GE CT Scanners – Doing Business In Michigan

Purchasing a Preowned Linear Accelerator – Great Quality at a Lower Cost

When choosing the medical equipment for your facility, it can be a difficult decision to find the best system that can provide treatments for patients while trying to stay inside a budget. Many radiation oncology centers struggle with the decision to purchase a new system vs. preowned refurbished medical equipment. If given a choice, a new linear accelerator will seem most appealing because of the updated technology and advanced features it offers. However, due to economic and other factors, it may not always be a reasonable option. Purchasing used and or refurbished medical equipment does not mean that your facility is stuck using out of date technology. There is still a lot of equipment available, allowing buyers the opportunity to receive the most up-to-date technology at a much lower price tag.

Starting a New Practice/ Facility

Purchasing used or refurbished medical equipment may be an excellent option for new clinics since they may not have the start-up capital for new products. If treatments are given to fewer patients (less than 8-10 times a day), and machine use is low, this will allow a business to start building up a revenue base for the practice. In the beginning, a facility may decide to buy newer equipment within 4-7 years while operating older equipment.

Having a Backup/ Relocation Plan

Many medical centers may be currently performing treatment with one system, so having a backup machine is a good plan to ensure patient schedules run without delay due to limited operating capacity. The process of replacing or supplementing a linear accelerator can extremely cumbersome, lasting 3 to 4 weeks in some cases. Having this long of a delay in treatment can be detrimental to patients that need treatment daily. One option to consider is to purchase a nearly identical, used linear accelerator and install it within a new location. Once the new center is operational, the company can remove and resell the original machine; This will ensure no disruption with patient care occurs and offer a smooth transition for relocation.

Room for Improvements

Purchasing a used linear accelerator will give your facility more room to grow and allow for cost-savings benefits. Many machines can receive upgrades later during their life since most original manufacturers or third-party companies offer upgradeable options for used equipment models. If the software is more important to your clinic than hardware, this option can be cost-effective since the software is typically more expensive than the hardware. However, this option is not a perfect solution for all medical centers as each center will have specific requirements that may find new medical equipment to be a better choice.

As an independent LINAC service company, Acceletronics is dedicated to delivering the best equipment performance and services for linear accelerators and CT scanners across all major brands and models, as well as new and refurbished LINAC systems for sale. More information can be found online at https://www.acceletronics.com/.

Types of Radiation Therapy

Radiation treatment continues to grow and change in order to improve the health and quality of life to cancer patients all around the world. With radiation therapy, high-energy particles or waves of energy are used to treat cancer by breaking up the DNA of cancer cells in a way that destroys their growth and division. Radiation can kill cancer cells or can decrease the rate at which cancer will spread.

Goals of Radiation Therapy

A doctor may recommend radiation as a treatment option at different stages of a cancer diagnosis. When cancer is found in earlier stages, radiation therapy can help decrease the size of a tumor before a scheduled surgery or be used after surgery to kill any remaining cancerous cells. Radiation therapy can also be used in later stages of cancer and can be used as a solution for pain relief, or part of palliative care. When speaking of types of radiation therapy available, there are two main forms used for treatments both external and internal. Doctors will sometime prescribe radiation therapy to be combined with other cancer treatments such as chemotherapy, surgery, and others.

External Radiation Therapy

The most common type of radiation treatment involves an external source of equipment that delivers radiation from outside a patient’s body that is aimed at a targeted cancer site. Equipment used in external beam therapy include systems such as proton and neutron beam machines, orthovoltage x-ray, Cobalt-60 machines, and linear accelerators. The team of radiation oncologists will determine which method and system are best for treatment, depending on the location of cancer within the body. These systems can be used for patients who have several tumors of the head, neck, breast, lung, colon, and prostate. There are two levels of radiation when external radiation therapy is performed depending on the location of the tumor, low-energy and high-energy radiation. Low-energy radiation may be a better choice in treating surface tumors like skin cancer since it will not penetrate very deep into the body. High-energy radiation is used when patients require deeper penetration to reach cancerous cells hidden in the patient’s body.

Internal Radiation Therapy

There are a few different types of internal radiation therapy available. One method is called Brachytherapy, which is described as placing radiation sources as close to the tumor site as possible. In some instances, it can be inserted directly inside the tumor. The implant may be temporary or permanent and is used in many cancers such as ones found in the cervix, uterus, vagina, rectum, eye, and in certain parts of the head and neck. Brachytherapy is separated into categories by the method in which radiation is placed on the body.

Interstitial Brachytherapy – involves placing radioactive needles or wires in the tumor area for a selected length of time, whether a day, a week or can remain in the patient’s body permanently.

