Author: Ruth Afanador, Daniela Branco, John M Bryant, John Campbell, Clement Chaphuka, Samuel A. Einstein, David B. Flint, Jeffrey R. Kemp, Mussa Kumwembe, Daniel J Mollura, Joseph Weygand 👨🔬
Affiliation: RAD-AID International, The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology and Applied Science, Dartmouth Health, UNC Health, Malawi National Cancer Center, Kamuzu Central Hospital, Penn State College of Medicine, Sutter Health, New York University, University of California San Diego / California Protons, Department of Radiation Oncology, Moffitt Cancer Center 🌍
Purpose: Malawi, a landlocked country in southeastern Africa with a population of over 20 million, ranks among the world’s least-developed nations and has the fourth-lowest gross domestic product per capita. Until now, Malawi lacked public radiotherapy services, leaving its population without access to this important treatment option. Efforts are underway to establish the country’s first radiotherapy program at Kamuzu Central Hospital. This project aimed to support the program’s implementation through an international medical physics collaboration focused on training, workflow development, and operational safety.
Methods: Two US-based medical physicists contributed to the program’s establishment through separate visits. The first physicist assisted in commissioning Malawi’s first linear accelerator and conducting a radiation safety survey. The second physicist delivered hands-on training to the local team, focusing on reference dosimetry, machine quality assurance (QA), patient setup, imaging, and radiation safety. Workflows were designed based on international guidelines to ensure safe clinical operations, and a framework for ongoing mentorship and collaboration was developed.
Results: The commissioning of Malawi's first linear accelerator was successfully completed, and the radiation safety survey confirmed that the vault met international safety standards. QA workflows, aligned with AAPM recommendations, were implemented, facilitating treatment accuracy and patient safety. Training sessions improved the local team’s competencies in patient setup and imaging. Persistent challenges were identified, including unreliable internet for system integration and a shortage of medical physicists. Despite these obstacles, the radiotherapy program is scheduled to begin clinical operations in February 2025.
Conclusion: This collaboration advanced efforts to establish public radiotherapy services in Malawi. The contributions of two US-based physicists addressed critical needs in commissioning, training, and workflow development. Continued mentorship, infrastructural upgrades, and capacity building will be essential to sustain the program’s long-term success. This project can serve as a model for future endeavors to introduce radiotherapy services to low-resource regions.