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Cyberknife Radiosurgery – A New Treatment Method
Figure 1: The Cyberknife System with Major Components Such as Figure 2: Metastasis from Renal Cancer in the Lateral Aspects of
the Treatment Couch, X-ray Detectors (Silicon Detectors), X-ray the Lumbar Vertebra L2
Cameras at the Ceiling, Robot and Compact Linear Accelerators
A.
B.
dose prescription to the target volume is defined by the tolerance dose to the
organs at risk. During treatment, the patient is awake and is monitored by a
video camera system. During treatment, the robot moves to 100 defined
virtual points that are distributed homogeneously above the target. From
each of these points, the robot can be directed to each point inside the
treatment area (non-isocentric radiation). Complex optimisation techniques
weight the individual beam in such a way that a high dose of radiation is
directed to the tumour, taking into account the specific limitations of the
organs at risk. The stereotactic X-ray system records images during treatment
and compares them with the generated DRRs of the planning CT, providing
Image A shows the lesion on axial positron emission tomography and computerised
tomography taken before spinal radiosurgery. Image B was taken six months later. Complete
the highest possible precision during treatment. remission of the metastasis and re-calcification of the pedicle tissue is obvious.
Medical Indications
The European Cyberknife Center Munich is a co-operative institution
with the University Hospital of the University of Munich. Principally,
Suzanne
well-circumscribed tumours with a clear border to the surrounding
CyberKnife Patient
Treated December 2005
healthy tissue are suitable for Cyberknife radiosurgery. Currently, main
indications are tumours of the brain and spine (see Figure 2). The
efficacy of Cyberknife radiosurgery for body lesions is presently being
evaluated. More than 150 spine tumours have already been treated in
the Munich centre using the new fiducial-free, image-guided tracking
system. Single-session spinal radiosurgery is effective for local control
Tumors Have
and tumour-associated pain syndromes.
3
Nowhere To Hide.
And patients now have somewhere to turn.
Future Perspectives
The CyberKnife® System is the ONLY commercially
New research activities are focusing on the full potential of robotic
available robotic radiosurgery system that delivers
techniques for radiosurgical applications. One of the primary goals is the
proven sub-millimeter accuracy with unlimited
reach anywhere in the body.
introduction of realtime image guidance of tumours in soft tissue without
• Unprecedented Targeting Accuracy
the implantation of fiducials.
7
This would require a fast, fully automated
• Unobstructed Intracranial Access
analysis of X-ray imaging during treatment. The technology is currently • Complete Spinal Access
undergoing phantom tests. In addition, research activities are being
• Unhindered Fractionation
• Convenient Treatment Workfl ow
carried out in order to optimise the inverse planning algorithm and to
With the CyberKnife System, you can
take into account the relative organ movement during respiration. ■
make untreatable and unreachable
tumors a thing of the past – off ering
new hope to more patients.
1. Adler Jr JR, et al., Neurosurgery, 1999;44(6):1299–1307.
Visit us at www.accuray.com
2. Chang SD, et al. In: Radiosurgery, Kondziolka D (ed.), New York: Karger Medical and Scientific
Publishers, 1999.
3. Muacevic A, et al., J Neurosurg Spine, 2006;(5):303–12.
4. Murphy MJ, Cox R, Med Phys, 1996;23(12):2043–9.
5. Schweikard, A, et al., Computer Aided Surgery, 2000;(5):263–77.
6. Schweikard A, Shiomi H, Adler Jr JA, American Association of Physicists in Medicine, 2006;(31):2738–41. No Fiducials - No Frames - No Gating
7. Schweikard A, Shiomi H, International Journal of Medical Robotics and Computer Assisted Surgery,
No Breath-Holding - No Gantry Mobility Restrictions
2005;(1):19–27.
EUROPEAN NEUROLOGICAL DISEASE 2007