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Summary The number of patients with cancer in Africa has been predicted to increase from 844 279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to analyse the gaps and needs of the continent for 2030 in the context of the UN Sustainable Development Goals. Data from 54 African countries on teletherapy megavoltage units and brachytherapy afterloaders were extracted from the Directory for Radiotherapy Centres, an electronic, centralised, and continuously updated database of radiotherapy centres. Cancer incidence and future predictions were taken from the GLOBOCAN 2018 database of the International Agency for Research on Cancer. Radiotherapy need was estimated using a 64% radiotherapy utilisation rate, while assuming a machine throughput of 500 patients per year. As of March, 2020, 28 (52%) of 54 countries had access to external beam radiotherapy, 21 (39%) had brachytherapy capacity, and no country had a capacity that matched the estimated treatment need. Median income was an important predictor of the availability of megavoltage machines: US$1883 (IQR 914–3269) in countries without any machines versus $4485 (3079–12480) in countries with at least one megavoltage machine (p=0·0003). If radiotherapy expansion continues at the rate observed over the past 7 years, it is unlikely that the continent will meet its radiotherapy needs. This access gap might impact the ability to achieve the Sustainable Development Goals, particularly the target to reduce preventable, premature mortality by a third, and meet the target of the cervical cancer elimination strategy of 90% with access to treatment. Urgent, novel initiatives in financing and human capacity building are needed to change the trajectory and provide comprehensive cancer care to patients in Africa in the next decade.

This paper reports on the IAEA’s Consultancy Meeting on “low-dose radiation for patients and population —Science, Technology and Society (STS) concepts for communication and perception among medical doctors and stakeholders—”, which was held on October 21 and 22, 2020. The meeting consisted of seven presentation sessions, with a total of 27 presentations and 39 participants from seven countries. The meeting focused on various areas including environmental, food, and personal dosimetry; radiation and other secondary health effects after nuclear disasters; communication between medical professionals and patients or residents; and medical education on nuclear accidents. This meeting was convened to discuss STS perspectives related to nuclear emergencies, to share the findings of the Fukushima Health Management Survey and the current situation in Fukushima with international experts. The meeting confirmed the importance of coordinated recovery of affected areas and global preparedness in the aftermath of nuclear accidents.

Purpose Brachytherapy (BT) is an essential component of definitive therapy for locally advanced cervical cancer. Despite the advantages of the dose distribution with BT in cervical cancer, there is paucity of specific skills required for good-quality BT applications. Furthermore, replacing BT with other modern external beam techniques as a boost can lead to suboptimal results in cervix cancer. Methods and Materials Review of available IAEA resources, research and cooperation programs available from the IAEA was completed. These opportunities can be used to address challenges in Brachytherapy. The International Atomic Energy Agency (IAEA) provides support for BT through various means that includes education and training, both long term, short term and continuing medical education of professionals, providing expert visits to support implementation, development of curricula for professionals, e-learning through the human health campus, contouring workshops, 2D to 3D BT training, and virtual tumor boards. In addition, the IAEA provides support for implementing quality assurance in radiotherapy to its member states and provides guidelines for comprehensive audits in radiation therapy (QUATRO), and produces safety standards and training in radiation safety. In addition, mapping BT resources, making the case for investment and support for setting up BT services and radiotherapy centers are also available. The IAEA Dosimetry Laboratory provides calibration services to Secondary Standards Dosimetry Laboratories for well chambers used to confirm the reference air kerma rate of Co60 and Ir192 high-dose-rate BT sources, as well as for Cs137 low-dose-rate sources. Furthermore, the IAEA supports research and development in radiotherapy (and BT) through coordinated research activities that include controlled randomized clinical trials, Patterns of Care studies among others. Partnerships with professional organizations and funding bodies, as well as through the United Nations Joint Global Programme on Cervical Cancer Prevention and Control support radiotherapy activities, including BT in countries worldwide. Conclusion The IAEA supports brachytherapy implementation, training and research and provides resources to professionals in the area.

