ScientificForum2026 Technical Session 2 - Strengthening access to cancer care

All right, welcome back everybody. I hope that we had enough time in the break to reset uh so to say um to fill up our bellies, maybe even do some networking. Uh it's always good to be together here in uh Vienna. So um I just maybe want to just pick up on the note we left off in the last um session which essentially which was the first technical session um where we were just seeing how broad and important the role of medical uses of radiation is. Um this this is of course across the cancer pathway. And now in our second uh starstudded uh technical session, so many stars up front here. Um we want to talk about strengthening access uh to cancer care. Um the advances in in cancer diagnosis and treatment. These are moving rapidly. We we heard this in some of the presentations that came earlier. Um but access to these advances remains deeply unequal and uh strengthening access requires more than technology. Uh we also require the skilled professionals. Uh we need the sustainable infrastructure. We need the financing. Um we need strong national commitment and we need effective partnerships. And so this afternoon we've brought uh these experts. they've got different perspectives um and experiences and together we're going to explore how these elements can all come together uh to make quality cancer care more accessible. So this is going to be a a little bit different to the first technical session. This is more sort of a Davos style discussion. So what I'm going to do is I'm going to ask each of them to briefly introduce themselves. So um they've got long CVs but they've been asked to do this introduction in a minute. Right? So just an introduction of yourself um and then we'll begin our discussion uh with me taking questions uh to you guys. There will also be an opportunity for questions to uh from the audience. This will also come at the end. So please note any questions you may have and I'll ask my speakers to bear in mind that we want to accommodate as many questions as possible. So if you could be um succinct in your uh in your interventions. All right. So why don't we begin now with the first of our uh speakers. This is a a minute introduction uh by Miss Anik Flora Yawa Katon, head of uh biohysics and nuclear medicine department at Koki University Hospital in Kivoir. >> It's okay. >> Yes. >> Okay. So allow me first to thank the agency for the great honor to represent Kodiva at this important conference to chair our experience in the cancer care. Many institutions are fighting cancer including two in private the European cancer center and the Dominic Watara mother and child hospital five in public's national cancer control program cancerology service in university hospital center in Treville theanatara national cancerology and radiotherapy center, the Institute of Nuclear Medicine, and the new Grand Batam Oncology and Radiotherapy Center. All these centers are working in collaboration on improving for cancer care. Thank you for your attention. >> Thank you uh very much. Uh next we'll hear from Miss Patal Suruch Pal, medical physicist at the Ministry of Health, also in Guyana. >> Thank you. A pleasant afternoon everyone as I bring to you our members of the International Atomic Energy Agency. Warmest greetings from Guyana. Privileged to be part of both South America and the Caribbean. The raise of hope initiative has created a butterfly effect on this part of the globe through various implementations. I'll be very brief. The first of which is the radiation safety and security act passed by parliament in 2020 2023 which has provided an enabling foundation for the safe expansion of modern imaging technology. The next is breast imaging and connectivity through the IEA donation of four digital latest technology mimography units in the underserved locations of study New Amsterdam, Lynden and letm is also in the process to link these units with the main hospitals to support image sharing referral and coordinated breast cancer management. We have also hosted the first IMography fellowship from Dominica in three of those four sites to further support the Caribbean region. Building national capacity is also evident through the training of radiographers and other professionals including long-term medical physicists and national breast training imaging course strengthen multiddisciplinary skills and local capacity. Quality assurance is also in continuous development as we prepare for the first quadril clinical audit mission. Thank you. Thank you. And next we have Miss Zinab Shinafi Baguru, Chief Executive Officer of Medicaid Cancer Foundation, President-elect uh for the Union for International Cancer Control in Nigeria. >> Good afternoon everyone. Am I introducing myself or speaking to my work? >> You are briefly introducing yourself and a little bit of your work in one minute. >> Okay. My name is Zay Shinkafi Babu. As you heard, I come from Nigeria, the largest black country on earth. And um we do a lot of work. I do work through various hats. I used to be the first lady of estates, which gave me exposure uh to how government works, how policies are developed. I work through my foundation, the Medicaid Cancer Foundation. And last two years ago, I was elected the first African uh to head the Union for International Cancer Control, which is the largest cancer organization in the globe and works with over 172 partners, including IAEA and many of your countries here would be members. Through the UIC, we have various partnerships, a lots of initiatives, and our goal remains to improve cancer control. Thank you. >> Thank you. And next is Mr. Thomas Pasqual, physician and nuclear medicine expert at the Philippine Nuclear Research Institute in the Philippines. >> Good afternoon everyone and thank you for this invitation. I'm Thomas Pascal. I'm a nuclear medicine physician. I am actually representing two institution the East Avenue Medical Center Cancer Care Center in the Philippines and the Philippine Nuclear Research Institute where we have our nuclear medicine research and innovation facility. Our involvement perhaps in the race of initiative of the IIA will be since we are in the process of uh planning and then starting these facilities. We actually gain insights or expertise from um anchor centers worldwide towards our strategic planning and as well as appropriate implementation so that our facilities in due time will be able to access more give access to more patients and uh being able to have diagnosed and treated more patients in a given time and down the line also be future anchor centers. Thank you. >> Thank you very much. Uh next we have Miss Renato Mikawa, director of um R&D at uh POA Laton in Poland. >> Thank you very much uh for this kind invitation. I really appreciate being here and being able to sharing with you uh my experience. I have spent my professional life on development of radio pharmaceutical working at the National Center for Nuclear Research in Poland. uh National Center for Nuclear Research in Poland has an unique uh uh infrastructure uh comprising Maria research reactor which is uh producing or irradiating target materials for production of radioisotopes uh contributes to stable radio supply chain. uh irradiating uh targets for mold denim 99 production for example also uh high capacity production of iodine 131 or lutesium 177 which is so important nowadays for cancer therapy and the radioisotope center platum where I am working uh is providing radioarmaceuticals to health care. So we have GMP manufactured uh facilities for uh radio pharmaceuticals. We provide we uh carry out research uh programs of novel applications. We support preclinical and clinical trials. Uh we are also providing expertise on reg regulatory approval and we also invest in new infrastructures such as new cyclone. So uh I think that with these capacities and activities we really try to uh support uh and strengthen cancer care in Poland and beyond. Thank you. >> Thank you. Next is Miss Tatiana Krillova, medical physicist and the president of the Russian Association of Medical Physicists uh for the Russian Federation. >> Uh thank you very much for invitation. I really appreciate it. And uh since uh 2012 uh IAA and Association of Medical Physicists in Russia have been jointly implemented technical cooperation projects. Under this partnership on the basis of Russian cancer research center we conducted uh 36 tech uh courses uh 10 long-term uh three months internships and uh with u se more than 700 participants totally. Our work is guided by several principles and of course sustainability is one of the main of them. A lot of IA publications were translated into Russian language. Uh and uh we're really glad because it's very important. For example, TRS uh protocol TRS uh 398 is the main uh protocol in clinicalry and now it's uh available in Russian. uh through external audits and dedicated uh mentorship we uh guarantee safe radiotherapy for every patient. Also uh this year in April uh we uh organized uh the first uh course here in Zyersdorf in IA laboratory. It was a course on clinical decime also in Russian uh language. So for for people