Our take
ZAP Surgical was founded by the inventor of CyberKnife to make brain radiosurgery cheaper to install. ZAP-X shields its own beam, so a hospital or outpatient center can put it in an ordinary room instead of building a concrete bunker, and it uses a linear accelerator rather than a radioactive cobalt source that must be replaced.1,2
The company passed its 50th system and nearly 10,000 patients in 2026 and raised $36 million led by Catalio Capital Management in October. The weak points are size and focus: 50 systems is small next to the established radiosurgery makers, and ZAP-X treats only the head and neck.3,2
Scores by criterion
Each criterion is defined on our methodology page.
Who uses ZAP and what it's for
ZAP-X is sold to academic medical centers, community hospitals, and physician-led practices that want to offer stereotactic radiosurgery for brain tumors and other conditions of the head and neck.3,2
The company says about five million people a year are candidates for radiosurgery but only about 200,000 receive it, because of the cost and complexity of existing systems.1
History
Dr. John R. Adler Jr., a Stanford neurosurgeon who invented the CyberKnife radiosurgery system, founded ZAP in 2014. ZAP-X received FDA 510(k) clearance in 2017, treated its first patients in 2019 at Barrow Brain and Spine in Phoenix, Arizona, and was cleared in Japan in 2020 and Europe in 2021.1,2,4
Baheal Medical has been ZAP's strategic partner in China. On October 19, 2026, ZAP announced $36 million led by Catalio Capital Management, with Catalio's Nicholas von Guionneau joining its board as an observer.3
ZAP-X
ZAP-X uses two independent gantries to aim a 3 MV beam from more than 1,000 angles around the head, with a tungsten-shielded collimator that keeps leakage under 0.002% of the primary beam. Its 45 centimeter source distance cuts beam penumbra by about half compared with full-body systems, the company says.2
ZAP says the self-shielded design avoids 2 to 3 million pounds of concrete and steel and about $1 million or more in vault construction, plus the recurring cost of about $1 million for cobalt source replacement on older systems.2
Beyond tumors
ZAP is studying low-dose radiation to the brain, which it calls radiomodulation, for psychiatric disorders. It reported early data from a first-in-human pilot in treatment-resistant depression and is planning multi-center trials beginning with depression and addiction.3
Competitive landscape
| Company | Product | Pricing model | Deployment footprint | Where ZAP wins or loses |
|---|---|---|---|---|
| ZAP Surgical | ZAP-X self-shielded radiosurgery robot for the brain2 | Not published; $1.8 million reported in 20194 | 50 systems shipped and nearly 10,000 patients treated3 | No vault needed; brain only |
| Elekta | Leksell Gamma Knife and Elekta Esprit radiosurgery systems5 | Not published5 | Hospital radiation oncology and neurosurgery centers5 | Elekta wins on Gamma Knife's long record in brain radiosurgery. ZAP wins on no vault and no cobalt source. |
| Accuray (CyberKnife) | CyberKnife S7 robotic radiosurgery for tumors anywhere in the body6 | Not published6 | Hospital cancer centers worldwide7 | Accuray wins on treating tumors anywhere in the body. ZAP wins on a cheaper, vault-free brain system. |
| Varian (Siemens Healthineers) | TrueBeam, Edge, and Ethos radiotherapy systems, now part of Siemens Healthineers8 | Not published8 | Hospital radiation oncology departments8 | Varian wins on full-body radiotherapy and Siemens' reach. ZAP wins on a dedicated brain system without a bunker. |
| RefleXion Medical | SCINTIX autonomous radiotherapy guided by signals from the tumor9 | Not published9 | Lung and bone tumors at hospital oncology centers9 | RefleXion wins on biology-guided treatment of lung and bone tumors. ZAP wins on brain radiosurgery in an ordinary room. |
Limits
ZAP does not publish a current price. HCB News reported a US price of $1.8 million in 2019, which may have changed.4
ZAP-X treats only the head and neck, so a center that also needs body radiosurgery would need a second system.2
Revenue is not disclosed. We estimate it at $15 million to $30 million a year, based on 50 systems shipped since 2019 at a reported price near $1.8 million, plus service. This is an estimate, not a reported figure.3,4
What customers say
Where it helps
ZAP says nearly 10,000 patients have been treated on ZAP-X worldwide, and that the dedicated cranial design limits dose to the eyes, optic nerves, and brain stem.3,2
ZAP says the vault-free design lets centers convert lobby space or meeting rooms into a radiosurgery suite, which opens sites outside large urban hospitals.2
Where it falls short
The radiomodulation work is early. The depression data come from a small first-in-human pilot, and larger trials are still being planned.3
We found no independent study comparing ZAP-X outcomes or cost per patient with Gamma Knife or CyberKnife. Buyers should ask for treatment time and service cost data from existing sites.2
Leadership
John R. Adler Jr.
Founder and chief executive officerDr. Adler invented the CyberKnife radiosurgery system and is an emeritus professor of neurosurgery and radiation oncology at Stanford University.1
Sources
- ZAP Surgical, About, accessed November 2, 2026
- ZAP Surgical, ZAP-X, accessed November 2, 2026
- ZAP Surgical, ZAP Surgical secures $36 million led by Catalio Capital Management, October 19, 2026, accessed November 2, 2026
- HCB News, ZAP Surgical launches radiosurgery platform for treating brain tumors, February 4, 2019, accessed November 2, 2026
- Elekta, Stereotactic radiosurgery, accessed November 2, 2026
- Accuray, CyberKnife, accessed November 2, 2026
- Accuray, Company, accessed November 2, 2026
- Siemens Healthineers, Cancer care (Varian), accessed November 2, 2026
- RefleXion, Homepage, accessed November 2, 2026
