This is an excellent document but I think one vitally important piece of advice is missing: as far as I can see there is no requrement mentioned to the effect that adequate, qualified staff must be in place before such high-tech radiotherapy equipment is placed into clinical use. I am especially referring to medical physics staff. There are statements about the lack of qualified staff and educational prorgrammes to train them, but no requirement that they be present. This will inevitably lead to administrators and governments thinking that as long as they are in the process of establishing educational opportunities for their staff then it is alright to go ahead and purchase and use this equipment. It is also not made clear in this document that additional staff, especially medical physicists, are needed for these high-tech modalities. All this needs to be in the text and in the ten main points at the beginning. If you look at past error experience, it has very often been associated with overworked or undertrained physicists.