FAQs – Useful answers - Helpful answers relating to our Gamma Knife Center

Teletherapy uses high-energy photons for external irradiation. We currently differentiate between two ways of beam generation: Devices based on the radioactive decay of cobalt 60 - the process used in the Gamma Knife -, and devices which generate the radiation themselves by accelerating electrons in an electric field - the process used in linear accelerators.

Cobalt 60 is a synthetic radioactive isotope produced in nuclear reactors. It has a half-life of 5.27 years and produces two gamma quanta with energies of 1.17 and 1.33 MeV. These are used for medical applications as high-energy - monochromatic - photon radiation. Cobalt 60 radiation sources are high-energy and compact. Each of the 192 beam sources in a modern Gamma Knife is about the size of a pencil tip, with an egg cup large enough to hold all of them. This is the only way of building an irradiation device that simultaneously focuses 192 beams on a single point. All other radiosurgical procedures generate a single therapeutic beam which has to be concentrated on a target point from various directions in a complicated process. This makes it less accurate and results in higher radiation exposure. The Gamma Knife has the steepest dose gradient and the lowest radiation exposure of all radiosurgical procedures (cyber knife, linear accelerator, photon therapy).

No! Cobalt-60 radiation sources are produced in large quantities and used mainly for the safe sterilization of medical devices. Manufacturers use cobalt-60 equipment and gamma radiation to sterilize all disposable medical devices such as syringes, cannulas, gloves, etc. Modern medicine around the globe would grind to a halt overnight without cobalt-60 sources. The cobalt-60 sources used in radiosurgical devices account for less than 1% of global demand.

The German Gamma Knife Centers obtain their cobalt 60 sources from the manufacturer ELEKTA through the Canadian company NORDION. At the end of their useful life, the sources are replaced by new ones and returned to Canada for recycling. Cobalt 60 sources are normally reactivated in the reactor. Where this is not possible, they are placed in final storage in Canada. The sources are produced in the Bruce B reactor in Ontario, Canada. The Bruce nuclear power plant is Canada’s largest electricity producer. Particularly in light of climate change, Canadians do not want to stop using the plant.

The cyberknife is a stereotactic radiotherapy device. It was developed by John Adler in Standford in the United States in 1987. He had worked previously in Sweden with Gamma Knife inventor Lars Leksell and wanted to build a machine that implements the Gamma Knife principle (converging many beams on a single point) to treat tumors in the body. The Gamma Knife can only be used to treat brain tumors and is not suitable for the rest of the body as it simply cannot fit into the device. John Adler had the idea of mounting a single radiation source (linear accelerator) on a robot. Unlike the Gamma Knife, which focuses the entire radiation simultaneously on a single point, the robot was designed to apply each individual beam in succession. This allows treatment of tumors in the spine, lungs, prostate, etc. as well. However, the linear accelerator is not as accurate as the Gamma Knife. What is more, a linear accelerator, which “dances around” the patient on a robot arm generates much higher scatter radiation which exposes the patient to much higher radiation. For that reason, U.S. centers normally have a Gamma Knife for pinpoint accuracy for treating brain tumors and also a cyber knife for the rest of the body. Only in Germany interested parties still see the cyber knife as a “further development” of the Gamma Knife. And, of course, a cyber knife that you can also use on the brain is far cheaper than buying two machines that sit next to each other. Particularly as you can use one of them - the Gamma Knife - only for the head. However, clinical and radiation protection constraints make this approach inviable.

The cost of radiosurgical treatment is calculated in the private medical sector according to the Doctors’ Fee Scale [GOÄ]. Private health insurance companies reimburse costs on this basis.

There are contracts between the Gamma Knife Center Krefeld and Hanover and individual health insurance companies for other indications, which means that Gamma Knife radiosurgery is available to their insured patients without a time-consuming application process if required. Statutory health insurance companies with which we have concluded corresponding agreements are, for example, DAK (Deutsche Angestellten Krankenkasse), AOK Rheinland - Hamburg, pronova BKK and other AOKs and BKKs that have joined the agreements. Please contact us if you would like to know whether your health insurance company participates in a corresponding contract.

Unfortunately, other statutory health insurers are still not entitled to reimbursement in the outpatient sector. Although radiosurgery has been successfully performed in Germany since 1994 and worldwide since the 1970s, further radiosurgical treatments have not yet been included in the SHI benefits catalog. As a result, patients with indications such as meningiomas, choroidal melanomas or trigeminal neuralgia, among others, must still first apply to their health insurance provider for coverage of the costs of outpatient radiosurgery treatment. In recent years, reimbursement has been granted in thousands of cases on a case-by-case basis.

We offer you assistance in applying for reimbursement. After the consultation and the indication, you will receive a doctor's letter from us with a cost estimate. Please submit this document to your health insurance company yourself. As soon as you have received written confirmation from your insurance company, please contact us again to arrange a treatment appointment. In the event of a rejection, we advise you to also contact us to discuss the next steps.

You can, of course, pay for the treatment with the Gamma Knife yourself.

In the case of medical necessity, you can also receive treatment at a hospital. Here we have access to beds in the neurosurgical department of the Helios Hospital Krefeld.

Side effects occur only rarely, depending largely on the treated clinical picture, the location of the diseased tissue, and the required radiation dose. For that reason, general statements are not possible. In the initial consultation the possible side effects are described in detail in each individual case.

The waiting time depends primarily on the treatment indication and the patient's request. As a rule, treatment is possible within 14 days, if necessary.

The transfer should be made via the general practitioner or specialist. In the case of oncological diseases, a tumor board recommendation should be available. However, "self-referral" in the context of a second opinion is also possible; if necessary, talk to your health insurance company about this.

Free parking: Our patients can park free of charge on the premises of the MVZ Gamma Knife Krefeld and on the premises of the Klinikum Nordstadt (MVZ Gamma Knife Hannover) during radiation treatment.

Own parking Krefeld: Our location Krefeld has 10 parking spaces. These are marked accordingly.

Own parking spaces Hannover: We have rented parking spaces that are exclusively available to our patients. The parking spaces are located directly in front of our practice in House X on the grounds of the Klinikum Nordstadt and are marked accordingly.