Japanese Structure Survey of Radiation Oncology in 2011.

We evaluated the evolving structure of radiation oncology in Japan in terms of equipment, personnel, patient load and geographic distribution to identify and overcome any existing limitations. From March 2012 to August 2015, the Japanese Society for Radiation Oncology conducted a questionnaire based on the Japanese national structure survey of radiation oncology in 2011. Data were analyzed based on the institutional stratification by the annual number of new patients treated with radiotherapy per institution. The estimated annual numbers of new and total (new plus repeat) patients treated with radiation were 211 000 and 250 000, respectively. Additionally, the estimated cancer incidence was 851 537 cases with approximately 24.8% of all newly diagnosed patients being treated with radiation. The types and numbers of treatment devices actually used included linear accelerator (LINAC; n = 836), telecobalt (n = 3), Gamma Knife (n = 46), 60Co remote afterloading system (RALS; n = 24), and 192Ir RALS (n = 125). The LINAC system used dual-energy functions in 619 units, 3D conformal radiotherapy functions in 719 and intensity-modulated radiotherapy (IMRT) functions in 412. There were 756 JRS or JASTRO-certified radiation oncologists, 1018.5 full-time equivalent (FTE) radiation oncologists, 2026.7 FTE radiotherapy technologists, 149.1 FTE medical physicists, 141.5 FTE radiotherapy quality managers and 716.3 FTE nurses. The frequency of IMRT use significantly increased during this time. To conclude, although there was a shortage of personnel in 2011, the Japanese structure of radiation oncology has clearly improved in terms of equipment and utility.

PREFACE

We highly appreciate the substantial contributions of the many radiation oncologists (ROs), radiation technologists and other staff to the national structure survey of radiation oncology. Despite some delays, the updated Japanese national structure survey data of radiation oncology in 2011 is now available.

Table 3

Annual number of new patients by scale classification and institution category

Scale category (number of institutions)	Institution category (number of institutions)						Total (694)	Average
	U (111)	G (28)	N (58)	P (198)	O (177)	H (122)
A (111)	212	75	591	2318	2342	1491	7029	63.3
B (232)	1380	244	4100	10 443	10 820	5891	32 878	141.7
C (135)	3331	575	2736	9134	11 025	5900	32 701	242.2
D (82)	6594	1825	1401	7549	5486	5576	28 431	346.7
E (52)	7679	440	1249	3049	5282	5402	23 101	444.3
F (82)	34 532	15 544	721	2649	2931	4938	61 315	747.7
Total (694)	53 728	18 703	10 798	35 142	37 886	29,198	185 455	267.2
Average	484.0	668.0	186.2	177.5	214.0	239.3	267.2

Table 14

Classification of institutions by number of FTE radiation oncologists in all radiotherapy institutions and designated cancer care hospitals

Institution category	Description	Institutions
RH-A	All radiotherapy hospitals (FTE RO ≥1.0)	394
RH-B	All radiotherapy hospitals (FTE RO <1.0)	300
Total		694
DCCH-A	Designated cancer care hospitals (FTE RO ≥1.0)	272
DCCH-B	Designated cancer care hospitals (FTE RO <1.0)	108
Total		380

FTE = full-time equivalent, RO = radiation oncologist.

Distribution of annual total (new plus repeat) patient load per LINAC in radiotherapy institutions. Horizontal axis represents institutions arranged in order of increasing value of annual number of total patients per LINAC within the institution. Q1: 0–25%, Q2: 26–50%, Q3: 51–75%, Q4: 76–100%.

Distribution of annual total (new plus repeat) patient load per FTE radiation oncologist in all radiotherapy institutions. Horizontal axis represents institutions arranged in order of increasing value of annual number of total patients per FTE radiation oncologist within the institution. Q1: 0–25%, Q2: 26–50%, Q3: 51–75%, Q4: 76–100%.

Distribution of annual total (new plus repeat) patient load per FTE radiotherapy technologist (RTT) in all radiotherapy institutions. Horizontal axis represents institutions arranged in order of increasing value of annual number of total patients per FTE RTT within the institution. Q1: 0–25%, Q2: 26–50%, Q3: 51–75%, Q4: 76–100%.

Distribution of annual total (new plus repeat) patient load per FTE radiation oncologist in designated cancer care hospitals. Horizontal axis represents institutions arranged in order of increasing value of annual number of total patients per FTE radiation oncologist within the institution. Q1: 0–25%, Q2: 26–50%, Q3: 51–75%, Q4: 76–100%.

Since 1991, the Japanese Society for Radiation Oncology (JASTRO) has conducted national structure surveys every 2 years [1-25]. From March 2012 to August 2015, a questionnaire regarding the 2011 national structure survey of radiation oncology was conducted that included the number of treatment systems by type, number of personnel by category and number of patients by type, site and treatment modality. To measure variables over a longer time period, data for the year 2011 were also considered. In total, 694 of 787 active institutions attempted the survey; the response rate was 88.2%.

