Linear Accelerators Radiotherapy Units, Cobalt: March 2002

March 2002
Linear Accelerators; Radiotherapy Units, Cobalt

Scope of this Product Comparison
This Product Comparison covers clinical linear accelerators (also called linacs) and cobalt radiotherapy units used for external-beam radiation therapy. For more information on related topics, see the following Product Comparisons: Brachytherapy Systems, Remote Afterloading Computers, Radiotherapy Planning System Computers, Radiotherapy Record and Verify; Portal Imaging Systems, Digital Image-Guided Surgery Systems Stereotactic Headframes; Stereotactic Systems, Radiosurgical depending on the accelerator. Some linacs also produce electron beams. Cobalt radiotherapy units use cobalt-60, a man-made radioisotope, to produce gamma-ray photons. Cobalt units and low-energy linacs are used primarily to treat bone cancer and tumors of the head, neck, and breast. High-energy linacs are used to treat deepseated neoplasms and tumors of the pelvis and thorax. Since the development of radiotherapy units, external-beam radiation therapy has become a primary treatment modality, along with chemotherapy and surgery. Radiation is used to treat at least 50% of all cancer cases, and many patients receive a combination of all three modalities. Radiation therapy can be either curative or palliative, depending on the stage and prognosis of the disease. For treatment to be successful, the radiation field must be of a uniform intensity
UMDNS information
This Product Comparison covers the following device terms and product codes as listed in ECRIs Universal Medical Device Nomenclature System (UMDNS): Linear Accelerators [12-364] Radiotherapy Units, Cobalt [16-972]
Purpose
Medical linacs and cobalt radiotherapy units are used in external-beam radiation therapy to treat cancer. Linacs emit a well-defined beam of uniformly intense x-ray photon radiation of different energies,
Linear accelerator
173621 424-010
5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA Telephone +1 (610) 825-6000 Fax +1 (610) 834-1275 E-mail hpcs@ecri.org
Healthcare Product Comparison System

and predictable energy level and must be well defined to avoid irradiating healthy tissue. 10 MV and electron beams of 9 to 15 million electron volts (MeV), and high-energy linacs produce photons between 15 and 25 MV and have electron energies ranging from 4 to 22 MeV. Most linacs are dual-energy units offering a low-energy beam at 6 MV and a highenergy beam of at least 10 MV, or they are multipleenergy units offering a range of photon and electron energies. Generally, a magnetron a microwave generator with RF cavities arranged in a circle is used in lowto medium-energy accelerators, and a klystron an amplifying electron tube with RF cavities arranged in a straight line is used in high-energy accelerators. In a magnetron, electrons generated by a heated cathode under the combined force of an electric and a magnetic field produce microwave energy. In a klystron, the electron beam interacts with microwaves, which modulate the beams velocity to concentrate the electrons into bunches. Klystrons require low RF power and are more expensive than magnetrons because they have specialized circuitry, provide higher output, and last longer. Magnetrons, which are self-oscillating devices, must be tuned to match the frequency of the RF system because they generate the incorrect power if other components of the system have slightly different frequencies. However, for low-energy applications, frequency instabilities are small, and magnetrons are more cost-effective than klystrons. The microwaves are transported to the accelerator guide by a waveguide, a hollow metallic tube closed at both ends by ceramic windows that are transparent to microwaves. The waveguide is filled with a pressurized gas to prevent microwaves from shorting across it. The accelerator guide, which consists of several copper, microwave-resonant cavities soldered into a single structure, accelerates the electrons to the desired energy. Two types of guides are available the standing wave and the traveling wave. Although very different, both require the use of ion vacuum pumps, which maintain an internal pressure of 10-7 to 10-10 torr, to remove any gas molecules that could interact with the electron gun and cause gun failure. The standing-wave accelerator guide is so named because the accelerating electric field oscillates in place within the tube, which is sealed at each end to reflect the microwave energy, thereby multiplexing the intensity of the incoming wave. In the travelingwave accelerator, the length of the accelerator is directly proportional to the acceleration energy produced. Each cavity is resonant and develops an oscillating electric field that moves down the tube carrying the electrons, much as waves carry surfers.
Principles of operation
Linear accelerators Linacs consist of four major components a modulator, an electron gun, a radio-frequency (RF) power source, and an accelerator guide (see Fig. 1). The electron beam produced by a linac can itself be used for treatment or can be directed toward a metallic target to produce x-rays. The modulator amplifies the AC power supply, rectifies it to DC power, and produces high-voltage DC pulses that are used to power the electron gun and RF power source. High-voltage cables electrically connect the electron gun and RF power source to the modulator, which can be located in the gantry, the gantry supporting stand, or a separate cabinet. The electron gun injects electrons into the accelerator guide in pulses of the appropriate duration, velocity, and position to maximize acceleration. The electron gun can be attached to the accelerator guide by a removable vacuum flange, which allows easy replacement of the gun. In designs with a permanently attached electron gun, the entire accelerator must be replaced when the guns filament burns out. The RF power source, either a magnetron or a klystron, supplies high-frequency electromagnetic waves (3,000 MHz), which accelerate the electrons injected from the electron gun down the accelerator guide. Linacs are classified according to their energy levels. Low-energy units produce 4 or 6 million volt (MV) photons, medium-energy units produce photons of 8 to
Vacuum System WaterCooling System
Electron Accelerator Guide Gun Waveguide RF Power Source
Beam Transport System (Bending Magnet) Control Console
Treatment Head
Modulator Patient Table

C204UN2C
Physical Connections
Figure 1. Typical linac components
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The RF power is fed directly to the traveling-wave accelerator, rather than through the waveguide. After the RF waves have passed through the accelerator guide, residual power is either absorbed by a load or fed back into the accelerator. For a given RF power and for the same maximum energy requirement, traveling-wave accelerator guides are significantly longer than standing-wave accelerator guides. Because the standing-wave guides are more compact, they can often be mounted vertically in the x-ray head. High-energy traveling-wave units, which require lengths of 2.5 meters or more, increase the overall length of the accelerator and may require larger treatment rooms. After the electrons are accelerated, they are aimed by a bending magnet to produce radiation for treatment. Most systems use a 270 achromatic magnet to position the beam. Some low-energy accelerators have a straight-through design; the accelerator guide is short enough to be mounted vertically in the treatment head, and beam steering with a bending magnet is not required (see Fig. 2). The high-energy electron beam is either directed at a tungsten target to produce photons for therapy or used for direct electron treatment. Because the photon beam produced from the tungsten target is most intense at its center, a flattening filter, usually made of lead, is provided to modify the beams intensity distribution for clinical use. For low-energy units, a material with a high atomic number (Z) is often used as a filter; for high-energy units, a low-Z filter is used. For electron-beam treatment, the highly collimated beam of electrons is distributed over the treatment area by means of a thin (0.5 mm) metallic foil interposed in the beam, which scatters the electrons laterally upon impact. Moving the electron beam itself in a raster pattern over the treatment area also distributes the beam over the treatment area. Alternatively, a varying magnetic field can be used to deflect the electrons in a raster pattern without the use of blocking material. All linacs have a dosimetry system in the treatment head that terminates the radiation at the preset dose. This system incorporates a compartmented, dual-system ionization chamber, which should be sealed against temperature and pressure fluctuations; the performance of this chamber must be checked frequently. Most dosimetry systems can detect asymmetries in the treatment beam and then terminate irradiation if the asymmetry exceeds a preset value. Some linacs can reposition the beam after an asymmetry is detected. Some systems also have beam-steering circuitry to automatically compensate for changes in the angle or position of the beam caused by gantry or collimator rotation. The radiation beam is shaped by the collimators, which are motor-driven, movable blocks of material that define the treatment field. A light field projected onto the patient outlines the area to be irradiated. Field sizes of up to 40 cm on a side are available, as are digital readouts of collimators positions. Adjustable collimator jaws are available on most units. In addition, special size-specific collimators for electron-beam treatment are suspended below the fixed collimator system, and other freestanding blocks or shaping wedges can be placed below the collimator trays to further customize the beam shape. The entire collimator assembly rotates about an axis that passes through the center of the treatment field and the isocenter (the spatial point where the collimators axis of rotation intersects the gantrys axis). Major manufacturers of linacs offer multileaf collimators. Multileaf collimators use multiple (up to 120) thin leaves, which are individually motorized, to define the treatment field. This computer-controlled collimation facilitates modification of the treatment field and replaces custom-made lead blocks for many treatments. A closed-loop water-cooling system removes the heat produced throughout the accelerator system. In particular, the tungsten target used in the production
Electron Gun
RF Power Input
Accelerator
Retractable Target
Ion Chamber
Primary Collimator Flattening Filter
Movable X-ray Collimators
Range-finder Optics
C204UN2D
Isocenter
Figure 2. Straight-through treatment head design

