Cloud-based Electronic Infrastructure in Support of Linac-based Radiotherapy in Challenging Environments

This study aims to adapt an existing Cloud-based Electronic Platform (CEP) to facilitate remote treatment planning, research, education and multidisciplinary training partnerships between radiotherapy teams working in high-income countries and those in low and middle-income countries (LMICs) which operate in challenging environments. As part of the proposed 3-month work package, four radiotherapy centre visits will be planned in Nigeria and Ghana as part of this feasibility study.

This proposal forms part of an initiative to design a linear accelerator for radiotherapy (cancer treatment) that is reliable, cost effective and appropriate for use in developing countries. However, the planned integration of novel linac designs require concomitant investments in training, research, data collection and manpower capacity to ensure the delivery of high quality radiotherapy and up-scaling of existing resources.

By evolving and adapting a cloud-based medical informatics infrastructure to support the delivery of radiotherapy based cancer treatment it is expected that the Cloud based electronic platform (CEP) will begin to address these needs. Currently, health records, diagnostic images, and radiotherapy data are located in disparate locations in a clinic and are not readily accessible. A CEP can facilitate the aggregation of these data and provide access to a wider range of services such as on-demand remote linac-based treatment planning, training and knowledge sharing in newer radiation modalities, and research trial participation. It will also facilitate the implementation of standard operating procedures for treatment planning, quality assurance and quality control (QA/QC). Cloud-based peer review allows radiation oncologists serving disparate populations in LMICs and in remote sites elsewhere to get expert advice from their clinical peers for linac-based treatments within each country (as part of a "hub and spoke system") or between international partners. A CEP can also obviate the need for local software modules such as treatment planning software and backup of data. The CEP infrastructure also links in with the linac service training and fault learning project.

Going forward this feasibility project will enable us to design a CEP that meets the unique needs of LMICs, which will subsequently be piloted to demonstrate its potential to support high quality linac-based radiotherapy in challenging environments. In addition it will be expected to develop new sustainable international partnerships between organisations to develop expertise and capacity for radiotherapy delivery in LMICs.

The work is of global importance, and by assessing the feasibility of adapting an existing CEP in Ghana and Nigeria it will undoubtedly provide insights that will be applicable beyond these countries to other LMICs across Africa and Asia. The results of our feasibility study will be published in at least one high income journal and we would expect to present the findings at one or more high impact international cancer conference. E.g. International Union for Cancer Control (UICC) and the American Society for Radiation Oncology (ASTRO).