Intracavitary Brachytherapy – the placement of a metal or plastic radioactive source that is inserted into body cavities such as the vagina, uterus, or larynx to irradiate the cancerous walls within the cavity or the tissues nearby.

Intraluminal Radiation Therapy – delivers radiation to hollow organs. A surgeon or a radiation oncologist performs this method by inserting a specially designed tube in an opening such as the esophagus for cancer treatment.

Radioactively Tagged Molecules – radioactive particles are attached to small molecules and delivered intravenously.

Purchasing a CT Simulator and X-Ray Tubes

Before a patient begins treatment with radiotherapy, a team of experts will meet to develop a specific plan for each individual patient. The first step in the planning process may involve the use of a CT simulator, which includes a CT scan of the area of the body that needs radiation treatment. This piece of equipment is essential during the initial planning process and is a great asset to any clinic or organization to have available for use. Many considerations should be made when purchasing radiotherapy equipment such as a CT simulator, the software and cooling systems, and the purchase of an x-ray tube.

Choosing a CT Simulator Based on the X-Ray Tube

The most expensive component of a CT Simulator that also needs to be replaced the most is the x-ray tube. The x-ray tube is required to endure very high heat loads, preferably having the ability to store 5 million heat units (MHU) or more. The use of high heat unit tubes provides a longer life of the unit, which will, in turn, save on downtime when needing to be replaced. In choosing a CT Simulator to purchase, it is best to base the decision on the tube it comes with. A system that may be less costly upfront may have a tube that does not last very long and could ultimately cost more in the long run than if initially purchased with a better tube, to begin with.

Best X-Ray Tubes for Your Buck

When looking at CT Simulators for purchase, the tubes as explained above are important to consider in longevity. Each system comes with a specific tube and no upgrade options are available. Some of the most popular x-ray tubes for CT Simulation include:

GE RT 4 MCS7079 Varian Mini Hercules 7.5 HUU – This tube is well known for not being the best, but perhaps one of the worst-performing tubes with a short life span as well. Another downfall is that Dunlee replacement tubes are not offered for this model and must have a Varian tube from GE that can cost roughly $200,000 new. There are used options for replacements for under $100,000. Overall, this tube should come with a large caution sign showing the many reviews from users to stay away from this system if possible.
GE RT 16 Hercules MX240 8.0 MHU – These next tubes have a reasonable life expectancy of about 6,000 to 10,000 patient scans performed however, they have been known to exceed this amount and go beyond 15,000 scans. The tubes are warranted from GE and Dunlee for 6,000 scans. There are new replacement options from the Dunlee manufacturer and Reevo 240G that are priced at $195,000 new. They can be purchased used for $75,000- $100,000 as well.
Philips MRC 600 8.0 MHU – This third option is by far the best in value with tubes that are among the longest-lasting on the market. The x-ray tubes exceed 800,000 to 1,6000,000 scan seconds or roughly 4 to 7 years at a mid-range patient occupancy level. On average, they can cost $140,000 new and $40,000-70,000 used.

Weighing Pros and Cons

Purchasing equipment for radiotherapy is never an easy task with having so many options available, both new and used provided as well. When choosing tubes at a lower price point, it may give a company good value in the short-term, but keep in mind, it will need to be replaced more frequently. If you don’t want to worry about needing to replace the tubes as often, a higher-end tube is your best option, but it will cost more. Ultimately, you need to take into consideration your facilities’ unique needs for the best solution available.

Should I Replace or Upgrade My LINAC System?

Having a shiny LINAC system in your clinic entitles you to benefits and services other clinics lacking this technology do not. Such a system is imperative when dealing with minute cancer situations and can not only give the medical staff an edge but also give patients a guarantee of quality others cannot. That said, a proper LINAC system is, quite obviously, not a cheap system to not only implement initially but maintain over time. At one point a clinician or technician may decide the time has come to upgrade to what’s best out there, but such a decision is not so black and white. This article should briefly outline why so.

What Do You Have?

When making the decision to upgrade, you have to look at what you have already implemented. What you have may actually be satisfactory despite being old. LINAC systems themselves are as pricy as one may expect but are also modifiable with different parts that make up the whole. Linear accelerators can be classified as defined by their part status. Essentially, your linear accelerator can be classified from older and lacking upgrades, through newer but lacking and older and possessing upgrades, to newer and possessing upgrades. Where your system lies on the spectrum indicates whether or not making upgrades is worth the cost when considering the competency.

What is Your Budget?

