Physics for radiosurgery with linear accelerators

Abstract

Radiosurgery had a long development period and, for more than three decades, was used only in a few specialized centers around the world. The development of LINAC-based radiosurgical techniques combined with the concurrent advances in imaging modalities during the 1980s, however, caused so much interest in this treatment modality that most major radiotherapy centers now offer this service or at least plan to offer it in the near future. When considering a LINAC for radiosurgical use, one should remember that technical and clinical requirements for accurate radiosurgery are far more stringent than those applied to standard radiotherapy. This is because in radiosurgery, the targeted volumes are much smaller and the dose is usually delivered in a single irradiation session, whereas in radiotherapy, the dose is delivered to a relatively large target volume on a fractionated basis. Linear accelerator-based radiosurgery broadens the scope of radiotherapy departments. The impetus to introduce this service at a medical center usually comes from neurosurgeons, however. Even after the service becomes routine at an institution, it is the neurosurgeon who refers the patient and who plays the most important role in determining the target volume and its location within the brain. The decision on the choice of isodose surface and the prescribed dose, however, belongs to the radiotherapist. It is becoming clear that radiosurgery is a complex treatment modality for which a successful outcome requires a collaborative team effort by several hospital-based professionals, including neurosurgeons, radiation oncologists, neuroradiologists, and medical physicists. As in standard radiotherapy, physics plays an important role in radiosurgery, not only in the development of target localization, treatment-planning, and dose delivery techniques, but also in the actual patient contact, from the diagnostic target localization procedures, through treatment planning, to patient preparation on the device and dose delivery.