The current report analyzes these institutional structure data (equipment, personnel, patient load and geographic distribution) based on institutional stratification by the annual number of new patients treated with radiotherapy at each institution. Clinical working hours of each staff member performing radiotherapy were derived from full-time equivalent (FTE; 40 h per week for radiation oncology work only) data. The Japanese Blue Book Guidelines (JBBG) [26, 27] were used for comparison with the results of this study. These guidelines pertain to the structure of radiation oncology in Japan based on Patterns of Care Study (PCS) [28, 29] data. The standard guidelines were set at 250–300 (warning level, 400) for annual patient load per external beam machine, at 200 (warning level, 300) for annual patient load per FTE RO and at 120 (warning level, 200) for annual patient load per FTE radiotherapy technologist. Furthermore, we analyzed data from the designated cancer care hospitals accredited by the Ministry of Health, Labor and Welfare. As on 1 October 2016, Japan had 427 designated cancer care hospitals [30]. Forty-seven institutions did not return the survey; therefore, the structure data for these 380 designated cancer care hospitals were analyzed and compared with the data for all radiotherapy hospitals. The analysis was conducted in two groups: institutions with <1.0 FTE RO and those with ≥1.0 FTE RO.

Here, preliminary results have been presented as tables and figures (Tables 1–18 and Figs 1–6). We have briefly summarized the Japanese national structure survey of radiation oncology for 2011. In total, 787

Table 1

Category of radiotherapy institution

Institution category
U	University hospital
G	Cancer center (including national centers)
N	National hospital organization (excluding cancer centers)
P	Public hospital (excluding cancer centers)
O	Red cross hospital, saiseikai hospital, company hospital, public corporation hospital, national health insurance hospital, social insurance hospital, mutual insurance hospital, industrial accident hospital, association hospital and Japan agricultural co-operative hospital
H	Medical corporation hospital, medical association hospital, private hospital and other hospital

Table 18

Number of radiotherapy institutions, treatment devices, patient load and personnel: trend 1990–2011

Survey year
	1990	1993	1995	1997	1999	2001	2003	2005	2007	2009	2010	2011
Institution	378	629	504	568	636	603	726	712	721	700	705	694
Response rate	48.5%	88.3%	73.9%	78.6%	86.3%	85.3%	100%	96.9%	94.2%	90.9%	90.4%	88.2%
New patients	62 829	—	71 696	84 379	107 150	118 016	149 793	156 318	170 229	182 390	190 322	185 455
Total patients	—	—	—	—	—	—	—	191 173	205 087	217 829	226 851	220 092
Average of new patients	166	—	142	149	168	196	206	220	236	261	270	267
Treatment device (actual use)
LINAC	311	508	407	475	626	626	744	765	807	816	829	836
Telecobalt	170	213	127	98	83	45	42	11	15	11	9	3
192Ir RALS	—	—	29	50	73	93	117	119	123	130	131	125
Full time RO	547	748	821	889	925	878	921	1003	1007	1085	1123	1102
FTE RO	—	—	—	—	—	—	—	774	826	939	959	1019
Full time JASTRO-certified RO	—	—	—	—	—	308	369	426	477	529	564	756
FTE RT technologist	592	877	665	733	771	918	1555	1635	1634	1836	1841	2027
Treatment planning equipment
X-ray simulators	295	430	394	452	512	464	532	502	445	361	348	320
CT simulators	30	75	55	96	164	247	329	407	497	575	633	654
RTP computers	238	468	374	453	682	680	874	940	1070	1271	1381	1484

LINAC = linear accelerator, Ir = iridium, RO = radiation oncologist, FTE = full-time equivalent, JASTRO = Japanese Society for Radiation Oncology, RT = radiotherapy, JRS = Japan Radiological Society, JASTRO = Japanese Society for Radiation Oncology, CT = computed tomography, RTP = radiotherapy planning.

Fig. 1

Estimate of increase in demand for radiotherapy in Japan, based on statistical correction of annual change in the number of new patients per year at Patterns of Care Study survey facilities [26]. x and o denote the estimated number of total (new plus repeat) and new patients by the results in structure surveys by the JASTRO.

Fig. 6

Distribution of annual total (new plus repeat) patient load per FTE radiotherapy technologist (RTT) in designated cancer care hospitals. Horizontal axis represents institutions arranged in order of increasing value of annual number of total patients per FTE RTT within the institution. Q1: 0–25%, Q2: 26–50%, Q3: 51–75%, Q4: 76–100%.

