611:. They may be interchangeable orifices with different diameters, typically varying from 5 to 40 mm in 5 mm steps, or multileaf collimators, which consist of a number of metal leaflets that can be moved dynamically during treatment in order to shape the radiation beam to conform to the mass to be ablated. As of 2017 Linacs were capable of achieving extremely narrow beam geometries, such as 0.15 to 0.3 mm. Therefore, they can be used for several kinds of surgeries which hitherto had been carried out by open or endoscopic surgery, such as for trigeminal neuralgia. Long-term follow-up data has shown it to be as effective as radiofrequency ablation, but inferior to surgery in preventing the recurrence of pain.
501:
36:
652:, and accelerated in successive transits through a circular, evacuated conduit or cavity, using powerful magnets to shape their path, until they reach the energy required to just traverse a human body, usually about 200 MeV. They are then released toward the region to be treated in the patient's body, the irradiation target. In some machines, which deliver protons of only a specific energy, a custom mask made of plastic is interposed between the beam source and the patient to adjust the beam energy to provide the appropriate degree of penetration. The phenomenon of the
607:", is mechanically rotated around the patient in a full or partial circle. The table where the patient is lying, the "couch", can also be moved in small linear or angular steps. The combination of the movements of the gantry and of the couch allow the computerized planning of the volume of tissue that is going to be irradiated. Devices with a high energy of 6 MeV are commonly used for the treatment of the brain, due to the depth of the target. The diameter of the energy beam leaving the emission head can be adjusted to the size of the lesion by means of
305:
3890:
173:. The principle of this instrument was to hit the intra-cranial target with narrow beams of radiation from multiple directions. The beam paths converge in the target volume, delivering a lethal cumulative dose of radiation there, while limiting the dose to the adjacent healthy tissue. Ten years later significant progress had been made, due in considerable measure to the contribution of the physicists Kurt Liden and Börje Larsson. At this time, stereotactic
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treatment modalities are reported to have identical outcomes for certain indications. Stereotactic radiosurgery has a greater emphasis on delivering precise, high doses to small areas, to destroy target tissue while preserving adjacent normal tissue. The same principle is followed in conventional radiotherapy although lower dose rates spread over larger areas are more likely to be used (for example as in
400:(conventional neurosurgery, requiring the opening of the skull) is about 15 days. The radiosurgery outcome may not be evident until months after the treatment. Since radiosurgery does not remove the tumor but inactivates it biologically, lack of growth of the lesion is normally considered to be treatment success. General indications for radiosurgery include many kinds of brain tumors, such as
213:, London. The system was handed over for physics and other testing in February 1953 and began to treat patients on 7 September that year. Meanwhile, work at the Stanford Microwave Laboratory led to the development of a 6 MeV accelerator, which was installed at Stanford University Hospital, California, in 1956. Linac units quickly became favored devices for conventional fractionated
222:. In 1984, Betti and Derechinsky described a Linac-based radiosurgical system. Winston and Lutz further advanced Linac-based radiosurgical prototype technologies by incorporating an improved stereotactic positioning device and a method to measure the accuracy of various components. Using a modified Linac, the first patient in the United States was treated in Boston
335:. These ions and radicals, which may be formed from the water in the cell or biological materials, can produce irreparable damage to DNA, proteins, and lipids, resulting in the cell's death. Thus, biological inactivation is carried out in a volume of tissue to be treated, with a precise destructive effect. The radiation dose is usually measured in
279:: repair, reassortment, repopulation, and reoxygenation. Today, both treatment techniques are complementary, as tumors that may be resistant to fractionated radiotherapy may respond well to radiosurgery, and tumors that are too large or too close to critical organs for safe radiosurgery may be suitable candidates for fractionated radiotherapy.
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of ejected protons gives proton therapy advantages over other forms of radiation, since most of the proton's energy is deposited within a limited distance, so tissue beyond this range (and to some extent also tissue inside this range) is spared from the effects of radiation. This property of protons,
419:
Stereotatic radiosurgery of the spinal metastasis is efficient in controlling pain in up to 90% of the cases and ensures stability of the tumours on imaging evaluation in 95% of the cases, and is more efficient for spinal metastasis involving one or two segments. Meanwhile, conventional external beam
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Gamma Knife therapy, like all radiosurgery, uses doses of radiation to kill cancer cells and shrink tumors, delivered precisely to avoid damaging healthy brain tissue. Gamma Knife radiosurgery is able to accurately focus many beams of gamma radiation on one or more tumors. Each individual beam is of
477:
The selection of the proper kind of radiation and device depends on many factors including lesion type, size, and location in relation to critical structures. Data suggest that similar clinical outcomes are possible with all of the various techniques. More important than the device used are issues
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offer dedicated radiosurgery Linacs as well as machines designed for conventional treatment with radiosurgery capabilities. Systems designed to complement conventional Linacs with beam-shaping technology, treatment planning, and image-guidance tools to provide. An example of a dedicated radiosurgery
262:
to inactivate or eradicate defined targets, typically in the head or spine, without the need for a surgical incision. Irrespective of the similarities between the concepts of stereotactic radiosurgery and fractionated radiotherapy the mechanism to achieve treatment is subtly different, although both
168:
Stereotactic radiosurgery was first developed in 1949 by the
Swedish neurosurgeon Lars Leksell to treat small targets in the brain that were not amenable to conventional surgery. The initial stereotactic instrument he conceived used probes and electrodes. The first attempt to supplant the electrodes
282:
Today, both Gamma Knife and Linac radiosurgery programs are commercially available worldwide. While the Gamma Knife is dedicated to radiosurgery, many Linacs are built for conventional fractionated radiotherapy and require additional technology and expertise to become dedicated radiosurgery tools.
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Radiosurgery is indicated primarily for the therapy of tumors, vascular lesions and functional disorders. Significant clinical judgment must be used with this technique and considerations must include lesion type, pathology if available, size, location and age and general health of the patient.