from different countries uh who who knows Russian. So uh we are happy with our collaboration uh and our achievements and looking forward uh for further u educational initiatives with IIA. Thank you. >> Thank you. Uh next we have Mr. Hussein Sabah, head of oncology department at the Al Borani University Hospital uh in the Syrian Arab Republic. >> Yeah. Uh good afternoon distinguished colleagues. I am Dr. Hussein Sabag, radiation oncologist, head of uh radiotherapy department in Albanon University Hospital, Damascus, Syria. In Syria, access to modern cancer care require a major challenges, particularly in radiotherapy. Uh thies of hope initiative and our partnership with the IAEA is helping us turn this major challenges into real progress for our patient. A key achievement has been establishing modern highdose rate plate therapy serve women with cervical cancer. The supported not only by equipment but also the supported by uh training course for our team expert mission and quality assurance system. Thank you. >> Thank you. Uh next we have Mr. Thomas Merchant, pediatric radiation oncologist at St. Jude uh in the United States of America. Thank you. Uh St. Jude and the IEA have a partnership and the partnership shares a very simple goal to help more children with cancer receive the right diagnosis and treatment wherever they live. Under our collaboration which involves rays of hope connects the St. Jude expertise in pediatric cancer with the IEA's global reach in radiation medicine and its relationship with member states. In just over one year, we've moved from agreement to action. Together, we're developing global goods. These are shared standards for pediatric radiotherapy, education, and training, and quality assurance tools. Our first competency framework has been published, and we've begun testing these approaches at the EA anchor centers. At the same time, we're also working to strengthen health systems and national cancer planning because expertise alone is not enough. We're preparing a cascade model where regional centers can train, mentor, and support others. The goal is simply not to produce guidance, is to turn expertise into sustainable capacity and ultimately to better access to highquality care for children with cancer. Thank you. >> Thank you. Next is Mr. Yuk Fuja, vice president of modality solutions at uh Fujim Healthcare Europe. >> Yeah, thank you. Good afternoon. My name is Yuski Hujitta the vice president of Hujif Europe. So first of all thank you very much for inviting this kind of the great Koda scientific forum. It's honor for us to join it. Yeah Hujif has uh made a practical arrangement in June this year. So from now on more and more Hujim want to uh collaborate with Koda IAEA and also more and more contribute to the healthcare sector especially in the field level. Yeah, thank you very much. >> Thank you. And um next is last but not least, Mr. Deepak Kuntia uh senior vice president in medical affairs and chief medical officer at Varian uh Zemen's Health and Ene. >> Uh thank you for the uh invitation today. So as mentioned I'm the chief medical officer for Variian. Variant is the uh cancer arm of Seaman's Health and Ears. uh about 5 years ago we were acquired uh by health and ears and so um the part I'm responsible for the cancer side of the company focuses on radiation oncology interventional radiology like cryo microwave radio frequency ablation and certainly the software behind cancer centers including um treatment planning as far as the scale of what we do um in terms of patient touches if we look at cancer patients throughout out the world about almost half of all patients that have been cured uh of their cancers were treated on our systems. And so we're really proud of that fact, but there's still more work to do. Thanks. >> Understood. All right. Thank you very much uh for for those uh brief introductions. And now I'll proceed to asking you all questions. A reminder to to really try and be succinct uh so that we can have more discussion with with the audience. Miss Krillova, I wish to start with you. Um, so we we talk about advanced technology perhaps being the most sort of visible uh part of modern cancer care, but it cannot deliver its full potential without a skilled workforce behind it. And that's I think been elaborated um in in the course of our discussion this morning. Just why is it important um for us to invest in people as well as this critical um equipment uh as well? Why is this important that we do both things at the same time? and not lean on one more than the other. >> Uh thank you for your question. Uh I think that in our field uh the if the equipment is like a body of cancer care then the medical physicist for example or radiation oncologist are the brain and the conscious of of this. Uh so you can have uh the most advanced linear accelerator but if the beam calibration is off by 5% for example uh the we can uh under irirdiate or overdiate patient. So uh linear accelerators and other equipment cannot uh check its own math. Uh only specialist qualified specialists can do it. So uh investing in u equipment without investing in people is like buying a racing car and not invest in training to a driver. Uh it's the same dangerous thing. Uh so that's why uh raise of hope initiative it's uh educational uh part is very important and it helps us in this case. Uh also uh I'd like to mention that um one specific lesson we learned uh from our courses is that it's uh very um uh good to learn in native language uh to spread the education in native language because uh if uh the for example again medical physicist uh understand the topic in details deeply the margin for the errors uh decreased uh dramatically. So it's um built confidence and competence. Uh so I think the real power and uh the real legacy of race of hope initiative uh is uh human human capacity has and if we invest in people and specialists today tomorrow the expertise will stay in the country in the clinic. >> That's it. >> Understood. >> Thank you. >> Um Mr. Sabbak let's maybe turn to the experience of expanding radiotherapy in uh Syria um recently through the raise of hope um projects initiative um Syria's been able to expand radiotherapy service in particular service for cervical cancer um can you maybe elaborate on how Syria and the IAEA have collaborated uh and the outcome on patients's access to radiotherapy in Syria >> yeah uh globally the high do rate of praotheret treatment is essential part of curative treatment for women with cervical cancer. Uh through of hope initiative uh we work it together step by step from prepare the facility and uh installing modern highdose rate bracket therapy system to training course for our team installoning quality assurance system and u bringing this technology into clinical practice. The most important point the highdose rate bracket therapy treatment is uh uh provided free of charge for women with cervical cancer within Syrian public health care. Uh in in in at the same time uh our local team has gained the uh knowledge and the skills needed to deliver this technology to patient safely and sustainable. Um for us the uh this capture the uh true value of rays of hope that supported not only by equipment and technology but also uh supported building uh national uh national uh sustainable national uh capacity. Thank you. >> Thank you Miss Sush Pal. uh let's look at access to early diagnosis uh and the experience of Guyana. Now under the rays of hope the agency delivered mimography equipment to both Latin America and Caribbean countries uh as well as African countries. How has the delivery of this equipment strengthened diagnostic services in Guyana? >> All right. So I'll start with a little bit of brief history. Um, prior to 2018, uh, Guyana didn't have any mimography services in the public sector. Um, and the only service between 2018 and 2024 that existed existed in the capital Georgetown. So only um patients who were able to afford to go to the capital from the outlying areas were able to be screened and of the patients that we had screened we half of them we had diagnostic findings since the implementation in 2025 of four mimography units in four uh outlined geographical areas. We've managed to decentralize that access and now provided access to the to the women mostly female population across those areas. And now what has that has resulted in is that breast cancer used to be the number one cancer in Guyana. Now it's moved to place three >> with cervical and prostate cancer being in the first place. So not only have we um dispatched the services throughout the entire country, we have been able to diagnose about 950 women in total within the last two years in those places. Um and now we've reduced the geographical barriers to diagnostic care and improve the health equity access. Additionally, we have also updated and reviewed our national cancer control plan. Uh there is implementation also of a national breast screening cancer registry in Guyana for monitoring outcomes. And we're in the process of re-implementing the tumor board for the multiddisciplinary approach to oncology services so that not only screening happens successfully but we also have a