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Editorial. Focuses on workforce issues in radiation oncology in Australia and New Zealand. Factors that influence structural and operational deficiencies in radiation oncology; Problems with the supply and demand of medical personnel; Discussion on the need to improve the recruitment of personnel in radiation oncology.

Delays in accessing radiation treatment are of concern in Australia and New Zealand, both in terms of the proportion of patients who are actually able to access care, and in the timeliness of starting treatment. For those who are able to access treatment, one in three patients experience an unacceptable delay in starting treatment, and only one in four patients starts radiotherapy within standard good practice times. During the year 2002, more than 15 000 Australians who potentially could have benefited from radiotherapy, did not receive this treatment. For those who were able to access radiotherapy treatment, worsening delays were experienced in Australia, with greater than 40% of patients receiving curative treatment, 30% receiving palliative treatment, and 56% receiving emergency treatment starting outside of standard good practice times. Delays of up to 151 days were experienced in Australia. In Australia, delays in implementing recommendations to improve the infrastructure are resulting in a declining service for cancer patients. In New Zealand, the situation, in general, is improving, although there needs to be an ongoing commitment to grow the service according to the population needs. Urgent implementation of strategic planning is required.

Prior to the dissemination of evidence-based quality assurance guidelines, the Australian National Breast Cancer Centre Radiation Oncology Group conducted a process survey of breast radiotherapy treatment delivery throughout Australia. A process survey was conducted in August/September 1998. This survey comprised questions enquiring about treatment positioning, immobilization devices used, planning strategies, simulation and dose computation methods, treatment prescribing and quality assurance. The survey was sent to 123 Australian fellows of the Royal Australian and New Zealand College of Radiologists (RANZCR) and to the six directors of New Zealand radiation oncology departments. Fifty-eight questionnaires were returned of which 38 were received from individuals and 20 represented a reply from a department with a routine breast radiotherapy protocol (representing an average of 4.5 radiation oncologists per reply). The study identified great consistency between departments with respect to dose and fractionation for breast tangents. The study also identified some areas of treatment planning and delivery that varied between individuals or departments. These mainly reflected a lack of evidence in some areas of radiotherapy treatment delivery. The circulation of quality assurance guidelines will perhaps improve consistency of radiotherapy techniques in which studies have identified that technique changes improve outcome. This study identified that these areas include the taking of simulation and port films and the use of off-axis dosimetry. Further studies are required for areas of radiotherapy treatment delivery that have little evidence for or against their implementation.