375:
to operate and maintain highly sophisticated, highly precise and complex instruments, including medical linear accelerators, the Gamma Knife unit and the
Cyberknife unit. The highly precise irradiation of targets within the brain and spine is planned using information from medical images that are
234:
Technological improvements in medical imaging and computing have led to increased clinical adoption of stereotactic radiosurgery and have broadened its scope in the 21st century. The localization accuracy and precision that are implicit in the word "stereotactic" remain of utmost importance for
193:
sources placed in a kind of helmet with central channels for irradiation with gamma rays. This prototype was designed to produce slit-like radiation lesions for functional neurosurgical procedures to treat pain, movement disorders, or behavioral disorders that did not respond to conventional
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effect" by analogy to the explosive weapons used in anti-submarine warfare, allows for conformal dose distributions to be created around even very irregularly shaped targets, and for higher doses to targets surrounded or backstopped by radiation-sensitive structures such as the
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As of 2013 there was no evidence that proton beam therapy is better than any other types of treatment in most cases, except for a "handful of rare pediatric cancers". Critics, responding to the increasing number of very expensive PBT installations, spoke of a "medical
217:
but it lasted until the 1980s before dedicated Linac radiosurgery became a reality. In 1982, the
Spanish neurosurgeon J. Barcia-Salorio began to evaluate the role of cobalt-generated and then Linac-based photon radiosurgery for the treatment of AVMs and
432:(WBRT), surgery, and systemic therapies. However, a recent systematic review found no difference in the affects on overall survival or deaths due to brain metastases when comparing SRS treatment alone to SRS plus WBRT treatment or WBRT alone.
1718:
Kaidar-Person O, Zagar TM, Deal A, Moschos SJ, Ewend MG, Sasaki-Adams D, et al. (July 2017). "The incidence of radiation necrosis following stereotactic radiotherapy for melanoma brain metastases: the potential impact of immunotherapy".
1368:
Sturm V, Pastyr O, Schlegel W, Scharfenberg H, Zabel HJ, Netzeband G, et al. (1983). "Stereotactic computer tomography with a modified
Riechert-Mundinger device as the basis for integrated stereotactic neuroradiological investigations".
1461:
Combs SE, Welzel T, Schulz-Ertner D, Huber PE, Debus J (January 2010). "Differences in clinical results after LINAC-based single-dose radiosurgery versus fractionated stereotactic radiotherapy for patients with vestibular schwannomas".
453:
reported in
December 2010 that radiation overdoses had occurred with the linear accelerator method of radiosurgery, due in large part to inadequate safeguards in equipment retrofitted for stereotactic radiosurgery. In the U.S. the
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treatment. The success of this first unit led to the construction of a second device, containing 179 cobalt-60 sources. This second Gamma Knife unit was designed to produce spherical lesions to treat brain tumors and intracranial
562:
through a target point in the patient's brain. The patient wears a specialized helmet that is surgically fixed to the skull, so that the brain tumor remains stationary at the target point of the gamma rays. An
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was too clumsy. Leksell proceeded to develop a practical, compact, precise and simple tool which could be handled by the surgeon himself. In 1968 this resulted in the Gamma Knife, which was installed at the
1881:
Herman JM, Petit JH, Amin P, Kwok Y, Dutta PR, Chin LS (May 2004). "Repeat gamma knife radiosurgery for refractory or recurrent trigeminal neuralgia: treatment outcomes and quality-of-life assessment".
1952:
Stafford SL, Pollock BE, Foote RL, Link MJ, Gorman DA, Schomberg PJ, Leavitt JA (November 2001). "Meningioma radiosurgery: tumor control, outcomes, and complications among 190 consecutive patients".
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General contraindications to radiosurgery include excessively large size of the target lesion, or lesions too numerous for practical treatment. Patients can be treated within one to five days as
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that enables accurate correlation of a virtual target seen in the patient's diagnostic images with the actual target position in the patient. Stereotactic radiosurgery may also be called
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by administering high-intensity gamma radiation therapy in a manner that concentrates the radiation over a small volume. The device was invented in 1967 at the
Karolinska Institute in
2653:
296:, a compact Linac mounted onto a robotic arm that moves around the patient and irradiates the tumor from a large set of fixed positions, thereby mimicking the Gamma Knife concept.
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Barnett GH, Linskey ME, Adler JR, Cozzens JW, Friedman WA, Heilbrun MP, et al. (January 2007). "Stereotactic radiosurgery--an organized neurosurgery-sanctioned definition".
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Wu A, Lindner G, Maitz AH, Kalend AM, Lunsford LD, Flickinger JC, Bloomer WD (April 1990). "Physics of gamma knife approach on convergent beams in stereotactic radiosurgery".
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275:. Historically, the field of fractionated radiotherapy evolved from the original concept of stereotactic radiosurgery following discovery of the principles of
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1296:"Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer"
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professor of neurosurgery and radiation oncology, and
Russell and Peter Schonberg at Schonberg Research, and commercialized under the brand name CyberKnife.
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of energy per kilogram of mass). A unit that attempts to take into account both the different organs that are irradiated and the type of radiation is the
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981:
Walton L, Bomford CK, Ramsden D (September 1987). "The
Sheffield stereotactic radiosurgery unit: physical characteristics and principles of operation".
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or brainstem. The development of "intensity modulated" techniques allowed similar conformities to be attained using linear accelerator radiosurgery.
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Cho DY, Tsao M, Lee WY, Chang CS (May 2006). "Socioeconomic costs of open surgery and gamma knife radiosurgery for benign cranial base tumors".
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Larsson B, Leksell L, Rexed B, Sourander P, Mair W, Andersson B (November 1958). "The high-energy proton beam as a neurosurgical tool".
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Gamma Knife radiosurgery has proven effective for patients with benign or malignant brain tumors up to 4 cm (1.6 in) in size,
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relatively low intensity, so the radiation has little effect on intervening brain tissue and is concentrated only at the tumor itself.
440:
Expansion of stereotactic radiotherapy to other lesions is increasing, and includes liver cancer, lung cancer, pancreatic cancer, etc.
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Barcia-Salorio JL, Herandez G, Broseta J, Gonzalez-Darder J, Ciudad J (1982). "Radiosurgical treatment of carotid-cavernous fistula".
40:
Intraoperative photograph showing a radiosurgery system being positioned. The patient in the photo is being treated for rectal cancer.