manageable treatment plan for the patients. >> Thank you. >> Thank you. Uh Mr. Pasqual you've participated in many IAEA missions. Um you've also sort of witnessed uh seen countries at different stages of the uh of their developing their cancer care capacity. Now as a nuclear medicine expert um as I said who's participated in all those missions for the IAEA can you provide an example of moving from assessment to implementation of enhanced capacity uh to expand access to cancer services? Thank you for your question. Um going on in and reviewing on my previous um expert missions, one thing that I really are or at least the group were able to identify in terms of cancer care was actually the waiting time of the patients and is a critical factor that we have to address within the concept of the entire cancer management profile. Um waiting time actually refers to the time when a patient is seen by the physician or the health expert until appropriate intervention is done either getting from screening getting a biopsy um getting diagnostic imaging services like um CT MRI PET scan and of course therapy chemotherapy or radiotherapy and last impalative care. Now the waiting time is actually affected not by one but several factors. One of which would be human resources. Second will be the infrastructure the physical infrastructure of the facility and the third one will be the equipment. So among these these three are very important to affect implementation and achievement of the outcomes that center would try to achieve. So towards the implementation I've seen member states really work hard towards achieving increased access to uh giving increased access to cancer patients. This can be done or has been done by receiving expert missions uh by improving human resources capacity by training the people the right way either to use the equipment or in in science in giving the right therapy for the patient. And in infrastructure, by strategic planning, they're able to um either reconstruct or make a new facility or improve the current physical facility to accommodate the proper number of patients because most facilities now could not accommodate the right number of patients. And lastly, the equipment. Sometimes the equipment is not working. Why? Because they have at some point the warranty is not already working. So they have so the important thing now is towards appropriate procurement you procure the right technology at the same time train the people get appropriate service warranty and at the same time use it to serve more people now once we have all those taken care of I've seen countries through the help of the IIA and through the race of hope initiative able to improve all those aspects in human resources infrastructure and procurement that would actually lead or influence s the waiting time of the patients. Of course, this is under um the the uh the scaffolding principle that they are all under the national cancer control plan and have appropriate funding. So once all of those aspects are uh taken cared of then we would reduce the waiting time of the patients and therefore be able to um provide access to patients who need the most. Thank you. >> Yeah. Yeah. Thank you. Um I'll come to you now Miss Cottoan because financing and of course um political commitment are also essential if the plans that are made are ultimately going to result in um functioning cancer services. So with the experience um in in Cord Deva and I just want to tell um people here that Cord Deva has taken the lead in enhancing access to cancer care through the Alisan Watara radiotherapy and medical oncology center in Abuja. Um can you elaborate then on the key steps that the government's taken to secure financing um as well as political support for this initiative? >> Okay, thank you for your questions. So uh before uh 2018, Kodivoir had uh no public and private radiotherapy services. To end this medical exile, our president Allesan Watara authorized the construction and equipment with public found of the National Center of Medical Oncology and Radiotherapy named Seno. Uh Seno functional since December 18. The senior receives an annual grant from the Ministry of Health whose ongoing support is very crucial. The center generates its own revenue thanks to a VMAT lin acquired in 22 and Alian Elite. This revenue has allowed to treat more than 16,000 patients since 18, including 4,500 with radiotherapy. Furthermore, an innovative financing system resulting from an agreement between the state and the roach lab reduce cost 40 by 40%. Thus uh since uh 19 concentrates have been free for all public passions with the subsidiary from the state. The progress also due to technicial cooperation with the EA as well as the support of of foundations and corporate sponsorship with approximately $340,000 raised since 2018. Thank you very much um for that. Um Miss Mikawak, I would like to turn to another sort of fundamental element of access and that's the ability to diagnose cancer accurately uh as well as to determine the right treatment. Now we often hear that you cannot treat what you cannot see. Um but how would you describe the importance of linking medical imaging and the availability of uh radioarmaceuticals to effective cancer treatment and what is needed to ensure equitable access to these technologies and therapies across the IAEA's member states. >> Thank you very much for this question. Uh radio pharmaceuticals are medicinal products. As such uh they are administered to patients but the beauty of radio pharmaceuticals is that they can deliver radiation to uh target cells or tissue uh while sparing the healthy one. And uh uh in contrary to chemotherapy when the patient is administered a chemotherapy drug there is no way to assess how much of the drug uh was uh accumulating or targeting the cancer. uh in radio pharmaceuticals. So we can uh uh establish that uh quite precisely uh by imaging before therapy and after and the example the excellent example of that I think it was mentioned already in the previous session is the treatment of prostate cancer patients where they can be diagnosed with gallium 68 or tnesium 99m before therapy then they are administered a tracer uh with lutesium 177 a therapeutic drug and then the efficacy of therapies again assessed by a diagnostic agent. So this is uh um like u the concept of terranostic but also a very nice example uh how these uh treatments are working also in other cancers. Uh that uh these achievements uh have been uh leading also to the uh high demand for radionuclides nowadays and the nuclear medicine motor. We treat what we see and we see what we treat. In fact, heavily depends on the access to radio pharmaceuticals. This is a big uh uh like concern uh nowadays and also uh the sustainable and equitable access to radio pharmaceuticals lies within the IAA uh programs and this is uh assessed or achieved via technical cooperation programs on uh building new infrastructure because we need infrastructures at various levels. uh we need to upgrade existing infrastructure. Uh the technical expertise provided by the IEA on um uh production uh processing safety operation uh of facilities but also on the medical side on the equipment imaging equip equipment diagnostic equipment therapy uh facilities uh including waste treatment safe handling etc. That is all these aspects are very important but also we have to remember that u uh these activities require uh cooperation >> harmonization uh regional uh cooperation and also involvement on of the industry. Uh I believe that uh what is happening now uh is really like uh you can say that nuclear medicine and radioarmaceuticals this is a blooming discipline uh but uh it needs strong support in human resources uh technical capacity and also um a well understood regulatory environment. Thank you. Uh Mr. Motion, perhaps we can bring in the pediatric um perspective into the conversation now because uh children with cancer face particular challenges when it comes to accessing specialized care. Um and as St. Jude's Children's Research Hospital is a global leader in pediatric oncology. Um, how does its partnership with the IAEA strengthen the efforts to expand access to childhood cancer care globally? In particular, how is St. Jude contributing to the development of expert recommendations that support countries in strengthening childhood cancer services through national policies and practices? >> Thank you. The strength of our partnership is that the two organizations bring very different but complimentary capabilities. St. Jude has deep expertise in pediatric cancer, clinical care, research, education, health systems, implementation. The IAEA brings expertise in radiation medicine and very importantly uh established mechanisms for working very directly with the member states and together that allows us as partners to take specialized knowledge and turn it into resources that countries and institutions can actually use. We call many of these resources global goods and we've already made substantial progress. uh an international multiddisciplinary group has been convened through the partnership to develop first a framework for defining competencies needed by radiation