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2009). Precise positioning of the intracranial volume to be treated in this unit is achieved by moving the entire patient on a high-precision couch, capable of submillimetric motion with six-sigma reliability for loads of up to 300 kg. By the end of 2009, some 266 Elekta Gamma Knife units were reported to be in use worldwide. 18), which does not include unreported treatments (Leksell Gamma Knife Society 2011). 18 Gamma Knife patients treated through calendar year 2011 as reported by the Leksell Society.

American physicist Arthur Mutscheller published a recommendation in 1925 that the level of exposure in x-ray centers be limited to 1/100th of the SED in a 30-day period (Mutscheller 1925). Mutscheller estimated the SED by multiplying the tube current times the exposure length divided by the square of the distance from the tube multiplied by an arbitrary constant. Later physicists estimated this “tolerance dose” as about 60–70 rem per year. Swedish physicist Rolf Sievert also recommended a tolerance dose of 1/10th of the SED per year, close to Mutscheller’s recommendation.

19 Bette and Derechinsky linear accelerator–based radiosurgery system with moveable patient chair. 19). This was one of the first examples of utilization of multiple noncoplanar arc x-ray beams converging on an intracranial target. Two more systems were later built and installed in French hospitals. A few years later, another group in Vicenza, Italy, lead by neurosurgeon Federico Colombo, developed its own stereotactic frame with a linac and mated it to a Varian Clinac 4 linear accelerator with a 4 MV x-ray beam (Colombo et al.

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