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A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana

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R Makufa

R Makufa1*, M Bvochora-Nsingo1, T Karumekayi1, RJ Schneider2, JA Efstathiou2,3, S Dryden-Peterson3,4, A Odom5, A Shulman6, Y Pipman7, DP Gierga2,3, (1) Gaborone Private Hospital, Gaborone, Botswana (2) Massachusetts General Hospital, Boston, MA, (3) Harvard Medical School, Boston, MA, (4) Brigham and Women's Hospital, Boston, MA, (5) Associates In Medical Physics, Louisville, KY, (6) Hamad Medical Corporation, Shelbyville, TN, (7) Forest Hills, NY


SU-F-P-9 (Sunday, July 31, 2016) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: The global burden of cancer is considerable, particularly in low and middle-income countries. Massachusetts General Hospital (MGH) and Botswana-Harvard AIDS Institute have partnered with the oncology community and government of Botswana to form BOTSOGO (BOTSwana Oncology Global Outreach) to address the rising burden of cancer in Botswana. Currently, radiation therapy (RT) is only available at a single linear accelerator (LINAC) in Gaborone Private Hospital (GPH). BOTSOGO worked to limit the absence of RT during a LINAC upgrade and ensure a safe transition to modern radiotherapy techniques.

Methods: The existing Elekta Precise LINAC was decommissioned in November 2015 and replaced with a new Elekta VERSA-HD with IMRT/VMAT/CBCT capability. Upgraded treatment planning and record-and-verify systems were also installed. Physicists from GPH and MGH collaborated during an intensive on-site visit in Botswana during the commissioning process. Measurements were performed using newly purchased Sun Nuclear equipment. Photon beams were matched with an existing model to minimize the time needed for beam modeling and machine down time. Additional remote peer review was also employed. Independent dosimetry was performed by irradiating OSLDs, which were subsequently analyzed at MGH.

Results: Photon beam quality agreed with reference data within 0.2%. Electron beam data agreed with example clinical data within 3%. Absolute dose calibration was performed using both IAEA and AAPM protocols. Absolute dose measurements with OSLDs agreed within 5%. Quentry cloud-based software was installed to facilitate remote review of treatment plans. Patient treatments resumed in February 2016. The time without RT was reduced, therefore likely resulting in reduced patient morbidity/mortality.

Conclusions: A global physics collaboration was utilized to commission a modern LINAC in a resource-constrained setting. This can be a useful model in other areas with limited resources. Further use of technology and on-site exchanges will facilitate the introduction of more advanced techniques in Botswana.

Funding Support, Disclosures, and Conflict of Interest: We acknowledge funding support from the AAPM International Educational Activities Committee and the NCI Federal Share Proton Beam Program Income Grant.

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