radiotherapy institutions were surveyed, and the estimated number of new patients was approximately 211 000, whereas that of total patients (new plus repeat) was 250 000. The estimated annual numbers of patients treated with radiation had not increased since 2010. It is assumed that there are two reasons for the above. First, because the response rate of this survey was lower than usual, the calculation of the estimated value had even more errors than usual. Secondly, the treatment time for each patient has increased because of an increase in the number of patients with high-precision radiotherapy such as SBRT and IMRT. In 2011, based on Japanese cancer registries, the cancer incidence was estimated at 851 537 cases [31] with approximately 24.8% (211 000 of 851 537) of all newly diagnosed patients being treated with radiation. Overall, 836 linear accelerators (LINACs), 3 telecobalt units, 46 Gamma Knife, 24 60Co remote afterloading systems (RALS) and 125 192Ir RALS were actually used. The LINAC system used dual-energy functions in 619 units, 3D conformal radiotherapy functions in 719 and intensity-modulated radiotherapy (IMRT) functions in 412. Regarding personnel, there were a total 756 board-certified ROs [JASTRO or JRS (Japan Radiological Society)], 1018.5 FTE ROs, 2026.7 FTE radiotherapy technologists, 149.1 FTE medical physicists, 141.5 FTE radiotherapy quality managers and 716.3 FTE nurses. Approximately 50.6% of all radiotherapy institutions had >200 new radiotherapy patients per year, whereas 31.1% of the institutions had >300. Additionally, 43.2% of all radiotherapy institutions had <1.0 FTE ROs. We expect that this updated national structure survey of radiation oncology for 2011 will aid the continuous improvement of all aspects of radiation oncology in Japan.

Table 2

Number of radiotherapy institutions by scale classification and institution category

Scale category (annual number of new patients)	Institution category						Total	Institution ratio [%]
	U	G	N	P	O	H
A (≤99)	5	1	11	41	32	21	111	16.0
B (100–199)	10	2	28	78	73	41	232	33.4
C (200–299)	13	2	11	46	39	24	135	19.5
D (300–399)	19	5	4	16	22	16	82	11.8
E (400–499)	17	1	3	12	7	12	52	7.5
F (≥500)	47	17	1	5	4	8	82	11.8
Total	111	28	58	198	177	122	694
Institution ratio [%]	16.0	4.0	8.4	28.5	25.5	17.6		100.0

Table 4

Annual number of total (new plus repeat) patients by scale classification and institution category

Scale category (number of institutions)	Institution category (number of institutions)						Total (694)	Average
	U (111)	G (28)	N (58)	P (198)	O (177)	H (122)
A (111)	227	135	745	2757	2633	1814	8311	74.9
B (232)	1600	254	4828	12 413	11 896	7113	38 104	164.2
C (135)	3861	726	3210	13 168	10 580	7561	39 106	289.7
D (82)	7890	2202	1602	6411	9560	6805	34 470	420.4
E (52)	9493	565	1444	6227	3735	6452	27 916	536.8
F (82)	40 135	18 867	800	3,355	2987	6041	72 185	880.3
Total (694)	63 206	22 749	12 629	44 331	41 391	35 786	220 092	317.1
Average	569.4	812.5	217.7	223.9	233.8	293.3	317.1

Table 5

Number of treatment devices and their functions by scale classification

Treatment devices and their functions	Scale category (number of institutions)						Total (694)
	A (111)	B (232)	C (135)	D (82)	E (52)	F (82)
LINAC	108	224	139	105	82	178	836
with dual energy function	56	163	108	85	62	145	619
with 3DCRT function (MLC width ≤1.0 cm)	74	180	120	98	76	171	719
with IMRT function	16	75	62	71	53	144	421
with cone beam CT or CT on rail	11	61	55	47	42	78	294
with treatment position verification system (x-ray perspective image)	22	57	56	47	39	76	297
with treatment position verification system (other than those above)	16	56	40	39	18	65	234
Annual no. patients/LINAC	77.0	170.1	281.3	328.3	340.4	405.5	263.3
CyberKnife®	2	4	2	4	2	3	17
Novalis®	1	3	4	9	6	8	31
Tomotherapy®	0	4	1	4	5	1	15
Particle	0	1	0	1	1	9	12
Microtoron	0	5	0	3	0	3	11
Telecobalt (actual use)	1 (1)	1 (2)	1 (0)	0 (0)	0 (0)	0 (0)	3 (3)
Gamma Knife®	5	10	9	8	8	6	46
Other accelerator	0	1	3	0	0	1	5
Other external irradiation device	0	1	2	0	0	4	7
New type 60Co RALS (actual use)	0 (0)	3 (3)	5 (4)	4 (4)	4 (4)	3 (3)	19 (18)
Old type 60Co RALS (actual use)	1 (0)	4 (3)	5 (2)	0 (0)	2 (1)	0 (0)	12 (6)
192Ir RALS (actual use)	1 (0)	9 (8)	15 (13)	23 (22)	21 (21)	61 (61)	130 (125)
137Cs RALS (actual use)	0 (0)	0 (0)	1 (1)	0 (0)	0 (0)	1 (0)	2 (1)

LINAC = linear accelerator, 3DCRT = 3D conformal radiotherapy, MLC = multileaf collimator, IMRT = intensity-modulated radiotherapy, CT = computed tomography, Co = cobalt, RALS = remote-controlled after-loading system, Ir = iridium, Cs = caesium.

