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• Imagine a smaller, specialist version of Siemens Healthineers (especially their former Varian Medical Systems division) dedicated solely to advanced radiation therapy for cancer.
• They are to radiation oncology what Intuitive Surgical is to robotic surgery – a leader in high-precision, specialized medical devices for a critical treatment area.

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• CyberKnife System: A robotic radiosurgery system that delivers non-invasive radiation treatment for cancerous and non-cancerous tumors throughout the body with sub-millimeter precision.
• Radixact System: A next-generation radiation therapy system delivering highly precise and personalized intensity-modulated radiation therapy (IMRT) with daily imaging for a wide range of cancer indications.
• TomoTherapy System: An integrated radiation therapy platform that provides daily image-guided, intensity-modulated radiation therapy (IG-IMRT) for efficient and comprehensive cancer treatment.
• Accuray Precision Treatment Planning System: Software that enables clinicians to create customized, highly accurate radiation treatment plans for patients receiving therapy on Accuray systems.

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Accuray (symbol: ARAY) designs, manufactures, and sells radiation therapy systems for the treatment of cancer and other medical conditions. As such, it sells primarily to other companies and healthcare organizations rather than directly to individuals.

Based on Accuray's latest SEC filings (Form 10-K), no single customer accounted for 10% or more of their total revenue in recent fiscal years. Therefore, Accuray does not have a small number of "major customer companies" that represent a significant portion of its sales and can be specifically named with their symbols.

Instead, Accuray sells its advanced radiation therapy systems to a broad and diverse base of healthcare institutions globally. These customers fall into the following categories:

• Hospital Systems and Medical Centers: This category includes large, integrated hospital networks, university teaching hospitals, and community hospitals worldwide that offer comprehensive cancer treatment services.
• Independent Cancer Treatment Centers and Clinics: These are specialized, often private or standalone, facilities dedicated primarily to oncology and radiation therapy services.
• Government-operated Healthcare Facilities: This includes public health systems and facilities, such as Veterans Affairs (VA) hospitals in the U.S. and similar government-funded healthcare providers in other countries, which acquire systems for their patient populations.

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Steve La Neve, Chief Executive Officer

Mr. La Neve joined Accuray as CEO effective October 20, 2025, bringing over 40 years of global experience in medical technology and biotechnology. Prior to Accuray, he held senior executive roles including President of Globus Medical Japan K.K. and President of Globus Medical Trauma and Joint Reconstruction. He also served as Global Sector President for Medtronic's Spine and Biologics Division, CEO and Board Director of Bone Biologics Corporation, and Global President of Pre-Analytical Systems at Becton Dickinson. Notably, he was President & CEO of ETEX Corporation, where he led the successful sale of the business to a global leader in joint reconstruction. Mr. La Neve has also served as a consultant for private equity companies in the medical device area.

Ali Pervaiz, Senior Vice President, Chief Financial Officer

Mr. Pervaiz was appointed Chief Financial Officer of Accuray in May 2022. He joined Accuray in August 2020 as Vice President, Global Commercial Operations. With nearly 20 years of experience in the healthcare sector, Mr. Pervaiz previously spent over 15 years with GE Healthcare in senior financial and operating leadership roles, starting his finance career in GE's Corporate Audit Staff program. He held CFO roles for two GE Healthcare business units, including the $1.3 billion US Imaging Equipment and $650 million US Life Support Solutions businesses. His career is marked by a strong focus on acquisition integration and financial strategy.

Sandeep Chalke, Senior Vice President, Chief Commercial Officer

Mr. Chalke joined Accuray as Senior Vice President, Chief Commercial Officer effective May 16, 2022, bringing over 25 years of medical device expertise in commercialization, business development, and operations. He is responsible for global commercial, product development, R&D, and engineering functions. Prior to Accuray, Mr. Chalke was President, Asia-Pacific and Latin America regions at Vyaire Medical. He also held various global leadership positions at Medtronic, Acelity, Inc., and GE Healthcare, where he led new product development and expanded markets.

Leonel Peralta, Senior Vice President, Chief Operations Officer

Mr. Peralta joined Accuray as Senior Vice President, Chief Operations Officer effective February 3, 2025. He has over 25 years of leadership experience in supply chain, business process improvement, and manufacturing optimization. Most recently, he was Vice President, Head of Global Operations for the ultrasound division at Siemens Healthineers. Prior to this, Mr. Peralta held executive management positions at Medtronic Diabetes, Hill-Rom (Baxter), KCI Medical (3M), and GE Healthcare.

