ASTRO 2026: The Linac Market Enters a New Era

A few stories that are likely to shape the conversation in the Exhibitor Hall at next week’s ASTRO conference in Boston.

ASTRO 2026 is right around the corner. Next week, clinicians, researchers, vendors and other industry professionals from around the world will gather in Boston to discuss the latest advances and updates in radiation oncology and radiation medicine. As usual, we expect to hear some industry buzz around the exhibit hall—from RefleXion’s apparent wind-down and the continued erosion of the Varian brand, to Siemens Healthineers’ anticipated Accela launch and the arrival of new linac competitors in the United States.

The Missing Booth: What Is Happening at RefleXion?

RefleXion Medical is still featured as an exhibitor in the ASTROnews Annual Meeting Guide. However, as of this writing, RefleXion no longer appears in ASTRO’s current online exhibitor directory.

An exhibitor’s late withdrawal does not, by itself, establish that a company is closing. Plans change, budgets are reduced, and exhibit strategies are revised. In this case, however, the discrepancy is difficult to ignore because it follows multiple signs that RefleXion may be winding down much of its operation.  A few years ago we learned about the collapse of ViewRay, and what happens when extraordinary technology does not guarantee success in the radiation oncology world.

RefleXion was founded around a genuinely ambitious concept. Its X1 system combined a linear accelerator with PET detection so that signals emitted by an injected radiopharmaceutical could help guide radiation delivery in real time. The company branded this approach SCINTIX biology-guided radiotherapy—more recently described as autonomous radiotherapy.

The technology achieved an important milestone in February 2023 when the FDA granted De Novo marketing authorization for SCINTIX treatment of certain lung and bone tumors. RefleXion’s own fact sheet later reported more than 265 employees and approximately $585 million in debt and equity funding. As recently as July 2026, the company announced an X2 platform with substantially greater biologic-signal sensitivity for presentation at AAPM.

The picture has seemed to change in just a few short months.

An anonymous Glassdoor review posted in August and subsequently discussed on the Student Doctor Network alleged that RefleXion had dismissed most of its remaining workforce on August 21, leaving roughly 45 employees from a staff that once exceeded 300. The post also claimed that only about a dozen systems had been sold and described the remaining work as largely involving installed-base and shutdown-related responsibilities.

One can speculate that RefleXion has not definitively closed, but that the available signals—including its disappearance from the live ASTRO exhibitor directory—make a substantial operational wind-down appear increasingly likely.

Innovation Is Not the Same as Commercial Durability

RefleXion’s challenge may ultimately become another reminder that a brilliant clinical idea still has to survive commercial reality.
The most important question now concerns the customers that invested in the X1. Who will provide technical support, replacement parts, software maintenance and ongoing clinical assistance? What happens if proprietary components fail? Can another organization acquire the technology or service infrastructure? And if radioactive sources or other controlled components must be removed, who will coordinate that work safely?

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At the Exhibit Hall, It’s Just Siemens Healthineers Now

While one name may be fading from the exhibit hall, another historic name is about to become less visible.

Siemens Healthineers completed its acquisition of Varian in April 2021. For the past five years, the two identities have coexisted: Varian remained the familiar name on linear accelerators, oncology software, service organizations and trade-show displays, while also being described as “a Siemens Healthineers company.”

That transition is now reaching its final stage. Industry communications this year have described the completion of Varian’s move to the Siemens Healthineers identity. ASTRO 2026 in Boston is expected to be the industry’s most visible expression of that change. Visitors should expect Siemens Healthineers—not Varian—to occupy the center of the company’s corporate presentation, even though established product names such as TrueBeam, Halcyon, Ethos, Eclipse and ARIA will remain deeply embedded in radiation oncology.

Retiring the Varian corporate identity at trade show exhibit booths is not merely a change of signage. Varian has been synonymous with radiation therapy for generations of physicists, therapists, engineers and administrators. In many departments, people do not say “the linac”; they say “the Varian.”

Siemens Healthineers is betting that a unified identity will ultimately carry more value than two separate brands. The strategic logic is understandable: imaging, treatment planning, treatment delivery, artificial intelligence, and enterprise data can all be presented as one connected cancer-care ecosystem. Nevertheless, the emotional and commercial significance of the Varian name should not be underestimated.

Accela: Is a New Linac Family Coming?

The more consequential ASTRO development may be the anticipated announcement of Accela, a new line of linear accelerators from Siemens Healthineers’ Varian division.

Public U.S. trademark filings made by Varian Medical Systems in February identify the Accela family and four apparent variants:

• Accela Go
• Accela Prime
• Accela Peak
• Accela Ultra

The filings cover medical linear accelerators, radiotherapy and radiosurgery systems, treatment-planning technology, patient-positioning and motion-management systems, beam collimation, and treatment-room imaging. They strongly indicate a multi-model platform rather than a single machine.

