Introduction of radiosurgery Introduction of cyber knife Structure of cyber knife Treatment procedure Comparison

1. Cyber knife
1
Shabnam Mousavi. Medical Physicist

2. Prepared by:
Seyedeh Shabnam Mousavi
2
Shabnam Mousavi. Medical Physicist

3. Outline
Introduction of radiosurgery
Introduction of cyber knife
Structure of cyber knife
Treatment procedure
Comparison
3
Shabnam Mousavi. Medical Physicist

4. Radiosurgery
A kind of closed surgery that has
fewer complication according to
the open surgery
( without pain, bleeding, and cutting)
Used for soft tissue masses &
malformations
4
Shabnam Mousavi. Medical Physicist

5. Radiosurgery (cont.)
Procedure that uses an intense, focused beam
of radiation as an ablative surgical instrument
to destroy tumors
The goal:
- Deposit a lethal dose of radiation in the tumor
- Avoid irradiation of dose-sensitive/critical areas
- Minimize irradiation of other normal tissue
5
Shabnam Mousavi. Medical Physicist

6. 6
Tumor = bad
Brain = good
Critical structures =
good and sensitive
Shabnam Mousavi. Medical Physicist

7. Radiosurgery
Cyber
knife
X
knife
ϒ
knife
7
Shabnam Mousavi. Medical Physicist

8. Dedicated to intracranial radiosurgery
High degree of accuracy (±1 mm)
Stereotactic frames
The Gamma Knife apparatus 201 individual
radiation sources around the cranium and focused on a
single point, the isocenter, within the patient’s tumor
8
Shabnam Mousavi. Medical Physicist

9. 9
Used x-ray for treatment
Frameless radiosurgery
6D robotic coach
360 degree gantry rotation
Shabnam Mousavi. Medical Physicist

10. It was first introduced in 1990 and first used in 2009.
Cyber ​​Knife system is in more than 18 countries and more
than 150 specialized cancer centers. So far more than
40,000 cancer patients have been treated with it.
There isn’t a knife. Precision and beam twisted like a knife
without anesthesia and destroys cancer cells.
10
Shabnam Mousavi. Medical Physicist

11. The Cyber Knife Robotic
Radiosurgery System is a non-
invasive alternative to surgery for
the treatment of both cancerous
and non _ cancerous tumors
anywhere in the body.
High precession, Pain free, non
surgical option, without cutting &
hemorrhage, low complication.
11
Shabnam Mousavi. Medical Physicist

12. Linac (Linear accelator)
robotic arm
imaging system
software
12
Shabnam Mousavi. Medical Physicist

13. It uses x-ray
Uniform dose of high-energy X is assigned to the
tumor
It uses microwave technology
13
Shabnam Mousavi. Medical Physicist

14. Beams secondary setup by 12 fixed
circular collimator, manually or
automatically.
12 tungsten-copper alloy segments into
banks of 6 with rotation by 30 degree
Iris collimator allows the field size to be
varied during treatment
No increasing in treatment time
14
Shabnam Mousavi. Medical Physicist

15. The location of Linac
Six-axis rotation in three - dimensional space
with a high accuracy
15
Shabnam Mousavi. Medical Physicist

16. Two diagnostic x-ray detector on the
ceiling, and two under the bed
The high-resolution digital image
The X-ray source with an angle of 45
degrees relative to the vertical plane
Between the detector axis and imaging
software is modified
16
Shabnam Mousavi. Medical Physicist

17. X-ray cameras are placed around the patient
Anatomic position of the target organ can be determined
with high precision
The beam is carefully applied to the mass
The robotic arm is guided accurately by a computer program
Different programs are used to treat different masses
17
Shabnam Mousavi. Medical Physicist

18. A first interview
The imaging
The treatment planning
The actual precision radiation
Routine follow-up examination
18
Shabnam Mousavi. Medical Physicist

19. Specific positioning devices keeps the
organ still during the treatment as much as
possible.
19
Shabnam Mousavi. Medical Physicist

20. Depending on the type of tumor, CT scan or MRI is
performed
For brain, spine and liver lesions an MRI not older than 4
weeks is mandatory. For lung lesions a CT scan is sufficient.
For body treatments using Synchrony small Gold markers (5
mm) have to be implanted in advance.
20
Shabnam Mousavi. Medical Physicist

21. The CT and MRI data are logged onto a computer
The attending physicians and specialized medical
physicists can plan and simulate the number,
intensity and direction of the beams which the
robot will deliver to the target.
21
Shabnam Mousavi. Medical Physicist

22. • Treatment is performed in modern practice rooms
• On the day of treatment no special measures
have to be taken. Have breakfast as usual and
take any medicine, if applicable.
22
Shabnam Mousavi. Medical Physicist

23. The patient is requested to lay down on the
treatment table
Anesthesia is not necessary since the treatment
is entirely pain free
23
Shabnam Mousavi. Medical Physicist

24. With video cameras the patient is observed by
the treating physicians.
Via microphone the patient can any time get into
contact with the attending doctor.
Treatment lasts 3 to 10 sessions, and a time
frame of about 45 - 90 minutes for the actual
treatment is calculated.
24
Shabnam Mousavi. Medical Physicist

25. Sync system to enhance radiation therapy to the tumor ,and reducing exposure
to surrounding healthy tissue is used
Optical fiber skin on the abdomen to determine the
movement of the abdomen during irradiation can be used
Abdominal motion during irradiation is calculated by a computer algorithm.
Robotic arm position according to abdominal
movement.
During the movement ; Image acquisition , location
the target & reformatting performed continuously.
25
Shabnam Mousavi. Medical Physicist

26. Check-ups:
In order to determine the actual health status it
is recommended to come for regular outpatient
follow-up examinations
26
Shabnam Mousavi. Medical Physicist

27. This example shows a 46 years old female patient harboring an
intramedullary breast cancer metastasis (left image)
Patient was treated by a 1 hour single session radiosurgical cyber
knife procedure.
4 weeks after cyber knife treatment the tumor was not visible anymore
(right image 27
Shabnam Mousavi. Medical Physicist

28. 28
Allow the device to be synchronized with breathing
Focus on accuracy and reduce damage to healthy tissue
Lower complication rate than other methods
No need to fix the frame
High dynamic range than the X-Knife Gantry
Applicable to all tumors in all of the part in the body
Repeatable
No need for anesthesia
Ray tube moving toward
the goal
Shabnam Mousavi. Medical Physicist

29. 29
Shabnam Mousavi. Medical Physicist

30. 30
Shabnam Mousavi. Medical Physicist

31. Thank you 31
Shabnam Mousavi. Medical Physicist