Seth Blacksburg M.D., MBA, Senior Vice President, Chief Medical Officer

Dr. Blacksburg has served as the SVP and Chief Medical Officer at Accuray since March 2023, and previously as VP and Chief Medical Officer of the Americas from August 2022 to February 2023. He is a board-certified radiation oncologist with expertise in stereotactic body radiotherapy (SBRT) and radiosurgery. Before joining Accuray, Dr. Blacksburg was Chairman of Radiation Medicine at Lenox Hill Hospital and Associate Professor at the Hofstra School of Medicine. He also served as the Associate Director of the Department of Radiation Oncology and Medical Director of NYCyberknife at NYU Winthrop Hospital. Dr. Blacksburg earned his MD from Duke University Medical Center and an MBA in Health Sector Management from the Fuqua School of Business.

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Key Risks to Accuray (ARAY)

1. Financial Health and Profitability Challenges: Accuray has demonstrated ongoing financial distress, characterized by a high debt-to-equity ratio, negative Altman Z-Score, and persistent profitability issues. The company has reported negative net margins and operational challenges, reflecting inefficiencies in generating shareholder returns and a history of GAAP net losses. While a strategic transformation plan is underway to improve operating profitability, its successful execution and impact on financial metrics remain a key risk.

2. Geopolitical and Tariff Impacts, particularly in China: The company's business has been significantly affected by U.S.-China tariffs, which have hampered its operations in China, a crucial market for growth. This has led to weaker revenue guidance and a decline in orders, particularly from China, and has intensified competition within that market. The ability to realize the expected benefits from its China joint venture and navigate enhanced international tariffs are ongoing concerns.

3. Execution and Operational Inconsistencies: Accuray has a historical pattern of struggling with consistent operational execution. Key challenges include converting its order backlog into revenue, managing supply chain disruptions, controlling increased logistics costs, and maintaining or improving gross margins on both product sales and services.

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The emergence and increasing adoption of Magnetic Resonance-guided Linear Accelerators (MRI-Linacs) pose a clear emerging threat to Accuray. MRI-Linacs combine real-time magnetic resonance imaging with radiation delivery, enabling superior soft-tissue visualization during treatment, which allows for highly precise and adaptive radiation therapy. This technology offers the potential for enhanced treatment accuracy and improved patient outcomes compared to traditional X-ray-based linacs, particularly for tumors in moving organs or those requiring frequent adaptation. Key competitors such as Elekta (Unity MR-Linac) have systems on the market and are actively deploying them globally. Accuray currently does not offer an MRI-Linac system in its product portfolio, potentially leaving it at a competitive disadvantage in the growing market for advanced, real-time adaptive radiation therapy solutions.

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Accuray (ARAY) operates within the radiation oncology market, offering systems for radiation therapy and radiosurgery. Their primary products are the CyberKnife and Radixact Systems (which are part of the TomoTherapy platform).

The addressable markets for Accuray's main products and services are as follows:

• Global Radiation Oncology/Therapy Market:
  • The global radiation oncology market size was estimated at USD 10.56 billion in 2024 and is projected to reach USD 21.19 billion by 2030, growing at a CAGR of 11.2% from 2025 to 2030.
  • Another estimate valued the global radiotherapy market size at USD 7.21 billion in 2024, projected to reach USD 9.62 billion by 2030, at a CAGR of 4.9% from 2024 to 2030.
  • The global radiotherapy market size was valued at USD 8.87 billion in 2024 and is expected to reach USD 18.88 billion by 2032, at a CAGR of 10.3% during the forecast period.
  • The global market for radiation therapy products and radiopharmaceuticals is expected to grow from $17.5 billion in 2024.
• Global Radiosurgery Systems Market:
  • The global radiosurgery systems market size was valued at USD 2.10 billion in 2021 and is projected to reach USD 3.98 billion by 2031, growing at a CAGR of 6.7% from 2022 to 2031.
  • The global radiosurgery market size was valued at USD 2.46 billion in 2024 and is estimated to grow to USD 4.4 billion by 2033, at a CAGR of 6.4% during the forecast period (2025–2033).
  • The global radiosurgery and radiotherapy robotics market size was USD 4.36 billion in 2024, with an expected growth to USD 5.73 billion by 2029 at a CAGR of 6.0%.
• Global CyberKnife Market:
  • The global CyberKnife market size was estimated at USD 637.4 million in 2024 and is projected to reach USD 1,788.0 million by 2030, growing at a CAGR of 17.6% from 2025 to 2030.
  • Another report estimated the global CyberKnife market size to be worth around USD 1,417 million by 2032 from USD 780 million in 2022, growing at a CAGR of 12.3% during the forecast period from 2023 to 2032.
  • The global CyberKnife Technology Market was valued at USD 0.89 billion in 2023 and is projected to reach USD 1.87 billion by 2035.
• Global Radixact Market:
  • A conservative estimate for the 2025 global market size for Radixact systems would be around USD 500 million, although a precise market size quantification is unavailable. The market is projected to experience a healthy CAGR (conservatively estimated at 7%) from 2025-2033.

