Unlocking radiotherapy access: the critical role of structural quality and radiation therapists in Saudi Arabia

Background/objective: Access to radiotherapy (RT) remains a challenge even in high-income countries such as the Kingdom of Saudi Arabia (KSA). This study aims to examine how key structural indicators such as staffing and equipment availability, distribution, and capacity affect access to care and the quality of RT services in Saudi Arabia. Methods: A mixed-methods design using a descriptive cross-sectional approach was employed. A survey was distributed electronically to supervisors and managers of 20 RT units in the KSA between September 24 and October 23, 2025. The qualitative phase explored the perspectives of radiation therapists (RTTs) and medical physicists, whereas the quantitative phase examined variables such as staff numbers and distribution, patient volumes, equipment availability, treatment waiting times, and overall facility capacity between January and December 2024. Results: The survey response rate was 85% (n =20). Public facilities treated the highest caseloads but had fewer linear accelerators per patient, higher clinician workloads, and longer waiting times, with radical treatment often exceeding 14 days and, in some cases, extending beyond 42 days. The mixed centers had the highest machine capacity and advanced technologies. Training opportunities were limited, particularly in the public sector, where most departments rated staffing and operational efficiency inadequate. Equipment procurement presented a challenge with 65% of centers (majority in the public sector), expressing tendering delays severely or critically affected their ability to provide care. Conclusion: These findings support the development of a strategic framework to strengthen RT capacity and reduce sector-based disparities. Outsourcing initiatives among different facility types have already been initiated. Ultimately, these results may support policy development and resource planning to promote more equitable cancer care delivery in the country.