As mentioned in our October 27, 2020 blog, radiation therapy patient volume has remained relatively stable throughout 2020, bucking a trend seen in diagnostic radiology, in which the COVID-19 pandemic has led to major drops in imaging exam volume, according to IMV’s recent 2020 Radiation Therapy Market Summary Report.

For 2020, an estimated 1,062,600 cancer patients will be treated with radiation therapy in the United States. Since 2006, the use of radiation therapy to treat cancer patients has been relatively stable, with the estimated number of patient cases increasing at an average annual rate of 1%.

The top three cancer types being treated using radiation therapy have consistently been breast, prostate, and lung cancer, which are performed by over 90% of the radiation therapy sites, and which together comprise almost three fifths of the total courses of treatment. Although the relative order of the cancer types treated using radiation has been consistent over the past decade, the proportion of radiation therapy courses of treatment for prostate cancer has increased since 2013 from 18% to 22% of patients.

While radiation therapy is a relatively stable market, medical technology is continuing to advance to improve the precision and accuracy in treating cancer patients. In particular, imaging technology has been adopted for all patient management phases, not only to diagnose where the cancer is, but for treatment planning, simulating the treatment plan, and more recently, for image guidance during the radiation therapy treatments. In this report, IMV sees that over the past decade, CT technology has become the #1 imaging tool for treatment plans, simulation, and image guidance, surpassing x-ray, and the field is continuing to grow with the adaptation of other imaging technologies, including PET, MRI, and ultrasound.

Although the COVID-19 pandemic has impacted the 2020 capital budgets for radiation therapy equipment, it is likely that investments are being shifted to 2021-2022. Going forward, a higher 25% of the sites are planning to have capital budgets of $1 million or more in 2021 and 2022, compared to the current 18% of 2020 budgets.

IMV’s report provides a department-wide view of the key radiation therapy technologies used in treating cancer patients, including external beam therapy equipment, image-guided radiotherapy (IGRT), brachytherapy equipment, treatment planning systems, simulators (X-ray, CT, PET, and MRI), and oncology information systems.

External Beam Therapy Equipment

The center stage for radiation therapy treatments takes place with external beam therapy technology, which includes traditional linear accelerators plus Gamma Knife, CyberKnife, and TomoTherapy configurations, and the newest technology platform, proton therapy. The installed base of all types of external beam therapy systems is estimated to be 3,770 units in 2,280 sites in the United States. Going forward, interest in buying external beam treatment systems from 2020 to 2022+ is relatively positive, with nearly half of the radiation therapy sites “Yes” or “Maybe” planning to purchase replacement or additional systems.

Key manufacturers include Accuray (which owns TomoTherapy), Elekta (including GammaKnife systems), and Varian, which has been the dominant manufacturer of linear accelerators. Siemens exited the linear accelerator business in 2012, but is planning to re-enter the radiation therapy market, having announced plans this August to acquire Varian, with the deal expected to close in the first half of 2021.

Treatment Planning

For treatment planning, virtually all the radiation therapy sites use CT technology in some portion of their treatment plans. However, due to the ability of PET imaging to identify the extent and change in the metabolism of tumor cells, the use of PET images in treatment planning has more than doubled over the past decade to about 30% of treatment plans. In addition, with the ability of MRI technology to identify tumors without the use of ionizing radiation, the use of MR images has also doubled since 2010. The key manufacturers being considered for future treatment planning system purchases include Accuray, Brainlab, Elekta, Philips, RaySearch, Varian and ViewRay.


Prior to a patient being treated using radiation therapy, their treatment plans are simulated using simulator hardware and virtual simulation software applications. Regarding the simulation hardware, CT simulators have substituted for x-ray technology, which used to be dominated by Varian and Elekta (including Nucletron). The traditional CT scanner providers are now the key providers of simulator hardware, including Canon (which owns Toshiba), GE, Philips, and Siemens. Meanwhile, PET/CT simulators are increasingly being used, growing from 1% of the simulator installed base to over 10%.


Image Guided Radiotherapy (IGRT)

The real-time use of imaging technology to guide radiation therapy treatments has increased dramatically over the past 15 years, rising from 15% of the sites using IGRT technology as of 2004 to over 90% of the radiation therapy sites. Of the current IGRT installed base, the top three types of image guidance systems used are CT or cone beam CT, electronic portal imaging devices, X-ray, and surface guidance (SGRT). Going forward, CT technology is the most preferred by those planning IGRT purchases. Key IGRT manufacturers include Accuray, Brainlab, Elekta, Varian, Vision RT, and ViewRay.


Record & Verify and Oncology Information Systems

Virtually all the radiation therapy sites have some type of record & verify or oncology information system installed. The top data types available on such systems are scheduling capabilities, images, electronic medical records (EMR), and billing records. Key information system manufacturers used by the radiation therapy sites include Accuray, Elekta, Epic, and Varian.

With this continued use of imaging in all patient management phases for cancer patients, almost two thirds of the RT sites indicate they currently have an image management system to network their treatment planning, simulation, and therapy systems, which has increased from about one third of the sites as of IMV’s 2011 census survey.




Lorna Young is senior director of imaging insights at IMV Medical Information Division, part of Science and Medicine Group.

The data source for IMV’s 2020 Radiation Therapy Market Summary Report is IMV’s 2020/2021 Radiation Therapy Census Database, which provides comprehensive profiles of hospital and non-hospital sites performing radiation therapy in the United States. This database can be separately licensed by qualified subscribers.

IMV’s 2020 Radiation Therapy Market Summary Report is based on interviews with respondents from over 430 radiation therapy departments/facilities who participated in IMV’s nationwide survey in February-August 2020, and the results are projected to the universe of 2,280 hospitals and non-hospitals that perform radiation therapy in the United States.

This report monitors trends over the past decade in the top cancer types treated with radiation, patient volume, installed equipment, market share, and technology adoption rates, as well as future plans for acquiring and using such technologies. Over 25 manufacturers providing hardware and software solutions for radiation therapy are covered in this report.

For information about purchasing IMV’s 2020 Radiation Therapy Market Summary Report and IMV’s 2020/21 Radiation Therapy Census Database, please call 773-778-3080 to speak with a representative.