Each week we field calls from radiation oncology clinics throughout the United States offering their used, and often not-so-used, brachytherapy machines—in particular, HDR (high dose rate systems) systems manufactured by Xoft, Elekta (formerly Nucletron) and Varian. So if you are an owner of a Xoft Axxent; an Elekta Microselectron V2, V3 or Flexitron; or Varian GammaMed or Varisource, you may be out of luck.
Recently, we have seen a record number of lightly used Xoft Axxent electronic brachytherapy systems up for sale resulting in a veritable glut of used systems in the marketplace. Two main factors have contributed to this excess of used HDR machines.
First, the recent cuts in electronic brachytherapy reimbursement have left many facilities without the adequate funding needed to continue to utilize this technology. Dermatologists that purchased this technology to take advantage of strong reimbursement rates are faced with the fact that it is not a viable technology any longer due to these cuts. Many are moving back to surgery and/or electron based therapy.
Second, for the other types of HDR systems such as those that use iridium, the availability of securing sources for pre-owned machines is also a key factor. For the last five years, Elekta and Varian have controlled the supply of the iridium sources needed to operate these systems. This prevents third parties from being able to purchase source contracts to keep second hand machines in operation.
So while the supply of these machines is plentiful, there simply is no demand for them, nor will there be a demand until it becomes feasible for buyers to secure source contract for these machines.
What about buying sources directly from the manufacturers? This is certainly a possibility, but the pricing tends to be on the higher side since manufacturers are in the business of selling new machines and do not encourage the re-sale of used systems. In most cases the buyer is then better off buying a brand new HDR system than a used one.
However, there is hope because a new supplier of iridium source contracts is entering the marketplace. This may make it possible for buyers of used machines to continue to use these systems. As of now, these sources will be compatible with Elekta’s Nucletron Classic with future plans in the works for Elekta’s V2s, V3s and Flexitrons; and Varian’s Gammamed and Varisource machines.
Unfortunately there is no solution in sight for their electronic source counterparts such as Xoft Axxent and Elekta Esteya systems. These machines will simply sit on shelves, collecting dust, and hoping that one day a third-party manufacturer of X-ray sources will be available.
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