Linear

March 2002

Linear Accelerators; Radiotherapy Units,Cobalt

Purpose

Medical linacs and cobalt radiotherapy units areused in external-beam radiation therapy to treat can-cer. Linacs emit a well-defined beam of uniformlyintense x-ray photon radiation of different energies,

depending on the accelerator. Some linacs also produceelectron beams. Cobalt radiotherapy units use cobalt-60,a man-made radioisotope, to produce gamma-ray pho-tons. Cobalt units and low-energy linacs are used pri-marily to treat bone cancer and tumors of the head, neck,and breast. High-energy linacs are used to treat deep-seated neoplasms and tumors of the pelvis and thorax.

Since the development of radiotherapy units, exter-nal-beam radiation therapy has become a primarytreatment modality, along with chemotherapy andsurgery. Radiation is used to treat at least 50% of allcancer cases, and many patients receive a combinationof all three modalities. Radiation therapy can be eithercurative or palliative, depending on the stage andprognosis of the disease. For treatment to be success-ful, the radiation field must be of a uniform intensity

173621424-010

Scope of this Product ComparisonThis Product Comparison covers clinical linearaccelerators (also called linacs) and cobalt ra-diotherapy units used for external-beam radia-tion therapy.

For more information on related topics, see thefollowing 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

UMDNS informationThis Product Comparison covers the followingdevice terms and product codes as listed in ECRI’sUniversal Medical Device Nomenclature System™(UMDNS™):

• Linear Accelerators [12-364]

• Radiotherapy Units, Cobalt [16-972]

5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USATelephone +1 (610) 825-6000 • Fax +1 (610) 834-1275 • E-mail [email protected]

Linear accelerator

and predictable energy level and must be well definedto avoid irradiating healthy tissue.

Principles of operationLinear accelerators

Linacs consist of four major components — a modu-lator, an electron gun, a radio-frequency (RF) powersource, and an accelerator guide (see Fig. 1). Theelectron beam produced by a linac can itself be used fortreatment or can be directed toward a metallic targetto produce x-rays.

The modulator amplifies the AC power supply, rec-tifies it to DC power, and produces high-voltage DCpulses that are used to power the electron gun and RFpower source. High-voltage cables electrically connectthe electron gun and RF power source to the modula-tor, which can be located in the gantry, the gantrysupporting stand, or a separate cabinet.

The electron gun injects electrons into the accelera-tor guide in pulses of the appropriate duration, veloc-ity, and position to maximize acceleration. Theelectron gun can be attached to the accelerator guideby a removable vacuum flange, which allows easyreplacement of the gun. In designs with a permanentlyattached electron gun, the entire accelerator must bereplaced when the gun’s filament burns out.

The RF power source, either a magnetron or aklystron, supplies high-frequency electromagneticwaves (3,000 MHz), which accelerate the electronsinjected from the electron gun down the acceleratorguide.

Linacs are classified according to their energy lev-els. Low-energy units produce 4 or 6 million volt (MV)photons, medium-energy units produce photons of 8 to

10 MV and electron beams of 9 to 15 million electronvolts (MeV), and high-energy linacs produce photonsbetween 15 and 25 MV and have electron energiesranging from 4 to 22 MeV. Most linacs are dual-energyunits offering a low-energy beam at 6 MV and a high-energy beam of at least 10 MV, or they are multiple-energy units offering a range of photon and electronenergies.

Generally, a magnetron — a microwave generatorwith RF cavities arranged in a circle — is used in low-to medium-energy accelerators, and a klystron — anamplifying electron tube with RF cavities arranged ina straight line — is used in high-energy accelerators.

In a magnetron, electrons generated by a heatedcathode under the combined force of an electric and amagnetic field produce microwave energy. In aklystron, the electron beam interacts with micro-waves, which modulate the beam’s velocity to concen-trate the electrons into bunches. Klystrons require lowRF power and are more expensive than magnetronsbecause they have specialized circuitry, provide higheroutput, and last longer. Magnetrons, which are self-os-cillating devices, must be tuned to match the frequencyof the RF system because they generate the incorrectpower if other components of the system have slightlydifferent frequencies. However, for low-energy appli-cations, frequency instabilities are small, and magne-trons are more cost-effective than klystrons.

The microwaves are transported to the acceleratorguide by a waveguide, a hollow metallic tube closed atboth ends by ceramic windows that are transparent tomicrowaves. The waveguide is filled with a pressurizedgas to prevent microwaves from shorting across it.

The accelerator guide, which consists of severalcopper, microwave-resonant cavities soldered into asingle structure, accelerates the electrons to the de-sired energy. Two types of guides are available — thestanding wave and the traveling wave. Although verydifferent, 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 interactwith the electron gun and cause gun failure.

The standing-wave accelerator guide is so namedbecause the accelerating electric field oscillates inplace within the tube, which is sealed at each end toreflect the microwave energy, thereby multiplexingthe intensity of the incoming wave. In the traveling-wave accelerator, the length of the accelerator is di-rectly proportional to the acceleration energyproduced. Each cavity is resonant and develops anoscillating electric field that moves down the tubecarrying the electrons, much as waves carry surfers.

C20

4UN

2C

ControlConsole

Modulator

TreatmentHead

Accelerator GuideBeam Transport

System(Bending Magnet)

VacuumSystem WaterCoolingSystem

Waveguide

RF PowerSource

ElectronGun

Physical Connections

PatientTable

Figure 1. Typical linac components

Healthcare Product Comparison System

2 ©2002 ECRI. Duplication of this page by any means for any purpose is prohibited.

The RF power is fed directly to the traveling-waveaccelerator, rather than through the waveguide. Afterthe RF waves have passed through the acceleratorguide, residual power is either absorbed by a load orfed back into the accelerator.

For a given RF power and for the same maximumenergy requirement, traveling-wave acceleratorguides are significantly longer than standing-waveaccelerator guides. Because the standing-wave guidesare more compact, they can often be mounted verticallyin the x-ray head. High-energy traveling-wave units,which require lengths of 2.5 meters or more, increasethe overall length of the accelerator and may requirelarger treatment rooms.

After the electrons are accelerated, they are aimedby a bending magnet to produce radiation for treat-ment. Most systems use a 270° achromatic magnet toposition the beam. Some low-energy accelerators havea straight-through design; the accelerator guide isshort enough to be mounted vertically in the treatmenthead, and beam steering with a bending magnet is notrequired (see Fig. 2).

The high-energy electron beam is either directed ata tungsten target to produce photons for therapy orused for direct electron treatment. Because the photonbeam produced from the tungsten target is most intenseat its center, a flattening filter, usually made of lead, isprovided to modify the beam’s intensity distribution for

clinical use. For low-energy units, a material with ahigh atomic number (Z) is often used as a filter; forhigh-energy units, a low-Z filter is used.

For electron-beam treatment, the highly collimatedbeam of electrons is distributed over the treatmentarea by means of a thin (0.5 mm) metallic foil inter-posed in the beam, which scatters the electrons later-ally upon impact. Moving the electron beam itself in araster pattern over the treatment area also distributesthe beam over the treatment area. Alternatively, avarying magnetic field can be used to deflect the elec-trons in a raster pattern without the use of blockingmaterial.

All linacs have a dosimetry system in the treatmenthead that terminates the radiation at the preset dose.This system incorporates a compartmented, dual-sys-tem ionization chamber, which should be sealedagainst temperature and pressure fluctuations; theperformance of this chamber must be checked fre-quently. Most dosimetry systems can detect asymme-tries in the treatment beam and then terminateirradiation if the asymmetry exceeds a preset value.Some linacs can reposition the beam after an asymme-try is detected. Some systems also have beam-steeringcircuitry to automatically compensate for changes inthe angle or position of the beam caused by gantry orcollimator rotation.

The radiation beam is shaped by the collimators,which are motor-driven, movable blocks of materialthat define the treatment field. A light field projectedonto the patient outlines the area to be irradiated.Field sizes of up to 40 cm on a side are available, as aredigital readouts of collimators’ positions. Adjustablecollimator jaws are available on most units. In addi-tion, special size-specific collimators for electron-beamtreatment are suspended below the fixed collimatorsystem, and other freestanding blocks or shapingwedges can be placed below the collimator trays tofurther customize the beam shape. The entire collima-tor assembly rotates about an axis that passes throughthe center of the treatment field and the isocenter (thespatial point where the collimator’s axis of rotationintersects the gantry’s axis).

Major manufacturers of linacs offer multileaf colli-mators. Multileaf collimators use multiple (up to 120)thin leaves, which are individually motorized, to definethe treatment field. This computer-controlled collima-tion facilitates modification of the treatment field andreplaces custom-made lead blocks for many treatments.

A closed-loop water-cooling system removes theheat produced throughout the accelerator system. Inparticular, the tungsten target used in the production

RF PowerInput

Electron Gun

Accelerator

RetractableTarget

PrimaryCollimator

Flattening Filter

Ion Chamber

Range-finderOptics

Isocenter

MovableX-ray

Collimators

C20

4UN

2D

Figure 2. Straight-through treatment head design

Linear Accelerators; Radiotherapy Units, Cobalt

©2002 ECRI. Duplication of this page by any means for any purpose is prohibited. 3

of x-rays becomes exceptionally hot during operationand will fail if not properly cooled. In units withtargets located inside the chamber, a burn-through ofthe target will also cause the high vacuum in theaccelerator guide to fail.

Linac components are packaged in mounting standsand movable gantries. The DC and microwave powersupplies are usually found in the stand, and the accel-erator, target, collimation, and dosimetry systems areusually in the gantry. Most low-energy linacs have themagnetron in the gantry, whereas many high-energymachines have separate cabinets for the modulatorand RF power source.

Cobalt radiotherapy units

Cobalt units provide low-energy (1.17 and/or 1.33MV) treatment using cobalt-60 as a radiation source.Nickel-plated, high specific activity cobalt-60 pelletsare encapsulated in two layers of low-carbon stainlesssteel sealed by heliarc welding in a cylinder. The sourcecylinder, approximately 1 to 2 cm in diameter, ismounted in the unit’s head; a pneumatically drivendrawer moves the source from storage into the exposureposition. Accurate source positioning is accomplishedwith limiting devices. The source is surrounded by leadin 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 treatmentfield, and special filters or beam modifiers are alsoavailable for individual therapy needs.

