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Clin Transl Oncol. 2018 Mar;20(3):402-410. doi: 10.1007/s12094-017-1727-x. Epub 2017 Aug 3.

Infrastructure and equipment for radiation oncology in the Spanish National Health System: analysis of external beam radiotherapy 2015-2020.

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Department of Radiation Oncology, Hospital Ruber Internacional, Calle de la Masó, 38, 28034, Madrid, Spain.
Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona, Spain.
Universitat Pompeu Fabra, San José de la Montaña 12, 08024, Barcelona, Spain.
Facultad de Medicina, Universidad Francisco de Vitoria, Ctra Pozuelo-Majadahonda km 1.800, Pozuelo de Alarcón, 28223, Madrid, Spain.
Department of Radiation Oncology, ERESA Hospital General Universitario, Calle de la Casa Misericordia 12, 46014, Valencia, Spain.
Department of Radiation Oncology, Hospital Universitario de La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain.
Department of Radiation Oncology, Hospital Quirón Zaragoza, Paseo Mariano Renovales, 50006, Saragossa, Spain.
Department of Radiation Oncology, Hospital Universitario Doce de Octubre, Avda de Córdoba s/n, 28041, Madrid, Spain.
Department of Radiation Oncology, Consorcio Hospitalario Provincial de Castellón, Avda del Dr Clará 19, 12002, Castellón, Spain.
Department of Radiation Oncology, Hospital Universitario Dr Negrín, Barranco de la Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.
Clinical Oncology, Universidad de Las Palmas, Las Palmas, Spain.



Planning for radiation oncology requires reliable estimates of both demand for radiotherapy and availability of technological resources. This study compares radiotherapy resources in the 17 regions of the decentralised Spanish National Health System (SNHS).


The Sociedad Española de Oncología Radioterápica (SEOR) performed a cross-sectional survey of all Spanish radiation oncology services (ROS) in 2015. We collected data on SNHS radiotherapy units, recording the year of installation, specific features of linear accelerators (LINACs) and other treatment units, and radiotherapeutic techniques implemented by region. Any machine over 10 years old or lacking a multileaf collimator or portal imaging system was considered obsolete. We performed a k-means clustering analysis using the Hartigan-Wong method to test associations between the gross domestic regional product (GDRP), the number of LINACs per million population and the percentage of LINACs over 10 years old.


The SNHS controls 72 (61%) of the 118 Spanish ROS and has 180 LINACs, or 72.5% of the total public and private resources. The mean rate of LINACs per million population is 3.9 for public ROS, and 42% (n = 75) of the public accelerators were obsolete in 2015: 61 due to age and 14 due to technological capability. There was considerable regional variation in terms of the number and technological capacity of radiotherapy units; correlation between GRDP and resource availability was moderate.


Despite improvements, new investments are still needed to replace obsolete units and increase access to modern radiotherapy. Regular analysis of ROS in each Spanish region is the only strategy for monitoring progress in radiotherapy capacity.


Radiation units obsolescence; Radiotherapy infrastructures; Spanish National Health System

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