An IAEA database helped the recently published Lancet Oncology Commission on Radiotherapy and Theranostics show that the current global distribution of radiotherapy equipment needs an international effort to meet the minimum standards for cancer care.
The commission utilized findings from the DIrectory of RAdiotherapy Centres (DIRAC) database, which for decades has provided doctors, researchers and policymakers with novel insights on the availability of radiotherapy, a key treatment option that nearly half of all cancer patients need at some point. With approximately 200 publications prepared with the DIRAC's information in the past five years alone, these data-driven insights have informed actions and policy dialogues on cancer care across the globe.
Since 1959, the IAEA has maintained an international inventory of radiotherapy centres and equipment. Initially available only in print, the IAEA built a computerized registry in 1995. This repository's current form - DIRAC - consists of information on conventional radiotherapy, proton and light-ion centres; teletherapy machines; brachytherapy equipment; treatment planning systems; computed tomography units; and simulators. The directory is continuously updated with information shared by external sources and with information obtained by the IAEA.
As the world's most comprehensive radiotherapy database, the information contained in DIRAC has been used to plan radiation therapy services and advocate for equitable access to cancer treatment. It has also been utilized to direct investments in health care infrastructure, conduct academic research and place fellows. At present, there are nearly 8800 radiotherapy centres, over 16 000 teletherapy machines and more than 3000 brachytherapy resources worldwide.
DIRAC's data on equipment availability can lead to a greater understanding of needs to ensure timely and high-quality cancer treatment. In high-income countries for example, one teletherapy machine serves over 130 000 people on average but, in low-income countries, this skyrockets to 15.6 million people. To meet the target of one radiotherapy machine for every 500 cancer patients, low-income countries on average need more than eight times their current number of machines. In Africa alone, only 28 of the continent's 54 countries had access to radiotherapy as of March 2020.
"When looking at these figures in the context of radiotherapy trends over time - which is made possible through DIRAC's historical information - it underscores the need to use existing machines more effectively, including through resource-sparing approaches. Thanks to DIRAC, studies like the Lancet Commission on Radiotherapy and Theranostics can undertake more targeted explorations of specific strategies and solutions to accelerate access," said May Abdel-Wahab, the Director of the IAEA's Division of Human Health and one of the commission's leads.
For the World Intellectual Property Organization's (WIPO) Global Innovation Index (GII) 2024 which was released in September, DIRAC helped show a 2.7 per cent increase in global radiotherapy equipment from 2022 to 2023. "WIPO's GII Tracker is not only about tracking global innovation investments - that is easy; metrics such as research and development or venture capital are readily available. Documenting global expenditures on this front is our bread and butter," noted Sacha Wunsch-Vincent, Head of Section in WIPO's Department for Economics and Data Analytics and co-editor of GII. "A more interesting and critical challenge for us is to improve our measurement of technology and innovation adoption - i.e. how do available innovations serve to buttress productivity or the everyday lives of citizens, and this in particular in fields such as health and medical technologies."
To that end, the IAEA developed two distinct indicators leveraging DIRAC's data - one on the global adoption of radiotherapy equipment and the other on access. Data from DIRAC helped WIPO's GII 2023 reveal last year that cancer cases requiring radiotherapy were outpacing available technology. Notably, only 20.9 per cent of countries met the minimum resource requirement in 2022. "Our collaboration with DIRAC is highly innovative and valuable," said Wunsch-Vincent. He added: "We indeed look forward to many more years of collaboration and possible fine tuning and further improvement on how to document the availability of cancer therapy equipment."
"As a precious and unique international resource, DIRAC enables policymakers, researchers and health economists to better comprehend and address a global health challenge that is projected to see 32.6 million new cases and 16.9 million deaths in 2045," said Mauro Carrara, Head of Dosimetry and Medical Radiation Physics in the IAEA's Division of Human Health