The current pandemic has resulted in unprecedented demands on health care systems overloaded with COVID-19–afflicted patients, with the challenges of an insufficient number of beds and insufficient equipment and personal protective equipment for staff. In an effort to spare resources and to minimize exposure of patients and personnel, a shift to limit access only to patients needing essential services was undertaken. This invariably led to decreased access to many routine hospital services. Furthermore, patients themselves were not accessing hospital services because house confinement, social distancing, limitation of gatherings, and general business lockdowns to flatten the curve came into effect. Under these unique circumstances, the move to telemedicine resources became a natural solution to pressing health care needs constrained by the disruptive crisis. Current telemedicine use Telemedicine, or the electronic transmission of medical information via digital communications, has become an essential tool. It has led to a significant increase in the utilization of remote telemedicine and telehealth interventions, with many physicians in some regions using these technologies to manage patients remotely. Expanded use of telemedicine in medical care and teleradiology occurred in tandem with the increased need for social distancing. Telemedicine tools are more commonly used for remote treatment, particularly in the United States, where 63% of health care practitioners have used it. Among physicians currently using telemedicine for consultation, nearly half (48%) are using it for the first time. When the outbreak ends, one-fifth of physicians using telemedicine tools expect to use them significantly more than before the pandemic.1 The COVID-19 pandemic has shone a spotlight on the innovative degree to which eHealth can empower health systems to avoid cross-infection of COVID-19 patients and ensure continuity of essential health services.

The National Cancer Institute's Radiation Research Program, in collaboration with the Radiosurgery Society, hosted a workshop called Understanding High-Dose, Ultra-High Dose Rate and Spatially Fractionated Radiotherapy on August 20 and 21, 2018 to bring together experts in experimental and clinical experience in these and related fields. Critically, the overall aims were to understand the biological underpinning of these emerging techniques and the technical/physical parameters that must be further defined to drive clinical practice through innovative biologically based clinical trials.

Background & Purpose: To report disease-free survival (DFS) for volume-based and point-A based brachytherapy (BT) in locally advanced cervical cancer. Materials & Methods: We conducted a meta-analysis of studies assessing the effects of point-A and volume-based brachytherapy on 3-year DFS. Studies including stage I-IVA cervical cancer patients were included if standard treatment of concomitant chemo-radiotherapy and high-dose- or pulsed dose rate BT was delivered. The primary outcome was 3-year DFS, and secondary outcomes were 3-year local control (LC), 3-year overall survival (OS) and late toxicity. A random-effects subgroup meta-analysis was done. Results: In total, 5499 studies were screened, of which 24 studies with 5488 patients were eligible. There was significant heterogeneity among point-A studies (1538 patients) (I2 = 82%, p < 0.05) relative to volume-based studies (3950 patients) (I2 = 58, p = 0.01). The 3-year DFS for point-A and volume-based studies were 67% (95% CI 60%-73%) and 79% (95% CI 76%-82%) respectively (p = 0.001). Three-year LC for point-A and volume-based studies were 86% (95% CI 81%-90%) and 92% (91%-94%) respectively (p = 0.01). The difference in 3-year OS (72% vs. 79%, p = 0.12) was not statistically significant. The proportion of prospectively enrolled patients was 23% for point-A studies and 33% for volume-based studies. There was no difference in late grade 3 or higher gastrointestinal (3% vs. 4%, p = 0.76) genitourinary toxicities (3% vs. 3% p = 0.45) between the two groups. Conclusion: Volume-based BT results in superior 3-year DFS and 3-year LC. In the absence of randomized trials, this meta-analysis provides the best evidence regarding transition to 3D planning.

Before 2005, cancer and other non-communicable diseases were not yet health and development agenda priorities. Since the 2005 World Health Assembly Resolution, which encouraged WHO, the International Agency for Research on Cancer (IARC), and the International Atomic Energy Agency (IAEA) to jointly work on cancer control, progress was achieved in low-income and middle-income countries on a small scale. Recently, rapid acceleration in UN collaboration and global cancer activities has focused attention in global cancer control. This Policy Review presents the evolution of the IAEA, IARC, and WHO joint advisory service to help countries assess needs and capacities throughout the comprehensive cancer control continuum. We also highlight examples per country, showcasing a snapshot of global good practices to foster an exchange of experiences for continuous improvement in the integrated mission of Programme of Action for Cancer Therapy (imPACT) reviews and follow-up support. The future success of progress in cancer control lies in the high-level political and financial commitments. Linking the improvement of cancer services to the strengthening of health systems after the COVID-19 pandemic will also ensure ongoing advances in the delivery of care across the cancer control continuum.

