Radiotherapy can be delivered with different types of machine, such as external beam high energy radiation machines, kilovoltage machines and brachytherapy equipment. Variation in the incidence of different cancer types, the complexity and cost of treatment technologies, and differences in local social, economic and physical circumstances are all factors that influence technology acquisition, purchase and implementation. This publication addresses one of the many factors, associated with the planning of a new radiotherapy facility or the upgrade of an existing one – the selection of a high energy (megavoltage) radiotherapy machine. The two main high energy machine types are medical linear accelerators (linacs) and cobalt-60 machines. Although both treatment modalities have been compared extensively in the relevant literature, very few publications describe all the issues to consider when choosing a megavoltage machine. This publication puts all appropriate questions into context and provides information for non-technical administrators and decision makers, and for professionals directly involved in treating patients.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. NATIONAL CANCER CONTROL PLANNING
• 3. EQUIPMENT SELECTION AND CUSTOMIZATION PROCESS
  • 3.1. Core implementation team
  • 3.2. Self-assessment questionnaire
• 4. CLINICAL FACTORS IN TECHNOLOGY ACQUISITION
• 5. TECHNICAL COMPARISON BETWEEN 60Co TELETHERAPY MACHINES AND LINACS
  • 5.1. Beam energy considerations
  • 5.2. Radiation beam profile characteristics
  • 5.3. Treatment plan considerations
  • 5.4. Machine characteristics
  • 5.5. Radiotherapy technique options
• 6. INFRASTRUCTURE
  • 6.1. Treatment room design
    • 6.1.1. Shielding
    • 6.1.2. Maze and entry door
    • 6.1.3. Room dimensions
    • 6.1.4. Air-conditioning requirements
  • 6.2. Machine servicing
  • 6.3. Radiation safety
  • 6.4. Staffing considerations
• 7. EQUIPMENT OTHER THAN TREATMENT MACHINES
  • 7.1. Pretreatment imaging
  • 7.2. Radiation treatment planning system
  • 7.3. Oncology information system
  • 7.4. Uninterruptable power supply
  • 7.5. Ancillary equipment
• 8. COST CONSIDERATIONS
  • 8.1. Cost estimation
  • 8.2. Calculation of the required number of treatment machines
• 9. SUMMARY OF THE COMPARISON BETWEEN 60Co MACHINES AND LINACS
• Appendix I STEPS IN A TYPICAL RADIATION TREATMENT PROCESS, TECHNOLOGIES USED AT EACH STAGE AND PROFESSIONAL STAFF TYPICALLY INVOLVED
• Appendix II QUESTIONS TO CONSIDER IN THE IMPLEMENTATION OF MEGAVOLTAGE RADIATION TREATMENT TECHNOLOGIES
• Appendix III STANDARD EQUIPMENT PACKAGE FOR A RADIOTHERAPY DEPARTMENT
• Appendix IV CALCULATION OF THE NUMBER OF TREATMENT MACHINES
• Appendix V EXAMPLE ILLUSTRATING THE METHOD SHOWN IN APPENDIX IV
• REFERENCES
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND REVIEW