Many larger tertiary and research facilities are now using MRI and PET/CT simulators, as well. "That is the next wave - that is exactly what people are looking at. You have CT for structures, MR for soft tissues and PET for biological information," says Zankowski. Software packages can co-register or fuse those images.





Philips Healthcare does not manufacture linear accelerators, but that doesn't stop them from dominating the CT simulator market. "Philips has really maintained a good position in the oncology market," says Rene Velasquez, product manager for Philips Healthcare.

Used and refurbished market thin but holding

Economic pressures and cuts in reimbursement are not only affecting the OEMs. Fewer new-unit sales mean fewer used systems being turned out for inventory.

"In general, like most other refurbished equipment businesses and medical device businesses right now, we're experiencing some decline because of cuts in reimbursement and uncertainties in the health care market," says Greg Bare, vice president of Radiation Oncology Systems, Inc. (ROS), but the service business is up and more customers are looking for any means of cost-savings.

ROS offers used Varian, Siemens and Elekta linear accelerators. Bare estimates that independent service contracts are running about 20% to 30% less than OEM contracts and a used or refurbished linear accelerator could cost about 40% to 60% off a brand new unit. ROS also offers GE and some Siemens simulators.

Tony Richardson, director of business development for Oncology Services International (OSI), says that the company is faring well, but buyers are definitely being more conservative in their used purchases.

"In the last 12 months, our unit volumes have remained steady despite a rapid slowdown in the sales of new equipment. However, the sales of more expensive (newer high specification) equipment are definitely slower with more buyers attracted to IMRT capable units which are somewhat older and offering maximum reimbursement at a lower acquisition price point," says Richardson.

Kenneth Wolff, CEO of RS&A, a southeast regional linear accelerator parts, sales and service organization, says that he is seeing a healthy increase in revenue - about a 15% increase over prior years, but more from the service side than used equipment sales. RS&A services Varian, Elekta and Siemens linacs at the company's 10,000 square foot facility with two linacs in house for testing. RS&A also offers a range of parts, which account for about 10% of the company's business. Available parts include L3's magnetrons, thyrotrons and klystrons - all vacuum tube technologies used to power the linear accelerator beam.

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