The Physics of Stereotactic Radiosurgery

  • Siyong Kim
  • Jatinder Palta


In radiosurgery, instead of using a surgical knife when treating a patient, high-energy ionizing radiation is the tool of choice. To understand the tumoricidal effects of ionizing radiation, it is important to know how radiation interacts with matter. This chapter describes general concepts and principles in radiation physics, including basic physics that are applicable to stereotactic radiosurgery. Commonly used delivery systems are also briefly reviewed. This chapter is written for non-physics professionals, especially neurosurgeons and radiation oncologists.


Proton Beam Radiat Oncol Biol Phys Linear Accelerator Gamma Knife Stereotactic Radiosurgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Evans RD. The Atomic Nucleus. Malabar, FL: Krieger, 1955.Google Scholar
  2. 2.
    Attix FH. Introduction to Radiological Physics and Radiation Dosimetry. New York: Wiley-Interscience, 1986.CrossRefGoogle Scholar
  3. 3.
    Khan FM. The Physics of Radiation Therapy, Second ed. Philadelphia: Lippincott Williams & Wilkins, 1992.Google Scholar
  4. 4.
    Johns HE, Cunningham JR. The Physics of Radiology, Fourth ed. Springfield, IL: Charles C Thomas Publisher, 1983.Google Scholar
  5. 5.
    Leksell L. Cerebral radiosurgery I. Gamma thalamotomy in two cases of intractable pain. Acta Chir Scand 1968; 134:585–595.PubMedGoogle Scholar
  6. 6.
    Wu A, Maitz AH, Kalend AM, et al. Physics of gamma knife approach on convergent beams in stereotactic radiosurgery. Int J Radiat Oncol Biol Phys 1990; 18:941–949.PubMedGoogle Scholar
  7. 7.
    Simonova G, Novotny J Jr, Vladyka V, et al. Fractionated stereotactic radiotherapy with the Leksell gamma knife: feasibility study. Radiother Oncol 1995; 37:108–116.CrossRefPubMedGoogle Scholar
  8. 8.
    Poffenbarger B. Viability of an isocentric cobalt-60 teletherapy unit for stereotactic radiosurgery. MSc thesis, McGill University, Montreal, Canada, 1998.Google Scholar
  9. 9.
    Poffenbarger B. Viability of an isocentric cobalt-60 teletherapy unit for stereotactic radiosurgery. Med Phys 1998; 25:1935–1943.CrossRefPubMedGoogle Scholar
  10. 10.
    Bellerive M, Kooy HM, Loeffler J. Linac radiosurgery at the Joint Center for Radiation Therapy. Med Dosim 1998; 23:187–199.CrossRefPubMedGoogle Scholar
  11. 11.
    Betti OO, Derechinsky VE. Hyperselective encelphalic irradiation with linear accelerator. Acta Neurochir Suppl 1984; 33:385–390.Google Scholar
  12. 12.
    Colombo F, Benedetti A, Pozza F, et al. External stereotactic irradiation by linear accelerator. Neurosurgery 1985; 16:154–160.CrossRefPubMedGoogle Scholar
  13. 13.
    Hamilton JA, Lulu BA, Fosmire H, et al. Preliminary clinical experience with linear accelerator based spinal stereotactic radiosurgery. Neurosurgery 1995; 36:311–318.PubMedGoogle Scholar
  14. 14.
    Lutz W, Winston KR, Maleki N. A system for stereotactic radiosurgery with a linear accelerator. Int J Radiat Oncol Biol Phys 1988; 14:373–381.PubMedGoogle Scholar
  15. 15.
    Larsson B. Dosimetry and radiobiology of protons as applied to cancer therapy and neurosurgery. In: Thomas RH, Perez-Mendez V, eds. Advances in Radiation Protection and Dosimetry in Medicine. New York: Plenum, 1980:367–394.Google Scholar
  16. 16.
    Frankel KA, Phillips MH. Charged particle method: protons and heavy charged particles. In: Phillips MH, ed. In Physical Aspects of Stereotactic Radiosurgery. New York: Plenum, 1993.Google Scholar
  17. 17.
    Kjellberg RN, Shintani NA, Frantz AG. Proton beams in acromegaly. N Engl J Med 1968; 278:689–695.PubMedCrossRefGoogle Scholar
  18. 18.
    Larsson B, Leksell L, Rexed B, et al. The high energy proton beam as a neurosurgical tool. Nature 1958; 182:1222–1223.CrossRefPubMedGoogle Scholar
  19. 19.
    Breuer H, Smit BJ. Proton Therapy and Radiosurgery. Berlin, Heidelberg, New York: Springer-Verlag, 2000.Google Scholar
  20. 20.
    Wieszczycka W, Scharf WH. Proton Radiotherapy Accelerators. Singapore: World Scientific, 2001.CrossRefGoogle Scholar
  21. 21.
    Karzmark CJ, Nunan CS, Tanabe E. Medical Electron Accelerators. New York: McGraw-Hill, 1993.Google Scholar
  22. 22.
    Shiu AS, Kooy HM, Ewton JR, et al. Comparison of miniature multileaf collimation with circular collimation for stereotactic treatment. Int J Radiat Oncol Biol Phys 1997; 37:679–688.PubMedGoogle Scholar
  23. 23.
    Arcovito G, Piermattei A, D’Abramo G et al. Dose measurements and calculations of small radiation fields for 9-MV x rays. Med Phys 1985; 12:779–784.CrossRefPubMedGoogle Scholar
  24. 24.
    Bova FJ. Radiation physics. Neurosurg Clin N Am 1990; 1:909–931.PubMedGoogle Scholar
  25. 25.
