Choosing a Linear Accelerator: The Evolving Landscape in 2025

Radiation therapy technology is advancing rapidly, with new linear accelerators (linacs) entering the market while industry leaders advance their systems. With so many options available, how can medical facilities make the best choice?

Despite new developments, the Varian TrueBeam remains the dominant platform in radiation oncology, continuing to set the standard for treatment delivery. Meanwhile, the market has undergone both consolidation and new competition, with emerging manufacturers introducing alternative platforms at varied price points.

Since we first explored this topic in our [2021 article], these shifts have reshaped the available options for clinics worldwide. With the global linear accelerator market expected to see continued growth, driven by technological advancements and expanding treatment accessibility, facilities must carefully evaluate both new and pre-owned options to meet evolving clinical needs.

 

To help navigate this landscape, we’ve created a linear accelerator comparison graph, which categorizes linacs by affordability and historical market presence. Affordability is determined by factors including cost of machine, installation, service, and maintenance. Historical Market Presence indicates how long a system or manufacturer has been available, reflecting its presence and adoption in the market.

This visualization helps facilities compare established industry leaders like Varian and Elekta with emerging companies like Akesis, Panacea, MagnetTX, and Linatech, offering insights into which systems have stood the test of time and which are new contenders in the market.

TrueBeam: The Established Leader

The Varian TrueBeam continues to strengthen its position as the standard of care in radiation therapy. The latest TrueBeam Version 4.1 brings significant enhancements to this proven platform, including:

• Gated CBCT — captures images precisely during treatment to reduce motion blur.
• RapidArc Dynamic — improves treatment planning and dose calculation by up to 70% with advanced algorithms.
• HyperSight Imaging — enhances image clarity with better contrast and fewer artifacts for more precise tumor targeting.

With extensive clinical evidence, a comprehensive feature set, and a proven track record of reliability, the TrueBeam platform remains the preferred choice for many facilities. The upgrade path to Version 4.1 also allows existing users to access new technology without replacing their entire system.

Halcyon: Streamlined Efficiency in Radiation Therapy

While TrueBeam remains the flagship platform for advanced treatments, Varian’s Halcyon system is designed to simplify and optimize radiation therapy, making high-quality treatment more efficient and accessible.

• Quick setup and training — enables clinics to begin treating patients within weeks of installation.
• Built-in image guidance — enhances accuracy by ensuring precise tumor targeting.
• Streamlined design — simplifies patient setup and enhances workflow efficiency.

Halcyon’s automation and efficiency helps clinics treat more patients while maintaining accuracy and quality.

Ethos: AI-Powered Adaptive Therapy

Varian’s Ethos system uses artificial intelligence (AI) to adjust treatment plans in real time, adapting to patient changes during each session.

• AI-driven adaptive therapy — refines plans instantly for greater precision.
• Efficient workflow — enables adaptive therapy within a standard treatment slot.

Ethos enhances personalization while maintaining speed and accuracy in radiation therapy.

Other Major Players in the Market

Alongside Varian, Elekta maintains a strong global market presence, with an overall market share of 42%. Their Versa HD platform remains particularly popular, offering:

• High-dose-rate beam delivery
• Sophisticated motion management features
• Advanced treatment modalities

Meanwhile, new FDA-cleared entrants are now offering modern capabilities at varied price points, expanding the competitive landscape.\

Linatech VenusX — treats some cases in under 5 minutes allowing for 120-160 patients per day.

Panacea Medical Technologies Siddharth II — offers the widest gantry opening in the industry at 1.5 meters and soft lighting to enhance patient comfort.

Akesis Gemini360RT — designed to treat almost all radiotherapy patients within a single system.

MRI and PET Guided Systems: The Next Generation of Adaptive Therapy

The integration of advanced imaging with radiotherapy is enhancing precision in ways never seen before. MRI-guided systems improve soft tissue visualization, while PET-guided therapy enables real-time biological targeting of tumors. These systems provide real-time tumor tracking, enabling adaptive therapy to respond to motion and biological changes during treatment.

