Varian Executive Partnership "VEP"

[firewicket]

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Appears to be Varian sweeping in and taking over everything...

Anyone have any experience with this VEP?

Shoot:

 

[Neuronix]

What is it?

 

[firewicket]

Well. It appears to be a new concierge service being provided by Varian.

Courts major hospital corporations for long term contracts with hardware/linac/treatment machine/software replacement timeline.

They swoop in on administrators who know nothing of radiation oncology, then teaches the administrators what they need to purchase. (thus the "Executive Partnership"

Quite a business model.

 

[Fpg1245]

And yet I don’t see them sponsoring clinical trials to help expand sales of their wares

 

[Neuronix]

They have gotten really tight on funding, and what little they give out only seems to go to long-term Varian yes-men.

 

[Fpg1245]

They have gotten really tight on funding, and what little they give out only seems to go to long-term Varian yes-men.

Is there financial situation getting worse? I understand Siemens bought them so maybe that’s where the cost cuts are coming from.

 

[Palex80]

I understand Siemens bought them so maybe that’s where the cost cuts are coming from.

I have had experience with Siemens with my current and previous employers, and this kind of tactic (binding customers with multi year contracts, including a comprehensive service deal) is something Siemens has been doing for quite some time now.
I think they are infusing this tactic now to Varian. I have even heard of hospitals now getting one service contract for all their machines (Siemens & Varian), basically a flatrate that covers all your service costs for all your machines, instead of actually getting individual contracts per machine.

 

[Gfunk6]

Hardware is slowly dying field. The cost of the machines and maintenance is ever rising, while reimbursement for using it is ever dropping. Thus, Varian has long-since realized that relying on hardware to make profit is a losing proposition. They have therefore expanded into software (not selling it but licensing it so that profts are always there) and professional services (including Dosi, Physics and more recently Therapy). They hire these guys then charge a premium for profit. Leasing Software and People from them have annual price increases that (at a minimum) keep place with inflation.

A lot of existing Rad Onc places are starting to get pissed because staff are quitting, getting hired by Varian, and (in some cases) being re-assigned to their old practies at increased cost.

 

[firewicket]

Personally. Unimpressed. Clear money grab.

 

[BobbyHeenan]

Varian badly needs a competitor but Elekta just seems always a few years behind. Everything so clunky and two steps elekta to one step Varian to accomplish many tasks. From on board imaging to a treatment table to customer service, Elekta just in my experience can’t seem to step it up. We have both machines in our system and watching them head to head you can tell Elekta is behind.

I hope Elekta gets it together though, because Varian is getting worse in many ways (like this thread) with the money grabs. …their slant toward “renting” these treatment planning upgrade software algorithms seems…ugh.

 

[medgator]

Varian badly needs a competitor but Elekta just seems always a few years behind. Everything so clunky and two steps elekta to one step Varian to accomplish many tasks. From on board imaging to a treatment table to customer service, Elekta just in my experience can’t seem to step it up. We have both machines in our system and watching them head to head you can tell Elekta is behind.

I hope Elekta gets it together though, because Varian is getting worse in many ways (like this thread) with the money grabs. …their slant toward “renting” these treatment planning upgrade software algorithms seems…ugh.

Elekta can be very competitive on linac pricing but all of the other hassles that go with it still make varian the obvious choice for most clinics

Essentially a de facto monopoly

 

[ramsesthenice]

Varian badly needs a competitor but Elekta just seems always a few years behind. Everything so clunky and two steps elekta to one step Varian to accomplish many tasks. From on board imaging to a treatment table to customer service, Elekta just in my experience can’t seem to step it up. We have both machines in our system and watching them head to head you can tell Elekta is behind.

I hope Elekta gets it together though, because Varian is getting worse in many ways (like this thread) with the money grabs. …their slant toward “renting” these treatment planning upgrade software algorithms seems…ugh.

Elekta is a funny company. They have put 100% of their efforts into the unity and just let the Versas languish. We have Versas at main and True Beams at our satellites and the difference is huge. But it doesn’t need to be. The lowest hanging fruit is the damn kV imager. Their abdominal and pelvic CBCTs are barely serviceable due to artifact susceptibility. You fix that one issue, the machines become a good bit more comparable (for the MD experience at least). But nope. They decided getting a gaiting system for the unity was more important. Now focused on other Unity upgrades.

Now let’s talk business 101 here. If you have roughly 15% of their market share, the easiest path to growth is to expand your share. If you had to choose between an MR Linac or a VMAT/SBRT capable CT based machine maximize your market share, which one would you prioritize?

 

[TheWallnerus]

Elekta could make a 1 or 2 MV unit, sell it for 750K, and dunk on Varian/Siemens. At least for a brief moment in time.

 

[BobbyHeenan]

Elekta can be very competitive on linac pricing but all of the other hassles that go with it just still make varian the obvious choice for most clinics

Essentially a de facto monopoly

Agree completely. That’s been my experience.

Elekta is a funny company. They have put 100% of their efforts into the unity and just let the Versas languish. We have Versas at main and True Beams at our satellites and the difference is huge. But it doesn’t need to be. The lowest hanging fruit is the damn kV imager. Their abdominal and pelvic CBCTs are barely serviceable due to artifact susceptibility. You fix that one issue, the machines become a good bit more comparable (for the MD experience at least). But nope. They decided getting a fairing system for the unity was more important. Now focused on other Unity upgrades.

