The aim of the project was to compare the workflow for an Elekta Linac with and without the surfacescanning system Catalyst and describe pros and cons with both workflows. The findings in the reportcan be used as decision support in development of Elekta products and workflow improvements. The method for the project was to do interviews, observations and time measurements at Södersjukhuset(not using Catalyst) and Sundsvalls sjukhus (using Catalyst). The workflows were graded in an as-sessment protocol covering time efficiency, comfort, noise, resources, reliability, cost, dosage and sideeffects. Different workflow scenarios were simulated in AnyLogic. The result of the project was that, according to our protocol, the workflow with Catalyst was ratedhigher than without it. The simulations in Anylogic showed that minimizing gaps in the treatment sched-ule generated the same number of patients treated per day, if the positioning could not be done faster.The simulations also showed that removing position verification with cone beam computer tomography(CBCT), an imaging system which is used in addition to the Catalyst system, would increase the numberof treated patients with approximately 33%. The conclusion was that there were no great differences in time efficiency between the workflows. How-ever, considering the higher reliability and comfort for the patient, optical surface scanning can improvethe positioning for Elekta Linac and is therefore worth implementing. Minimizing treatment gaps wouldnot improve the workflow. Removing the use of CBCT would increase the number of treated patientsper day.

Title: International Services Marketing – A case study of Gammaknife surgery in Argentina Level: Final assignment for Bachelor Degree in Business Administration Author: Michael Eriksson Supervisor: Akmal Hyder Date: 2013 – May Aim: The aim of this study is to describe the internationalization process of services by looking at a Swedish healthcare service. The study has been performed before in different countries with distant cultures. By examining the service in Argentina it will be the first study of Gammaknife within a Latin-American context.   Method: The author wanted to get a deeper understanding of a contemporary phenomenon with no control over events. Therefore a qualitative case study was conducted. This was believed to be the only way to capture all nuances and get respondents viewpoint of the phenomenon. Result & Conclusions: The case shows how Elekta has successfully overcome many of the obstacles associated with internationalization of services by working together with INVAP. With that Elekta get access to INVAP’s extensive network and their high credibility in the local market generates trust for Elekta as well. Another main factor for Gammaknife surgery in Argentina is time. The first Gammaknife was installed in 1983 and the treatment is therefore well known by the public.   Suggestions for future research: Similar studies have been conducted of Gammaknife centers throughout the world. Next step in the research process is to compare the results from the different studies. Another topic for future research is a comparison of using a distributor or expand over borders with establishment of an own division Contribution of the thesis: This study provides insights in the internationalization process of services. It contributes with empirical findings on how issues related to intangibility and heterogeneity in marketing services internationally can be overcome.

Purpose: The purpose of this study is to comprehend and analyse the impact of national culture on leadership within the healthcare industry. Method: This is an exploratory research in which qualitative data have been used. Interviews have been held with employees at Elekta-Greece EPE, Athens in Greece. As for validity and reliability, the data for this study were collected from a real business case (Elekta) via Skype interviews and then the responses were transcribed and later analysed in relation to fundamental academic research in combination with our critical thinking. Findings & Conclusions: By conducting this study, we discovered that culture can play a major role in the leadership behaviour for companies that operate within the healthcare industry on a global scale. Both national and corporate cultures influence the leader(s) and the employees of a company, either in a positive or a negative way. Cultural attributes, background, history, policies, rules and regulations are some of the factors that can be a game „‟changer‟‟ for the leadership of international companies. Those characteristics can affect work performance, job satisfaction, and the image of the company. Finally our conclusions also suggest that there is a difference between other industries and healthcare industry because of the power structure and the rigidness of the last one. Originality & Value: This research is unique in its kind due to the fact that there is no similar case or literature that examines the impact of national culture on leadership for international healthcare companies, like Elekta. However, there has been some research conducted within this industry during the last years, covering the subject of marketing. Limitations & Future Research: The limitation of this research is that it is a single case study so it cannot represent and be reflected for the whole healthcare industry. Also we could not acquire raw data from the parent company so we based the comparison on the data from Elekta-Greece and secondary data for the parent company. As for further investigation we suggest the expansion of this topic by conducting more case studies, add more countries at the same time in order to be able to create results that can be generalized for a successful cultural leadership on health-care industry.

