Key Considerations When Removing a Linear Accelerator
25,000 lbs. of sophisticated technology and metal…dismantling and removing large medical equipment like linear accelerators sounds easy enough. Nevertheless, there are many factors and considerations your clinic or hospital should pay attention to when removing a linear accelerator.
Just as most sports are a game of inches, so too is rigging out large capital equipment. High energy and low energy linacs each have minimum requirements for the number of inches needed for room clearance. Accurately measuring all facility doors along the rig path, including the vault door and outside door, is critical. A professional vendor will request or require a rig info sheet to be filled out prior to their arrival to ensure no door frames or walls need to be removed by the facility contractor. If your vendor is not asking about measurements, it’s time to look elsewhere. A few minutes with a tape measure can save thousands of dollars down the road.
It is regularly overlooked and always advisable to remove all clutter along the rig path. Often, equipment vaults that has been shut down for some time become either storage areas or filing rooms. These items, along with any bulky furniture, need to be moved out of the way for the rigging team to efficiently and successfully remove your equipment.
It is also very important to note any steps that may occur along the rig path, from vault door to the final loading destination outside. Your rigging team will need to make special arrangement if steps are involved.
Since this equipment is very heavy, any removal paths that have open spaces below (a basement, for example) need to be properly shored. This requires a structural engineer to sign off on plans and a licensed contractor to install the necessary shoring prior to removal of equipment.
Crane removals, on occasion, are necessary. Machines can be rigged out through skylights or open walls if deemed necessary. An experienced linac removal engineer will know how to work with your crane operator to safely and correctly remove the equipment.
Lastly, protecting your floor is common practice for a professional rigger. ¾” masonite is a commonly used material to protect floors from scratches and dents.
There are many safety concerns to be privy to during a removal. If the measurements mentioned above are inaccurate and it is determined your vault door needs to come off at the last minute, this poses as safety risk. Vault doors can weigh several thousand pounds each depending on size and thickness and fatalities have occurred when removed improperly. It is very important that if a vault door needs to be removed, it is done so by professionals who have had years of experience removing these specialty items. Knowing ahead of time that this is part of the removal allows the facility to budget for this cost as well as avoid any last minute decisions that could result in dangerous actions.
It follows, then, that your vendor should have the proper liability insurance at all times while on site. Demanding to see a certificate of insurance is always a good idea.
While most rigging companies will do what they can to contain dust and work after hours and on weekend to avoid disrupting patient care, any facility-implemented health protocols need to be relayed in advance so the removal team can do their best to comply (HIPPA compliance, immunizations, security badges, etc.). A good rigging team will always put the facility and patient needs above all else.
Another overlooked aspect of removals is the loading area. Linear Accelerators, such as a Varian iX or Trilogy linear accelerator, are often moved on large 53’ Air-Ride semi-trailers. There needs to be ample access and space for the trailer to park near the final exit door of the rig path. Facilities often will need to block off parking spaces or side streets to accommodate a safe loading environment. If a loading dock is not available, the rigging team will rent the appropriate sized forklift to lift the equipment into the trailer.
Accessories & Other Ancillary Equipment
A great cost-saving measure is to assess all equipment on site that may need to be removed and communicate that to your vendors. Often, power conditioners and chillers and other heavy, ancillary items are left on site as it was not made clear ahead of time that the facility desired to part with these items. These Varian linear accelerator and Elekta linear accelerator accessories can often be removed at no cost if discussed ahead of time. Additionally, if there is a second used linear accelerator or other radiation oncology or imaging equipment in the facility that needs removal, getting a quote with one vendor to remove all items on one trip could lead to material savings.
It is always a good idea to clearly label all items in the vault or removal area that you want removed and those items which are to stay. An even safer precaution is to remove all items that are not meant to stay with equipment. A proper inventory of what goes and what stays is advisable.
Facility Requirements / Responsibility
In every removal, there will always be some actions needed on the part of the facility. Most riggers prefer the facility engineer or local plumber and/or electrician to turn off water to the linac and lock and tag the power soon after the removal team arrives. This protects the facility from dangerous “live” power once equipment is removed and ensures the rigging crew, unfamiliar with facilities’ specific power setup, does not turn off power to adjacent rooms or lighting that may be tied into the same power source.
The facility should also arrange access for after hours and provide any necessary security badges they may require.
Knowing how you plan to repurpose the room after removal can save time and money. If another linear accelerator may go into the same vault down the road, the base frame and current isocenter may be able to be used again without having to go through a more intrusive base frame removal. If the room is simply going to be used for storage or a traditional office, the four remaining machine studs that protrude above ground can simply be cut off and the facility can re-cover the floor with carpet or other resurfacing materials.
There are situations when the Varian base frame either needs to come out due to a lease agreement or if a full room renovation is in the works. In this case, an experienced rigging crew will know how to use the appropriate tools (sawcutters, jackhammers, etc.) to safely remove the heavy steel base plate. Dust will need to be controlled by a combination of air scrubbers, sealing off vents and fire extinguishers, sealing the room and even creating negative air flow so no dust gets into other areas of the hospital. These jobs do create a lot of noise so are often scheduled over the weekend.
A full walk-through immediately after the job is complete or when the crew is finishing up is a great strategy. This allows the customer to identify any damage or items that were left on site that need to be removed, or even more importantly, items that were taken that were meant to be left on site. If the crew is still nearby or onsite they can resolve immediately without added expenses.
Cost Savings / Budgeting Your Removal Project
While removal of large capital equipment (Linear Accelerator, CT Scanner, PET/CT or MRI Scanner) does come at a cost, there are measures to take to reduce the burden. As mentioned previously, combining projects by having multiple pieces removed during one visit is a good place to start. Good planning ahead of time will almost always reduce unexpected costs. A good vendor will request a strategy call to gather the customer, the local staff that may need to be involved, and the rigging crew leader on the phone to go over the project in detail. If accurate dimensions are given and the rig info sheet is filled out correctly, then all parties can feel comfortable with their roles. Clear discussion of logistics, timeframes, and responsibilities should be discussed. Your vendor should then summarize the call and the entire project scope in email format so all parties have transparency and understanding of their roles and the appropriate contact info should further discussion be needed. A pre-removal site visit can be planned if uncertainty still remains after the conference call.
If your machine, whether Varian, Elekta, Siemens, Tomotherapy, or CyberKnife, is still clinical and complete with no parts removed and in operational condition, a parts credit can often be negotiated to mitigate your costs. This of course is dependent on the year and model of equipment as well as current condition. RapidArc technology, VMAT, On-Board Imager (OBI), Portal Vision, and Varian Millennium 120 Leaf MLC are sought-after parts on your pre-owned linear accelerator.
Removal of hazardous materials should also be discussed. Depleted Uranium or other hazardous materials need to be handled in the appropriate manner. See our blog post on Older Accelerators with Depleted Uranium Counterweights. “Hot material” will need to be identified and if exposed, put in the proper sealed container and stored safely.
Hiring the right company that has the experience to deal with all of these issues is the key to a successful removal. ROS has been in business for over 20 years and is proud to be known for its unique problem solving capabilities and professionalism.