of x-rays becomes exceptionally hot during operation and will fail if not properly cooled. In units with targets located inside the chamber, a burn-through of the target will also cause the high vacuum in the accelerator guide to fail. Linac components are packaged in mounting stands and movable gantries. The DC and microwave power supplies are usually found in the stand, and the accelerator, target, collimation, and dosimetry systems are usually in the gantry. Most low-energy linacs have the magnetron in the gantry, whereas many high-energy machines have separate cabinets for the modulator and RF power source. Cobalt radiotherapy units Cobalt units provide low-energy (1.17 and/or 1.33 MV) treatment using cobalt-60 as a radiation source. Nickel-plated, high specific activity cobalt-60 pellets are encapsulated in two layers of low-carbon stainless steel sealed by heliarc welding in a cylinder. The source cylinder, approximately 1 to 2 cm in diameter, is mounted in the units head; a pneumatically driven drawer moves the source from storage into the exposure position. Accurate source positioning is accomplished with limiting devices. The source is surrounded by lead in all directions for radiation shielding (see Fig. 3). Like linacs, cobalt units are mounted isocentrically. The source-to-axis distance is either 80 or 100 cm. Adjustable collimators are used to define the treatment field, and special filters or beam modifiers are also available for individual therapy needs. Cobalt radiotherapy units operate similarly to lowenergy linacs. The photon energy produced is 1.33 MV; this beam behaves much like a linac beam of 3.3 MV. Because cobalt radiation reaches its maximum dose at 0.5 cm below the skin surface, it is especially suited for radiotherapy of the head, neck, and breast, as well as
Source Capsule Air Cylinder Shielding Block Source Position Indicator Rod
for tumors within 5 cm of the skin surface that are located in other parts of the body. Radiation dose and therapy planning The penetrating effect of the radiation produced by the radiotherapy unit varies depending on the energy. Megavoltage electrons are stopped after traveling a few centimeters into the patient, whereas megavoltage photons penetrate more deeply. The high-energy photons have a skin-sparing effect; that is, the maximum ionization of the beam is not achieved until the beam has penetrated 0.5 cm to 2 or 3 cm below the surface, so the skin receives a dose considerably lower than the maximum. Data describing the beams, such as energy and radiation dosage, is collected from each accelerator by a medical physicist at the time of installation and periodically rechecked. Using this data and a prescription specifying the dosage of radiation and the anatomic site to be irradiated, a radiotherapy treatment planning system is used to calculate a treatment plan that includes the number of beams to enter the patient, the energy and type of radiation (photons and/or electrons), and the geometric distribution of the beams. Variable beam geometry is further designed to reduce dosage to normal tissue while maximizing the dose-to-tumor volume and can be accomplished using single or multiple stationary beams, rotating a beam or beams around the tumor, or combining these methods. Wedge filters or tissue compensators affixed to the accelerator are used to alter beam geometry to facilitate treatment of irregularly shaped tumors. In three-dimensional (3-D) conformal radiotherapy, data from computed tomography (CT) and magnetic resonance imaging scans is reformatted for 3-D display on a computer workstation; dose distributions are then superimposed on this anatomic display to formulate customized treatment plans. The 3-D treatment plan allows beam shaping from different directions for more accurate radiation delivery to the target tumor volume. In situations where it is difficult to produce a satisfactory plan, intensity-modulated radiotherapy (IMRT) is designed to enhance the capability of conforming dose distributions in three dimensions by allowing the beam intensity to vary across the fields in addition to the methods listed above. Radiotherapy simulators use radiographic/fluoroscopic and CT imaging to locate the tumor and accurately determine the desired positions of the linac or cobalt unit before the patient is treated. (See the Product Comparison titled RADIOTHERAPY SIMULATION SYSTEMS.) Port films diagnostic films taken with the patient in the treatment position are compared
Lead-Filled Source Drawer Lead Shielding Collimator Leaves
Field Definer
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Figure 3. Basic head design of a cobalt radiotherapy unit

with the simulator films to ensure that radiation is delivered as prescribed. Some linac manufacturers offer electronic portal imaging (also called digital verification), which provides rapid, computer-processed, digital image acquisition; some systems allow realtime imaging. Digitally processed port films can provide better image quality than traditional port films, and electronic portal imaging systems can permit more frequent port filming, high-capacity digital image storage, and real-time comparisons. Records of each treatment, including the accumulated radiation dose, are usually kept by the treatment technologist, but most manufacturers offer record-and-verify computers that keep these records automatically. For information on radiotherapy planning, record-and-verify computers, or digital portal imaging, see the Product Comparisons titled COMPUTERS, RADIOTHERAPY PLANNING SYSTEM and COMPUTERS, RADIOTHERAPY RECORD AND VERIFY; PORTAL IMAGING SYSTEMS, DIGITAL.
Panamas National Institute of Oncology; data entry and software errors, along with a lack of treatment plan verification, were cited as contributing factors by the U.S. Food and Drug Administration (FDA). There was no suggestion that a failure or malfunction of the teletherapy system contributed to the overexposure. Risk management in radiotherapy requires a comprehensive quality assurance program (Nath et al. 1994). According to FDA, treatment plans should be verified by independent means, possibly including manual calculations or measurement of radiation dose.
Purchase considerations
Because cancerous tumors occur at different depths and locations within the body, radiation treatment requires a range of photon and electron energy and treatment field sizes. Approximately 60% of patients require low-energy therapy, 25% require medium- to high-energy therapy, and 15% require a high-energy electron beam. Therefore, a well-equipped radiotherapy department should include a linac with 18 to 22 MeV electron energies and a cobalt unit or low-energy linac for treating patients requiring a low-energy therapy beam. Purchasers should prepare a comprehensive quality assurance program to calibrate equipment and to identify operating irregularities. A medical physicist should be consulted to determine the shielding requirements before the radiotherapy unit is installed. Cost containment In the United States, cobalt units generally cost between $350,000 and $500,000, while linacs cost between $600,000 and $2.5 million. Linacs that provide higher electron and x-ray energies usually cost more and require more technical staff and more expensive housing. Options such as an electronic portal imaging system and a multileaf collimator will also add to the total cost. Because linacs and cobalt radiotherapy units entail ongoing maintenance and operational costs, the initial acquisition cost does not accurately reflect the total cost of ownership. Therefore, a purchase decision should be based on issues such as life-cycle cost (LCC), local service support, discount rates and non-price-related benefits offered by the supplier, and standardization with existing equipment in the department or hospital (i.e., purchasing radiotherapy equipment from one supplier). An LCC analysis can be used to compare high-cost alternatives and/or to determine the positive or negative
Reported problems
A systematic view of reported problems has shown that most errors and incidents are caused by user error. At least one study (Macklis et al. 1998) has reported that it is unlikely that a given patient will suffer a significant adverse medical event caused by a radiotherapy treatment error (routine toxicities and side effects were not documented, however). In this study, 15% of the errors were related to the use of the record-and-verify system (resulting from incorrect data entry). Errors can also occur at the planning stage or in equipment calibration. Missed clinical information at the planning stage has caused severe (even fatal) radiation injury, and poor calibration can lead to serious medical errors. Electromagnetic interference (EMI) from a linear accelerator caused infusion-pump failure when the pumps were being used on patients undergoing radiation therapy. ECRI believes that this problem could affect other electronic devices as well. See citations from Health Devices below. Hardware failures can also result in the misadministration of a radiotherapy prescription. Because of the complexity of linacs and cobalt radiotherapy units, mechanical problems are common, although most injuries are caused by heavy equipment hitting patients and technologists. All units should have fault-detection systems that minimize the probability of an equipment-induced treatment error. Software, or programming, errors can have a serious impact on patient treatment. One small programming error can affect many patients. For example, several patient deaths from teletherapy overexposure occurred at

economic value of a single alternative. For example, hospitals can use LCC analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing the equipment outright. Because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time, LCC analysis is most useful for comparing alternatives with different cash flows and for revealing the total costs of equipment ownership. One LCC technique present value (PV) analysis is especially useful because it accounts for inflation and for the time value of money (i.e., money received today is worth more than money received at a later date). Conducting a PV/LCC analysis often demonstrates that the cost of ownership includes more than just the initial acquisition cost and that a small increase in initial acquisition cost may produce significant savings in long-term operating costs. The PV is calculated using the annual cash outflow, the dollar discount factor (the cost of capital), and the lifetime of the equipment (in years) in a mathematical equation. The following represents a sample seven-year PV/LCC analysis for a linac with dual x-ray energies and electron energies from 4 to 20 MeV: Present Value/Life-Cycle Cost Analysis Assumptions Operating costs are considered for years 1 through 7 Dollar discount factor is 5% Inflation rate is 6% for a full-service contract Operating costs are for 1 linac treating 250 patients per year, with each patient receiving 20 treatments at a cost of $35 per fraction Costs are considered for one full-time medical physicist, two full-time radiotherapy technologists, and one part-time radiotherapy technologist Capital Costs Linac with positioning lasers, a fiberoptic backpointer, and patient-positioning accessories = $1,067,000 Multileaf collimator = $360,000 Record-and-verify computer system = $196,150 Electronic portal imaging system = $210,000 Total Capital Costs = $1,833,150 Operating Costs Radiotherapy treatments for 250 patients per year, 20 treatments per patient, at $35 per fraction = $175,000/year Service contract, years 2 through 7 = $92,440/year
6
Salary and expenses for 1 medical physicist = $130,000/year Salary and expenses for 2 full-time radiotherapy technologists = $70,000/year each Salary for 1 part-time radiotherapy technologist = $40,000/year Total Operating Costs = $485,000 in year 1; $577,440 in years 2 through 7 PV = ($5,938,862) Other costs not incorporated into the above analysis that should be considered for budgetary planning include those associated with the following: Hardware and software upgrades not covered by the service contract Utilities Other disposables and accessories, such as blocks, wedges, phantoms, and dosimetric equipment Contributions to overhead As illustrated by the above sample PV/LCC analysis, the initial acquisition cost is only a fraction of the total cost of operation over seven years. Therefore, before making a purchase decision based solely on the acquisition cost, buyers should consider operating costs over the lifetime of the equipment. For customized analyses and purchase decision support, readers should contact ECRIs SELECT Group. Hospitals can purchase service contracts or service on a time-and-materials basis from the supplier. Service may also be available from a third-party organization. The decision to purchase a contract should be carefully considered and can be justified for several reasons. Most suppliers provide routine software updates, which enhance system performance, at no charge to service contract customers. Furthermore, software updates are often cumulative; that is, previous software revisions may be required in order to install and operate a new performance feature. Purchasing a service contract also ensures that preventive maintenance will be performed at regular intervals, thereby eliminating the possibility of unexpected maintenance costs. Also, many suppliers do not extend system performance and uptime guarantees beyond the length of the warranty unless the system is covered by a service contract. Some facilities may choose to pay for service only when the unit is in need of repair, even though associated costs and downtime could be extensive. In-house equipment maintenance can be a costeffective alternative if in-house staff are trained in