Cobalt radiotherapy units operate similarly to low-energy 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 at0.5 cm below the skin surface, it is especially suited forradiotherapy of the head, neck, and breast, as well as

for tumors within 5 cm of the skin surface that arelocated in other parts of the body.

Radiation dose and therapy planning

The penetrating effect of the radiation produced bythe radiotherapy unit varies depending on the energy.Megavoltage electrons are stopped after traveling afew centimeters into the patient, whereas megavoltagephotons penetrate more deeply. The high-energy pho-tons have a skin-sparing effect; that is, the maximumionization of the beam is not achieved until the beamhas penetrated 0.5 cm to 2 or 3 cm below the surface,so the skin receives a dose considerably lower than themaximum.

Data describing the beams, such as energy andradiation dosage, is collected from each accelerator bya medical physicist at the time of installation andperiodically rechecked. Using this data and a prescrip-tion specifying the dosage of radiation and theanatomic site to be irradiated, a radiotherapy treat-ment planning system is used to calculate a treatmentplan that includes the number of beams to enter thepatient, the energy and type of radiation (photonsand/or electrons), and the geometric distribution of thebeams. Variable beam geometry is further designed toreduce dosage to normal tissue while maximizing thedose-to-tumor volume and can be accomplished usingsingle or multiple stationary beams, rotating a beamor beams around the tumor, or combining these meth-ods. Wedge filters or tissue compensators affixed tothe accelerator are used to alter beam geometry tofacilitate treatment of irregularly shaped tumors. Inthree-dimensional (3-D) conformal radiotherapy, datafrom computed tomography (CT) and magnetic reso-nance imaging scans is reformatted for 3-D display ona computer workstation; dose distributions are thensuperimposed on this anatomic display to formulatecustomized treatment plans. The 3-D treatment planallows beam shaping from different directions for moreaccurate radiation delivery to the target tumor vol-ume. In situations where it is difficult to produce asatisfactory plan, intensity-modulated radiotherapy(IMRT) is designed to enhance the capability of con-forming dose distributions in three dimensions by al-lowing the beam intensity to vary across the fields inaddition to the methods listed above.

Radiotherapy simulators use radiographic/fluoro-scopic and CT imaging to locate the tumor and accu-rately determine the desired positions of the linac orcobalt unit before the patient is treated. (See the Prod-uct Comparison titled RADIOTHERAPY SIMULATIONSYSTEMS.)Port films — diagnostic films taken with thepatient in the treatment position — are compared

Air Cylinder

Source Capsule

ShieldingBlock

Source PositionIndicator Rod

FieldDefiner

Collimator Leaves

Lead Shielding

Lead-FilledSource Drawer

C20

4UN

2E

Figure 3. Basic head design of a cobalt radiotherapyunit



with the simulator films to ensure that radiation isdelivered as prescribed. Some linac manufacturersoffer electronic portal imaging (also called digital veri-fication), which provides rapid, computer-processed,digital image acquisition; some systems allow real-time imaging. Digitally processed port films can pro-vide better image quality than traditional port films,and electronic portal imaging systems can permit morefrequent port filming, high-capacity digital image stor-age, and real-time comparisons. Records of each treat-ment, including the accumulated radiation dose, areusually kept by the treatment technologist, but mostmanufacturers offer record-and-verify computers thatkeep these records automatically. For information onradiotherapy planning, record-and-verify computers,or digital portal imaging, see the Product Comparisonstitled COMPUTERS, RADIOTHERAPY PLANNING SYSTEMand COMPUTERS, RADIOTHERAPY RECORD AND VER-IFY; PORTAL IMAGING SYSTEMS, DIGITAL.

Reported problemsA systematic view of reported problems has shown

that most errors and incidents are caused by usererror. At least one study (Macklis et al. 1998) hasreported that it is unlikely that a given patient willsuffer a significant adverse medical event caused by aradiotherapy treatment error (routine toxicities andside effects were not documented, however). In thisstudy, 15% of the errors were related to the use of therecord-and-verify system (resulting from incorrectdata entry). Errors can also occur at the planning stageor in equipment calibration. Missed clinical informa-tion at the planning stage has caused severe (evenfatal) radiation injury, and poor calibration can lead toserious medical errors.

Electromagnetic interference (EMI) from a linearaccelerator caused infusion-pump failure when thepumps were being used on patients undergoing radia-tion therapy. ECRI believes that this problem couldaffect other electronic devices as well. See citationsfrom Health Devices below.

Hardware failures can also result in the misadmin-istration of a radiotherapy prescription. Because ofthe complexity of linacs and cobalt radiotherapy units,mechanical problems are common, although most in-juries are caused by heavy equipment hitting patientsand technologists. All units should have fault-detec-tion systems that minimize the probability of anequipment-induced treatment error. Software, or pro-gramming, errors can have a serious impact on pa-tient treatment. One small programming error canaffect many patients. For example, several patientdeaths from teletherapy overexposure occurred at

Panama’s National Institute of Oncology; data entryand software errors, along with a lack of treatmentplan verification, were cited as contributing factors bythe U.S. Food and Drug Administration (FDA). Therewas no suggestion that a failure or malfunction of theteletherapy system contributed to the overexposure.

Risk management in radiotherapy requires a com-prehensive quality assurance program (Nath et al.1994). According to FDA, treatment plans should beverified by independent means, possibly includingmanual calculations or measurement of radiationdose.

Purchase considerationsBecause cancerous tumors occur at different depths

and locations within the body, radiation treatmentrequires a range of photon and electron energy andtreatment field sizes. Approximately 60% of patientsrequire low-energy therapy, 25% require medium- tohigh-energy therapy, and 15% require a high-energyelectron beam. Therefore, a well-equipped radiother-apy department should include a linac with 18 to 22MeV electron energies and a cobalt unit or low-energylinac for treating patients requiring a low-energy ther-apy beam.

Purchasers should prepare a comprehensive qualityassurance program to calibrate equipment and to iden-tify operating irregularities. A medical physicistshould be consulted to determine the shielding re-quirements before the radiotherapy unit is installed.

Cost containment

In the United States, cobalt units generally costbetween $350,000 and $500,000, while linacs cost be-tween $600,000 and $2.5 million. Linacs that providehigher electron and x-ray energies usually cost moreand require more technical staff and more expensivehousing. Options such as an electronic portal imagingsystem and a multileaf collimator will also add to thetotal cost.

Because linacs and cobalt radiotherapy units entailongoing maintenance and operational costs, the initialacquisition cost does not accurately reflect the totalcost of ownership. Therefore, a purchase decisionshould be based on issues such as life-cycle cost (LCC),local service support, discount rates and non-price-re-lated benefits offered by the supplier, and stand-ardization with existing equipment in the departmentor hospital (i.e., purchasing radiotherapy equipmentfrom one supplier).

An LCC analysis can be used to compare high-costalternatives and/or to determine the positive or negative



economic value of a single alternative. For example,hospitals can use LCC analysis techniques to examinethe cost-effectiveness of leasing or renting equipmentversus purchasing the equipment outright. Because itexamines the cash-flow impact of initial acquisition costsand operating costs over a period of time, LCC analysisis most useful for comparing alternatives with differentcash flows and for revealing the total costs of equipmentownership. One LCC technique — present value (PV)analysis — is especially useful because it accounts forinflation and for the time value of money (i.e., moneyreceived today is worth more than money received at alater date). Conducting a PV/LCC analysis often demon-strates that the cost of ownership includes more than justthe initial acquisition cost and that a small increase ininitial acquisition cost may produce significant savingsin long-term operating costs. The PV is calculated usingthe annual cash outflow, the dollar discount factor (thecost of capital), and the lifetime of the equipment (inyears) in a mathematical equation.

The following represents a sample seven-yearPV/LCC analysis for a linac with dual x-ray energiesand 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 patientsper year, with each patient receiving 20 treatmentsat a cost of $35 per fraction

• Costs are considered for one full-time medical physi-cist, two full-time radiotherapy technologists, andone part-time radiotherapy technologist

Capital Costs

• Linac with positioning lasers, a fiberoptic backpoin-ter, 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

• Salary and expenses for 1 medical physicist =$130,000/year

• Salary and expenses for 2 full-time radiotherapytechnologists = $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 analysisthat should be considered for budgetary planning in-clude those associated with the following:

• Hardware and software upgrades not covered by theservice 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 analy-sis, the initial acquisition cost is only a fraction of thetotal cost of operation over seven years. Therefore,before making a purchase decision based solely on theacquisition cost, buyers should consider operatingcosts over the lifetime of the equipment.

For customized analyses and purchase decision sup-port, readers should contact ECRI’s SELECT™ Group.

Hospitals can purchase service contracts or serviceon a time-and-materials basis from the supplier. Serv-ice may also be available from a third-party organiza-tion. The decision to purchase a contract should becarefully considered and can be justified for severalreasons. Most suppliers provide routine software up-dates, which enhance system performance, at nocharge to service contract customers. Furthermore,software updates are often cumulative; that is, pre-vious software revisions may be required in order toinstall and operate a new performance feature. Pur-chasing a service contract also ensures that preventivemaintenance will be performed at regular intervals,thereby eliminating the possibility of unexpectedmaintenance costs. Also, many suppliers do not extendsystem performance and uptime guarantees beyondthe length of the warranty unless the system is coveredby a service contract. Some facilities may choose to payfor service only when the unit is in need of repair, eventhough associated costs and downtime could be exten-sive. In-house equipment maintenance can be a cost-effective alternative if in-house staff are trained in



maintaining and repairing radiotherapy equipmentcomponents (Moretti 1993).

ECRI recommends that, to maximize bargainingleverage, hospitals negotiate pricing for service con-tracts before the system is purchased. As a guideline,full service contracts typically cost approximately 5%to 8% of the system’s purchase price. Additional servicecontract discounts may be negotiable for multiple-yearagreements or for service contracts that are bundledwith contracts on other radiotherapy equipment in thedepartment or hospital. Service contracts shouldclearly indicate whether full coverage of parts andlabor is included or whether any parts are excluded;usually, the accelerator waveguide and magnetron orklystron power source are not included.

In addition, hospitals should negotiate for a signifi-cant discount — some suppliers may discount up to20% or 30%. The actual discount received will dependon the hospital’s negotiating skills, the system configu-ration and model to be purchased, previous experiencewith the supplier, and the extent of concessionsgranted by the supplier, such as extended warranties,fixed prices for annual service contracts, and guaran-teed on-site service response. Buyers should make surethat applications training is included in the purchaseprice of the system. Some suppliers do offer moreextensive on-site or off-site training programs at anadditional cost.

