Linear Accelerator-Based Radiosurgery: Technique

Stereotactic radiosurgery utilizing modern linear accelerators (LINAC) permits the delivery of high-dose conformal radiotherapy treatment with dosimetry and plan quality comparable to traditional cobalt-60 platforms or robotics systems. The introduction of frameless patient immobilization devices and advanced image-fusion techniques has enabled streamlined clinical workflows capable of delivering radiosurgery across multiple fractions. Novel treatment planning algorithms are available that deliver arc-based LINAC radiosurgical treatment with either cone applicators or multileaf collimators (MLC) more efficiently and precisely than ever before, allowing LINAC-based radiosurgery to be delivered across a variety of practice settings. This chapter highlights both historical perspectives of LINAC-based radiosurgery, current treatment delivery approaches, and future directions of radiosurgical treatment as it pertains to utilizing LINAC platforms.