{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:20:07Z","timestamp":1787743207660,"version":"build-2784847793"},"reference-count":37,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"unspecified","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,8,12]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>This study evaluated the operational status of Ukrainian radiotherapy (RT) centres to characterise wartime capacity following the Russian invasion and to identify priorities for improving RT delivery and resilience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study integrated two data sources: (1) a 38-item survey conducted by Help Ukraine Group (HUG) in August 2025 across all Ukrainian RT departments, assessing patient volumes, waiting times, equipment status, cobalt-60 (Co-60) source replacement, staffing, training needs and operational challenges; and (2) International Atomic Energy Agency DIRAC datasets collected by the Grigoriev Institute (2021\u20132025), tracking equipment, staffing and patient volumes. Descriptive and comparative analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In December 2021, before the full-scale invasion, Ukraine operated 41 RT departments with 82 megavoltage (MV) machines (38 linear accelerators, 44 Co-60 units), 53 orthovoltage units and 36 brachytherapy afterloaders. During the first 3\u2009months of war, four centres were occupied, most departments experienced service disruptions averaging 26 days and patient volume declined by 27.5%. Volumes recovered to baseline in 2023 and increased by 8.9% in 2024 and 9.3% in 2025 relative to 2021.<\/jats:p>\n                    <jats:p>In December 2025, Ukraine operated 42 RT departments with 96\u2009MV machines (68 linear accelerators, 28 Co-60 units), 38 orthovoltage units and 34 afterloaders. However, 56% of departments still relied on Co-60 and 94.1% reported future source replacement would be unfeasible because sources were historically procured from Russia. Consequently, 78.6% of Co-60 users planned the transition to linear accelerators. Workforce shortages remain critical, with reported deficits of 41.4% for medical physicists, 33.6% for RTTs and 21.1% for radiation oncologists. Average waiting times increased from 6.4\u2009days in 2021 to 10.3\u2009days in 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite ongoing war, Ukraine is actively modernising RT services, with a rapid transition from Co-60 to linear accelerators. Workforce development and targeted training are now urgently needed to convert equipment investment into sustainable clinical capacity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2026-025404","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:35:44Z","timestamp":1787740544000},"page":"e025404","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Russian invasion on radiation therapy capacity in Ukraine: a national survey study"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5584-3918","authenticated-orcid":false,"given":"Zoia","family":"Shepil","sequence":"first","affiliation":[{"name":"Radiation Oncology, National Institute \u201cO.O. Shalimov National Scientific Center of Surgery and Transplantology\u201d, Kyiv, Ukraine"},{"name":"Help Ukraine Group, San Carlos, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladyslav","family":"Buryk","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Stereotactic Radiosurgery Center, Sigulda, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8130-1903","authenticated-orcid":false,"given":"Ruslan","family":"Zelinskyi","sequence":"additional","affiliation":[{"name":"Help Ukraine Group, San Carlos, California, USA"},{"name":"Radiation Oncology, National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larysa","family":"Stadnyk","sequence":"additional","affiliation":[{"name":"Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuliia","family":"Lozko","sequence":"additional","affiliation":[{"name":"Help Ukraine Group, San Carlos, California, USA"},{"name":"Radiation Oncology, National Cancer Institute, Kyiv, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serhii","family":"Brovchuk","sequence":"additional","affiliation":[{"name":"Radiation Oncology, National Institute \u201cO.O. Shalimov National Scientific Center of Surgery and Transplantology\u201d, Kyiv, Ukraine"},{"name":"Radiation Oncology, LISOD - Israeli Oncology Hospital, Pliuty, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesia","family":"Mytsak","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Precarpathian Clinical Oncology Center, Ivano Frankivsk, Ukraine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulia","family":"Romalis","sequence":"additional","affiliation":[{"name":"Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Bhatia","sequence":"additional","affiliation":[{"name":"Emory University Winship Cancer Institute, Atlanta, Georgia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalka","family":"Suchowerska","sequence":"additional","affiliation":[{"name":"Help Ukraine Group, San Carlos, California, USA"},{"name":"Radiation Oncology, University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Iakovenko","sequence":"additional","affiliation":[{"name":"Help Ukraine Group, San Carlos, California, USA"},{"name":"Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darya","family":"Kizub","sequence":"additional","affiliation":[{"name":"Breast Medical Oncology, MD Anderson Cancer