maintaining and repairing radiotherapy equipment components (Moretti 1993). ECRI recommends that, to maximize bargaining leverage, hospitals negotiate pricing for service contracts before the system is purchased. As a guideline, full service contracts typically cost approximately 5% to 8% of the systems purchase price. Additional service contract discounts may be negotiable for multiple-year agreements or for service contracts that are bundled with contracts on other radiotherapy equipment in the department or hospital. Service contracts should clearly indicate whether full coverage of parts and labor is included or whether any parts are excluded; usually, the accelerator waveguide and magnetron or klystron power source are not included. In addition, hospitals should negotiate for a significant discount some suppliers may discount up to 20% or 30%. The actual discount received will depend on the hospitals negotiating skills, the system configuration and model to be purchased, previous experience with the supplier, and the extent of concessions granted by the supplier, such as extended warranties, fixed prices for annual service contracts, and guaranteed on-site service response. Buyers should make sure that applications training is included in the purchase price of the system. Some suppliers do offer more extensive on-site or off-site training programs at an additional cost. was introduced in 1992 as an alternative to the Gamma Knife, a device that uses multiple cobalt-60 sources to focus radiation beams on a single target in the brain. Stereotactic radiosurgery involves very precise focusing of intense ionizing radiation and is typically accomplished in a single dose without significantly irradiating the surrounding tissue. Some manufacturers of linacs offer add-on radiosurgery packages, which include collimators, a computer workstation with radiosurgery planning software, and a stereotactic headframe attached either to a floorstand or to the patient couch. For more information on stereotactic radiosurgery, see the Product Comparison titled
STEREOTACTIC HEADFRAMES; STEREOTACTIC SYSTEMS, RADIOSURGICAL.
Other technological enhancements offered by a few manufacturers are 3-D conformal radiotherapy, dynamic radiotherapy, intraoperative radiotherapy, and dynamic wedge sequencing. Dynamic radiotherapy involves simultaneous movement of the table and collimator during treatment and is used in conjunction with 3-D treatment planning for greater precision in treating irregularly shaped tumors. In intraoperative radiotherapy, a malignancy that has been unresponsive to other forms of treatment is surgically exposed, and ionizing radiation is then aimed directly at the site. Dynamic wedge sequencing is used to produce variable wedge-shaped treatment fields by computercontrolled collimator jaw speed and motion.
Stage of development
Cobalt units have been available for radiotherapy since the early 1950s, and for 30 years, most radiotherapy was performed using these units. The first medical linac was developed in 1961, and they are now considered the primary radiotherapy treatment device. However, because of their lower acquisition and maintenance costs, cobalt units are used in many developing countries as the sole treatment device, as well as in developed countries to provide backup for a linac. In early 1990, a cobalt unit with a 100 cm treatment distance identical to that of most linacs was introduced. Some cobalt units offer a computer console for networking, tables similar to those used with linacs, and high source strengths. Computer control and digital capabilities now allow remote diagnostics for service, easier upgrades, more precise control of beam parameters, and networking of radiotherapy equipment (e.g., linacs, data management systems, treatment planning systems). A linac dedicated to stereotactic radiosurgery for noninvasive treatment of intracranial lesions and tumors, arteriovenous malformations, and retinal blastomas
Bibliography
Almn A, Ahlgren L, Mattsson S. Absorbed dose to technicians due to induced activity in linear accelerators for radiation therapy. Phys Med Biol 1991 Jun;36(6):815-22. Boyer AL, Geis P, Grant W, et al. Modulated beam conformal therapy for head and neck tumors. Int J Radiat Oncol Biol Phys 1997 Aug 1;39(1):227-36. Buchgeister M, Nsslin F. Startup performance of the traveling wave versus standing wave linear accelerator. Med Phys 1998 Apr;25(4):493-5. Colligan SJ, Mills JA. A philosophical approach to treatment machine maintenance and breakdown. Br J Radiol 1997 Dec;70(840):1274-9. Dutreix A, Derreumaux S, Chavaudra J, et al. Quality control of radiotherapy centres in Europe: beam calibration. Radiother Oncol 1994 Sep;32(3):256-64. Galvin JM, Han K, Cohen R. A comparison of multileaf-collimator and alloy-block field shaping. Int J Radiat Oncol Biol Phys 1998 Feb 1;40(3):721-31.

Hendee WR, Ibbott GS. Radiation therapy physics. 2nd ed. St. Louis: Mosby-Year Book; 1996. Johns HE, Cunningham JR. The physics of radiology. 4th ed. Springfield (IL): Charles C Thomas; 1983. Karzmark CJ, Nunan CS, Tanabe E. Medical electron accelerators. New York: McGraw-Hill; 1993. Macklis RM, Meier T, Weinhous MS. Error rates in clinical radiotherapy. J Clin Oncol 1998 Feb;16(2):551-6. Moretti A. Servicing radiation therapy equipment: a successful maintenance alternative. Second Source Imaging 1993 Nov;8(11):89-93. Nath R, Biggs PJ, Bova FJ, et al. AAPM code of practice for radiotherapy accelerators: report of AAPM Radiation Therapy Task Group No. 45. Med Phys 1994 Jul;21(7):1093-121. Palta JR, Yeung DK, Frouhar V. Dosimetric considerations for a multileaf collimator system. Med Phys 1996 Jul;23(7):1219-24. Purdy JA, Biggs PJ, Bowers C, et al. Medical accelerator safety considerations: report of AAPM Radiation Therapy Committee Task Group No. 35. Med Phys 1993 Jul-Aug;20(4):1261-75. Scharf WH, Chomicki OA. Medical accelerators in radiotherapy: past, present, and future. Physica Medica 1996 Oct-Dec;12(4):199-226. Ting JY, Yankelevich R, Goswami G, et al. Scattered radiation from linear accelerator and cobalt-60 collimator jaws. Int J Radiat Oncol Biol Phys 1994 Nov 15;30(4):985-92. U.S. Food and Drug Administration. Center for Devices and Radiological Health. FDA statement on radiation overexposure in Panama. 2001 Jul 6 [cited Jun 2001]. Available from internet: http://www.fda.gov/ cdrh/ocd/panamaradexp.html. van der Giessen PH. A comparison of maintenance costs of cobalt machines and linear accelerators. Radiother Oncol 1991 Jan;20(1):64-5. van Santvoort, J. Dosimetric evaluation of the Siemens Virtual Wedge. Phys Med Biol 1998 Sep; 43(9):2651-63. American Association of Physicists in Medicine. AAPM code of practice for radiotherapy accelerators [report]. Radiation Therapy Committee Task Group #45. Med Phys 1994 Jul;21(7):36. Comprehensive QA for radiation oncology [report]. Radiation Therapy Committee Task Group #40. Med Phys 1994 Apr;21(4):581-618. Fetal dose from radiotherapy with photon beams [report]. Radiation Therapy Committee Task Group #36. Med Phys 1995 Jan;22(1):63-82. Medical accelerator safety considerations [report]. Nuclear Medicine Committee Task Group #35. Med Phys 1993 Jul-Aug;20(4):1261-75. Radiation treatment planning dosimetry verification [report]. Radiation Therapy Committee Task Group #23. 1995. American College of Radiology. Standard for radiation oncology physics for external beam therapy. 1994. Standards for radiation oncology. 1990 (revised 1995). American National Standards Institute. Guidelines for maintaining cobalt-60 and cesium-137 teletherapy equipment [standard]. ANSI N4491974 1974 (R1984). (reaffirmed 1984). British Standards Institution. Medical electrical equipment. Particular requirements for performance. Methods of declaring functional performance characteristics of medical electron accelerators in the range of 1 MeV to 50 MeV [standard]. BS 5724:Part 3: Sect. 3.1. 1990. Specification for gamma beam therapy equipment [standard]. BS 5724:Section 2.11. 1989. Specification for medical electron accelerators in the range 1 MeV to 50 MeV [standard]. BS 5724:Section 2.1. 1989. Health Council of the Netherlands. Developments in radiotherapy [technology assessment report]. 1993. International Commission on Radiation Units and Measurements. Measurement of dose equivalents from external photon and electron radiations [report]. 47. 1992. International Electrotechnical Commission. Medical electrical equipment medical electron accelerators in the range of 1 MeV to 50 MeV: guidelines for functional performance characteristics [standard]. IEC/TR 60977 (1989-10). 1989. Medical electrical equipment part 1: general requirements for safety [standard]. IEC 60601-1 (1988-12). 1988.
Standards and guidelines

Note: Although every effort is made to ensure that the following list is comprehensive, please note that other applicable standards may exist.

Medical electrical equipment part 1: general requirements for safety. Amendment 1 [standard]. IEC 60601-1-am1 (1991-11). 1991. Medical electrical equipment part 1: general requirements for safety. Amendment 2 [standard]. IEC 60601-1-am2 (1995-03). 1995. Medical electrical equipment part 1: general requirements for safety. Section 2. Collateral standard: electromagnetic compatibility requirements and tests. IEC 60601-1-2 (2001-09). 2001. Medical electrical equipment part 2: particular requirements for the safety of gamma beam therapy equipment [standard]. IEC 60601-2-11 (1997-08). 1997. Medical electrical equipment part 2: particular requirements for medical electron accelerators in the range 1 MeV to 50 MeV. Section one: general. Section two: radiation safety for equipment: amendment 2, 1990 [standard]. IEC 60601-2-1:1981/Amendment 2:1990. Radiotherapy equipment. Coordinates, movements and scales. IEC 61217 (1996-08). 1996. National Council on Radiation Protection and Measurements. Dosimetry of x-ray and gamma-ray beams for radiation therapy in the energy range 10 keV to 50 MeV [recommendation]. 69. 1981. Medical x-ray, electron beam and gamma-ray protection for energies up to 50 MeV (equipment design, performance and use) [recommendation]. 102. 1989. Neutron contamination from medical electron accelerators [recommendation]. 79. 1984. Structural shielding design and evaluation for medical use of x-rays and gamma rays of energies up to 10 MeV [recommendation]. 49. 1976. Swedish Council on Technology Assessment in Health Care. Radiotherapy in cancer treatment [technology assessment report]. 1996. United Kingdom Department of Health. Technical requirements for the supply and installation of apparatus for diagnostic imaging and radiotherapy. 1989. World Health Organization. Quality assurance in radiotherapy. 1150282. 1988. Minimizing electromagnetic interference between medical devices [User Experience NetworkTM]. 2000 Jul-Aug;29(7-8):294. Electromagnetic interference from linear accelerators can affect electronic devices. 2001 Jul;30(7):259-62.
Health Devices Alerts