BACKGROUND AND OBJECTIVE: Borderline resectable pancreatic cancer (BRPC) is a tumor that infiltrates into the large blood vessels, with a high probability that the tumor will remain after surgical resection. To date, there has been no confirmed treatment strategy for BRPC. However, high-level studies, such as those using the intention-to-treat analysis, have recently been published. This review aimed to update the current status of treatment strategies for BRPC. METHODS: We searched for studies, including those investigating patients with BRPC, either treated by upfront surgery or with neoadjuvant treatment and reported the R0 resection rate and overall survival using an intention-to-treat analysis. KEY CONTENT AND FINDINGS: Consequently, 22 articles were identified. Twelve were prospective studies. Six studies compared neoadjuvant therapy with upfront surgery, and both the R0 resection rate and overall survival in patients who underwent upfront surgery were significantly worse than in those who underwent neoadjuvant treatment in all studies. Six studies evaluated neoadjuvant chemotherapy, while 15 studies neoadjuvant chemoradiation. No reports showed the superiority or inferiority of the two methods, and the optimal regimen was not determined in either treatment. The high-precision radiation therapy techniques have been studied, but the optimal method and dose fractionation were unclear. CONCLUSIONS: The current standard of care for the BRPC is neoadjuvant therapy. Although the optimal regimen of neoadjuvant therapy was not determined, several prospective trials are underway to identify the optimal neoadjuvant treatment.

Background and purpose Canada is a high-income country with universal healthcare. In international comparisons, its overall level of access to radiotherapy appears sufficient. However, challenges exist due to Canada’s large geographic area and small population density. The association between access and cancer outcomes nationally has not yet been described. Materials and methods We quantified geographic accessibility for 2012 using the linear distance from each Canadian health region centroid to the nearest radiotherapy center. We used geospatial analytic techniques to detect clusters of age-standardized all-cancer mortality-to-incidence ratios (MIRs) across health regions, from 2010–2012. Global ordinary least squares (OLS) and geographically-weighted regression (GWR) were conducted to examine relationships between distance and MIR, adjusting for sociodemographic factors. Results Median distance from health region centroid to nearest radiotherapy center was 101.73 km (range 1.14–2095.12). One cluster of worse outcomes (MIR range 0.45–0.88) involved most of northern Canada, with a second cluster of better outcomes (MIR range 0.40–0.41) in southern British Columbia. In both regression models, regions with longer distance to radiotherapy center (s = 0.0001), increased smoking (s = 0.002), and poorer food security (s = –0.003) were significantly associated with worse outcomes (OLS R2 = 0.70, GWR R2 = 0.74). Distance remained independently associated with MIR for lung and colorectal cancer subgroups, but not breast and prostate. Conclusions A clear north–south discordance in cancer outcomes exists in Canada, with poorer outcomes in the north, while radiotherapy centers are concentrated along the south. Increased distance to radiotherapy, along with other sociodemographic and health-system factors, are associated with poorer cancer outcomes. Our study could be replicated, particularly in other high-income countries, to help identify national patterns and regional disparities in access and outcomes.

Purpose The American Radium Society Appropriate Use Criteria (ARS AUC) presented in this manuscript are evidence-based guidelines for curative- intent treatment of non-metastatic anal squamous cell cancer that are developed by a multidisciplinary expert panel. Methods Guideline development and systematic review using PRISMA methodology include an extensive analysis of current medical literature from peer-reviewed journals and application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is not definitive, expert opinion may be used to recommend imaging or treatment. Results Evidence-based guidelines are presented about the evaluation and treatment of anal cancer in various clinical scenarios that are derived from supporting literature and multidisciplinary consensus. Conclusions These guidelines are intended for the use of all practitioners and patients who desire information about the management of anal cancer covered in these guidelines.

