In Canada, the average time of machine operation per day is 10 h. A radiotherapy center is a medical department where patients are treated with usually megavoltage radiotherapy. The definition is not redundant. Centers that use orthovoltage only for skin lesions, radiosurgery only for intracranial disease, brachytherapy only or radiotherapy for veterinarian applications are not considered radiotherapy centers. International regulations on safety require that treatments with ionizing radiation be prescribed by a physician trained and licensed in this discipline and the dosimetry monitored by a trained medical physicist.
Radiotherapy centers location should follow the population concentration distribution in a country. A single center may suffice in small countries or even in large countries with a small population if transport services between population centers are adequate. The centralized comprehensive facility model may be adequate when the distances involved are short, but for longer distances, a fully decentralized service is warranted In large countries, a network of oncology services will be required, with a radiotherapy center within each region.
For those patients, living at a distance from the radiotherapy center, funding will have to be set aside to cover for costs of transport and accommodation facilities, in particular for pediatric patients and their families. Countries where a significant proportion of the population are living at a distance or geographically isolated from the main centers, may also consider either the implementation of consultation clinics as focal points for further referral primary care clinics can fulfill this role or alternatively facilitate patient commuting through an organized transport service.
A similar study from the North of England showed socio-economic gradients in access to services 15 related to education levels and car use. The professional team required to design, construct, and commission a radiotherapy facility needs to be multi-disciplinary because the project not only involves the construction of specialized bunkers to house the radiotherapy imaging and treatment equipment but also needs to take into account the clinical workflow as well as anticipate non-disruptive expansion in the future.
Since the process of radiotherapy is closely related to key staff functions, the detail of the internal design of the facility is important to achieving sound work-place ergonomics and to facilitate workflow. An overall concept design should therefore consist of the five key functional areas, which expedite radiotherapy workflow.
These functional areas are the reception, clinical consulting areas, the imaging and treatment planning area, and the treatment suites teletherapy and brachytherapy. The relative placement of these areas should be adapted to the proposed site and preferred local practice; however, it should expedite broader staff and patient movement, consultation, and communication. Expansion route possibilities are also indicated. Clinically qualified medical physicists are responsible for ensuring that the shielding calculations are based on acceptable estimates of the projected local workload, use, and occupancy factors, and that the design accommodates the desired clinical workflow.
In addition, the future implementation of new techniques and technologies should also be considered. The national radiation safety regulator is mandated to approve the final design prior to construction, and license the facility prior to the initiation of operations.
Timeline synchronization between building a radiotherapy facility, procurement, and installation of equipment and training of staff is very important and has to be planned carefully. If the equipment is installed but the team has not completed their training, the result will be a non-operational facility, which is generating costs but not treating patients. Conversely, if staff completes their training long before the facility is ready, members may be compelled to take other job positions, change career, or emigrate in search of their livelihood.
Our experience indicates that training of a radiotherapy team should start roughly 2 years before the initiation of construction. Funds for staff training must be allocated early and be part of the initial business plan or project proposal. A second teletherapy unit may become necessary to expedite workflow and for back-up. Procurement of new equipment has to be implemented through a transparent tendering process. Since technological developments in radiotherapy occur much faster than the economic lifetime of a linear accelerator, larger radiotherapy centers, which replace one or more machines every few years, enable the introduction of new technology at a faster rate.
The cost and cost-benefit of radiotherapy has been extensively studied. The cost of radiotherapy in a given facility tends to rise as the number of treated patients decreases below , and extended hours of operation do not appear to generate significant, if any, savings when realistic assumptions about machine lifetime and overtime payments are made A very important consideration is staffing levels.
There is very little evidence-based documentation that precisely quantifies the number and type of professionals needed to support a service that is also directly related to patient workload, technology, techniques, procedures, and infrastructure.
As a result, initiation of new radiotherapy services in low and middle-income countries has traditionally been planned in accordance with IAEA guidelines, which list a suite of equipment constituting a basic service that is resourced by a core number of professionals who attend to a given patient workload 18 , These professionals, including radiation oncologists and medical physicists, are required in the practice of radiotherapy under the IAEA International Basic Safety Standards 2.