Stage of developmentCobalt units have been available for radiotherapy

since the early 1950s, and for 30 years, most radiother-apy was performed using these units. The first medicallinac was developed in 1961, and they are now consid-ered the primary radiotherapy treatment device.However, because of their lower acquisition and main-tenance costs, cobalt units are used in many develop-ing countries as the sole treatment device, as well asin developed countries to provide backup for a linac.

In early 1990, a cobalt unit with a 100 cm treatmentdistance — identical to that of most linacs — was in-troduced. Some cobalt units offer a computer consolefor networking, tables similar to those used with li-nacs, and high source strengths.

Computer control and digital capabilities now allowremote diagnostics for service, easier upgrades, moreprecise control of beam parameters, and networking ofradiotherapy equipment (e.g., linacs, data manage-ment systems, treatment planning systems).

A linac dedicated to stereotactic radiosurgery for non-invasive treatment of intracranial lesions and tumors,arteriovenous malformations, and retinal blastomas

was introduced in 1992 as an alternative to theGamma Knife, a device that uses multiple cobalt-60sources to focus radiation beams on a single target inthe brain. Stereotactic radiosurgery involves very pre-cise focusing of intense ionizing radiation and istypically accomplished in a single dose without signifi-cantly irradiating the surrounding tissue. Some manu-facturers of linacs offer add-on radiosurgery packages,which include collimators, a computer workstationwith radiosurgery planning software, and a stereotac-tic headframe attached either to a floorstand or to thepatient couch. For more information on stereotacticradiosurgery, see the Product Comparison titledSTEREOTACTIC HEADFRAMES; STEREOTACTIC SYS-TEMS, RADIOSURGICAL.

Other technological enhancements offered by a fewmanufacturers are 3-D conformal radiotherapy, dy-namic radiotherapy, intraoperative radiotherapy, anddynamic wedge sequencing. Dynamic radiotherapy in-volves simultaneous movement of the table and colli-mator during treatment and is used in conjunctionwith 3-D treatment planning for greater precision intreating irregularly shaped tumors. In intraoperativeradiotherapy, a malignancy that has been unrespon-sive to other forms of treatment is surgically exposed,and ionizing radiation is then aimed directly at thesite. Dynamic wedge sequencing is used to producevariable wedge-shaped treatment fields by computer-controlled collimator jaw speed and motion.

BibliographyAlmén A, Ahlgren L, Mattsson S. Absorbed dose to

technicians due to induced activity in linear accel-erators for radiation therapy. Phys Med Biol 1991Jun;36(6):815-22.

Boyer AL, Geis P, Grant W, et al. Modulated beamconformal therapy for head and neck tumors. Int JRadiat Oncol Biol Phys 1997 Aug 1;39(1):227-36.

Buchgeister M, Nüsslin F. Startup performance of thetraveling wave versus standing wave linear accel-erator. Med Phys 1998 Apr;25(4):493-5.

Colligan SJ, Mills JA. A philosophical approach totreatment machine maintenance and breakdown.Br J Radiol 1997 Dec;70(840):1274-9.

Dutreix A, Derreumaux S, Chavaudra J, et al. Qualitycontrol of radiotherapy centres in Europe: beamcalibration. Radiother Oncol 1994 Sep;32(3):256-64.

Galvin JM, Han K, Cohen R. A comparison of mul-tileaf-collimator and alloy-block field shaping. Int JRadiat Oncol Biol Phys 1998 Feb 1;40(3):721-31.



Hendee WR, Ibbott GS. Radiation therapy physics. 2nded. 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 electronaccelerators. New York: McGraw-Hill; 1993.

MacklisRM,MeierT,WeinhousMS.Errorrates inclinicalradiotherapy. J Clin Oncol 1998 Feb;16(2):551-6.

Moretti A. Servicing radiation therapy equipment: asuccessful maintenance alternative. Second SourceImaging 1993 Nov;8(11):89-93.

Nath R, Biggs PJ, Bova FJ, et al. AAPM code of practicefor radiotherapy accelerators: report of AAPM Ra-diation Therapy Task Group No. 45. Med Phys 1994Jul;21(7):1093-121.

Palta JR, Yeung DK, Frouhar V. Dosimetric considera-tions for a multileaf collimator system. Med Phys1996 Jul;23(7):1219-24.

Purdy JA, Biggs PJ, Bowers C, et al. Medical accelera-tor safety considerations: report of AAPM RadiationTherapy Committee Task Group No. 35. Med Phys1993 Jul-Aug;20(4):1261-75.

Scharf WH, Chomicki OA. Medical accelerators inradiotherapy: past, present, and future. PhysicaMedica 1996 Oct-Dec;12(4):199-226.

Ting JY, Yankelevich R, Goswami G, et al. Scatteredradiation from linear accelerator and cobalt-60 col-limator jaws. Int J Radiat Oncol Biol Phys 1994 Nov15;30(4):985-92.

U.S. Food and Drug Administration. Center for Devicesand Radiological Health. FDA statement on radia-tion overexposure in Panama. 2001 Jul 6 [cited Jun2001]. Available from internet: http://www.fda.gov/cdrh/ocd/panamaradexp.html.

van der Giessen PH. A comparison of maintenancecosts of cobalt machines and linear accelerators.Radiother Oncol 1991 Jan;20(1):64-5.

van Santvoort, J. Dosimetric evaluation of the Sie-mens Virtual Wedge. Phys Med Biol 1998 Sep;43(9):2651-63.

Standards and guidelines

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

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. MedPhys 1993 Jul-Aug;20(4):1261-75.

Radiation treatment planning dosimetry verifica-tion [report]. Radiation Therapy Committee TaskGroup #23. 1995.

American College of Radiology. Standard for radiationoncology physics for external beam therapy. 1994.

Standards for radiation oncology. 1990 (revised1995).

American National Standards Institute. Guidelinesfor maintaining cobalt-60 and cesium-137teletherapy equipment [standard]. ANSI N449-1974 1974 (R1984). (reaffirmed 1984).

British Standards Institution. Medical electricalequipment. Particular requirements for perform-ance. Methods of declaring functional performancecharacteristics of medical electron accelerators inthe range of 1 MeV to 50 MeV [standard]. BS5724:Part 3: Sect. 3.1. 1990.

Specification for gamma beam therapy equipment[standard]. BS 5724:Section 2.11. 1989.

Specification for medical electron accelerators inthe range 1 MeV to 50 MeV [standard]. BS 5724:Sec-tion 2.1. 1989.

Health Council of the Netherlands. Developments inradiotherapy [technology assessment report]. 1993.

International Commission on Radiation Units andMeasurements. Measurement of dose equivalentsfrom external photon and electron radiations [re-port]. 47. 1992.

International Electrotechnical Commission. Medicalelectrical equipment — medical electron accelera-tors in the range of 1 MeV to 50 MeV: guidelines forfunctional performance characteristics [standard].IEC/TR 60977 (1989-10). 1989.

Medical electrical equipment — part 1: general re-quirements for safety [standard]. IEC 60601-1(1988-12). 1988.



Medical electrical equipment — part 1: general re-quirements for safety. Amendment 1 [standard].IEC 60601-1-am1 (1991-11). 1991.

Medical electrical equipment — part 1: general re-quirements for safety. Amendment 2 [standard].IEC 60601-1-am2 (1995-03). 1995.

Medical electrical equipment — part 1: general re-quirements for safety. Section 2. Collateral standard:electromagnetic compatibility — requirements andtests. IEC 60601-1-2 (2001-09). 2001.

Medical electrical equipment — part 2: particularrequirements for the safety of gamma beam therapyequipment [standard]. IEC 60601-2-11 (1997-08).1997.

Medical electrical equipment — part 2: particular re-quirements for medical electron accelerators in therange 1 MeV to 50 MeV. Section one: general. Sectiontwo: radiation safety for equipment: amendment 2,1990 [standard]. IEC 60601-2-1:1981/Amendment2:1990.

Radiotherapy equipment. Coordinates, movementsand scales. IEC 61217 (1996-08). 1996.

National Council on Radiation Protection and Meas-urements. Dosimetry of x-ray and gamma-ray beamsfor radiation therapy in the energy range 10 keV to50 MeV [recommendation]. 69. 1981.

Medical x-ray, electron beam and gamma-ray pro-tection for energies up to 50 MeV (equipment de-sign, performance and use) [recommendation]. 102.1989.

Neutron contamination from medical electron accel-erators [recommendation]. 79. 1984.

Structural shielding design and evaluation formedical use of x-rays and gamma rays of energiesup to 10 MeV [recommendation]. 49. 1976.

Swedish Council on Technology Assessment in HealthCare. Radiotherapy in cancer treatment [technologyassessment report]. 1996.

United Kingdom Department of Health. Technical re-quirements for the supply and installation of appara-tus for diagnostic imaging and radiotherapy. 1989.

World Health Organization. Quality assurance in ra-diotherapy. 1150282. 1988.

Citations from other ECRI publicationsHealth Devices

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

Minimizing electromagnetic interference betweenmedical devices [User Experience NetworkTM]. 2000Jul-Aug;29(7-8):294.

Electromagnetic interference from linear acceleratorscan affect electronic devices. 2001 Jul;30(7):259-62.

Health Devices Alerts

This Product Comparison lists Health DevicesAlerts (HDA) citations published since the last updateof this report. Each HDA abstract is identified by anAccession Number. Recalls and hazard reports includedescriptions of the problem involved; abstracts of otherpublished articles are referenced by bibliographic in-formation. HPCS subscribers can call the Hotline foradditional information on any of these citations or torequest more extensive searches of the HDA database.

32615 Dawson DJ, Wissing WW, Tonks RE. A door-less entry system for high-energy radiation therapyrooms. Med Phys 1998 Feb;25(2):199-201.

37105 Saw CB, Krishna KV, Enke CA, et al. Dosimet-ric evaluation of abutted fields using asymmetric col-limators for treatment of head and neck. Int J RadiatOncol Biol Phys 2000 Jun 1;47(3):821-4.

37471 Shirato H, Shimizu S, Kitamura K, et al.Four-dimensional treatment planning and fluoro-scopic real-time tumor tracking radiotherapy for mov-ing tumor. Int J Radiat Oncol Biol Phys 2000 Sep1;48(2):435-42.

