Journey through technological advancements in radiation therapy

Radiation therapy (RT) has advanced substantially since the introduction of the first medical linear accelerator, progressing through successive generations of technological innovation that have improved treatment precision, efficiency, and patient safety. This review provides a comprehensive overview of the evolution of RT technologies-from early linear accelerators to contemporary clinical systems-and examines ongoing research shaping the future of radiotherapy. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science, covering peer-reviewed publications from the era of the first linear accelerator to the present. Studies addressing historical milestones, technological developments, clinical implementation, and emerging research directions in RT were included. The literature demonstrates continuous advancement from early accelerator models to modern high-precision platforms integrating image guidance, adaptive radiotherapy, and motion management. Recent developments include automation, artificial intelligence-driven workflows, magnetic resonance-guided radiotherapy, and biologically informed modeling to enable personalized treatment. Ongoing investigations focus on real-time tumor tracking, radiobiology-guided planning, artificial intelligence-based clinical decision support, and next-generation delivery systems. From its origins to today's state-of-the-art systems, RT has undergone transformative growth. Sustained research and rigorous clinical validation remain essential to effectively integrate emerging innovations and enhance patient outcomes.