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The difficultly of loading and reloading the U type unit led Elekta to redesign the source configuration into more of a donut-type array (Fig. 3). Based on the unique success of the initial Gamma Knife and the threat that closing the U unit for reloading was bad for patients as well as the hospital economy, I persuaded the leadership to add the B unit in a new vault 20 yards away. Reconstruction of the vault required moving one of the main hospital support trusses, a feat remarkable to me but a no-brainer to the architects and the engineers. Shielding requirements changed based on the new loading strategy that Elekta developed for the B (and subsequent devices). Patient care with the B unit began in 1996. The addition of robotic positioning technology allowed modification of the existing B unit to the C unit with the robotic retrofit.

Fig. 3. The robotic manipulators loading the first 201 cobalt-60 Gamma Knife in Pittsburgh.