A Pilot Study of Computed Tomography Simulator Downtime at an African Cancer Conference: Survey Results From AORTIC 2023.

Dykstra MP, Netherton TJ, Lasebikan NN, Ndoli DA, Kibudde S, Mohammed BA, Balter P, Melancon AD, Roberts D, Shah JL, Coleman J, Kitonyi MN, Mallum A, Lazarus GL, Waweru AK, Shaw W, Hawley ST, Wallner LP, Court LE. A Pilot Study of Computed Tomography Simulator Downtime at an African Cancer Conference: Survey Results From AORTIC 2023. International journal of radiation oncology, biology, physics. 2025 Aug 1; 122(5):1090-1094, DOI: 10.1016/j.ijrobp.2025.02.019.

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Abstract:

PURPOSE: Computed tomography (CT) simulation is required for centers performing 3-dimensional conformal radiation therapy and intensity modulated radiation therapy. Therefore, CT simulator downtime is likely to lead to delays in patient care. We sought to characterize CT simulator downtime within the African context. METHODS AND MATERIALS: A pilot clinician survey was developed to evaluate CT simulator downtime frequency, causes, and workflow impact over the last year. It was distributed to African Organization for Research and Training in Cancer Conference attendees in November 2023 and through radiation therapy networks on the African continent. Descriptive statistics were used to summarize data. RESULTS: Responses were obtained for 22 CT scanners in 16 centers across 9 African countries. Nigeria (n = 6) and South Africa (n = 3) had the most centers represented. Most centers (n = 10, 63%) had a single CT scanner capable of simulation, 5 (31%) had 2, and 1 (6%) had 3 scanners. For the 19 CT simulators with downtime information available, 11 (58%) were down for at least 15 days in the last year. Median downtime per episode was 3.5 days (IQR, 1-9.75 days). Three CT simulators were down all year, 2 of which were the only CT simulator at their respective centers. CT simulators were down because of intrinsic causes for median 8 days (IQR, 3-37.5 days) and extrinsic causes for median 1 day (IQR, 0-7.5 days). Most machines (n = 17, 77%) were under an active maintenance contract. Most centers (n = 11, 69%) lacked access to an alternate CT scanner for simulation during downtime, whereas 3 (19%) maintained normal workflow. CONCLUSIONS: CT simulator downtime is highly variable across the African continent and can cause significant disruptions in radiation therapy treatment at some centers. Intrinsic causes led to most downtime. These results suggest reducing CT simulator downtime frequency and duration or implementing simulation-free workflows may decrease patient delays.