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582:(AVM), pain, and other functional problems. For treatment of trigeminal neuralgia the procedure may be used repeatedly on patients.
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dose of radiation is thereby sent through the tumor in one treatment session, while surrounding brain tissues are relatively spared.
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When used outside the CNS it may be called stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR).
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Acute complications following Gamma Knife radiosurgery are rare, and complications are related to the condition being treated.
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beams had replaced the x-rays. The heavy particle beam presented as an excellent replacement for the surgical knife, but the
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SRS may be administered alone or in combination with other therapies. For brain metastases, these treatment options include
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clinical linear accelerator began in June 1952 in the
Medical Research Council (MRC) Radiotherapeutic Research Unit at the
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target, usually tungsten. The process is also referred to as "x-ray therapy" or "photon therapy." The emission head, or "
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regarding indications for treatment, total dose delivered, fractionation schedule and conformity of the treatment plan.
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Chin LS, Lazio BE, Biggins T, Amin P (May 2000). "Acute complications following gamma knife radiosurgery are rare".
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Régis J, Bartolomei F, Hayashi M, Chauvel P (2002). "What role for radiosurgery in mesial temporal lobe epilepsy".
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as "a single high dose fraction of radiation, stereotactically directed to an intracranial region of interest".
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In the 21st century the original concept of radiosurgery expanded to include treatments comprising up to five
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Galloway Jr RL (2015). "Introduction and
Historical Perspectives on Image-Guided Surgery". In Golby AJ (ed.).
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Winston KR, Lutz W (March 1988). "Linear accelerator as a neurosurgical tool for stereotactic radiosurgery".
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Fry DW, R-Shersby-Harvie RB (November 1948). "A traveling-wave linear accelerator for 4-MeV. electrons".
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There is not a clear difference in efficacy between these different approaches. The major manufacturers,
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A linear accelerator (linac) produces x-rays from the impact of accelerated electrons striking a high
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This article is about the medical procedure. For the album by American rock band New Found Glory, see
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Bernier J, Hall EJ, Giaccia A (September 2004). "Radiation oncology: a century of achievements".
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Bernier J, Hall EJ, Giaccia A (September 2004). "Radiation oncology: a century of achievements".
3642:
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Kwon Y, Whang CJ (1995). "Stereotactic Gamma Knife radiosurgery for the treatment of dystonia".
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Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, DeLuca J, et al. (October 2006).
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Gamma Knife versus adapted linear accelerators: A comparison of two radiosurgical applications
347:, a unit that describes both the amount of energy deposited and the biological effectiveness.
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416:, trigeminal neuralgia, arteriovenous malformations, and skull base tumors, among others.
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may be useful for treatment of radiation necrosis following stereotactic radiotherapy.
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of tissue, by means of high-energy beams of radiation. Ionization is the production of
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Schoelles KM, Uhl S, Launders J, Inamdar R, Bruening W, Sullivan N, Tipton KN (2011).
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De Salles A (2008). "Radiosurgery from the brain to the spine: 20 years experience".
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198:(AVMs). Additional units were installed in the 1980s all with 201 cobalt-60 sources.
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Leksell L (December 1951). "The stereotaxic method and radiosurgery of the brain".
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Leksell L (December 1951). "The stereotaxic method and radiosurgery of the brain".
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Betti OO (1984). "Hyperselective Encephalic Irradiation with Linear Accelerator".
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Leksell L, Larsson B, Andersson B, Rexed B, Sourander P, Mair W (October 1960).
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1834:"Gamma knife treatment for refractory cluster headache: prospective open trial"
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1675:"Radiation Therapy for Brain Metastases | Effective Health Care (EHC) Program"
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858:"Lesions in the depth of the brain produced by a beam of high energy protons"
742:"Stereotactic radiotherapy | Cancer treatment | Cancer Research UK"
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treatments). Fractionated radiotherapy relies more heavily on the different
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458:(FDA) regulates these devices, whereas the Gamma Knife is regulated by the
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156:(SBRT) or stereotactic ablative radiotherapy (SABR) when used outside the
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Book on LINAC-based radiosurgery using multileaf collimation (March 2011)
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Joaquim AF, Ghizoni E, Tedeschi H, Pereira EB, Giacomini LA (June 2013).
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In parallel to these developments, a similar approach was designed for a
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Leksell L (1949). "A stereotaxic apparatus for intracerebral surgery".
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A Gamma Knife (also known as the Leksell Gamma Knife) is used to treat
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1627:"Stereotactic radiosurgery for spinal metastases: a literature review"
1237:. Acta Neurochirurgica Supplementum. Vol. 101. pp. 163–168.
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129:. Radiosurgery was originally defined by the Swedish neurosurgeon
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644:. Protons are extracted from proton donor materials by a medical
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Protons may also be used in radiosurgery in a procedure called
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radiotherapy is more suitable for multiple spinal involvement.
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The fundamental principle of radiosurgery is that of selective
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with IV contrast in a patient with left cerebellopontine angle
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radiosurgical interventions and are significantly improved via
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1699:"A Pinpoint Beam Strays Invisibly, Harming Instead of Healing"
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and Sturm-Pastyr localizer that were originally developed for
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International Journal of Radiation Oncology, Biology, Physics
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International Journal of Radiation Oncology, Biology, Physics
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International Journal of Radiation Oncology, Biology, Physics
486:"Gamma Knife" redirects here. For the album by Kayo Dot, see
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493:. For the song by King Gizzard & the Lizard Wizard, see
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113:, that is, the destruction of precisely selected areas of
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1577:. Karger Medical and Scientific Publishers. p. 196.
674:" and "crazy medicine and unsustainable public policy".
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Radiosurgery is performed by a multidisciplinary team of
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1951:
125:(also called radiotherapy), it is usually used to treat
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of the target and the surrounding normal tissue to the
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rather than excision with a blade. Like other forms of
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Advances in Stereotactic and Functional Neurosurgery 6
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4421: Also known as sealed-source radiation therapy.
2040:"Uncertainty About Proton-Beam Radiotherapy Lingers"
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1606:. Agency for Healthcare Research and Quality (US).