Table 6

Number of treatment planning equipment and accessories by scale classification

Treatment planning equipment and accessories	Scale category (number of institutions)						Total (694)
	A (111)	B (232)	C (135)	D (82)	E (52)	F (82)
X-ray simulator	49	96	46	41	27	61	320
CT simulator	86	206	128	85	52	97	654
RTP computer (≥2)	116 (14)	306 (51)	221 (53)	194 (46)	188 (41)	459 (77)	1484 (282)
X-ray CT (≥2)	186 (66)	526 (188)	380 (117)	274 (79)	187 (47)	434 (80)	1987 (577)
for RT only	35	127	93	71	40	91	457
MRI (≥2)	128 (25)	326 (93)	244 (99)	172 (66)	129 (46)	251 (74)	1250 (403)
for RT only	1	2	5	6	6	3	23
Computer use for RT recording	113	281	165	104	65	116	844
Water phantom (≥2)	109 (18)	266 (53)	170 (43)	112 (29)	88 (24)	171 (48)	916 (215)
Film densitometer (≥2)	32 (2)	93 (1)	70 (0)	60 (1)	50 (7)	84 (9)	389 (20)
Dosemeter (≥3)	281 (46)	759 (141)	497 (80)	362 (58)	279 (40)	540 (70)	2718 (435)

CT = computed tomography, RTP = radiotherapy planning, MRI = magnetic resonance imaging, RT = radiotherapy.

Table 7

Number of personnel and annual patients by scale classification

	Scale category (number of institutions)						Total (694)
	A (111)	B (232)	C (135)	D (82)	E (52)	F (82)
Scale (annual no. of new patients)	≤99	100–199	200–299	300–399	400–499	≥500
Institution ratio [%]	16.0%	33.4%	19.5%	11.8%	7.5%	11.8%	100%
New patients	7029	32 878	32 701	28 431	23 101	61 315	185 455
New patients/institution	63.3	141.7	242.2	346.7	444.3	747.7	267.2
Total patients	8311	38 104	39 106	34 470	27 916	72 185	220 092
Total patients/institution	74.9	164.2	289.7	420.4	536.8	880.3	317.1
Beds	37 008	99 656	65 101	46 505	33 805	64 075	346 150
Institutions with RT beds (%)	19 (17.1)	52 (22.4)	39 (28.9)	28 (34.1)	28 (53.8)	56 (68.3)	222 (32)
RT beds	64.5	256.5	205.0	165.5	296.0	827.7	1,815.2
RT beds/total beds (%)	0.2%	0.3%	0.3%	0.4%	0.9%	1.3%	0.5%
RT beds/institution	0.6	1.1	1.5	2.0	5.7	10.1	2.6
RT beds/institution with RT beds	3.4	4.9	5.3	5.9	10.6	14.8	8.2
JRS-certified institutions (%)	3 (2.7)	31 (13.4)	43 (31.9)	48 (58.5)	37 (71.2)	74 (90.2)	236 (34)
JRS-cooperation institutions (%)	37 (33.3)	111 (47.8)	52 (38.5)	27 (32.9)	10 (19.2)	16 (19.5)	253 (36.5)
JASTRO-certified institutions (%)	1 (0.9)	47 (20.3)	59 (43.7)	57 (69.5)	41 (78.8)	78 (95.1)	283 (40.8)
JRS membership (full time)	50	176	135	143	122	415	1041
JASTRO membership (full time)	35	160	130	132	113	415	985
JRS or JASTRO-certified ROs (full time)	22	133	115	108	86	292	756
Institutions with full time RO (%)	44 (39.6)	151 (65.1)	109 (80.7)	78 (95.1)	49 (94.2)	82 (100)	513 (73.9)
ROs (full time)	59	190	145	149	130	429	1,102
ROs (full time)/institution	0.5	0.8	1.1	1.8	2.5	5.2	1.6
FTE RO (full time)	24.4	145.0	125.3	121.9	103.1	359.4	878.9
FTE RO (full time)/institution	0.22	0.63	0.93	1.49	1.98	4.38	1.27
ROs (part time)	90	201	104	57	63	103	618
ROs (part time)/institution	0.81	0.87	0.77	0.70	1.21	1.26	0.89
FTE RO (part time)	15.2	34.8	19.3	9.6	15.0	45.8	139.6
FTE RO (part time)/institution	0.1	0.1	0.1	0.1	0.3	0.6	0.2
FTE RO (full plus part time)	39.6	179.8	144.5	131.5	118.1	405.2	1018.5
FTE RO (full plus part time)/institution	0.36	0.77	1.07	1.60	2.27	4.94	1.47
Radiologists (full time)	116.0	437.0	380.8	380.0	315.0	901.0	2,529.8
Radiologists (part time)	134.7	360.0	240.1	144.9	105.0	173.0	1157.7
RTTs (full time)*	331	800	547	415	308	696	3097
FTE RTT	156.0	470.1	334.5	286.4	228.8	551.0	2026.7
Medical physicists (full-time)*	14	71	49	66	43	104	347
FTE Medical physicist	4.4	25.2	18.5	25.2	19.0	56.9	149.1
RT quality manager (full-time)*	35	122	86	71	61	119	494
FTE RT quality manager	9.6	32.0	26.2	18.8	19.0	36.0	141.5
Dosimetrists (full-time)*	14	45	23	24	5	54	165
FTE dosimetrist	2.2	7.3	4.2	5.4	2.0	11.2	32.3
Craftworkers (full-time)*	45	101	52	32	21	62	313
FTE craftworker	7.2	15.9	8.0	5.7	1.8	7.5	46.0
Nurses (full time)	120	298	229	188	131	238	1204
FTE nurse	44.8	167.09	124.09	106.97	79.8	193.5	716.3
Nursing assistants	3.3	5.8	12.9	10.6	17	22.54	72.1
Clerks	18.9	62.4	69.25	66.9	56.4	116.9	390.8

