Lessons Learned from a Successful Transition from Co-60 to the Halcyon Linac In a Low to Middle Income Country (LMIC)
Abstract
Purpose
Despite the global transition toward more precise and conformal radiotherapy, many countries currently treat with Co-60 units. This paper describes key steps, challenges and lessons learned from a successful transition from Co-60 to LINAC based radiotherapy in a low to middle income (LMIC) country.
Methods
The transition from an Equinox 80 Co-60 unit to a Varian Halcyon 4.0 LINAC at the Queen Elizabeth Hospital (QEH) was implemented between May 2023 and November 2025 using a structured, phased methodology. The planning phase established governance structures, regulatory approvals and arrangements for the decommissioning and dismantling of the Co-60 unit and the export of the Co-60 source. Facility audits addressed procurement strategy, logistics and site-readiness requirements, including shielding specification calculations, electrical upgrades, HVAC improvements and structural load assessments to support the new LINAC. Collaboration with the International Atomic Energy Agency (IAEA) and a partner institution provided technical expertise, training opportunities and professional support.
Results
Civil works were completed between January and October 2025. An additional corridor was constructed forming a maze entrance, significantly reducing the cost of the entrance door. Bunker structural improvements included construction of the maze wall, bunker floor re-leveling, upgrades to the HVAC system and IT infrastructure ensuring thermal stability and connectivity. Workforce requirements were quantified using the IAEA activity-based staffing algorithm, followed by competency development through a train-the-trainer approach, vendor-led instruction, clinical observerships at partner institutions, targeted recruitment and interim physics and dosimetry support. Project risks were monitored by a multidisciplinary steering committee through weekly reviews. Final implementation included installation, acceptance testing, and commissioning, with full clinical operation achieved in November 2025.
Conclusion
This project demonstrates the technical feasibility and clinical value of LINAC implementation in a resource-constrained setting through structured planning, workforce optimization, and risk-controlled infrastructure adaptation, providing a scalable framework for radiotherapy modernization in LMIC countries.