38731 Low DA, Sohn JW, Klein EE, et al. Charac-terization of a commercial multileaf collimator used forintensity modulated radiation therapy. Med Phys 2001May;28(5):752-6.

39087 Kok JG. Fixed bending current for Elekta SL25linear accelerators. J Med Eng Technol 2001 Jul-Aug;25(4):169-72.

Healthcare Risk Control

Overview of radiation therapy liability. 1996;4:Radi-ology:2.

Supplier information

Advanced Medical

Advanced Medical Systems Inc [148792]121 N Eagle StGeneva OH 44041-1106Phone: (440) 466-8005Fax: (440) 466-8629



Canberra-Packard

Canberra-Packard spol sr o [374969]Sultysova 37CZ-169 00 Praha 6Czech RepublicPhone: 420 (2) 20513765Fax: 420 (2) 20513562E-mail: [email protected]: http://www.cpe.att.cz

Elekta Oncology

Elekta Instruments Asia Ltd [230128]28/Fl Morrison Plaza9 Morrison Hill RoadWanchaiHong Kong SARPeople’s Republic of ChinaPhone: 852 28912208Fax: 852 25757133E-mail: [email protected]: http://www.elekta.com

Elekta Oncology Systems Inc/Elekta InstrumentsInc [344494]3155 Northwoods PkwyNorcross GA 30071-1539Phone: (770) 300-9725, (800) 535-7355Fax: (770) 448-6338E-mail: [email protected]: http://www.elekta.com

Elekta Oncology Systems Ltd [309782]Linac HouseFleming WayCrawley, West Sussex RH10 2RREnglandPhone: 44 (1293) 544422Fax: 44 (1293) 654321E-mail: [email protected]: http://www.elekta.com

INVAP

INVAP SE [237889]F P Moreno 1089Casilla de Correos 9618400 SC de BarilochePcia de Rio NegroArgentinaPhone: 54 (2944) 422121Fax: 54 (2944) 423051E-mail: [email protected]: http://www.invap.com.ar

MDS Nordion

MDS Nordion [321017]447 March RdOttawa ON K2K 1X8CanadaPhone: (613) 592-2790, (800) 465-3666Fax: (613) 591-3705E-mail: [email protected]: http://www.mds.nordion.com

MDS Nordion GmbH [394706]Postbus 500164D-79027 FreiburgGermanyPhone: 49 (761) 455130Fax: 49 (761) 4551310E-mail: [email protected]: http://www.mds.nordion.com

MDS Nordion (Hong Kong) [351565]901 Matheson CentreCauseway BayHong Kong SARPeople’s Republic of ChinaPhone: 852 28278666Fax: 852 28278302E-mail: [email protected]: http://www.mds.nordion.com

MDS Nordion (US) Inc [394250]1195 Park Ave Suite 101Emeryville CA 94608-3655Phone: (510) 652-5810Fax: (510) 652-0109E-mail: [email protected]: http://www.mds.nordion.com

Mitsubishi

Mitsubishi Electric Corp [157965]2-2-3 MarunouchiChiyodu-kuTokyo 100JapanPhone: 81 (3) 32182111Internet: http://www.mitsubishielectric.com

Mitsubishi Electronics America IncMedical Systems Div [346060]3121 Rt 22 E Suite 304Somerville NJ 08876Phone: (908) 252-1312, (800) 366-0254Fax: (908) 252-1590



Scanditronix Medical

Scanditronix SA [183979]107 route du Nant d’AvrilCH-1217 Meyrin-GeneveSwitzerlandPhone: 41 (22) 7820055Fax: 41 (22) 7820215Internet: http://www.scanditronix.com

Siemens

Siemens AG Medizinische Technik [138334]Henkestrasse 127Postfach 3260D-91050 ErlangenGermanyPhone: 49 (9131) 847299Fax: 49 (9131) 844189E-mail: [email protected]: http://www.siemens.de/med

Siemens Medical Solutions USA IncOncology Care Systems Group [399203]4040 Nelson AveConcord CA 94520-1200Phone: (925) 246-8200, (800) 318-5602Fax: (925) 602-8066E-mail: [email protected]: http://www.sms.siemens.com/ocsg

Varian

Varian Medical Systems IncOncology Systems [363156]3100 Hansen WayPalo Alto CA 94304-1129Phone: (650) 493-4000, (800) 544-4636Fax: (650) 493-5637Internet: http://www.varian.com

Varian Medical Systems International AG[363212]Chollerstrasse 38PostfachCH-6303 ZugSwitzerlandPhone: 41 (41) 7498844Fax: 41 (41) 7403340E-mail: [email protected]: http://www.os.varian.com

Varian TEM Ltd [324840]Gatwick RoadCrawley, West Sussex RH10 2RGEnglandPhone: 44 (1293) 531244Fax: 44 (1293) 510260E-mail: [email protected]: http://www.varian.com

Note: The following company did not provide us withany product information in time for publication. Itsaddress is listed as a service to our readers.

Guangdong WeidaMedical Apparatus Group Corp [156992]510095 GuangdongJiexi ProvincePeople’s Republic of ChinaPhone: 86 (20) 87320898Fax: 86 (20) 87320828E-mail: [email protected]: http://www.weida.com.cn

About the chart specificationsThe following terms are used in the chart:

Accelerator type: The two basic types of acceleratorconfigurations are traveling wave and standingwave. Standing-wave accelerator guides can bemade shorter than traveling-wave tubes withoutaffecting the level of energy delivered but are morecomplex and thus more expensive.

Microwave power: Either a magnetron or a klystronprovides the RF power necessary to accelerate theelectrons in the accelerator guide.

Beam bending, deg: The degree of bend for the electronbeam exiting the accelerator guide when the guideis mounted horizontally in the gantry.

Gantry, SAD, cm: The source-to-axis distance; the dis-tance in centimeters from the source of the radiationto the point in space about which the gantry rotates.

Arc therapy: Indicates whether the radiotherapy unitcan provide treatment (x-ray and/or electron) as thegantry rotates about the patient.

List price: Some of the pricing information in this charthas been derived from ECRI’s in-house informationresources. A footnote identifies these prices. Inthese instances, suppliers have declined to provideus with prices and may not have confirmed theinformation. These prices are estimates and may ormay not reflect discounts, options, special packages,and multiple-unit sales. They are provided for theconvenience of our readers.



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 RadiologicalProtection

ICRU — International Commission on RadiationUnits and Measurements

IEC — International Electrotechnical Commission

IMRT — Intensity-modulated radiation therapy

ISO — International Organization for Standardiza-tion

MDD — Medical Devices Directive

MLC — Multileaf collimator

MU/min — Monitor units/minute, which is a meas-ure of absorbed radiation dose; 1 MU = approxi-mately 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 suppli-ers’ specifications and have not been verified throughindependent testing by ECRI or any other agency.Because test methods vary, different products’ specifi-cations are not always comparable. Moreover, prod-ucts and specifications are subject to frequent changes.ECRI is not responsible for the quality or validity ofthe information presented or for any adverse conse-quences of acting on such information.

When reading the charts, keep in mind that, unlessotherwise noted, the list price does not reflect supplierdiscounts. And although we try to indicate whichfeatures and characteristics are standard and whichare not, some may be optional, at additional cost.

For those models whose prices were supplied to usin currencies other than U.S. dollars, we have alsolisted the conversion to U.S. dollars to facilitate com-parison among models. However, keep in mind thatexchange 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); [email protected] (e-mail).



Product Comparison Chart

MODEL ADVANCED MEDICAL ADVANCED MEDICAL CANBERRA-PACKARD CANBERRA-PACKARD

ATC C-9 ATC V-9 TERAGAM K01 TERAGAM K02

WHERE MARKETED Worldwide Worldwide, except Worldwide WorldwideJapan

FDA CLEARANCE Yes Yes Submitted Submitted

CE MARK (MDD) Not specified Not specified Submitted Submitted

TYPE Cobalt radiotherapy Cobalt radiotherapy Cobalt radiotherapy Cobalt radiotherapy

PHOTON ENERGY, MV 1.33 1.33 1.25 1.25

ELECTRON ENERGY, MeV NA NA NA NA

ACCELERATOR TYPE NA NA NA NALength, m NA NA NA NA

MICROWAVE POWERSource NA NA NA NAPower, MW NA NA NA NA

BEAM BENDING, deg NA NA NA NA

GANTRYRotation range, deg 360 (continuous) NA ±280 ±280SAD, cm 80 NA 80 100

TREATMENT UNITL x W x H, cm (in) 230 x 91.4 x 239 205 x 71 x 254 288 x 102 x 230 288 x 102 x 270

(91 x 36 x 94) (81 x 28 x 100) (113.4 x 40.2 x (113.4 x 40.2 x90.6) 106.2)

Weight, kg (lb) 3,606 (7,950) 3,175 (7,000) ~5,900 (13,000) ~6,200 (13,670)

COLLIMATIONRotation range, deg ±180 ±180 ±180 ±180Field size range

at SAD, cmX-ray 35 x 35 35 x 35 36 x 36 45 x 45Electron NA NA NA NA

MultileafNo. of leaves NA NA NA NA

Special features None specified None specified Asymmetric jaws Asymmetric jaws

Colons separate data on similar models of a device. This is the first ofthree pages coveringthe above model(s).These specificationscontinue onto thenext two pages.






MAXIMUM OUTPUTat SAD, rad/min

X-ray 234 234 ~320 cGy/min ~200 cGy/min

Electron NA NA NA NA

TREATMENT COUCHL x W, cm (in) 213 x 43 (84 x 17) Not included * 216 x 50 (85 x 19.7) 216 x 50 (85 x 19.7)

Movement, cm (in)Vertical range 37.5 (14.8), travel Not specified 55-176 (21.7-69.3) 55-176 (21.7-69.3)

Longitudinal range 96 (37.8), travel Not specified 0-149 (0-58.7) 0-149 (0-58.7)

Lateral range ±14.6 (±5.7) Not specified ±25 (±9.8) ±25 (±9.8)

Base rotation, deg ±90 Not specified ±110 ±110

Maximum patientweight, kg (lb) 135 (298) Not specified 250 (550) 250 (550)

Special features None specified None specified Motorized motions, Motorized motions,manual table manual tablerotation rotation

ARC THERAPYX-ray Yes No Yes YesElectron NA NA NA NA

RECOMMENDED MINIMUMROOM SIZE

L x W x H, m (ft) 4.2 x 4.4 x 2.7 4.3 x 4.6 x 2.7 5.8 x 5.6 x 3 5.8 x 5.6 x 3(13.7 x 14.5 x 9) (14 x 15 x 9) (19 x 18.4 x 9.8) (19 x 18.4 x 9.8)

POWER REQUIREMENTSLine voltage, VAC 120/240, 50/60 Hz 120/240, 50/60 Hz 220, 50 Hz, single 220, 50 Hz, single

phase phase

kVA (beam-on) 1.2 1.2 2 maximum 2 maximum

LIST PRICE Not specified Not specified $350,000 $400,000

FISCAL YEAR October to September October to September Not specified Not specified

Colons separate data on similar models of a device. This is the second of* Treatment couch is available at an additional cost. three pages covering

the above model(s).These specificationscontinue onto thenext page.