*Overlap is included in the total number of each staff (radiotherapy technologist, medical physicist and radiotherapy quality manager).

RT = radiotherapy, JRS = Japan Radiological Society, RO = radiation oncologist, JASTRO = Japanese Society for Radiation Oncology, FTE = full-time equivalent, RTT = radiotherapy technologist.

Table 8

Number of population, patients, institutions and patient load according to prefecture

Prefecture	Population (×103) [32]	Institutions	New patients	New patients/institution	Total patients	Total patients/institution
Hokkaido	5486	30	9285	309.5	11704	390.1
Aomori	1363	10	2107	210.7	2366	236.6
Iwate	1314	8	1606	200.8	2059	257.4
Miyagi	2327	12	3754	312.8	4621	385.1
Akita	1075	10	1644	164.4	2015	201.5
Yamagata	1161	6	1316	219.3	1490	248.3
Fukushima	1990	10	2726	272.6	3147	314.7
Ibaraki	2958	12	3331	277.6	4009	334.1
Tochigi	2000	9	2659	295.4	3363	373.7
Gunma	2001	14	3760	268.6	4225	301.8
Saitama	7207	20	7101	355.1	3094	404.7
Chiba	6214	23	7609	330.8	8877	386.0
Tokyo	13 196	65	23 627	363.5	28250	434.6
Kanagawa	9058	39	11 779	302.0	13412	343.9
Niigata	2,362	14	3637	259.8	4225	303.9
Toyama	1088	8	1608	201.0	1919	239.9
Ishikawa	1166	7	1789	255.6	2144	306.3
Fukui	803	6	1130	188.3	1375	229.2
Yamanashi	857	3	959	319.7	1188	396.0
Nagano	2142	15	3466	231.1	3880	258.7
Gifu	2071	11	2815	255.9	3509	319.0
Shizuoka	3749	23	6205	269.8	7837	340.7
Aichi	7416	38	10 197	268.3	12390	326.1
Mie	1847	12	1870	155.8	2169	180.8
Shiga	1414	10	1755	175.5	2158	215.8
Kyoto	2632	13	3900	300.0	4680	360.0
Osaka	8861	51	13 474	264.2	15987	313.5
Hyogo	5582	30	7855	261.8	8934	297.8
Nara	1396	8	2152	269.0	2523	315.4
Wakayama	995	9	1569	174.3	1812	201.3
Tottori	585	7	1036	148.0	1160	165.7
Shimane	712	5	985	197.0	1166	233.2
Okayama	1941	10	2680	268.0	3156	315.6
Hiroshima	2855	19	4562	240.1	5512	290.1
Yamaguchi	1442	14	1833	130.9	2069	147.8
Tokushima	780	5	1320	264.0	1425	285.0
Kagawa	992	5	961	192.2	1123	224.6
Ehime	1423	10	2439	243.9	2867	286.7
Kochi	758	5	1231	246.2	1397	279.4
Fukuoka	5079	25	8048	321.9	9944	397.8
Saga	847	4	830	207.5	969	242.3
Nagasaki	1417	9	2277	253.0	2695	299.4
Kumamoto	1813	13	3004	231.1	3446	265.1
Oita	1191	11	1621	147.4	1948	177.1
Miyazaki	1131	7	1569	224.1	1893	270.4
Kagoshima	1699	12	2618	218.2	2928	244.0
Okinawa	1401	7	1756	250.9	2002	286.0
Total	127 797	694	185 455	267.2	220092	317.1

Table 9

Number of population, patients, radiation oncologists and patient load according to prefecture

