Co- -60 60- - No Time for retirement? Co No Time for - PowerPoint PPT Presentation

Co- -60 60- - No Time for retirement? Co No Time for retirement? Round Table Round Table Pierre ALETTI Pierre ALETTI Centre A.Vautrin - Centre A.Vautrin - Nancy - Nancy - France France ICARO 27- -28 28- -29 Avril 2009 29 Avril 2009 ICARO 27

1- - The Manufacturers of Co- -60 Machines 60 Machines 1 The Manufacturers of Co Year 1950: Picker, Year 1950: Picker, AECL, Baraseti,.. AECL, Baraseti,.. Year 1970 : AECL, Year 1970 : AECL, Philips, CIS international, … …. . Philips, CIS international, Year 2009 : Best Theratronics, Year 2009 : Best Theratronics, Bhabhatron, Interaktif, Elekta (Gamma Bhabhatron, Interaktif, Elekta (Gamma knife), Medway Technologies , knife), Medway Technologies , Terabalt, …… …… Terabalt,

1 ’ - The Manufacturers of 1 ’ - The Manufacturers of pellets Cobalt Sources: pellets Argentina Canada India?? Russia

2- -Cobalt Cobalt- -60 Machine 60 Machine 2 Advantages Advantages Low cost of the machine Low cost of the machine Robustness Robustness Reduced maintenance, Reduced maintenance, Low running costs Low running costs Not much downtime Not much downtime Easyness of the QC Easyness of the QC for : Well adapted for : Well adapted • « « Head and neck » and Breast localizations Head and neck » and Breast localizations • • the junction of fields the junction of fields « « Large penumbra » Large penumbra » •

2’ ’- - Cobalt- -60 Machine 60 Machine 2 Cobalt Disadvantages Disadvantages Decay of the dose rate Decay of the dose rate Change of the source every 5- -7 Years 7 Years Change of the source every 5 Cost of the source Cost of the source Transportation of the source( Nuclear Safety Regulation) Nuclear Safety Regulation) Transportation of the source( Return of the old source Return of the old source Not adequate for the deap seated Tumors (Cervix, Lung, … …) ) Not adequate for the deap seated Tumors (Cervix, Lung, Not adequate for the treatment of the Children « Not adequate for the treatment of the Children « Large Large penumbra » » penumbra

3 - - Cobalt- -60 in France 60 in France 3 Cobalt 2003 – – 2007 Cancer Plan 2003 2007 Cancer Plan Change of the « « old » equipment ( old Linac and all Cobalt • Change of the old » equipment ( old Linac and all Cobalt • machines ) before 2007 machines ) before 2007 Evaluation of the IMRT (prostate and « « Head and Neck ») ) • Evaluation of the IMRT (prostate and Head and Neck » • Evaluation of the new Machines « « Cyberknife and Tomotherapy » • Evaluation of the new Machines Cyberknife and Tomotherapy » • Actual status: Actual status: The ’standard standard ’ Cobalt machines will be finished in 2010 – – The ’ ’ Cobalt machines will be finished in 2010 o o 2012 2012 o 3 3 « « Gamma knife » equipments for stereotaxic irradiation Gamma knife » equipments for stereotaxic irradiation o

3’ ’ - Cobalt- -60 In France 60 In France 3 - Cobalt 179 Departments of Radiotherapy and 402 Machines 179 Departments of Radiotherapy and 402 Machines

4 - Cobalt Machine and the Low Income Countries Increasing of the demand for new departments of Radiation Therapy apy • Increasing of the demand for new departments of Radiation Ther • and consequently for the equipments: and consequently for the equipments: o in Africa (Burkina Fasso, Mali, Senegal, Madagascar, in Africa (Burkina Fasso, Mali, Senegal, Madagascar,… ….., .., o o In Asia (Vietnam in Mekong delta, Cambodia, Laos, In Asia (Vietnam in Mekong delta, Cambodia, Laos, o Myanmar ,… … Myanmar ,

4 ’- The Reality of the most Low Income Countries (Cambodia, Senegal,…) Rich patients are treated in developped countries (Singapour,Europe,..) ope,..) • Rich patients are treated in developped countries (Singapour,Eur • Poor patients are not treated • Poor patients are not treated • No social Security • No social Security • The patients have to pay the treatments • The patients have to pay the treatments • A lot of patients with big tumors (Nasopharyngeal, breast , cervix, vix, • A lot of patients with big tumors (Nasopharyngeal, breast , cer • lung carcinoma,… …..) ..) lung carcinoma, Problems of stability of the electrical power • Problems of stability of the electrical power • A lot of electrical power cut (3times per day depending on the season) season) • A lot of electrical power cut (3times per day depending on the • Maintenance technician with a low level of knowledge • Maintenance technician with a low level of knowledge •

4 ’’- The response for the Low Income Countries? • Low cost of the treatment Low cost of the treatment • Robust machine • Robust machine • Very few downtime • Very few downtime • A machine with easy maintenance • A machine with easy maintenance • A few spare parts • A few spare parts • Recommendations • Recommendations • • For the First Machine: a Cobalt unit For the First Machine: a Cobalt unit • For the second machine it is depending on • For the second machine it is depending on • the type of patients to be treated • the type of patients to be treated • the improvement of the technical environment ç çElectrical Electrical • the improvement of the technical environment • power,… ….) .) power, The level of knowledge of the staff (Physicist, technician, • The level of knowledge of the staff (Physicist, technician, • radiographers,… ….) .) radiographers,

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