Gentlemen (and Ladies), Choose your Weapons: Gamma Knife vs. Linear Accelerator Radiosurgery

Abstract

“In a sense, every tool is a machine—the hammer, the ax, and the chisel. And every machine is a tool. The real distinction is between one man using a tool with his hands and producing an object that shows at every stage the direction of his will and the impression of his personality; and a machine which is producing, without the intervention of a particular man, objects of a uniformity and precision that show no individual variation and have no personal charm. The problem is to decide whether the objects of machine production can possess the essential qualities of art.” —Sir Herbert Read (1893–1968), British critic and poet. Art and Industry, pt. 1, Horizon (1953). “But lo! men have become the tools of their tools.” —Henry David Thoreau (1817–1862), U.S. philosopher, author, naturalist. “Economy,” Waiden (1854). This article compares and contrasts Gamma Knife® radiosurgery with linear accelerator-based radiosurgery; where appropriate, Cyberknife™ technology is discussed. Topics covered are: positioning of the head (invasive versus non-invasive positioning systems); collimator construction; beam properties; beam arrangements; treatment planning; and issues regarding manpower (including a discussion of patient repositioning during treatment), machine availability, and financial considerations.