Inventory Insider May 2019

Is It A Good Idea to Purchase A Pre-Owned Linear Accelerator?

Not every facility needs to purchase a new linear accelerator. There are many times where a slightly used LINAC will serve the purpose of the facility at a fraction of the cost of a new one. Some facilities however, benefit from the purchase of new equipment. It really just depends on a number of variables to determine if a used, new, or refurbished linear accelerator is the solution for your facility. When a facility needs the newest technology on the market, it is obvious a used or refurbished LINAC will not benefit them. This is also the case if you are not looking to replace the machine anytime soon. A brand new or almost new linear accelerator is a better option for facilities that don’t want to replace their machine in the next ten to fifteen years and are looking for the latest and greatest technology. The struggle between buying new, refurbished, and used radiation oncology equipment is a struggle many facilities face. It is probably important to note however, that the minute you use a new linear accelerator it becomes used. So not every used machine is “used” to the same extent. Used and refurbished linear accelerators can be suitable for facilities under certain circumstances including:

When your facility is treating less than 8 to 10 patients a day, the revenue you are producing will not sustain the expense of a new machine.
Areas where reimbursement is low, and your clinic needs to be profitable to continue providing treatment may be better suited to purchase a used or refurbished unit.
The machine will be used in a limited capacity and doesn’t necessarily benefit from the latest technologies. These circumstances may include using the machine for research, treating animals, or non-medical, industrial purposes.
Your facility will be able to afford the latest and greatest in the next couple of years but just can’t without first building a profitable practice.
You are opening a new medical center and don’t have the resources to secure financing on a new machine.
You are moving to a new location, can’t afford downtime, and need to be able to treat patients during the process and currently only have one machine.
If your facility needs a back up to prevent downtime in patient care during maintenance and repairs on your main LINAC.
A new facility is being built but you need a temporary way to treat patients.
When the hardware aspect of treatment is not as important as the software. Used and refurbished equipment can have updated software installed when your budget doesn’t allow for both upgraded software and hardware.

Obviously, brand new, state of the art equipment when purchasing linear accelerators and CT scanners is something all facilities desire, it is not always the most practical situation. Purchasing used equipment doesn’t mean that your facility is operating with technology that is necessarily out of date. Often newer style equipment can be acquired with little use. It is important to remember just because it is used it doesn’t mean it is used up. Used simply means that at one time or another it has been in use for patient care. It could be the latest Varian model used for treatment in a facility briefly. Used equipment can often save facilities a great deal of money in machine costs and financing. Radparts is the world’s largest independent distributor of OEM replacement parts for Linear Accelerators and Radiation Oncology equipment. Radparts provides high quality, user friendly, low cost parts support for linear accelerators and radiation equipment. More information can be found at https://www.radparts.com/.

A Little Preparation Goes A Long Way In Maintaining Linear Accelerators

Linear accelerators, LINAC, are large scaled medical devices that deliver external radiation in the form of a beam to cancerous tumors in order to shrink them. As with most medical equipment, LINAC systems are expensive which is a barrier that many facilities face when purchasing a new or refurbished unit.

With the expense of these large scaled systems it is important to make sure they are properly maintained and that you have access to linear accelerator parts for repair as needed. Medical facilities can contract with companies that specialize in maintenance and repair services of LINAC systems such as Acceletronics or have on staff a team of professionals whose job it is to provide these services for their equipment. There are advantages and disadvantage to both options, facilities choose based on their budget and facility needs.

Linear accelerators have evolved over the years. LINAC machines no longer only provide external radiation beams for treatment. Major advancement in this technology include onboard imaging systems and portal dosimetry. Such complex systems require biomedical and clinical engineers to not only understand what these machines do but also how they are operated. Even with advanced training, until the engineer has hands on experience it is difficult to truly understand how the machine functions.

Not only is the linear accelerator expensive but the expertise to use and understand the machine is costly as well. This again is an issue that faces many medical facilities. These two factors alone make up the most significant aspect of expense faced by facilities when deciding on the purchase of equipment.

