2019, the number of cancer patients being treated with radiation therapy in the United States is estimated to be 1,148,900, according to IMV’s newly published 2019 Radiation Therapy Market Summary Report.  The use of radiation therapy to treat cancer patients is relatively stable, with the estimated number of patient cases increasing at an average annual rate of 2%.  The top three cancer types being treated using radiation therapy include breast, prostate, and lung cancer, which are performed by over 90% of the radiation therapy sites.

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.

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.

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 nearly 4,000 units in over 2,000 U.S. sites.  Key manufacturers include Accuray (which owns TomoTherapy), Elekta (including GammaKnife systems), and Varian.  Proton therapy systems comprise less than 1% of the total external beam therapy installed base, with 32 operational systems in the U.S., with Hitachi, IBA, Mevion, and Varian addressing this market.

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 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 doubled since 2010, to 24% of treatment plans.  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 its current 9%.

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 (with 81% of the units using), X-ray (60%), and electronic portal imaging devices (58%), and going forward, CT technology is most preferred by those planning purchases.  Other technologies being used for image guidance include on-board imaging (OBI), RF or electromagnetic transponders, ultrasound, and MRI.  Key IGRT manufacturers include Accuray, Brainlab, Elekta, Varian, Vision RT, and ViewRay.

With this continued use of imaging in all phases, 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 market research at IMV Medical Information Division, part of Science and Medicine Group.

IMV’s 2019 Radiation Therapy Market Summary 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 20 manufacturers providing hardware and software solutions for radiation therapy are covered in this report.

The data source for this report is IMV’s 2018/19 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, and includes contact and site-specific information.