oncologists, medical physicists and other specialists um who care for children with cancer and the framework has gone through the review process international review process and has already been published just a few weeks ago. We've then taken the next step and this is translating the competencies into clinical education and training. The model being developed is deliberately flexible. Um it combines foundational learning, short-term clinical experience, longer fellowships, mentorship and advanced training uh really tailored to the needs and experience of the professional and resources of their institution. But the workforce development um alone is not enough. Sustainable improvement also requires uh enabling the health system as you uh asked about and that's why the partnership also connects the technical work with childhood cancer assessment, national cancer control planning and the intent is to help uh countries understand their needs, identify their gaps, better integrate childhood cancer and radiation medicine into national priorities. And then finally, the partnership connects expert recommendations, workforce development, quality assurance and improvement, and national policy. The IEA provides the pathway to the member states. St. Jude contributes pediatric cancer expertise, and together we can move knowledge to implementation at a scale that neither organization could achieve alone. Thank you. >> Thank you, Dr. Merchant. So we've sort of gotten um or we've heard about the role of governments um health professionals as well as international cooperation. I think it's a good segue now to hear from a representative of industry and that's where you come in Dr. Kier. I just wanted to um tell the audience that um Varian Zimmons Health has been a strategic partner of IAEA under rays of hope and and even before that and one notable contribution uh was the donation of a line to the IEA for a raise of hope country. Please tell the audience a bit about this decision and how you see contributions like this serving as a force multiplier if we can call it that in the health system. >> Yeah, thanks for the question. Um, the number one key performance indicator for us as a company is patient touches. And that's something that resonates very well for our 72,000 employees. And it's something that's easy for us to get meaning for the work we do when we come into the office every day. So, you know, bringing up that concept of force multiplier that you brought and then also some comments related to what Thomas said earlier about uh what some of the problems are that we see and it's these long waits. We had one of the uh governors or one of the African states in our headquarters in Palo Alto a few weeks ago and he was sharing with me that in his state the average wait time for getting treatment for cancer for cervical cancer with radiation is 477 days. >> These types of delays are unacceptable. So we've partnered with the IAEA to identify centers uh that have the ability to not only take equipment but bridge a gap and also train others to be able to use radiation oncology equipment to the best of its uh ability. So um coupled with our our high priorities of of patient touches along with our desire to reduce that burden and improve access that was the initiative behind um donating this lac that actually is going into black lion hospital in Ethiopia. The other thing that's of interest is, you know, I I know the two ladies in the front row here were instrumental in allowing us to do this, but um we signed the the the intent to donate the system about a year ago and we should have that treating patients by the end of the calendar year or early January. that is almost unheard of for us to even, you know, get a lin placed in a commercial type of setting where we're dealing with academic centers or other centers. But to to partner with the IAA and do this so quickly and have such a a big impact in in short order is the kind of thing that wants makes us want to donate more of these systems. >> Thank you, Dr. Quintier. Um, Mission Kafu Baguru, this brings us naturally to the question of political commitment because um, as you were saying earlier, you've seen cancer from different um, care perspectives. Um, you've you're a physician, you're also a cancer advocate, uh, the former first lady of estate as you mentioned. Um, you've seen cancer from both the clinical and the policy perspective. So what does it take to move cancer from a health sector issue uh to a national development priority uh particularly in countries where access to diagnosis and treatment remains limited as we've heard. >> Well, thank you. It is true that um political will is very important but it's not the sole factor. you have to consider the health systems that the operators are in and also things like the financial standing of the state or the entity that we're talking about. Um we make plans. There are lots of very good plans which we develop in collaboration with IAEA in Nigeria for instance. Uh and we always have reviews like the impact review uh which some of us are members of and UIC is also a member of it. But we have to really put those partnerships together in a stronger way that and make the case. The economic case in particular is one point that leaders often listen to and this case has to come from the financial experts as well as the patients that have the lived experience. We heard about 400 days waiting time. What is the cost of that to a woman that is living in a rural area? How much of that time does she need to spend, you know, looking for accommodation, transportation? We're talking about the cost of um radiation treatment, chemotherapy. How about the social determinance of health? How does she get to the nearest uh center that offers radiation? How does she feed when she gets to that center? Uh what kind of transportation is going to take her there? And where will she stay for instance? So these are all things stories that if we frame them in the right way on the right platforms uh coming together and sharing experiences through different platforms then uh governments tend to listen more. The other important aspect that uh we must not forget is the statistics. How much data are we generating? A lot of civil society organizations do credible work in our environments but the data and the way in which they frame and put together what they have found is not always the case. Uh it doesn't make a good case that will bring intervention. Uh UIC does a lot of capacity building programs. One of which is how to frame your and position your civil society organization and to be a better advocate for cancer uh across the world. Thank you Miss Shinafi Baguru. Um Mr. Fuja, why don't we close this first round um by returning to the role that industry can play in expanding access to diagnosis. Um, as a strategic partner under Rays of Hope, how does Fujifilm see its future engagement in supporting countries to expand access to diagnostic imaging so that more patients can benefit from early and timely diagnosis um as well as accurate staging and appropriate referral for cancer cancer care? >> Yeah, thank you M for your question. So yeah actually the access to the cancer treat to treatment begin with the access to the cancer diagnosis. So but uh unfortunately still got a lot of patient are facing the difficulty to receive the early diagnosis or of course to treatment also. Why? Because a lot of the difficulties there when I'm lack of shortage of the kod enough equipment shortage of the kod trained healthcare professionals of course even there is the equipment for example l l l l l l l l l l l l l l l l l l l l lacking of the certain quality assurance or not enough let's say medical service so the situation is still complicated but under this circumstance uh as for the fujif film we have a the three pillars to approach uh as a partner of the lay of hope. Firstly as a manufacturer of course we would like to develop uh new technology new equipment and then by using the high image quality product how expanding the access to the early diagnosis with accuracy. This is called the first point. The second point is most probably most important for the related education. So yeah together with IA and go of hope anchor center also would like to support the training education knowledge transfer all kind of the for the healthcare professionals this is also most important point the third point is we would like to not go only deliver the product how to keep the core let's say sustainable let's His support as a partner. So those three is a good P as for the Fujif film for Fujif film our successes not only for deliver the product how contribute healthcare sector in that sense the collaboration with IA EA IAEA global leadership and experience will enable more co patient receiving appropriate cancer diagnosis and treatment. >> Thank you Mr. FA thank you for that. So I think we've we've gotten the point that expanding access to to access really depends on many sort of interconnected elements here. You've talked about the people aspect, the technology, the financing, the national commitments as well as the partnerships. I just want to scan the room to see are there