All linear accelerators are not created equally and therefore when replacing an existing system there will be a significant cost to not only bring new equipment in but also the training on the individual piece of equipment. One way to combat this is to replace existing LINAC with identical refurbished linear accelerators.

We have discussed a lot about the expense of these units however there is also significant revenue to be gained by having external radiation treatment available to patients seeking treatment for cancerous tumors. It is important for facilities to make sure these machines are functioning at peak capabilities at all times. Downtime not only impacts revenue but also patient care. In order for patients to have effective treatment for their tumors it is important they are able to strictly follow the treatment schedule laid out by their radiation team. If equipment is down this is not possible.

To ensure that patient care and revenue is not affected by machine downtime it is crucial to maintain equipment. Machine maintenance includes repairs in anticipation of failure. If a parts failure is eminent based on previous experience it behooves the facility to purchase the LINAC replacement part ahead of time so that service can be provided around patient’s treatment schedules. This allows facilities to schedule downtime to prevent unplanned downtime.

Radparts is the world’s largest independent distributor of OEM replacement parts for Linear Accelerators and Radiation Oncology equipment. Radparts provides high quality, user friendly, low cost parts support for linear accelerators and radiation equipment. More information can be found at https://www.radparts.com/.

April 2019 – Inventory Insider

Choosing To Replace Medical Equipment Opposed to Repair

There is quite a balancing act that goes on within healthcare facilities when it comes to whether or not medical equipment should be repaired or replaced. Unfortunately there is not one answer to address the issue. Decisions for repairing or replacing medical equipment such as linear accelerators and CT scanners needs to be done on a case by case basis. The most important factors being how the decision affects patient care and patient outcomes.

Many professionals involved in the decision to replace or repair medical equipment find weighing the costs and patient interests to be a difficult task. Facility decision makers need to determine the risks vs the rewards in how long to keep large scaled medical equipment in action. Preventative and corrective maintenance must be evaluated on a per machine basis to ensure the best decisions are made.

It is impractical to repair medical equipment when:

Replacement Parts Are Scarce: Replacement parts for LINACS or CT scanners aren’t common off the shelf items that you can find at any medical supply store. In fact, with manufacturers in a race to keep up with the latest and greatest technologies in equipment they are constantly phasing out older equipment which makes finding parts to repair medical equipment harder and harder to find. This alone makes it scary to rely on older equipment for critical patient care.

The Cost of Service: If medical equipment is not maintained or repaired by in house technicians’ facilities must look at the expense of service plans. Another factor is that as equipment ages, replacement parts are harder to find if not obsolete.

Patient Care Will Be Disrupted: When large scaled equipment starts to break down on a regular basis and interrupts patient care this wreaks havoc with patient care. If this is on-going, it can greatly affect your service and dissatisfied patients will seek care elsewhere.

On-Going Equipment Failure: Sometimes the equipment that you have is a giant lemon. If it is found that your device is failing time and time again it may make sense to replace it. Sometimes there is more liability in keeping a piece of equipment around that continues to fail than starting over.

There is a lot that goes into replacing a large scaled piece of medical equipment like a LINAC system, so it is crucial to have a plan in place for when the need arises. Not only does new equipment need to be purchased, the old equipment needs to be moved out to make room for the new. It is important to evaluate and reevaluate equipment frequently in order to avoid costly surprises. This is especially true in smaller facilities with stricter budgets.

Purchasing vs. Repairing Medical Equipment

Many medical facilities and healthcare clinics find themselves mauling over questions regarding repairing or replacing medical equipment. Questions may include ones such as the following:

What is the typical lifespan of the equipment?
Are we near the end or at the beginning of the equipment’s lifecycle?
Is it going to be cheaper to replace the piece now or to repair it?
Are repairs feasible and if so, are they cost effective?
When repaired will the equipment still be able to provide the high patient care standards we desire?
What is the cost of removing the old equipment?
Do we see maintenance costs of the older equipment increasing?