Prefecture	Population (×103) [32]	Total patients	JRS or JASTRO—certified RO	FTE RO	Total patients/FTE RO
Hokkaido	5486	11 704	41	51.1	229.0
Aomori	1363	2366	10	9.7	243.9
Iwate	1314	2059	9	10.0	206.9
Miyagi	2327	4621	11	21.8	212.5
Akita	1075	2015	4	7.6	265.1
Yamagata	1161	1490	5	8.5	175.3
Fukushima	1990	3147	8	13.9	226.4
Ibaraki	2958	4009	11	16.3	246.0
Tochigi	2000	3363	10	13.1	256.7
Gunma	2001	4225	26	31.6	133.7
Saitama	7207	8094	19	27.5	294.8
Chiba	6214	8877	33	50.8	174.9
Tokyo	13 196	28 250	91	122.4	230.9
Kanagawa	9058	13 412	45	57.1	234.9
Niigata	2362	4255	14	19.0	223.9
Toyama	1088	1919	6	9.5	202.0
Ishikawa	1166	2144	8	8.6	249.3
Fukui	803	1375	10	10.1	136.1
Yamanashi	857	1188	5	7.6	156.3
Nagano	2142	3880	8	12.3	316.7
Gifu	2071	3509	6	10.1	347.4
Shizuoka	3749	7837	24	30.8	254.4
Aichi	716	12 390	40	57.8	214.4
Mie	1847	2169	5	9.0	241.0
Shiga	1414	2158	7	13.1	165.1
Kyoto	2632	4680	20	30.0	156.0
Osaka	8861	15 987	62	80.3	199.1
Hyogo	5582	8934	35	44.9	199.0
Nara	1396	2523	9	15.7	160.7
Wakayama	995	1812	7	7.7	235.3
Tottori	585	1160	5	4.5	257.8
Shimane	712	1166	7	7.3	159.7
Okayama	1941	3156	12	18.4	172.0
Hiroshima	2855	5512	23	26.6	207.2
Yamaguchi	1442	2069	7	10.8	191.6
Tokushima	780	1425	7	7.2	197.9
Kagawa	992	1123	3	4.7	238.9
Ehime	1423	2867	9	12.2	235.0
Kochi	758	1397	5	4.3	324.9
Fukuoka	5079	9944	32	44.1	225.5
Saga	847	969	7	5.6	173.0
Nagasaki	1417	2695	10	10.5	256.7
Kumamoto	1813	3446	12	18.4	187.3
Oita	1191	1948	5	7.3	266.8
Miyazaki	1131	1893	9	7.6	249.1
Kagoshima	1699	2928	10	13.7	213.7
Okinawa	1401	2002	4	7.8	256.7
Total	127 797	220 092	756	1018.5	216.1

JASTRO = Japanese Society for Radiation Oncology, RO = radiation oncologist, FTE = full-time equivalent.

Table 10

Number of population, patients, staff and patient load according to prefecture

Prefecture	Total patients	FTE RTT	Total patients/FTE RTT	FTE MP	FTE RTQM
Hokkaido	11 704	74.0	158.2	16.8	5.7
Aomori	2366	26.1	90.7	2.8	2.6
Iwate	2059	22.5	91.7	1.3	0.7
Miyagi	4621	39.7	116.4	3.0	2.1
Akita	2015	19.0	106.1	1.1	1.6
Yamagata	1490	16.1	92.5	0.7	1.5
Fukushima	3147	35.7	88.3	2.5	1.5
Ibaraki	4009	42.0	95.5	1.6	2.1
Tochigi	3363	28.8	116.8	0.9	2.4
Gunma	4225	46.0	91.8	2.8	3.1
Saitama	8094	59.9	135.1	3.4	4.5
Chiba	8877	81.9	108.4	7.2	3.0
Tokyo	28 250	242.4	116.5	14.5	10.8
Kanagawa	13 412	139.5	96.1	6.6	8.1
Niigata	4255	41.5	102.5	2.1	0.8
Toyama	1919	20.4	94.3	0.7	1.9
Ishikawa	2144	22.7	94.4	1.7	1.7
Fukui	1375	21.8	63.1	0.0	0.6
Yamanashi	1188	6.3	190.1	0.4	1.1
Nagano	3880	31.7	122.4	2.3	1.7
Gifu	3509	29.7	118.2	1.4	2.9
Shizuoka	7837	78.0	100.5	4.3	6.6
Aichi	12 390	108.1	114.6	8.4	6.8
Mie	2169	28.1	77.2	1.2	2.5
Shiga	2158	31.3	69.1	0.7	2.5
Kyoto	4680	37.5	124.8	5.7	5.2
Osaka	15 987	156.3	102.3	20.3	13.2
Hyogo	8934	99.6	89.7	4.0	5.5
Nara	2523	23.7	106.5	1.6	2.5
Wakayama	1812	24.2	74.9	0.3	0.2
Tottori	1160	13.4	86.6	0.3	1.9
Shimane	1166	12.5	93.3	0.2	2.2
Okayama	3156	30.3	104.2	2.3	2.9
Hiroshima	5512	44.4	124.1	3.1	4.8
Yamaguchi	2069	25.6	80.8	0.1	1.3
Tokushima	1425	14.9	95.6	0.3	2.0
Kagawa	1123	7.7	145.8	0.1	0.0
Ehime	2867	25.5	112.4	2.2	3.3
Kochi	1397	9.6	145.5	1.1	0.8
Fukuoka	9944	69.5	143.2	5.6	7.3
Saga	969	9.2	105.3	0.1	0.1
Nagasaki	2695	18.5	145.7	2.1	2.1
Kumamoto	3446	31.0	111.2	6.3	3.1
Oita	1948	19.2	101.7	1.3	1.9
Miyazaki	1893	17.5	108.2	0.8	1.2
Kagoshima	2928	28.4	103.1	2.8	1.0
Okinawa	2002	15.4	130.4	0.4	0.6
Total	220 092	2026.7	108.6	149.1	141.5

FTE = full-time equivalent, RTT = radiotherapy technologist, MP = medical physicist, RTQM = radiotherapy quality manager, NS = nurse.