Center, Houston, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelya","family":"Melnitchouk","sequence":"additional","affiliation":[{"name":"Gastrointestinal and General Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2619-7262","authenticated-orcid":false,"given":"Nataliya","family":"Kovalchuk","sequence":"additional","affiliation":[{"name":"Help Ukraine Group, San Carlos, California, USA"},{"name":"Radiation Oncology, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"2026082603350799000_11.8.e025404.1","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1016\/j.ijrobp.2026.03.047","article-title":"Can Radiation Therapy Services Survive in Conflict-Affected Regions?","volume":"125","author":"Ashmeg","year":"2026","journal-title":"International Journal of Radiation Oncology*Biology*Physics"},{"key":"2026082603350799000_11.8.e025404.2","doi-asserted-by":"crossref","unstructured":"Bricknell M , Sullivan R , eds. Handbook of Global Health, Security, and War. 1st edn. Chichester: Wiley, 2025.","DOI":"10.1002\/9781394326129"},{"key":"2026082603350799000_11.8.e025404.3","unstructured":"United Nations High Commissioner for Refugees . Ukraine emergency. 2026. Available: https:\/\/www.unrefugees.org\/emergencies\/ukraine\/ [Accessed 24 Apr 2026]."},{"key":"2026082603350799000_11.8.e025404.4","unstructured":"eyeWitness to Atrocities, Insecurity Insight, Media Initiative for Human Rights, Physicians for Human Rights, Truth Hounds, Ukrainian Healthcare Center . Attacks on healthcare in Ukraine. 2026. Available: https:\/\/www.attacksonhealthukraine.org\/ [Accessed 24 Apr 2026]."},{"key":"2026082603350799000_11.8.e025404.5","first-page":"126","article-title":"External beam radiotherapy facilities in Ukraine: trends and challenges","volume":"112","author":"Starenkiy","year":"2017","journal-title":"Probl Atomic Sci Technol"},{"key":"2026082603350799000_11.8.e025404.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.adro.2022.100965","article-title":"While Ukrainian Soldiers Are Fearlessly Defending Their Country, Ukrainian Oncologists Are Bravely Battling Cancer","volume":"7","author":"Kovalchuk","year":"2022","journal-title":"Adv Radiat Oncol"},{"key":"2026082603350799000_11.8.e025404.7","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21324"},{"key":"2026082603350799000_11.8.e025404.8","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1200\/JCO.2024.42.16_suppl.1513","article-title":"Effect of war on radiotherapy in Ukraine and how to help","volume":"42","author":"Kovalchuk","year":"2024","journal-title":"JCO"},{"key":"2026082603350799000_11.8.e025404.9","unstructured":"Goldberg P . Three weeks in Mariupol: how Dr. Hanych kept his cancer patients alive amid Russia\u2019s attack. Cancer Lett 2022. Available: https:\/\/cancerletter.com\/the-cancer-letter\/20220805_1\/"},{"key":"2026082603350799000_11.8.e025404.10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/S1470-2045(22)00298-4","article-title":"Radiotherapy in conflict: lessons from Ukraine","volume":"23","author":"Price","year":"2022","journal-title":"Lancet Oncol"},{"key":"2026082603350799000_11.8.e025404.11","doi-asserted-by":"crossref","first-page":"101027","DOI":"10.1016\/j.adro.2022.101027","article-title":"Radiation therapy under the falling bombs: a tale of 2 Ukrainian cancer centers","volume":"7","author":"Kovalchuk","year":"2022","journal-title":"Adv Radiat Oncol"},{"key":"2026082603350799000_11.8.e025404.12","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2023.1151242","article-title":"War and oncology: cancer care in five Iraqi provinces impacted by the ISIL conflict","volume":"13","author":"Skelton","year":"2023","journal-title":"Front Oncol"},{"key":"2026082603350799000_11.8.e025404.13","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1016\/j.ijrobp.2020.05.060","article-title":"Cancer Care in Times of War: Radiation Oncology in Iraq","volume":"108","author":"Mula-Hussain","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2026082603350799000_11.8.e025404.14","first-page":"46","article-title":"Board-certified specialty training program in radiation oncology in a war-torn country: Challenges, solutions and outcomes","volume":"19","author":"Mula-Hussain","year":"2019","journal-title":"Clin Transl Radiat Oncol"},{"key":"2026082603350799000_11.8.e025404.15","doi-asserted-by":"crossref","DOI":"10.1186\/s13031-023-00550-9","article-title":"Radiology in conflict: scoping review","volume":"18","author":"Suji","year":"2024","journal-title":"Confl Health"},{"key":"2026082603350799000_11.8.e025404.16","doi-asserted-by":"crossref","DOI":"10.1200\/GO-24-00363","article-title":"Building an Effective International Medical Evacuation Program for Ukrainian Patients With Cancer Amid Prolonged Military Conflict","volume":"10","author":"Huivaniuk","year":"2024","journal-title":"JCO Glob Oncol"},{"key":"2026082603350799000_11.8.e025404.17","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/S1470-2045(23)00629-0","article-title":"Design and implementation of a humanitarian cancer care programme for Ukrainian refugees in Moldova and Romania","volume":"25","author":"Vulpe","year":"2024","journal-title":"Lancet Oncol"},{"key":"2026082603350799000_11.8.e025404.18","doi-asserted-by":"crossref","unstructured":"Klek S , Chrobak-Kasprzyk K , Machnicka K , et al . Cancer Care to Ukrainian War Refugees in Poland. JAMA Netw Open 2023. doi:10.1001\/jamanetworkopen.2023.21967","DOI":"10.1001\/jamanetworkopen.2023.21967"},{"key":"2026082603350799000_11.8.e025404.19","unstructured":"Agulnik A , Nogovitsyna Y , Kizyma R , et al . Strategies to promote sustainable care for children with cancer in Ukraine. Lancet Oncol 2024;00577\u20136."