Accuray Transforming Patient Care Through Innovation Investor Day

1 Proprietary and Confidential Property of Accuray Accuray Overview Video Exhibit 99.1

Accuray Transforming Patient Care Through Innovation Investor Day October 25, 2021

Agenda 3 Proprietary and Confidential Property of Accuray

Proprietary and Confidential Property of Accuray Safe Harbor Statement

Statements in this presentation (including the oral commentary that accompanies it) that are not statements of historical fact are forward-looking statements and are subject to the "safe harbor" provisions of the Private Securities Litigation Reform Act of 1995. Forward-looking statements in this presentation relate, but are not limited, to: our preliminary financial results, including expectations regarding gross orders, revenues and adjusted EBITDA for the first quarter of fiscal 2022; expectations regarding fiscal 2022 full-year adjusted EBITDA and revenue; our positioning and strategy for accelerating revenue, market share and margin expansion, including expectations regarding our financial model; expectations regarding market growth rates and market trends; expectations regarding new product enhancements or offerings; expectations regarding partnerships and planned partnerships; our long term growth catalysts; expectations related to our joint-venture in China and Type-B product, including our ability to drive additional growth and market share in China; our ability to expand addressable markets; and our ability to capitalize on operating leverage to drive greater profits and cash flows. Forward-looking statements generally can be identified by words such as "anticipates," "believes," "estimates," "expects," "intends," "plans," "projects," "may," "will be," "will continue," and similar expressions. These forward-looking statements involve risks and uncertainties that could cause actual results to differ materially from expectations. These risks and uncertainties include, but are not limited to: the effects of the COVID-19 pandemic on our business, financial condition, results of operations or cash flows; our ability to achieve widespread market acceptance of our products, including new product offerings and improvements; our ability to develop new products or enhance existing products to meet customers' needs and compete favorably in the market; our ability to realize the expected benefits of the joint-venture and other partnerships; risks inherent in international operations; our ability to effectively manage our growth; our ability to maintain or increase our gross margins on product sales and services; delays in regulatory approvals or the development or release of new offerings; our ability to meet the covenants under our credit facilities; our ability to convert backlog to revenue; and other risks identified under the heading "Risk Factors" in our annual report on Form 10-K, filed with the Securities and Exchange Commission (the "SEC") on August 17, 2021, and as updated periodically with our other filings with the SEC.

Forward-looking statements speak only as of the date the statements are made and are based on information available to Accuray at the time those statements are made and/or management's good faith belief as of that time with respect to future events. Accuray assumes no obligation to update forward-looking statements to reflect actual performance or results, changes in assumptions or changes in other factors affecting forward-looking information, except to the extent required by applicable securities laws. Accordingly, investors should not place undue reliance on any forward-looking statements.

Non-GAAP Financial Measures

This presentation also contains non-GAAP financial measures. Management believes that non-GAAP financial measures provide useful supplemental information to management and investors regarding the performance of the company and facilitates a more meaningful comparison of results for current periods with previous operating results. Additionally, these non-GAAP financial measures assist management in analyzing future trends, making strategic and business decisions, and establishing internal budgets and forecasts. A reconciliation of these non-GAAP financial measures to the most directly comparable GAAP measure is provided in the Appendix.

There are limitations in using these non-GAAP financial measures because they are not prepared in accordance with GAAP and may be different from non-GAAP financial measures used by other companies. These non-GAAP financial measures should not be considered in isolation or as a substitute for GAAP financial measures. Investors and potential investors should consider non-GAAP financial measures only in conjunction with the company's consolidated financial statements prepared in accordance with GAAP.

Medical Advice Disclaimer

Accuray Incorporated as a medical device manufacturer cannot and does not recommend specific treatment approaches. Individual results may vary.

Forward-looking statements This presentation is intended exclusively for investors. It is not intended for use in Sales or Marketing

5 Proprietary and Confidential Property of Accuray Our Vision:

To EXPAND the CURATIVE POWER of RADIATION THERAPY to improve as many lives as possible Broader treatment options

Global patient access Enable advanced treatments

Survival, long term outcomes

Quality of life Precision technology

Superior patient experience

Partnerships Focused resources

6 Entering the Golden Age of Radiotherapy Proprietary and Confidential Property of Accuray Accuray is leading the transformation 1 Versus 8 Week Treatments* Imaging Innovation Adaptive Therapy Partnerships Drug/Device

Combination *SBRT treatments vs conventional fractionated treatments (5 sessions vs 35 to 40 sessions)

7 Accuray Systems: Differentiated Solutions Proprietary and Confidential Property of Accuray TomoTherapy System Radixact System Personalized

Fast S7 System CyberKnife 4D Dynamic Delivery

Speed Treatment Planning System Accuray Precision Efficient

Automated Ultimate IMRT/SBRT Workhorse Dedicated Whole Body SRS/SBRT System Connectivity to the RT Department

8 Proprietary and Confidential Property of Accuray Strategy for Accelerating Revenue and Margin Expansion Financial model designed to both invest as well as grow the top line Reposition for Success Enhanced leadership

Established China JV

Introduced Synchrony

Improved cost structure and operating leverage FY18 - FY19 Transform Culture and Begin Innovation Driven Growth Redefined vision and technology roadmap

China type-A revenue ramp

Build our global infrastructure and operations

Restructured debt for growth FY20 - FY21 Accelerate Growth New products and partnerships

Execution on China growth

Expand markets and drive market share gain

Drive greater profits and cash flows FY22+ Plan

9 Proprietary and Confidential Property of Accuray Long Term Growth Catalysts

10 Proprietary and Confidential Property of Accuray Commercial Orders Momentum Entering FY22 AMERICAS EMEA APAC +19% Q4 Y/Ya

