The Hindu Business Line : Health Ministry's Linacs purchase in eye of storm

THE Ministry of Health has landed into a controversy over the purchase of radiotherapy equipment for the treatment of cancer under the National Cancer Control Programme (NCCP).

Overriding the opinion of medical practitioners, experts and the WHO, the Health Ministry recently issued a circular to all Government-aided Central and regional cancer centres (RCCs) across the country proposing that in future, grants from the Ministry would be made available only for the purchase of the "more advanced" and "sophisticated" linear accelerators (Linacs) and not for the less expensive "cobalt" machines.

"Cobalt units will no longer be assisted in view of the outdated technology as well as the problem associated with the disposal of radioactive sources of these machines," a communiqué from the Ministry said.

This move would enforce a ban on purchase of the cobalt machines for which the suppliers have reportedly developed a reliable system for disposal of used radioactive material.

Medical experts said that the Ministry's step would add to the agony of cancer patients in more ways than one. And at stake is the cancer control programme itself.

During the 9th Plan period, grants were extended to about 50 institutions for the purchase of 52 machines, of which 26 were cobalt-based equipment.

For the 10th Plan, similar grants are being extended, not for cobalt machines but for the purchase of about 15-18 Linacs.While each cobalt machine (with accessories) costs about Rs 1.85 crore, the cost of a Linac is more than double at Rs 4 crore.

The major manufacturer of cobalt machines globally is MDS Nordion/Theratronics of Canada, whose equipment is to be supplied through an Indian outfit called Kirloskar Theratronics.

Others in the field are a firm in Argentina and the Atomic Energy Commission of India through one of its vendors.

Linacs, on the other hand, are being produced by Siemens of Germany through its outfit in the US, Varian, and Elekta, UK.

According to a WHO study, India requires 1,000 radiotherapy machines.

Only 300 such machines are installed in various hospitals currently, which leaves a gap of 700 machines.

A cobalt machine can work on a 3 KVA power input or a generator. It does not need air-conditioning or water-cooling or dust filters and can operate under all weather conditions.

It can work three shifts a day and treat about 140 patients. Maintenance requirement, at the most, is a single day in a year and the annual charge on this count does not exceed Rs 4 lakh.

Linacs, on the contrary, require uninterrupted quality power supply without any voltage fluctuation. Any variation leads to the need for recalibration, which may take between two days and two months.

Besides, they require back-up equipment, sophisticated dust-free air-conditioning and water supply for cooling.

A Linac can treat about 40-60 patients a day and for maintenance, the charge is as much as Rs 50 lakh annually for a two-year-old machine, as in the case of Kolkata-based Chittaranjan Hospital.

A WHO expert group, while reviewing the progress of NCCP, had said: "Radiotherapy may be administered by cobalt machines or by accelerators. Both machines serve the same purpose and the clinical outcomes will be identical. Cobalt machines are less expensive and robust; accelerators are more expensive and require sophisticated maintenance and frequent calibration. The requirements of stable electrical power and water supplies are high."

The group concluded stating: "For the majority of treatable cancers in developing countries, however, accelerators offer little advantage over cobalt therapy."

The Ministry's decision to purchase Linacs is bound to raise many more questions.

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