Technology evolution: is it survival of the fittest?

New technologies are constantly being developed and introduced into medical practice. Their potential or actual use raises questions of efficacy and cost. All too often financial considerations of profit primarily determine whether a technology will be adopted. In an era in which the need to control costs has become clear, this situation is undesirable. The assessment of efficacy can, however, be very difficult, and the control of financial aspects is likewise problematic. In this article, we address these problems and suggest potential solutions, using proton radiotherapy as an example that may be relevant to the development of other medical devices.