# Linac, proton system and brachytherapy machine manufacturing

Source: https://onco.cc/technologies/radiotherapy-equipment-manufacturing/  
OnCo record `radiotherapy-equipment-manufacturing` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Radiotherapy machines are built by a very small number of companies. Two of them make most of the world's linear accelerators, a handful build proton systems, and installing, commissioning and servicing a machine is as much a part of the supply chain as building it.

## Summary

A medical linear accelerator is a factory product: a waveguide and magnetron or klystron, a bending magnet and target, a multileaf collimator with over a hundred motorised tungsten leaves, kilovoltage and megavoltage imaging panels, a treatment couch and the control and record-and-verify software, assembled and tested over weeks and then installed in a shielded bunker and commissioned by physicists for months. Varian (part of Siemens Healthineers, headquartered in Palo Alto with manufacturing there and in Beijing) and Elekta (Stockholm, with its linac factory in Crawley, England, and a plant in Beijing) build most of the world's linacs; Accuray builds TomoTherapy and Radixact in Madison, Wisconsin, and CyberKnife, with a joint venture in Chengdu for the Chinese market; Chinese makers such as Shinva and United Imaging are growing at home. Elekta's Unity and ViewRay's MRIdian created the MR-linac category, and RefleXion adds PET guidance. Brachytherapy afterloaders come from Elekta (Flexitron) and Varian (BRAVOS), with iridium-192 and cobalt-60 sources from a few source makers; cobalt-60 teletherapy units, still important where linacs cannot be serviced, come from Best Theratronics in Ottawa.

Proton and heavy-ion systems are a separate industry of cyclotrons and synchrotrons, gantries and pencil-beam scanning nozzles: IBA in Louvain-la-Neuve (the largest installed base), Hitachi in Japan, Varian's ProBeam built in Troisdorf, Germany, Mevion's single-room synchrocyclotron in Littleton, Massachusetts, Sumitomo Heavy Industries, ProTom, and newer upright-treatment designs from Leo Cancer Care and P-Cure. Supply constraints are less about factory volume than about capital cost, bunkers, trained physicists and service networks: the IAEA's DIRAC directory shows most low-income countries with a handful of megavoltage machines or none, a gap covered in the radiotherapy access record. Machine and software recalls are published in the FDA device recall database and equivalent national registers, and are recorded here only as a class.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-17
- Tags: manufacturing-wave
- Principle: Low-volume, high-precision assembly of accelerators, collimators, imaging and control software, followed by site installation, commissioning and lifelong servicing.
- Since: 1953
- Strengths: Mature, reliable machines with long service lives; Competition on software and imaging rather than the beam; Upright and compact designs are cutting proton costs
- Limitations: Duopoly in linacs and few proton vendors; Installation and physics staff limit deployment more than production; Service contracts and parts keep machines alive or not

## Sources

- IAEA DIRAC: directory of radiotherapy centres: https://dirac.iaea.org/
- FDA medical device recalls database: https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfres/res.cfm
- Wikipedia: https://en.wikipedia.org/wiki/Linear_particle_accelerator#Medical_linacs

## Connected records

- fronts: [Devices & Physical Therapies](https://onco.cc/fronts/devices/), [Radiation Therapy](https://onco.cc/fronts/radiation/)
- technologies: [Brachytherapy](https://onco.cc/technologies/brachytherapy/), [Cobalt-60 teletherapy](https://onco.cc/technologies/cobalt-60-teletherapy/), [CT, MRI and PET scanner manufacturing](https://onco.cc/technologies/medical-imaging-scanner-manufacturing/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [MR-guided adaptive radiotherapy](https://onco.cc/technologies/mr-linac/), [Proton therapy](https://onco.cc/technologies/proton-therapy/), [Radiotherapy access and the global machine gap](https://onco.cc/technologies/radiotherapy-access-gap/), [Radiotherapy treatment planning and QA software](https://onco.cc/technologies/treatment-planning-systems/), [Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS)](https://onco.cc/technologies/radiosurgery-srs/)
- companies: [Accuray](https://onco.cc/companies/accuray/), [Brainlab](https://onco.cc/companies/brainlab/), [Elekta](https://onco.cc/companies/elekta/), [Hitachi (particle therapy)](https://onco.cc/companies/hitachi/), [IBA (Ion Beam Applications)](https://onco.cc/companies/iba/), [Leo Cancer Care](https://onco.cc/companies/leo-cancer-care/), [Mevion Medical Systems](https://onco.cc/companies/mevion/), [P-Cure](https://onco.cc/companies/p-cure/), [RefleXion Medical](https://onco.cc/companies/reflexion/), [Siemens Healthineers](https://onco.cc/companies/siemens-healthineers/), [Sun Nuclear (Mirion)](https://onco.cc/companies/sun-nuclear/), [United Imaging](https://onco.cc/companies/united-imaging/), [Varian (Siemens Healthineers)](https://onco.cc/companies/varian/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)

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