OPTIONAL ACCESSORIES Optical backpointer, Trimmer bars, pin Laser alignment Laser alignmentbeam-shaping rails, and arc beam- system, laser back- system, laser back-tangential breast directing device, pointer, radiation pointer, radiationdevice, armrest, wall and ceiling room monitor, room monitor,adjustable headrest, alignment lasers, wedges (15, 30, 45, wedges (15, 30, 45,patient-monitoring tangential breast 60 W), block tray 60 W), block trayTV system, trimmer device, patient- with plates, set of with plates, set ofbars, knee crutch monitoring TV 8 blocks, TERABASE 8 blocks, TERABASEset, tabletop with system, motorized or verification system verification systemcenter opening, manual collimator,motorized or manual mechanical front-collimator, machine and backpointers,counterweight or attachment post,radiation beam combination wedgeinterceptors, compensator andoblique incidence block tray with 11compensators for 60 wedgesor 80 cm, combina-tion wedge compen-sator and a blocktray w/11 wedges,floor scale fortable, accessoryattachment post,pin and arc beam-directing device,isocentric alignmentpaddle, 30, 60, and90 deg wedges

OTHER SPECIFICATIONS Surface-mounted unit Surface-mounted unit Head is integral Head is integralwith detachable with wall-/floor- part of B(U)- part of B(U)-float-top table, mounted stand and certified transport certified transporttriaxial source arm, remote-control container; designed container; designedhead, continuous console with key to accept 15-21 mm to accept 15-21 mm360 deg clockwise or lock, fail-safe source w/activities source w/activitiescounterclockwise source drive, and up to 450 TBq, up to 450 TBq,rotation; C-arm biplane source head including those from including those fromrotation speed of with automatic MDS Nordion MDS Nordion40-399 deg/min; centering. (Canada), CIS bio (Canada), CIS biorotation and Meets requirements International Internationaldirection are of AECB, DOT, IAEA, (France), MAJAK (France), MAJAKcontrolled from and NRC. (Russia), and (Russia), andpendant or remote AMERSHAM Interna- AMERSHAM Interna-master control; tional (UK). Unit tional (UK). Unitfail-safe source complies with FDA complies with FDAdrive. Meets CFR 21; IAEA CFR 21; IAEArequirements Safety Series No. Safety Series No.of AECB, DOT, IAEA, 115; IEC 60601-1 and 115; IEC 60601-1 andand NRC. 60601-2-11; ICRU 60601-2-11; ICRU

Rep. 15, 18 and 102; Rep. 15, 18 and 102;and ISO-1677, gener- and ISO-1677, gener-al and leakage test al and leakage testmethods for sealed methods for sealedradioactive source. radioactive source.

Colons separate data on similar models of a device.




MODEL ELEKTA ONCOLOGY INVAP MDS NORDION * MDS NORDION *

Precise TERADI 800 Phoenix Theratron 780E

WHERE MARKETED Worldwide Worldwide Worldwide Worldwide

FDA CLEARANCE Yes Not specified Yes Yes

CE MARK (MDD) Yes Not specified No Yes

TYPE Linear accelerator Cobalt radiotherapy Cobalt radiotherapy Cobalt radiotherapy

PHOTON ENERGY, MV 4, 6, 8, 10, 12, 15, 1.17 1.33, 1.17 1.33, 1.1718, 25 (select 1 to3 energies)

ELECTRON ENERGY, MeV 4, 6, 8, 9, 10, 12, NA NA NA15, 18, 20, 22(select 3 to 9energies)

ACCELERATOR TYPE Traveling wave NA NA NALength, m 2.5 NA NA NA

MICROWAVE POWERSource Magnetron NA NA NAPower, MW 5 NA NA NA

BEAM BENDING, deg 45; 45; 112.5 slalom NA NA NAachromatic

GANTRYRotation range, deg 365 360 (continuous) 360+ (continuous) 360+ (continuous)SAD, cm 100 80 80 80

TREATMENT UNITL x W x H, cm (in) 351 x 390 x 248 228 x 140 x 310 225 x 225 x 299 299 x 225 x 235

(138 x 154 x 98) (90 x 55 x 122) (88.6 x 88.6 x (117.7 x 88.6 x117.7) 92.5)

Weight, kg (lb) 6,200 (13,668) 5,500 (12,128) 6,033 (13,300) 6,125 (13,500)

COLLIMATIONRotation range, deg 365 ±110 360 360Field size range

at SAD, cmX-ray 40 x 40 35 x 35 35 x 35 35 x 35Electron 25 x 25 NA NA NA

MultileafNo. of leaves 40 pairs Not specified Not specified Not specified

Special features Independent Collimator closes None specified None specifiedasymmetric jaws, automatically when12.5 cm overtravel source transit timefor upper set is longer than

normal

Colons separate data on similar models of a device. This is the first of* Formerly Theratronics. three pages covering

the above model(s).These specificationscontinue onto thenext two pages.







X-ray 600 312 (at 80 cm from 314 (at 80 cm from 360 (at 80 cm fromcobalt source) cobalt source) cobalt source)

Electron 400 NA NA NA

TREATMENT COUCHL x W, cm (in) 230 x 50 245 x 45 235 x 46 235 x 46

(90 x 20) (96.5 x 18) (93 x 18) (93 x 18)

Movement, cm (in)Vertical range 65-175 (22.6-68.9) 80-125 (31.5-49.2) 78-117 (30.7 x 46.1) 78-117 (30.7 x 46.1)

Longitudinal range 100 (39.4) 80 (31.5) See footnote ** See footnote **

Lateral range ±25 (±9.8) ±10 (±4) 40.6 (16) 40.6 (16)

Base rotation, deg ±95; column ±145 220 220rotation, ±180

Maximum patientweight, kg (lb) 200 (440) 140 (309) 136 (300) 136 (300)

Special features Uninterruptible Optional motorized None specified None specifiedpower supply on movementdown drive, optionalC-arm tabletop,carbon-fiber tennisracquet, variablespeed controls,rotatable couchtopenabling SRS andphysics measurements

ARC THERAPYX-ray Yes Yes Yes YesElectron Yes NA NA NA


L x W x H, m (ft) 6.5 x 6 x 3.2 5.5 x 8 5.5 x 8.4 x 3.1 5.5 x 8.4 x 3.1(21.3 x 19.7 x 10.5) (18 x 26.4) (18 x 27.6 x 10) (18 x 27.6 x 10)

POWER REQUIREMENTSLine voltage, VAC 220/415, 3-phase 110/220, 50/60 Hz 115/230, 50/60 Hz 115/230, 50/60 Hz

kVA (beam-on) 30 maximum 1.5 1.5 1.5

LIST PRICE Not specified Not specified Not specified Not specified

FISCAL YEAR Not specified February to January November to October November to October

Colons separate data on similar models of a device. This is the second of* Formerly Theratronics. three pages covering** 79 cm (31") beam stopper and 75 cm (29.5") pendulum. the above model(s).

These specificationscontinue onto thenext page.






OPTIONAL ACCESSORIES Fully integrated Complete set of Diode-laser align- Diode-laser align-MLC, electronic wedges, shaping ment system, full ment system, fullportal imaging, blocks, general range of wedges, range of wedges,stereotactic treatment, trimmers beam-shaping blocks, interlocks, beam-radiosurgery system, at 55 cm and 65 cm, collimator shaping blocks,treatment recording, backpointer, front- extensions, collimatorelectron pointer tangential breast extensions,applicators, device, immobiliza- immobilizationnetworking, remote tion accessories accessories withdiagnostics and with table clamps, table clamps, roomsupport, linear room monitors monitorsaccelerator QAtools, immobiliza-tion devices

OTHER SPECIFICATIONS Graphical user in- Computerized Manual table motions Motorized tableterface; integrated control; automatic and motorized gantry motions; head swivelverification; auto setting of angular rotation; head ±180°wedge (0-60 deg); velocity for swivel ±180° from isocenterSliC Beam Control; kinetics treatment. from isocenter; (2-speed control);open-architecture hand control mounted ergonomic handconnectivity; on overhead support control mountedstandard therapy arm. Manufactured on overhead supportmode for urgent to ISO 9001 arm; dual timer.treatments; assisted standards. Meets Manufactured toautomatic setup; requirements of ISO 9001 standards.designed for dynamic ICRP #15 and NRC. Meets requirementstherapy; upper and of ICRP #15,lower independent IEC 60601-1 andcollimators; 60601-2-11, and NRC.desktop patient-management system;remote service;clockwise andcounterclockwisearc therapy; low(124 cm) isocenter;high-stabilitydrum gantry design. **

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.




MODEL MDS NORDION * MDS NORDION * MDS NORDION * MITSUBISHIFAILED TO RESPOND **

Theratron 1000E Theratron Elite 80 Theratron Elite 100 EXL-12DP

WHERE MARKETED Worldwide Worldwide Worldwide Asia, North America,South America

FDA CLEARANCE Yes Yes Yes Yes

CE MARK (MDD) Yes Yes Yes No

TYPE Cobalt radiotherapy Cobalt radiotherapy Cobalt radiotherapy Linear accelerator

PHOTON ENERGY, MV 1.33, 1.17 1.33, 1.17 1.33, 1.17 4, 10; 6, 10

ELECTRON ENERGY, MeV NA NA NA 4, 6, 8, 10, 12

ACCELERATOR TYPE NA NA NA Standing waveLength, m NA NA NA 0.9

MICROWAVE POWERSource NA NA NA MagnetronPower, MW NA NA NA 3.1

BEAM BENDING, deg NA NA NA 270 (achromatic)

GANTRYRotation range, deg 360+ (continuous) 360+ (continuous) 360+ (continuous) ±195SAD, cm 100 80 100 100


(117.7 x 103.1 x (117.7 x 88.6 x (117.7 x 103.1 x (116 x 53 x 101)112.2) 92.5) 112.2)

Weight, kg (lb) 6,600 (14,500) 6,125 (13,500) 6,600 (14,500) 6,690 (14,750)

COLLIMATIONRotation range, deg 360 360 360 290Field size range

at SAD, cmX-ray 43 x 43 35 x 35 43 x 43 40 x 40 (clipped)Electron NA NA NA 25 x 25

MultileafNo. of leaves Not specified Not specified Not specified 62/120

Special features None specified None specified None specified 4 independent jaws,dynamic wedge,interface to R & V,RTP

Colons separate data on similar models of a device. This is the first of* Formerly Theratronics. three pages covering** Specifications current as of September 2000. the above model(s).

