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CyberKnife: Radiosurgery System Introduction

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CyberKnife: Radiosurgery System Introduction

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Radiation source is mounted on a precisely controlled industrial robot.
- Image guidance system(continuous tracking system)
- Eliminates the need of gating techniques and restrictive head frames

Radiation source is mounted on a precisely controlled industrial robot.
- Image guidance system(continuous tracking system)
- Eliminates the need of gating techniques and restrictive head frames

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CyberKnife: Radiosurgery System Introduction

  1. 1. CyberKnife: Radiosurgery system Copyright @ www.radiosurgery-india.com
  2. 2. Thanks to technology !! Copyright @ www.radiosurgery-india.com
  3. 3. Radiosurgery: IndicationsRadiosurgery: Indications Intra-cranial:Intra-cranial: 1.1.Brain metsBrain mets 2.2.MeningiomaMeningioma 3.3.Acaustic schwannomaAcaustic schwannoma 4.4.AVMsAVMs 5.5.TNTN Extra-cranial:Extra-cranial: 1.1.Lung: Primary & metsLung: Primary & mets 2.2.Liver: HCC & metsLiver: HCC & mets 3.3.Inoperable pancreasInoperable pancreas 4.4.ProstateProstate 5.5.Bone metastasisBone metastasis Copyright @ www.radiosurgery-india.com
  4. 4. Robotic Radiosurgery Highly precise RT delivery system - Respiratory tracking - Fiducial based tracking system - Intra-fraction motion correction - Uncomparable dose distribution - X-ray based image verification Hypofractionated RT - High dose short course RT - Higher BED delivered to target Ideal for moving targets - Radiation source is mounted on a precisely controlled industrial robot. - Image guidance system(continuous tracking system) - Eliminates the need of gating techniques and restrictive head frames Copyright @ www.radiosurgery-india.com
  5. 5. GTV= Gross tumour volume CTV= Clinical target volume IM= Internal margin SM= Setup margin PTV= Planning target volume PTV= IM+SM ICRU 62 CyberKnife in liver tumour: NO IM & SM<1 mm In Liver, PTV = GTV/ CTV+ 0-1 mm marginIn Liver, PTV = GTV/ CTV+ 0-1 mm margin Copyright @ www.radiosurgery-india.com
  6. 6. Robotic Radiosurgery Copyright @ www.radiosurgery-
  7. 7. 5 1 2 3 4 65 Copyright @ www.radiosurgery-
  8. 8. Pitch RollYaw Copyright @ www.radiosurgery- india.com
  9. 9. Robot is capable of delivering radiation from different 100 nodes, with each node is capable of giving a max 12 different beams. Usage of these nodes depends on the treatment room constraints Copyright @ www.radiosurgery-india.com
  10. 10. Table consists of 12 fixed cones and housings of ‘Fixed’ and ‘Iris’ Collimator Collimator sizes(mm): 5, 7.5, 10, 12.5, 15, 20, 25, 30, 35, 40, 50, 60 Laser Sensor Copyright @ www.radiosurgery-india.com
  11. 11. Copyright @ www.radiosurgery-india.com
  12. 12. Cyberknife treatment delivery is based on the following tracking systems  6D_ Skull tracking system  Fiducials tracking system  Synchrony tracking system  X_sight Spine tracking system  X_sight Lung tracking system Copyright @ www.radiosurgery-india.com
  13. 13. 6D_ Skull tracking system: used for intra-cranial lesions up to C2 Bony anatomy of the skull is used as reference for tracking Copyright @ www.radiosurgery-india.com
  14. 14. • Fiducial tracking system: used for soft tissues, where gold fiducials can be implanted. Minimum of 3 nos. to be implanted Copyright @ www.radiosurgery-
  15. 15. Copyright @ www.radiosurgery-india.com
  16. 16. Day 1 Day 5 Fiducial ‘migration’ Copyright @ www.radiosurgery-india.com
  17. 17. Copyright @ www.radiosurgery-india.com
  18. 18. Respiratory-induced motion of tumors causes significant targeting uncertainty Lung, liver, pancreas, Prostate, kidney Traditional radiation therapy margins are not optimized for high-dose radiosurgery
  19. 19. Two features to form the basis for accuracy Fiducials, implanted prior to treatment Optical markers on a special patient vest Copyright @ www.radiosurgery-india.com
  20. 20.  Prior to treatment start: creation of dynamic correlation model Markers are monitored in real time by a camera system Imaging system takes positions of fiducials at discrete points of time
  21. 21.  Prior to treatment start: creation of dynamic correlation model Markers are monitored in real time by a camera system Imaging system takes positions of fiducials at discrete points of time time displacement displacement time This process repeats throughout the treatment, updating and correcting beam delivery based upon the patient’s current breathing pattern Copyright @ www.radiosurgery-india.com
  22. 22. Immobilization device Copyright @ www.radiosurgery-india.com
  23. 23. Positioning
  24. 24. Tracking device Copyright @ www.radiosurgery-india.com
  25. 25. Tracking & treatment delivery Copyright @ www.radiosurgery- india.com
  26. 26. Tracking & treatment delivery
  27. 27. Copyright @ www.radiosurgery-india.com
  28. 28. The mechanical accuracy of the system is 0.12 mm , according to Accuray The system maintains sub-millimeter tracking accuracy, if the patient positions are within the following limits Left / Right (Lat) 10 mm Ant/ Post (Ver) 10 mm Sup/ Inf ( Long) 10 mm Roll (Left / Right) 10 Pitch (Head Up / Down) 10 Yaw ( C.W / C.C.W) 30 Copyright @ www.radiosurgery-india.com
  29. 29. CK planning
  30. 30. ‘‘CyberKnife is an extension of Gamma-Knife’CyberKnife is an extension of Gamma-Knife’ - Principles of ‘field arrangement’ - Dose distribution pattern - Multiple isocentre -Treatment principles - Treatment delivery accuracy similar - Delivered dose in single fractions - Intra-cranial indications CK & GK: SimilarityCK & GK: Similarity ‘CyberKnife treatment is as good as Gamma-Knife’ Dr Bernadt Wowra Copyright @ www.radiosurgery-india.com
  31. 31. Cyberknife Vs Gamma-Knife:Cyberknife Vs Gamma-Knife: DissimilarityDissimilarity GK CK Comments Immobilization device Rigid frame Orfit CK has favorable orfit RT source Co60 6MV LA GK need to replace sources every 5/6 yrs Planning No complex planning Inverse planning Favorable dosimetry in CK Planning method Simple Complex Even neurosurgeons can plan in GK Isodose pres Usually 50% Usually 80-95% GK: more dose heterogeniety Fractions Single May treat multiple fraction Radiobiology favorable in CK Tumour size Only smaller lesions can be treated Larger lesions also can be treated in fractionated schedule Increased indications with CK Energy source Radiation Electricity GK can work with less electricity Verification Not possible Possible Even Intra-fraction movement can be corrected Indications Only brain lesions Extra & intra cranial CK more economical
  32. 32. SummarySummary CyberKnife Radiosurgery is an ideal machine for both cranial & extracranial radiosurgery Appropriate patient selection is the most important factor CyberKnife is safe and patient friendly radiotherapy delivery system Short course, precise, high dose RT may be beneficial in few indications However, the indications are limited and long-term data of most of the extra- cranial indication is still to be available With more clinical data, indications are expanding Copyright @ www.radiosurgery-india.com

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