Understand Your Clinical Goals: 
From the onset, it is crucial to identify the types of cases you will see and identify what technology will be required to deliver the quality therapy you require. Do you want to be fully digital? Then you need to consider having Electronic Portal Imaging Device (EPID). Are you planning to image the target daily? An IGRT solution is a must. How defined of a treatment field do you want? A multi-leaf collimator (MLC) with leaves <1cm will be required.

Site Planning:
The installation of a linear accelerator is a monumental task that requires knowledge of the kind of technology you need in order to select the appropriate site. If you are performing new construction, think about the various building constraints – local permits, room dimensions, power, water supply, future equipment technology. If you are renovating an existing room, the constraints such as shielding, location of iso-center become increasingly important.

While obvious, the timeline is essential in order to effectively allocate the major milestones for your project. Plan and know in advance such milestones as vault completion date or equipment acceptance testing date, or even when you will have the Oncology Information System vendor arrive to connect your IT to your linear accelerator. While it is nearly impossible to preplan the exact timeline, building in flexibility will decrease uncertainty and account for unforeseen bottle necks.
After considering your clinical goals and your timeline, you should develop a budget for your equipment acquisition. The prices vary greatly depending on the age of equipment, technology and manufacturer. Buying a refurbished linear accelerator already reduces your budget requirements. Be sure to allocate for other products and services you will require to operate your practice such as patient positioning devices, consumables, equipment commissions, and staff training.

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