Cancer treatment machines in Africa break down far too often, leaving patients without access to radiotherapy for weeks at a time. A survey of 28 African countries found that medical linear accelerators (M-LINACs) suffer frequent breakdowns of specific components, especially the multi-leaf collimators that shape radiation beams to match tumours. There is also a severe shortage of trained physicists to maintain and improve these machines. SAPPHIRE will train junior African physicists to collect detailed fault and usage data from M-LINACs in Ghana and South Africa, including environmental factors such as temperature, humidity, and voltage stability. The team will analyse this data to understand why components fail and to design more robust multi-leaf collimators. They will test candidate designs against current commercial machines using real patient treatment plans. If successful, the project will produce a fault-tolerant M-LINAC tailored for low- and middle-income countries, with deployment targeted by 2030. It will also build lasting expertise among African physicists, enabling them to lead future improvements in radiotherapy infrastructure rather than relying on external support.
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Vision: SAPPHIRE is a UK-African research and training partnership which will build capacity in Africa to obtain better fault information of M-LINACs and to feed into an M-LINAC tailored to low- and middle-income countries (LMICs). Importance: Our previous STFC funded ITAR project surveyed 28 African countries, revealing two major challenges: 1) many African M-LINACs suffer from considerable down-time down due to frequent breakdowns of specific components; and 2) a shortfall exists in radiotherapy workforce, especially trained physicists. Team: We will bring together M-LINAC facilities in Accra and Kumasi (Ghana) and Pretoria (South Africa), two STFC accelerator centres in Oxford & Lancaster, and medical physics expertise from Cambridge in partnership with CERN and ICEC. Our global team has decades of experience in accelerator and M-LINAC research and has engaged in collaboration with African partners since 2010. Areas of Focus: Specific focus will be given to post-acceleration beam-shaping systems that match radiation beam to tumour target (i.e. multi-leaf collimator devices). MLCs are prone to frequent breakdowns. Project SAPPHIRE has 3 key objectives: Objective 1: To identify junior physicists in Africa to train in electronic data collection and analysis of usage and fault data from M-LINAC stock in their own centres. Objective 2: To use gathered data to assess the effect of faults and to define MLC tolerances, studying different candidate leaf designs for an improved and robust MLC unit. Objective 3: To compare the performance of candidate designs with current-generation commercial M-LINAC devices for treatment planning using real-world clinical data. We will achieve these objectives through four key Physics Education And Research Linkage work packages (PEARLs): PEARL-1 Data Capture. We will create a solution for electronic data capture (EDC) of M-LINAC fault and usage data, enhanced with key environmental factors (e.g. operating temperature, voltage stability, humidity and atmospheric particulate levels). Hasford, Addison and Nethwadzi will supervise training of junior physicists for EDC work in Ghana and South Africa. PEARL-2 MLC Improvements. Dosanjh, Burt, Addison, Hasford and Nethwadzi will develop an understanding of the causes of MLC faults, analyse the implications on the radiation patterns using Geant4 and develop improvements of the MLC design. This will allow researchers throughout our collaboration to investigate the relationship between reported fault and environmental data and the design constraints of the MLC. PEARL-3 Training workshops. Burt, Dosanjh, Jena, Ayette, Addison, Grover, Hasford, and Nethwadzi will establish two physics schools in Africa, first one in Ghana focussing on LINACs, their sub-components and faults/maintenance of those system and the second in Pretoria focussing on radiation physics simulations and imaging and treatment planning. PEARL-4 Treatment planning. Jena, Dosanjh, Ayette and Grover, will compare the performance of candidate hardware designs with current-generation commercial M-LINAC devices in a suite of treatment planning tasks typical of today’s clinical demands. Pathway to success: 1) We have a rich and capable multi-professional team and a long track record of successful collaboration. 2) We will make lasting impact through successful upskilling of junior physics staff in Africa, to perform better research and development in M-LINAC component design and operational robustness. 3) Data from SAPPHIRE will be used by our global consortium (ICEC) to design and deploy a novel fault tolerant M-LINAC design for LMICs by 2030.
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