Report Highlights

Analyst Findings and Recommendations

Finding 01 — Tungsten sourcing exposure: Multileaf collimators and radiation shielding depend on tungsten, and China's February 2025 export controls on the metal forced American linear accelerator makers to requalify non-Chinese supply. Hospital vault schedules absorb these delays for twelve months or more.

Finding 02 — Proton capacity overbuilt: The U.S. hosts more than 40 proton therapy centers, yet photon-based intensity-modulated treatment still delivers most courses at lower capital cost. Expansion will shift toward compact, lower-cost systems rather than new large facilities.

Analyst Recommendation — Lock component contracts early: Hospital system procurement heads should secure multi-year linear accelerator service and component contracts before Q4 2026, when Section 232 medical equipment tariff outcomes will reset landed costs for European and Japanese imports.

The United States' Role in the Global Radiotherapy Supply Chain

The United States sits at the centre of the global radiotherapy supply chain as the largest end market and the home base for accelerator design, treatment-planning software, and clinical intellectual property. Varian Medical Systems, now part of Siemens Healthineers, anchors primary linear accelerator development in Palo Alto, California. Assembly and high-value subsystems draw heavily on European and Japanese suppliers, including RF klystrons and gantry drives, while Canadian-origin cobalt-60 sources supply teletherapy units.

Export value runs in a different direction for advanced platforms. Mevion Medical Systems in Littleton, Massachusetts, and Accuray's CyberKnife and TomoTherapy lines from Sunnyvale, California, ship proton and precision photon systems to Asia, the Middle East, and Latin America. The United States remains a net importer of finished HTS 9022 radiation apparatus overall, while its exports concentrate in proton platforms and software.

Growth Drivers for U.S. Radiotherapy Trade and Production

Cancer incidence is the primary volume driver. The American Cancer Society projects more than 2 million new cancer diagnoses in 2025, and a large share of those patients require external beam treatment. This demand sustains replacement cycles for aging linear accelerators across more than 2,000 U.S. radiation oncology facilities, lifting import volumes of finished systems and subassemblies.

Domestic production is expanding as OEMs move final assembly and subsystem machining closer to customers to hedge tariff exposure. Adaptive and MR-guided platforms, including Elekta's Unity MR-linac, are also gaining installations at academic centres, which raises demand for magnetic-compatible components sourced from U.S. precision machinists. Stereotactic body radiotherapy adoption continues to expand, favouring compact systems and accessory exports.

Supply Chain Risks and Trade Barriers

Raw material concentration is the most acute risk. Multileaf collimators, shielding, and target assemblies depend on tungsten, and China's February 2025 export controls on tungsten disrupted procurement timelines for American OEMs. Cobalt-60 teletherapy sources face a similar single-origin dependency on Canadian reactor output, which exposes hospitals using cobalt units to supply interruptions.

Tariff exposure and logistics constraints compound these risks. Reciprocal tariffs introduced in 2025 and the Section 232 review of medical equipment raise landed costs for imported accelerators from the European Union and Japan. Linear accelerators weigh several tons, require heavy haulage, and sit inside vaults with concrete walls often exceeding six feet, so delays at a single port or road link postpone installations by months. Euro and yen exchange-rate swings also alter contract economics for multi-year equipment purchases.

Trade and Investment Opportunities in the United States

Import substitution in precision subassemblies offers a clear opening. Tier-two machining and electronics suppliers in the Midwest can produce collimator housings, waveguide components, and gantry bearings that currently arrive from overseas. Qualifying these suppliers under OEM quality systems reduces tariff and transit exposure while creating domestic employment in component manufacturing.

Export capacity for proton and compact photon systems is underdeveloped relative to demand in Latin America and Southeast Asia. Houston and Miami ports can serve as staging hubs for these shipments, which require specialised shielding and commissioning crews. Foreign direct investment into domestic proton and MR-linac assembly would strengthen this export position and shorten delivery lead times for regional buyers.

Market at a Glance

Leading Market Participants

• Varian Medical Systems
• Elekta
• Accuray
• Mevion Medical Systems
• IBA
• RefleXion Medical
• Sun Nuclear
• Brainlab
• Leo Cancer Care
• Best Theratronics

Regulatory and Trade Policy Environment

Linear accelerators and charged-particle systems are regulated by the FDA under 21 CFR 892.5050 and cleared through premarket notification or approval pathways. Cobalt-60 and brachytherapy sources fall under Nuclear Regulatory Commission and state licensing authorities. Reimbursement is governed by the Medicare Physician Fee Schedule, which sets rates for IMRT, SBRT, and proton therapy codes and shapes which technologies hospitals can finance.

Trade policy is shaped by the USMCA, which governs component and cobalt-60 flows with Canada and Mexico, and by the 2025 U.S.–EU and U.S.–Japan tariff framework arrangements that set ceilings on most European and Japanese equipment. Section 232 investigations add sector-specific exposure for medical devices. Certificate-of-need laws in more than 30 states further control where hospitals can invest in new radiotherapy capacity.

U.S. Radiotherapy Supply Chain Outlook to 2032

Through 2032, the U.S. supply chain will shift toward dual sourcing and domestic subsystem assembly. OEMs will qualify non-Chinese tungsten and rare-earth suppliers, and Midwest precision manufacturers will absorb a growing share of collimator and gantry production. Trade flows will tilt further toward exports of proton and MR-guided platforms as domestic demand matures.

Technology change will alter comparative advantage. Compact proton systems and MR-linac platforms reduce vault size and installation time, which favours suppliers able to ship modular units through Gulf and Atlantic ports. Software-driven adaptive planning will increase the value of U.S.-developed intellectual property relative to hardware volume, keeping the country's position as a design and services hub intact.