"To understand the architecture of our system: We have a linear accelerator, the radiation source, that's mounted on a CT gantry. So it's a CT scanner that's used to both generate diagnostic images as well as during the treatment process," explained Robertson.

For treatment planning or simulation, typically 4- and 8-slice CT scanners are utilized, but 16-slice systems are not unheard of. Hospitals and cancer centers in the market for pre-owned equipment are looking for newer, late-model technology, like any other aftermarket.


"It seems that almost everyone wants linear accelerators on the refurbished market that have IMRT capabilities with multi-leaf collimators and image guidance as well," stressed Kenneth Wolff, President and CEO, RS&A Inc., Rural Hall, NC.

Nevertheless, older systems can play an important role in cancer treatment. Many are resold to small therapy centers in rural areas in the U.S., or exported.

RISMED Oncology Systems, through its sister company OncoAmerica, is bringing used Varian technologies to cancer centers in Venezuela and Mexico. "We like Varian because it is a reliable machine and most of the parts that Varian uses are from manufacturers in the industry. We can buy 90% of the components in the open market. Siemens and Elekta--many of their parts are proprietary--so every time you need a part you have to go back to those companies," explained Jose A. Rodriquez, President of the Huntsville, Alabama-based companies.

Independent service organizations like RISMED have a competitive yet symbiotic relationship to the OEMs. "We don't take business from [the OEMs] because whoever buys a machine from us for $100,000 cannot afford to buy a new, $800,000+ machine," Rodriguez said.

Needs Vary by Practice Setting

In addition to hospitals, more than 2,000 cancer treatment clinics in various networks throughout the U.S. use this equipment.

"More than half of our customers are in the free-standing community and of that about 60% are not individual centers but networks," said OSI's Richardson. "Working with those organizations the trend is for them to partner and form alliances with organizations like ours that can control their operating costs over the long haul--not just the initial purchase but for the lifetime of the equipment. That is often more money than the purchase of the equipment in the first place."

By many accounts, the for-profit clinics can be more high-tech than hospitals.

"Hospitals are slow to upgrade their equipment to the latest technology. I find that the free-standing clinics are usually more on the cutting edge than hospitals in radiation therapy," said Richard Kimball, President, Acceltek, Rio Rancho, NM. "In hospitals, budgeting is stricter because they know that radiation therapy is their cash cow. So they take all their excess revenue from radiation [oncology services] and apply it to all their negatives. In a free-standing clinic, they upgrade because they don't have to spend their profits somewhere else."

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