The diagnosis and treatment of patients with cancer requires access to imaging to ensure accurate management decisions and optimal outcomes. Our global assessment of imaging and nuclear medicine resources identified substantial shortages in equipment and workforce, particularly in low-income and middle-income countries (LMICs). A microsimulation model of 11 cancers showed that the scale-up of imaging would avert 3·2% (2·46 million) of all 76·0 million deaths caused by the modelled cancers worldwide between 2020 and 2030, saving 54·92 million life-years. A comprehensive scale-up of imaging, treatment, and care quality would avert 9·55 million (12·5%) of all cancer deaths caused by the modelled cancers worldwide, saving 232·30 million life-years. Scale-up of imaging would cost US$6·84 billion in 2020-30 but yield lifetime productivity gains of $1·23 trillion worldwide, a net return of $179·19 per $1 invested. Combining the scale-up of imaging, treatment, and quality of care would provide a net benefit of $2·66 trillion and a net return of $12·43 per $1 invested. With the use of a conservative approach regarding human capital, the scale-up of imaging alone would provide a net benefit of $209·46 billion and net return of $31·61 per $1 invested. With comprehensive scale-up, the worldwide net benefit using the human capital approach is $340·42 billion and the return per dollar invested is $2·46. These improved health and economic outcomes hold true across all geographical regions. We propose actions and investments that would enhance access to imaging equipment, workforce capacity, digital technology, radiopharmaceuticals, and research and training programmes in LMICs, to produce massive health and economic benefits and reduce the burden of cancer globally.

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.

BACKGROUND According to the World Health Organization (WHO), non-communicable diseases are responsible for 71% of annual global mortality. National governments and international organizations are increasingly considering medical imaging and nuclear medicine access data in strategies to address epidemiologic priorities. Our objective here was to develop a statistical model to assist countries in estimating their needs for PET-CT systems for the management of specific cancer types. MATERIAL AND METHODS We introduce a patient-centered statistical model based on country-specific epidemiological data, PET-CT performance, and evidence-based clinical guidelines for PET-CT use for cancer. The output of the model was integrated into a Bayesian model to rank countries or world regions that would benefit the most from upscaling PET-CT scanners. RESULTS We applied our model to the IMAGINE database, recently developed by the International Atomic Energy Agency (IAEA). Our model indicates that at least 96 countries should upscale their PET-CT services and more than 200 additional PET-CT scanners would be required to fulfill their needs. The model also provides quantitative evidence indicating that low-income countries would benefit the most from increasing PET-CT provision. Finally, we discuss several cases in which the standard unit [number of scanners]/[million inhabitants] to guide strategic planning or address inequities is misleading. CONCLUSIONS Our model may help in the accurate delineation and further reduction of global inequities in access to PET-CT scanners. As a template, the model also has the potential to estimate the costs and socioeconomic impact of implementing any medical imaging modality for any clinical application.

Summary Background Accurate survival estimates are important for cancer control planning. Although observed survival estimates are unavailable for many countries, where they are available, wide variations are reported. Understanding the impact of specific treatment and imaging modalities can help decision makers to effectively allocate resources to improve cancer survival in their local context. Methods We developed a microsimulation model of stage-specific cancer survival in 200 countries and territories for 11 cancers (oesophagus, stomach, colon, rectum, anus, liver, pancreas, lung, breast, cervix uteri, and prostate) comprising 60% of global diagnosed cancer cases. The model accounts for country-specific availability of treatment (chemotherapy, surgery, radiotherapy, and targeted therapy) and imaging modalities (ultrasound, x-ray, CT, MRI, PET, single-photon emission CT), as well as quality of care. We calibrated the model to reported survival estimates from CONCORD-3 (which reports global trends in cancer survival in 2000–14). We estimated 5-year net survival for diagnosed cancers in each country or territory and estimated potential survival gains from increasing the availability of individual treatment and imaging modalities, and more comprehensive packages of scale-up of these interventions. We report the mean and 95% uncertainty intervals (UIs) for all outcomes, calculated as the 2·5 and 97·5 percentiles of the simulation results. Findings The estimated global 5-year net survival for all 11 cancers combined is 42·6% (95% uncertainty interval 40·3–44·3), with survival in high-income countries being an average of 12 times (range 4–17) higher than that in low-income countries. Expanding availability of surgery or radiotherapy or improving quality of care would yield the largest survival gains in low-income (2·5–3·4 percentage point increase in survival) and lower-middle-income countries (2·4–6·1 percentage point increase), whereas upper-middle-income and high-income countries are more likely to benefit from improved availability of targeted therapy (0·7 percentage point increase for upper-middle income and 0·4 percentage point increase for high income). Investing in medical imaging will also be necessary to achieve substantial survival gains, with traditional modalities estimated to provide the largest gains in low-income settings, while MRI and PET would yield the largest gains in higher-income countries. Simultaneous expansion of treatment, imaging, and quality of care could improve 5-year net survival by more than ten times in low-income countries (3·8% [95% UI 0·5–9·2] to 45·2% [40·2–52·1]) and could more than double 5-year net survival in lower-middle-income countries (20·1% [7·2–31·7] to 47·1% [42·8–50·8]). Interpretation Scaling up both treatment and imaging availability could yield synergistic survival gains for patients with cancer. Expanding traditional modalities in lower-income settings might be a feasible pathway to improve survival before scaling up more modern technologies. Funding Harvard T H Chan School of Public Health.