This Product Comparison lists Health Devices Alerts (HDA) citations published since the last update of this report. Each HDA abstract is identified by an Accession Number. Recalls and hazard reports include descriptions of the problem involved; abstracts of other published articles are referenced by bibliographic information. HPCS subscribers can call the Hotline for additional information on any of these citations or to request more extensive searches of the HDA database. 32615 Dawson DJ, Wissing WW, Tonks RE. A doorless entry system for high-energy radiation therapy rooms. Med Phys 1998 Feb;25(2):199-201. 37105 Saw CB, Krishna KV, Enke CA, et al. Dosimetric evaluation of abutted fields using asymmetric collimators for treatment of head and neck. Int J Radiat Oncol Biol Phys 2000 Jun 1;47(3):821-4. 37471 Shirato H, Shimizu S, Kitamura K, et al. Four-dimensional treatment planning and fluoroscopic real-time tumor tracking radiotherapy for moving tumor. Int J Radiat Oncol Biol Phys 2000 Sep 1;48(2):435-42. 38731 Low DA, Sohn JW, Klein EE, et al. Characterization of a commercial multileaf collimator used for intensity modulated radiation therapy. Med Phys 2001 May;28(5):752-6. 39087 Kok JG. Fixed bending current for Elekta SL25 linear accelerators. J Med Eng Technol 2001 Jul-Aug; 25(4):169-72.
Healthcare Risk Control

Overview of radiation therapy liability. 1996;4:Radiology:2.
Supplier information
Advanced Medical Advanced Medical Systems Inc [148792] 121 N Eagle St Geneva OH 44041-1106 Phone: (440) 466-8005 Fax: (440) 466-8629
Citations from other ECRI publications

Health Devices
Cracked welds on EMI Therapies Systems/ATC Medical Technologies linear accelerators [hazard]. 1995 Jan;24(1):35-6.

Canberra-Packard Canberra-Packard spol sr o [374969] Sultysova 37 CZ-169 00 Praha 6 Czech Republic Phone: 420 (2) 20513765 Fax: 420 (2) 20513562 E-mail: cpcz@cpcz.cz Internet: http://www.cpe.att.cz Elekta Oncology Elekta Instruments Asia Ltd [230128] 28/Fl Morrison Plaza 9 Morrison Hill Road Wanchai Hong Kong SAR Peoples Republic of China Phone: 852 28912208 Fax: 852 25757133 E-mail: mona.lee@elekta.com Internet: http://www.elekta.com Elekta Oncology Systems Inc/Elekta Instruments Inc [344494] 3155 Northwoods Pkwy Norcross GA 30071-1539 Phone: (770) 300-9725, (800) 535-7355 Fax: (770) 448-6338 E-mail: info@elekta.com Internet: http://www.elekta.com Elekta Oncology Systems Ltd [309782] Linac House Fleming Way Crawley, West Sussex RH10 2RR England Phone: 44 (1293) 544422 Fax: 44 (1293) 654321 E-mail: info@elekta.com Internet: http://www.elekta.com INVAP INVAP SE [237889] F P Moreno 1089 Casilla de Correos 961 8400 SC de Bariloche Pcia de Rio Negro Argentina Phone: 54 (2944) 422121 Fax: 54 (2944) 423051 E-mail: marketing@invap.com.ar Internet: http://www.invap.com.ar MDS Nordion MDS Nordion [321017] 447 March Rd Ottawa ON K2K 1X8 Canada Phone: (613) 592-2790, (800) 465-3666 Fax: (613) 591-3705 E-mail: info@mds.nordion.com Internet: http://www.mds.nordion.com MDS Nordion GmbH [394706] Postbus 500164 D-79027 Freiburg Germany Phone: 49 (761) 455130 Fax: 49 (761) 4551310 E-mail: saleseurope@mds.nordion.com Internet: http://www.mds.nordion.com MDS Nordion (Hong Kong) [351565] 901 Matheson Centre Causeway Bay Hong Kong SAR Peoples Republic of China Phone: 852 28278666 Fax: 852 28278302 E-mail: niiapo@asiaonline.net Internet: http://www.mds.nordion.com MDS Nordion (US) Inc [394250] 1195 Park Ave Suite 101 Emeryville CA 94608-3655 Phone: (510) 652-5810 Fax: (510) 652-0109 E-mail: info@mds.nordion.com Internet: http://www.mds.nordion.com
Mitsubishi Mitsubishi Electric Corp [157965] 2-2-3 Marunouchi Chiyodu-ku Tokyo 100 Japan Phone: 81 (3) 32182111 Internet: http://www.mitsubishielectric.com Mitsubishi Electronics America Inc Medical Systems Div [346060] 3121 Rt 22 E Suite 304 Somerville NJ 08876 Phone: (908) 252-1312, (800) 366-0254 Fax: (908) 252-1590
10

Scanditronix Medical Scanditronix SA [183979] 107 route du Nant dAvril CH-1217 Meyrin-Geneve Switzerland Phone: 41 (22) 7820055 Fax: 41 (22) 7820215 Internet: http://www.scanditronix.com Varian TEM Ltd [324840] Gatwick Road Crawley, West Sussex RH10 2RG England Phone: 44 (1293) 531244 Fax: 44 (1293) 510260 E-mail: adele.lyons@varian.com Internet: http://www.varian.com Note: The following company did not provide us with any product information in time for publication. Its address is listed as a service to our readers. Guangdong Weida Medical Apparatus Group Corp [156992] 510095 Guangdong Jiexi Province Peoples Republic of China Phone: 86 (20) 87320898 Fax: 86 (20) 87320828 E-mail: contact@weida.com.cn Internet: http://www.weida.com.cn
Siemens Siemens AG Medizinische Technik [138334] Henkestrasse 127 Postfach 3260 D-91050 Erlangen Germany Phone: 49 (9131) 847299 Fax: 49 (9131) 844189 E-mail: hartwig.newiger@med.siemens.de Internet: http://www.siemens.de/med Siemens Medical Solutions USA Inc Oncology Care Systems Group [399203] 4040 Nelson Ave Concord CA 94520-1200 Phone: (925) 246-8200, (800) 318-5602 Fax: (925) 602-8066 E-mail: info@smsocs.com Internet: http://www.sms.siemens.com/ocsg
About the chart specifications

The following terms are used in the chart: Accelerator type: The two basic types of accelerator configurations are traveling wave and standing wave. Standing-wave accelerator guides can be made shorter than traveling-wave tubes without affecting the level of energy delivered but are more complex and thus more expensive. Microwave power: Either a magnetron or a klystron provides the RF power necessary to accelerate the electrons in the accelerator guide. Beam bending, deg: The degree of bend for the electron beam exiting the accelerator guide when the guide is mounted horizontally in the gantry. Gantry, SAD, cm: The source-to-axis distance; the distance in centimeters from the source of the radiation to the point in space about which the gantry rotates. Arc therapy: Indicates whether the radiotherapy unit can provide treatment (x-ray and/or electron) as the gantry rotates about the patient. List price: Some of the pricing information in this chart has been derived from ECRIs in-house information resources. A footnote identifies these prices. In these instances, suppliers have declined to provide us with prices and may not have confirmed the information. These prices are estimates and may or may not reflect discounts, options, special packages, and multiple-unit sales. They are provided for the convenience of our readers.
Varian Varian Medical Systems Inc Oncology Systems [363156] 3100 Hansen Way Palo Alto CA 94304-1129 Phone: (650) 493-4000, (800) 544-4636 Fax: (650) 493-5637 Internet: http://www.varian.com Varian Medical Systems International AG [363212] Chollerstrasse 38 Postfach CH-6303 Zug Switzerland Phone: 41 (41) 7498844 Fax: 41 (41) 7403340 E-mail: sales.os@ch.varian.com Internet: http://www.os.varian.com
11

Abbreviations: AECB Atomic Energy Control Board of Canada BJR British Journal of Radiology CCTV Closed-circuit television CE mark Conformite Europeene mark CSA Canadian Standards Association CT Computed tomography DOT U.S. Department of Transportation EN European Norm ETL ETL Testing Laboratories FDA U.S. Food and Drug Administration HW/SW Hardware/software IAEA International Atomic Energy Agency ICRP International Commission on Radiological Protection ICRU International Commission on Radiation Units and Measurements IEC International Electrotechnical Commission IMRT Intensity-modulated radiation therapy ISO International Organization for Standardization MDD Medical Devices Directive MLC Multileaf collimator MU/min Monitor units/minute, which is a measure of absorbed radiation dose; 1 MU = approximately 1 cGy (linac calibration dependent) NRC U.S. Nuclear Regulatory Commission QA Quality assurance R & V Record and verify RAM Random-access memory RTP Radiation therapy planning SAD Source-to-axis distance TBq Terabecquerel UL Underwriters Laboratories
Note: The data in the charts derive from suppliers specifications and have not been verified through independent testing by ECRI or any other agency. Because test methods vary, different products specifications are not always comparable. Moreover, products and specifications are subject to frequent changes. ECRI is not responsible for the quality or validity of the information presented or for any adverse consequences of acting on such information.
When reading the charts, keep in mind that, unless otherwise noted, the list price does not reflect supplier discounts. And although we try to indicate which features and characteristics are standard and which are not, some may be optional, at additional cost. For those models whose prices were supplied to us in currencies other than U.S. dollars, we have also listed the conversion to U.S. dollars to facilitate comparison among models. However, keep in mind that exchange rates change often.
Need to know more?

