Cyberknife is a robotic radiosurgery system that can treat tumors anywhere in the body with sub-millimeter accuracy. It contains a linear accelerator mounted on a robotic arm that moves in six degrees of freedom to accurately deliver radiation from numerous angles. Treatment is tracked in real-time using x-ray images and the robotic arm moves to correct for any tumor motion during treatment. Cyberknife allows for both single and multiple fraction stereotactic radiosurgery treatments without the need for invasive head frames.

1. CYBERKNIFE
Introduction &System
Overview
-Vikraman Subramani
Email ID : emailvikraman@gmail.com

2. Questions ???

3. 1. What is Cyberknife ?
2. For what it is ?
3. How it differs from Linac?
4. What it contains ?
5. What is the mould room procedure?
6. How to take the CT for this ?
7. Do we need 4D CT ?
8. Is it real time tracking machine?
9. What is the tracking tool ?
10. Is there 3D imaging ?
11. Is there iso centre /Refernce point ?
12. How to setup the patient without reference ?
13. Can we use the fiducial ?
14. What is field sizes?
15. Fixed field sizes ?
16. Is there MLC ?
17. Irregular tumor and maximum /Minimum tumor size ?
18. What kind of cases we can treat ?
19. What is the dose rate ?
20. How much MU /fraction ?
21. Is there any record and verify as MOSAIQ ?
22. 6D couch ?
23. Treatment time ?

4. 24.What is the planning system
25 . How to contour ?
26. Fusion ?
27 .Invasive ?
28 . Frame/Frameless ?
29.DRR ?
30.How many DRR?
31.Every beam will have DRR ?
32.How many degrees of freedom ?
33.What is the reference field sizes ?
34.What is the daily QA ?
35.How to do the warm up ?
36.
……………………………………etc

5. 1. What is Cyberknife ? (Robotic radiosurgery )
2. For what it is ? (Full body stereotactic radio surgery /therapy)
3. How it differs from Linac?
4. What it contains ? (Robot/linac/x Ray/Imager/laser/couch/modulator/chiller)
5. What is the mould room procedure? (Different)
6. How to take the CT for this ? (Standard technique for all cases)
7. Do we need 4D CT ? (No)
8. Is it real time tracking machine? (Yes)
9. What is the tracking tool ? ( 6 Types)
10. Is there 3D imaging ? (No)
11. Is there iso centre /Refernce point ? ( Yes for dosimetry purpose)
12. How to setup the patient without reference ? (DRR)
13. Can we use the fiducial ? (Yes but not necesary)
14. What is field sizes? (60 mm)
15. Fixed field sizes ? (Yes)
16. Is there MLC ? (IRIS)
17. Irregular tumor and maximum /Minimum tumor size ? (Yes)
18. What kind of cases we can treat ?
19. What is the dose rate ? ( 1000MU)
20. How much MU /fraction ? ( 10000-15000 MU)
21. Is there any record and verify as MOSAIQ ? ( No )
22. 6D couch ? ( Yes)
23. Treatment time ? ( 40 minutes)

6. 24.What is the planning system ( Multiplan)
25 . How to contour ?
26. Fusion ? ( fiducial/auto)
27 .Invasive ? ( No)
28 . Frame/Frameless ? ( frameless)
29.DRR ? (Yes)
30.How many DRR? (Depends on site)
31.Every beam will have DRR ? ( No)
32.How many degrees of freedom ? ( 6)
33.What is the reference field sizes ? (60 mm)
34.What is the daily QA ? (Yes)
35.How to do the warm up ? ( 2000MU)
36.
……………………………………etc

7. Accuray/Cyberknife/VSI
Versatile/Simple/Intelligent

8. Cyberknife robotic radiosurgery
• Revolutionary piece of
technology which delivers the
radiation with sub millimeter
accuracy
• Worlds first & only robotic
radiosurgery to treat tumors
anywhere in the body
• Single /Multiple fractions
• Fullbody radiosurgery
/Radiotherapy
state