This manuscript represents a collaboration from an international group of quality and safety expert radiation oncologists. It is a position/review paper with the specific aim of defining the role of the radiation oncologist in quality and safety management. This manuscript is unique in that we recommend specific quality assurance/control tasks and correlated quality and indicators and safety measures that are the responsibility of the radiation oncologist. The article addresses the role of the radiation oncologist in quality and safety from a strong perspective of multidisciplinarity and teamwork. Our manuscript is "cross-cutting" and applicable to radiation oncologist in any practice setting (i.e. low middle-income countries).

The authors P. Orellana and N. El-Haj were inadvertently deleted in the original paper.

Background A high cancer burden exists among indigenous populations worldwide. Canada and Greenland have similar geographic features that make health service delivery challenging. We sought to describe geographic access to radiotherapy for indigenous populations in both regions. Methods We used geospatial analyses to calculate distance and travel-time from indigenous communities in Canada and Greenland to the nearest radiotherapy center. We calculated the proportion of indigenous communities and populations residing within a 1 and 2-hour drive of a radiotherapy center in Canada, and compared the proportion of indigenous versus non-indigenous populations residing within each drive-time area. We calculated the potential distance and travel-time saved if radiotherapy was available in northern Canada (Yellowknife and Iqaluit), and Greenland (Nuuk). Results Median one-way travel from indigenous communities to nearest radiotherapy center in Canada was 268 km (3 h when considering any transportation mode), and 4111 km (6 h by plane) in Greenland. In Canada, 84% and 68% of indigenous communities were outside a 1 and 2-hour drive from a radiotherapy center, respectively. Only 2% of the total population in Canada resided outside a 2-hour drive from a radiotherapy center. However, indigenous peoples were 336 times more likely to live more than a 2-hour drive away, compared to non-indigenous peoples. Nearly 3 million km and 4000 h of travel could be saved over a 10-year period for patients with newly diagnosed cancers in Canada, and 7 million km and 10,000 h in Greenland, if radiotherapy was available in Yellowknife, Iqaluit and Nuuk. Conclusions Geography is an important barrier to accessing radiotherapy for indigenous populations in Canada and Greenland. A significant disparity exists between indigenous and non-indigenous peoples in Canada. Geospatial analyses can help highlight disparities in access to inform radiotherapy service planning.

Aim Preoperative chemoradiation for non-metastatic pancreatic cancer patients has been associated with improved outcomes; however, direct comparisons to adjuvant therapy are limited. Methods Single institution data were obtained for non-metastatic pancreatic cancer patients treated with concurrent chemoradiation +/- resection from 2011-2014. Univariate analyses were performed to evaluate clinical and pathologic outcomes. Results Fifty-two well matched patients met inclusion criteria (neoadjuvant chemoradiation = 21, adjuvant chemoradiation = 11, definitive = 20). Pretreatment median tumor size was 2.6 cm and 2.5 cm after neoadjuvant chemoradiation but 3.2 cm on pathology with treatment effect in 95% of specimens. Clinical node positivity at diagnosis for the neoadjuvant and adjuvant chemoradiation groups was similar (29% and 27% respectively, p=0.12). Twenty-one of the 36 neoadjuvant patients (58%) underwent complete resection. In the neoadjuvant versus adjuvant chemoradiation groups, positive margins were decreased (3% vs. 63%, p