These specificationscontinue onto thenext two pages.







X-ray 250 (at 100 cm from 360 (at 80 cm from 250 (at 100 cm from 300 for 6 MV;cobalt source) cobalt source) cobalt source) 500 for 10 MV

Electron NA NA NA 1,000


(93 x 18) (93 x 18) (93 x 18) (83 x 23.6)

Movement, cm (in)Vertical range 87-133 (34-52) 78-117 (31-46) 87-133 (34-52) 40-170 (15.8-66.9)

Longitudinal range See footnote *** 79 (31) 79 (31) 90 (35.4)

Lateral range 40.6 (16) 40.6 (16) 40.6 (16) 50 (19.7)

Base rotation, deg 220 220 220 ±190


Special features None specified None specified None specified None specified

ARC THERAPYX-ray Yes Yes Yes YesElectron NA NA NA Yes


L x W x H, m (ft) 5.5 x 8.4 x 3.1 5.5 x 8.4 x 3.1 5.5 x 8.4 x 3.1 6 x 5.1 x 3(18 x 27.6 x 10) (18 x 27.6 x 10) (18 x 27.6 x 10) (19.7 x 16.7 x 9.8)

POWER REQUIREMENTSLine voltage, VAC 115/230, 50/60 Hz 115/230, 50/60 Hz 115/230, 50/60 Hz 208, 3-phase

kVA (beam-on) 1.5 1.5 1.5 30

LIST PRICE Not specified Not specified Not specified $761,000

FISCAL YEAR November to October November to October November to October January to December

Colons separate data on similar models of a device. This is the second of* Formerly Theratronics. three pages covering** Specifications current as of September 2000. the above model(s).*** 79 cm (31") beam stopper and 75 cm (29.5") pendulum. These specifications

continue onto thenext page.






OPTIONAL ACCESSORIES Diode-laser align- Diode-laser align- Diode-laser align- Laser alignmentment system, full ment system, full ment system, full system, laser back-range of wedges, range of wedges, range of wedges, pointer, retractableinterlocks, beam- interlocks, beam- interlocks, beam- beam shield, asym-shaping blocks, shaping blocks, shaping blocks, metric collimator,collimator exten- collimator collimator exten- CCTV system, RAMsions, collimator extensions, sions, collimator pedestal couch,tray adapters allow immobilization tray adapters allow portal imaginguse of linear accessories with use of linear system, externalaccelerator table clamps, room accelerator computer system,shielding, immobili- monitors shielding, immobili- high-resolutionzation accessories zation accessories color display inwith table clamps, with table clamps, roomroom monitors room monitors

OTHER SPECIFICATIONS Motorized table Computerized console Computerized console Automatic parametermotions; head swivel with R & V with R & V setting function;±180° communication communication laptop stylefrom isocenter capabilities; head capabilities; head computer console;(2-speed control); swivel ±180° swivel ±180° R & V function;dual ergonomic hand from isocenter from isocenter extended-controls (unit and (2-speed control); (2-speed control); travel-range couch;table) mounted ergonomic hand dual ergonomic hand beam symmetry inter-on overhead support control mounted on control mounted on lock; energy inter-arm; dual timer. overhead support overhead support lock; sealed ionManufactured to arm; dual timer. arm; dual timer. chamber; compactISO 9001 standards. Manufactured to Manufactured to standing-waveMeets requirements ISO 9001 standards. ISO 9001 standards. accelerator design.of ICRP #15, Meets requirements Meets requirements Meets requirementsIEC 60601-1 and of ICRP #15, of ICRP #15, of ISO 9000.60601-2-11, and NRC. IEC 60601-1 and IEC 60601-1 and

60601-2-11, and NRC. 60601-2-11, and NRC.

Colons separate data on similar models of a device.* Formerly Theratronics.** Specifications current as of September 2000.




MODEL MITSUBISHI MITSUBISHI MITSUBISHI SCANDITRONIX MEDICALFAILED TO RESPOND * FAILED TO RESPOND * FAILED TO RESPOND * FAILED TO RESPOND *EXL-12SP EXL-15DP EXL-20DP UR 2X-3D RT

WHERE MARKETED Asia, North America, Asia, North America, Asia, North America, Not specifiedSouth America South America South America

FDA CLEARANCE Yes Yes Yes Not specified

CE MARK (MDD) No No Not specified Not specified

TYPE Linear accelerator Linear accelerator Linear accelerator Linear accelerator

PHOTON ENERGY, MV 4; 6 4, 10; 4, 15; 4, 10; 4, 15; 4, 18; 76, 10; 6, 15 6, 10; 6, 15; 6, 18

ELECTRON ENERGY, MeV 4, 6, 8, 10, 12 4, 6, 9, 12, 15 6, 9, 12, 15, 20 Not specified

ACCELERATOR TYPE Standing wave Standing wave Standing wave Standing waveLength, m 0.9 1.5 1.8 0.8

MICROWAVE POWERSource Magnetron Klystron Klystron MagnetronPower, MW 3.1 7 7 2

BEAM BENDING, deg 270 (achromatic) 270 (achromatic) 270 (achromatic) Not specified

GANTRYRotation range, deg ±195 ±195 ±195 360SAD, cm 100 100 100 40


(116 x 53 x 101) (131 x 53 x 101) (131 x 53 x 101) (142 x 47 x 79)

Weight, kg (lb) 6,690 (14,750) 7,038 (15,515) 7,038 (15,515) 1,600 (3,527)

COLLIMATIONRotation range, deg 290 290 290 0Field size range

at SAD, cmX-ray 40 x 40 (clipped) 40 x 40 (clipped) 40 x 40 (clipped) 0.4-12 (cm

2)

Electron 25 x 25 25 x 25 25 x 25 66Multileaf

No. of leaves 62/120 62/120 62/120 Not specified

Special features 4 independent jaws, 4 independent jaws, 4 independent jaws, None specifieddynamic wedge, dynamic wedge, dynamic wedge,interface to R & V, interface to R & V, interface to R & V,RTP RTP RTP

Colons separate data on similar models of a device. This is the first of* Specifications current as of September 2000. three pages covering

the above model(s).These specificationscontinue onto thenext two pages.






X-ray 300 300 for 6 MV; 300 for 6 MV; 400500 for 10 MV and 500 for 10 MV,15 MV 15 MV, and 18 MV

Electron 1,000 1,000 1,000 Not specified


(83 x 23.6) (83 x 23.6) (83 x 23.6) (66.9 x 19.7)

Movement, cm (in)Vertical range 40-170 (15.8-66.9) 40-170 (15.8-66.9) 40-170 (15.8-66.9) 20-40 (7.9-15.7)

Longitudinal range 90 (35.4) 90 (35.4) 90 (35.4) 35 (13.8)

Lateral range 50 (19.7) 50 (19.7) 50 (19.7) 20 (7.9)

Base rotation, deg ±190 ±190 ±190 Fixed


Special features None specified None specified None specified Standard adaptersfor stereotacticframes

ARC THERAPYX-ray Yes Yes Yes YesElectron Yes Yes Yes Not specified


L x W x H, m (ft) 6 x 5.1 x 3 6 x 5.1 x 3 6 x 5.1 x 3 7 x 6 x 3(19.7 x 16.7 x 9.8) (19.7 x 16.7 x 9.8) (19.7 x 16.7 x 9.8) (23 x 19.7 x 9.8)

POWER REQUIREMENTSLine voltage, VAC 208, 3-phase 208, 3-phase 208, 3-phase 400

kVA (beam-on) 30 40 40 35

LIST PRICE $655,000 $933,900 $1,065,900 $2,000,000-2,500,000

FISCAL YEAR January to December January to December January to December Not specified

Colons separate data on similar models of a device. This is the second of* Specifications current as of September 2000. three pages covering






OPTIONAL ACCESSORIES Laser alignment Laser alignment Laser alignment None specifiedsystem, laser back- system, laser back- system, laser back-pointer, retractable pointer, retractable pointer, retractablebeam shield, asym- beam shield, asym- beam shield, asym-metric collimator, metric collimator, metric collimator,CCTV system, RAM CCTV system, RAM CCTV system, RAMpedestal couch, pedestal couch, pedestal couch,portal imaging portal imaging portal imagingsystem, external system, external system, externalcomputer system, computer system, computer system,high-resolution high-resolution high-resolutioncolor display in color display in color display intreatment room treatment room treatment room

OTHER SPECIFICATIONS Automatic parameter- Automatic parameter- Automatic parameter- Integrated controlsetting function; setting function; setting function; system; multileaflaptop-style laptop-style laptop-style collimator forcomputer console; computer console; computer console; dynamic conforma-record-and-verify record-and-verify record-and-verify tional multiarcfunction; extended- function; extended- function; extended- therapy; integratedtravel-range couch; travel-range couch; travel-range couch; CT imaging systembeam symmetry inter- beam symmetry inter- beam symmetry inter- and associatedlock; energy interlock; energy interlock; energy inter- software for directlock; sealed ion lock; sealed ion lock; sealed ion patient positioningchamber; compact chamber; compact chamber; compact or positionstanding-wave standing-wave standing-wave verification; 3-Daccelerator design. accelerator design; accelerator design. treatment.Meets requirements 3rd photon beam. 3rd photon beam.of ISO 9000. Meets requirements Meets requirements

of ISO 9000. of ISO 9000.

Colons separate data on similar models of a device.* Specifications current as of September 2000.




