To assess helical tomotherapy (TOMO) current clinical application and practice in mainland China.

Data were collected for all TOMO units clinically operational in mainland China by 30 April 2016, including (a) the distribution of installation and staffing levels; (b) types of cancers treated; (c) utilisation efficiency; (d) quality assurance; (e) maintenance; (f) optional features; and (g) satisfaction levels. The data were collected as a census and analysed qualitatively and quantitatively.

As of 30 April 2016, 23 TOMO units were used clinically by 22 hospitals in mainland China. In the same period, 22,558 cancer patients were treated. For TOMO units with more than a year of clinical utilisation, a median of 378 cases were treated annually per machine. The median daily operation was 10·5 hours, and treatment headcount was 38·3 patients. The median service outage rate was 2·6%, and the most common cause was malfunction of the multi-leaf collimator. In terms of overall satisfaction levels, 3 hospitals were very satisfied, 16 were satisfied and 3 considered their satisfaction level as average.

The overall operation of TOMO is good, but there are some problems due to running at full capacity, lack of clinical efficacy research and insufficient quality assurance regulations.