1015:
531:, Romanian-born neurosurgeon Ladislau Steiner, and
169:with radiation was made in the early fifties, with
2842:Blue Ribbon Commission on America's Nuclear Future
2070:Book on Radiosurgery to moving targets (July 2007)
1838:Journal of Neurology, Neurosurgery, and Psychiatry
1496:
1066:
903:Journal of Neurology, Neurosurgery, and Psychiatry
1831:
396:. By comparison, the average hospital stay for a
4442:
4415: Also known as external-beam radiotherapy.
1994:
2037:
554:), placed in a hemispheric array in a heavily
258:discipline that utilizes externally generated
3934:
3545:Small sealed transportable autonomous (SSTAR)
2095:
1832:Donnet A, Valade D, Régis J (February 2005).
2031:
1711:
1539:
504:A doctor performing Gamma Knife Radiosurgery
472:
1334:
1197:
205:or Linac. Installation of the first 4
3941:
3927:
2102:
2088:
2068:Treating Tumors that Move with Respiration
1410:
1408:
34:
1857:
1796:
1650:
1570:
1311:
1232:
922:
873:
614:The first such systems were developed by
3457:
1799:Stereotactic and Functional Neurosurgery
1456:
1454:
697:Dorland's Illustrated Medical Dictionary
507:
499:
350:
339:(one gray (Gy) is the absorption of one
303:
1405:
896:
777:
758:
710:
684:
4443:
3948:
3472:Liquid-fluoride thorium reactor (LFTR)
2109:
736:
734:
625:
435:
423:
299:
3922:
3714:
3477:Molten-Salt Reactor Experiment (MSRE)
2886:
2873:
2083:
1600:"Currently Marketed Devices for SBRT"
1540:Mathis S, Eisner W (6 October 2010).
1451:
1339:. Amsterdam: Elsevier. pp. 2–4.
1144:
542:A Gamma Knife typically contains 201
4123:Selective internal radiation therapy
3901:
2874:
690:
3482:Integral Molten Salt Reactor (IMSR)
1604:Stereotactic Body Radiation Therapy
731:
154:stereotactic body radiation therapy
13:
3291:
2442:Positron-emission tomography (PET)
2038:Roxanne Nelson (30 January 2013).
2009:10.1227/01.NEU.0000209892.42585.9B
1345:10.1016/B978-0-12-800870-6.00001-7
1149:. Vol. 33. pp. 385–390.
589:Linear accelerator-based therapies
515:graphic of the Leksell Gamma Knife
358:
14:
4477:
2465:Neutron capture therapy of cancer
2364:Radioisotope thermoelectric (RTG)
2061:
1960:(5): 1029–37, discussion 1037–8.
1544:(Report). HTA-Projektbericht 47.
546:sources of approximately 30
4216:Intraoperative radiation therapy
3900:
3889:
3888:
3876:
3565:Fast Breeder Test Reactor (FBTR)
2003:(5): 866–73, discussion 866–73.
1966:10.1097/00006123-200111000-00001
1212:10.1227/00006123-198803000-00002
983:The British Journal of Radiology
273:total accumulated radiation dose
148:" refers to a three-dimensional
2654:Historical stockpiles and tests
1988:
1945:
1910:
1874:
1825:
1790:
1764:Zentralblatt für Neurochirurgie
1755:
1691:
1667:
1643:10.1590/S1679-45082013000200020
1618:
1591:
1564:
1533:
1490:
1361:
1328:
1287:
1226:
1191:
1138:
1103:
1060:
1009:
974:
229:
4006:Stereotactic radiation therapy
3555:Energy Multiplier Module (EM2)
2437:Single-photon emission (SPECT)
1925:(5): 498–502, discussion 502.
939:
890:
849:
798:
771:
752:
704:
481:
1:
4427: Also known as systemic
4263:Radiation-induced lung injury
3883:Nuclear technology portal
1931:10.1016/S0090-3019(00)00219-6
677:
460:Nuclear Regulatory Commission
430:whole brain radiation therapy
4461:Radiation therapy procedures
4393:Radiation treatment planning
3745:Field-reversed configuration
3355:Uranium Naturel Graphite Gaz
1896:10.1016/j.ijrobp.2003.10.041
1733:10.1097/CAD.0000000000000497
1679:effectivehealthcare.ahrq.gov
1476:10.1016/j.ijrobp.2009.01.064
1300:Journal of Clinical Oncology
1243:10.1007/978-3-211-78205-7_28
1155:10.1007/978-3-7091-8726-5_60
995:10.1259/0007-1285-60-717-897
960:10.1016/0360-3016(90)90421-f
897:Leksell L (September 1983).
780:Acta Chirurgica Scandinavica
761:Acta Chirurgica Scandinavica
713:Acta Chirurgica Scandinavica
456:Food and Drug Administration
224:Brigham and Women's Hospital
7:
4378:Percentage depth dose curve
3702:Aircraft Reactor Experiment
2887:
2649:States with nuclear weapons
1235:Reconstructive Neurosurgery
899:"Stereotactic radiosurgery"
657:which has been called the "
203:linear particle accelerator
196:arteriovenous malformations
10:
4482:
3715:
3540:Liquid-metal-cooled (LMFR)
2664:Tests in the United States
629:
592:
580:arteriovenous malformation
558:assembly. The device aims
485:
382:magnetic resonance imaging
331:which are damaging to the
163:
18:
4411:
4403:Tissue to Air Ratio (TAR)
4281:
4245:
4208:
4144:
4090:
4050:
4031:
3976:
3967:
3956:
3870:
3826:
3778:
3735:
3725:
3677:
3665:Stable Salt Reactor (SSR)
3578:
3560:Reduced-moderation (RMWR)
3525:
3508:
3448:
3375:
3367:Advanced gas-cooled (AGR)
3341:
3332:
3284:
3264:
3217:
3199:
3155:
3060:
3042:
2910:
2897:
2882:
2869:
2824:
2757:
2702:
2693:
2641:
2549:
2540:
2507:
2450:
2412:
2403:
2324:
2256:
2179:
2121:
2117:
1337:Image-Guided Neurosurgery
875:10.3109/00016926009172547
578:malformations such as an
473:Types of radiation source
239:technologies such as the
186:and consisted of several
138:stereotactic radiosurgery
89:
75:
61:
45:
33:
28:
4363:Oxygen enhancement ratio
4318:Dose verification system
3570:Dual fluid reactor (DFR)
3186:Steam-generating (SGHWR)
2522:Electron-beam processing
2074:Shaped Beam Radiosurgery
1850:10.1136/jnnp.2004.041202
1429:10.3171/jns.2007.106.1.1
1313:10.1200/JCO.2006.07.5937
746:www.cancerresearchuk.org
443:
3685:Organic nuclear reactor
2857:Nuclear power phase-out
2780:Nuclear decommissioning
2720:Reactor-grade plutonium
2470:Targeted alpha-particle
2349:Accidents and incidents
1417:Journal of Neurosurgery
1112:Applied Neurophysiology
1499:Nature Reviews. Cancer
1069:Nature Reviews. Cancer
516:
505:
465:This is evidence that
316:
158:central nervous system
4323:Dose-volume histogram
2847:Anti-nuclear movement
1571:McDermott MW (2010).
