The CyberKnife® Robotic Radiosurgery System in 2010

The integration of in‐room X‐ray imaging and optical surface tracking has gained increasing importance in the field of image guided radiotherapy (IGRT). An essential step for this integration consists of temporally synchronizing the acquisition of X‐ray projections and surface data. We present an image‐based method for the synchronization of cone‐beam computed tomography (CBCT) and optical surface systems, which does not require the use of additional hardware. The method is based on optically tracking the motion of a component of the CBCT/gantry unit, which rotates during the acquisition of the CBCT scan. A calibration procedure was implemented to relate the position of the rotating component identified by the optical system with the time elapsed since the beginning of the CBCT scan, thus obtaining the temporal correspondence between the acquisition of X‐ray projections and surface data. The accuracy of the proposed synchronization method was evaluated on a motorized moving phantom, performing eight simultaneous acquisitions with an Elekta Synergy CBCT machine and the AlignRT optical device. The median time difference between the sinusoidal peaks of phantom motion signals extracted from the synchronized CBCT and AlignRT systems ranged between ‐3.1 and 12.9 msec, with a maximum interquartile range of 14.4 msec. The method was also applied to clinical data acquired from seven lung cancer patients, demonstrating the potential of the proposed approach in estimating the individual and daily variations in respiratory parameters and motion correlation of internal and external structures. The presented synchronization method can be particularly useful for tumor tracking applications in extracranial radiation treatments, especially in the field of patient‐specific breathing models, based on the correlation between internal tumor motion and external surface surrogates.PACS number: 87

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An image‐based method to synchronize cone‐beam CT and optical surface tracking

Fassi

Schaerer

Riboldi

et al. 2015

“…The MLC plans were generated using the conformal avoidance method with the corresponding radiation fields having eroded, perimeter, and random shapes. Ray‐tracing dose calculation algorithms were employed to develop the fixed and variable collimator plans,15 while a finite‐sized pencil beam (FSPB) algorithm was used to generate the MLC plans since ray‐tracing algorithms could not be applied in those cases.…”

Section: Methodsmentioning

confidence: 99%

Clinical usefulness of MLCs in robotic radiosurgery systems for prostate SBRT

Tomida

Kamomae

Suzuki

et al. 2017

Stereotactic body radiation therapy (SBRT) using recently introduced multileaf collimators (MLC) is preferred over circular collimators in the treatment of localized prostate cancer. The objective of this study was to assess the clinical usefulness of MLCs in prostate SBRT by comparing the effectiveness of treatment plans using fixed collimators, variable collimators, and MLCs and by ensuring delivery quality assurance (DQA) for each. For each patient who underwent conventional radiation therapy for localized prostate cancer, mock SBRT plans were created using a fixed collimator, a variable collimator, and an MLC. The total MUs, treatment times, and dose–volume histograms of the planning target volumes and organs at risk for each treatment plan were compared. For DQA, a phantom with a radiochromic film or an ionization chamber was irradiated in each plan. We performed gamma‐index analysis to evaluate the consistency between the measured and calculated doses. The MLC‐based plans had an ~27% lower average total MU than the plans involving other collimators. Moreover, the average estimated treatment time for the MLC plan was 31% and 20% shorter than that for the fixed and variable collimator plans respectively. The gamma‐index passing rate in the DQA using film measurements was slightly lower for the MLC than for the other collimators. The DQA results acquired using the ionization chamber showed that the discrepancies between the measured and calculated doses were within 3% in all cases. The results reinforce the usefulness of MLCs in robotic radiosurgery for prostrate SBRT treatment planning; most notably, the total MU and treatment time were both reduced compared to the cases using other types of collimators. Moreover, although the DQA results based on film dosimetry yielded a slightly lower gamma‐index passing rate for the MLC than for the other collimators, the MLC accuracy was determined to be sufficient for clinical use.

“…The CyberKnife ® system can deliver stereotactic radiotherapy (SRT) treatments with high doses in a few fractions using small radiation fields, with submillimeter positional accuracy 1, 2. The linear accelerator (linac), mounted on a robotic arm, is operated without a flattening filter and the treatment beam is shaped using fixed circular cones, the InCise™ multileaf collimator or the variable aperture Iris™ collimator (Fig.…”

Section: Introductionmentioning

confidence: 99%

“…1). 1, 3 The latter, allowing for the radiation field size to be varied during treatment delivery, has the potential to decrease the peripheral dose compared to fixed collimators4 and to reduce treatment time 3. A CyberKnife system, the first of its kind in Australia, was recently installed at the Sir Charles Gairdner Hospital (SCGH), Nedlands, WA, with promising early clinical results 5…”

Section: Introductionmentioning

confidence: 99%

CyberKnife^® fixed cone and Iris™ defined small radiation fields: Assessment with a high‐resolution solid‐state detector array

Biasi

Petasecca

Guatelli

et al. 2018

PurposeThe challenges of accurate dosimetry for stereotactic radiotherapy (SRT) with small unflattened radiation fields have been widely reported in the literature. In this case, suitable dosimeters would have to offer a submillimeter spatial resolution. The CyberKnife® (Accuray Inc., Sunnyvale, CA, USA) is an SRT‐dedicated linear accelerator (linac), which can deliver treatments with submillimeter positional accuracy using circular fields. Beams are delivered with the desired field size using fixed cones, the InCise™ multileaf collimator or a dynamic variable‐aperture Iris™ collimator. The latter, allowing for field sizes to be varied during treatment delivery, has the potential to decrease treatment time, but its reproducibility in terms of output factors (OFs) and dose profiles (DPs) needs to be verified.MethodsA 2D monolithic silicon array detector, the “Octa”, was evaluated for dosimetric quality assurance (QA) for a CyberKnife system. OFs, DPs, percentage depth‐dose (PDD) and tissue maximum ratio (TMR) were investigated, and results were benchmarked against the PTW SRS diode. Cross‐plane, in‐plane and 2 diagonal dose profiles were measured simultaneously with high spatial resolution (0.3 mm). Monte Carlo (MC) simulations with a GEANT4 (GEometry ANd Tracking 4) tool‐kit were added to the study to support the experimental characterization of the detector response.ResultsFor fixed cones and the Iris, for all field sizes investigated in the range between 5 and 60 mm diameter, OFs, PDDs, TMRs, and DPs in terms of FWHM measured by the Octa were accurate within 3% when benchmarked against the SRS diode and MC calculations.ConclusionsThe Octa was shown to be an accurate dosimeter for measurements with a 6 MV FFF beam delivered with a CyberKnife system. The detector enabled real‐time dosimetric verification for the variable aperture Iris collimator, yielding OFs and DPs consistent with those obtained with alternative methods.