Five IORT "Leaders," and One of Them Quit the Business in 2023

A market-research report with a title like this one — "Assessment of the Global Intraoperative Radiation Therapy Market … Featuring Profiles of Siemens Healthineers, Elekta, Carl Zeiss Meditec, IntraOp Medical, iCAD" — smuggles in three assumptions at once. It assumes IORT is a defined market, that its size is knowable, and that the named companies are a stable, roughly comparable set an investor could actually act on. All three are shaky. The cheapest way to see how shaky is to ask five research houses to name the same number.

The term you must not trust first is simply how many dollars are in this market.

One Market, Five Different Pricetags

Here are the figures for essentially the same thing — the global market for intraoperative radiation therapy, the practice of delivering a single dose of radiation to the tumor bed during surgery — as reported by different firms around the same base year:

• Towards Healthcare: $69.6 million in 2025, growing at 6.45% to $130 million by 2035.
• Straits Research: $129 million in 2025, growing at 8.17% to $260 million by 2034.
• Mordor Intelligence: $132.9 million in 2026, at 7.72%.
• ReportPrime: $1.23 billion in 2025.

Read that again. For the same market in the same base year, one house says a tenth of a billion and another says more than a billion — an 18-fold gap. These are not different forecasts of a disputed future; they cannot even agree on the present.

Here is the mental model to replace the broken one: a market research report is the product being sold, and the market size is its marketing copy. The firm that writes "IORT: $X billion by 2035" sells the report, the data license, and the consulting hours that follow. A market that is big and compounding is a better pitch than a market that is small and uncertain, so the incentives push the number up, quietly, in the ways that are hardest to audit — where the market boundary is drawn. Broaden the definition to include brachytherapy applicators, disposable supplies, services, and a few more regions, and a $70 million niche becomes a $1.3 billion category without any patient changing treatment. Every house draws the line somewhere, and the line is rarely disclosed. The number is an output of a choice, and the choice is invisible.

That is your governing analogy in one sentence: a market size is like a restaurant's advertised capacity — it depends entirely on whether you count the bar, the patio, and the waiting room as seats. Same venue, wildly different "covers." Nobody is lying on purpose; everybody is defining to their own advantage.

Now label the props. The report = the menu the firm is trying to sell you. The capacity number = the market size that makes its report look important. The bar, patio, and waiting room = the extra products and services a firm tucks into "the market" to inflate it. And you, the investor, are the diner deciding whether the crowd makes this a hot restaurant worth backing — while the real question is whether the restaurant you actually fund is even serving the dish.

What the Dish Actually Is

Put the sizing dispute aside for a moment and look at the mechanism, because it is real and worth understanding on its own terms.

IORT compresses weeks of daily, after-surgery external beam radiation into a single dose fired directly at the tumor bed while the patient is still open on the table. The convenience argument is genuine: one treatment in the operating room instead of several weeks of daily visits, which is meaningful for patients and for overstretched departments. Breast cancer has the cleanest evidence, the TARGIT trial showing a single intraoperative dose was non-inferior to conventional external beam radiation. Carl Zeiss's INTRABEAM device — a robotic-assisted low-energy x-ray system — won new U.S. FDA 510(k) clearance as recently as April 2025.

Two broad flavors split the field. Electron-based IORT, where IntraOp Medical is the long-running specialist with its portable Mobetron linear accelerator, is high-energy and generally wants a repurposed, shielded operating room. Low-energy x-ray / electronic-brachytherapy systems like Zeiss's INTRABEAM and — after a 2023 deal — Elekta's Xoft are lighter and more mobile, needing no bunker. That distinction matters for hospital buyers: one is a bigger capital commitment with more construction; the other is a smaller, portable machine.

Here is the economics that keeps the whole market small. IORT is not a subscription or a recurring consumable business in the way the biggest medtech is. It is a capital sale: a hospital writes a check for a machine that can run for a decade, which means a company sells maybe a handful of units a year, on long sales cycles, and sometimes or often must wait for a reimbursement decision or a construction project that never comes. A market built from a few dozen machines per year priced in the hundreds of thousands to low millions each is always going to be a niche, no matter how the research houses frame the growth.

The Leader List Has a Ghost

Now the roster in the title. This is where the report's claim to be a map of the field shows its age.

Start with iCAD. If you read the title and assumed iCAD is one of the leading IORT names, you are reading a list left over from before October 2023, when iCAD sold its Xoft electronic-brachytherapy (IORT) business to Elekta for about $5.5 million and focused on its AI cancer-detection software. The company named as an IORT leader no longer makes an IORT product. Exposure didn't vanish; it moved — the Xoft line now lives inside Elekta, whose Xoft brachytherapy products are sold globally.

The other two listed giants are the mirror image of the same problem, from the opposite direction. Siemens Healthineers (which owns Varian) and Carl Zeiss Meditec are real, successful, multibillion-dollar companies — but IORT is a rounding error inside them. Siemens Healthineers posted adjusted EBIT of just under €3.9 billion in fiscal 2025. The entire IORT market, even at the most generous research-house count, is smaller than a rounding of a rounding of that number. Buying Siemens Healthineers to get IORT exposure is like buying a supermarket chain because you like the produce section: technically the produce is there, but it will never drive the stock. The same logic applies to Carl Zeiss Meditec and, in a smaller frame, to Elekta, for whom IORT via Xoft is one brachytherapy line among many.

Which leaves IntraOp Medical — the only name on the list where IORT is close to the whole business. That cuts both ways. It is the purest bet on the electron side of the technology, a specialist that has shipped its mobile Mobetron systems for decades. It is also a micro-cap, over-the-counter stock with exactly the lumpy, few-units-a-year revenue profile described above: no diversified giant's balance sheet to cushion the quarters where no hospital signs. Your exposure to the "growing IORT market" would be real — and so would every dollar of its lumpiness, its reimbursement dependence, and its long sales cycles.

Where the Analogy Breaks

Do not let the filing become the tool's opposite error. "Market reports inflate their numbers" is not the same as "this technology is worthless." IORT is a legitimate, growing treatment with published clinical support and fresh regulatory wins. The reports differ wildly on how much and how fast; they do not invent the fact that the technology exists and works. The restaurant is real, and it is serving people. What is unreliable is the claim about how many seats it has and which of the investors hovering nearby will actually get paid.

The One Test to Keep

So when the next report hands you a CAGR and a roster of "leaders," run these two checks before you spend a minute on it.

First, cross-check the size number. Pull two or three research houses on the same year. If they agree within a few points, you may have a real, well-bounded market. If — as here — two firms give $69 million and $1.3 billion for the same year, you have learned the number is a boundary choice, not a fact, and the market is probably small enough that the choice changed everything.

Second, ask each named leader whether it still does the business, and how much of its revenue it is. A "leader" who sold the product line in 2023, and a pair of giants for whom the niche is below rounding error, are not an investable cohort; they are a roster assembled because names were needed, not because their IORT economics are comparable. The most useful question you can ask of any of these five is not "is IORT growing?" — it already is — but "of this company's revenue, how many dollars actually come from IORT, and would the stock notice if that line disappeared overnight?" For four of the five, the honest answer is: no, it would not notice at all. That gap between the report's portrait and the reality of the ledger is where the investment judgment actually lives.