IMV: Imaging boosts precision in radiation therapy

By Lorna Young, contributing writer

October 17, 2019 -- Radiation therapy is a relatively stable market, with procedure volume growing at an average annual rate of 2%. But major technological changes in radiation oncology are brewing under the surface, such as the growing use of imaging, according to a new report by IMV Medical Information Division.

In 2019, the number of cancer patients being treated with radiation therapy in the U.S. 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%.

Lorna Young
Lorna Young of IMV Medical Information Division.

The top three types of cancer being treated using radiation therapy include breast, prostate, and lung cancers, which are performed by over 90% of the radiation therapy sites and together comprise almost three-fifths of the total courses of treatment.

IMV's report provides a department-wide view of the key radiation therapy technologies used in treating cancer patients, including external-beam radiation therapy equipment, image-guided radiation therapy (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, the technology is continuing to advance to improve precision and accuracy in treating cancer patients. In particular, imaging technology has been adopted for all patient management phases, not only to diagnose where cancer is but also to direct treatment planning, simulate 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 primary imaging tool for treatment planning, simulation, and image guidance, surpassing x-ray. 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, as well as the newest technology platform, proton therapy.

The installed base of all types of external-beam therapy systems is estimated to be 3,850 units at 2,265 sites in the U.S. Key manufacturers include Accuray (which sells the TomoTherapy system), Elekta (including Gamma Knife systems), and Varian Medical Systems. Proton therapy systems comprise less than 1% of the total installed base of external-beam therapy systems, with 32 operational systems in the U.S. This market is addressed by Hitachi, IBA, Mevion, and Varian.

Treatment planning

For treatment planning, virtually all the radiation therapy sites in the IMV survey 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, the use of MR images has doubled since 2010 to 24% of treatment plans, thanks to the modality's ability to identify tumors without the use of ionizing radiation. The key manufacturers being considered for future treatment planning system purchases include Accuray, Brainlab, Elekta, Philips Healthcare, 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 Medical Systems, GE Healthcare, 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 radiation therapy

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 conebeam CT (used by 81% of the units), x-ray (60%), and electronic portal imaging devices (58%). Going forward, CT technology was most preferred by those in the IMV survey who are planning purchases.

Other technologies being used for image guidance include on-board imaging (OBI), radiofrequency (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 radiation oncology sites in the IMV survey indicated that 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 the 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 nonhospital sites performing radiation therapy in the U.S. This database can be separately licensed by qualified subscribers and includes contact and site-specific information.

For information about purchasing IMV's "2019 Radiation Therapy Market Summary Report" or IMV's 2018/19 Radiation Therapy Census Database, visit the corporate website at or call 773-778-3080 to speak with a representative.

Disclosure notice: IMV Medical Information Division is a sister company of

Copyright © 2019

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