Cobalt- -60: No time for retirement 60: No time for retirement Cobalt The Cost Benefit of High Technology in the cancer treatment The Cost Benefit of High Technology in the cancer treatment at rural or developing areas on Brazil at rural or developing areas on Brazil Paulo Eduardo Novaes, MD, PhD Paulo Eduardo Novaes, MD, PhD Carlos E. de Almeida, PhD Carlos E. de Almeida, PhD A. Peregrino DSc DSc A. Peregrino Paulo C. Canary MD Paulo C. Canary MD ICARO 2009 - AIEA
Territorial area area & & population population Territorial 2 ) 1. China 1,315,844,000 1. Russia (17.075.400 km 2 ) 2. I ndia 1,103,371,000 2. Canada (9.922.330 km 2 ) 3. USA 298,213,000 3. China (9.461.300 km 2 ) 4. I ndonesia 222,781,000 4. USA (9.363.124 km 2 ) 5. Brasil 186,405,000 5. Brasil (8.511.996 km World Population Prospects- Countries with highest population for 1950, 2005 and 2050 http:/ / www.geohive.com/ charts/ pop_data3.php
Radiation Therapy Therapy Equipments Equipments - - Brasil Brasil Radiation n n Linacs 206 Linacs 206 Cobalt 60 60 58 Cobalt 58 TPS (2D- -3D) 3D) 106 TPS (2D 106 HDRB HDRB 90 90 Simulators Simulators 32 32 Tendence: LINACS Tendence : LINACS - - Co- Co -60 60 Comitê de Radioterapia do Brasil. Status da Radioterapia no Brasil. Data until 2009
Cobalt 60 machines 60 machines Cobalt Caracteristics Caracteristics – Photon Photon energy energy: 1.25 : 1.25 MeV MeV – – Half Half- -life life: 5.5 : 5.5 years years – – Distance Distance treatment treatment: 80cm : 80cm – – Colimators Colimators: : simetrical simetrical - - MLC: no MLC: no – – Technical Technical maintenance maintenance and and operation operation: : easy easy – – Clinical Clinical experience experience: : High High –
Cobalt 60 machines 60 machines Cobalt Minimal Requirements Requirements (CNEN) (CNEN) Minimal – Isocenter Isocenter rotational rotational gantry gantry – – Distance Distance treatment treatment: 80cm : 80cm – – Dose Dose- -rate rate: 50cGy : 50cGy- -min min – – Mechanical Mechanical test test & QC & QC evaluation evaluation – Brasil: On the next two years we will have about 30 Co-60
Cobalt- -60 60 Cobalt Questions Questions – In In what what situations situations may may be be used used without without clinical clinical – results compromise compromise results – What What are are the the costs costs involved involved on on acquisition acquisition, , – installation and and maintenance maintenance installation – Is Is there there any any advantage advantage over over low low energy energy LINAC LINAC – – What What are are the the dificulties dificulties to to replace replace a Co a Co- -60 60 by by a a – LINAC LINAC
Cobalt- -60 60 Cobalt Questions Questions – In In what what situations situations may may be be used used without without – clinical results results compromise compromise clinical – What What are are the the costs costs involved involved on on acquisition acquisition, , – installation and and maintenance maintenance installation – What What are are the the dificulties dificulties to to replace replace a Co a Co- -60 60 – by a LINAC a LINAC by
Cobalt- -60 60 Cobalt Clinical indications indications to to consider consider... ... Clinical – Advanced Advanced tumours tumours – 50% Pts Public Hospital – Metastatic Metastatic cancer cancer – – Breast Breast cancer cancer – – tangential tangential fields fields – – H&N H&N cancer cancer – – some cases some cases – – Cervix Cervix and and Prostate Prostate – – combined combined with with HDRB HDRB – Clinical judment and experience are fundamental
Cost Estimates of acquisition, installation and maintenance of a radiation oncology Cost Estimates of acquisition, installation and maintenance of a radiation oncology facility without considering the costs of staff, consumables, taxes. xes. facility without considering the costs of staff, consumables, ta Basic Equipment Equipment Cost Room Cost US$ Maintenance & Parts Yearly Costs Basic Equipment Equipment Cost Room Cost US$ Maintenance & Parts Yearly Costs US$ US$ X X- - ray ray 150 000,00 20 000,00 Tube: [10] US$ 3 000,00 150 000,00 20 000,00 Tube: [10] US$ 3 000,00 (30- -150 kVp 150 kVp ) (30 Maintenance contract US$ 5 000,00 Maintenance contract US$ 5 000,00 ) Others; US$ 1 000,00 Others; US$ 1 000,00 Depreciation[15] US$ 10 000,00 Depreciation[15] US$ 10 000,00 Total: US$ 19 000,00 Total: US$ 19 000,00 450 000,00 450 000,00 100 000,00 100 000,00 Source: [5] US$ 30 000,00 Source: [5] US$ 30 000,00 Cobalt- -60 60 Cobalt Others: US$ 2 000,00 Others: US$ 2 000,00 12 000 Ci Ci source source 12 000 Maintenance contract US$ 12 000,00 Maintenance contract US$ 12 000,00 Depreciation [15] US$ 30 000,00 Depreciation [15] US$ 30 000,00 Total: US$ 74 000,00 Total: US$ 74 000,00 600 000,00 600 000,00 150 000,00 150 000,00 Thyratron [2]: US$ 5 000,00 Thyratron [2]: US$ 5 000,00 6 MV Linac 6 MV Linac Magnetron: [4] US$ 10 000,00 Magnetron: [4] US$ 10 000,00 Ion chamber:[4] US$ 2 000,00 Ion chamber:[4] US$ 2 000,00 Target: [4] US$ 2 000,00 Target: [4] US$ 2 000,00 Wave guide: [10] US$ 7 000,00 Wave guide: [10] US$ 7 000,00 Others: US$ 5 000,00 Others: US$ 5 000,00 Maintenance contract US$ 30 000,00 Maintenance contract US$ 30 000,00 Depreciation [15] US$ 40 000,00 Depreciation [15] US$ 40 000,00 Total: US$ 101 000,00 Total: US$ 101 000,00 Numbers in brackets [ ] are estimates of the component half life in years, including taxes
Dificulties to to replace replace a Co a Co- -60 60 by by a LINAC a LINAC Dificulties To consider consider... ... To � Radiological Radiological Protection Protection aspects aspects � – The – The same same room room or or another another one one is is necessary necessary � Equipment Equipment dimension dimension � – LINACS: 100cm SSD x Co LINACS: 100cm SSD x Co- -60: 80 cm 60: 80 cm – Technical limitations limitations � Technical � – Beam Beam stoper stoper –
Co- -60: No time for 60: No time for retirement retirement Co – Criterious Criterious clinical clinical use use – – Low Low cost cost, , easier easier maintenance maintenance program program and and – more operative operative time time compared compared to LINAC to LINAC more – Good Good option option on on low low income income regions regions and and – developing countries countries developing
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