The names also suggest a carefully tiered portfolio which will likely be a big source of buzz at the conference, and the industry will be all ears for this big announcement, with many questions looming:

• Will it replace the TrueBeam family (that includes the Edge and the Vital Beam) altogether, much like the TrueBeam family replaced the Clinac iX series?
• Will the TrueBeam eventually be discontinued, if so, when? After all, iX’s were manufactured for over seven years after the introduction of the TrueBeam.

One thing is clear: Siemens Healthineers will continue to dominate the linac market in the United States with both existing and new offerings, and its leadership position will likely continue to grow vs. its once-formidable competitors — Elekta and Accuray.

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New Linac Entrants Begin to Find a U.S. Foothold

Another story worth watching in Boston is the gradual arrival of Chinese-developed systems—and other emerging linac suppliers—in the United States. For years, China’s linac industry was easy for many American buyers to view as distant: while large in its home market, relatively unsophisticated, and not a credible threat. That distance is continuing to narrow.

LinaTech

LinaTech’s FDA-cleared VenusX has secured its first U.S. installation, moving the China-manufactured system beyond trade-show introduction. We wrote an article about the VenusX Linac a few years ago, and the first U.S. machine is being accepted this week. It’s a long-time dream for the founder and CEO, Mr. Jonathan Yao, who lists its U.S. headquarters in Sunnyvale, CA.

Public details about the site and clinical start remain limited, but the milestone matters. Finally securing an American site gives LinaTech something no booth demonstration can provide—a domestic reference installation that prospective customers can visit, question, and evaluate.

Akesis

Akesis has crossed that threshold more visibly. Advanced Radiation Centers of New York treated the first U.S. patient on the company’s Gemini360RT in December 2025. The ring-gantry linac is designed for treatments ranging from image-guided IMRT through SBRT, SRS/SRT and ART. Akesis also announced that University Hospitals Seidman Cancer Center in Cleveland would become the first U.S. center to implement its Galaxy RTi radiosurgery system. Although sometimes grouped into conversations about new Asian competition, Akesis should be distinguished from the Chinese manufacturers: the company is headquartered in California and says it manufactures all of its systems there.

Neither LinaTech nor Akesis is about to displace the established market leaders overnight. U.S. buyers will look beyond acquisition price to clinical evidence, software sophistication, service uptime, parts logistics, cybersecurity, software integration, applications support and the depth of the service organization. Still, first installations are how an unfamiliar vendor becomes a credible alternative. If these early sites perform well, competition could put pressure on pricing and widen access to modern treatment technology—particularly for independent and community centers.

The notable absentee is United Imaging. The company has already built a substantial U.S. presence in CT, MRI, PET/CT, and other imaging categories, and in Europe it has highlighted the CE-marked uRT-linac 506c as part of a broader radiotherapy portfolio. Yet United Imaging does not appear in ASTRO’s current online exhibitor directory, and its latest linac will apparently not be on the Boston exhibit floor. For a company with a recognized U.S. imaging brand and ambitions in integrated cancer care, that absence may generate almost as much curiosity as a product launch. The question is not whether United Imaging can build a linac; it is when—and how aggressively—it intends to bring that platform to the American radiation oncology market.

Other Linac manufacturers exhibiting include Zap Surgical, MammoKnife (not yet FDA-cleared), and ViewRay Systems, Inc.

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A Changing of the Guard in Boston

ASTRO has always been part scientific meeting, part industry showroom, and part annual reunion. It’s always exciting to tune in and observe how our industry continues to evolve and improve, despite the challenges of the healthcare industry. The equipment part of the industry is no exception.

The transition from Varian to Siemens Healthineers highlights the reality of consolidation and the power of a global imaging company to connect diagnosis, planning, treatment, and data under one identity.

RefleXion’s news, or lack thereof, is a reminder to investors and developers of the challenges of building a sustainable radiation oncology equipment company—even after raising hundreds of millions of dollars and obtaining groundbreaking FDA clearance.

LinaTech and Akesis are a reminder that new linac entrants are finding footing in the U.S., and despite the challenges facing the industry, there is hope for new players. United Imaging’s absence, meanwhile, leaves the industry wondering when the largest Chinese imaging presence in America will make its own move in radiation therapy.

And Accela may be the bridge to whatever comes next.

Editor’s note: This article reflects publicly available information as of September 21, 2026. RefleXion has not publicly announced a bankruptcy or formal shutdown. Accela product specifications, regulatory status, commercial availability, and final model configurations should be confirmed following Siemens Healthineers’ official announcement. Public details concerning LinaTech’s first U.S. VenusX installation remain limited.

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About Radiology Oncology Systems

Radiology Oncology Systems (ROS) provides new and refurbished radiation therapy and diagnostic imaging equipment, parts, and service. For over 25 years, ROS has worked to empower clinicians and expand access to affordable healthcare worldwide.

If you are attending ASTRO 2026 in Boston, please visit ROS at Booth 1921 to meet our team and learn how we can support your facility’s equipment needs.