MODEL SIEMENS SIEMENS VARIAN VARIAN

PRIMUS High Energy PRIMUS Mid Energy Clinac 21EX Clinac 23EX



CE MARK (MDD) Yes Yes Yes Yes


PHOTON ENERGY, MV From 4 to 23 4 to 15 From 4, 10; 6, 10; From 6, 16; 6, 23;(2 energies) (2 energies) 6, 16; 6, 23; 8, 16; 6, 25 (2 energies)

8, 23 (2 energies) per BJR 17per BJR 17

ELECTRON ENERGY, MeV From 6 to 21 (up to From 5 to 14 (1 to 6 4 to 20 4 to 22 (6 energies)6 energies) energies) depending (5 energies)

on photon selection

ACCELERATOR TYPE Standing wave Standing wave Standing wave Standing waveLength, m Not specified Not specified 1.3 1.3

MICROWAVE POWERSource Klystron Magnetron Klystron KlystronPower, MW 7.5 2.6 5.5 5.5

BEAM BENDING, deg 270 (achromatic) 270 (achromatic) 270 270

GANTRYRotation range, deg 370 370 ±185 ±185SAD, cm 100 100 100 100

TREATMENT UNITL x W x H, cm (in) 308.6 x 143.3 x 283.9 x 130.8 x 259 x 124 x 371 259 x 124 x 371

260.4 (121.5 x 56.4 264.4 (111.8 x 51.5 (102 x 48.8 x 146.1) (102 x 48.8 x 146.1)102.5) x 104.1)

Weight, kg (lb) 7,730 (17,000) 7,030 (15,501) * 9,660 (21,300) 9,660 (21,300)

COLLIMATIONRotation range, deg 360 360 ±165 ±165Field size range

at SAD, cmX-ray 40 x 40 40 x 40 40 x 40 40 x 40Electron 40 x 40 40 x 40 25 x 25 25 x 25

MultileafNo. of leaves See footnote ** See footnote ** Optional 52, 80, or Optional 52, 80, or

120 120Special features Jaw design allows Jaw design allows Dynamic MLC for IMRT Dynamic MLC for IMRT

for tracing diver- for tracing diver- available with MLC available with MLCgent beams, even in gent beams, even in option, MLC moves option; MLC movesovertravel; optional overtravel; optional as a function both as a function bothMLC, Virtual Wedge; MLC, Virtual Wedge; of dose-delivered of dose-deliveredHD 270 MLC option HD 270 MLC option (Dose Dynamic) and (Dose Dynamic) and(virtually increases (virtually increases of gantry arc angle of gantry arc anglenumber of leaves to number of leaves to (Arc Dynamic), com- (Arc Dynamic); com-108, 162, or 220) 108, 162, or 220) patible w/forward & patible w/forward &

inverse treatment inverse treatmentplanning systems planning systems

Colons separate data on similar models of a device. This is the first of* Weight includes accelerator and moderator. three pages covering** 27 @ 1 cm, 2 @ 6.5 cm (measured at isocenter, per side). the above model(s).

These specificationscontinue onto thenext two pages.







X-ray See footnote * 200-300, depends on 250 for 4 MV, 600 600energy selected; for 6-23 MV50 low-dose mode

Electron 300/900 300/900 1,000 1,000


(96.5 x 19.7) (96.5 x 19.7) (93 x 20.9), (93 x 20.9),Exact couch Exact couch

Movement, cm (in)Vertical range 65-175 (25.6-68.9) 65-175 (25.6-68.9) 62.7-169.7 62.7-169.7

(24.7-66.8) (24.7-66.8)Longitudinal range 90 (35.4) 90 (35.4) 93.5-288.5 93.5-288.5

(36.8-113.6) (36.8-113.6)with extension; with extension;93.5-264.9 93.5-264.9(36.8-104.3) (36.8-104.3)without extension without extension

Lateral range ±25 (±9.8) ±25 (±9.8) ±25 (±9.8) ±25 (±9.8)

Base rotation, deg ±180 column, ±180 column, ±95 ±95±120 isocentric ±120 isocentric


Special features Couch has 3 points Couch has 3 points Exact couch Exact couchof table rotation of table rotation designed to designed to

facilitate transfer facilitate transferfrom simulation to from simulation totreatment; treatment;dual pendants; dual pendants;Lok-bar technology; Lok-bar technology;optional indexing optional indexingaccessories; Mylar accessories; Mylarcovers and removable covers and removablerails; movable rails; movablesupport rails and support rails andUnipanel avoid Unipanel avoidcouchtop pivot couchtop pivot

ARC THERAPYX-ray Yes Yes Yes YesElectron Optional Optional Yes Yes


L x W x H, m (ft) 6.1 x 5.8 x 3 6.1 x 5.8 x 3 6.1 x 7.1 x 3.1 6.1 x 7.1 x 3.1(20 x 19.6 x 9.8) (20 x 19.6 x 9.8) (20 x 23.6 x 10) (20 x 23.6 x 10)

POWER REQUIREMENTSLine voltage, VAC 208, see Other Specs 208, see Other Specs 208 208

kVA (beam-on) 45 45 45 45

LIST PRICE Not specified Not specified ~$1,637,000 ~$1,848,000

FISCAL YEAR October to September October to September October to September October to September

Colons separate data on similar models of a device. This is the second of* 200-300 standard, 300-500 optional, depends on energy selected; 50, low-dose mode. three pages covering







OPTIONAL ACCESSORIES SIMTEC option for SIMTEC option for PortalVision, VARiS PortalVision, VARiSautomatic delivery automatic delivery radiotherapy manage- radiotherapy manage-of a sequence of of a sequence of ment system, laser ment system, laserfields; 3-D MLC fields; 3-D MLC alignment system, alignment system,40 x 40 cm field 40 x 40 cm field laser backpointer, laser backpointer,size providing 30 cm size providing 30 cm CCTV system, CCTV system,travel of leaves travel of leaves intercom system, intercom system,integrated with integrated with retractable beam retractable beamLANTIS, Virtual LANTIS, Virtual stopper, BrainLAB stopper, Dynamic MLCWedge, BEAMVIEW, Wedge, BEAMVIEW, micro multilevel for automatedPRIMEVIEW for PRIMEVIEW for monitor, Dynamic MLC delivery of IMRT,graphic representa- graphic representa- for automated Varian Millenniumtion of treatment tion of treatment delivery of IMRT, technology for beamparameters with parameters with Varian Millennium matching to EX Goldadvanced setup of advanced setup of technology for beam Standard data set,parameters, 2 sec parameters, 2 sec matching to EX Gold data set includedQuick startup for Quick startup for Standard data set, for faster machineRAD ON, remote table RAD ON, remote table data set included commissioning,control, HD 270 MLC, control, HD 270 MLC, for faster machine flat-panel monitor,Total Body Total Body commissioning, gating interfaceIrradiation Control Irradiation Control flat-panel monitor, board, respirator(TBIC), IMFAST (TBIC), IMFAST gating interface gating and interface(optimizes (optimizes board, respirator for simulation,beam-fluence beam-fluence gating and interface CT simulation anddistributions and distributions and for simulation, treatmentreduced treatment reduced treatment CT simulation andtime for IMRT) time for IMRT) treatment

OTHER SPECIFICATIONS Solid-state Provides maximum Enhanced Dynamic Enhanced Dynamictechnology used for clearance of 43 cm Wedge; Automatic Wedge; Automaticmodulators; (16.9 in) from Field Sequencing Field Sequencingintegrated klystron bottom of accessory for automated for automatedfor compact design; holder to isocenter; delivery of multiple delivery of multiplelow noise levels; monitored by 126 Clinac fields; Clinac fields;provides maximum active check points dual independent dual independentclearance of 43 cm and >900 HW/SW collimators; remote collimators; remote(16.9 in) from checks before and diagnostics; diagnostics;bottom of accessory after radiation extended collimator extended collimatorholder to isocenter; delivery; supplied rotation; optional rotation; optional>900 HW/SW inter- with power Silhouette edition Silhouette editionlock checks before conditioner/stepdown with minimum floor with minimum floorand after radiation transformer space dimensions space dimensionsdelivery; supplied requiring 480 VAC, of 4.9 x 5.8 m of 4.9 x 5.8 mwith power 3-phase WYE @ ±5% (16 x 19 ft). (16 x 19 ft).conditioner/stepdown input with neutral Meets requirements Meets requirementstransformer ground; 208 VAC of EN 46001, of EN 46001,requiring 480 VAC, input after ETL, and ISO 9001. ETL, and ISO 9001.3-phase WYE @ ±5% conditioner; 10-yearinput with neutral prorated warranty onground; 208 VAC waveguide.input afterconditioner; 10-yearprorated warranty onwaveguide.





MODEL VARIAN VARIAN VARIAN VARIAN

Clinac 2100C Clinac 2100C/D Clinac 2300C/D Clinac 600C



CE MARK (MDD) Yes Yes Yes Yes


PHOTON ENERGY, MV From 4, 10; 6, 10; From 4, 10; 6, 10; From 6, 16; 6, 23; 4 or 6, per BJR 176, 16; 6, 23; 8, 16; 6, 16; 6, 23; 8, 16; 6, 25 (2 energies)8, 23 (2 energies) 8, 23 (2 energies) per BJR 17per BJR 17 per BJR 17

ELECTRON ENERGY, MeV 4 to 20 4 to 20 4 to 22 NA(5 energies) (5 energies) (6 energies)

ACCELERATOR TYPE Standing wave Standing wave Standing wave Standing waveLength, m 1.3 1.3 1.3 0.3

MICROWAVE POWERSource Klystron Klystron Klystron MagnetronPower, MW 5.5 5.5 5.5 2.5

BEAM BENDING, deg 270 270 270 0

GANTRYRotation range, deg ±185 ±185 ±185 ±180SAD, cm 100 100 100 100


(102 x 48.8 x 146.1) (102 x 48.8 x 146.1) (102 x 48.8 x 146.1) (107 x 50 x 106)

Weight, kg (lb) 9,660 (21,300) 9,660 (21,300) 9,660 (21,300) 6,668 (14,700)

COLLIMATIONRotation range, deg ±95; ±165 option ±165 ±165 ±95; ±165 optionField size range

at SAD, cmX-ray 40 x 40 40 x 40 40 x 40 40 x 40Electron 25 x 25 25 x 25 25 x 25 NA

MultileafNo. of leaves Optional 52, 80, or Optional 52, 80, or Optional 52, 80, or Optional 52, 80, or