Depending on the overall budget and success of your clinic you may find it smarter to simply upgrade certain parts on your older LINAC system. If money is no object you can naturally swap out your system – even if it’s new – for a newer, more modern and up-to-date model. Having an infinite source of funds is most likely not the case for most clinics, so you must take budget into effect and decide if your system is old enough to really warrant a true upgrade. Remember, upgrading certain parts of your system will always be cheaper than an outright replacement, and going with used upgrades is still a viable and more cost-effective option.

Do You Have Time?

When replacing a LINAC system completely, time is of great importance. Upgrading certain parts on a system can take hours and can be done overnight, but swapping out an entire system can take much, much longer. Are you able to survive with such an important machine out of the office for so long? If your system isn’t too old and has competent upgrades, then it can be hard to justify that absence. Any experienced clinician understands his or her own office enough to know whether or not that absence is detrimental to overall clinic success.

Treating Cancer with External Beam Radiation

Cancer treatment has continued to evolve with new technology and knowledge on new innovative techniques to increase the effectiveness with fewer treatments needed. External beam radiation therapy is a form of treatment that aims radiation from a machine called a linear accelerator. The beam of radiation is aimed at a targeted area where tumor cells are found. This type of radiation therapy is a local treatment and treats the specific area in a person’s body such as lungs and not their entire body. There are several options when using external beam radiation therapy with all the same goal to deliver the highest dose of prescribed radiation to a tumor while protecting the surrounding tissue. Below each treatment type is explained more in detail.

3D conformal radiation therapy

This type of technique is a common option in radiation therapy in which it uses images from CT, MRI, and PET scans to create a precise plan for the treatment area. The process allows doctors to sculpt radiation beams to the shape of a tumor and often used in instances where the tumor is oddly shaped or if the tumor lies close to healthy tissue/ organs. The radiation beams can then be directed at the target from several angles as needed.

Intensity-modulated radiation therapy (IMRT)

Intensity-modulated radiation therapy (IMRT) is an advanced type of 3-D conformal radiation therapy to treat cancer and noncancerous tumors. IMRT is used by multiple small photons and proton beams aimed at targeted tumor cells with varied, controlled intensity. During each treatment, the beam shape and the beam strength will continue to change to give higher doses to certain parts of the tumor as needed. Due to the greater level of accuracy, IMRT is a possible treatment option for patients that may have reached the maximum allowable dose from conventional radiation therapy with reoccurring tumors.

Image-guided radiation therapy (IGRT)

Image-guided radiation therapy (IGRT) is a form of IMRT. What sets this type of treatment apart from IMRT is that it not only uses imaging scans before radiation sessions begin but also uses them during the actual radiation therapy session. Tumors can shift inside the body due to breathing or other body movements that can sometimes be hard to control. IGRT allows doctors to locate and track tumors during the procedure to deliver more precise radiation therapy. Technical adjustments can be made by the radiation oncologists when the tumor moves outside of the targeted area helping to limit radiation exposure that could damage healthy tissues nearby and decrease common radiation side effects.

Consideration When Buying A Linear Accelerator

Purchasing a new Linear Accelerator can be a very costly investment that can range between $1 million and upwards to over $5 million. This cost alone is not the only expected fees associated with this equipment since delivery charges and secondary equipment such as a simulator, treatment planning computer, the treatment room itself, and the compensation for the radiographers/ physicist salaries. There is a lot of options to consider when replacing or installing new radiotherapy equipment and a few helpful tips below may help make the decision process a little simpler.

The Resale Value

Before purchasing any new or refurbished linear accelerator, it is important to ask yourself the question “How much will my Linac system be worth if choosing to replace or upgrade it in the future?” The answer to this may affect your company’s ability to purchase equipment in the future so the best way to solve this is by three other factors. First is obsolescence, this factor will greatly impact the long-term maintenance of any equipment. As parts continue to get older, replacement parts will become more and more difficult to locate for obsolete equipment. This also will make service personal harder to find as well since they will not be as familiar with repairs on older machines. Research the manufacturing company and choose one that has been in business for a decent amount of time, If you feel the company will not be around in the next ten years it will most likely not have very good resale value.

Re-licensing Fees

When shopping for a new linear accelerator, if a machine requires new relicensing it will become more costly to a buyer hence making it less attractive for purchase. Providing the license on the equipment will increase the demand which will, in turn, make it have a higher resale value as well. Company’s such as Varian and Elekta have always had higher resale value because of the licensing fees/ software and relocation charges being less than their competitors.