Summary During the past six decades, the International Atomic Energy Agency (IAEA) has helped to address the growing cancer burden, by delivering substantial cancer-related assistance to low-income and middle-income member states. IAEA assistance has primarily been facilitated through sustainable radiotherapy and nuclear medicine programmes to establish safe and effective diagnostic imaging, nuclear medicine, and radiotherapy capacity to safely treat patients with cancer. Planning of a National Cancer Control Programme starts with a needs assessment of all aspects of cancer control in the country to ensure evidence-based strategies are adapted to the country's specific needs. The IAEA offers its member states a tool, known as an integrated mission of Programme of Action for Cancer Therapy Review, to assess the status of national capacities for implementation and delivery of cancer control plans and activities and the readiness to develop and implement a long-term radiation medicine infrastructure and plan to improve capacity.

The aim of this review paper is to examine medical overexposure accidents related to new technologies in radiation therapy during the period 2000–2009. Reported radiation therapy overexposures from 2000 to 2009 were searched in English (mainly) and Japanese. Radiation therapy accidental overexposure incidents relating to new radiation therapy technology reported in the period 2000–2009 were included. Radiotherapy root causes of overexposure were classified into three main groups: “human-,” “system-,” and “equipment-” related errors. A total of 24 of the most serious radiation therapy overexposure accidents were reviewed. The accidents occurred most frequently in patients treated with 3D conformal radiation therapy (11) and stereotactic radiosurgery (7). The majority of the accidents were related to treatment planning procedure (8) and calibration (7) of new equipment or radiotherapy treatment planning system software, followed by accidents in treatment delivery (5), and treatment setup (4). The main causes of the accidents were related to human error—62.5% (15), equipment—29.2% (7), and system—8.3% (2). Several factors have been identified that can have a significant impact on reduction of the number of accidents related to the use of new radiation therapy technologies. These include thorough preparation and management of resources, such as having sufficient number of staff, adequate staff training, risk audits of new technology, quality assurance, and an enhanced safety culture.

The International Atomic Energy Agency (IAEA) has been involved in radiation therapy since soon after its creation in 1957. In response to the demands of Member States, the IAEA׳s activities relating to radiation therapy have focused on supporting low- and middle-income countries to set up radiation therapy facilities, expand the scope of treatments, or gradually transition to new technologies. In addition, the IAEA has been very active in providing internationally harmonized guidelines on clinical, dosimetry, medical physics, and safety aspects of radiation therapy. IAEA clinical research has provided evidence for treatment improvement as well as highly effective resource-sparing interventions. In the process, training of researchers occurs through this program. To provide this support, the IAEA works with its Member States and multiple partners worldwide through several mechanisms. In this article, we review the main activities conducted by the IAEA in support to radiation therapy. IAEA support has been crucial for achieving tangible results in many low- and middle-income countries. However, long-term sustainability of projects can present a challenge, especially when considering health budget constraints and the brain drain of skilled professionals. The need for support remains, with more than 90% of patients in low-income countries lacking access to radiotherapy. Thus, the IAEA is expected to continue its support and strengthen quality radiation therapy treatment of patients with cancer.

The 2019 European Congress of Radiology program, “Women in Focus: Be Inspired,” offered insights from successful women and men for overcoming a number of everyday work and personal life challenges. With regard to balancing career and personal life and achieving well-being, the advice of female and male radiology leaders on the front lines, throughout the world, shares common themes. This paper highlights and expands on points of advice and encouragement from the “Women in Focus” program. The first step is to know yourself, so you can set priorities. Then, take charge, be brave, and follow your dreams, which may not be the same as other people’s. Finding balance requires examining your goals and acknowledging that you may not be able to get everything you want all at once. Receiving effective mentorship from numerous sources is key, as is finding an environment that supports your growth. It is important to surround yourself both at work and at home with people who support your ideas and give you a sense of peace, well-being, and resilience. If the culture does not fit, have the courage to move on. Current leaders should reach out to ensure the diversity of future teams. Society benefits, radiology benefits, and our patients benefit from a specialty that values equity, diversity, and inclusiveness.