Often the choice to purchase a new piece of equipment verse repairing an older piece of equipment has to do with the cost of maintaining the older unit. Medical facilities and clinics figure if they are spending a couple of thousand dollars to maintain it then it is most likely better to replace it with a new piece. When it gets too expensive to maintain it is time to purchase a new piece of equipment.

For larger pieces of equipment like linear accelerators, CT scanners, and other radiation therapy equipment parts may start to become obsolete. When this occurs, parts for older equipment LINAC become quite scarce. It is important for facilities to ensure there are enough replacement parts available to maintain their equipment because the parts won’t be available any longer. It doesn’t mean that facilities need to plan for new equipment in the next year but that they should start planning for alternative part sources and planning for new equipment.

Make sure you are totaling up the annual costs of medical equipment repairs. Costs for parts and repairs can change as parts become scarce. Obviously, manufacturers of large scaled equipment want you to buy new sooner rather than later while the finance people within your facility want you to maintain the equipment as long as possible, especially when technology has not changed a great deal. Obviously, the goal is to make sure you are not spending valuable resources unnecessarily.

Medical facilities should find various resources in which to seek opinions on equipment and whether it should be replaced or not. Finding a solid medical repair and maintenance partner, such as Acceletronics and Radparts when determining whether to replace or repair an item, as well as what to do with older pieces when purchasing new ones.

The Ins and Outs Of Radiation Therapy Using a Linear Accelerator

A linear accelerator is a large scaled piece of medical equipment that is used to treat cancerous tumors. It does this through a process of high energy x-rays that conform to the shape of a tumor and emits a radiation beam that destroys cancer cells while trying to spare the surrounding healthy tissue. Linear accelerators have a number of features that are built in which works to ensure the patients safety. These measures prevent dosages higher than what the patient has been prescribed to be given.

When you are schedule to receive radiation therapy using a linear accelerator, your oncologist will deliver the treatment that was planned between them, the dosimetrist and your physicist. The oncologist will double-check your treatment plan each and every time before they begin treatment. This ensures quality control and ensures that your treatment is delivered exactly as it should be.

Linear accelerators delivers external radiation therapy for patients with cancer. The LINAC is used to delivery treatment on a variety of areas throughout the body. High energy x-rays are delivered directly to the tumor using a radiation beam that is delivered from the linear accelerator. The treatment is designed to shrink and destroy the cancerous tumor without harming the healthy tissue that surrounds the tumor. LINAC is used to treat cancerous areas throughout the body using all of the conventional radiation techniques including: IMRT, IGRT, VMAR, SRS, and SBRT.

Linear accelerators work using technology similar to a radar. In the “wave guide” a part of the accelerator, electrons collide with a metal target to produce high-energy x-rays. The high-energy x-rays exit the machine in the shape of a patient’s tumor. These beams are shaped by a multileaf collimator that is within the head of the linear accelerator.

Patients are put onto a moveable treatment couch that is positioned properly and are asked to lie still. It is important to note that the treatment couch can move up, down, right, left, in, and out. The radiation beam comes out of the gantry, part of the accelerator, that can be rotated around the patient. These two systems, working together, can deliver radiation in a variety of angles.

Linear accelerators are operated by a radiation therapist. There are a team of experts who work together to create a treatment plan. A radiation oncologist, a medical physicist, and a dosimetrist work in conjunction of one another to come up with a treatment plan. The radiation oncologists prescribes the correct treatment volume and dose. A medical physicist and dosimetrist determine how your prescribed dose is delivered and calculated.

Patient safety is insured in a number of ways. Before treatment is given the plan is developed and approved in collaboration with your team. This plan is continually reviewed for quality assurance. Safety measurements are built directly into the accelerator that does not allow a higher dose of radiation to be delivered to patients. Before a patient is treated the radiation, therapist will perform unilateral checks across the LINAC. More thorough linear accelerator checks are done monthly and annually. Specialized companies are available for hire that maintain, service, and repair linear accelerators. It is important to have access to LINAC service providers and LINAC parts for repair. The less downtime a facility incurs the higher the quality of patient care they can provide.

Patients are supervised throughout treatment using monitors and microphones that in the room. This allows the patient and radiation therapist to communicate. The position of the radiation beam are continually checked to ensure the positioning has not moved from the original treatment plan.

