Why do Lamborghinis run on Honda tires?

Proton therapy is often hailed as the Lamborghini of radiation oncology, its precise dose profiles can spare normal tissues and theoretically improve outcomes. Yet fewer than 1% of radiotherapy patients worldwide receive proton therapy, and each center costs tens to hundreds of millions of dollars to build.

Meanwhile, there are roughly 14,000 teletherapy machines globally, of which about 86% are conventional linear accelerators, the Hondas of the radiation world, delivering photon therapy to nearly everyone.

In practice, today’s “Lamborghinis” rely on yesterday’s workflows and patient‑positioning tools - Honda tires. That’s not a failure of vision; it’s a pragmatic bridge. Without the installed base of linear‑accelerator‑based processes, proton therapy wouldn’t have reached its current level at all. Conversely, innovations developed for proton facilities can eventually put Lamborghini tires on Honda accelerators, lifting the performance of mainstream treatments as well.

Are we investing enough in the “tires”? Advanced beams are only half the equation; the road beneath them matters just as much.

- David