Varian Trilogy vs. TrueBeam: Which Refurbished Linear Accelerator is Right for Your Clinic?

Should I purchase a refurbished Varian TrueBeam or a refurbished Varian Trilogy linear accelerator?  This question is often asked by clinicians and managers when either opening a new radiation oncology center, replacing an older linear accelerator, or expanding an existing site.

Deciding between a Trilogy or a TrueBeam linear accelerator will usually depend on several key factors.  In this article, we review some of these considerations. For the purposes of this article, we will include the Varian iX and related models as similar products to the Trilogy, given their many similarities.

(Note: Most radiation oncology centers in the U.S. purchase brand-new equipment. Refurbished linear accelerators are appropriate in specific circumstances).

Acquisition Costs

The Varian Trilogy was introduced in 2004, and the Varian TrueBeam debuted six years later.  The TrueBeam is a newer generation device, and the Trilogy is the last iteration of a very reliable product line that began decades earlier with the Varian Clinac 1800 and later evolved as the Varian Clinac series that included the 2100C, 2100C/D, 2300C/D, 21EX and finally the iX/Trilogy line.

As an older generation system that has been in the market for a longer period, the acquisition cost of a Trilogy linear accelerator is generally lower compared to the TrueBeam of a similar age. The exact cost of each will vary depending on factors such as the system configuration, software, upgrades, additional accessories, age, and overall usage (measured in beam or high voltage hours).  For example, a Trilogy system manufactured in 2015 may exceed the acquisition value of a TrueBeam system manufactured in 2012, since newer systems tend to hold their value longer.

Recently, some OEM service regions in the United States have required customers purchasing refurbished TrueBeam systems to buy expensive licensing rights to integrate the linac with the Varian Aria oncology information system.  The same has not been true for Varian Trilogy systems, which are no longer being manufactured.

Winner:  Varian Trilogy

Parts Availability

Compared to the TrueBeam, the Varian Trilogy (and its product lineage) has been around for a longer period, and its parts are generally more readily available in the secondary market.  Also, Trilogy parts are almost always interchangeable with Varian iX parts.  This large supply of readily available used parts are able support the Trilogy well into the future.

The Trilogy has many discrete Printed Circuit Boards (PCBs) which can often be repaired. This makes board level repairs both feasible and cost-effective, offering perspective owners more economical service options.  The TrueBeam’s PCBs are more integrated and significantly more expensive.

However, as a newer generation system, the TrueBeam benefits from a greater availability of new parts directly from Varian (now part of Siemens Healthineers). However, as the system ages, parts availability may become a concern in the future, especially for older models like the TrueBeam “Long Stand” manufactured prior to 2014.

Since the Trilogy and iX models are now officially discontinued and no longer in production, their parts may become harder to source over time.  But for now, the Varian Trilogy has more accessible and affordable replacement parts.

Winner:  Varian Trilogy

Performance

The TrueBeam was designed to be more integrated than the Trilogy, to provide faster treatment times, higher dose rate options including Flattening Free Filter (FFF) mode, improved treatment accuracy, and more advanced options like HyperArc and, in newer systems, HyperSight, which allows for CT Scanner-quality images from the imaging system.

Some later model Trilogy systems do come equipped with FFF mode, whereas some TrueBeam systems don’t have FFF mode enabled.

Similarly, some TrueBeams come equipped with 6 DoF (degrees of freedom) couches.  These couches are also known as Pitch ‘N Roll and are designed for SRS/SBRT treatments.  Later model Trilogy systems also have similar couch upgrades.

The TrueBeam was also designed as a more ergonomic, integrated system, whereas the older Trilogy system was less integrated with more keyboards workstations.

However, the Trilogy is still a highly reliable, powerful and robust system that meets the needs of most clinics seeking to purchase refurbished equipment.  And since the introduction of IMRT in 2000 and IGRT in 2005, no new technologic enhancements have been made that provide for higher reimbursement rates in the U.S., which means the TrueBeam doesn’t really help generate incremental revenue.  Nonetheless, the TrueBeam is today the clear winner.

Winner:  Varian TrueBeam

Maintenance Costs

Currently a Trilogy will tend to have lower maintenance costs vs. its TrueBeam counterpart since the technology has been around longer, parts availability is ample, and the less-expensive, independent service providers tend have more experience servicing this model.   Pricing for a Trilogy one or multi-year service contract is on average 20% or more lower than for a TrueBeam.

As a newer and more advanced system, the TrueBeam typically has higher maintenance costs due to the complexity of the technology, the greater reliance on OEM involvement for software integration, and the need for specialized, TrueBeam-trained service personnel.  Parts support is also more expensive, since the TrueBeam has more complex and expensive boards that sometimes require repair or replacement.  However, the cost differential compared to the Trilogy may erode over time, as linac engineers complete more training and gain more experience servicing the system, and as the aging C-Series line fades into the sunset.

Winner:  Varian Trilogy

OEM Support

Now that the Trilogy/iX product line has been discontinued, Varian (now part of Siemens Healthineers) will likely provide diminished support for the Trilogy as it phases out older systems that reach end-of-support in favor of newer equipment. However, there are several third-party service providers that may offer maintenance and support for the Trilogy at a reduced cost compared to Varian.

As a newer model system, the TrueBeam is likely to receive more direct support and attention from Siemens Healthineers (the OEM), both with software updates, upgrades; as well as with more recently trained TrueBeam-specific engineers.

Winner:  Varian TrueBeam

Recruiting Talent

Finding good therapists, physicists and radiation oncologists is a key factor in the success of any new radiotherapy clinic.  Without good clinicians, it’s practically impossible to get a new cancer center off the ground.  Attracting such talent often requires a clinic to have the newer generation of equipment.

If attracting new talent is important, then the newer generation TrueBeam model is preferred.

Winner:  Varian TrueBeam

Conclusion

In general, the ideal choice between the Varian Trilogy and the TrueBeam depends on the specific needs and priorities of the healthcare facility. If cost is a significant concern and the facility has access to reliable third-party service providers, the Varian Trilogy may be a superior option, especially if parts availability is not a major issue in the near term. However, if the facility prioritizes the latest technological advancements, increased efficiency, and the assurance of direct OEM support, the TrueBeam may be a better choice, despite higher upfront and maintenance costs.

It is essential to carefully evaluate the facility’s budget, projected patient volume, and clinical requirements to determine the most suitable option that balances cost, performance, and long-term support.