For OEMs, new unit sales dip but upgrades buoy revenue

Historically, there's been a 3% annual growth in linear accelerator units sold. This year, there's been a decent downturn in new units sold - about a 15% decline, but revenue is only down 1% due to upgrading, says Evans.


"Basically, what this means to us is customers are upgrading their existing machines rather than opting to purchase new linear accelerators," he says.

As far as the most advanced systems go, Varian offers the Novalis Tx, a radiosurgery platform based on Varian's Trilogy linear accelerator and a suite of additional technologies for image guidance, motion management and treatment planning. About 18 months ago, Varian introduced Rapid-Arc radiotherapy, an IMRT technology that shapes the dose distribution as it is delivered with one or more arcs, or rotations, around the patient. The accelerator delivers up to 10 grays per minute for "very fast, high-dose treatment." Varian's MLC is a 120 tungsten-leaf collimator that can shape the beam to 2.5 mm and the Trilogy offers both 2-D and 3-D KV onboard image guidance.

"Varian accelerators-Trilogy, Novalis Tx, and Clinic iX models have everything you need for the radiotherapy market," says Zankowski.

Elekta is also a major manufacturer of linear accelerators and offers the Infinity, which provides a therapy called VMAT, or volumetric modulated arc therapy, a similar IMRT technique.

"The beam stays on and you rotate the gantry around the patient in a continuous motion," says Timothy Prosser, director of Elekta's Radiation Oncology Business. "That allows you to spread the dose out a lot more at the target. This has been a very recent innovation. It's just now starting to catch on within the last one or two years."

The Infinity features VolumeView, a 3-D cone-beam imaging system for IGRT. Elekta also offers the Axesse linear accelerator, a dedicated stereotactic system for both radiosurgery and radiation therapy.

Siemens launched the Artiste linear accelerator last year. This is the system used at Dr. Parda's practice at Allegheny General Hospital. The Artiste features the fastest MLC on the market, with 160 leaves - 80 on each side, says Evans. It delivers up to 23 MV photon therapy and onboard imaging includes 3-D cone-beam imaging.

What's new in radiation therapy simulators

Before therapy gets underway, oncologists must first conduct treatment planning with a simulator, which provides all the essential information about the tumor. Up until recently, this was done using a traditional radiographic simulator, but in recent years, most radiation oncology practices have moved into using CT simulators. Dr. Parda's practice uses a Siemens 40-slice 4-D CT simulator.

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