Radiation therapy is a critical component for curative and palliative treatment of cancer and is used in more than half of all patients with cancer. Yet there is a global shortage of access to this treatment, especially in Sub-Saharan Africa, where there is a shortage of technical staff as well as equipment. Linear accelerators (LINACs) offer state-of-the-art treatment, but this technology is expensive to acquire, operate and service, especially for low- and middle-income countries (LMICs), and often their harsh environment negatively affects the performance of LINACs, causing downtime.

A global initiative was launched in 2016 to address the technology and system barriers to providing radiation therapy in LMICs through the development of a novel LINAC-based radiation therapy system designed for their challenging environments. As the LINAC prototype design phase progressed, it was recognised that additional information was needed from LMICs on the performance of LINAC components, on variables that may influence machine performance and their association, if any, with equipment downtime. Thus, a survey was developed to collect these data from all countries in Africa that have LINAC-based radiation therapy facilities. In order to understand the extent to which these performance factors are the same or different in high-income countries, facilities in Canada, Switzerland, the UK and the USA were invited to participate in the survey, as was Jordan, a middle-income country. Throughout this process, LMIC representatives have provided input on technology challenges in their respective countries.

This report presents the method used to conduct this multilevel study of the macro- and microenvironments, the organisation of departments, the technology, the training and the service models that will provide input into the design of a LINAC prototype for a LINAC-based radiation therapy system that will improve access to radiation therapy and thus improve cancer treatment outcomes. It is important to note that new technology should be introduced in a contextual manner so as not to disrupt existing health systems inadvertently, especially with regards to existing staffing, infrastructure and socioeconomic issues. A detailed analysis of data is underway and will be presented in a follow-up report. Selected preliminary results of the study are the observation that LINAC-based facilities in LMICs experience downtime associated with failures in multileaf collimators and vacuum pumps, as well as power instability. Also, that there is a strong association of gross national product per capita with the number of LINACs per population.

放射治疗是癌症治愈性和姑息性治疗的重要组成部分，超过一半的癌症患者使用放射治疗。然而，全球缺乏获得这种治疗的机会，特别是在撒哈拉以南非洲，那里技术人员和设备都短缺。直线加速器 (LINAC) 提供最先进的处理方法，但该技术的获取、运行和服务成本高昂，尤其是对于中低收入国家 (LMIC)，而且其恶劣的环境通常会对性能产生负面影响LINAC，导致停机。

2016 年启动了一项全球倡议，旨在通过开发一种新型的基于 LINAC 的放射治疗系统来解决在中低收入国家提供放射治疗的技术和系统障碍。随着 LINAC 原型设计阶段的进展，人们认识到需要从 LMIC 获得关于 LINAC 组件性能、可能影响机器性能的变量以及它们与设备停机时间的关联（如果有的话）的更多信息。因此，开展了一项调查，以从拥有基于 LINAC 的放射治疗设施的所有非洲国家收集这些数据。为了了解这些绩效因素在高收入国家的相同或不同程度，加拿大、瑞士、英国和美国的设施被邀请参加调查，约旦也是中等收入国家。在整个过程中，LMIC 代表就各自国家的技术挑战提供了意见。

本报告介绍了用于对宏观和微观环境、部门组织、技术、培训和服务模型进行多层次研究的方法，这些模型将为基于 LINAC 的放射治疗的 LINAC 原型设计提供输入系统将改善获得放射治疗的机会，从而改善癌症治疗结果。重要的是要注意，新技术的引入应结合上下文，以免无意中破坏现有的卫生系统，尤其是在现有人员配备、基础设施和社会经济问题方面。正在对数据进行详细分析，并将在后续报告中提出。该研究的选定初步结果是观察到 LMIC 中基于 LINAC 的设施经历与多叶准直器和真空泵故障以及功率不稳定相关的停机时间。此外，人均国民生产总值与人均 LINAC 数量之间存在很强的关联。