Background: Townsville University Hospital provides radiation oncology services to a vast rural and remote catchment in North Queensland, where geographic isolation poses significant barriers to timely curative-intent lung cancer treatment. To address this, we have overhauled our lung SABR protocols since 2022, integrating advanced motion management, tele-medicine, and a structured workforce credentialing system to expand treatment eligibility, reduce patient travel, and ensure sustainable service delivery.
Methods: Our protocol adopts active breath-hold control (ABC) for all lung stereotactic ablative body radiotherapy (SABR) cases. This motion management technology enables safe, precise dose escalation to central tumours and facilitates simultaneous treatment of multiple primary or oligometastatic lesions—indications previously referred to metropolitan centres. Concurrently, we established a tele-radiotherapy clinic for initial consultation and all on-treatment reviews, with patients travelling to Townsville only for CT simulation and the treatment course itself. To address constant staff turnover and upskill new radiotherapists, we implemented an in-housecredentialing and competency-based assessment framework for SABR planning and delivery, integrated with staff long-term rostering. This system incorporates structured supervised proctoring, graduated learning plans, and ongoing practice to ensure involved therapists achieve and maintain proficiency in ABC, online image-guidance, and complex multi-lesion planning, thereby building a resilient and sustainable local workforce.
Results: Since implementation, we have observed increased local treatment capacity for complex lung SABR, with reduced median patient travel distance for consultations. The training and credentialing system has enabled rapid onboarding of new staff while maintaining consistent treatment quality and safety standards.
Conclusions: Our integrated model demonstrates that combining advanced motion management technology, telehealth, and a robust radiotherapist training and credentialing framework is feasible and effective in a remote setting. This approach ensures workforce sustainability despite staff movement, improving long-term access to high-quality lung radiation oncology for regional patients.