Optimal implementation of stereotactic radiosurgery requires multidisciplinary input from neurosurgeons, radiation oncologists, and physicists. Clinical processes of most importance to the physics staff include stereotactic imaging, treatment planning, and radiation delivery. Careful attention to each of these details helps to ensure the quality of the overall process. Here we provide a practical review of the clinical processes involved in linac scalpel radiosurgery. The linac scalpel system is a linear-accelerator-based radiosurgery system that was developed at the University of Florida. It has been used at the University of Florida to treat more than 1000 patients since 1988. The aim of the linac scalpel system is to minimize all possible uncertainties in imaging and treatment delivery. Once these errors are minimized, truly conformal treatment plans can be generated and delivered with confidence, allowing clinicians to focus solely on the patient's problem. By following practical examples of this well established system, many pitfalls in the clinical process can be avoided.
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