Now let’s talk business 101 here. If you have roughly 15% of their market share, the easiest path to growth is to expand your share. If you had to choose between an MR Linac or a VMAT/SBRT capable CT based machine maximize your market share, which one would you prioritize?

YES!

Nearly my identical experience/thoughts. Make the imaging better and clean up the therapists interface/work flow/speed. The plans are fine and reliability/down time has been fine too.

 

[Palex80]

Elekta is basically running a monopoly with their MR-Linac. The only issue is, that data on superiority of MR-Linac over modern VMAT is still lacking. We only have a few trials that were run by Viewray and even those have ... debateable results.

Personally, I feel that adaptive treatment based on CBCT (as Varian already offers it) or CT (as Accuray is introducing it), will be a stronger selling argument and more easy to introduce into clinics.

 

[BobbyHeenan]

Elekta is basically running a monopoly with their MR-Linac. The only issue is, that data on superiority of MR-Linac over modern VMAT is still lacking. We only have a few trials that were run by Viewray and even those have ... debateable results.

Personally, I feel that adaptive treatment based on CBCT (as Varian already offers it) or CT (as Accuray is introducing it), will be a stronger selling argument and more easy to introduce into clinics.

I agree, though I think the MRI linac platform/AI/tx planning has a few years runway here to make it quicker which will increase clinic scalability/utility. I do think there are some good cases for the MRI linac/adaptive, but when I took a deep dive it seems to me the reimbursement numbers just don't work unless it gets quicker/can treat more patients AND you get paid for a new plan every fraction when you adapt.

 

[ramsesthenice]

Elekta is basically running a monopoly with their MR-Linac. The only issue is, that data on superiority of MR-Linac over modern VMAT is still lacking. We only have a few trials that were run by Viewray and even those have ... debateable results.

Personally, I feel that adaptive treatment based on CBCT (as Varian already offers it) or CT (as Accuray is introducing it), will be a stronger selling argument and more easy to introduce into clinics.

None of this is data driven. Do you think the negative prostate proton trial will slow down proton expansion or stop places that have them from saying it’s a more precise treatment that can avoid their bowel better? I don’t.

On average, you can expect (at this point in time at least) to collect around 1.5x on the MR compared to a traditional linac with CBCT. So, if you have a very efficient group and treat 14 per day (which we do), it will collect closer to what 20 would on a versa or true beam. Which…is not even close to capacity on one of those. It’s not to say they can’t be profitable. But over the last 5 years, my experience has proven to me that until reimbursement for adaptive therapy increases, the actual earning potential (unit revenue X max throughput) is higher with a standard accelerator.

These are 80% marketing. Yes, I am able to treat some complex cases with this that I otherwise would pass on. Do I treat 14 of those a day? Not even close. On average, 2-3 fall into that category. A couple are things I could do on a standard machine but are technically easier on the MR (panc SBRT, etc). The rest are SBRTs including prostate. In my defense, the image quality on a versa in the pelvis is borderline passable for prostate SBRT. If there is any air in the rectum…forget it. If I had a TrueBeam, that’s where I would put most of them.

 

[HolySmokes]

Nearly my identical experience/thoughts. Make the imaging better and clean up the therapists interface/work flow/speed. The plans are fine and reliability/down time has been fine too.

Add to that Monaco is a dumpster fire, offline image review in MOSAIQ is punitively slow, having to use a Hexapod bridge for 6Dof is archaic, and who decided to make the imaging panels fold IN?

I do like that they have 5mm MLCs through the entire field and it's nice that you can theoretically use the same collimator angle for arcs.

 

[BobbyHeenan]

Add to that Monaco is a dumpster fire, offline image review in MOSAIQ is punitively slow, having to use a Hexapod bridge for 6Dof is archaic, and who decided to make the imaging panels fold IN?

I do like that they have 5mm MLCs through the entire field and it's nice that you can theoretically use the same collimator angle for arcs.

YES.

The hexapod bridge and really pushing everything into Monaco is an issue.

We are really happy with eclipse , so even though the price is right there is so much friction to even think about going more to Elekta when that also includes a change (for the worse IMO) on the planning side too.

 

[medgator]

YES.

The hexapod bridge and really pushing everything into Monaco is an issue.

We are really happy with eclipse , so even though the price is right there is so much friction to even think about going more to Elekta when that also includes a change (for the worse IMO) on the planning side too.

Exactly our calculus to stick with varian despite the much higher price tag.

The value is in the software, not the hardware (like most things.. Apple, Tesla etc)

 

[ramsesthenice]

Add to that Monaco is a dumpster fire, offline image review in MOSAIQ is punitively slow, having to use a Hexapod bridge for 6Dof is archaic, and who decided to make the imaging panels fold IN?

I do like that they have 5mm MLCs through the entire field and it's nice that you can theoretically use the same collimator angle for arcs.

Oh Monaco. This epitomizes my issues Elekta. Spend just a little bit of time with it, and you will begin asking yourself questions such as, did they include a single dosimetrist in the development process? We've been using it for the Unity for years and its a serviceable program once your whole team gets used to its "peculiarities". But it takes way longer than it should because so many things about its interface are just...odd.