Technology Reimbursements

The centers for Medicare and Medicaid Services utilize reimbursement rates to entice clinicians to accept the use of new, proven treatment for the future. For example, several years ago when CMS code 77421 was released, image-guided radiation therapy (IGRT) became widely accepted and hundreds of linear accelerators were upgraded, therefore. A linear accelerator that has the technology to benefit from higher reimbursement rates which certainly affect the price of a machine in the market of used equipment. Systems that use IMRT, IGRT, and CBCT technology will lead more than machines without these capabilities. The future can be a mystery when attempting to predict which technologies will be reimbursed in the following years but company’s such as Varian and Elekta have a long history of systems that have the possibility for upgrades which has helped them increase in value on used products.

What is Equipment Relocation?

Linear accelerators and CT simulators are large, that’s obvious. Any business who has obtained an accelerator understands the headache of moving such a large and delicate machine to their offices. When moving offices or simply needing to move an accelerator from one place to another there are companies that have staff on hand who are specialized in moving this equipment so you the business owner do not have to worry about how it’s going to get done. These companies offer a range of services related to accelerator relocation so there should be a service to fit any needs a business may have.

Quality Moving

The companies that specialize in moving large equipment are specialized because of the talent on hand. These employees are specially trained to handle large equipment moving with ease and delicacy that these machines require and can do so with advanced logistics that other companies do not possess. With these logistics intact these companies can ensure your equipment is free from damage of any kind during the moving process and can move the equipment over a small area to even internationally. You’ve no-doubt seen videos of unqualified employees attempting to move large equipment and failing miserably causing thousands of dollars of damage to the company, so it pays tremendously to hire a professional relocation company that can handle the move in a professional and careful manner.

Installation

Simply moving equipment is great, but what about those who need it and moved as well as installed in their offices? Equipment relocation isn’t just moving equipment from one place to another but also making sure the instrument is properly installed using the correct tools for the job. The machines usually involved in relocation such as linear accelerators are simply impossible to move on your own, so the crews at these relocation companies are able to use specific rigging materials to make sure the equipment is lifted and moved to right where it needs to be as carefully as can be. The process of installing the electrical components of these instruments is also handled by professional and experienced engineering specialist who can handle the job with the proper care and respect.

Testing

Once an instrument like a linear accelerator is moved to a new location and properly installed in the right spot in the office it still requires careful calibration before it can be used properly. The companies that supply relocation services also provide physics support related to calibration and testing. This completes the full suite of process and steps necessary when transporting a large instrument like a linear accelerator from one office to another and is a full suite that certain relocation companies can offer.

Key Points to Consider for Linac Removal

Removing a 25,000 lb piece of machinery from a medical clinic or hospital, what could go wrong? It can be crucial to other surrounding equipment and to your facility to have safe and efficient removal services performed so that your facility will have peace of mind knowing that this process will be handled correctly. A few tips below will help this removal process go more smoothly and will get you to the goal of out with the out and in with the new more quickly.

Removal Path

To start, cleaning of any removable clutter is always overlooked and can become an obstacle that can be avoided. Measuring will be the next step to take when its time to start moving any type of equipment. A tape measurer will be your best friend since when it comes to moving high or low energy linacs, each have a minimum requirement for the number of inches required for room clearance. Accurately measuring all building doors including the vault and outside door along the removal path is very important. Prior to the arrival or replacement equipment, a professional vendor will request a rig info sheet to be submitted to guarantee that there is no door frames or walls that will need to be removed. If the vendor does not ask about the measurements beforehand, this is a red flag that you should be looking for equipment elsewhere.

Safety Concerns

When transporting heavy equipment at any times, the safety of the removal team is of utmost importance. If the above-mentioned measurements are done inaccurately and realize that a vault door must be removed with late notice, this will pose a very big safety hazard. Depending on size, vault doors can easily weigh a few thousand pounds and unfortunate deaths have resulted when removal of these doors have been done incorrectly. When they doors need to be removed, it is critical that they are removed by professionals that have experience in the field. Last minute decisions for vault door removal will also cut into extra expenses that was not part of the company budget so it again if very important for the measurements to be calculated right the first time. Proper liability insurance should be provided by your vendor when on site during the removal process as well.

Loading Space

Once you have the old equipment outside the next step is often overlooked as well. The loading area needs to have enough space in order to load the linear accelerator into trailer for transportation. Facilities will typically need to block off any side streets or parking spots to allow a safe loading area. If loading space is unavailable, the removal team will need to utilize a forklift of suitable size to lift and move machinery to the trailer manually.