The safety of the staff and patient are crucial when using linear accelerators in treating cancerous tumors. The LINAC is installed in a room all by itself. The walls of the room are made from lead and concrete to eliminate the high energy x-rays from escaping and exposing people outside of the room. Radiation therapists do not tun on the LINAC until they are safely outside of the treatment area. Linear accelerators will only emit radiation when the machine is in use.

Installment Two – The Process of Treating Cancer Using Radiation

In our first installment on treating cancer with radiation we took a look in to exactly what radiation therapy was, how it worked, and how treatment is planned and delivered. In today’s installment we will look deeper into what patients can and cannot doing during treatment, how long treatment sessions take, what to expect, and potential side effects.

During treatment are there particular things I should or shouldn’t do?

It is hard to believe however, life as normal can continue while you receive radiation therapy. In fact, the less interruption to your overall schedule, the better. Try to think of radiation as you would any other appointment, don’t make it any more important than any other task in your daily life. Taking the importance away helps to ease anxiety. Consider the following when planning treatment:

Radiation therapy is performed using a linear accelerator. Some Skin tumors require a superficial x-ray unit, however for the most part radiation is delivered using a LINAC system. You will be required to lay still while on the table/couch underneath the linear accelerator while the treatment is occurring. You will feel nothing at all during the procedure. Many times, you don’t even know that treatment has occurred. A myth has circulated that you will be radio active after radiation therapy however this is incorrect. There is not a possibility of this at all.

Treatment can range from a single treatment, one time to multiple treatments a week for several weeks. This depends on a number of different factors including the type of cancer, where it is located, and how it is responding to treatment. Treatment is most often done during the week. The duration of your session will vary as well depending on the LINAC system that is used, and duration set in your treatment plan. Certain linear accelerators operate faster than others and certain cancers require slow and steady treatment. Your radiation oncologist will go over your specific case when reviewing your treatment plan.

During treatment it is important to drink plenty of fluids while eating regularly. A small, balanced meal several times a day will help with energy loss. It is also important to keep up on your regular, daily hygiene regimen. Try to avoid extreme foods of any nature, too spicy, too hot, too cold, and so on are not desirable when receiving treatment. It is also important to avoid extreme sun exposure during radiation as your skin will be more sensitive to burns.

What side effects should I be prepared for?

Radiation therapy provides a localized treatment which means that any side effect will depend on where it is received. You may experience the following:

Nausea: Depending on where treatment is given you may feel nauseous during or after treatment. (This could also be nerves) Whatever the case symptoms can easily be treated with the use of anti-nausea medication.

Diarrhea: As with nausea, diarrhea can be treated with medicine. Depending on severity a dietician can help prepare your diet to prevent future occurrences.

Sore Throat/Mouth: If you are having treatment done on your mouth or throat you can experience some tenderness. Your oncologist will offer suggestions to help prevent chewing and swallowing difficulties.

Increased Urination: Treatment in the lower abdomen and pelvic region can lead to frequently needing to relieve yourself. To prevent discomfort be sure to stay well hydrated by drinking extra water throughout the day. Take note of drastic changes which could be signally an infection verse side effects from treatment.

Hair Loss: This too is localized to the treatment area. Hair loss may occur on your chest, arms, legs, face, and head depending on where the radiation treatment is performed.

Can I continue to work?

As stated earlier, keeping your routine as normal is possible is key. Of course, each treatment plan is different, and your oncologist may recommend rest after treatment. If this is the case, you will want to follow their specific instructions. Once treatment is finished any side effects and symptoms should subside within a few weeks.

Will I need to follow up?

After radiation therapy is performed you will need to follow up with your physician. In most cases, the first time you meet after treatment will be between four and six weeks. This is not true in all cases and therefore it is important to work with your doctor to make these arrangements at the time of or before your last treatment of radiation.

Installment One – The Process Of Treating Cancer Using Radiation

What is radiation therapy anyway?