Staff numbers and training should be adapted to the number of patients treated, the case-mix, the number of courses given per year, the activities performed and the level of complexity of the equipment and techniques. Staffing requirements vary greatly depending on case-mix, type, and complexity of the techniques, research, and teaching commitments.
Staffing levels in the clinical environment are not only important for planning and budgetary purposes and fundamental to quality patient care and safety but they are often also specified for practice accreditation purposes and professional credentialing. The estimation of reasonable staffing levels to support radiotherapy services has often been loosely based on patient population size, infrastructure, equipment availability, and disease incidence.
Retrospective subjective estimates based on existing practice are often the benchmark for predicting future staffing needs locally. Detailed measurements of how long each procedure or activity takes to perform is probably the most objective basic evidence required to estimate full-time equivalent staffing levels Such measurements are logically more useful and valid if they are performed in a variety of clinics, for a range of services and applied to professionals with a wide range of experience.
The concept of access or accessibility to radiotherapy services refers to the fact that these medical services can be utilized by all patients who need them. Access includes availability, accessibility, affordability, accommodation, and awareness of health professionals and the public. The existence of radiotherapy departments or services in a country availability is a necessary but not sufficient condition for access.
For example, a clinic may be geographically inaccessible to patients residing in another region of the country. Or a majority of available clinics in a given country may be private clinics demanding payment for service, which makes them inaccessible to a significant sector of the population below the poverty level. Thus, quality in radiotherapy has different meanings from the perspective of the patient, the professional, or the administrator.
The concept of total quality management TQM consists of organization-wide efforts to install and make permanent a climate in which an organization continuously improves its ability to deliver high-quality products or services to customers, has been borrowed from the industry, particularly from the standardized approach to quality called ISO It is a set of control points that ensures that each element of a process or a series of processes conforms to a pre-established standard.
The idea behind it is that if a process conforms to its standards, then the result will actually meet the expectations. In radiotherapy, the expectations are the control of a cancer with minimal and predictable negative impact on quality-of-life. Quality can be assessed by three different approaches 22 : by the infrastructure, processes, or outcomes. Infrastructure: the rationale is that quality can only be produced within an appropriate infrastructure buildings, staffing, competences and equipment.
Process: a second approach is process control. It is based on the observation that if a process conforms to a standard, then the quality of its results is predictable. Outcomes: the ultimate goal of radiotherapy, as mentioned earlier, is disease control. To assess quality in countries with established services, it is recommended to conduct an annual survey of production, equipment, and personnel of radiotherapy centers.
This should include questions on the number and type of external beam and brachytherapy treatment equipment, absolute number, and number of full-time equivalent radiation oncologists, medical physicists, and radiation technologists and support personnel number of persons in training and vacancies. It is also advisable to select a set of validated quality indicators and apply this set year after year to document the dynamics of the radiotherapy system as a whole.
Budgetary provisions must be set aside for the maintenance of equipment, maintenance service and repairs, replacement of parts and sources, overheads and consumables and training and education of staff. Radiotherapy services should be patient-centered. Main aspects of the service that are important to patients include: receiving the highest level of medical care, a reduction of the waiting time between diagnosis and treatment, appropriate communication with medical and other healthcare staff, obtaining information about their condition and its treatment and convenience of access.
Avoiding excessive waiting time more than 14 days and waiting lists is particularly important. Excessive waiting time for radiotherapy increases the risk of local tumor recurrence and eventual treatment failure Waiting lists for radiotherapy are a highly visible indicator of the inability of the healthcare system to provide the service needed. Patients and families are understandably very sensitive to this problem.
They may approach the media. In several countries, the direct intervention of government even through specific normative has resulted in the reduction or elimination of waiting lists. Obstacles to the effectiveness and efficiency of radiotherapy services at country level include: 1 the lack of a network type organizational structure that would link radiotherapy centers in such a way that it ensures access to a wide range of radiotherapy techniques available, 2 a limited quality management culture with services oriented to the professionals more than to the patients, 3 work organization oriented to the day-to-day practice rather than a medium or long-term strategic planning, and 4 lack of a system of self-evaluation based on carefully recorded clinical outcomes.
Observation and analysis of radiotherapy services planning around the world show that the optimal provision and outcomes are reached when 1 radiotherapy services are centrally planned and monitored through the continued use of validated indicators over time, 2 radiotherapy services are integrated into national cancer control plans, 3 local problems of access to radiotherapy services are systematically identified and addressed, 4 radiotherapy services are given the necessary attention through a combination of political will tapping into resources from government, international organizations and NGOs.
