Entering the US market

The gamma knife first attracted international attention in the 1970s, but it would be many years before it made a real breakthrough outside of Sweden. During those years, a steady stream of foreign neurosurgeons came to Stockholm as visiting researchers. They saw first-hand how the knife could be used in the treatment of different patients and were impressed, explains Rolf Kjellström, who started at Elekta in 1988 and is now in 2022 vice president in charge of neuroscience sales and marketing.

“ Karolinska被认为是神经外科的麦加。很荣幸能来斯德哥尔摩并与卡罗林斯卡的一些知名人士一起擦肘部，其中拉尔斯·莱克尔（Lars Leksell）是其中之一。每个完成在斯德哥尔摩团契的人都回家说：“我们必须有伽玛刀”。”

Now, as markets went, the US market was of course of prime interest to Elekta, as the company looked to start selling internationally. But the first gamma knife in the US was not a sale, but a donation. In November 1981, the first prototype which had been in use at Sophiahemmet in Stockholm was moved to UCLA in Los Angeles. The formal handover took place at a clinic with close to five hundred guests in attendance. The machine was installed for research purposes – but would a few years later pave the way for the gamma knife's clinical application in the US.

Around the same time, Dade Lunsford, a young American neurosurgeon, was a visiting researcher at Karolinska University Hospital. His saw tremendous potential for the gamma knife. Upon his return to the US, he began pushing for a gamma knife to be installed at the University of Pittsburgh Medical Center, says Catherine Gilmore Lawless, who was one of Elekta’s earliest employees, a Canadian who happened to live in Stockholm at the time.

“因此，作为一个年轻人，伦斯福德看到了潜力。他说服了，他跳过了很多篮球。他搬了山脉，在匹兹堡大学获得了这台机器。”

与此同时,瑞典以外的首家γ刀were sold to a hospital in Buenos Aires, Argentine and a hospital in Sheffield, UK. Elekta did not make these machines themselves, but they were manufactured and distributed by Nuclitec, a Swiss subsidiary of the Uppsala-based company Scanditronix, which produced the gamma knife under license from Elekta for a number of years.

在1980年代早期,Elekta是个小公司to make a breakthrough and its marketing and sales were focused on Lars Leksell’s earlier stereotaxic instruments. To boost sales, the company enlisted the help of the Johnson Group’s foreign sales staff and the British company Downs Surgical.

“Not long into the 1980s, we passed a million kronor in sales for the first time and a lot of things started to happen”, says Larry Leksell.

“If anyone can do it, Dade can do it.”

1983年，莱克尔（Leksell）与唐斯外科的美国销售人员约翰·里格比（John Rigby）接触，并要求他在美国创办Elekta的子公司。里格比（Rigby）当时住在亚特兰大，由于没有足够的资金来搬家，埃莱克塔（Elekta）的美国总部最终出现在乔治亚首都。一年后，凯瑟琳·吉尔莫尔（Catherine Gilmore Lawless）也搬到了那里，以加强美国的销售并促进国际业务。

“The gamma knife was still in the early stages and Scanditronix owned the rights. But there was a lot of interest from dad's star pupil, Dade Lunsford in Pittsburgh”, says Larry Leksell.

Lunsford had convinced the hospital director of the benefits of investing in the ground breaking gamma knife. To say that Lars Leksell was excited is an understatement.

“Dad told me that if Dade is able to get a gamma knife, he will establish the method once and for all.”

Larry Leksell reached an agreement with the Pittsburgh Medical Center on the terms of a deal. Seeing where the winds were blowing, he decided to leave his successful consulting company Nordic Management and become a full-time CEO for Elekta. This would prove to be a critical period in the company’s history.

