CT Simulator Downtime in Africa: Survey Results from AORTIC 2023

• Published in: International journal of radiation oncology, biology, physics Vol. 120; no. 2; pp. e749 - e750
• Main Authors: Dykstra, M.P., Netherton, T., Lasebikan, N., Ndoli, D.A., Kibudde, S., Mohammed, B.A., Balter, P., Melancon, A.D., Roberts, D., Shah, J.L., Joubert, N., Kitonyi, M.N., Mallum, A., Lazarus, G.L., Waweru, A.K., Shaw, W., Hawley, S., Wallner, L., Court, L.E.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.10.2024
• ISSN: 0360-3016
• DOI: 10.1016/j.ijrobp.2024.07.1645

CT simulation is a requirement for all centers performing 3D conformal radiation therapy and intensity modulated radiation therapy. Little is known about how frequently downtime of CT simulator machines impacts workflow in low- and middle-income countries, nor whether downtime is more commonly caused by intrinsic (tube, gantry, detector, communication system, patient support assembly, reconstructor, intrinsic software, other mechanical) or extrinsic (power, cooling, information transfer system, network down, blocked ports) problems. We sought to characterize CT sim downtime in Africa. A survey was developed to evaluate CT sim downtime over the last year. The survey was distributed to attendees of the African Organization for Research and Training in Cancer (AORTIC) Conference in November 2023, as well as through existing collaborative networks across the African continent. Responses were obtained for a total of 22 CT simulators in 16 centers across 9 countries on the African continent. One center was excluded due to unfinished radiotherapy center with no CT sim installed, leaving 15 centers across 8 countries. Nigeria (n = 6) and South Africa (n = 3) had the most centers represented. Most centers were public (n = 11, 73%), two (13%) were public-private partnerships, and two (13%) were private. Six (40%) respondents were physicists, six (40%) were consultant physicians, and three (20%) were physician trainees. Most centers (n = 9, 60%) had a single CT sim, five (33%) had two CT sims, and one (7%) had three CT sims. Of the 22 CT sims, 13 (59%) were only for radiotherapy planning, eight (36%) were shared with radiology, and one was unknown. Three shared scanners did not have detailed downtime information available. Three CT sims were down all year, two of which were the only CT sim at the center. Annual frequency of unexpected downtime >2 hours over the last year ranged from 0 to 20 episodes, with a median of three episodes. Eleven (58%) machines across ten (67%) centers had total CT sim downtime of ≥15 days. Of these 10 centers, one maintained normal workflow with a CT from diagnostic radiology, two had a CT available only for emergent cases, and seven had no alternate CT simulation capacity. The estimated total days that a CT sim was down from intrinsic causes ranged from 1 to 365 days, with nine (47%) scanners down for ≥10 days. CT sim was down due to extrinsic problems for a range of 0 to 60 days, with four (21%) scanners with downtime of ≥10 days. Twelve centers had CT sims under service contract, one did not, and two respondents were unsure. CT simulator downtime is highly variable across the African continent. Most CT sim problems were intrinsic to the scanner itself. At many centers, downtime can lead to delays on the order of days to weeks. However, for a minority of African radiotherapy centers, CT sim downtime can cause significant limitations in radiotherapy treatment capacity for months at a time.