For further information about the contents of this Product Comparison, contact the HPCS Hotline at +1 (610) 825-6000, ext. 5265; +1 (610) 834-1275 (fax); or hpcs@ecri.org (e-mail).
12
Product Comparison Chart

MODEL ADVANCED MEDICAL ATC C-9 WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Not specified Cobalt radiotherapy 1.33 ADVANCED MEDICAL ATC V-9 Worldwide, except Japan Yes Not specified Cobalt radiotherapy 1.33 CANBERRA-PACKARD TERAGAM K01 Worldwide Submitted Submitted Cobalt radiotherapy 1.25 CANBERRA-PACKARD TERAGAM K02 Worldwide Submitted Submitted Cobalt radiotherapy 1.25
ELECTRON ENERGY, MeV
NA
NA
NA
NA
ACCELERATOR TYPE Length, m MICROWAVE POWER Source Power, MW BEAM BENDING, deg GANTRY Rotation range, deg SAD, cm TREATMENT UNIT L x W x H, cm (in)
NA NA
NA NA
NA NA
NA NA
NA NA NA
NA NA NA
NA NA NA
NA NA NA
360 (continuous) 80
NA NA
280 80
280 100
230 x 91.4 x 239 (91 x 36 x 94)
205 x 71 x 254 (81 x 28 x 100)
288 x 102 x 230 (113.4 x 40.2 x 90.6)
288 x 102 x 270 (113.4 x 40.2 x 106.2)
Weight, kg (lb) COLLIMATION Rotation range, deg Field size range at SAD, cm X-ray Electron Multileaf No. of leaves Special features
3,606 (7,950)
3,175 (7,000)
~5,900 (13,000)
~6,200 (13,670)
180 35 x 35 NA NA None specified
180 35 x 35 NA NA None specified
180 36 x 36 NA NA Asymmetric jaws
180 45 x 45 NA NA Asymmetric jaws
Colons separate data on similar models of a device.
This is the first of three pages covering the above model(s). These specifications continue onto the next two pages.
13

MODEL ADVANCED MEDICAL ATC C-9 MAXIMUM OUTPUT at SAD, rad/min X-ray ADVANCED MEDICAL ATC V-9 CANBERRA-PACKARD TERAGAM K01 CANBERRA-PACKARD TERAGAM K02
234
234
~320 cGy/min
~200 cGy/min
Electron TREATMENT COUCH L x W, cm (in)
NA 213 x 43 (84 x 17)
NA Not included *
NA 216 x 50 (85 x 19.7)
NA 216 x 50 (85 x 19.7)
Movement, cm (in) Vertical range Longitudinal range
37.5 (14.8), travel 96 (37.8), travel
Not specified Not specified
55-176 (21.7-69.3) 0-149 (0-58.7)
55-176 (21.7-69.3) 0-149 (0-58.7)
Lateral range Base rotation, deg Maximum patient weight, kg (lb) Special features
14.6 (5.7) 90 135 (298) None specified
Not specified Not specified
25 (9.8) 110 250 (550) Motorized motions, manual table rotation
25 (9.8) 110 250 (550) Motorized motions, manual table rotation
Not specified None specified
ARC THERAPY X-ray Electron RECOMMENDED MINIMUM ROOM SIZE L x W x H, m (ft) POWER REQUIREMENTS Line voltage, VAC
Yes NA
No NA
Yes NA
Yes NA
4.2 x 4.4 x 2.7 (13.7 x 14.5 x 9) 120/240, 50/60 Hz
4.3 x 4.6 x 2.7 (14 x 15 x 9) 120/240, 50/60 Hz
5.8 x 5.6 x 3 (19 x 18.4 x 9.8) 220, 50 Hz, single phase 2 maximum $350,000 Not specified
5.8 x 5.6 x 3 (19 x 18.4 x 9.8) 220, 50 Hz, single phase 2 maximum $400,000 Not specified
This is the second of three pages covering the above model(s). These specifications continue onto the next page.
kVA (beam-on) LIST PRICE FISCAL YEAR
1.2 Not specified October to September
1.2 Not specified October to September
Colons separate data on similar models of a device. * Treatment couch is available at an additional cost.
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MODEL ADVANCED MEDICAL ATC C-9 OPTIONAL ACCESSORIES Optical backpointer, beam-shaping rails, tangential breast device, armrest, adjustable headrest, patient-monitoring TV system, trimmer bars, knee crutch set, tabletop with center opening, motorized or manual collimator, machine counterweight or radiation beam interceptors, oblique incidence compensators for 60 or 80 cm, combination wedge compensator and a block tray w/11 wedges, floor scale for table, accessory attachment post, pin and arc beamdirecting device, isocentric alignment paddle, 30, 60, and 90 deg wedges Surface-mounted unit with detachable float-top table, triaxial source head, continuous 360 deg clockwise or counterclockwise rotation; C-arm rotation speed of 40-399 deg/min; rotation and direction are controlled from pendant or remote master control; fail-safe source drive. Meets requirements of AECB, DOT, IAEA, and NRC. ADVANCED MEDICAL ATC V-9 Trimmer bars, pin and arc beamdirecting device, wall and ceiling alignment lasers, tangential breast device, patientmonitoring TV system, motorized or manual collimator, mechanical frontand backpointers, attachment post, combination wedge compensator and block tray with 11 wedges CANBERRA-PACKARD TERAGAM K01 Laser alignment system, laser backpointer, radiation room monitor, wedges (15, 30, 45, 60 W), block tray with plates, set of 8 blocks, TERABASE verification system CANBERRA-PACKARD TERAGAM K02 Laser alignment system, laser backpointer, radiation room monitor, wedges (15, 30, 45, 60 W), block tray with plates, set of 8 blocks, TERABASE verification system
OTHER SPECIFICATIONS
Surface-mounted unit with wall-/floormounted stand and arm, remote-control console with key lock, fail-safe source drive, and biplane source head with automatic centering. Meets requirements of AECB, DOT, IAEA, and NRC.
Head is integral part of B(U)certified transport container; designed to accept 15-21 mm source w/activities up to 450 TBq, including those from MDS Nordion (Canada), CIS bio International (France), MAJAK (Russia), and AMERSHAM International (UK). Unit complies with FDA CFR 21; IAEA Safety Series No. 115; IEC 60601-1 and 60601-2-11; ICRU Rep. 15, 18 and 102; and ISO-1677, general and leakage test methods for sealed radioactive source.
Head is integral part of B(U)certified transport container; designed to accept 15-21 mm source w/activities up to 450 TBq, including those from MDS Nordion (Canada), CIS bio International (France), MAJAK (Russia), and AMERSHAM International (UK). Unit complies with FDA CFR 21; IAEA Safety Series No. 115; IEC 60601-1 and 60601-2-11; ICRU Rep. 15, 18 and 102; and ISO-1677, general and leakage test methods for sealed radioactive source.
15

MODEL ELEKTA ONCOLOGY Precise WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Yes Linear accelerator 4, 6, 8, 10, 12, 15, 18, 25 (select 1 to 3 energies) 4, 6, 8, 9, 10, 12, 15, 18, 20, 22 (select 3 to 9 energies) Traveling wave 2.5 INVAP TERADI 800 Worldwide Not specified Not specified Cobalt radiotherapy 1.17 MDS NORDION * Phoenix Worldwide Yes No Cobalt radiotherapy 1.33, 1.17 MDS NORDION * Theratron 780E Worldwide Yes Yes Cobalt radiotherapy 1.33, 1.17
NA
NA
NA
NA NA
NA NA
NA NA
Magnetron 5 45; 45; 112.5 slalom achromatic 365 100
NA NA NA
NA NA NA
NA NA NA
360 (continuous) 80
360+ (continuous) 80
351 x 390 x 248 (138 x 154 x 98)
228 x 140 x 310 (90 x 55 x 122)
225 x 225 x 299 (88.6 x 88.6 x 117.7)
299 x 225 x 235 (117.7 x 88.6 x 92.5)
6,200 (13,668)
5,500 (12,128)
6,033 (13,300)
6,125 (13,500)
365
110 35 x 35 NA Not specified Collimator closes automatically when source transit time is longer than normal
360
360
40 x 40 25 x 25 40 pairs Independent asymmetric jaws, 12.5 cm overtravel for upper set
35 x 35 NA Not specified None specified
Colons separate data on similar models of a device. * Formerly Theratronics.
16

MODEL ELEKTA ONCOLOGY Precise MAXIMUM OUTPUT at SAD, rad/min X-ray INVAP TERADI 800 MDS NORDION * Phoenix MDS NORDION * Theratron 780E
600
312 (at 80 cm from cobalt source) NA 245 x 45 (96.5 x 18)
314 (at 80 cm from cobalt source) NA 235 x 46 (93 x 18)
400 230 x 50 (90 x 20)
65-175 (22.6-68.9) 100 (39.4)
80-125 (31.5-49.2) 80 (31.5)
78-117 (30.7 x 46.1) See footnote **
78-117 (30.7 x 46.1) See footnote **
25 (9.8) 95; column rotation, 180 200 (440) Uninterruptible power supply on down drive, optional C-arm tabletop, carbon-fiber tennis racquet, variable speed controls, rotatable couchtop enabling SRS and physics measurements
10 (4) 145 140 (309) Optional motorized movement
40.6 (16) 220
40.6 (16) 220
136 (300) None specified
Yes Yes
Yes NA
Yes NA
Yes NA
6.5 x 6 x 3.2 (21.3 x 19.7 x 10.5) 220/415, 3-phase
5.5 x 8 (18 x 26.4) 110/220, 50/60 Hz
5.5 x 8.4 x 3.1 (18 x 27.6 x 10) 115/230, 50/60 Hz
5.5 x 8.4 x 3.1 (18 x 27.6 x 10) 115/230, 50/60 Hz
30 maximum Not specified Not specified
1.5 Not specified February to January
1.5 Not specified November to October

Colons separate data on similar models of a device. * Formerly Theratronics. ** 79 cm (31") beam stopper and 75 cm (29.5") pendulum.
17

