Cyber knife .Shabnam.pptx. Introduction of radiosurgery

Cyber knife
1
Shabnam Mousavi. Medical Physicist

Prepared by:
Seyedeh Shabnam Mousavi

2

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

6
Tumor = bad
Brain = good
Critical structures =
good and sensitive

Radiosurgery
Cyber
knife
X
knife
ϒ
knife
7

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
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9
Used x-ray for treatment
Frameless radiosurgery
6D robotic coach
360 degree gantry rotation

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

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

Linac (Linear accelator)
robotic arm
imaging system
software
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It uses x-ray
Uniform dose of high-energy X is assigned to the
tumor
It uses microwave technology
13

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
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The location of Linac
Six-axis rotation in three - dimensional space
with a high accuracy
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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

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

A first interview
The imaging
The treatment planning
The actual precision radiation
Routine follow-up examination
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Specific positioning devices keeps the
organ still during the treatment as much as
possible.
19

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

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

• 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

The patient is requested to lay down on the
treatment table
Anesthesia is not necessary since the treatment
is entirely pain free
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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

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

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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

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30

Thank you 31

Cyber knife .Shabnam.pptx. Introduction of radiosurgery

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Cyber knife .Shabnam.pptx. Introduction of radiosurgery