Table 11

Number of institutions and patients with special radiotherapy by scale classification

Specific therapy	2011							2010
	A (111)	B (232)	C (135)	D (82)	E (52)	F (82)	Total (694)	Total (705)
Intracavitary radiotherapy
Treatment institutions	0	14	19	25	25	59	142	152
Patients	0	117	265	442	404	1780	3008	3245
Interstitial radiotherapy
Treatment institutions	0	13	10	18	14	50	105	115
Patients	0	198	299	476	685	2413	4071	4194
Radioactive iodine therapy for prostate
Treatment institutions	0	10	10	16	13	44	93	101
Patients	0	160	298	443	472	1900	3273	3115
Radioactive iodine therapy for hyperthyroidism
Treatment institutions	0	3	12	4	12	23	54	59
Patients	0	53	207	125	417	1077	1879	2080
Total body radiotherapy
Treatment institutions	9	14	25	27	28	59	162	186
Patients	69	109	252	220	322	985	1957	1937
Intraoperative radiotherapy
Treatment institutions	3	1	1	5	2	8	20	24
Patients	4	1	1	36	13	47	102	161
Stereotactic brain radiotherapy
Treatment institutions	14	40	42	44	34	40	214	211
Patients	888	1921	2698	2676	2712	2873	13 768	13 800
Stereotactic body radiotherapy
Treatment institutions	2	35	47	46	33	59	222	203
Patients	4	210	572	877	438	1451	3552	3536
IMRT
Treatment institutions	2	19	27	31	27	58	164	136
Patients	8	880	1263	1723	1584	3429	8887	6356
Thermoradiotherapy
Treatment institutions	1	6	4	2	1	5	19	20
Patients	22	47	41	61	74	82	327	359
90Sr-90 radiotherapy for pterygia
Treatment institutions	1	1	3	2	0	1	8	5
Patients	1	2	9	14	0	19	45	33
Internal 89Sr radiotherapy
Treatment institutions	7	31	35	29	27	40	169	142
Patients	21	119	170	135	141	383	969	793
Internal 90Y radiotherapy
Treatment institutions	2	4	4	0	6	15	31	33
Patients	16	20	12	0	15	43	106	153

IMRT = intensity-modulated radiotherapy, Sr = strontium, Y = yttrium.

Table 12

Annual number of new patients by disease site*

Primary site	n	%
Cerebrospinal	7728	4.4
Head and neck (including thyroid)	16 168	9.1
Esophagus	9392	5.3
Lung, trachea and mediastinum	34 071	19.2
Lung	30 442	17.2
Breast	41 421	23.4
Liver, biliary tract pancreas	6310	3.6
Gastric, small intestine, colorectal	8297	4.7
Gynecologic	8358	4.7
Urogenital	27 909	15.7
Prostate	22 321	12.6
Hematopoietic and lymphatic	8388	4.7
Skin, bonel, and soft tissue	4132	2.3
Other (malignant)	2738	1.5
Benign tumors	2,445	1.4
Pediatric = < 15 years (included in totals above)	852	0.5
Total	177 357	100

*Total number of new patients in Table 3 differ from these data because no data on primary sites were reported by some institutions.

Table 13

Annual number of total patients (new plus repeat) treated for any brain metastasis and bone metastasis by scale classification.

Metastasis	Scale category (number of institutions)												Total (694)
	A (111)		B (232)		C (135)		D (82)		E (52)		F (82)
	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Brain	1104	13.3	3680	9.7	4165	10.7	3096	9.0	2861	10.2	5974	8.3	20 934	9.5
Bone	1207	14.5	5658	14.8	5192	13.3	4578	13.3	3400	12.2	8521	11.8	28556	13.0

Table 15

Annual numbers of patients receiving radiotherapy, numbers of LINACs, numbers of staff, patient load per LINAC and patient load per personnel according to institution categories shown Table 14; all radiotherapy hospitals

