# Pay for radiotherapy machine uptime, not for the machine

Source: https://onco.cc/ideas/idea-acc-linac-uptime-contracts/  
OnCo record `idea-acc-linac-uptime-contracts` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Governments and donors should buy guaranteed working hours from radiotherapy vendors, with remote monitoring and regional spare-parts depots, instead of buying machines that then sit broken.

## Summary

Radiotherapy machines in low- and middle-income countries are frequently non-operational for months awaiting a part or a visiting engineer. A regional shared-service model would bundle continuous remote diagnostics, an in-region spare-parts depot, and locally trained engineers into a multi-country service contract with penalties for downtime. Vendors already run remote monitoring in high-income markets; the change is contractual, not technical.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Uptime-linked service contracts covering a regional cluster of at least ten machines will raise annual scheduled-hours delivered by at least 30% within two years compared with machines under standard warranty terms.
- Rationale: Availability-based contracting transformed aircraft-engine and hospital-imaging maintenance economics. Concentrating demand across countries makes an in-region engineer and parts depot affordable.
- Proposed test: A donor-backed pilot across one region (e.g., East Africa) comparing uptime, mean time to repair, and patients treated per machine between contracted and non-contracted sites, reported quarterly and published.
- Maturity: early-clinical
- Actor: policy

## Sources

- IAEA Rays of Hope: https://www.iaea.org/services/rays-of-hope

## Connected records

- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- companies: [Elekta](https://onco.cc/companies/elekta/), [Varian (Siemens Healthineers)](https://onco.cc/companies/varian/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)

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