Facility Jobs

No matter the size or details of removal that is performed, there will be responsibilities of the facility that will be requested. Generally, the removal team will ask local facility engineers, electricians, or plumbers to turn off the water or other power sources that are attached to the specific equipment that is being removed. This will protect the office building from having potentially dangerous live power to the area and helps to not disrupt any of the surrounding rooms that lighting and power may be connected to as well. Many times, the facility will manage and schedule the removal times so that it is occurring after hours or assist in security throughout the building.

Improving LINAC Service Response Time

Linear accelerators and complex support devices are at the heart of today’s radiation oncology. As technology continues to advance and change the way in which LINAC systems treat cancerous tumors, it becomes increasingly difficult to manage the way in which equipment maintenance, malfunction, and breakdowns are managed. The strategies to manage quality, mitigate risk and analyze failures have improved to adjust to the changing needs of radiation oncology equipment.

Manufacturers of oncology equipment add guidelines to ensure successful management of equipment maintenance including system monitoring and cyclical measurements of key functions verse pre-specified tolerances. This information was previously documented by hand whereas in today’s environment data can be recorded, distributed company-wide, and stored electronically. IT plays an integral role in storing and managing the data which can then be integrated into the everyday workflow in the radiation oncology department.

Work to cultivate IT clinical management solutions in the radiation department is often done in house working in collaboration with equipment vendors. This process is an essential component in quality management of radiation oncology equipment services.

Service and support of linear accelerators are a key element in quality management in the radiation oncology department. In most facilities, radiation therapists will report all technical problems with the LINAC to a clinical medical physicist who then reports the events of the machine’s failure to the vendor’s dispatch center to schedule support. When this call is made the therapist or physicist reporting the LINAC failure will provide the identification of the linear accelerator, the location of the machine, and a detailed report of the problem including what issues led up to the failure..

Depending on where the machine is located, the vendors dispatch center will provide information to equipment engineers at their technical support help desk. Together the user and engineers will attempt to diagnosis the issue at hand and coordinate actions for repair.

Facilities looking to improve the efficiency of support and service to linear accelerators when failure occurs can implement key changes in the overall process. These procedure modifications include:

Lessen the number of steps involved in reporting the LINAC failure to the vendor’s support team.
Reduce duplication and surplus in the diffusion of information related to the linear accelerators’ failure.
Record events electronically for improvement and evaluation of delivering services related to LINAC maintenance and repairs.
Utilize remote support from vendor approved engineers that are familiar with the installed system and its maintenance and service history.

3 Tips For Installing or Replacing a Linear Accelerator

New linear accelerators can cost a medical facility between 1 and 5 million dollars. The expense of owning a LINAC does not stop once it has ben purchased. There are items outside of the actual equipment purchase such as a simulator, training computers, treatment rooms, salaries, ongoing training, operation expenses, maintenance, repairs, and more. The total cost of large scaled medical equipment is never one that should be underestimated. Whether you are installing a brand new or refurbished linear accelerator, installing a LINAC for the first time, or replacing an existing one there are three tips the professionals at Acceletronics want to give you.

Step One – Plan, Plan, and Plan Some More

The installation planning process for a linear accelerator takes between six months to eight years. The length of time for planning your project can span almost any length of time.

When planning new technology, you will first want to establish the technology that you need in order to treat patients. What types of cases will you be treating? Consider the options IMRT, IGRT, and so on.
If you are installing a linear accelerator in new construction, you will want to consider the constraints that come along with that. What local permits do you need, do you have the proper power supply needed for this large scaled equipment, are there constraints that will limit your installation? If you are renovating a space consider the rooms constraints, size, location of isocenter and so forth.
Create a timeline for major milestones. When will the vault be completed, when are vendors scheduled to install computers? When planning these things consider potential areas where conflict can occur and come up with a backup plan.
Once the goals are established, a budget is needed to acquire the new equipment. Consider other aspects as well such as training, equipment needed to run the LINAC and treat patients, and the extra items that can be forgotten about when focusing on the large scaled purchase.

Step Two – Hire Based on Experience

When hiring a team of professionals, it is crucial that you hire experts. Experts are needed for designing the vault, construction, providers of equipment and supplies, IT support, clinical implementation teams, and such. Don’t trade cost for quality. Sometimes a little bit more money now can save you a great deal of money later on down the road. Ask for references when working with different vendors. Hire only those vendors that understand the collaboration effort needed to install medical equipment such as CT Scanners and Linear Accelerators.

Step Three – Commit to Quality

When buying a used or refurbished linear accelerator there is a three-step process that you should follow to ensure you get a machine that meets your needs and beyond. These steps include: a review of the LINAC’s service history (look at major service events such as waveguide replacement), review the machine’s utilization and beam hours, and perform a physical inspection of the machine.