	RH-A (394)		RH-B (300)		Total (694)
	Average per hospital	Total number	Average per hospital	Total number	Average per hospital	Total number
Total patients	431.8	170 117	166.6	49 975	317.1	220 092
New patients	361.7	142 505	143.2	42 950	267.2	185 455
LINAC	1.4	546	1.0	290	1.2	836
Annual no. of total patients/LINAC	311.6		172.3		263.3
Annual no. of new patients/LINAC	261.0		148.1		221.8
FTE RO	2.3	900.0	0.4	118.5	1.5	1018.5
JRS or JASTRO-certified RO (full time)	1.7	672	0.3	84	1.1	756
Annual no. of total patients/FTE RO	189.0		421.7		216.1
Annual no. of new patients/FTE RO	158.3		362.4		182.1
FTE RT technologist	3.8	1485.0	1.8	541.7	2.9	2026.7
Annual no. of total patients/FTE RTT	114.6		92.3		108.6
Annual no. of new patients/FTE RTT	96.0		79.3		91.5
FTE RT technologist/LINAC	2.7		1.9		2.4
FTE medical physicist	0.33	128.7	0.07	20.4	0.21	149.1
Annual no. of total patients/FTE MP	1322.0		2449.8		1476.3
Annual no. of new patients/FTE MP	1107.4		2105.4		1244.0
FTE RT quality manager	0.28	110.2	0.10	31.3	0.20	141.5
Annual no. of total patients/FTE RTQM	1543.7		1596.6		1555.4
Annual No. of new patients/FTE RTQM	1293.1		1372.2		1310.6
FTE RT quality manager/LINAC	0.20		0.11		0.17

LINAC = linear accelerator, FTE = full-time equivalent, RO = radiation oncologist, RTT = radiotherapy technologist, MP = medical physicist, RTQM = radiotherapy quality manager.

Table 16

Annual numbers of patients receiving radiotherapy, numbers of LINACs, numbers of staff, patient load per LINAC and patient load per personnel according to institution categories shown Table 14; designated cancer care hospitals (DCCH)

	DCCH-A (272)		DCCH-B (108)		Total (380)
	Average per hospital	Total number	Average per hospital	Total number	Average per hospital	Total number
Total patients	498.7	135 633	200.0	21 595	413.8	157 228
New patients	416.7	113 329	175.6	18 968	348.2	132 297
LINAC	1.5	418	1.1	114	1.4	532
Annual no. of total patients/LINAC	324.5		189.4		295.5
Annual no. of new patients/LINAC	271.1		166.4		248.7
FTE RO	2.5	677.8	0.5	54.6	1.9	732.4
JRS or JASTRO-certified RO (full time)	1.9	515	0.4	44	1.5	559
Annual no. of total patients/FTE RO	200.1		395.9		214.7
Annual no. of new patients/FTE RO	167.2		347.7		180.6
FTE RT technologist	4.1	1112.9	2.1	229.4	3.5	1342.3
Annual no. of total patients/FTE RTT	121.9		94.2		117.1
Annual no. of new patients/FTE RTT	101.8		82.7		98.6
FTE RT technologist/LINAC	2.7		2.0		2.5
FTE medical physicist	0.36	98.7	0.09	10.0	0.29	108.7
Annual no. of total patients/FTE MP	1374.1		2159.5		1446.3
Annual no. of new patients/FTE MP	1148.1		1896.8		1217.0
FTE RT quality manager	0.30	81.7	0.14	15.3	0.26	97.0
Annual no. of total patients/FTE RTQM	1660.1		1416.1		1621.7
Annual no. of new patients/FTE RTQM	1387.1		1243.8		1364.6
FTE RT quality manager/LINAC	0.20		0.13		0.18

LINAC = linear accelerator, FTE = full-time equivalent, RO = radiation oncologist, RTT = radiotherapy technologist, MP = medical physicist, RTQM = radiotherapy quality manager.

Table 17

Number of items of equipment and their functions according to institution categories shown Table 14

	RH-A (n = 394)		RH-B (n = 300)		Total (n = 694)
	n	%	n	%	n	%
LINAC	546	96.4	290	94.7	836	95.7
with dual energy function	430	84.0	189	62.7	619	74.8
with 3DCRT function (MLC width = < 1.0 cm)	505	90.6	214	70.3	719	81.8
with IMRT function	352	62.9	69	22.7	421	45.5
with cone beam CT or CT on rail	241	50.3	53	17.7	294	36.2
with treatment position verification system (x-ray perspective image)	230	45.9	67	21.7	297	35.4
with treatment position verification system (other than those above)	171	35.5	63	20.3	234	29.0
CT simulator	402	92.4	252	79.7	654	86.9
	DCCH-A (n = 272)		DCCH-B (n = 108)		Total (n = 380)
	n	%	n	%	n	%
LINAC	418	99.6	114	100.0	532	99.7
with dual energy function	340	91.5	84	76.9	424	87.4
with 3DCRT function (MLC width = < 1.0 cm)	397	95.6	90	80.6	487	91.3
with IMRT function	280	69.9	35	31.5	315	58.9
with cone beam CT or CT on rail	192	56.6	24	22.2	216	46.8
with treatment position verification system (x-ray perspective image)	181	51.5	30	26.9	211	44.5
with treatment position verification system (other than those above)	130	37.5	30	25.9	160	34.2
CT simulator	280	95.2	98	84.3	378	92.1

LINAC = linear accelerator, 3DCRT = 3D conformal radiotherapy, MLC = multileaf collimator, IMRT = intensity-modulated radiotherapy, CT = computed tomography.