Radiotherapy (RT) is essential to effectively treat the most common cancers in low resource settings, yet there is a severe shortage of RT worldwide. Fair, principled systems for explicit rationing of this scarce but critical resource are needed. At Butaro Hospital in Rwanda, an oncology program supported by international partners is able to refer ten patients per month for RT. This project will develop an ethical approach to RT allocation at Butaro that can be applied broadly to other settings.