MRI-Guided Linacs

MRI-guided linear accelerators provide real-time, high-resolution imaging, allowing clinicians to track soft tissue changes and adapt treatment during each session. The Elekta Unity delivers 1.5T MR imaging, even while the gantry rotates, ensuring precise adaptive treatments. Similarly, the MagnetTx Aurora RT features an extra-large bore, offering flexibility to treat a wide range of tumors with MRI-guided radiation therapy.

PET-Guided Radiotherapy

PET-guided radiation therapy takes a biological approach to targeting cancer by using real-time tumor emissions to guide radiation delivery. This method allows for highly adaptive treatments that respond to tumor motion and metabolic activity. The RefleXion X1, powered by SCINTIX® technology, is the first PET-guided linear accelerator, using tumor emissions to automatically adjust radiation delivery in real time. This enables the simultaneous treatment of multiple tumors, making it particularly beneficial for metastatic disease.

As MRI and PET-based technologies continue to evolve, they have the potential to broaden the role of adaptive radiotherapy, making treatment more precise, personalized, and responsive to individual patient needs.

Market Growth and Future Trends

The global medical linear accelerator market continues to expand, driven by technological advancements, increasing cancer incidence, and broader access to radiation therapy worldwide. According to the Medical Linear Accelerator Global Market Report 2025 by The Business Research Company, the market is projected to grow from $3.69 billion in 2024 to $5.54 billion by 2029, reflecting a compound annual growth rate (CAGR) of 8.5%.

However, meeting future demand will require significant investment in radiotherapy infrastructure. A recent study published in The Lancet Oncology and covered by DOTmed estimates that over 16,000 new Linacs will be needed by 2045 to close the global treatment gap, with the greatest shortages in low- and middle-income countries. The study highlights the need for $123.9 billion in investment to install and replace aging systems, emphasizing the urgency of expanding radiotherapy access worldwide.

As more treatment centers seek cost-effective solutions, both new and pre-owned linear accelerators are expected to play a critical role in bridging this gap. While newer systems offer advanced imaging, adaptive therapy, and AI-driven treatment planning, pre-owned linacs provide affordable and reliable alternatives, allowing facilities to increase treatment capacity without significant capital investment.

Ultimately, expanding access to radiation therapy will depend on sustained investment, technological advancements, and strategic deployment of new and refurbished equipment to ensure cancer patients worldwide receive the care they need.

Legacy Systems and Pre-Owned Linacs: Delivering Value and Cost Savings

While newer technologies dominate industry discussions, many facilities still rely on proven, pre-owned linacs to meet clinical and budgetary needs. Systems like the Varian Clinac iX, Trilogy, and TrueBeam, as well as Elekta Synergy, Infinity, and VersaHD, continue to play a vital role in treatment delivery.

• Supports IMRT, IGRT, VMAT, and other advanced modalities.
• Offers reliable performance — trusted by radiation oncology centers worldwide for standard radiotherapy needs.
• Provides cost-effective solutions — savings of 30-70% compared to new linacs allow facilities to allocate funds elsewhere.
• Shortens installation timelines — readily available equipment means faster deployment and minimal downtime.
• Remains manufacturer-serviceable — many refurbished linacs, including TrueBeam, Trilogy, and iX models, can still be supported by OEMs like Varian after passing a System Performance Audit (SPA).

For facilities looking to expand services, manage costs, or add backup treatment capacity, pre-owned linacs remain a financially viable and proven alternative.

Making the Right Choice for Your Facility

With a growing number of new and pre-owned linac options, healthcare providers must carefully evaluate their needs. Clinical capabilities, patient volume, infrastructure requirements, and long-term costs all play a role in determining the right system. Service and support availability — whether through OEM or third-party providers — is also essential for long-term reliability.

The radiation therapy market continues to evolve. The Varian TrueBeam and Varian Halcyon remain the industry standard, while platforms like Aurora RT, Gemini360RT, and VenusX introduce new treatment approaches at varying price points. Refurbished linacs offer a proven, cost-effective alternative — delivering advanced treatment capabilities at a fraction of the cost of new systems.

Choosing the right linac is a major decision that impacts patient care, clinical efficiency, and long-term costs. Whether you’re evaluating new systems, considering a pre-owned linac, or exploring service options, our team at Radiology Oncology Systems (ROS) can help you find the best solution for your facility. Contact a radiation oncology equipment specialist today to discuss your needs.