It's a privilege to address you on my first earnings call as Accuray's CEO. Today, I'm excited to share why I chose to join Accuray and my high level of conviction in Accuray's success as we enter the next phase of transformational growth. This makes me more confident than ever about the potential to enhance our performance, market position, and our long-term growth prospects. I've come to Accuray with over 40 years of global experience in Medtech and Biotech, including capital equipment.

The common thread across my experience was driving top-line growth profitably while meaningfully improving patients' lives with innovative technology. Turning to the first quarter results, net revenue for the first quarter was $94 million, which was down 7% versus the prior year and down 9% on a constant currency basis. With that said, product revenue for the first quarter was $37 million, which was below expectations, mainly due to slower performance in our EMEA and China regions. Year-over-year product revenue was down 23% and down 24% on a constant currency basis.

On the other hand, as you know, our install base generates a relatively predictable, higher-margin, valuable revenue stream, which continues to grow and which we intend to emphasize strategically. Service revenue was, again, the highlight of the quarter, with revenue of $57 million, up 7% from the prior year and up 4% on a constant currency basis. This increase was driven by contract revenue growth of 10% year-over-year, which was higher than our installed rates growth of 2% over the same period, illustrating that our pricing actions are taking effect. Product orders for the first quarter were approximately $40 million and represented a book-to-bill ratio of 1.1, with a trailing 12-month ratio of 1.2.

What went well
  • Service revenue was again the highlight at $57 million, up 7% (contract revenue up 10%, ahead of ~2% installed-base growth), showing pricing actions taking hold.
  • Accuray launched its Stellar adaptive-radiotherapy product at ASTRO in September to an overwhelmingly positive reception from existing and new customers.
  • The company signed an MOU with the University of Wisconsin School of Medicine and Public Health to advance online adaptive radiotherapy on the helical platform.
  • First patients were treated in Melbourne, Australia on a CyberKnife system, expanding community access in a new market.
  • New CEO Steve La Neve began his tenure and started a strategic, operational and financial transformation, with board member Steven Mayer named transformation sponsor.
What went wrong
  • Net revenue of $94 million was down 7% year-over-year (down 9% constant currency), below expectations.
  • Product revenue of $37 million fell 23%, driven by slower performance in EMEA and China.
  • Overall gross margin dropped to 28.3% from 33.9%, with product gross margin at 20.3% (vs. 32.9%) hit by geographic/product mix (7.8 pts), tariffs (3 pts) and a one-time aged-inventory obsolescence charge (1.7 pts).
  • Operating loss widened to $11.3 million and adjusted EBITDA was a loss of $4.1 million (vs. +$3.1 million), including ~$2.8-3.3 million of restructuring and post-financing costs.
  • Gross orders of ~$40 million were below expectations on timing of customer orders in China and the Americas, with a net-vs-gross gap widened by a canceled unit and age-outs.

Guidance Changes

MetricPeriodCurrent guidance
Fiscal 2026 revenueFY2026Reiterated $471 million to $485 million
Fiscal 2026 adjusted EBITDAFY2026Reiterated $31 million to $35 million
Revenue phasing (H1/H2)FY2026Now ~40% first half / 60% second half as product demand shifts to the back half
Adjusted EBITDA margin run-rateNext ~12 monthsExpect to reach a high-single-digit adjusted EBITDA margin run-rate within 12 months; double digits over the medium-to-long term

Performance Breakdown

MetricYoYNote
Net revenue -7% to $94 million (-9% cc) Product revenue weakness in EMEA and China amid geopolitical and macro headwinds.
Product revenue -23% to $37 million Slower EMEA and China performance; long sales cycles and low unit volumes make quarterly product revenue volatile.
Service revenue +7% to $57 million Contract revenue up 10% on pricing actions outpacing ~2% installed-base growth.
Product gross margin 20.3% vs. 32.9% Geographic/product mix (7.8 pts), tariffs (3 pts) and a one-time aged-inventory obsolescence charge (1.7 pts).
Adjusted EBITDA -$4.1 million vs. +$3.1 million Product gross margin pressure and restructuring/post-financing costs.
Backlog ~$396 million (>18 months of product revenue) Book-to-bill of 1.1 in the quarter (1.2 trailing 12 months); one ~$2 million unit canceled for backlog quality.

Earnings Call Themes & Trends

TopicPrevious mentionCurrent periodTrend
CEO transition and transformationSuzanne Winter as CEOSteve La Neve took over October 2025; launched a transformation to sharpen strategy, expand margins and build a performance culture, with details promised for early 2026 and Steven Mayer as sponsor.
Adaptive radiotherapy / StellarAdaptive solutions previewedStellar launched at ASTRO with strong reception; UW-Madison MOU to advance online adaptive radiotherapy on the helical platform.
Service-led recurring revenueService growth strategyService +7% with contract revenue +10%; pricing actions clearly taking effect and installed-base growth remains the key driver.
Geopolitics and tariffsChina tariffs, Middle East unrestEMEA and China slowed product sales; duty drawback active and foreign trade zone still under evaluation as the tariff environment stays fluid.
Back-half-weighted year~45%/55% phasingPhasing shifted to ~40%/60% as delayed China/EMEA product demand is expected to convert in the second half.

Q&A Summary

Marie Thibault (BTIG) asked about the capital-equipment purchasing and ordering environment across regions.
Pervaiz said it varies by region -- a Q1 slowdown in EMEA and China on geopolitical/macro issues that are starting to ease, steady U.S. capital sentiment and continued APAC growth -- and the team is working to get a better pulse for the rest of fiscal 2026.
Marie Thibault (BTIG) asked about the larger-than-usual gap between gross and net orders and whether age-outs (China-related) drove it.
Pervaiz said there were age-outs but not out of the norm; he focuses on gross orders as the true measure of new business (~$40 million, below expectation on timing of customer receipts in the Americas and China).
Marie Thibault (BTIG) asked for the latest on tariff-mitigation efforts.
Pervaiz said the duty drawback program is very active for equipment leaving the U.S. and a foreign trade zone remains under evaluation; the environment is fluid. He reiterated FY2026 guidance and flagged a ~40%/60% first-half/second-half revenue split as demand shifts to the back half.
Marie Thibault (BTIG) asked whether product gross-margin pressure from mix continues into Q2 and improves in the second half.
Pervaiz agreed -- more emerging-market deals hit Q1 and are expected again in Q2, with better-margin developed-market backlog teed up for later, while service (+7%, contract +10%) remains a strong margin contributor.

More on Accuray Inc

Reported 2025-11-05 · figures from the Accuray Inc Q1 2026 earnings call.

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