====== Accuray ======
https://www.accuray.com/

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===== Accuray Products for Neurosurgery =====

[[Accuray]] develops [[radiosurgery systems]] applicable to **intracranial lesions**, **brain tumors**, and **functional disorders** through the following platforms:

==== CyberKnife® System ====
Non-invasive, robotic stereotactic radiosurgery (SRS) system designed for:
  * **Benign and malignant brain tumors** (e.g. meningiomas, metastases, acoustic neuromas)
  * **Arteriovenous malformations (AVMs)**
  * **Trigeminal neuralgia**
  * **Functional targets** (e.g. thalamotomy)

**Key Features:**
  * Sub-millimetric accuracy with image-guided robotics
  * Frameless, non-isocentric delivery
  * Adaptive capabilities (real-time motion tracking)
  * No need for rigid immobilization frames (unlike Gamma Knife)

**Limitations:**
  * Slower treatment times compared to single-isocenter systems
  * Limited adoption in high-volume cranial-only centers

==== Radixact® System ====
Primarily used for body indications, but applicable to certain neuro-oncological cases:
  * **Spinal tumors (primary or metastatic)**
  * **Postoperative stereotactic radiotherapy**
  * **Extended craniospinal axis coverage**

**Technology Base:**
  * Helical IMRT (intensity-modulated radiotherapy)
  * Tomographic delivery
  * Compatible with Accuray’s Synchrony® real-time tracking system

==== In Development: Neuro Package (Unreleased) ====
Announced features include:
  * **High-fidelity imaging**
  * **Neurosurgical workflow optimization**
  * **Enhanced cranial targeting tools**

> ❗ *Status: Under development — not FDA-cleared or CE-marked at this time*

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((Adler JR Jr. Accuray, incorporated: a neurosurgical business case study. Clin Neurosurg. 2005;52:87-96. PMID: 16626058))

Official source: https://www.accuray.com/



====== 🔥 Critical Review: The Future of Accuray in Neurosurgery ======

<WRAP box warning 100%>
**Caution:** This is a ruthless, evidence-based critique. Not suitable for readers allergic to hard truths.
</WRAP>

===== 1. Weak Pipeline and Vaporware =====
Accuray itself acknowledges that its **CyberKnife Neuro Package** and “High‑Fidelity Imaging” are *under development* and may *never reach the market*.

> ❗ **Red Flag:** In neurosurgical tech, vaporware isn’t innovation—it’s delay disguised as strategy.

===== 2. Fierce Competition: Gamma Knife and Others =====
Elekta's **Gamma Knife** continues to dominate intracranial stereotactic radiosurgery. Despite CyberKnife's flexibility, it lacks the targeted precision and robust evidence to displace it.

  * No demonstrated superiority in cranial indications  
  * Underrepresented in comparative academic studies  
  * Limited adoption for single-lesion brain SRS  

> ❗ CyberKnife is a generalist tool in a field that rewards specialization.

===== 3. Sparse and Non-Disruptive Clinical Evidence =====
Accuray promotes its technology at congresses like ESTRO, but fails to produce **landmark trials** proving clinical superiority in neurosurgical applications.

> ❗ Repetition isn’t validation. Without rigorous multicenter data, the claims remain unconvincing.

===== 4. “Integration” ≠ Innovation =====
The partnership with Brainlab is primarily about **compatibility**, not **technological leadership**.

  * No AI-powered planning tools  
  * No adaptive or real-time MR-guided workflows  
  * Just basic system interoperability—expected in 2025  

> ❗ “It integrates” is not a breakthrough; it’s the bare minimum.

===== 5. Regulatory ≠ Revolutionary =====
Recent approvals (e.g. Radixact SynC in China) show **geographic expansion**, but not **technical advancement**.

> ❗ Compliance is not innovation. There’s no paradigm shift—just market access.

===== 🧭 Strategic Risk Table =====

^ Challenge ^ Risk ^
| Tech stagnation | Falls behind AI/MR-based competitors |
| Weak evidence base | Reduced trust from neurosurgical community |
| Lack of clinical USP | Increased pricing pressure |
| Overpromising roadmap | Credibility erosion |

===== 💣 Final Verdict: Overmarketed, Underwhelming =====

Accuray’s current neurosurgical strategy lacks:

  * 💡 Clear clinical leadership  
  * 📊 Outcome-driven superiority  
  * 🧠 Advanced neuroimaging or AI integration  

> 🚨 Without urgent action, **CyberKnife risks becoming a legacy system** in a fast-evolving, precision-first landscape.

<WRAP round important 80% center>
**Accuray must deliver disruptive, peer-reviewed neuro-oncological tools—or face obsolescence.**
</WRAP>