Should I Upgrade my Linear Accelerator System, or Just Replace it Altogether?
Linear accelerator (LINAC) systems are one of the most expensive capital medical equipment pieces in a hospital today. The decision of when to upgrade vs. replace is a very important one, and has implications for the facility, its patients, its stakeholders, and its clinicians. We’ve broken this down for you so that you can make the most informed decision for your practice.
Linear accelerators can be classified into four groups:
- Older, and lacking upgrades.These are machines that were manufactured over 15 years ago, that don’t have the current technologies, like MLCs, KV-Imaging systems, Cone Beam CT software, VMAT or Rapid Arc, or even high dose rate.
- Older, and with upgrades. Older linear accelerator machines may not have been originally manufactured with current technologies but may have been upgraded throughout its life.
- Newer, and lacking upgrades. It’s not uncommon for customers to purchase newer equipment without all the bells and whistles in order to save money. You may also see newer machines, sometimes less than 10 years old, that don’t have an On Board Imager or even a portal imaging device.
- Newer and complete with upgrades. Most newer machines in the U.S. have the latest technologies (in the case of the newer Varian TrueBeam or Elekta Versa HD LINACs) and don’t require any upgrades other than software.
If your equipment falls into group 1, the decision is generally easy: It’s time to replace.
Group 1: An older and technologically outdated linear accelerator.
Older and outdated equipment is rarely upgraded since the upgrade components are often worth more than the underlying machine. Only in certain rare cases, such as when the linear accelerator cannot be replaced, is this a viable option. Prior to Varian’s introduction of the Halcyon, the smallest linac on the market was the Siemens Mev 67. These space efficient linacs were often squeezed into tiny vaults, with no hope of replacement. These circumstances are extremely rare, and most of the time older equipment with outdated technology is simply scrapped.
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If your equipment falls into group 4, the decision is also easy: Don’t replace.
Group 4: A newer and currently updated linac.
If you have the latest technologies to provide your patients with the finest care available in the market today, there is no need to replace. Even if you are moving into a new center or clinic, in a brand new building, it makes more sense to pay the $100K+ in relocation expenses than it would to purchase a new machine, especially if you are still depreciating the linear accelerator
Now, the tricky ones: Do I replace?
Group 2: An older linac that’s been upgraded over the years.
Let’s say you have a linac that was manufactured 20 years ago, that has, over the years, gone through extensive upgrades. It may have been a Varian 21EX that was at some point upgraded to OBI, cone beam CT and Rapid Arc (VVMAT). What now? It’s still a reliable workhorse, and although maintenance costs and downtime are starting to tick up due to the age of the machine, it still provides great treatments for your patients.
Chances are this machine has more than paid for itself over the years, and depending on the current and expected patient load, it may be time for an upgrade to a newer LINAC machine. Maybe you are moving into a new building, and the relocation expenses exceed the value of the machine itself… then it’s time to replace. Or you want to do more SBRT and could really use an FFF (flattening free filter) machine with a high dose rate… then it may be time to replace. And if you don’t feel that your clinical needs or patient volumes justify the expense of replacing it with a new machine, then you can consider replacing it with a newer, refurbished machine (perhaps a seven to eight-year-old system with the upgrades you want).
Group 3: A newer linac, but lacking the latest features.
What if you have purchased a Varian VitalBeam, and realize that you want something that is only offered with the Varian TrueBeam, like the 6 Degree of Freedom Couch? Or if you purchased a Varian Trilogy and realize you really wanted the capabilities of a TrueBeam? Or you purchased an Elekta Synergy Platform and now realize you want KV-imaging and VMAT capability? Or just realized that an MR-guided linac would have been ideal.
Chances are you are going to be stuck with your (newer) equipment for a while, at least until you can further depreciate. Some upgrades might be impossible while other upgrades, like simply adding a portal imaging device if one is lacking might make sense. Here is where a team meeting with the various stakeholders in the department would be a good idea, so that you can weigh the pros and cons of each possible upgrade option.
In Closing:
The decision of whether to upgrade or replace a linear accelerator is often a complex one that requires considerable attention, as there are many considerations to take into account. With new models in the market today (such as the Varian Edge, Varian Halcyon, the Zap-X, the View Ray MRIdian), replacing a system might be more tempting than ever. Most upgrades can be done with little to no downtime as they can be performed after hours – whereas a machine replacement can take months. Consideration of technologies available, patient mix, patient load, competitive landscape, and financial constraints can help you narrow down the choices.