ABSTRACT Title: Services Marketing in a Cross-Cultural Environment – The Case of Elekta in Russia Level: Final assignment for Master Degree in Business Administration Authors: Alena Bazyleva and Maria Zaytseva Supervisor: Dr. Maria Fregidou-Malama Aim: The aim of this research is to investigate how the products and services of the Swedish company Elekta are marketed in Russia, a country with cultural environment different from Sweden. For this purpose such aspects of marketing strategy as adaptation/standardization, trust and network development, which help to decrease the influence of intangibility and heterogeneity of services, are examined. Method: In present research explanatory applied type of study was used to describe services marketing process. Combination of induction and deduction methods, and qualitative methods of research were used. Case study of Swedish company Elekta was chosen as the research area. Primary data was collected through survey by means of semi-structured interviews and open questionnaires. Secondary data was collected from sources such as relevant books, scientific articles, company brochure, and websites of company and its clients. Results and conclusion: The research reveals that trust, network building, balance of adaptation and standardization strategies, employed by Elekta company, help to overcome heterogeneity and intangibility of its services in Russian market. It has also been found that the image of Sweden as a country of origin plays an important role in trust establishment in Russia, but in a sense that it is a foreign country, not Sweden in particular. Moreover, it is suggested, that organizational structure of international company, matrix structure in this particular case study, favours the development and effectiveness of the discussed variables. In spite of such characteristics of Russian market as high bureaucracy, corruption, “blat” network, unstable laws, etc., this market is considered to be a promising emerging market for international business. Russian national culture displays large power distance, high uncertainty avoidance, collectivist and feminine values, which influence the whole society and the business sphere as well. Suggestions for future research: It would be beneficial for future research to expand the range of complementing studies, examining the cases of Elekta in different countries and emerging markets in particular. In addition, in order to develop international services marketing theory, it is necessary to include other services industries in the scope of research. Furthermore, getting feedback from the patients, who experienced treatment on Elekta equipment, can contribute to the future research. Contribution of the thesis: The modification and adaptation of the theoretical framework of Fregidou-Malama and Hyder (2011) made by authors of this study contributes to the theory of international services marketing process. In addition, as there is lack of research in this area for health care sector, this study can be valuable addition to this research area. Research of the case of Elekta in Russia complements the range of studies on international services marketing process in health care sector with the cases of Elekta company in different countries: Egypt, China, the Philippines, Brazil, Hong Kong. Besides, current research has certain practical value: it is beneficial for international companies expanding into emerging markets in general and in Russian market in particular. This research may help to increase awareness about Elekta treatment solutions. Key words: Elekta, Gamma Knife, Russia, Services Marketing, Services characteristics, Network, Trust, Adaptation, Standardization, Culture, Organizational structure.

Aim: The aim of this study is to investigate how relationships are built in a cross-cultural setting and to identify which interpersonal factors need to be taken into account to guarantee the successful creation of relationships.   Methodology: The method of this study follows a qualitative approach through the gathering of empirical data. The case of the healthcare equipment company Elekta is selected for data collection from employees of the Brazilian and Swedish office. Interviews have been conducted face-to-face and through videoconference tools. The selection of interviewees is based on the role of the individual within the company and the involvement in the market expansion from Sweden to Brazil. Secondary data from scientific articles and academic journals is compared and analyzed with primary data.   Findings: The establishment of relationships during an international market expansion is bounded to the cultural differences present between two parties. Among these differences language, communication, trust and local business practices play a role in the relationship building process. The use of local employees can reduce risks of an unknown market and give access to business networks. Relationships are essential for Brazilians and personal connections are more important than institutional relationships. Cultural differences should, however, not be completely adapted to the local market, since a mix of Brazilian and Swedish business practices has been shown to be advantageous. This is due to high reputation of the Swedish country of origin of Elekta and the favored Swedish business practices. Therefore, foreignness and cultural differences do not necessarily imply negative effects on relationship building, but can have a positive outcome on the development of trust.   Contribution: The study contributes to relational theories by providing new theoretical insight in the phenomenon of relationship building in a cross-cultural environment. It contributes to current academic studies, focusing on strategies to successfully conduct market expansions and establish physical presence in a foreign county. Furthermore, it gives new insight in relationship building practices in the healthcare sector. The study emphasizes the positive effect of culture in an international environment, which has been neglected in previous studies.   Limitations: Since cultural aspects play a large role in this study, findings are specific to the Latin American continent. Responses obtained during the interviews were a product of questions aimed to the specific geographical area, in regards to the healthcare sector. Therefore, including additional countries in a same sector study may result in dissimilar results.   Suggestions for further research: This research involves Brazil and Sweden as a cultural framework. Therefore, perception of the reputation of country origin and perception of cultural business practices may differ between other geographic locations. Further research should investigate on the differences of relationship building in other nations. This could give insight in positive and negative aspects perceived per country of another culture.

