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The work contrasts the 2015 and 2024 states, tracking gradual transformation through collaboration among academic centers, government bodies, the IAEA, industry, and nonprofits. Infrastructure, staffing, radiotherapy and physics equipment, patient care, Co-60 decommissioning, and education are analyzed to show operational, clinical, and governance impacts.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/lessons-learned-from-an-epic-transformation-of-a-radiation-oncology-department-in-guatemala-keys-to-success/411346/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/lessons-learned-from-an-epic-transformation-of-a-radiation-oncology-department-in-guatemala-keys-to-success/411346.png","ImageObject",300,407,{"name":92,"@type":93},"McQueen","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-31","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the main purpose of the transformation described in the article?","Question",{"text":112,"@type":113},"The article describes the radical modernization of a radiation oncology department in Guatemala from 2015 to early 2024, highlighting the keys to achieving success.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the article compare the department’s state over time?",{"text":117,"@type":113},"It contrasts the radiation oncology department in 2015 versus 2024 while chronicling the gradual transformation through multi-stakeholder collaboration.",{"name":119,"@type":110,"acceptedAnswer":120},"Which areas are analyzed to evaluate the modernization impact?",{"text":121,"@type":113},"The analysis covers infrastructure, staffing, radiotherapy and physics equipment, patient care activities, Co-60 decommissioning, and educational initiatives, along with effects on treatment delivery and patient workflows.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},411346,1790890617,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},5909890329169,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Advances in Radiation Oncology (2026) 11, 101928  \nInternational Corner  \nLessons Learned From an Epic Transformation of a Radiation Oncology Department in Guatemala: Keys to Success  \nEdgar Ruiz, MD,a, 1 Hiram A. Gay, MD,b,*, 1 Milton Ixquiac, MS,a Angel Velarde, MD,a Baozhou Sun, PhD,c Jose García-Ramirez, MS,b Eric Laugeman, MS,b Benjamin Li, MD,d,e,f Jeff Michalski, MD,b  \nVicky de Falla, MD,a Geoff Hugo, PhD,b and Jacaranda Van Rheenen, PhDg  \naLiga Nacional Contra el Cancer/INCAN, Guatemala City, Guatemala; bDepartment of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; cDepartment of Radiation Oncology, Baylor College of Medicine, Houston, Texas; dDepartment of Radiation Oncology, Rayos Contra Cancer, Seattle, Washington; eDepartment of Radiation Oncology, University of Washington, Seattle, Washington; fDivision of Radiation Oncology, Fred Hutch Cancer Center, Seattle, Washington; and gGlobal Health Center at the Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri  \nReceived 2 July 2025; accepted 9 October 2025  \nPurpose: We describe the radical modernization of a radiation oncology department in a developing country, Guatemala, from 2015 to the beginning of 2024 . The Instituto de Cancerología y Hospital Dr. Bernardo del Valle S (INCAN) is the only public radiotherapy clinic serving patient referrals from the Ministry of Public Health and Social Assistance program.  \nMethods and Materials: We describe the state of the radiation oncology department in 2015 versus 2024 while chronicling its gradual transformation. This multifaceted collaboration involved academic centers, government agencies, International Atomic Energy Agency (IAEA), industry, and nonprofits and continues to this day. We analyze the infrastructure, staff, radiotherapy equipment, physics equipment, patient careCo-60 decommissioning, and educational initiatives.  \nResults: We graphically illustrate the impact of these changes in treatment delivery time, consults, follow-up visits, CT simulations, new patients treated in each linear accelerator, new patients treated with 2D, 3D, IMRT/VMAT, and superficial techniques, new patients treated with 2D LDR, 2D HDR, or 3D techniques, causes of linear accelerator downtime, and weekly patients on treatment. We provide a figure of the various sequential and parallel steps to modernize a radiation oncology department. We describe the complexities of radioisotope repatriation and safe disposal. We provide a comprehensive table of wisdom pearls regarding project governance, team, education, finances, culture, and language. We also discuss the impact of artificial intelligence in contouring Conclusion: The transformation of the INCAN radiation oncology department in Guatemala is a testimony to many's hard work, vision, and perseverance for the betterment of Guatemalan patients while facing incredible financial hardship. We hope that what we have learned in the past nine years will help others achieve even greater success in a shorter time  \n© 2025 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)).  \nSources of support: This work was supported by USAID/ASHA, Varian Medical Systems, LIGA, Washington University in Saint Louis, BJC Healthcare, and additional donors.  \nResearch data are stored in an institutional repository and will be shared upon request to the corresponding author.  \n1E.R. and H.A.G. contributed equally to this work.  \n*Corresponding author: Hiram A. Gay, MD.; [Email:](Email: hiramgay@wustl.edu)[ hiramgay@wustl.edu](Email: hiramgay@wustl.edu)  \n[https://doi.org/10.1016/j.adro.2025.101928](https://doi.org/10.1016/j.adro.2025.101928)  \n2452-1094/© 2025 The Authors. Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.","cbCaihigLQAsicYZ","https://ap.wps.com/l/cbCaihigLQAsicYZ","pdf",2025503,15,"English","# Purpose\n# Methods and Materials\n# Results\n# Conclusion\n# Introduction\n# Radiation Oncology Department Infrastructure","[{\"question\":\"What is the main purpose of the transformation described in the article?\",\"answer\":\"The article describes the radical modernization of a radiation oncology department in Guatemala from 2015 to early 2024, highlighting the keys to achieving success.\"},{\"question\":\"How does the article compare the department’s state over time?\",\"answer\":\"It contrasts the radiation oncology department in 2015 versus 2024 while chronicling the gradual transformation through multi-stakeholder collaboration.\"},{\"question\":\"Which areas are analyzed to evaluate the modernization impact?\",\"answer\":\"The analysis covers infrastructure, staffing, radiotherapy and physics equipment, patient care activities, Co-60 decommissioning, and educational initiatives, along with effects on treatment delivery and patient workflows.\"}]","Lessons Learned From an Epic Transformation of a Radiation Oncology Department in Guatemala - Keys to Success | PDF",1790588279,38]