},{"key":"2026082603350799000_11.8.e025404.20","unstructured":"International Atomic Energy Agency . Planning national radiotherapy services: a practical tool. IAEA human health series no.14. Vienna IAEA; 2010."},{"key":"2026082603350799000_11.8.e025404.21","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1200\/GO.21.00029","article-title":"Global Radiotherapy: Current Status and Future Directions-White Paper","volume":"7","author":"Abdel-Wahab","year":"2021","journal-title":"JCO Glob Oncol"},{"key":"2026082603350799000_11.8.e025404.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.adro.2026.102014","article-title":"Global Assessment of Megavoltage External Beam Radiation Therapy Facilities: Current Status and Projections for 2030-2050","volume":"11","author":"Tabatabaei","year":"2026","journal-title":"Adv Radiat Oncol"},{"key":"2026082603350799000_11.8.e025404.23","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/S1470-2045(25)00192-5","article-title":"Destruction of Gaza\u2019s only cancer specialist hospital","volume":"26","author":"Burki","year":"2025","journal-title":"Lancet Oncol"},{"key":"2026082603350799000_11.8.e025404.24","doi-asserted-by":"crossref","DOI":"10.1016\/j.adro.2024.101514","article-title":"Radiation Therapy Delivery During the 2023 Israel-Hamas War: Trust Prevails Over Fear","volume":"9","author":"Brazg Ferro","year":"2024","journal-title":"Adv Radiat Oncol"},{"key":"2026082603350799000_11.8.e025404.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjonc-2025-000943","article-title":"Cancer care in wartime Ukraine: disruption, resilience and recovery","volume":"5","author":"Karavska","year":"2026","journal-title":"BMJ Oncol"},{"key":"2026082603350799000_11.8.e025404.26","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1158\/1538-7755.ASGCR25-Abstract-85","article-title":"Abstract 85: Support for Radiotherapy in Ukraine: Help Ukraine Group (HUG) Activities and the Importance of International Collaboration","volume":"34","author":"Kovalchuk","year":"2025","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"2026082603350799000_11.8.e025404.27","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2026.1752691","article-title":"Advancing radiation oncology care in Ukraine during the war: impact of international observerships on professional development and clinical practice","volume":"16","author":"Lozko","year":"2026","journal-title":"Front Oncol"},{"key":"2026082603350799000_11.8.e025404.28","doi-asserted-by":"crossref","DOI":"10.1200\/GO-25-00439","article-title":"Deployment of a Tailored and Hybrid Educational Strategy for Wartime Capacity Building: American Association of Physicists in Medicine\/Help Ukraine Group\/Ukrainian Association of Medical Physicists Training Program to Transition Ukraine From Co-60 to Intensity-Modulated Radiation Therapy","volume":"12","author":"Zelinskyi","year":"2026","journal-title":"JCO Glob Oncol"},{"key":"2026082603350799000_11.8.e025404.29","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2010.29.1351"},{"key":"2026082603350799000_11.8.e025404.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2007.03.010"},{"key":"2026082603350799000_11.8.e025404.31","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(92)90768-D"},{"key":"2026082603350799000_11.8.e025404.32","doi-asserted-by":"publisher","DOI":"10.3109\/02841868809090333"},{"key":"2026082603350799000_11.8.e025404.33","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2025.6215","article-title":"Breast Cancer Stage Among Ukrainian Refugees in Poland","volume":"8","author":"Sk\u00f3rniak","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026082603350799000_11.8.e025404.34","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.25197","article-title":"Disparities in Breast Cancer Characteristics Among Syrian Migrants and Jordanian Women in the Jordan Cancer Registry from 2010 to 2016","volume":"6","author":"Hazra","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026082603350799000_11.8.e025404.35","doi-asserted-by":"crossref","first-page":"102290","DOI":"10.1016\/j.canep.2022.102290","article-title":"The delay of breast cancer diagnosis and management during the Syrian war","volume":"82","author":"Hanafi","year":"2023","journal-title":"Cancer Epidemiol"},{"key":"2026082603350799000_11.8.e025404.36","doi-asserted-by":"crossref","DOI":"10.1200\/GO.23.00304","article-title":"Enhancing Cancer Care Amid Conflict: A Proposal for Optimizing Oncology Services During Wartime","volume":"9","author":"Ahmed","year":"2023","journal-title":"JCO Glob Oncol"},{"key":"2026082603350799000_11.8.e025404.37","doi-asserted-by":"crossref","DOI":"10.1016\/j.adro.2022.100955","article-title":"Help Ukraine","volume":"7","author":"Kovalchuk","year":"2022","journal-title":"Adv Radiat Oncol"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2026-025404","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:35:49Z","timestamp":1787740549000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2026-025404"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":37,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,26]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bmjgh-2026-025404"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2026-025404","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}