Any center planning to install a Gamma Knife radiosurgery unit has to provide for an efficient shielding of the treatment room, to protect the patient, the staff and the public, against undesired radiation. The shielding barrier design is controlled by national and international recommendations; the reference documents for gamma ray radiotherapy facilities are the National Council on Radiation Protection and Measurements (NCRP) reports 49 and 151. However, some facts highlighted in this thesis point out that NCRP methods are ill-adapted to the Gamma Knife. Spectroscopic measurements were performed around the Gamma Knife with a Germanium detector. They revealed that the radiation field contains few high energy photons, is highly anisotropic, and that the leakage level is much lower than the NCRP estimation. These observations led to the development of a new approach to determine the necessary shielding, based on the actual and directly measurable radiation field around the unit. This method would reduce the shielding oversizing induced by the unsuitability of the NCRP recommendations for the Gamma Knife.

Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Linear accelerators of high energy beams have been used to treat tumors in radiotherapy. Some questions about the protection of the patient and occupationally exposed workers have been arisen because high energy bundles generate scattered radiations that are undesirable in treatment. A possible radiation type generated due to the interaction of the beam with accelerator elements is the neutron, mainly fast neutrons. Such radiation can cause serious problems for patients besides cause damage to devices used by them. This work aims investigate the presence of fast neutrons around a mobile accelerator dedicated to intraoperative radiotherapy (IORT) using high energy electron beams. The aim is to detect the possible fast neutrons and further evaluate their distribution within phantom irradiated. For this study a mobile accelerator (LIAC), for electron beams, and a conventional accelerator (Elekta), for the photon beam, were used. Neutron measurements were made using bubble detectors (C-318) which are sensitive only to fast neutrons. In order to simulate the patient two polymethylmethacrylate (PMMA) phantoms, with a volume of 62 x 29 x 24 cm3 and 80 x 30 x 20 cm3, were used. Three detectors were positioned around the LIAC accelerator to measure the fast neutrons radiation generated by the accelerator elements. The measurements inside the phantom were made with three detectors positioned at three different depths, 5, 10 and 15 cm; 1, 5 and 10 cm. Moreover, two distances with respect to the central axis were chosen to the phantons irradiated by LIAC and Elekta: 0 and 4 cm; 0 and 30 cm, respectively. The results from the measurements around the LIAC demonstrate the abscense of fast neutrons. The results for both, LIAC and Elekta, showed that the dose of fast neutrons is mainly concentrated in the central axis and a decrease of 60% and 99%, respectively, in relation to off-axis doses. The highest values found for the different energies of 12, 10 and 8 MeV were 2.44, 1.14 and 0.59 uSv / Gy, respectively, for the LIAC. While the highest values for energies of 15, 10 and 6 MeV for Elekta were 2.98, 1.08 and 0.15 mSv/Gy, respectively. These results also showed the increasing ratio of dose to energy, both for Elekta and for LIAC. The relation between dose and depth also was discussed. It was found that in some cases the neutron attenuation increases with depth as expected while in others the ratio is not clear. The comparison between the doses established in each accelerator showed a difference around 10−3. The data presented in this work, therefore, demonstrate that the LIAC minimally generates fast neutrons within the phantom, when compared with the Elekta, and around were not detected for the LIAC. The neutrons generated by both accelerators presented similar behaviour within the phantom in relation to the energy variation, depth and central axis distance. / Aceleradores