KEY POINTS
- The IAEA distributed a 121-question survey covering paediatric radiotherapy, imaging, workforce and quality assurance. Responses came from 47 Member States, including 12 high-income, 18 upper-middle-income, 11 lower-middle-income and 6 low-income countries.
- Lower-middle-income settings showed substantial technological progress compared with the 2013 survey. Linac availability increased from 71% to 100%, CT simulator availability from 66% to 91%, electronic portal imaging from 51% to 73%, and IMRT from 15% to 55%.
- Progress was much less consistent in low-income settings. Linac availability remained unchanged at 33%, while reported cobalt-60 availability increased from 67% to 100%. Only 17% reported IMRT access and none reported electronic portal imaging.
- Workload disparities were substantial. Responding centres treated an average of 22 paediatric patients per year in high-income countries compared with 156 per year in low-income countries, despite comparable or smaller staffing complements.
- Specialist paediatric radiotherapy expertise remained limited. Centres reported an average of only 0-2 radiation oncologists specifically trained in paediatric radiotherapy, and low-income respondents reported an average of zero.
- Imaging disparities persisted. PET availability was 58% in high-income centres but 0% in low-income respondents; nuclear medicine departments were available in 92% versus 33%, respectively. Only 33% of low-income respondents reported access to diagnostic and interventional radiology medical physics services.
- Interpretation is limited by survey methodology: only 47 of 157 Member States responded, and each country's response came from a single designated centre. The findings therefore describe participating centres and cannot be assumed to represent all facilities within each country.
CLINICAL TAKEAWAY
Modern paediatric radiotherapy infrastructure has expanded substantially in parts of the world over the past decade, especially for linacs, CT simulation and IMRT. But the data show that access to modern delivery, imaging, QA and specialist training remains highly unequal, making workforce development and basic radiotherapy infrastructure as important as further technological innovation.