{"entity":{"id":"idea-acc-modern-cobalt-bridge","kind":"idea","name":"Modernised cobalt-60 machines as a deliberate bridge where linacs cannot be kept running","aka":[],"tldr":"In places where sophisticated machines break down, a modern version of the older cobalt radiotherapy unit, upgraded with image guidance, could treat more people reliably while infrastructure catches up.","summary":"Cobalt-60 teletherapy units are mechanically simple, tolerate power instability, and need far less maintenance than linacs, but were abandoned in rich countries because of inferior beam characteristics and source-security concerns. A modernised unit with a multileaf collimator and cone-beam image guidance, with secure source logistics through the IAEA, might deliver adequate conformal treatment for common indications. This is controversial and must be tested rather than assumed.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Most of the world has almost no cancer care): WHO fact sheet, Cancer","url":"https://www.who.int/news-room/fact-sheets/detail/cancer"}],"tags":[],"related":[],"cancers":["cervical"],"sections":["radiation"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-global-access","b-surgery-radiation-innovation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"For cervical, breast, and palliative indications, plans from a modernised cobalt unit will meet contemporary dose-constraint standards in at least 90% of cases, and unit uptime will exceed 95% in settings where linac uptime is under 70%.","rationale":"Appropriate technology beats the best technology if the best is switched off. The dosimetric gap between cobalt and 6 MV photons is modest for many pelvic and breast targets, and the maintenance gap is large.","test":"A planning study comparing cobalt-MLC and linac plans on 200 anonymised LMIC treatment scans against agreed constraints, followed by a two-site operational pilot measuring uptime and treatment completion.","maturity":"speculative","actor":"engineering","cost":"medium","horizonYears":4},"route":"/ideas/idea-acc-modern-cobalt-bridge/","neighbours":{"cancer":[{"id":"cervical","kind":"cancer","name":"Cervical cancer","route":"/cancers/cervical/"}],"section":[{"id":"radiation","kind":"section","name":"Radiation Therapy","route":"/fronts/radiation/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-surgery-radiation-innovation","kind":"bottleneck","name":"Surgery and radiotherapy cure most, get least","route":"/bottlenecks/b-surgery-radiation-innovation/"}]}}