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Radiation Therapy 2014
The Fight Against Cancer Is Heating Up

author - Monique Rasband
Monique Rasband
September 10, 2014 | Read Time: 3  minutes

The fight against cancer continues to be one of the fiercest in healthcare today. The battle to enable providers to be successful in that fight is gaining in intensity too. Varian has long been the market share leader, with the CyberKnife and TomoTherapy units delivering distinct options. Previously ignored by Varian and Accuray, Elekta has been strong recently, adding the Versa HD to their portfolio with strong, provider-centric support. The established vendors now recognize they are in a fight. And another fight is brewing in treatment planning: while Elekta, Philips, and Varian are striving to deliver a complete enterprise solution, newcomer RaySearch is stepping into the ring. Can Elekta continue to raise the bar? What is Varian doing to combat them? Will Philips and Accuray find an edge? KLAS spoke with 101 oncology providers to find out.

how loyal are you to your vendor



Elekta earns the top spot (by a large margin) in this study because of their continued technology improvement combined with a focus on partnering with providers. Varian is flexing their technology muscle to counter Elekta’s push. While Elekta users rate their overall experience higher, 5 of the 19 Elekta Agility customers said they would trade their Agility for a TrueBeam: 2 of the 5 would switch for equipment standardization; the other 3 felt Varian had better technology.


The TrueBeam had the most users reporting more than 20 total work hours lost to downtime in the past six month s. Software glitches that resulted in small periods of downtime were usually handled quickly by remote service, but these small lost treatment times have added up. The TomoTherapy follows close behind. Varian’s overall reliability remains lower than other vendors’, but customers report that recent upgrades have improved the downtime issues.


Users feel Pinnacle3 integrates well with Elekta technology but reported that Philips’ development of new functionality has fallen behind. Of the TrueBeam participants in this study, 45% reported using Pinnacle3, and many of those reported frustration with the time it took to get Pinnacle3 integrated with new technology. Varian is taking advantage of that frustration by delivering tight integration with the latest Varian accelerators and displacing Philips at several sites.

impact of equipment downtime


ACCURAY CyberKnife

Customers are loyal, with only 2 of 20 saying they would trade for another system. Low interest in M6 collimator: only 2 of the 20 interviewed would trade their current system for M6 version. Multiple providers cited bad experiences with Iris collimator, which is praised for being accurate but dinged for slow treatments, time-intensive planning, and expensive upgrades.

ACCURAY TomoTherapy

Some loyal providers still report that the TomoTherapy is the best IMRT solution. With transition to Accuray management, support is less available and more expensive. Multiple reports of permanent fixes, not just temporary ones, starting to improve downtime. Tomotherapy not as unique as it once was, as multiple participants said the newest systems from Varian and Elekta compete strongly for IMRT.

ELEKTA Infinity with Agility MLC

Building on Elekta’s Best in KLAS performance with the Leksell Gamma Knife Perfexion. Users of Agility recognize Elekta’s strong relationship acumen that smooths over some varied usability nuisances, largely at sites converting from Varian. Technology continues to improve and seen as close to even with Varian’s. Relationships and communication are where Elekta excels—seen as a partner. Being considered in new deals. Less nickel-and-diming than competition. Users most familiar with Varian find Elekta more difficult to use.


Market share leader. Providers recognize Varian’s track record of successful therapy equipment but rank them lower than Elekta due to lack of solid relationships. Sales and support teams are knowledgeable but are sometimes perceived to be arrogant and difficult to work with. Ongoing frustrations with contracting. On-Board Imager not always up to expectations. Reliability improving overall. Strong field service.

cost and functionality


Elekta (n=11) 84.1*

Working to bring IMRT into Monaco so providers can have all the planning modalities in one system. Several providers looking forward to this integration in Monaco v.5. Other Elekta planning customers still do not feel like they have the full picture of Elekta’s road map. Several looking at Varian’s Eclipse solution.

Philips (n=30) 81.8

Easy to use; customizable interface. Providers feel Pinnacle3 is intuitive and works well with Elekta equipment. Frustrations in working with Philips if buying newest treatment systems due to lag in development of planning functionality for those technologies. Providers recognizing Philips for recent increased attention and development of the product they felt had been stagnant since Philips’ purchase of ADAC Laboratories.

Varian (n=32) 83.6

Eclipse has strongest support in Varian’s portfolio. Customers appreciate the tight integration with ARIA and Varian equipment along with continued development that keeps up with the latest equipment. Integration frustrations among Elekta equipment users. Providers feel that RapidPlan shows a lot of promise to streamline the process. Several report Eclipse being “thrown in” with purchase of other Varian solutions. Varian has opportunity to be more flexible with user interface and locked-down prescriptions.

*Does not meet minimum KLAS Konfidence level

round 3

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This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.