The Proforma Altitude Problem In 2026 Oncology Capital Decisions

The Vendor Landscape Just Widened. Your Capital Conversation Changed Whether You Know It Or Not.

At ESTRO 2026, United Imaging showed a CE-marked uRT-linac 506c on the show floor. Diagnostic-CT integrated with a linear accelerator on a single platform. Online adaptive radiotherapy positioned without an MR-linac, without a third-party planning system, and without RaySearch. Reported as CE marked in Europe. Not yet in the US market. Capital decisions in flight in the US in 2026 are not changing because of what showed up in Berlin. What changed is the leverage map on every conversation around them. medsolvedynamics.com [http://medsolvedynamics.com]  |  team@medsolvedynamics.com [team@medsolvedynamics.com]

The Hospital Math Says Build. The Physician Math Says Do Not. That Gap Is The wRVU Trap.

Most rad onc programs sitting on soft Q2 numbers are looking outside the building for offsetting revenue. The infrastructure for radioligand therapy is already inside the building, and a Jefferson-authored paper accepted by Practical Radiation Oncology in May 2026 puts the 340B-eligible hospital gross margin at roughly $101,000 per Pluvicto patient over a full course. The same paper names why programs stall. The rad onc on a dollars-per-wRVU comp model takes a 26-wRVU haircut against EBRT for picking up RPT. The credential map is already in the department. The comp model discussion is in the way. The operator move is to renegotiate the comp model with the 340B margin as the leverage before the service line gets approved. medsolvedynamics.com [http://medsolvedynamics.com] | team@medsolvedynamics.com [team@medsolvedynamics.com]

Ask The Vendor What The Same Software Costs Without The AI. The Unbundled-Price Question

From 20 years on the vendor side of oncology software sales, the one question that exposes the AI price premium baked into software renewal quotes in 2026. Treatment planning systems, contouring software, registry products, SaaS modules. The AI features were priced higher than the same software would have priced two years ago. Get the unbundled price. medsolvedynamics.com [http://medsolvedynamics.com] | team@medsolvedynamics.com [team@medsolvedynamics.com]

When I Was On The Vendor Side: The AI Demo That Skipped The Workflow Question

A vendor-side story Yoel Bakas has watched play out dozens of times in radiation oncology. A software demo runs without anyone asking what is actually broken in the customer's workflow. The tool gets relabeled AI-enabled a year later. Until the customer understands what is broken, it does not matter what the tool is. AI in radiation oncology, workflow design, vendor evaluation, capital decision. medsolvedynamics.com [http://medsolvedynamics.com] | team@medsolvedynamics.com [team@medsolvedynamics.com]

Why Your LINAC's Unbooked Hours Are The Cheapest Margin Audit You Will Run In 2026

From 20 years on the vendor side of LINAC capital and service negotiations, the data point most radiation oncology programs do not see with the same precision the vendor sees it: their own unbooked machine hours. Every unbooked hour is a fixed cost paid for and not recovered. The 15-minute utilization audit is the cheapest margin discipline in the 2026 reimbursement environment. medsolvedynamics.com [http://medsolvedynamics.com] | team@medsolvedynamics.com [team@medsolvedynamics.com]