lineares de feixes de alta energia são utilizados para tratamento de tumores em radioterapia. Isso tem gerado algumas questões sobre a proteção do paciente e dos trabalhadores ocupasionalmente expostos, pois feixes de alta energia geram radiações espalhadas que são indesejáveis no tratamento. Uma das possíveis radiações geradas devido à interação do feixe com elementos do acelerador é o nêutron, principalmente nêutrons rápidos. Essa radiação pode causar sérios problemas para pacientes caso interajam com o mesmo e ainda podem causar danos a dispositivos utilizados pelo paciente. A proposta desse estudo foi investigar a presença de nêutrons rápidos ao redor de um acelerador móvel dedicado, LIAC, para radioterapia intraoperatória (RT-IO) que utiliza feixes de elétrons de alta energia. Busca-se detectar os possíveis nêutrons rápidos e ainda avaliar a sua distribuição dentro de objeto simulador irradiado. Para este estudo foram utilizados tanto um acelerador móvel (LIAC), para feixes de elétrons, quanto um acelerador convencional (Elekta), para feixe de fótons. As medidas dos nêutrons foram feitas utilizando detectores de bolhas (C-318) que são sensíveis apenas a nêutrons rápidos. Para simular o paciente foram utilizados dois phantons de polimetilmetacrilato (PMMA) com volume de 62 x 29 x 24 cm3 e 80 x 30 x 20 cm3. Em cada posição escolhida, três detectores foram posicionados ao redor do acelerador LIAC para medir a radiação de nêutrons rápidos que eram gerados pelos elementos constituintes do acelerador. As medidas dentro do phantom foram feitas com três detectores posicionados em três profundidades diferentes, 5, 10 e 15 cm; 1, 5 e 10 cm e duas distâncias em relação ao eixo central, 0 e 4 cm; 0 e 30 cm para os phantons irradiados pelo LIAC e Elekta, respectivamente. Os resultados das medidas ao redor do LIAC demonstraram a ausência de nêutrons rápidos. Os resultados tanto para o LIAC quanto para o Elekta mostraram que a dose de nêutrons rápidos é principalmente concentrada no eixo central do feixe e uma queda de 60%, a 4 cm do eixo, e 99%, a 30 cm do eixo, respectivamente. Os maiores valores encontrados para as diferentes energias de 12, 10 e 8 MeV foram 2,44, 1,14 e 0,59 uSvGy para o LIAC, respectivamente. Enquanto que os maiores valores para energias de 15, 10 e 6 MeV para o Elekta foi de 2,98, 1,08 e 0,15 mSVGy, respectivamente. Esses resultados ainda mostraram a relação crescente da dose com a energia, tanto para Elekta quando para LIAC. Outra relação que foi discutida é da dose com a profundidade, porque em alguns casos é nítida a atenuação de nêutrons com o aumento da profundidade e em outros não se demonstra tão regular. A comparação entre as doses estabelecidas em cada acelerador mostrou uma diferença em torno de 10−3. Os dados apresentados nesse trabalho, portanto, demonstram que o LIAC gera minimamente nêutrons rápidos dentro do phantom, se comparado com o Elekta, e ao redor do LIAC não foram detectados. O nêutrons gerados por ambos aceleradores apresentaram comportamento parecido dentro do phantom em relação a variação de energia, profundidade e distância do eixo central. / São Cristóvão, SE

The Leksell Gamma Knife® (LGK) is a device for performing radiosurgery. The LGK contains approximately 200 radioactive sources whose beams intersect in a focal point in order to treat brain tumours. Quality assurance tools are used at Elekta to indirectly assess the number of sources in an LGK from the total amount of radiation. In order to increase patient safety, regulatory agencies have been asking for evidential proof of the number of sources in the LGK. This thesis' goal is to directly measure each source in the LGK and optimize the total detection time. To do this, a source detection system was developed with two parts, a radiation detection system and a moving gantry. Initial tests of the design were performed at Elekta and a final test was performed on an LGK at Karolinska Universitetssjukhuset. The results show that the proposed design has the possibility of detecting all sources in an LGK.