perhaps any questions that have come up from what you've already heard from the panel. if you could just show by indicating uh raising your hand uh if there are any questions at the moment or I'll just proceed up front while you all are still thinking um why don't we look now at how we can build on these efforts right so we've talked about the people the technology the financing the national commitments as well as the partnerships how can we build on these efforts to make our progress sustainable okay um so I perhaps we'll start with you again um Miss Krill over um particularly on the question of building the workforce for the future, a sustainable workforce for the future. I know that you're somebody who's dedicated to training and mentoring the next generation of medical physicists. Um how have the medical physics training initiatives under rays of hope helped strengthen the delivery of safe and effective radiotherapy? >> Oh, thank you for important question. Uh so the main point that we see our roles not only in teaching formulas but building the culture of safety. Uh before raise of hope uh initiative I would say that u a lot of people uh in our regions have excellent technical education but it's only theoretical education. Uh it's a lack of hands-on clinical structured training. So people uh they should uh learn at work by trials and errors which is totally not safe uh for patient. Uh so through the raise of hope initiative uh we built uh the standardized and competency based pathway. Uh so when physicist uh came home to his clinic he already did measurements he made some mistakes uh he analyzed it and u correct them under supervision so into the simulation environment not during treating patients. So the practice it's our um main goal and um the training is not uh one event it's a chain. So we train the trainers. Um again before raise of hope I think it was very often that when one physicist for example senior physicist left clinic the radiotherapy would drop. Uh but now uh continuous education and professional development um are uh building a resilient workforce. So safety is not a privilege but now it's a standard. That's >> Yeah. Thank you. Uh Mr. Sabah, uh just bringing you back into the conversation because alongside expanding services, um countries also need to make strategic decisions about where their resources they have can can make the greatest impact. I think there was a speaker earlier uh who talked about reallocating um certain resources. Um but in Syria, you recently uh received an impact review, it's called, to guide decisions in strengthening cancer care. Please elaborate on the importance of the strategic guidance in deciding where to place resources. >> Uh thank you for this important question. Uh the impact review is very important for Syria because our resource are limited. So we need to place this resource where they can have the greatest impact. Also uh the impact review is helping us identify uh our main needs uh decided the right place for investment uh and make sure we have the right people and infrastructure in uh in the simple words the uh the right resource in the right place with the right people. Okay. Thank you. >> Thank you very much. Um Mr. Surouch Pal earlier you were talking about the impact uh that the new mimography equipment has had in Gana and if we can just maybe look forward to what comes next now. So following the installation of this new mimography equipment what are the upcoming next steps under the rays of hope to capitalize on this expanded activity. >> All right thank you for the question. Um the raise of hope initiative has actually um in Guyana we're very thankful for it because not only has it had the butterfly effect that I mentioned earlier but maybe some riptides in time because now um we have research underway to analyze in the four of the 10 administrative regions what would be the common principal factors for breast cancer causes in addition to the mean glandular doses. So two separate resources. Um one of them has been accepted for the IDOS conference that's coming up from the IEA. Additionally, the four mamograms that were installed by the IEA has inspired the government now using the IA model to install several more mamograms in farreaching areas. Um and these are locations where you normally have to travel maybe 12 hours by land, not smooth terrain. we're talking about off-road or land watered and land again. So there there four four at least two or three more current installations during the year of 2026 and some more in the future. Additionally, uh we had a pax mission for the pax to support the mamography units. We're now rolling out PS and all of the healthcare facilities in Guyana. So there have been eight new regional hospitals in addition to the existing public sector and now using the model for the IEA um PAX will be installed in all of those. They're currently that's currently in progress. Uh we also have more human resource capacity building with the support of the IIA of course and quality assurance and mimography services. Um we've also inspired the occupational doymmetry national project. Um we've had doymmetry radiation monitoring system in the health sector. Uh now we're going to expand to the industrial sector and this is we've never had that service offered in country. Now we're going to have that and hopefully that should be able to also reduce any potential radiation effects such as cancers. And the last of the the future um prospects stemming out of spiraling out of the risophobia initiative is the isotropic water analysis project for 2028 where part of the project project has a larger scope but part of it is to help identify the specific minerals that may be related to the formation of some canceries. So there have been several several um buildouts coming out from this procurement. Thank you very much. >> Thank you. Uh Mr. Pascal, you mentioned the importance of uh capacity building earlier and u technology itself is also creating new possibilities for how we uh train people, how training can be delivered. Um so can you talk about what you've seen uh in terms of how for instance the adoption of technology has been used via things like distant assisted training um where you've seen member states implement this and how technology could be integrated into this training to speed up uh capacity building. >> Yes. Uh the beauty of educational technology right now is it provides immediacy of information. information is delivered right away and um as one thing that you mentioned is about this distance assisted training and perhaps one of the successful initiatives of the IEA would be the distance assisted training online program for nuclear medicine professionals and for technologists. Now I say distance assisted training online because historically it's not online. It was before when I was a resident it was they delivered the training programs in books in physical books shipped from Vienna but now with the initiative of the division of human health and TC they have actually put this training online for nuclear medicine professionals easily accessible for people who do not have a proper curriculum for training nuclear medicine technologist now this is not only exclusive for nuclear medicine technologist I've seen the curriculum the program this is all for nuclear medicine professionals working in the field doctors uh medical physicists and even nurses can go through the program and then once they finish this modular program over time then they get a certificate as a certificate as accredited by the IEA and this can be actually used at the local level for them to use it as a way as a measurement of their competence and since this is distance assisted training and it's online they normally would nominate one um a mentor locally and then um also some uh some some distant tutors that would let them go through the exercise. So that's one of the successful programs that can be used by countries who do not have yet uh a proper curriculum for nuclear medicine technologies. In addition um again for immediiacy of information, the IEA would always support member states in providing virtual access to key critical conferences for nuclear medicine professionals. So I say free. So they give virtual access to conferences for nuclear medicine professionals u and radiation radiation oncology professionals for example society of nuclear medicine annual conferences and they give away virtual access for those who are of course challenged logistically challenged to go to these conferences and apply it in their clinical practice. And the good thing about this one is they once they gain these attendance to this virtual um uh virtual access or to to to the conferences they could apply uh these learnings or attendance in their local context and at the same time apply it in uh as part of their continuous professional development or CME continuous medical education which would be necessary for their maintenance of professional certification. So those are the two I think very important and immediate uh um uh uh initiatives of the IIA wherein the member states could have access specifically in the field of radiation medicine. Thank you. >> Thank