915:10.1136/jnnp.46.9.797
511:
503:
369:radiation oncologists
351:Clinical applications
314:vestibular schwannoma
307:
4451:Neurology procedures
4383:Radiation oncologist
4373:Pencil-beam scanning
4348:Multileaf collimator
4198:ibritumomab tiuxetan
3755:Reversed field pinch
3550:Traveling-wave (TWR)
3034:Supercritical (SCWR)
2532:Gemstone irradiation
1805:(Suppl 1): 222–227.
1776:10.1055/s-2002-35824
1631:Einstein (Sao Paulo)
1371:Acta Neurochirurgica
495:"Gamma Knife" (song)
245:stereotactic surgery
211:Hammersmith Hospital
184:Karolinska Institute
21:Radiosurgery (album)
4388:Radiation Therapist
4258:Radiation proctitis
4117:Plaque radiotherapy
3992:Orthovoltage X-rays
2920:Aqueous homogeneous
2715:Reprocessed uranium
2388:Safety and security
1030:1948Natur.162..859F
819:1958Natur.182.1222L
813:(4644): 1222–1223.
638:Proton Beam Therapy
626:Proton beam therapy
620:Stanford University
535:Börje Larsson from
436:Other bodily organs
424:Combination therapy
378:computed tomography
300:Mechanism of action
4423:
4417:
4193:Radioimmunotherapy
3997:Megavoltage X-rays
3987:Superficial X-rays
3950:Radiation oncology
3834:Dense plasma focus
2749:Actinide chemistry
2214:Isotope separation
2111:Nuclear technology
1919:Surgical Neurology
1704:The New York Times
1383:10.1007/BF01406197
595:Megavoltage X-rays
537:Uppsala University
517:
506:
450:The New York Times
317:
260:ionizing radiation
226:in February 1986.
119:ionizing radiation
16:Surgical Specialty
4438:
4437:
4398:Radiopharmacology
4358:Neutron generator
4241:
4240:
4086:
4085:
3916:
3915:
3866:
3865:
3862:
3861:
3813:Magnetized-target
3710:
3709:
3673:
3672:
3504:
3503:
3500:
3499:
3444:
3443:
3328:
3327:
3260:
3259:
2865:
2864:
2820:
2819:
2689:
2688:
2676:Weapon-free zones
2503:
2502:
2495:Radiopharmacology
1811:10.1159/000098782
1721:Anti-Cancer Drugs
1354:978-0-12-800870-6
1306:(30): 4833–4839.
1252:978-3-211-78204-0
1164:978-3-211-81773-5
1124:10.1159/000101675
1024:(4126): 859–861.
827:10.1038/1821222a0
402:acoustic neuromas
150:coordinate system
123:radiation therapy
100:
99:
4473:
4424:
4418:
4268:Bystander effect
4155:
4154:
4061:Particle therapy
4042:Electron therapy
3974:
3973:
3965:
3964:
3943:
3936:
3929:
3920:
3919:
3904:
3903:
3892:
3891:
3881:
3880:
3879:
3791:
3750:Levitated dipole
3720:
3712:
3711:
3660:Helium gas (GFR)
3523:
3522:
3518:
3455:
3454:
3339:
3338:
3289:
3288:
3282:
3281:
3277:
3276:
3058:
3057:
3054:
3053:
2892:
2884:
2883:
2876:Nuclear reactors
2871:
2870:
2770:High-level (HLW)
2700:
2699:
2547:
2546:
2527:Food irradiation
2517:Atomic gardening
2410:
2409:
2393:Nuclear meltdown
2219:Nuclear material
2209:Fissile material
2204:Fertile material
2119:
2118:
2104:
2097:
2090:
2081:
2080:
2055:
2054:
2052:
2050:
2035:
2029:
2028:
1992:
1986:
1985:
1949:
1943:
1942:
1914:
1908:
1907:
1878:
1872:
1871:
1861:
1829:
1823:
1822:
1794:
1788:
1787:
1759:
1753:
1752:
1715:
1709:
1708:
1695:
1689:
1688:
1686:
1685:
1671:
1665:
1664:
1654:
1622:
1616:
1615:
1595:
1589:
1588:
1568:
1562:
1561:
1537:
1531:
1530:
1494:
1488:
1487:
1458:
1449:
1448:
1412:
1403:
1402:
1365:
1359:
1358:
1332:
1326:
1325:
1315:
1291:
1285:
1284:
1278:
1274:
1272:
1264:
1230:
1224:
1223:
1195:
1189:
1188:
1182:
1178:
1176:
1168:
1142:
1136:
1135:
1118:(4–5): 520–522.
1107:
1101:
1100:
1064:
1058:
1057:
1038:10.1038/162859a0
1013:
1007:
1006:
989:(717): 897–906.