Radiation therapy is one of the most common ways to treat cancer. Depending on the type and nature of cancer being treated will depend on what method radiation is delivered to your tumor. Most commonly, a linear accelerator is used to deliver external beam therapy. LINAC machines deliver radiation directly to your tumor, externally.

How does radiation therapy work?

When radiation is delivered using a linear accelerator it is delivered to both cancerous cells and healthy cells. Radiation affects cancerous cells more than healthy cells. The highest possible dose of radiation is delivered to kill off the cancerous cells. Smaller doses can be delivered when the aim of treatment is to reduce the size of the cancerous tumor and relieve the symptoms.

Who plans and delivers your treatment?

Cancer oncologists will create a plan of treatment for patients. When the treatment that is planned requires radiation, a radiation oncologist will oversee the treatment and delivery of radiation. A team of cancer experts including nurses, specialists, counselors, dieticians, and assistants will help guide you throughout your treatment.

How is your treatment planned?

All cancer treatments are designed with the patient, the type of, and size of cancer. Radiation therapy is no different. Before radiation treatment is given patients will visit the facility to go over the plan of treatment that has been designed specifically for them. Radiation oncologists and radiation therapists will develop a plan based on x-rays and scans from simulators. Marks are then placed in strategic locations to pin point the areas to be treated. These marks will be placed each and every visit as the cancerous tumor changes. For cancers that are in the head, a guidance mask is created from a mold of the patients heads and is used to stabilize and pin point treatment due to the sensitivity of the area.

Does radiation therapy require hospitalization?

Radiation therapy is most often done on an outpatient basis however in some situations your radiation oncologist may recommend that you be admitted if they think it would enhance the success of your treatment. This is rare and usually does not occur as long as you are able to travel to and from the hospital for treatment.

What tests are performed in conjunction with radiation therapy?

Over the course of radiation treatment your oncologist will want to perform a number of follow up scans and x-rays to make sure the cancer is reacting to the radiation as expected. Occasionally additional lab work is required and is considered normal and nothing to worry about.

In our next installment on radiation therapy we will look deeper into what you can and cannot do during treatment and ways to combat side effects and more.

Replacing Equipment: Age Is Not the Only Factor

There are a number of factors that hospitals, medical facilities, and healthcare organizations must consider before they replace equipment besides age. Each year companies could potentially waste thousands of assets by focusing solely on the age of their equipment.

It wasn’t long ago that healthcare facilities were zealous to add all of the latest surgical equipment to their organization. From robotic surgery systems, linear accelerators, and other large scaled medical equipment were installed to keep physicians happy and be competitive.

However, in recent years budgets have gotten smaller and funds have become more restricted and facilities are seeing that equipment can’t just be discarded on a whim or purchased without advanced planning. Instead equipment needs to be repaired or refurbished and kept at peak performance for longer and a strategic approach needs to be taken to replace not only large scaled equipment but also universal equipment such as beds, linens, and so forth.

Proactive replacement planning is necessary between financial and clinical leaders within organizations need to work together to plan in order to achieve:

A reduction in expenses associated with service, parts, maintenance, and training
A decrease “close call” events that come with the use of older equipment with more precise maintenance schedules
A reallocation of assets that are underutilized throughout the facility
An ability to cross train employees throughout facility locations
An increase in consistency and standardization throughout facilities

When the above objectives can be achieved, a reduction in costs can occur with an increase in the quality of care patients receive.

Instead of the reactive strategy that medical facilities have embraced in the past more proactive approaches are being embraced. When purchasing new or refurbished medical equipment in a proactive approach allows leaders to embrace the situation over a period of time verse the reactive approach which tends to be more mission critical. Being proactive allows financial leaders in medical facilities to work with clinical leaders to plan for the addition of new equipment whether it is brand new or refurbished. When the replacement of equipment no longer is a life or death situation a better decision for the facility can be made.

Proactive planning in medical facilities allows for better outcomes overall. Financial teams and clinical teams can work together, armed with historical data, to have meaningful conversations instead of hypothetical ones. This allows better decisions to made for everyone throughout the facility from administrators and physicians to patients and care givers.