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Radiotherapy for cancer. Acta Oncol 35 Suppl 6 :1— Google Scholar. International Atomic Energy Agency. GSR Part 3 Interim. Vienna: IAEA Dunscombe P. Front Oncol 2 Planning of radiotherapy capacity and productivity. This business plan should feature a three-year profit and loss statement, cash flow analysis, balance sheet, breakeven analysis, and business ratios page.
Special attention should be paid within the business plan to the types of equipment that is going to either be purchased or leased with the capital sought in the business planning document. Given that this is highly specialized medical equipment — can be heavily collateralized by any underlying debt obligation. Within the business plan, complete industry research regarding the radiation oncology market should be included as well.
About 5, of these people are the actual radiation oncology physicians. Beyond the financial information and industry research information, a full demographic analysis should be carried out as well for the specific target market in which the radiation oncology practice whopper operate. This includes over viewing operation age, percentage of people over the age of 65, median household income, median family income, and median household value.
An additional analysis regarding the number of people that have private insurance, Medicare, Medicaid, and state-based health program should also be included as well in order to get an understanding of how the revenue mix will occur as it relates to reimbursement. A radiation oncology marketing plan needs to be developed as well, but this can be done somewhat on a limited basis. Most of these practices have extensive ties with area hospitals, medical schools, teaching hospitals, and related medical entities that will refer their patients to the radiation oncologist in order to have proper treatments carried out.
However, a moderate broad-based marketing plan should be implemented as well within the target market. This includes taking out television advertisements, print advertisements, and maintaining an expansive online presence so that the practice can be easily found among people that have been recently diagnosed with cancer.
As it relates to the proprietary website, a radiation oncology practice should showcase the biographies of key physicians, types of services offered, types of equipment used, insurances accepted, and how to get an appointment with the business. Many of these businesses now have online functionality that allows individuals to immediately contact the business so that an appointment can be made very quickly.
In many cases where a person is very ill, time is of the essence and as such the new technological advances allow individuals to more quickly see physicians. As it relates to print and television advertisements — usually, a third-party marketing and advertising firm is hired to manage this aspect of operations.
Although this contributes to a slightly higher marketing expense, it does reduce the number of personnel that need to be maintained on staff in order to properly enter this market. The return on investment is usually higher when a third-party marketing firm is used rather than hiring and developing and in-house sales and marketing team. A radiation oncology practice SWOT analysis should be produced as well. This analysis focuses on the strengths, weaknesses, opportunities, and threats that are normally faced by these types of companies.
As it relates to strengths, these companies are wholly immune from negative changes in the economy and that people will continue to get sick and require highly specialized medical treatments. For weaknesses, these businesses have very high operating costs given the extensive amount of equipment uneasy maintained and the salaries for highly skilled medical professionals. Additionally, there may be continued advances in medical treatments that allow for cancer to be treated via non-radiation means.
For opportunities, this is quite simple in that these businesses can rapidly expand by acquiring additional equipment, developing additional facilities, and hiring additional staff radiation oncologists in order to render services to the general public. For threats, as this is a medical business there are going to be ongoing issues as it relates to the receipt of reimbursements from Medicare, Medicaid, private insurance, and patient co-pays.
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|Custom dissertation hypothesis ghostwriters sites for college||Minimally invasive, image guided, prostrate ablation for cancer treatment. Additionally, there may be continued advances in medical treatments that allow for cancer to be treated via non-radiation means. A similar study from the North of England showed socio-economic gradients in access to services 15 related to education levels and car use. For weaknesses, these businesses have very high operating costs given the extensive amount of equipment uneasy maintained and the salaries for highly skilled medical professionals. Access includes availability, accessibility, affordability, accommodation, and awareness radiation therapy business plan health professionals and the public. Data from Australia 13 indicates that a curative course of radiotherapy requires an average of 22 fractions and a palliative course four fractions, radiation therapy business plan the total average would be 18 fractions per first course. Timeline synchronization between building a radiotherapy facility, procurement, and installation of equipment and training of staff is very important and has to be planned carefully.|
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