Strategic governance of integrated nuclear medicine, diagnostic radiology, and radiation therapy in comprehensive cancer centres: A balanced scorecard framework.

Comprehensive cancer centres depend on nuclear medicine, diagnostic radiology and radiation therapy for diagnosis, staging, treatment planning, image guidance, treatment delivery, response assessment and follow-up. Although these services are clinically interdependent, they are often governed through separate departmental structures, budgets, information systems, quality routines and performance reports. This fragmentation can limit the ability of cancer-centre leaders to balance access, clinical quality, patient safety, workforce capacity, equipment sustainability, innovation and data stewardship. This policy analysis proposes a Balanced Scorecard and Strategy Map for integrated radiation medicine governance in comprehensive cancer centres. The framework adapts the classical Balanced Scorecard by making six domains explicit: patient access and experience, clinical quality and safety, integrated care pathways, resources and sustainability, workforce learning and innovation, and data, digital infrastructure and decision support. It also proposes a two-tier governance dashboard, with a concise strategic scorecard for executive and cancer-centre leadership and more detailed operational scorecards for nuclear medicine, diagnostic radiology and radiation therapy teams. The framework is intended to complement, not replace, discipline-specific audit, accreditation, quality assurance and incident-learning systems. Its purpose is to align these systems within a shared governance architecture that supports transparent investment prioritisation, workforce planning, access improvement, technology adoption and quality improvement. The scorecard should not be used as a punitive performance system. Its value depends on co-design, precise indicator definitions, trusted data sources, contextual interpretation and recurring non-punitive review. Future work should pilot the framework and evaluate feasibility, acceptability, data burden and influence on leadership decisions.