level of access enjoyed in higher income countries, some developing nations would need to increase radiotherapy availability tenfold or more. There is a clear need for additional radiotherapy facilities around the world [I.7]. Strategies for developing new radiotherapy facilities need careful planning at the local [I.8] and national levels [I.9], and have to be accompanied by substantial investments in infrastructure, equipment and staff training. The radiotherapy utilization (RTU) rate is the proportion of cancer patients requiring at least one treatment course of radiotherapy during the evolution of their disease (Chapter 3). A country’s teletherapy needs can be roughly approximated as follows. In developed countries, the RTU rate is approximately 50%. This means that 50% of patients diagnosed with cancer will require radiotherapy treatments at least once at some stage of the evolution of their disease. In developing countries, it is assumed that the optimal RTU rate should be higher (i.e. >55%) and that it may reach 70–80% of patients diagnosed with 6 cancer, with the higher rates in low income countries. In many low income countries, lack of prevention and screening programmes, and limited oncological surgical services mean that the majority of patients diagnosed with cancer have advanced disease and most will need radiotherapy for palliation. However, IAEA experience in conducting reviews of cancer services in low income countries has shown that the actual RTU rate is between 25% and 40%. In other words, only 25–40% of patients diagnosed with cancer actually receive radiotherapy in this particular group of countries. The IAEA has found a 52% optimal RTU rate and a mean 28% (9–46%) actual utilization rate in a group of 9 middle income countries [I.10]. The reasons for the discrepancy between optimal and actual RTU rate lie in underdiagnoses, under-reporting and under-referral of cancer patients to treatment facilities. Chapter 30 includes a tentative calculation of the need for teletherapy machines worldwide in the foreseeable future. I.4. RESPONSE OF THE INTERNATIONAL COMMUNITY TO THE CHALLENGE In 2000, the United Nations established the Millennium Development Goals (MDGs) to improve social and economic conditions in the world’s poorest countries. The MDGs consisted of eight international development goals that all 193 United Nations Member States and at least 23 international organizations agreed to achieve by 2015. The need for treatment of cancer or non-communicable diseases (NCDs) was not explicitly mentioned in the MDGs, but Goal 6 states: “Combat HIV/AIDS, malaria and other diseases”. Until recently, financing and sponsoring efforts have been globally oriented towards programmes against communicable diseases, malnutrition and, more recently, AIDS. This was justified by the prevalence and major negative impact of these diseases on the social and economic development of human society, particularly in less developed countries. The international community is beginning to pay attention to NCDs, including cancer, as a problem not exclusive to affluent countries. The process started in 2005 with the World Health Assembly meeting in Geneva. In September 2011, the United Nations held a high level meeting of the General Assembly to address the prevention and control of NCDs worldwide, with a particular focus on socioeconomic impacts, particularly in developing countries. The General Assembly adopted a Political Declaration [I.11] that recognized the importance of strengthening prevention, early detection, diagnosis, treatment and palliation of NCDs, including cancer, particularly in developing countries. This important event and document represent a potential platform for the rechannelling 7 of resources to the areas mentioned, including cancer radiotherapy. It is hoped that this process will result in more resources being directed to cancer research and care as well as to coordinated efforts among the international stakeholders committed to the fight against cancer. I.5. THE IAEA’S DOSIMETRY SERVICES The IAEA’s subprogramme on Dosimetry and Medical Physics for Imaging and Therapy is responsible for the quality assurance (QA)