In this sense, the technology lends itself well to the aftermarket where the basic LINAC device can be resold and in many cases augmented with high-tech, bolt-on components.





"The basic accelerator has not changed over the last 20 years. Only the external software and hardware have advanced radiation therapy. Unlike diagnostic imaging equipment, most upgrades to linear accelerators are external to the LINAC itself so a lot of aftermarket products can be put on to achieve a similar effect as manufacturers achieve with [integrated] technology," explained Greg Bare, Sales Director, Radiation Oncology Systems, San Diego, CA."

CT is the imaging technology now widely used in conjunction with software as a treatment planning tool. "The trend in simulation is away from conventional static film simulation to CT and we do see people replacing their old simulators pretty often. They are very rarely replacing an old simulator with a conventional simulator. They will always tend to go for a CT these days," said Tony Richardson, Marketing Director, Oncology Services International (OSI), Ramsey, NJ.




"Conventional X-ray units had been used for simulation but now CT scanners enhance the ability to locate and pinpoint accurately the target area. CT provides digital images and multiple slices. That can turn into three-dimensional plans for things like respiratory gating," said Greg Kramer, President, C&G Technologies, Inc., Jeffersonville, IN, specializing in pre-owned GE and Toshiba CT systems. In addition to their use prior to the procedure as a planning tool, some advanced systems have the CT onboard the LINAC or in the treatment room itself as a continual reference guide to revise treatment as the tumor moves or shrinks. Varian offers its On-Board Imager device, for example, which is mounted on the linear accelerator for generating radiographic, fluoroscopic, and cone-beam CT images just prior to treatment. However, Varian Medical Systems told DOTmed Business News that not all models of LINACs are upgradeable to IGRT. If a healthcare provider acquires a LINAC from a third party, Varian may be able to upgrade the system but first they would need to conduct an audit of technology and software to determine if the system meets specifications and is in fact upgradeable. There is a cost associated with the audit.TomoTherapy is another OEM noted for its integrated systems. Their Hi-Art system includes treatment planning, CT imaging, quality assurance, treatment delivery, and adaptive therapy.

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