you. Um Miss Cotwan, you spoke about the national commitment behind the expanding of cancer care in Cord Deivoir uh in your earlier intervention um and also how partnerships have played an important role now to establish the new cancer center. Unique partnerships were explored uh in Civvar. Can you tell the audience about a few of these partnerships and how they enhance the experience for patients but also for families? Okay, thank you for your question and for this question about partnership, we can say that for the well-being of patients and their families, the government has taken measures through the ministry of uh health by uh creating a fund of nearly three million millions dollars to continue the initiatives undertaken. ained by partners for the new uh Gambasam project. K partnerships have been established with South Korea. I said South Korea. The EI is providing support through various TC projects in radiotherapy in imaging and uh in nuclear medicine with the first specs spec gamma camera and the accessories for nuclear medicine. And uh there are the the capacity building has enable of seat training for four radiation oncologist. >> Mhm. >> Four nuclear medicine physicians, four medical physicist and one radicist. And uh in this contest I say that uh the government has authorized the creation of a nuclear medicine diploma in partnership with ENSTN ENSTN in SACE in France and with the EIA. So uh this program begins this years with already 16 students this year. >> Impressive. >> So what I would say to you for the partnership thank you very much for that. Um Miss Mikawuk, why don't we maybe look at the infrastructure aspect um for a little bit um because many countries are expanding their cancer care programs. Um radio pharmaceutical uh therapies are an emerging area so to say but infrastructure does remain one of the significant barriers. Now beyond acquiring equipment, what are the key elements that countries should prioritize uh to build sustainable and resilient infrastructure for cancer care? >> Yeah, thank you for these questions. Uh before the radioarmaceutical uh can reach the patient uh we need to remember that there is a long uh uh supply chain and many actors are involved. uh so starting from uh irradiation facilities such as nuclear reactors and particle accelerators or medical cyclotrons uh then we have processing facilities for radionuclides then we need uh uh GMP certified facilities where the radionuclide becomes a medicinal product radioaceutical as a medicinal product once it meets regulatory requirements it can be delivered to the hospital and In the hospital again we need to be sure that the hospital is licensed for receiving radio pharmaceuticals and it's equipped with uh diagnostic imaging modalities such as PET or spec or therapy uh facilities and um at all these uh elements uh we need infrastructures. Yeah. uh investment in infrastructures and uh also we have to remember that uh the regulatory environment and also the capacity uh so the needs of patients are increasing. So also the capacity of these facilities need to increase that means a continuous uh effort uh to support these facilities. However, uh facilities itself they will not provide radio pharmaceuticals. We need personnel uh to do that and personnel uh is uh really an important part of the entire process. We need to remember that uh because uh we know there are shortages practically at all levels. So um to make uh young people interested in joining the field to provide them uh adequate training. I think this is the role of I IAA and that is really we can see that it's working very well. Uh there are training programs, training courses uh etc. Uh so um uh that's one part but also um for this uh to to make the facilities operational uh we need maintenance programs. So it's like um more the governmental issues etc. But we also need to provide a continuous support and I think that's IA doing uh on new technological developments uh on the changing uh regulatory landscape and also on um uh like current needs uh resulting from uh developments in therapeutic agents or diagnostic imaging agents. An example being activities of the IEA in reaction to the increased demand for actinium to 25 uh also with the recent uh CRP so coordinated research program uh which is promoting the use of actinium uh to 25 in member states and um another aspect very important is regulations. We need to remember that uh radio pharmaceuticals are very specific because they need to meet uh uh both radiation protection and the pharmaceutical uh law. Uh so both these aspects um uh need uh a very careful um understanding and also communication. uh I think this uh this uh especially is addressed by the recent uh initiative of the IA uh within the technical working group on radio pharmaceutical medicines regulation. So uh it's uh infrastructures are uh necessary uh but uh the operational part and the human part is uh also something that cannot be neglected and I think IA addresses all these needs very well. >> Um Dr. information to I think just coming back to childhood cancer from your perspectives what are the most uh significant gaps in pediatric radiotherapy um that this partnership for example can help to address uh especially in low middle inome countries and could you also highlight some of the key achievements and ongoing efforts under this collaboration? >> Thank you. So the challenge in pediatric radiotherapy is not whether a country simply has a machine. Treating children safely and effectively requires of course the right technology but also trained expertise, multi-disiplinary decision making, pediatric specific expertise, quality assurance in the health system capable of supporting all of those elements. Those capabilities are unevenly distributed especially in low and middle inome countries. structured pediatric radiotherapy training is often limited and professionals may have very different levels of pediatric expertise. And so our partnership is trying to address those gaps systematically. And now we're beginning to see uh tangible results. First, we developed the multiddisciplinary competency framework that I I mentioned uh in the first question. And second, we're translating this into an adaptable education and training model that can meet the professional where they are in terms of their experience and knowledge. And this includes everything from foundational training to hands-on experience, mentorship, advanced specialization. Importantly, the model also incor incorporates train the trainer so that the benefit doesn't stop with the individual u who actually received the training. And then third, we're developing a patient specific quality assurance tools based on the IEA's established quattro methodology. Um, an international multi-disiplinary group has adapted the tools for pediatric practice including such areas as environment of care, total body irdiation, cranium spinal radiation, very specialized procedures that we do in children. Uh, more than 60 experts so far uh have contributed uh to their development. So there's been very broad input and that's often a question that we receive and importantly we're no longer developing the just developing these tools. We've actually start to put them into practice. So last month in Sao Paulo uh the partnership conducted a pediatric radiotherapy workshop um including uh selected IAEA anchor centers. There were about 50 participants. Satisfaction was 100%. Um we paired the training with an assessment of the host uh pediatric radiotherapy program and that allowed us to pilot um and refine the quality assurance approach in a real environment. The next step is scale. Um and of course it's always important to remember that most of individuals who treat children also treat adults. So they're spread quite thin. But we want strong regional centers to become training and mentoring hubs so that the knowledge and quality improvement can cascade to other institutions. And then I would describe uh what we're trying to achieve or build as an ecosystem standards people training quality policy networks of institutions and the long-term goal is to make highquality pediatric radiotherapy less dependent on geography and more consistently available to children wherever they live. Thank you. >> Thank you Dr. merchant. Um, coming back to you, uh, Dr. Contia, now equipment is clearly only one part of what industry can contribute beyond donating equipment. Um, what are the other areas where the IAEA and member states can benefit from industry experience and please maybe mention one or two areas where we can expand the partnership on behalf of patients. So, you know, in the previous panel, we talked about the cancer burden and what's happening and the increasing gaps. We do not have enough medical schools in place today to train enough clinicians to meet that gap. It's not going to happen with just professional services, training more doctors, more nurses, more physicists. those schools would have had to already be in existence today to address that gap. So that means technology has to bridge the gap and and you know this is um this is a research project that I'll mention and so so be careful