History of LINAC and Proton Radiosurgery

The official history of stereotactic radiosurgery begins with the Swedish neurosurgeon Lars Leksell and his seminal paper, “The stereotaxic method and radiosurgery of the brain” published in 1951 [ 1 , 2 ]. Here, Leksell coined, for the very first time, the term radiosurgery to represent his idea of delivering external therapeutic radiation using stereotactic guidance. As a result, Lars Leksell is considered the father of radiosurgery, and his influence was enhanced through the invention of the Gamma Knife radiosurgery (GKRS) platform. Similar to GKRS, linear accelerator (LINAC) and proton radiosurgery rely on stereotaxis principles. However, GKRS is based on the therapeutic delivery of gamma ray radiation (a beam of high-energy photons produced during nuclear decay) from the nucleus of a Co-60 atom, while LINAC and proton radiosurgery are based on the science of particle accelerators. LINAC radiosurgery requires the acceleration of electrons (negatively charged and low mass particles) in order to subsequently generate therapeutic X-rays, while proton radiosurgery requires an efficient acceleration of protons (positively charged and higher mass particles) in order to grant them therapeutic properties [ 2 ].