Remote Global Radiation Oncology Education and Training: A Pathway to Increase Access to High-Quality Radiation Therapy Services in Low- and Middle-Income Countries

Awusi Kavuma, Solomon Kibudde, Matthew Schmidt, Tianyu Zhao, Hiram Gay, Benjamin Li, Jeff Michalski, Geoffrey Hugo, Enkhtsetseg Vanchinbazar, Minjmaa Minjgee, Erdenekhuu Nansalmaa, Fred Ssewamala, Angel Velarde, Vicky De Fella, Milton Ixquiac, Lauren Henke, Jacaranda van Rheenen, Baozhou Sun

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Purpose: There is a vital need to train radiation therapy professionals in low- and middle-income countries (LMICs) to develop sustainable cancer treatment capacity and infrastructure. LMICs have started to introduce intensity modulated radiation therapy (IMRT), which is the standard of care in high-income countries, because of improved outcomes and reduced toxicities. This work reports the efficacy of a complementary asynchronous plus synchronous virtual-training approach on improving radiation therapy professions’ self-confidence levels and evaluating participants’ attitudes toward asynchronous and synchronous didactic hands-on learning in 3 LMICs. Methods and Materials: Training was provided to 37 participants from Uganda, Guatemala, and Mongolia, which included 4 theoretical lectures, 4 hands-on sessions, and 8 self-guided online videos. The 36-day training focused on IMRT contouring, site-specific target/organ definition, planning/optimization, and quality assurance. Participants completed pre- and postsession confidence surveys on a 0 to 10 scale, which was converted to a 5-point Likert rating scale to evaluate the training outcomes. The pros and cons of the 3 different training formats were compared. Results: The participants included 15 (40.5%) radiation oncologists, 11 (29.7%) medical physicists, 6 (16.2%) radiation therapists, and 5 (13.5%) dosimetrists. Approximately 50% had more than 10 years of radiation therapy experience, 70.8% had no formal IMRT training, and only 25% had IMRT at their institutions. The average experience and confidence levels in using IMRT at baseline were 3.2 and 2.9, which increased to 5.2 and 4.9 (P <.001) after the theoretical training. After the hands-on training, the experience and confidence levels further improved to 5.4 and 5.5 (P <.001). After the self-guided training, the confidence levels increased further to 6.9 (P <.01). Among the 3 different training sessions, hands-on trainings (58.3%) were most helpful for the development of participants’ IMRT skills, followed by theoretical sessions with 25%. Conclusions: After completing the training sessions, Uganda and Mongolia started IMRT treatments. Remote training provides an excellent and feasible e-learning platform to train radiation therapy professionals in LMICs. The training program improved the IMRT confidence levels and treatment delivery. The hands-on trainings were most preferred.

Original languageEnglish
Article number101180
JournalAdvances in Radiation Oncology
Issue number3
StatePublished - May 1 2023


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