MODEL ELEKTA ONCOLOGY Precise OPTIONAL ACCESSORIES Fully integrated MLC, electronic portal imaging, stereotactic radiosurgery system, treatment recording, electron applicators, networking, remote diagnostics and support, linear accelerator QA tools, immobilization devices INVAP TERADI 800 Complete set of wedges, shaping blocks, general treatment, trimmers at 55 cm and 65 cm, backpointer, frontpointer MDS NORDION * Phoenix Diode-laser alignment system, full range of wedges, beam-shaping blocks, collimator extensions, tangential breast device, immobilization accessories with table clamps, room monitors MDS NORDION * Theratron 780E Diode-laser alignment system, full range of wedges, interlocks, beamshaping blocks, collimator extensions, immobilization accessories with table clamps, room monitors
Graphical user interface; integrated verification; auto wedge (0-60 deg); SliC Beam Control; open-architecture connectivity; standard therapy mode for urgent treatments; assisted automatic setup; designed for dynamic therapy; upper and lower independent collimators; desktop patientmanagement system; remote service; clockwise and counterclockwise arc therapy; low (124 cm) isocenter; high-stability drum gantry design. **
Computerized control; automatic setting of angular velocity for kinetics treatment.
Manual table motions and motorized gantry rotation; head swivel 180 from isocenter; hand control mounted on overhead support arm. Manufactured to ISO 9001 standards. Meets requirements of ICRP #15 and NRC.
Motorized table motions; head swivel 180 from isocenter (2-speed control); ergonomic hand control mounted on overhead support arm; dual timer. Manufactured to ISO 9001 standards. Meets requirements of ICRP #15, IEC 60601-1 and 60601-2-11, and NRC.
Colons separate data on similar models of a device. * Formerly Theratronics. ** Meets requirements of CSA; IEC 1217, 60601-1, 60601-2-1, and 60977; ISO 9001 and 13485; and UL.
18

MODEL MDS NORDION * Theratron 1000E WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Yes Cobalt radiotherapy 1.33, 1.17 MDS NORDION * Theratron Elite 80 Worldwide Yes Yes Cobalt radiotherapy 1.33, 1.17 MDS NORDION * Theratron Elite 100 Worldwide Yes Yes Cobalt radiotherapy 1.33, 1.17 MITSUBISHI FAILED TO RESPOND ** EXL-12DP Asia, North America, South America Yes No Linear accelerator 4, 10; 6, 10
NA
NA
NA
4, 6, 8, 10, 12
NA NA
NA NA
NA NA
Standing wave 0.9
NA NA NA
NA NA NA
NA NA NA
Magnetron 3.1 270 (achromatic)
195 100
299 x 262 x 285 (117.7 x 103.1 x 112.2)
299 x 225 x 235 (117.7 x 88.6 x 92.5)
299 x 262 x 285 (117.7 x 103.1 x 112.2)
294 x 135 x 256 (116 x 53 x 101)
6,600 (14,500)
6,125 (13,500)
6,600 (14,500)
6,690 (14,750)
360
360
360
290
40 x 40 (clipped) 25 x 25 62/120 4 independent jaws, dynamic wedge, interface to R & V, RTP
Colons separate data on similar models of a device. * Formerly Theratronics. ** Specifications current as of September 2000.
19

MODEL MDS NORDION * Theratron 1000E MAXIMUM OUTPUT at SAD, rad/min X-ray MDS NORDION * Theratron Elite 80 MDS NORDION * Theratron Elite 100 MITSUBISHI FAILED TO RESPOND ** EXL-12DP
300 for 6 MV; 500 for 10 MV 1,000 210 x 60 (83 x 23.6)
87-133 (34-52) See footnote ***
78-117 (31-46) 79 (31)
87-133 (34-52) 79 (31)
40-170 (15.8-66.9) 90 (35.4)
40.6 (16) 220
40.6 (16) 220
40.6 (16) 220
50 (19.7) 190 180 (400) None specified
Yes NA
Yes NA
Yes NA
Yes Yes
5.5 x 8.4 x 3.1 (18 x 27.6 x 10) 115/230, 50/60 Hz
5.5 x 8.4 x 3.1 (18 x 27.6 x 10) 115/230, 50/60 Hz
5.5 x 8.4 x 3.1 (18 x 27.6 x 10) 115/230, 50/60 Hz
6 x 5.1 x 3 (19.7 x 16.7 x 9.8) 208, 3-phase
30 $761,000 January to December

Colons separate data on similar models of a device. * Formerly Theratronics. ** Specifications current as of September 2000. *** 79 cm (31") beam stopper and 75 cm (29.5") pendulum.
20

MODEL MDS NORDION * Theratron 1000E OPTIONAL ACCESSORIES Diode-laser alignment system, full range of wedges, interlocks, beamshaping blocks, collimator extensions, collimator tray adapters allow use of linear accelerator shielding, immobilization accessories with table clamps, room monitors MDS NORDION * Theratron Elite 80 Diode-laser alignment system, full range of wedges, interlocks, beamshaping blocks, collimator extensions, immobilization accessories with table clamps, room monitors MDS NORDION * Theratron Elite 100 Diode-laser alignment system, full range of wedges, interlocks, beamshaping blocks, collimator extensions, collimator tray adapters allow use of linear accelerator shielding, immobilization accessories with table clamps, room monitors MITSUBISHI FAILED TO RESPOND ** EXL-12DP Laser alignment system, laser backpointer, retractable beam shield, asymmetric collimator, CCTV system, RAM pedestal couch, portal imaging system, external computer system, high-resolution color display in room
Motorized table motions; head swivel 180 from isocenter (2-speed control); dual ergonomic hand controls (unit and table) mounted on overhead support arm; dual timer. Manufactured to ISO 9001 standards. Meets requirements of ICRP #15, IEC 60601-1 and 60601-2-11, and NRC.
Computerized console with R & V communication capabilities; head swivel 180 from isocenter (2-speed control); ergonomic hand control mounted on overhead support arm; dual timer. Manufactured to ISO 9001 standards. Meets requirements of ICRP #15, IEC 60601-1 and 60601-2-11, and NRC.
Computerized console with R & V communication capabilities; head swivel 180 from isocenter (2-speed control); dual ergonomic hand control mounted on overhead support arm; dual timer. Manufactured to ISO 9001 standards. Meets requirements of ICRP #15, IEC 60601-1 and 60601-2-11, and NRC.
Automatic parameter setting function; laptop style computer console; R & V function; extendedtravel-range couch; beam symmetry interlock; energy interlock; sealed ion chamber; compact standing-wave accelerator design. Meets requirements of ISO 9000.
Colons separate data on similar models of a device. * Formerly Theratronics. ** Specifications current as of September 2000.
21

MODEL MITSUBISHI FAILED TO RESPOND * EXL-12SP Asia, North America, South America Yes No Linear accelerator 4; 6 MITSUBISHI FAILED TO RESPOND * EXL-15DP Asia, North America, South America Yes No Linear accelerator 4, 10; 4, 15; 6, 10; 6, 15 MITSUBISHI FAILED TO RESPOND * EXL-20DP Asia, North America, South America Yes Not specified Linear accelerator 4, 10; 4, 15; 4, 18; 6, 10; 6, 15; 6, 18 SCANDITRONIX MEDICAL FAILED TO RESPOND * UR 2X-3D RT Not specified Not specified Not specified Linear accelerator 7
WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV
4, 6, 8, 10, 12
4, 6, 9, 12, 15
6, 9, 12, 15, 20
Not specified
Standing wave 0.9
Standing wave 1.5
Standing wave 1.8
Standing wave 0.8
Klystron 7 270 (achromatic)
Klystron 7 270 (achromatic)
Magnetron 2 Not specified
195 100
195 100
195 100
360 40
294 x 135 x 256 (116 x 53 x 101)
333 x 135 x 256 (131 x 53 x 101)
333 x 135 x 256 (131 x 53 x 101)
360 x 120 x 200 (142 x 47 x 79)
6,690 (14,750)
7,038 (15,515)
7,038 (15,515)
1,600 (3,527)
290
290
290
0
2
0.4-12 (cm ) 66 Not specified None specified
Colons separate data on similar models of a device. * Specifications current as of September 2000.
22

MODEL MITSUBISHI FAILED TO RESPOND * EXL-12SP MITSUBISHI FAILED TO RESPOND * EXL-15DP MITSUBISHI FAILED TO RESPOND * EXL-20DP SCANDITRONIX MEDICAL FAILED TO RESPOND * UR 2X-3D RT
MAXIMUM OUTPUT at SAD, rad/min X-ray
300
1,000 210 x 60 (83 x 23.6)
300 for 6 MV; 500 for 10 MV and 15 MV 1,000 210 x 60 (83 x 23.6)
300 for 6 MV; 500 for 10 MV, 15 MV, and 18 MV 1,000 210 x 60 (83 x 23.6)
400
Not specified 170 x 50 (66.9 x 19.7)
40-170 (15.8-66.9) 90 (35.4)
40-170 (15.8-66.9) 90 (35.4)
40-170 (15.8-66.9) 90 (35.4)
20-40 (7.9-15.7) 35 (13.8)
50 (19.7) 190 180 (400) None specified
50 (19.7) 190 180 (400) None specified
50 (19.7) 190 180 (400) None specified
20 (7.9) Fixed
150 (330) Standard adapters for stereotactic frames
Yes Yes
Yes Yes
Yes Yes
Yes Not specified
6 x 5.1 x 3 (19.7 x 16.7 x 9.8) 208, 3-phase
6 x 5.1 x 3 (19.7 x 16.7 x 9.8) 208, 3-phase
6 x 5.1 x 3 (19.7 x 16.7 x 9.8) 208, 3-phase
7x6x3 (23 x 19.7 x 9.8) 400
40 $1,065,900 January to December
35 $2,000,000-2,500,000 Not specified

