Italy Gamma Knife radiosurgery service back in business following natural disaster

Two years after epic flooding, Maria Cecilia Hospital thrives with Elekta Esprit

Just six months after Maria Cecilia Hospital (Lugo-Cotignola, Italy) replaced the cobalt-60 sources on its Leksell Gamma Knife Icon radiosurgery system, the heavens opened up and treated northern Italy's Emilia-Romagna region to biblical amounts of rain. Two major weather events in May 2023 dumped a total of 18 inches of rain onto the land - seven to eight times the typical May rainfall - causing rivers to breach their banks and flood the area. On May 18, the below-ground bunker in which the newly loaded Icon system was situated was inundated from floor-to-ceiling.

"The water was more than five meters deep, so the Icon was essentially at the bottom of the pool," recalls Enrico Motti, MD, Coordinator of the Gamma Knife Operating Unit at Maria Cecilia Hospital, part of the GVM Care & Research hospital network. "While the water didn't reach the Icon's cobalt sources - in fact they were perfectly preserved - for medical and regulatory reasons we couldn't refurbish the system."

The event triggered a 16-month recovery effort to get the radiosurgery service back up and running. It took days to pump the water out of the wide belowground area that housed the Icon bunker, in addition to the two radiotherapy department bunkers for Elekta linear accelerators, which were a total loss. Treatments for radiosurgery and radiotherapy patients were relocated to GVM network hospitals.

While contractors rebuilt the respective departments and their bunkers, the Cotignola team resumed responsibility for the Gamma Knife Perfexion unit at Anthea Hospital (Bari, Puglia, Italy), which they had originally planned and operated a few years earlier. Augusto Saletta, Elekta Service Operations Manager, was alerted on the day the hospital flooded.

"We received a call from one of the physicists about the situation and once the water was pumped out, we coordinated the removal of the Icon sources and the Icon itself."

"We received a call from one of the physicists about the situation and once the water was pumped out, we coordinated the removal of the Icon sources and the Icon itself," Saletta says. "Instead of replacing the system with another Icon, the hospital decided to acquire an Elekta Esprit."

"The team at Maria Cecilia Hospital introduced Gamma Knife technology in Italy in December 1992 while at San Raffaele Hospital in Milan, starting with model B, then opened in 2002 a new center (by then the third in Italy) in Cotignola with a model 4 unit, then Perfexion which we later upgraded to the Icon system," Dr. Motti says. "Elekta introduced Esprit the year preceding the flood, so it was the latest Elekta radiosurgery system - with improved CBCT and integrated high-definition imaging. Esprit would also provide us with AI-powered planning, better automation and a more intuitive user interface. The system seemed like it would be a good fit for our renewed radiosurgery service."

In September 2024, Elekta engineers began installing the Esprit system in the hospital's neurosurgery department, and in January 2025, Maria Cecilia Hospital restarted its radiosurgery service.

"The flooding in 2023 was an extraordinary event both for the customer and for Elekta service," Saletta remembers. "We have never had to address a catastrophe such as this, and we did our best to make the customer whole. We learned some important lessons on how to deal with an environmental emergency, but hopefully we will never need to put them into practice, as 2023 was literally a once in a 200-year occurrence."

"Even when faced with extraordinary circumstances, this steadfastness has become part of Elekta lore and makes them highly reliable. That commitment was especially evident during the flood."

"In my long life with medical companies, I would like every company to behave like Elekta," Dr. Motti says. "I witnessed the Gamma Knife being built from an original block of steel, fully handmade product on a lathe in 1990. The technicians treated each unit as their personal creation. Those exceptional individuals passed on their work ethic to a younger generation that also never cuts corners. Even when faced with extraordinary circumstances, this steadfastness has become part of Elekta lore and makes them highly reliable. That commitment was especially evident during the flood."

Learn more about Elekta's latest Gamma Knife, Elekta Esprit.

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