerator design said: “I am keen to apply the knowledge and expertise at Daresbury Laboratory to develop a novel medical linac design in this phase of the project which will prepare us to build a prototype to test our novel ideas.”

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Emphasizing the critical importance of EXPERTISE

A Broad Impact for Global Oncology
JAMA Oncology, August 8, 2019. Co-authors from International Cancer Expert Corps

Emphasizing the critical importance of EXPERTISE, the article, “A Broad Impact for Global Oncology” available at the bottom of this post and online at, emphasizes the breadth of opportunities for global oncology. The critical need for mentorship is a driving force of ICEC with the creation of a career path being essential.  The breadth of expertise required- noted on the ICEC website- creates an opportunity for many participants in all stages of their careers.

Figure 1 from the paper includes all that can be accomplished, requiring global partnerships, innovative thinking and built up Expertise.

The paper concludes: “The size and complexity of the problems present a grand challenge worthy of the best minds and transformational approaches, often requiring partnerships that have the potential for common projects even among countries and neighbors who have political conflicts. How could one not want to eradicate cancer and its deleterious impact? The Figure provides the components and benefits of a systems approach that supports leading-edge science and technology but, critically, pays attention to those populations historically and currently left behind in the trailing-edge turbulence of inequality. In this way, creativity, innovation, altruism, and commitment can bring rewarding results.”

The critical need for mentorship is a driving force of ICEC with the creation of a career path being essential.  The breadth of expertise required- noted on the ICEC website- creates an opportunity for many participants in all stages of their careers.

A Broad Impact for Global Oncology

A Broad Impact for Global Oncology

Global oncology demands attention, with approximately 9 million people dying from cancer annually. It provides an extraordinary opportunity to address the urgent need for cancer care and be a catalyst for solutions to address critical societal issues including the disruptive forces in and among countries involving the health of individuals and the planet, relationships among cultures, the digital revolution, inequality, and the sociopolitical conflict of globalism vs isolationism.  Read the article published online in JAMA Oncology

Job opportunity with the IAEA

Great opportunity to work at the IAEA! A 2-year global health position is for a Junior professional (JPO) in the Division of Human Health (NAHU) supported through the US government.   Click here for job listing. Apply through Argonne National labs.

April 30th deadline!


“I think the message is very simple: it’s wasteful not to invest in health”

The alarming report released by the WHO details the staggering drain that disease has on the African economy. It projects that by 2030, the loss in GDP could be almost $1.7 trillion unless ambitious goals to increase the investment in health care improvement are met. The report also highlights the large percentage (37%) that non-communicable diseases account for in this burden. The necessary shift to translate political commitments into investment is possible by implementing changes not only to treat disease but to promote good health and prevention.
Read more…

ICEC’s response to The Lancet, “Offline: Why has global health forgotten cancer?”

ICEC’s response to Richard Horton’s thoughtful commentary, “Offline: Why has global health forgotten cancer?” was published in The Lancet.

While prevention is critical, tackling cancer is about much more than just prevention. “The solution to the deficit of global cancer care is a systematic approach to build expertise, capacity, and capability using a sustainable model that recognizes the mutually beneficial links among cancer, the other non-communicable diseases, infectious diseases, and health-care systems, while also producing economic benefit”. Read more…

Developing Innovative, Robust and Affordable Medical Linear Accelerators for Challenging Environments

Motivated by stunning projections regarding the rise of cancer cases globally to 25 million cases in 2035 with 70% of those occurring in low- and middle- income countries, coupled with the paucity of access to radiotherapy treatment – an essential component of curative and palliative care – a group of individuals from the International Cancer Expert Corps (ICEC), Science and Technology Facilities Council (STFC UK), CERN and others, took on the challenge to meet the demands for cancer care focusing on the need to develop a medical linear accelerator to be used in resource-limited settings.  Read the Editorial in Clinical Oncology