978:
972:
971:
943:
937:
936:
926:
894:
888:
887:
877:
862:Acta Radiologica
853:
847:
846:
802:
796:
795:
775:
769:
768:
756:
750:
749:
738:
729:
728:
708:
702:
701:
688:
269:radiosensitivity
179:synchrocyclotron
93:edit on Wikidata
85:
71:
38:
26:
25:
4481:
4480:
4476:
4475:
4474:
4472:
4471:
4470:
4441:
4440:
4439:
4434:
4422:
4416:
4407:
4286:
4284:
4277:
4273:Abscopal effect
4237:
4204:
4156:
4152:
4151:
4148:
4147:Unsealed source
4140:
4082:
4071:neutron-capture
4046:
4027:
3961:
3959:
3952:
3947:
3917:
3912:
3877:
3875:
3858:
3822:
3789:
3774:
3731:
3721:
3716:
3706:
3669:
3574:
3519:
3512:
3511:
3496:
3440:
3371:
3346:
3324:
3296:
3278:
3271:
3270:
3269:
3256:
3222:
3213:
3195:
3160:
3151:
3065:
3048:
3047:
3046:
3038:
2952:Natural fission
2906:
2905:
2893:
2888:
2878:
2861:
2837:Nuclear weapons
2816:
2775:Low-level (LLW)
2753:
2685:
2637:
2536:
2499:
2446:
2399:
2320:
2252:
2175:
2113:
2108:
2064:
2059:
2058:
2048:
2046:
2036:
2032:
1993:
1989:
1950:
1946:
1915:
1911:
1879:
1875:
1830:
1826:
1795:
1791:
1760:
1756:
1716:
1712:
1697:
1696:
1692:
1683:
1681:
1673:
1672:
1668:
1623:
1619:
1596:
1592:
1585:
1569:
1565:
1538:
1534:
1511:10.1038/nrc1451
1495:
1491:
1459:
1452:
1413:
1406:
1366:
1362:
1355:
1333:
1329:
1292:
1288:
1276:
1275:
1266:
1265:
1253:
1231:
1227:
1196:
1192:
1180:
1179:
1170:
1169:
1165:
1143:
1139:
1108:
1104:
1081:10.1038/nrc1451
1065:
1061:
1014:
1010:
979:
975:
944:
940:
895:
891:
854:
850:
803:
799:
776:
772:
757:
753:
740:
739:
732:
709:
705:
689:
685:
680:
634:
628:
597:
591:
560:gamma radiation
550:each (1.1
498:
484:
475:
446:
438:
426:
361:
359:Brain and spine
353:
302:
232:
166:
96:
81:
67:
41:
24:
17:
12:
11:
5:
4479:
4469:
4468:
4463:
4458:
4453:
4436:
4435:
4433:
4432:
4425:
4419:
4412:
4409:
4408:
4406:
4405:
4400:
4395:
4390:
4385:
4380:
4375:
4370:
4365:
4360:
4355:
4350:
4345:
4340:
4335:
4330:
4325:
4320:
4315:
4310:
4305:
4300:
4295:
4289:
4287:
4282:
4279:
4278:
4276:
4275:
4270:
4265:
4260:
4255:
4253:Radiation burn
4249:
4247:
4243:
4242:
4239:
4238:
4236:
4235:
4230:
4229:
4228:
4223:
4212:
4210:
4206:
4205:
4203:
4202:
4201:
4200:
4190:
4185:
4175:
4170:
4159:
4157:
4145:
4142:
4141:
4139:
4138:
4120:
4114:
4113:
4112:
4107:
4096:
4094:
4088:
4087:
4084:
4083:
4081:
4080:
4079:
4078:
4073:
4068:
4057:
4055:
4048:
4047:
4045:
4044:
4038:
4036:
4029:
4028:
4026:
4025:
4023:Cobalt therapy
4020:
4019:
4018:
4013:
3999:
3994:
3989:
3983:
3981:
3971:
3962:
3957:
3954:
3953:
3946:
3945:
3938:
3931:
3923:
3914:
3913:
3911:
3910:
3898:
3886:
3871:
3868:
3867:
3864:
3863:
3860:
3859:
3857:
3856:
3851:
3846:
3844:Muon-catalyzed
3841:
3836:
3830:
3828:
3824:
3823:
3821:
3820:
3815:
3810:
3805:
3804:
3803:
3793:
3784:
3782:
3776:
3775:
3773:
3772:
3767:
3762:
3757:
3752:
3747:
3741:
3739:
3733:
3732:
3726:
3723:
3722:
3708:
3707:
3705:
3704:
3699:
3698:
3697:
3692:
3681:
3679:
3675:
3674:
3671:
3670:
3668:
3667:
3662:
3657:
3652:
3651:
3650:
3645:
3640:
3635:
3630:
3625:
3620:
3615:
3610:
3605:
3600:
3595:
3584:
3582:
3576:
3575:
3573:
3572:
3567:
3562:
3557:
3552:
3547:
3542:
3537:
3535:Integral (IFR)
3532:
3526:
3520:
3509:
3506:
3505:
3502:
3501:
3498:
3497:
3495:
3494:
3489:
3484:
3479:
3474:
3469:
3463:
3461:
3452:
3446:
3445:
3442:
3441:
3439:
3438:
3437:
3436:
3431:
3430:
3429:
3424:
3419:
3414:
3399:
3394:
3393:
3392:
3381:
3379:
3373:
3372:
3370:
3369:
3364:
3359:
3350:
3348:
3344:
3336:
3330:
3329:
3326:
3325:
3323:
3322:
3317:
3312:
3307:
3301:
3299:
3294:
3286:
3279:
3265:
3262:
3261:
3258:
3257:
3255:
3254:
3253:
3252:
3247:
3242:
3237:
3226:
3224:
3220:
3215:
3214:
3212:
3211:
3205:
3203:
3197:
3196:
3194:
3193:
3188:
3183:
3182:
3181:
3176:
3165:
3163:
3158:
3153:
3152:
3150:
3149:
3148:
3147:
3142:
3137:
3132:
3127:
3126:
3125:
3120:
3115:
3105:
3100:
3099:
3098:
3093:
3090:
3087:
3084:
3070:
3068:
3063:
3055:
3040:
3039:
3037:
3036:
3031:
3030:
3029:
3026:
3021:
3016:
3015:
3014:
3009:
2999:
2994:
2989:
2984:
2979:
2974:
2969:
2964:
2954:
2949:
2948:
2947:
2942:
2937:
2932:
2922:
2916:
2914:
2908:
2907:
2899:
2898:
2895:
2894:
2880:
2879:
2867:
2866:
2863:
2862:
2860:
2859:
2854:
2852:Uranium mining
2849:
2844:
2839:
2834:
2828:
2826:
2822:
2821:
2818:
2817:
2815:
2814:
2809:
2808:
2807:
2802:
2792:
2787:
2782:
2777:
2772:
2767:
2761:
2759:
2755:
2754:
2752:
2751:
2746:
2745:
2744:
2734:
2729:
2728:
2727:
2725:Minor actinide
2722:
2717:
2706:
2704:
2697:
2691:
2690:
2687:
2686:
2684:
2683:
2678:
2673:
2668:
2667:
2666:
2661:
2651:
2645:
2643:
2639:
2638:
2636:
2635:
2634:
2633:
2623:
2618:
2617:
2616:
2611:
2601:
2596:
2591:
2590:
2589:
2579:
2574:
2569:
2564:
2559:
2553:
2551:
2544:
2538:
2537:
2535:
2534:
2529:
2524:
2519:
2513:
2511:
2505:
2504:
2501:
2500:
2498:
2497:
2492:
2487:
2482:
2477:
2472:
2467:
2462:
2456:
2454:
2448:
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2062:External links
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632:Proton therapy
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2281:Cross section
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1707:. 2010-12-28.