勒克尔（Leksell）立即开始工作，以终止与Scanditronix的许可协议，并重新获得了Elekta伽马刀的权利。他还设法从国有投资银行投资者银行获得了财务保证，这为埃莱克塔（Elekta）提供了自己的生产所需的肌肉。Leksell重新建立了与工程师Hans Sundkvist的接触，后者是在制作第一个原型时去过那里的。Sundkvist在Motala车间的阁楼上找到了梁刀的图纸。因此，经过二十多年的生产，又在瑞典开始了伽马刀的生产。

The Pittsburgh deal was also subject to approval by the US Food and Drug Administration (FDA), which is usually a lengthy and complex process. But the company had an ace in the hole – the research unit that had already been installed at UCLA paved the way for a smooth approval process for clinical use.

In 1986, the contract was signed in Pittsburgh – the first time Elekta sold a gamma knife under in its own brand. Before Professor Leksell passed away the same year, he got the news that the deal was final.

Getting the knife to Pittsburgh

The actual transportation and installation process for the gamma knife in Pittsburgh was a challenge in itself. The rules for equipment that used radioactive sources were extremely strict. The gamma knife could not be shipped from Sweden with radioactive cobalt sources; the radiation sources had to be transported separately from the other equipment.

The first patient in Pittsburgh was treated in August 1987. In the years that followed, Dade Lunsford performed a series of treatments that demonstrated the clinical benefit of the gamma knife. Catherine Gilmore Lawless praises his work.

“He opened the door for the new method and the opportunities it offered. We couldn’t have asked for more in terms of a pioneer who then systematically elucidated the role of the Gamma Knife in each cranial indication. So arteriovenous malformations, meningiomas, pituitary tumors, metastases, etc.. Metastases in this location, meningiomas in this type of pituitary. He published extensively on it all.”

Rolf Kjellström agrees. “Dade Lunsford was a very big part of our success. He was extremely energetic. If you look at all of the literature, he probably has the most publications and is considered to be the most important factor in making the gamma knife what it is today.”

这款伽玛刀大约是35-4亿瑞典克朗，是一项相对较大的投资，但研究很快就证明了该方法的经济生存能力。很快，更多的订单到了美国。第二把伽玛刀去了弗吉尼亚大学和尼尔·卡塞尔教授。然后将单位运送到芝加哥和佛罗里达。埃莱克塔（Elekta）在美国市场上取得了强大的立足点。

“One factor in its success was the robust technology”, says Catherine Gilmore Lawless. “The technology itself was unique. We had competition, but our technology was superior and right out of the gate it worked. It was Swedish quality and it worked. It did exactly what we said it would do, sub-millimetric accuracy. It basically never broke”.

When entering the American market, Elektra benefited from the gamma knife’s simple, elegant design and the good reputation of Swedish-made products.

“ Lars Leksell代表的简单性确实很难实现。瑞典因高质量而闻名，也许在一定程度上要归功于沃尔沃（Volvo），我们从中受益。

匹兹堡成为渴望学习如何使用伽马刀的美国神经外科医生的枢纽。达德·伦斯福德（Dade Lunsford）是放射外科新一代恒星的导师。凯瑟琳·吉尔莫尔·劳勒斯（Catherine Gilmore Lawless）说，他们将继续在美国或其他国家的其他医院练习。

“例如，在纽约大学（Jason Sheehan）在UVA经营的杰森·希恩（Jason Sheehan）经营伽玛刀计划的道格·康兹奥尔卡（Doug Kondziolka），但也有许多国际从业人员。因此，我们不能要求一个更好的第一个网站，或者是不可能的，或者是更好的领导者，而伦斯福德（Lunsford）自那时以来就获得了许多赞誉。”

Elekta现在朝着成为领先的出口公司迈出了决定性的一步。该组织增长，销售额增加到2000万SEK以北，并招募了许多关键员工。

“回顾过去，这个时期非常重要，”丹·莱克尔（Dan Leksell）强调，他多年来负责公司的研发。他说，这些年对于埃莱克塔（Elekta）的生存和伽玛刀的生存至关重要。