Computer aided robotic radiosurgery

Abstract

Radiosurgery involves the precise delivery of sharply collimated high-energy beams of radiation to a distinct target volume along selected trajectories. Historically, accurate targeting required the application of a stereotactic frame, thus limiting the use of this procedure to single treatments of selected intracranial lesions. However, the scope of radiosurgery has undergone a remarkable broadening since the introduction of image-guided robotic radiosurgery. Recent developments in real-time image guidance provide an effective frameless alternative to conventional radiosurgery and allow both the treatment of lesions outside the skull and the possibility of performing hypofractionation. As a consequence, targets in the spine, chest and abdomen can now also be radiosurgically ablated with submillimetric precision. Meanwhile, the combination of image guidance, robotic beam delivery, and non-isocentric inverse planning can greatly enhance the conformality and homogeneity of radiosurgery. The aim of this article is to describe the technological basis of image-guided radiosurgery and provide a perspective on future developments. The current clinical usage of robotic radiosurgery will be reviewed with an emphasis on those applications that may represent a major shift in the therapeutic paradigm.

Do Tumors in the Lung Deform During Normal Respiration? An Image Registration Investigation

“…For real time correction strategies (11)(12)(13)(14)(15), the investigation of this problem assumes critical importance as this will determine the complexity of the systems. Recently, Liu et al performed a preliminary study of intrafraction tumor deformation (3).…”

Performance evaluation of a CyberKnife® G4 image-guided robotic stereotactic radiosurgery system

“…In stereotactic radiosurgery and stereotactic radiotherapy, single or multiple fractions of a high radiation dose are delivered to a well-defined small target. SRS has become an important treatment modality in the management of a wide variety of intracranial and extracranial lesions, offering the possibility for a significant reduction of dose to critical healthy tissues with significant benefit to patients (Wurm and Okunieff 2006, Kavanagh and Timmerman 2006, Nishizaki et al 2006, Romanelli et al 2006a, 2006b, Casamassima et al 2006, Strassmann et al 2006, Wu et al 2006. The CyberKnife R (CK) SRS system (Accuray Incorporated, Sunnyvale, California, USA) is a frameless radio surgery device that combines image guidance with robotic technology aiming at the delivery of highly conformal dose distributions to intracranial and extracranial lesions with a standard uncertainty of less than 1 mm (Murphy and Cox 1996, Adler et al 1999, Kuo et al 2003, Chang et al 2003, Schweikard et al 2004, Romanelli et al 2006a, 2006b, Muacevic et al 2006.…”

The Emerging Role of Stereotactic Radiosurgery in the Treatment of Glioblastoma Multiforme

“…This and other frame-based systems are typically used to treat intracranial targets with a single session, because wearing the frame for more than a few hours is not practical and can induce progressive localization error due to shifting of the pins fixing the frame to the skull. Frameless radiosurgery is based on real-time image guidance provided by digitally reconstructed skull radiographs [16,17].…”

“…As a result the CyberKnife has submillimetric accuracy [18] and can be used to treat intracranial lesions ( Figs. 1, 2) as well as extracranial spinal lesions including intramedullary AVMs [16,17,19] and lesions in the chest and abdomen [20].…”