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665:
660:
655:
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647:
643:
639:
633:
623:
621:
617:
616:John R. Adler
612:
610:
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581:
577:
572:
568:
566:
561:
557:
553:
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534:
530:
527:, Sweden, by
526:
522:
514:
510:
502:
496:
492:
490:
479:
470:
468:
467:immunotherapy
463:
461:
457:
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451:
441:
433:
431:
421:
417:
415:
411:
407:
403:
399:
395:
389:
387:
383:
379:
376:obtained via
374:
370:
366:
365:neurosurgeons
356:
348:
346:
342:
338:
334:
330:
329:free radicals
326:
322:
315:
311:
306:
297:
295:
292:Linac is the
290:
286:
280:
278:
274:
270:
266:
261:
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256:neurosurgical
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204:
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147:
144:), the word "
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53:
50:
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37:
32:
27:
22:
4466:Neurosurgery
4456:Radiobiology
4429:radioisotope
4343:Monitor unit
4313:Dose profile
4283:Features and
4149:radiotherapy
4129: /
4125: /
4066:fast neutron
4004: /
4002:Radiosurgery
4001:
3905:
3893:
3874:
3854:Pyroelectric
3808:Laser-driven
3588:Sodium (SFR)
3515:fast-neutron
3354:
2900:
2790:Reprocessing
2671:WMD treaties
2490:Radiosurgery
2489:
2460:Fast-neutron
2432:Scintigraphy
2047:. Retrieved
2043:
2033:
2000:
1997:Neurosurgery
1996:
1990:
1957:
1954:Neurosurgery
1953:
1947:
1922:
1918:
1912:
1887:
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1802:
1798:
1792:
1767:
1763:
1757:
1724:
1720:
1713:
1702:
1693:
1682:. Retrieved
1678:
1669:
1634:
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1620:
1603:
1593:
1574:Radiosurgery
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1289:
1234:
1228:
1203:
1200:Neurosurgery
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783:
779:
773:
764:
760:
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745:
716:
712:
706:
696:
686:
668:
664:optic chiasm
659:depth charge
637:
635:
613:
600:
598:
584:
573:
569:
541:
529:Lars Leksell
521:brain tumors
518:
488:
476:
464:
448:
447:
439:
427:
418:
390:
371:and medical
362:
354:
318:
281:
277:radiobiology
249:
233:
230:21st century
215:radiotherapy
200:
167:
146:stereotactic
141:
137:
135:
131:Lars Leksell
103:Radiosurgery
102:
101:
56:Neurosurgery
29:Radiosurgery
4233:Tomotherapy
4131:TheraSphere
4127:SIR-Spheres
4016:Gamma Knife
3969:Teletherapy
3765:Stellarator
3729:confinement
3623:Superphénix
3450:Molten-salt
3402:VHTR (HTGR)
3179:HW BLWR 250
3145:R4 Marviken
3074:Pressurized
3044:Heavy water
3028:many others
2957:Pressurized
2912:Light water
2614:underground
2572:Disarmament
2480:Tomotherapy
2475:Proton-beam
2339:Power plant
2301:Temperature
2134:Engineering
700:, Elsevier.
646:synchrotron
609:collimators
489:Gamma Knife
482:Gamma Knife
410:meningiomas
394:outpatients
386:angiography
241:N-localizer
191:radioactive
63:MedlinePlus
4445:Categories
4303:Bragg peak
4246:Conditions
4178:Lexidronam
4163:Iobenguane
4011:Cyberknife
3790:(acoustic)
3407:PBR (PBMR)
2795:Spent fuel
2785:Repository
2765:Fuel cycle
2732:Activation
2509:Processing
2376:Propulsion
2334:by country
2266:Activation
1684:2023-10-24
1423:(1): 1–5.
678:References
654:Bragg peak
539:, Sweden.
414:metastases
406:germinomas
398:craniotomy
373:physicists
321:ionization
294:CyberKnife
4333:Isocenter
4328:Dosimetry
4285:equipment
4119: (I)
3960:therapies
3760:Spheromak
3459:Fluorides
3123:IPHWR-700
3118:IPHWR-540
3113:IPHWR-220
2902:Moderator
2582:Explosion
2557:Arms race
2344:Economics
2296:Reflector
2291:Radiation
2286:Generator
2241:Plutonium
2194:Deuterium
2159:Radiation
2129:Chemistry
1558:1993-0488
1550:1993-0496
1279:ignored (
1269:cite book
1183:ignored (
1173:cite book
672:arms race
650:cyclotron
640:(PBT) or
544:cobalt-60
525:Stockholm
308:Planning
252:fractions
188:cobalt-60
111:radiation
77:eMedicine
47:Specialty
4431:therapy.