23

MODEL MITSUBISHI FAILED TO RESPOND * EXL-12SP Laser alignment system, laser backpointer, retractable beam shield, asymmetric collimator, CCTV system, RAM pedestal couch, portal imaging system, external computer system, high-resolution color display in treatment room MITSUBISHI FAILED TO RESPOND * EXL-15DP Laser alignment system, laser backpointer, retractable beam shield, asymmetric collimator, CCTV system, RAM pedestal couch, portal imaging system, external computer system, high-resolution color display in treatment room MITSUBISHI FAILED TO RESPOND * EXL-20DP Laser alignment system, laser backpointer, retractable beam shield, asymmetric collimator, CCTV system, RAM pedestal couch, portal imaging system, external computer system, high-resolution color display in treatment room SCANDITRONIX MEDICAL FAILED TO RESPOND * UR 2X-3D RT None specified
OPTIONAL ACCESSORIES
Automatic parametersetting function; laptop-style computer console; record-and-verify function; extendedtravel-range couch; beam symmetry interlock; energy interlock; sealed ion chamber; compact standing-wave accelerator design. Meets requirements of ISO 9000.
Automatic parametersetting function; laptop-style computer console; record-and-verify function; extendedtravel-range couch; beam symmetry interlock; energy interlock; sealed ion chamber; compact standing-wave accelerator design; 3rd photon beam. Meets requirements of ISO 9000.
Automatic parametersetting function; laptop-style computer console; record-and-verify function; extendedtravel-range couch; beam symmetry interlock; energy interlock; sealed ion chamber; compact standing-wave accelerator design. 3rd photon beam. Meets requirements of ISO 9000.
Integrated control system; multileaf collimator for dynamic conformational multiarc therapy; integrated CT imaging system and associated software for direct patient positioning or position verification; 3-D treatment.
24

MODEL SIEMENS PRIMUS High Energy WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Yes Linear accelerator From 4 to 23 (2 energies) SIEMENS PRIMUS Mid Energy Worldwide Yes Yes Linear accelerator 4 to 15 (2 energies) VARIAN Clinac 21EX Worldwide Yes Yes Linear accelerator From 4, 10; 6, 10; 6, 16; 6, 23; 8, 16; 8, 23 (2 energies) per BJR 17 4 to 20 (5 energies) VARIAN Clinac 23EX Worldwide Yes Yes Linear accelerator From 6, 16; 6, 23; 6, 25 (2 energies) per BJR 17 4 to 22 (6 energies)
From 6 to 21 (up to 6 energies)
From 5 to 14 (1 to 6 energies) depending on photon selection Standing wave Not specified
Standing wave Not specified
Standing wave 1.3
Standing wave 1.3
Klystron 7.5 270 (achromatic)
Klystron 5.5 270
Klystron 5.5 270
370 100
370 100
185 100
185 100
308.6 x 143.3 x 260.4 (121.5 x 56.4 102.5)
283.9 x 130.8 x 264.4 (111.8 x 51.5 x 104.1)
259 x 124 x 371 (102 x 48.8 x 146.1)
259 x 124 x 371 (102 x 48.8 x 146.1)
7,730 (17,000)
7,030 (15,501) *
9,660 (21,300)
9,660 (21,300)
360
360
165 40 x 40 25 x 25 Optional 52, 80, or 120 Dynamic MLC for IMRT available with MLC option, MLC moves as a function both of dose-delivered (Dose Dynamic) and of gantry arc angle (Arc Dynamic), compatible w/forward & inverse treatment planning systems
165 40 x 40 25 x 25 Optional 52, 80, or 120 Dynamic MLC for IMRT available with MLC option; MLC moves as a function both of dose-delivered (Dose Dynamic) and of gantry arc angle (Arc Dynamic); compatible w/forward & inverse treatment planning systems
40 x 40 40 x 40 See footnote ** Jaw design allows for tracing divergent beams, even in overtravel; optional MLC, Virtual Wedge; HD 270 MLC option (virtually increases number of leaves to 108, 162, or 220)
40 x 40 40 x 40 See footnote ** Jaw design allows for tracing divergent beams, even in overtravel; optional MLC, Virtual Wedge; HD 270 MLC option (virtually increases number of leaves to 108, 162, or 220)
Colons separate data on similar models of a device. * Weight includes accelerator and moderator. ** 27 @ 1 cm, 2 @ 6.5 cm (measured at isocenter, per side).
25

MODEL SIEMENS PRIMUS High Energy MAXIMUM OUTPUT at SAD, rad/min X-ray SIEMENS PRIMUS Mid Energy VARIAN Clinac 21EX VARIAN Clinac 23EX
See footnote *
300/900 245 x 50 (96.5 x 19.7)
200-300, depends on energy selected; 50 low-dose mode 300/900 245 x 50 (96.5 x 19.7)
250 for 4 MV, 600 for 6-23 MV 1,000 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension; 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes Yes
600
1,000 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension; 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes Yes
65-175 (25.6-68.9) 90 (35.4)
65-175 (25.6-68.9) 90 (35.4)
25 (9.8) 180 column, 120 isocentric 200 (440) Couch has 3 points of table rotation
25 (9.8) 180 column, 120 isocentric 200 (440) Couch has 3 points of table rotation
Yes Optional
Yes Optional
6.1 x 5.8 x 3 (20 x 19.6 x 9.8) 208, see Other Specs
6.1 x 5.8 x 3 (20 x 19.6 x 9.8) 208, see Other Specs
6.1 x 7.1 x 3.1 (20 x 23.6 x 10) 208
6.1 x 7.1 x 3.1 (20 x 23.6 x 10) 208
45 Not specified October to September
45 Not specified October to September
45 ~$1,637,000 October to September

Colons separate data on similar models of a device. * 200-300 standard, 300-500 optional, depends on energy selected; 50, low-dose mode.
26

MODEL SIEMENS PRIMUS High Energy OPTIONAL ACCESSORIES SIMTEC option for automatic delivery of a sequence of fields; 3-D MLC 40 x 40 cm field size providing 30 cm travel of leaves integrated with LANTIS, Virtual Wedge, BEAMVIEW, PRIMEVIEW for graphic representation of treatment parameters with advanced setup of parameters, 2 sec Quick startup for RAD ON, remote table control, HD 270 MLC, Total Body Irradiation Control (TBIC), IMFAST (optimizes beam-fluence distributions and reduced treatment time for IMRT) SIEMENS PRIMUS Mid Energy SIMTEC option for automatic delivery of a sequence of fields; 3-D MLC 40 x 40 cm field size providing 30 cm travel of leaves integrated with LANTIS, Virtual Wedge, BEAMVIEW, PRIMEVIEW for graphic representation of treatment parameters with advanced setup of parameters, 2 sec Quick startup for RAD ON, remote table control, HD 270 MLC, Total Body Irradiation Control (TBIC), IMFAST (optimizes beam-fluence distributions and reduced treatment time for IMRT) VARIAN Clinac 21EX PortalVision, VARiS radiotherapy management system, laser alignment system, laser backpointer, CCTV system, intercom system, retractable beam stopper, BrainLAB micro multilevel monitor, Dynamic MLC for automated delivery of IMRT, Varian Millennium technology for beam matching to EX Gold Standard data set, data set included for faster machine commissioning, flat-panel monitor, gating interface board, respirator gating and interface for simulation, CT simulation and treatment VARIAN Clinac 23EX PortalVision, VARiS radiotherapy management system, laser alignment system, laser backpointer, CCTV system, intercom system, retractable beam stopper, Dynamic MLC for automated delivery of IMRT, Varian Millennium technology for beam matching to EX Gold Standard data set, data set included for faster machine commissioning, flat-panel monitor, gating interface board, respirator gating and interface for simulation, CT simulation and treatment
Solid-state technology used for modulators; integrated klystron for compact design; low noise levels; provides maximum clearance of 43 cm (16.9 in) from bottom of accessory holder to isocenter; >900 HW/SW interlock checks before and after radiation delivery; supplied with power conditioner/stepdown transformer requiring 480 VAC, 3-phase WYE @ 5% input with neutral ground; 208 VAC input after conditioner; 10-year prorated warranty on waveguide.
Provides maximum clearance of 43 cm (16.9 in) from bottom of accessory holder to isocenter; monitored by 126 active check points and >900 HW/SW checks before and after radiation delivery; supplied with power conditioner/stepdown transformer requiring 480 VAC, 3-phase WYE @ 5% input with neutral ground; 208 VAC input after conditioner; 10-year prorated warranty on waveguide.
Enhanced Dynamic Wedge; Automatic Field Sequencing for automated delivery of multiple Clinac fields; dual independent collimators; remote diagnostics; extended collimator rotation; optional Silhouette edition with minimum floor space dimensions of 4.9 x 5.8 m (16 x 19 ft). Meets requirements of EN 46001, ETL, and ISO 9001.
Enhanced Dynamic Wedge; Automatic Field Sequencing for automated delivery of multiple Clinac fields; dual independent collimators; remote diagnostics; extended collimator rotation; optional Silhouette edition with minimum floor space dimensions of 4.9 x 5.8 m (16 x 19 ft). Meets requirements of EN 46001, ETL, and ISO 9001.
27

MODEL VARIAN Clinac 2100C WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Yes Linear accelerator From 4, 10; 6, 10; 6, 16; 6, 23; 8, 16; 8, 23 (2 energies) per BJR 17 4 to 20 (5 energies) VARIAN Clinac 2100C/D Worldwide Yes Yes Linear accelerator From 4, 10; 6, 10; 6, 16; 6, 23; 8, 16; 8, 23 (2 energies) per BJR 17 4 to 20 (5 energies) VARIAN Clinac 2300C/D Worldwide Yes Yes Linear accelerator From 6, 16; 6, 23; 6, 25 (2 energies) per BJR 17 4 to 22 (6 energies) VARIAN Clinac 600C Worldwide Yes Yes Linear accelerator 4 or 6, per BJR 17
NA
Standing wave 1.3
Standing wave 1.3
Standing wave 1.3
Standing wave 0.3
Klystron 5.5 270
Klystron 5.5 270
Klystron 5.5 270
Magnetron 2.5 0
185 100
185 100
185 100
180 100
259 x 124 x 371 (102 x 48.8 x 146.1)
259 x 124 x 371 (102 x 48.8 x 146.1)
259 x 124 x 371 (102 x 48.8 x 146.1)
272 x 127 x 269 (107 x 50 x 106)
9,660 (21,300)
9,660 (21,300)
9,660 (21,300)
6,668 (14,700)
95; 165 option 40 x 40 25 x 25 Optional 52, 80, or 120 Dynamic MLC for IMRT available with MLC option; MLC moves as a function both of dose-delivered (Dose Dynamic) and of gantry arc angle (Arc Dynamic); compatible w/forward & inverse treatment planning systems
95; 165 option 40 x 40 NA Optional 52, 80, or 120 Dynamic MLC for IMRT available with MLC option; MLC moves as a function both of dose-delivered (Dose Dynamic) and of gantry arc angle (Arc Dynamic); compatible w/forward & inverse treatment planning systems
28