with how you interpret this but if you for those of us that are in the clinic we understand at least in the US Tom and I know this really well we we see the patient for a consult if they need radiation we'll do a treatment planning CT typically um which is done maybe 3 or 4 days later uh in a typical clinic and then it'll take another week or so by the time the doctor does their work and the physicist does their work, dommetrist does their work and so it could be 10 days to two weeks from the consult before the patient actually got treated. Well, we just um sent a a paper to Nature um they reviewed it and we made some corrections so hopefully it'll get published this year where from the time that the simulation is done, which is the scan that we do beforehand, before any of the treatment planning and the doctor does any of their work. From the time that planning scan is done, within one second, the treatment plan is completed. That means segmenting out all the normal structures, segmenting out all the targets that need to be treated, optimizing the plan, QAing the plan. So, so if we could bring that type of technology into low and middle inome countries, for example, where we have the 477day weight list, we could actually put a huge dent in some of the access problems. Technology like this is very scary, particularly in the US. It disrupts specialties. It negatively impacts reimbursement. the reimbursement structure in the US, you are incentivized to go slow. You get paid less if you do all of the planning on the same day as the consult. That's why many practices separate things day by day by day to capture all the billing. That's not good medicine, but that's how you make medicine profitable in the US. That's a US problem. It's not a rest of the world problem. And so partnering with industry may allow you to get access to technology like this that just isn't going to take off in the US right away. >> Just like going from landlines directly to cell phones, it's that type of disruptive innovation that I think could work really well with the IAA supervision on some of these uh tools that we have. >> Thank you very much uh for that. Um, Miss Shin Kafi, uh, Baguru, you talked about making cancer a national priority. Um, of course, the next challenge, as you would know, is is taking that political commitment into tangible um, improvements for patients. Now, the IAEA and UIC and its partners are working to strengthen access to cancer care through initiatives such as Rays of Hope. From your perspectives, how can global partnerships better support countries in translating political commitment into practical improvements for patients, especially for women and children who we know face um the greatest barriers to care. Um I think we mentioned some of them already and uh the fact that such organizations are coming into partnership together is shows us that there's a need for having those partnerships. Um they have platforms fora the UIC partners with I or IAEA supports UIC to have different uh platforms like the cancer planners forum uh the world cancer congress. These are all uh events where we can come together and learn what each other what the other person is doing in his or her own country and showcase the practical examples. The country visits are also important in that they allow everybody to see what is actually going on and to you know assess what we can do better. We can come and talk at these fora but if you don't go to the countries you need to go to the low middle inome countries and have a feeling of experience of what the patients are going through what the doctors are going through how many doctors do they need how many medical physicists are available and so on and then offering bilateral training opportunities is another way that we can help to build workforce and uh it improves the or it encourages the leaders it's not just we're not asking them to put money on the table all the time but we're offering training opportunities which is one of the things that we know that IA is very good for uh collaborating with NYAK in Nigeria and all the other African countries we've heard there have been a lot of training opportunities offered to uh med those who are involved in the radiation uh therapy in particular medical physicists radiologists and so on uh So these are ways in which we can improve that collaboration. And then one of the people that we often we don't talk about a lot are the legislators. For governments to move forward, legislators need to be involved more in putting together plans or when we're putting together our plans. Uh they are the ones that are going to appropriate the funding. Uh they appoint or approve the appointments of leaders. uh so capacity building let them even understand what we're talking about and have a basic awareness about cancer and what it takes to treat a cancer patients. It's very easy to talk about these uh numbers but they don't appreciate it until we take the teaching into the houses of uh representatives and the senates of our countries and so on. So involving the other politicians not the governor per se who knows and sees it on his table but those who are involved in making the laws of that state or country. Yeah understood. Thank you. And Mr. Fuja perhaps finally let's look at what's needed to make investments in diagnostic imaging sustainable over the long term. Now beyond the provision of imaging technology, what practical elements should be built into partnerships with industry to ensure that diagnostic imaging services in LMIC's are sustainable including workforce training, maintenance, digital connectivity and quality assurance. >> Yeah, thank you for the question. So actually from my point of view, from our point of view, sustainability begins the day after the installation. Yeah, as a reality the number of the equipment will not directly uh reflect or generate the contribution to the healthcare sector. Why? Because the equipment correctly working and then show the best performance and then working timely then finally we can contribute the good healthcare sector. This is a good real situation. Therefore, so the partnership uh with industry must go far beyond the technology and this is a key point in that sense. uh I think there are four let's say important factor firstly again same things but the education is quite important because how maximize the equipment capability capacity this part we have to transfer the healthcare sector then of course service and maintenance also mandatory from the industry side yeah how sustained quality and efficient work for the long term. Long term is called the key key point. Then also nowadays uh one of the important point is called digital connectivity actually could reduce the distance between industry and the clinical let's say field. So not only this of course uh the reduce distance between country by country, hospital by hospital. Then uh realize the bottom up the quality they realize really really anytime anywhere. So this is one of the key. The fourth point is of course the quality assurance the sustained high quality performance. This is also in the long term those four point is quite important and then everything is become a kind of cycle cycle like a good ecosystem. So in this with this go integrated approach is more and more essential to establishing the go diagnostic structure. >> Yeah. >> Thank you Mr. Fuja. And um we have a few minutes on the clock. If there are any questions from any members in the audience I'll give you an opportunity. Okay. I see one question. Do we have I see another question. Um may I ask you to just briefly introduce yourself and then also to direct your question to a single panelist. We'll start up front here and then we'll go to the back for the gentleman there. >> Thank you. My name is Gorgi Simano from the European Commission and actually don't have a question. It's more of a comment on some of the things that we we heard uh we heard also in the previous session about the nuclear medicine and now with the advance of the radlean therapies things are really changing. I think this is one area which is potentially undergoing a revolution. Some people believe very firmly that it is undergoing revolution. I I think there is still a bit needed you know to get there. Uh and uh it's a very complex supply system as uh as uh Renata Mikolichek just said uh you know it it actually starts even earlier than than what she said. It starts some somewhere in mine in Africa maybe and then goes through a enrichment facility for stabilizotops in Europe or America or Russia you know etc etc to after a lot of steps to reach the patient and there is one very practical thing which I which is very firmly within the IIA domain because IA is regulating directly there and this is in transport safe transport of radioactive material and there has been very good uh job done lately on the denial of shipment working group which was just delivered white paper. Um what I think is this needs to continue uh because as far as I understand the mandate is considered the mandate of this group is considered now completed. you know this working group maybe will close and I think the recommendations are very