4338:Mobetron
4221:electron
4100:Prostate
4034:electron
3958:Specific
3895:Category
3849:Polywell
3780:Inertial
3737:Magnetic
3492:TMSR-LF1
3487:TMSR-500
3467:Fuji MSR
3427:THTR-300
3267:Graphite
3130:PHWR KWU
3096:ACR-1000
3024:IPWR-900
3007:ACPR1000
3002:HPR-1000
2992:CPR-1000
2967:APR-1400
2758:Disposal
2710:Actinide
2703:Products
2562:Delivery
2405:Medicine
2234:depleted
2229:enriched
2199:Helium-3
2164:ionizing
2049:22 March
2044:Medscape
2025:38660074
2017:16639320
1982:13646182
1974:11846894
1939:10874151
1904:15093906
1868:15654036
1784:12457334
1741:28368903
1661:23843070
1612:21735562
1527:12382751
1519:15343280
1484:19604653
1437:17240553
1399:38864553
1322:17050868
1261:18642653
1097:12382751
1089:15343280
1046:18103121
884:13760648
835:13590280
792:14914373
725:14914373
692:Elsevier
576:vascular
565:ablative
556:shielded
220:epilepsy
52:Oncology
4293:BEAMnrc
4180: (
4165: (
4133: (
3907:Commons
3818:Z-pinch
3788:Bubble
3770:Tokamak
3633:FBR-600
3613:CFR-600
3608:BN-1200
3274:coolant
3201:Organic
3086:CANDU 9
3083:CANDU 6
3051:coolant
3012:ACP1000
2987:CAP1400
2925:Boiling
2890:Fission
2737:Fission
2681:Weapons
2621:Warfare
2604:Testing
2594:History
2587:effects
2542:Weapons
2452:Therapy
2427:RadBall
2414:Imaging
2306:Thermal
2271:Capture
2258:Neutron
2246:Thorium
2224:Uranium
2189:Tritium
2169:braking
2149:Fission
2139:Physics
2122:Science
1859:1739520
1819:8584831
1749:3560210
1652:4872903
1445:1007105
1391:6344559
1220:3129667
1132:7036892
1054:4075004
1026:Bibcode
1003:3311273
968:2182583
933:6352865
924:1027560
843:4163683
815:Bibcode
491:(album)
345:sievert
310:CT scan
164:History
160:(CNS).
107:surgery
83:1423298
4368:Pencil
4226:TARGIT
4076:proton
4053:hadron
3979:photon
3718:Fusion
3678:Others
3618:Phénix
3603:BN-800
3598:BN-600
3593:BN-350
3422:HTR-PM
3417:HTR-10
3397:UHTREX
3362:Magnox
3357:(UNGG)
3250:Lucens
3245:KS 150
2982:ATMEA1
2962:AP1000
2945:Kerena
2825:Debate
2577:Ethics
2567:Design
2550:Topics
2381:rocket
2359:Fusion
2354:Policy
2316:Fusion
2276:Poison
2154:Fusion
2023:
2015:
1980:
1972:
1937:
1902:
1866:
1856:
1817:
1782:
1747:
1739:
1659:
1649:
1610:
1581:
1556:
1548:
1525:
1517:
1482:
1443:
1435:
1397:
1389:
1351:
1320:
1259:
1249:
1218:
1161:
1130:
1095:
1087:
1052:
1044:
1018:Nature
1001:
966:
931:
921:
882:
841:
833:
807:Nature
790:
767:: 229.
723:
605:gantry
548:curies
384:, and
289:Elekta
285:Varian
175:proton
171:x-rays
127:cancer
117:using
115:tissue
109:using
69:007577
4298:Bolus
4209:Other
3839:Migma
3827:Other
3796:Fusor
3695:Piqua
3690:Arbus
3648:PRISM
3390:MHR-T
3385:GTMHR
3315:EGP-6
3310:AMB-X
3285:Water
3230:HWGCR
3169:HWLWR
3108:IPHWR
3079:CANDU
2940:ESBWR
2695:Waste
2659:Tests
2642:Lists
2626:Yield
2369:MMRTG
2326:Power
2021:S2CID
1978:S2CID
1745:S2CID
1546:eISSN
1523:S2CID
1441:S2CID
1395:S2CID
1093:S2CID
1050:S2CID
839:S2CID
444:Risks
341:joule
337:grays
333:cells
91:[
3655:Lead
3638:CEFR
3628:PFBR
3510:None
3320:RBMK
3305:AM-1
3235:EL-4
3209:WR-1
3191:AHWR
3135:MZFR
3103:CVTR
3092:AFCR
3019:VVER
2977:APWR
2972:APR+
2935:ABWR
2805:cask
2800:pool
2742:LLFP
2631:TNTe
2311:Fast
2181:Fuel
2051:2017
2013:PMID
1970:PMID
1935:PMID
1900:PMID
1864:PMID
1815:PMID
1780:PMID
1737:PMID
1657:PMID
1608:PMID
1579:ISBN
1554:ISSN
1515:PMID
1480:PMID
1433:PMID
1387:PMID
1349:ISBN
1318:PMID
1281:help
1257:PMID
1247:ISBN
1216:PMID
1185:help
1159:ISBN
1128:PMID
1085:PMID
1042:PMID
999:PMID
964:PMID
929:PMID
880:PMID
831:PMID
788:PMID
721:PMID
618:, a
327:and
325:ions
287:and
265:VMAT
4308:D50
4051:by
4032:by
3977:by
3727:by
3643:PFR
3434:PMR
3412:AVR
3334:Gas
3272:by
3240:KKN
3174:ATR
3089:EC6
3049:by
2997:EPR
2930:BWR
2005:doi
1962:doi
1927:doi
1892:doi
1854:PMC
1846:doi
1807:doi
1772:doi
1729:doi
1647:PMC
1639:doi
1507:doi
1472:doi
1425:doi
1421:106
1379:doi
1341:doi
1308:doi
1239:doi
1208:doi
1151:doi
1120:doi
1077:doi
1034:doi
1022:162
991:doi
956:doi
919:PMC
911:doi
870:doi
823:doi
811:182
784:102
717:102
648:or
552:TBq
513:NRC
207:MeV
142:SRS
136:In
105:is
4447::
4188:Sr
4182:Sm
4110:Pd
3377:He
3343:CO
3219:CO
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