9. Cases
Acoustic neuroma Osteosarcoma
Anaplastic astrocytoma Nasopharyngeal carcinoma
Arteriovenous malformation (AVM) Squamous cell carcinoma
Craniopharyngioma
Non-small cell lung cancer
DNET
Ependymoma Small-cell lung cancer
Epidural hematoma Pancreatic cancer
Gangliocytoma Hepatocellular carcinoma
Germinoma Prostate cancer
Glioblastoma multiforme Renal cell carcinoma
Glioma Colon cancer
Glomus jugulare tumor Ovarian cancer
Hemangioblastoma
Uterine cancer
Meningioma
Neurocytoma Arteriovenous malformation (AVM)
Neurofibroma
Neurofibromatosis
Oligodendroglioma
PNET
Pituitary adenoma
Schwannoma
Trigeminal neuralgia
Vestibular schwannoma

10. http://www.accuray.com/sites/default/files/demos/vsi/index.html

11. http://www.accuray.com/sites/default/files/demos/vsi/index.html

12. Targeting System
Linear
accelerator
X-ray sources
Synchrony™
camera
Manipulator Robotic Delivery System
Image
detectors
Treatment couch

13. History
Computer controlled robot
Kuka robot KR240
The name derived from the initial letters of “Keller und
Knappich Augsburg”.
Founded in 1898
Millimeter ==========Sub millimeter
MECHANICAL PRECISION <+/- 0.06 millimeter
Sub millimeter accuracy
GM, Chrysler, Ford, Porsche, BMW, Audi, Mercedes-
Benz, Volkswagen, Ferrari, Harley-Davidson, Boeing,
Siemens, IKEA, Swarovski, Wal-Mart, Budweiser, BSN
Medical as well as Coca-Cola and others,

15. Computer controlled robot
Kuka robot KR240
derived from the initial letters of the company name
“Keller und Knappich Augsburg”.
Founded in 1898 &
John Adler – American Neurosurgeon who
Invented cyberknife – fellowship at karolinska
Institute sweden with Larslekshell in radiosurgery
2001 FDA approved for cyberknife
MECHANICAL PRECISION <+/- 0.06 millimeter
Sub millimeter accuracy

16. Computer controlled robot

18. H
e
a
d
&
N
e
c
k

20. Collimator Assembly

28. 12 directions in each nodes

29. Proximity prediction program & Proximity detection Program

30. Proximity prediction program & Proximity detection Program

36. Workflow

37. Tracking
•6D Skull Tracking
•Synchrony Tracking
•Fiducial tracking
•Xsight lung tracking
•Xsight spine tracking
•In tempo adaptive tracking

38. http://www.accuray.com/sites/default/files/demos/vsi/index.html
http://accuray.learn.com/files/scorm/Fiducial%20Placement%20Guidel
ines/index_lms.html

41. 1. What is Cyberknife ?
2. For what it is ?
3. How it differs from Linac?
4. What it contains ?
5. What is the mould room procedure?
6. How to take the CT for this ?
7. Do we need 4D CT ?
8. Is it real time tracking machine?
9. What is the tracking tool ?
10. Is there 3D imaging ?
11. Is there iso centre /Refernce point ?
12. How to setup the patient without reference ?
13. Can we use the fiducial ?
14. What is field sizes?
15. Fixed field sizes ?
16. Is there MLC ?
17. Irregular tumor and maximum /Minimum tumor size ?
18. What kind of cases we can treat ?
19. What is the dose rate ?
20. How much MU /fraction ?
21. Is there any record and verify as MOSAIQ ?
22. 6D couch ?
23. Treatment time ?

42. 24. QA
25.What is the planning system
26 . How to contour ?
27. Fusion ?
28 .Invasive ?
29 . Frame/Frameless ?
30.DRR ?
31.How many DRR?
32.Every beam will have DRR ?
33.How many degrees of freedom ?
……………………………………etc

44. Thanks