Barriers and Facilitators of Implementing Automated Radiotherapy Planning: A Multisite Survey of Low- and Middle-Income Country Radiation Oncology Providers

Global access to radiotherapy (RT) is inequitable, with obstacles to implementing modern technologies in low- and middle- income countries (LMICs). The Radiation Planning Assistant (RPA) is a web-based automated RT planning software package intended to increase accessibility of high-quality RT planning. We surveyed LMIC RT providers to identify barriers and facilitators of future RPA deployment and uptake. METHODS: RT providers underwent a pilot RPA teaching session in sub-Saharan Africa (Botswana, South Africa, and Tanzania) and Central America (Guatemala). Thirty providers (30 of 33, 90.9% response rate) participated in a postsession survey. RESULTS: Respondents included physicians (n = 10, 33%), physicists (n = 9, 30%), dosimetrists (n = 8, 27%), residents/registrars (n = 1, 3.3%), radiation therapists (n = 1, 3.3%), and administrators (n = 1, 3.3%). Overall, 86.7% expressed interest in RPA; more respondents expected that RPA would be usable in 2 years (80%) compared with now (60%). Anticipated barriers were lack of reliable internet (80%), potential subscription fees (60%), and need for functionality in additional disease sites (48%). Expected facilitators included decreased workload (80%), decreased planning time (72%), and ability to treat more patients (64%). Forty-four percent anticipated that RPA would help transition from 2-dimensional to 3-dimensional techniques and 48% from 3-dimensional to intensity-modulated radiation treatment. Of a maximum acceptability/feasibility score of 60, physicians (45.6, standard deviation [SD] = 7.5) and dosimetrists (44.3, SD = 9.1) had lower scores than the mean for all respondents (48.3, SD = 7.7) although variation in scores by roles was not significantly different (P = .21). CONCLUSION: These data provide an early assessment and create an initial framework to identify stakeholder needs and establish priorities to address barriers and promote facilitators of RPA deployment and uptake across global sites, as well as to tailor to needs in LMICs.