120 120 120 120Special features Dynamic MLC for IMRT Dynamic MLC for IMRT Dynamic MLC for IMRT Dynamic MLC for IMRT

available with MLC available with MLC available with MLC available with MLCoption; MLC moves option; MLC moves option; MLC moves option; MLC movesas a function both as a function both as a function both as a function bothof dose-delivered of dose-delivered of dose-delivered of dose-delivered(Dose Dynamic) and (Dose Dynamic) and (Dose Dynamic) and (Dose Dynamic) andof gantry arc angle of gantry arc angle of gantry arc angle of gantry arc angle(Arc Dynamic); com- (Arc Dynamic); com- (Arc Dynamic); com- (Arc Dynamic); com-patible w/forward & patible w/forward & patible w/forward & patible w/forward &inverse treatment inverse treatment inverse treatment inverse treatmentplanning systems planning systems planning systems planning systems








X-ray 250 for 4 MV, 600 600 600 250 for 4 MV, 400for 6-23 MV for 6 MV

Electron 400 1,000 1,000 NA


(93 x 20.9), (93 x 20.9), (93 x 20.9), (93 x 20.9),Exact couch Exact couch Exact couch Exact couch

Movement, cm (in)Vertical range 62.7-169.7 62.7-169.7 62.7-169.7 62.7-169.7

(24.7-66.8) (24.7-66.8) (24.7-66.8) (24.7-66.8)Longitudinal range 93.5-288.5 93.5-288.5 93.5-288.5 93.5-288.5

(36.8-113.6) (36.8-113.6) (36.8-113.6) (36.8-113.6)with extension, with extension, with extension, with extension,93.5-264.9 93.5-264.9 93.5-264.9 93.5-264.9(36.8-104.3) (36.8-104.3) (36.8-104.3) (36.8-104.3)without extension without extension without extension without extension

Lateral range ±25 (±9.8) ±25 (±9.8) ±25 (±9.8) ±25 (±9.8)

Base rotation, deg ±95 ±95 ±95 ±95


Special features Exact couch Exact couch Exact couch Exact couchdesigned to designed to designed to designed tofacilitate transfer facilitate transfer facilitate transfer facilitate transferfrom simulation to from simulation to from simulation to from simulation totreatment; treatment; treatment; treatment;dual pendants; dual pendants; dual pendants; dual pendants;Lok-bar technology; Lok-bar technology; Lok-bar technology; Lok-bar technology;optional indexing optional indexing optional indexing optional indexingaccessories; Mylar accessories; Mylar accessories; Mylar accessories; Mylarcovers and removable covers and removable covers and removable covers and removablerails; movable rails; movable rails; movable rails; movablesupport rails and support rails and support rails and support rails andUnipanel avoid Unipanel avoid Unipanel avoid Unipanel avoidcouchtop pivot couchtop pivot couchtop pivot couchtop pivot

ARC THERAPYX-ray Yes Yes Yes YesElectron Optional Yes Yes NA


L x W x H, m (ft) 6.1 x 7.1 x 3.1 6.1 x 7.1 x 3.1 6.1 x 7.1 x 3.1 6.1 x 6.1 x 3.2(20 x 23.6 x 10) (20 x 23.6 x 10) (20 x 23.6 x 10) (20 x 20 x 10.5)

POWER REQUIREMENTSLine voltage, VAC 208 208 208 208

kVA (beam-on) 45 45 45 15

LIST PRICE ~$1,341,000 ~$1,522,000 ~$1,724,000 ~$641,000

FISCAL YEAR October to September October to September October to September October to September

Colons separate data on similar models of a device. This is the second ofthree pages coveringthe above model(s).These specificationscontinue onto thenext page.






OPTIONAL ACCESSORIES Auto Field Sequenc- Auto Field Sequenc- Auto Field Sequenc- Auto Field Sequenc-ing (for automated ing (for automated ing (for automated ing (for automatedmovement of Clinac movement of Clinac movement of Clinac movement of Clinacbetween treatment between treatment between treatment between treatmentfields when used fields when used fields when used fields when usedwith R & V system), with R & V system), with R & V system), with R & V system),micromultileaf micromultileaf micromultileaf micromultileafcollimator (Brain- collimator (Brain- collimator (Brain- collimator (Brain-LAB), VARiS radio- LAB), VARiS radio- LAB), VARiS radio- LAB), VARiS radio-therapy information therapy information therapy information therapy informationmanagement system, management system, management system, management system,laser alignment laser alignment laser alignment laser alignmentsystem, laser back- system, laser back- system, laser back- system, laser back-pointer, CCTV pointer, CCTV pointer, CCTV pointer, CCTVsystem, intercom system, intercom system, intercom system, intercomsystem, Stereotactic system, Stereotactic system, Stereotactic system, StereotacticLock Kit including Lock Kit including Lock Kit including Lock Kit includingelectronic and couch electronic and couch electronic and couch electronic and couchlockout, in-room lockout, in-room lockout, in-room lockout, in-roommonitor, fine beam monitor, fine beam monitor, fine beam monitor, gatingmatching, portal matching, portal matching, portal interface board,vision, flat-panel vision, flat-panel vision, flat-panel Enhancedmonitor, respiratory monitor, gating monitor, gating Dynamic Wedge (forgating and interface interface board, interface board, electronic wedging),for simulation, CT respiratory gating respiratory gating dual independentsimulation and and interface for and interface for collimatorstreatment simulation, CT simu- simulation, CT simu- (required with

lation, & treatment lation, & treatment multileaf option)

OTHER SPECIFICATIONS Dual independent Dual independent Dual independent Optional extendedcollimators; collimators; collimators; collimator rotation;Enhanced Dynamic Enhanced Dynamic Enhanced Dynamic optional specialWedge; sealed ion Wedge; sealed ion Wedge; sealed ion accessory plugschambers; dynamic chambers; dynamic chambers; dynamic (for total-bodybeam steering to beam steering to beam steering to x-ray irradiation),correct for beam correct for beam correct for beam 9,000 MU total-bodyangle or beam angle or beam angle or beam x-ray (at isocenter)position changes; position changes; position changes; delivery; sealed iondemountable electron demountable electron demountable electron chamber; beam sym-gun; built-in gun; redundant gun; redundant metry interlock;Morning Checkout readouts on all readouts on all Morning CheckoutMode QA tool; dynamic axes; remote dynamic axes; remote Mode QA tool. Meetsretractable beam diagnostics; built- diagnostics; built- requirements ofstopper; optional in Morning Checkout in Morning Checkout EN 46001, ETL, andSilhouette edition Mode QA tool; Mode QA tool; ISO 9001.with minimum floor retractable beam retractable beamspace dimensions stopper; optional stopper; optionalof 4.9 x 5.8 m Silhouette edition Silhouette edition(16 x 19 ft). with minimum floor with minimum floorMeets requirements space dimensions space dimensionsof EN 46001, of 4.9 x 5.8 m of 4.9 x 5.8 mETL, and ISO 9001. (16 x 19 ft). (16 x 19 ft).

Meets requirements Meets requirementsof EN 46001, of EN 46001,ETL, and ISO 9001. ETL, and ISO 9001.





MODEL VARIAN

Clinac 600C/D

WHERE MARKETED Worldwide

FDA CLEARANCE Yes

CE MARK (MDD) Yes

TYPE Linear accelerator

PHOTON ENERGY, MV 4 or 6, per BJR 17

ELECTRON ENERGY, MeV NA

ACCELERATOR TYPE Standing waveLength, m 0.3

MICROWAVE POWERSource MagnetronPower, MW 3

BEAM BENDING, deg 0

GANTRYRotation range, deg ±180SAD, cm 100

TREATMENT UNITL x W x H, cm (in) 272 x 127 x 269

(107 x 50 x 106)

Weight, kg (lb) 6,668 (14,700)

COLLIMATIONRotation range, deg ±165Field size range

at SAD, cmX-ray 40 x 40Electron NA

MultileafNo. of leaves Optional 52, 80, or

120Special features Dynamic MLC for IMRT

available with MLCoption; MLC movesas a function bothof dose-delivered(Dose Dynamic) andof gantry arc angle(Arc Dynamic); com-patible w/forward &inverse treatmentplanning systems





MODEL VARIAN

Clinac 600C/D


X-ray 400 for 4 MV, 600for 6 MV

Electron NA

TREATMENT COUCHL x W, cm (in) 236 x 53

(93 x 20.9),Exact couch

Movement, cm (in)Vertical range 62.7-169.7

(24.7-66.8)Longitudinal range 93.5-288.5

(36.8-113.6)with extension,93.5-264.9(36.8-104.3)without extension

Lateral range ±25 (±9.8)

Base rotation, deg ±95

Maximum patientweight, kg (lb) 200 (440)

Special features Exact couchdesigned tofacilitate transferfrom simulation totreatment;dual pendants;Lok-bar technology;optional indexingaccessories; Mylarcovers and removablerails; movablesupport rails andUnipanel avoidcouchtop pivot

ARC THERAPYX-ray YesElectron NA


L x W x H, m (ft) 6.1 x 6.1 x 3.2(20 x 20 x 10.5)

POWER REQUIREMENTSLine voltage, VAC 208

kVA (beam-on) 15

LIST PRICE ~$829,000

FISCAL YEAR October to September

Colons separate data on similar models of a device. This is the second ofthree pages coveringthe above model(s).These specificationscontinue onto thenext page.




MODEL VARIAN

Clinac 600C/D

OPTIONAL ACCESSORIES Auto Field Sequenc-ing (for automatedmovement of Clinacbetween treatmentfields when usedwith R & V system),micromultileafcollimator (Brain-LAB), VARiS radio-therapy informationmanagement system,laser alignmentsystem, laser back-pointer, CCTVsystem, intercomsystem, StereotacticLock Kit includingelectronic and couchlockout, in-roommonitor, gatinginterface board

OTHER SPECIFICATIONS Demountableelectron gun;Special Proceduresmode includingspecial accessoryplugs (for total-body x-ray irradia-tion), 9,000 MUtotal-body x-ray (atisocenter) delivery;Enhanced DynamicWedge (forelectronic wedging);extended collimatorrotation; dualindependent colli-mators (requiredwith multileafoption); sealed ionchamber; beamsymmetry interlock;Morning CheckoutMode QA tool. Meetsrequirements ofEN 46001, ETL, andISO 9001.




Documents

Linear