The goal of treatment for early stage rectal cancer is to optimize oncologic outcome while minimizing effect of treatment on quality of life. The standard of care treatment for most early rectal cancers is radical surgery alone. Given the morbidity associated with radical surgery, local excision for early rectal cancers has been explored as an alternative approach associated with lower rates of morbidity. The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines for the use of local excision in early stage rectal cancer that include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by a multidisciplinary expert panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. These guidelines are intended for the use of all practitioners and patients who desire information regarding the use of local excision in rectal cancer.

Since radiation accidents, particularly nuclear disasters, are rarer than other types of disasters, a comprehensive radiation disaster medical curriculum for them is currently unavailable. The Fukushima compound disaster has urged the establishment of a new medical curriculum in preparation for any future complex disaster. The medical education will aim to aid decision making on various health risks for workers, vulnerable people, and residents addressing each phase in the disaster. Herein, we introduce 3 novel educational programs that have been initiated to provide students, professionals, and leaders with the knowledge of and skills to elude the social consequences of complex nuclear disasters. The first program concentrates on radiation disaster medicine for medical students at the Fukushima Medical University, together with a science, technology, and society module comprising various topics, such as public risk communication, psychosocial consequences of radiation anxiety, and decision making for radiation disaster. The second program is a Phoenix Leader PhD degree at the Hiroshima University, which aims to develop future leaders who can address the associated scientific, environmental, and social issues. The third program is a Joint Graduate School of Master’s degree in the Division of Disaster and Radiation Medical Sciences at the Nagasaki University and Fukushima Medical University.

Over the last 60 years, the International Atomic Energy Agency (IAEA) has been working to introduce, expand and improve radiotherapy services, working with partners such as the World Health Organization (WHO) to improve cancer diagnosis, treatment, care and control through collective action in low- and middle-income countries (LMICs). The Lancet Oncology Commission on radiotherapy published a report that defined five calls for action to expand global access to radiotherapy, drawing on the previous work of the Global Taskforce on Radiotherapy for Cancer Control. The IAEA supports LMICs in the development of the required national infrastructure and regulatory authority for radiation and nuclear safety and in the training of human resources necessary for the provision of high-quality effective and safe radiation medicine services for the diagnosis, treatment and palliative care of cancer patients, helping in this way to address the different priorities outlined in the Lancet Commission report.

Although not a new concept in itself, competency-based education has set the trend for the globally accepted standard norm for education and training of medical professionals including postgraduate education in radiation oncology. Societal needs demand from radiation oncologists that they be not only competent in the knowledge and skills relevant to their specific discipline, but that they also display competencies such as professionalism, scholarship, health advocacy, management/leadership, collaboration and communication. The realities of developing countries, in particular low and middle income countries (LMICs) set different priorities than in high income countries. A large proportion of cancer patients do not have access to adequate radiotherapy services. Resource constraints determine limitations in equipment, accessories, and dosimetry. Lower than standard staffing levels and limited quality education and training also contribute to substandard care and clinical outcomes. In this environment, the addition and assessment of competency-based elements to training programmes can be challenging. On the other hand, it is precisely in these countries, where competencies such as the ones listed above are highly needed in the radiation oncology profession. Implementation of competency-based medical education in the education of radiation oncologists in LMICs is both a need and a challenge. The available frameworks and competencies, despite being very relevant to the realities faced by radiation oncologists in LMICs, will still need to be adapted in order to ensure effective implementation at the national/regional level. Radiation oncologists need to employ effective change-management strategies to ensure that the changes which are introduced can remain sustainable within the context of national healthcare, education and political systems.

After the March 2011 Fukushima Daiichi Nuclear Power Plant accident, overseas experts and representatives of international organizations visited Japan to provide advice, technical support, and resources. Several international meetings on radiological protection and health issues have since been held in Fukushima to provide further advice. The content discussed has changed alongside local developments in health-related issues from radiation health effects and radiological protection to risk communication and psychological, public health, and social issues. The support of international organizations and experts has been valuable in implementing public health and support programs in Fukushima. The Fukushima accident showed that after a nuclear accident, authorities need to balance the risks of radiation with other health effects and develop programs to mitigate the overall effects on health (whole-health management), but there was little evidence of the importance of this at the time. Future research should examine international collaboration to assess this.