    Houdek PV, VanBuren JM, Fayos JV. Dosimetry of small radiation fields for 10-MV x rays. Med Phys 1983; 10:333–336.CrossRefPubMedGoogle Scholar
  26. 26.
    Rice RK, Hansen JL, Svensson GH, et al. Measurements of dose distributions in small beams of 6 MV x-rays. Phys Med Biol 1987; 32:1087–1099.CrossRefPubMedGoogle Scholar
  27. 27.
    Heydarian M, Hoban PW, Beddoe AH. A comparison of dosimetry techniques in stereotactic radiosurgery. Phys Med Biol 1996; 41:93–110.CrossRefPubMedGoogle Scholar
  28. 28.
    Rustgi SN. Evaluation of dosimetric characteristics of a diamond detector for photon beam measurement. Med Phys 1995; 22:567–570.CrossRefPubMedGoogle Scholar
  29. 29.
    Vatnitsky S, Jarvinen H. Application of natural diamond detector for the measurement of relative dose distribution in radiotherapy. Phys Med Biol 1993; 38:173–184.CrossRefPubMedGoogle Scholar
  30. 30.
    Schell MC, Smith V, Larson DA, et al. Evaluation of radiosurgery techniques with cumulative dose volume histograms in linac-based stereotactic irradiation. Int J Radiat Oncol Biol Phys 1991; 20:1325–1330.PubMedGoogle Scholar
  31. 31.
    Serago CF, Houdek PV, Bauer-Kirpes B, et al. Stereotactic radiosurgery: dose volume analysis of linear accelerator techniques. Med Phys 1992; 19:181–185.CrossRefPubMedGoogle Scholar
  32. 32.
    Friedman WA, Bova FJ. The University of Florida radiosurgery system. Surg Neurol 1989; 32:334–342.CrossRefPubMedGoogle Scholar
  33. 33.
    Meeks SL, Bova FJ, Friedman WA, et al. Linac scalpel radiosurgery at the University of Florida. Med Dosim 1998; 23:177–185.CrossRefPubMedGoogle Scholar
  34. 34.
    Webb S. Optimization by simulated annealing of three-dimensional conformal treatment planning for radiation fields defined by a multileaf collimator. Phys Med Biol 1991; 36:1201–1226.CrossRefPubMedGoogle Scholar
  35. 35.
    Adler JR, Cox RS. Preliminary clinical experience with the CyberKnife: image guided stereotactic radiosurgery. In: Kondziolka D, ed. Radiosurgery. Basel: Karger, 1995:317–326.Google Scholar
  36. 36.
    Maciunas RJ, Fitzpatrick M, Galloway RL, et al. Beyond stereotaxy: extreme levels of application accuracy are provided by implantable fiducial markers for interactive image guided neurosurgery. In: Maciunas RJ, ed. Interactive Image Guided Neurosurgery. Washington, DC: AANS, 1994:261–270.Google Scholar
  37. 37.
    Ma L, Kwok Y, Chin LS, et al. Comparative analyses of linac and Gamma Knife radiosurgery for trigeminal neuralgia treatments. Phys Med Biol 2005; 50:5217–5227.CrossRefPubMedGoogle Scholar
  38. 38.
    Gerbi BJ, Higgins PD, Cho KH, et al. Linac-based stereotactic radiosurgery for treatment of trigeminal neuralgia. J Appl Clin Med Phys 2004; 5:80–90.CrossRefPubMedGoogle Scholar
  39. 39.
    Verhey LJ, Smith V, Sergo CF. Comparison of radiosurgery treatment modalities based on physical dose distributions. Int J Radiat Oncol Biol Phys 1998; 40:495–505.Google Scholar
  40. 40.
    Plowman PN, Doughty D. Stereotactic radiosurgery, X: clinical isodosimetry of Gamma knife versus linear accelerator X-knife for pituitary and acoustic tumors. Clin Oncol 1999; 11:321–329.CrossRefGoogle Scholar
  41. 41.
    Perks JR, St. George EJ, Hamri KE, et al. Stereotactic radiosurgery XVI: isodose comparison of photon stereotactic radiosurgery techniques (Gamma knife vs. micromultileaf collimator linear accelerator) for acoustic neuroma-and potential clinical importance. Int J Radiat Oncol Biol Phys 2003; 57:1450–1459.PubMedGoogle Scholar
  42. 42.
    Hartmann G, Lutz W, Arndt J, et al. Quality Assurance Program on Stereotactic Radiosurgery. Berlin: Springer-Verlag, 1995.Google Scholar
  43. 43.
    Schell M, Bova FJ, Larson DA, et al. Stereotactic radiosurgery. Report of Task Group 42. American Association of Physicists in Medicine (AAPM), Report No. 54. Medical Physics Publishing: Madison, WI, 1995.Google Scholar
  44. 44.
    Shaw E, Kline R, Gillin M, et al. Radiation therapy oncology group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993; 27:1231–1239.PubMedGoogle Scholar
  45. 45.
    Fraass B, Doppke K, Hunt M, et al. American Association of Physicists in Medicine (AAPM): Radiation Therapy Committee Task Group 53: Quality assurance for clinical radiotherapy treatment planning. Med Phys 1998; 25:1773–1829.CrossRefPubMedGoogle Scholar
  46. 46.
    Falco T, Lachaine M, Poffenbarger B, et al. Setup verification in linac-based radiosurgery. Med Phys 1999; 26:1972–1978.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Siyong Kim
    • 1
  • Jatinder Palta
    • 2
  1. 1.Department of Radiation OncologyMayo ClinicJacksonvilleUSA
  2. 2.Department of Radiation OncologyUniversity of FloridaGainesvilleUSA

Personalised recommendations