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Accuray (ARAY) is anticipated to drive future revenue growth over the next 2-3 years through several key initiatives and market trends:

1. International and Emerging Market Expansion: Accuray has demonstrated robust growth in international markets, particularly in China (with 27% year-over-year growth in fiscal 2024), the rest of APAC (14% year-over-year growth in fiscal 2024), and EIMEA (8.5% year-over-year growth in fiscal 2024, largely from India, the Middle East, and CIS regions). The company has also seen strong order momentum in Latin America. This continued expansion into high-growth regions is expected to be a significant revenue driver.
2. Growth in Service Revenue: The service segment consistently contributes to Accuray's revenue, with a 5% year-over-year increase in service revenues in Q1 FY25, primarily driven by higher contract revenue. This recurring revenue stream is bolstered by an expanding global installed base of systems and efforts to increase service contract capture rates.
3. New Product Launches and Technological Innovation: Accuray continues to launch and promote innovative radiotherapy solutions. The introduction of the Stellar product (a new configuration of the Radixact Treatment Delivery System) in September 2025 at the ASTRO conference received positive reception and is expected to drive demand from both new and existing customers. Additionally, the CyberKnife System's precision and the Accuray Precision Treatment Planning System (TPS) (which gained approval in China for use with the Tomo C system) are key offerings that are anticipated to contribute to future product sales.
4. U.S. Market Recovery and Installed Base Upgrades: While the U.S. market has experienced softness, Accuray anticipates a recovery in the second half of fiscal year 2025 and into fiscal year 2026. This recovery is expected to lead to increased replacement activity for the aging installed base of Accuray systems, presenting an opportunity for significant product revenue growth.
5. Strong Order Backlog: The company maintains a substantial order backlog, reported at approximately $427 million in Q4 FY25, providing over 18 months of product revenue visibility. This robust backlog signifies committed future sales that are expected to convert into revenue over the next 2-3 years, despite some recent declines in gross orders.

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Share Repurchases

There is no significant information available regarding share repurchases or authorized buyback programs by Accuray in the last 3-5 years.

Share Issuance

• In June 2025, Accuray completed an exchange of approximately $82.0 million in aggregate principal amount of its 3.75% Convertible Senior Notes due 2026 for 8,881,579 shares of common stock and an aggregate cash payment of approximately $68.6 million.
• As of June 30, 2025, approximately 4.82 million shares were available for issuance under the company's 2016 Equity Incentive Plan.
• In October 2025, Accuray granted its new CEO, Stephen La Neve, equity inducement awards consisting of 1.5 million restricted stock units and 1.5 million performance-based restricted stock units (PSUs), which were made outside the company's current equity plan.

Inbound Investments

• In June 2025, Accuray entered into a new $190 million senior secured credit facility with TCW, which included a $150 million term loan, a $20 million delayed draw loan, and a $20 million revolving credit facility. This financing was used to repay prior debt.

Outbound Investments

• Accuray has an equity method investment in a China joint venture, to which it sells products and services.
• Sales of products to this joint venture were $28.644 million for the three months ended September 30, 2024, and $21.952 million for the same period in 2023.
• The company also includes chargebacks to the joint venture related to research and development, amounting to $355,000 for the three months ended September 30, 2024, and $132,000 for the same period in 2023.

Capital Expenditures

• Accuray's capital expenditures coverage for fiscal years ending June 2021 to 2025 averaged 2.9x, with a median of 0.7x.
• Capital expenditures coverage reached its highest point in June 2021 at 16.6x and its lowest point in June 2024 at -3.3x.
• The coverage decreased in fiscal years 2022 (-0.5x) and 2024 (-3.3x) while increasing in 2021 (16.6x), 2023 (1.2x), and 2025 (0.7x).