Cobalt- -60: No time for retirement 60: No time for retirement - - PowerPoint PPT Presentation

Cobalt Cobalt-

• 60: No time for retirement

60: No time for retirement

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
• A. Peregrino DSc

DSc Paulo C. Canary MD Paulo C. Canary MD

ICARO 2009 - AIEA

Territorial Territorial area area & & population population

• 1. Russia (17.075.400 km

2)

• 2. Canada (9.922.330 km

2)

• 3. China

(9.461.300 km

2)

• 4. USA

(9.363.124 km

2)

• 5. Brasil

(8.511.996 km

2)

World Population Prospects- Countries with highest population for 1950, 2005 and 2050

http:/ / www.geohive.com/ charts/ pop_data3.php

• 1. China

1,315,844,000

• 2. I ndia

1,103,371,000

• 3. USA

298,213,000

• 4. I ndonesia

222,781,000

• 5. Brasil

186,405,000

Radiation Radiation Therapy Therapy Equipments Equipments -

• Brasil

Brasil

n n Linacs Linacs 206 206 Cobalt Cobalt 60 60 58 58 TPS (2D TPS (2D-

• 3D)

3D) 106 106 HDRB HDRB 90 90 Simulators Simulators 32 32 Tendence Tendence: LINACS : LINACS -

• Co

Co-

• 60

60

Comitê de Radioterapia do Brasil. Status da Radioterapia no Brasil. Data until 2009

Cobalt Cobalt 60 machines 60 machines

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

• peration:

: easy easy – – Clinical Clinical experience experience: : High High

Cobalt Cobalt 60 machines 60 machines

Minimal Minimal Requirements Requirements (CNEN) (CNEN)

– – 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 Cobalt-

• 60

60

Questions Questions

– – In In what what situations situations may may be be used used without without clinical clinical results results compromise compromise – – What What are are the the costs costs involved involved on

• n acquisition

acquisition, , installation installation and and maintenance maintenance – – Is Is there there any any advantage advantage over

• ver 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 Cobalt-

• 60

60

Questions Questions

– – In In what what situations situations may may be be used used without without clinical clinical results results compromise compromise – – What What are are the the costs costs involved involved on

• n acquisition

acquisition, , installation installation and and maintenance maintenance – – What What are are the the dificulties dificulties to to replace replace a Co a Co-

• 60

60 by by a LINAC a LINAC

Cobalt Cobalt-

• 60

60

Clinical Clinical indications indications to to consider consider... ...

– – Advanced Advanced tumours tumours – – 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

50% Pts Public Hospital

Cost Estimates of acquisition, installation and maintenance of a Cost Estimates of acquisition, installation and maintenance of a radiation oncology radiation oncology facility without considering the costs of staff, consumables, ta facility without considering the costs of staff, consumables, taxes. xes.

Basic Equipment Basic Equipment Equipment Cost Equipment Cost US$ US$ Room Cost US$ Room Cost US$ Maintenance & Parts Yearly Costs Maintenance & Parts Yearly Costs

X X-

• ray

ray (30 (30-

• 150 kVp

150 kVp)

) 150 000,00 150 000,00 20 000,00 20 000,00 Tube: [10] US$ 3 000,00 Tube: [10] US$ 3 000,00 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

Cobalt Cobalt-

• 60

60 12 000 12 000 Ci Ci source source

450 000,00 450 000,00 100 000,00 100 000,00 Source: [5] US$ 30 000,00 Source: [5] US$ 30 000,00 Others: US$ 2 000,00 Others: US$ 2 000,00 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

6 MV Linac 6 MV Linac

600 000,00 600 000,00 150 000,00 150 000,00 Thyratron [2]: US$ 5 000,00 Thyratron [2]: US$ 5 000,00 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 Dificulties to to replace replace a Co a Co-

• 60

60 by by a LINAC a LINAC To To consider consider... ...

• Radiological

Radiological Protection Protection aspects aspects

– – The The same same room room or

• r another

another one

• ne 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

Technical limitations limitations

– – Beam Beam stoper stoper

Co Co-

• 60: No time for

60: No time for retirement retirement

– – Criterious Criterious clinical clinical use use – – Low Low cost cost, , easier easier maintenance maintenance program program and and more more operative

• perative time

time compared compared to LINAC to LINAC – – Good Good option

• ption on
• n low

low income income regions regions and and developing developing countries countries