bring in maintenance workers from Europe or North America, at high cost. Often, if the warranty has expired or does not cover the costs, a cancer centre may be forced to leave a machine non-operational, if insufficient funds are available to support maintenance or source replacement. In recent years, the transport of radioactive sources, such as those in 60Co units, has also become more complicated and costly. In many cases, special authorization and licensing is required from other transit countries, unless the supplier is able to use international routes and direct means of transport. Other issues can arise in relation to the technical support needed to run a radiotherapy unit. The number of professionals actually involved in the operation of a radiotherapy service can vary widely between centres, often depending on the number of available professionals. An example of best practice is to have a staff of approximately 20 for each basic radiotherapy clinic, consisting of a radiation oncologist in chief, one staff radiation oncologist per 200–250 patients, one radiation physicist for every 400 patients, one dosimetrist or physics assistant per 300 patients, several radiotherapists (one per mould room for every 600 patients, plus four per megavoltage unit treating up to 50 patients per day, plus an additional two for every 500 patients simulated annually and one for brachytherapy as needed), as well as a nurse, a social worker, a dietician, a physiotherapist and a maintenance engineer or electronics technician [1.4]. Meeting the staff requirements for a radiotherapy clinic can be difficult, as the world faces a shortfall of 4.3 million trained health workers and 57 countries are currently experiencing a health care workforce crisis, leaving health systems everywhere with insufficient staff to meet patient needs. Looking solely at cancer professionals, it is estimated by the World Health Organization (WHO) that in Africa alone there will be a deficit of 3000 cancer health professionals over the next ten years. Considering that some of the positions necessary to establish a radiotherapy service require a university degree, postgraduate studies and at least two years of clinical training, staffing radiotherapy centres will continue to be a challenge. 21 The problem is exacerbated in LMICs, where a lack of resources and the prospect of better pay drives trained professionals to work in high income countries. In many cases, the cancer care professionals who remain in LMICs have had limited access to radiotherapy and other radiation medicine equipment, due to a lack of equipment availability, and require additional training to operate newly acquired technologies. Additionally, workforce strength may require that a small group of professionals take on an overstretched role in the operation of equipment, requiring further specialized training to operate a radiotherapy unit efficiently and safely. As procuring a machine is pointless (and even hazardous) without a proper understanding of its utilization and an adequate workforce to operate it, it is important that manufacturers provide specialized training or tutorials on the use and maintenance of their products to ensure that those operating the machines do so with the highest level of expertise possible. Understanding the radiotherapy needs of its developing Member States, the IAEA has, for over thirty years, worked in some 115 LMICs to deploy robust radiotherapy and nuclear medicine programmes, expending over US $250 million on cancer related assistance under its technical cooperation programme, with technical support provided by its human health programme. This has enabled many Member States to establish safe and effective diagnostic imaging and increase radiotherapy capacity to provide treatment and higher quality care to many of their cancer patients. The IAEA also helps establish new nuclear medicine facilities and encourages their integration with diagnostic imaging procedures by facilitating appropriate advice and support for human resources capacity building. This helps Member States achieve and maintain high standards of professional practice. The global survey of the IAEA’s Directory of Radiotherapy Centres (DIRAC) [1.13] shows a