good but recommendations don't change anything unless you put them in practice and there is a lot to be done including in liazing with other internationalizations like Kayata for uh air transport and others and the second again for transport um in the latest uh the latest revision of the SSR6 there were some significant changes when it comes to transport of half emitting radionuclides and these some of them are the very key ones which are the next generation already into clinical trials and uh expected to hit the market in the next five to 10 years and there is a need to kickstart the work there and I already took uh steps in this direction but we really be happy you know to to see the the work starting in earnest you know and and would be really committed to take part in this work >> so it's not a question I thank you so much for that to to the agency I guess Well, thank you for that interview. I will maybe give an opportunity to somebody who might want to speak to that if at all, but it was a comment rather than rather than a question. Okay, so we'll go back to the floor. And by the way, do I have another question? I know there's one more, but another one. Okay, one up front here. So, we'll take the question at the back and we'll come back to the front. >> Hi, thank you. Thank you for all the inputs. Uh, I'm Deljali, director of international affairs at Sunup Fusion in Shanghai. uh we develop uh fusion energy devices but we also look at the spin-off technology from plasma uh technology uh including medical devices and we work with food university who's also trying to expand the access to education in nuclear devices radiation technology etc. So I want to ask like where is the role for that in this conversation? So not just training practitioners in clinics, not just the supplying of medical devices but actually the training of the wider science around this medical topic. So then people in low and middle inome countries they can maintain these devices they can become producers of technology. They can be become producers of the pharmaceuticals and the nuclear science behind it. uh I don't know who this is um directed at but kind of broadly where is the role for that and how can people get involved with supporting those activities thank you >> yeah I'll come back to does somebody want to volunteer but Mr. Krillova, I almost want to lean in your direction. No. Any takers up front for that one? Should I maybe ask the gentleman to rephrase the question >> or you want? Okay. >> It's a very multi- faceted question and it brings into question issues of equity, issues of funding. How can we we're just talking about um capacity building using technology but how much of the low middle inome countries have access to the digital technology that will enable them to be trained. So I think really at the crux of that question is the issue of equity in radiation access and the other wider uh issues that he mentioned. Again, we have to come back to partnerships, collaborations, working through um the highincome countries as well as the gatekeepers, getting the communities and the gatekeepers of those communities who are the leaders to be involved and be trained and be encouraged to jump on board the uh access programs that we have. really a lot of countries have very good access programs but people don't know the people living in those countries don't know about them and embedded in the access programs are all the commodities and so on that we're talking about thank you for that I have two up front here can I uh go to the back and then come forward yes ma'am >> yes >> so here so the online people Thank you. I have a question for Guyana because the butterfly effect is really impressive going from the radiation protection law to procurement to capacity building to training to IT infrastructure and decentralizing the whole health system at least for medical imaging. So congratulations for this. You mentioned also research and quality assurance. So the question to you is because quality assurance specifically in imaging and radiology is not as common as in radiation therapy. What do you think is the added value of quality assurance in imaging and specifically mamography that you have been experiencing the last years? Thank you. >> Thank you. And before you answer that, let me already collect the next question. >> Sure. Thank you. Um Lisa Stevens, director of PACT and one of the scientific secretaries. I wish I could ask each of you a question, but I'm actually going to not pick on but invite four of the member states. There was a lot about political will. So, thank you Zab for for talking about that. And I heard that also from Kotvois, from Gana, and also from Syria. So, how can you use experiences like this to not only maintain but perhaps to grow the political will as you look to grow the program and and increase the access? So if we could hear maybe succinctly how you're going to apply some of the lessons from this session and um the experience you have. >> Thank you. We'll start with a question for Guyana. >> All right. So I I heard a lot of questions in there. Um to start with the one from Virginia. Uh quality in mimography is very important because one of the things that we found um mimography is also complemented by ultrasound. uh if you don't have a clear quality image that you can be able to distinguish not only the dimensions and the locations of what you're looking at but the type of tissue um you're going to actually miss a diagnosis or miss the staging of the diagnosis and the problem with that is that the pathology evolutionizes very quickly. So if there is not a timely diagnosis, you may actually not be able to help a patient as much as you could if you had the quality systems in place and the entire multid-disciplinary team approach as well because in the case of biopsies and so on one of the mimography units we have tomosynthesis and we're getting we're looking to get the support for biopsies as well um is if you miss those details and those are very key clinical information that you need to have from especially especially from the medical physics perspective. Um in terms of the second question so um I think our country has had Guyana I'm speaking on behalf of has had a large political will. Our minister of health has propagated a lot of the assistance and support through the IE as well as through other channels. Um the first being the radiation safety and security legislation because without that um there is no legal obligation for all of the institutions to adhere to all the quality rules all the safety practices and to ensure that multiddisciplinary approach because if not we're a small country and because of that we tend to do things in silos separated from each other. So now you have to have the comprehensive approach to everything especially through the legislation. >> I think that's it for me. >> Another member state. Yes. Thank you. >> So in u in Kodiva we our experience in cancer is uh is is began in uh 19 2019. Okay. Or 18 2018. So it's uh very young it's a young uh experience in in cancer and uh we we in Cardiva we are we have a private uh and a public uh experience. So in private we have two or three but in public there is there are u many many institutions for the for the cancer and uh we said in our slides the the searo it's a center of radiotherapy and oncology service and uh the nuclear medicine it is here is there and in codivir the the the strengthening if I say like that it's it's the the all institute institutions are uh have main is autonom They they working uh in with the >> Yes, in French I can say in France. No. >> Yes. So in uh in >> autonomies yes we are autonomist but uh it's the the state and the government give us the autonomies in the give us the big jet budgets. Yes. and uh we so it's very it's very interesting for the the yes >> you see you know >> thank you very much uh coach so I think we well we actually have uh reached uh the conclusion of our session now um because as the clock dictates we must now wrap up and I want to thank you all very much uh for your input this morning. Thank you for uh the light you've shown uh particularly on this uh raise of her partnership and everything that we're accomplishing there. Um so what this discussion really made clear to me is that um expanding access to cancer care is not only possible but actually it is happening. Um and we just have to scale that up now uh through more collaboration, innovation and shared commitment. Uh the progress we've heard about today reflects the growing impact of raise of hope which is our success story here uh and the determination of countries and partners to ensure that more people uh deserve the will receive the care that they deserve. So this concludes our second technical session which was strengthening access to health care. We're now going to take a very short break. We'll reconvene here at quarter to 4. So that's 15:45. I'm going to ask the panelists of the next session to assemble five minutes before. So at 20 uh to 4, if you could please assemble so that we could just do some logistics before we take the stage. Thank you. And may I please get a round of applause for them. Thank you.