# An open-hardware radiotherapy machine built for unreliable power and dust

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

## TL;DR

Design a radiotherapy machine from scratch for hospitals with patchy electricity, heat and few engineers, and publish the design so several companies can build it cheaply.

## Summary

Commercial linear accelerators are built for well-staffed Western hospitals; in sub-Saharan Africa they sit idle for long stretches because of power failures, heat, and the cost of a service call. A consortium (the CERN/STFC/ICEC 'Project STELLA' work is a precedent) would specify a ruggedised, modular, remotely diagnosable machine with battery-buffered power, sealed electronics, swappable modules that a local technician can replace, and an open interface specification. The design and test data would be published so multiple manufacturers can bid; the buyer pays for uptime, not for the box.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A purpose-designed machine will achieve more than 90% scheduled uptime in district hospitals in sub-Saharan Africa, against a historical figure well below that for conventional linacs in the same settings, at a total ten-year cost of ownership at least 40% lower.
- Rationale: Every other capital good used in low-resource health systems (solar vaccine refrigerators, oxygen concentrators, GeneXpert) was eventually redesigned for the environment rather than shipped as-is. Radiotherapy has never had that redesign, despite the IAEA DIRAC database showing dozens of countries with one or zero working machines.
- Proposed test: Fund a two-year design phase with a published requirements document, then a three-site field trial (one machine each in three countries) measuring uptime, mean time to repair, dose accuracy audits by the IAEA, and patients treated per month against a matched conventional linac.
- Maturity: speculative
- Actor: engineering

## Sources

- IAEA DIRAC directory of radiotherapy centres: https://dirac.iaea.org/
- IAEA Rays of Hope: https://www.iaea.org/services/rays-of-hope

## Connected records

- fronts: [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/)
- companies: [Elekta](https://onco.cc/companies/elekta/), [United Imaging](https://onco.cc/companies/united-imaging/), [Varian (Siemens Healthineers)](https://onco.cc/companies/varian/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/)
- 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/)

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