MODEL VARIAN Clinac 2100C MAXIMUM OUTPUT at SAD, rad/min X-ray Electron TREATMENT COUCH L x W, cm (in) VARIAN Clinac 2100C/D VARIAN Clinac 2300C/D VARIAN Clinac 600C
250 for 4 MV, 600 for 6-23 MV 400 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension, 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes Optional
600 1,000 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension, 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes Yes
600 1,000 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension, 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes Yes
250 for 4 MV, 400 for 6 MV NA 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension, 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes NA
6.1 x 7.1 x 3.1 (20 x 23.6 x 10) 208
6.1 x 7.1 x 3.1 (20 x 23.6 x 10) 208
6.1 x 7.1 x 3.1 (20 x 23.6 x 10) 208
6.1 x 6.1 x 3.2 (20 x 20 x 10.5) 208
15 ~$641,000 October to September

29

MODEL VARIAN Clinac 2100C OPTIONAL ACCESSORIES Auto Field Sequencing (for automated movement of Clinac between treatment fields when used with R & V system), micromultileaf collimator (BrainLAB), VARiS radiotherapy information management system, laser alignment system, laser backpointer, CCTV system, intercom system, Stereotactic Lock Kit including electronic and couch lockout, in-room monitor, fine beam matching, portal vision, flat-panel monitor, respiratory gating and interface for simulation, CT simulation and treatment VARIAN Clinac 2100C/D Auto Field Sequencing (for automated movement of Clinac between treatment fields when used with R & V system), micromultileaf collimator (BrainLAB), VARiS radiotherapy information management system, laser alignment system, laser backpointer, CCTV system, intercom system, Stereotactic Lock Kit including electronic and couch lockout, in-room monitor, fine beam matching, portal vision, flat-panel monitor, gating interface board, respiratory gating and interface for simulation, CT simulation, & treatment Dual independent collimators; Enhanced Dynamic Wedge; sealed ion chambers; dynamic beam steering to correct for beam angle or beam position changes; demountable electron gun; redundant readouts on all dynamic axes; remote diagnostics; builtin Morning Checkout Mode QA tool; retractable beam stopper; optional Silhouette edition with minimum floor space dimensions of 4.9 x 5.8 m (16 x 19 ft). Meets requirements of EN 46001, ETL, and ISO 9001. VARIAN Clinac 2300C/D Auto Field Sequencing (for automated movement of Clinac between treatment fields when used with R & V system), micromultileaf collimator (BrainLAB), VARiS radiotherapy information management system, laser alignment system, laser backpointer, CCTV system, intercom system, Stereotactic Lock Kit including electronic and couch lockout, in-room monitor, fine beam matching, portal vision, flat-panel monitor, gating interface board, respiratory gating and interface for simulation, CT simulation, & treatment Dual independent collimators; Enhanced Dynamic Wedge; sealed ion chambers; dynamic beam steering to correct for beam angle or beam position changes; demountable electron gun; redundant readouts on all dynamic axes; remote diagnostics; builtin Morning Checkout Mode QA tool; retractable beam stopper; optional Silhouette edition with minimum floor space dimensions of 4.9 x 5.8 m (16 x 19 ft). Meets requirements of EN 46001, ETL, and ISO 9001. VARIAN Clinac 600C Auto Field Sequencing (for automated movement of Clinac between treatment fields when used with R & V system), micromultileaf collimator (BrainLAB), VARiS radiotherapy information management system, laser alignment system, laser backpointer, CCTV system, intercom system, Stereotactic Lock Kit including electronic and couch lockout, in-room monitor, gating interface board, Enhanced Dynamic Wedge (for electronic wedging), dual independent collimators (required with multileaf option) Optional extended collimator rotation; optional special accessory plugs (for total-body x-ray irradiation), 9,000 MU total-body x-ray (at isocenter) delivery; sealed ion chamber; beam symmetry interlock; Morning Checkout Mode QA tool. Meets requirements of EN 46001, ETL, and ISO 9001.
Dual independent collimators; Enhanced Dynamic Wedge; sealed ion chambers; dynamic beam steering to correct for beam angle or beam position changes; demountable electron gun; built-in Morning Checkout Mode QA tool; retractable beam stopper; optional Silhouette edition with minimum floor space dimensions of 4.9 x 5.8 m (16 x 19 ft). Meets requirements of EN 46001, ETL, and ISO 9001.
30

MODEL VARIAN Clinac 600C/D WHERE MARKETED FDA CLEARANCE CE MARK (MDD) TYPE PHOTON ENERGY, MV Worldwide Yes Yes Linear accelerator 4 or 6, per BJR 17
NA
Standing wave 0.3
Magnetron 3 0
180 100
272 x 127 x 269 (107 x 50 x 106)
6,668 (14,700)
165 40 x 40 NA Optional 52, 80, or 120 Dynamic MLC for IMRT available with MLC option; MLC moves as a function both of dose-delivered (Dose Dynamic) and of gantry arc angle (Arc Dynamic); compatible w/forward & inverse treatment planning systems
31

MODEL VARIAN Clinac 600C/D MAXIMUM OUTPUT at SAD, rad/min X-ray
400 for 4 MV, 600 for 6 MV NA 236 x 53 (93 x 20.9), Exact couch 62.7-169.7 (24.7-66.8) 93.5-288.5 (36.8-113.6) with extension, 93.5-264.9 (36.8-104.3) without extension 25 (9.8) 95 200 (440) Exact couch designed to facilitate transfer from simulation to treatment; dual pendants; Lok-bar technology; optional indexing accessories; Mylar covers and removable rails; movable support rails and Unipanel avoid couchtop pivot Yes NA
6.1 x 6.1 x 3.2 (20 x 20 x 10.5) 208
15 ~$829,000 October to September

32

MODEL VARIAN Clinac 600C/D OPTIONAL ACCESSORIES Auto Field Sequencing (for automated movement of Clinac between treatment fields when used with R & V system), micromultileaf collimator (BrainLAB), VARiS radiotherapy information management system, laser alignment system, laser backpointer, CCTV system, intercom system, Stereotactic Lock Kit including electronic and couch lockout, in-room monitor, gating interface board
Demountable electron gun; Special Procedures mode including special accessory plugs (for totalbody x-ray irradiation), 9,000 MU total-body x-ray (at isocenter) delivery; Enhanced Dynamic Wedge (for electronic wedging); extended collimator rotation; dual independent collimators (required with multileaf option); sealed ion chamber; beam symmetry interlock; Morning Checkout Mode QA tool. Meets requirements of EN 46001, ETL, and ISO 9001.
33

Linear Accelerators Radiotherapy Units, Cobalt: March 2002

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March 2002

Linear Accelerators; Radiotherapy Units, Cobalt

Healthcare Product Comparison System

Electron Accelerator Guide Gun Waveguide RF Power Source

Beam Transport System (Bending Magnet) Control Console

Modulator Patient Table

Figure 1. Typical linac components

Linear Accelerators; Radiotherapy Units, Cobalt

Primary Collimator Flattening Filter

Movable X-ray Collimators

Figure 2. Straight-through treatment head design

Healthcare Product Comparison System

Lead-Filled Source Drawer Lead Shielding Collimator Leaves

Figure 3. Basic head design of a cobalt radiotherapy unit

Linear Accelerators; Radiotherapy Units, Cobalt

Healthcare Product Comparison System

Linear Accelerators; Radiotherapy Units, Cobalt

Healthcare Product Comparison System

Standards and guidelines

Linear Accelerators; Radiotherapy Units, Cobalt

Health Devices Alerts

Healthcare Risk Control

Citations from other ECRI publications

Healthcare Product Comparison System

Linear Accelerators; Radiotherapy Units, Cobalt

About the chart specifications

Healthcare Product Comparison System

Need to know more?

Linear Accelerators; Radiotherapy Units, Cobalt

Product Comparison Chart

ELECTRON ENERGY, MeV

230 x 91.4 x 239 (91 x 36 x 94)

205 x 71 x 254 (81 x 28 x 100)

288 x 102 x 230 (113.4 x 40.2 x 90.6)

288 x 102 x 270 (113.4 x 40.2 x 106.2)

180 35 x 35 NA NA None specified

180 35 x 35 NA NA None specified

180 36 x 36 NA NA Asymmetric jaws

180 45 x 45 NA NA Asymmetric jaws

Colons separate data on similar models of a device.

Healthcare Product Comparison System

Product Comparison Chart

Electron TREATMENT COUCH L x W, cm (in)

NA 213 x 43 (84 x 17)

NA 216 x 50 (85 x 19.7)

NA 216 x 50 (85 x 19.7)

Movement, cm (in) Vertical range Longitudinal range

37.5 (14.8), travel 96 (37.8), travel

Not specified Not specified

55-176 (21.7-69.3) 0-149 (0-58.7)

55-176 (21.7-69.3) 0-149 (0-58.7)

14.6 (5.7) 90 135 (298) None specified

Not specified Not specified

25 (9.8) 110 250 (550) Motorized motions, manual table rotation

25 (9.8) 110 250 (550) Motorized motions, manual table rotation

Not specified None specified

4.2 x 4.4 x 2.7 (13.7 x 14.5 x 9) 120/240, 50/60 Hz

4.3 x 4.6 x 2.7 (14 x 15 x 9) 120/240, 50/60 Hz

kVA (beam-on) LIST PRICE FISCAL YEAR