There are constant advancements in the treatment of diseases. With these advancements the equipment used in treatment must also continue to evolve. Radiation therapy is a great example of this process, as the cancers treated change and more effective treatments are found the equipment used must also adapt. You can see this with IGRT, Image-Guided Radiation Therapy, that not only delivers the radiation therapy but does so while incorporating imaging as the treatment is being done. So instead of separate imaging and then radiation this process allows everything to happen at once.
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/.
Researchers are continuing to find new techniques and develop new technology to better improve cancer treatment by using cutting edge Flash radiotherapy. This procedure delivers doses of ultrahigh radiation to a patient in fractions of a second. This type of treatment could be very beneficial and increasingly more effective in tumor treatment. With faster and fewer treatments, less healthy tissues will be damaged. It also will potentially allow more patients access to the linear accelerator equipment in treatment rooms if treatments are less time. More studies continue to focus on this new medical revelation that could help shape a new form of treatment in the near future.
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 partahead 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/.
Hearing the word “Cancer” can be very scary when a doctor first diagnoses you or someone you love. When choosing the path of Radiotherapy, often a person is unsure what this journey will entail which makes things even scarier. A simplified treatment course will follow: consultation with radiation oncologist, CT simulation scan, treatment planning, and then finally the actual treatment. Each person’s own case is unique with intensity and amount of time a treatment will need to be administered.
To Read whole article below to understand the radiotherapy process below:
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.
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/.
The prototype radiotherapy system combines a fixed
vertical radiation beam with horizontal patient rotation. (Courtesy:
Paul Liu)
Radiation therapy plays a fundamental role in cancer treatment, but there is a global shortage of radiotherapy centres, with many low-to-middle-income countries having limited or no treatment capability. This situation exists in part due to the cost of facilities and the expense of acquiring and operating radiotherapy systems. Linear accelerators with simplified designs, such as fixed gantry systems, could reduce these costs.
Researchers at the ACRF Image X Institute at the University of Sydney are developing a 3D conformal radiotherapy system with a fixed vertical X-ray beam, horizontal patient rotation and image guidance. The full-size proof-of-concept prototype, which offers high-quality radiation therapy from a smaller, more robust and more cost-effective system, has now been successfully commissioned (Med. Phys. 10.1002/mp.13356).
From a financial perspective, there are many potential advantages of a
such a fixed-beam system. Without a rotating gantry, the system has
fewer moving parts, which could improve reliability and robustness, and
potentially reduce maintenance costs. It would also require less bunker
shielding to operate safely, thereby reducing the cost of building new
bunkers or renovating bunkers housing older radiotherapy equipment such
as cobalt-60 units.
The prototype system — developed by Paul Liu and colleagues working on the Nano-X project to improve global access to radiotherapy — is based on the concept of patient rotation, specifically, keeping the radiation beam stationary while still achieving the necessary beam angles to achieve a desired dose distribution. Image guidance technologies will identify the tumour and adapt the treatment in real-time to ensure that the radiation dose is precisely delivered to the target.
The prototype comprises a standard Synergy linac with the gantry fixed at 0° and a horizontal patient rotation system (PRS). The PRS is a custom-designed radiotherapy couch equipped with straps for the head, chest, hips and legs, plus three independently controlled airbags that inflate over a patient’s chest and sides. The couch can move with two degrees-of-freedom to position and rotate the patient.
After the patient is immobilized and in a specified treatment
position, they can be rotated to a specific angle for either kilovoltage
(kV) imaging via the on-board imager or treatment with the megavoltage
beam. The software operating the PRS allows for precise motion control,
setting the target position or angle along with the desired velocity,
acceleration and deceleration. It can also follow a series of queued
motion commands, or execute quick-stop, return-to-home and patient
egress commands.
The system passed all commissioning steps, which involved
verification of geometric and dosimetric accuracy following conventional
radiotherapy guidelines. The team also performed thorough testing of
safety and interlock systems.
Clinical potential
The authors note that three essential steps will be needed before
treating patients. Cone-beam CT image reconstruction under gravitational
deformation may require advanced image reconstruction algorithms. They
also need to develop methods to shift the beam to account for
gravitational deformation-induced target motion.
Additionally, a patient’s tolerance of, and anxiety level relating to, horizontal rotation is unknown. It could be as much of a problem as an MRI exam is to a claustrophobic or noise-averse patient. An upcoming clinical trial will investigate and quantify how patients respond to strap and airbag immobilization and horizontal rotation.
Liu discussed the challenges with Physics World. “While we
initially focused on static targets, an important part of the system
will be its ability to adapt to motion, both from the patient’s normal
physiological functions like breathing and from gravity as the patient
is rotated,” he explains. “The next stage of the project will focus on
implementing and testing algorithms that we’ve developed to both
identify the amount of motion and to compensate for it accordingly.”
To enable real-time image guidance, the researchers are testing
kilovoltage intrafraction monitoring (KIM), a novel tumour localization
system developed at the University of Sydney that accurately estimates
the 3D position of a target based on the 2D position of segmented
markers in kV projections.
Read more
Real-time image-guided ART achieved on a standard linac
“KIM will offer real-time 3D target tracking with sub-degree and
sub-millimetre accuracy,” Liu says. “We have successfully tested KIM
together with real-time multileaf collimation tracking on a miniature
version of this system, and are currently scaling these algorithms to
our full-size prototype. We will be using KIM with a deformable phantom
where the target will move as it undergoes rotation.”
The researchers are also investigating intensity-modulated
radiotherapy and volumetric-modulated arc therapy, which are under
various stages of implementation. Liu says that both are technically
feasible, because the software and hardware control of the PRS has
sufficient precision and flexibility.
Much work, followed by testing with veterinary radiation treatments, will be required before the first palliative treatments on human cancer patients can be undertaken. The system is not designed for infants, very small children or obese patients. But for all other cancer patients, this prototype radiotherapy system has potential to fill the existing and expanding gap between available treatment and need, especially for patients living in economically challenged areas of the world.
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 partsmay 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.
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/.
