Investigating a Mobile Radiotherapy Solution for Remote Western Australia
Abstract
Purpose
To establish the feasibility and a development pathway for a fully mobile radiotherapy facility to improve treatment access for rural and remote Western Australians.
Methods
A review was undertaken identifying the impact of distance-to-treatment and general remoteness on treatment access and outcomes. With a focus on the state of Western Australia (approximately four times the size of Texas), a case for service provision was developed based on caseload, identified need and governmental priorities. Following a survey of precedents, potential design solutions were identified and a pathway to develop and deliver the mobile service created.
Results
Geographic barriers to treatment access are acknowledged globally. A reduction in the burden of travel for treatment has been identified as an international priority, with patient transport identified as a principal source of carbon emissions. People living in remote areas of Australia are 1.3 times more likely to die from cancer compared to those living in major cities, with Aboriginal people disproportionately disadvantaged. A truck trailer configuration is proposed using either helical tomotherapy or the implementation of a fixed beamline with a rotating upright support system. Although presenting some treatment limitations relative to C-arm linacs, these designs add mechanical robustness and reduce shielding demands. Recent developments in treatment technology, digital solutions including automation and hypofractionation help make the mobile approach viable. The optimal technical and operational design needs to balance health economics, clinical needs and the psycho-social needs of the patient population. The established development pathway will take approximately 6 years and a budget of approximately $13M USD, requiring a consortium of government, commercial, regulatory and community partners to progress.
Conclusion
A substantial case was found for a mobile radiotherapy solution to overcome inequities in treatment access for rural and remote cancer patients. Design solutions have been proposed and a pathway to implementation developed.