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 regarding indications for treatment, total dose delivered, fractionation schedule and conformity of the treatment plan. Gamma Knife A Gamma Knife (also known as the Leksell Gamma Knife) is used to treat brain tumors 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 Stockholm, Sweden, by Lars Leksell, Romanian-born neurosurgeon Ladislau Steiner, and radiobiologist Börje Larsson from Uppsala University, Sweden. The first Gamma Knife was brought to the United States through an arrangement between US neurosurgeon Robert Wheeler Rand and Leksell and was given to the University of California, Los Angeles (UCLA) in 1979. A Gamma Knife typically contains 201 cobalt-60 sources of approximately 30 curies each (1.1 TBq), placed in a hemispheric array in a heavily shielded assembly. The device aims gamma radiation 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 ablative dose of radiation is thereby sent through the tumor in one treatment session, while surrounding brain tissues are relatively spared. 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 relatively low intensity, so the radiation has little effect on intervening brain tissue and is concentrated only at the tumor itself. Gamma Knife radiosurgery has proven effective for patients with benign or malignant brain tumors up to in size, vascular malformations such as an arteriovenous malformation (AVM), pain, and other functional problems. For treatment of trigeminal neuralgia the procedure may be used repeatedly on patients. Acute complications following Gamma Knife radiosurgery are rare, and complications are related to the condition being treated. Linear accelerator-based therapies A linear accelerator (linac) produces x-rays from the impact of accelerated electrons striking a high z target, usually tungsten. The process is also referred to as "x-ray therapy" or "photon therapy." The emission head, or "gantry", is mechanically rotated