+39% Q1 Y/Yb WW MARKET

CAGR 2021-2026 JAPAN a: Q4 FY21 orders Y/Y

b: Q1 FY22 orders Y/Y. Q1 FY22 orders are preliminary unaudited results.

c: MarketsAndMarkets RADIOTHERAPY MARKET - GLOBAL FORECAST 2021-2026

Four (4) Accuray business regions and strategies

Long Term Revenue Growth Catalysts 11 Proprietary and Confidential Property of Accuray Technology Innovation Pipeline China Growth and Unique Business Model New Market Opportunities Acceleration of Favorable Market Trends

Robust Technology Pipeline 12 Proprietary and Confidential Property of Accuray Innovation Pipeline 15%

Invested in R&D* ClearRT CyberKnife Online Adaptive Breast Package Radixact VOLO Ultra Radixact ClearRT Radixact Neuro Package CyberKnife Synchrony Radixact FY21-FY24 Launched products Planned launches *R&D as a planned percentage of revenue FY22

13 Proprietary and Confidential Property of Accuray China Growth and Unique Business Model

China Joint Venture Business Progress Proprietary and Confidential Property of Accuray 175 employees

Commercial execution:

Type-A: 85% market share*

Type-B: Commercial coverage with JV product on-track

Customer support team active with 30 systems installed in calendar 2021

World class training and education center *100 out of 118 type-A licenses awarded in the 13th - 5-year plan

15 Proprietary and Confidential Property of Accuray China JV manufacturing ready for BIMTa testing ISO 13485 certified

Type-B product on track

Planned market introduction in summer 2022

Anticipate shipments following NMPAb approval by end of CY2022

Sister manufacturing site development b NMPA: The National Medical Products Administration (NMPA) is the Chinese agency for regulating drugs and medical devices

(formerly the China Food and Drug Administration or CFDA) a BIMT: China Medical Manufacturer, Diagnostic, Testing supplier JV Manufacturing Facility Prepared for Type-B Product

16 Proprietary and Confidential Property of Accuray New Market Opportunities

Expansion to Global Value Segment Proprietary and Confidential Property of Accuray Upgradeability Path Reduced Total Cost of Care Expand Patient Access High Throughput

Workflow Efficiency Differentiated Feature Set Base Clinical Capabilities with Options Mid-CY2023 Availability * Internal total new unit market forecast FY23 (Brazil and India) $300M Annual Opportunity* Target emerging markets where RT is underpenetrated

NeuroRadiosurgery: Replacement Market Opportunity Proprietary and Confidential Property of Accuray *MarketsAndMarkets RADIOTHERAPY MARKET - GLOBAL FORECAST TO 2026

Gamma Knife is a registered trademark of Elekta AB (publ) Target neurosurgeons

Treats brain AND spine

Improved patient experience

Synchrony 4D dynamic delivery

19 Proprietary and Confidential Property of Accuray Dr. DAVID ROBERGE

Adjunct Professor, Oncology

McGill University, CHUM - Notre Dame

20 Proprietary and Confidential Property of Accuray Market Trends and Technology Implications

Growing Use of Ultra-Hypofractionated Treatments 21 Proprietary and Confidential Property of Accuray

Growth Since 2015 Number of patients *Medicare is subset of total treatments

2015 - 2019 Medicare Hospital Outpatient Standards Analytics File; 2015 - 2018 The Medicare Physician & Other Practitioners by Provider and Service dataset Public Use File; Freestanding volume for 2019 estimated based on annual 2015-2018 average growth rates

COVID-19: Accelerates Hypofractionation Adoption 22 Proprietary and Confidential Property of Accuray Increasing Clinical Evidence Guidelines

Reduce the patient and provider risk of exposure

Aged Equipment Need Technology Upgrade Proprietary and Confidential Property of Accuray Conventional Ultra-HF Treat More Patients with Ultra-Hypofractionationb 40% U.S. Installed Base >9 yearsa a IMV 2019 Radiation Therapy Market Summary Report b Accuray internal data on file Installed base is aged

Technology needed for ultra-HF treatments

Increase annual patients treated

Compete more effectively in RO-APM reimbursement

Potential for improved outcomes and quality of life

24 Proprietary and Confidential Property of Accuray PROF. RAPHAEL MOECKLI

Group Leader, Medical Physicist at CHUV

25 Proprietary and Confidential Property of Accuray Global leader in SRS/SBRT

Only robotic delivery system

Fast <15 min treatments CYBERKNIFE S7 System 360-degree helical arc therapy

Fast <15 min treatments RRADIXACT System Outstanding image quality

Synchrony 4D dynamic delivery

VOLO and VOLO Ultra speed

ACCURAY-ONLY TECHNOLOGY ClearRT Synchrony VOLO

26 Proprietary and Confidential Property of Accuray Clinical Evidence

~ 1 in 8 men in the U.S. will be diagnosed with prostate cancera

First phase 3 trial testing 5-fraction SBRT for prostateb

N=874 patients from 37 centers in 3 countriesb

Subset analysis of the SBRT arm is favorable for the CyberKnife system PACE-B Prostate Study Shows Lower Side Effects with the CyberKnife System Proprietary and Confidential Property of Accuray a American Cancer Society

b Dr Alison Tree:, Royal Marsden Hospital, London, UK: Oral presentation and book of abstract at ESTRO 2021, Madrid, Spain

c Compared to conventional linac. Dr Alison Tree:, Royal Marsden Hospital, London, UK: Oral presentation at ESTRO 2021, Madrid, Spain 50% less bladder side effectsc Study shows 50% less bladder side effects compared to conventional linac

28 Proprietary and Confidential Property of Accuray Dr. Alison Tree

Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust

~ 1 in 8 women in the U.S. will develop invasive breast cancera

80% of all breast cancer treated are early stage, outcomes are excellentb