Robotics and its applications in stereotactic radiosurgery

✓ Stereotactic radiosurgery has undergone a remarkable evolution since its conception and the subsequent introduction of image-guided radiosurgery, primarily because of the concurrent advances in imaging and computer technology. However, recent improvements in real-time imaging, inverse planning techniques, and frameless alternatives have greatly enhanced the conformity and accuracy of the radiosurgical procedure. As a consequence, the possibility of hypofractionation is offered, and both intra- and extracranial targets can now be ablated with sustained submillimetric precision. Although all indispensable features, none is as impressive or useful as the incorporation of robotics, robotic beam delivery, or robotic-assisted planning, which has only served to improve the accuracy and homogeneity of therapy. The aim of this article was to describe the general technological basis of robots in radiosurgery and to review current clinical usage of robotic radiosurgery devices. Emphasis has been placed on robotic principles and the various popular applications currently available.

Download Full-text

Image-guided Hypo-fractionated Stereotactic Radiosurgery to Spinal Lesions

Neurosurgery ◽

10.1097/00006123-200110000-00011 ◽

2001 ◽

Vol 49 (4) ◽

pp. 838-846 ◽

Cited By ~ 61

Author(s):

Stephen I. Ryu ◽

Steven D. Chang ◽

Daniel H. Kim ◽

Martin J. Murphy ◽

Quynh-Thu Le ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Vascular Malformations ◽

Planning System ◽

Treatment Planning System ◽

Spinal Tumors ◽

High Dose ◽

Image Guided ◽

Robotic Radiosurgery ◽

Spinal Lesions

Abstract OBJECTIVE This article demonstrates the technical feasibility of noninvasive treatment of unresectable spinal vascular malformations and primary and metastatic spinal tumors by use of image-guided frameless stereotactic radiosurgery. METHODS Stereotactic radiosurgery delivers a high dose of radiation to a tumor volume or vascular malformation in a limited number of fractions and minimizes the dose to adjacent normal structures. Frameless image-guided radiosurgery was developed by coupling an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the therapy beam to treatment sites within the spine or spinal cord, in an outpatient setting, and without the use of frame-based fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Sixteen patients with spinal lesions (hemangioblastomas, vascular malformations, metastatic carcinomas, schwannomas, a meningioma, and a chordoma) were treated with total treatment doses of 1100 to 2500 cGy in one to five fractions by use of image-guided frameless radiosurgery with the CyberKnife system (Accuray, Inc., Sunnyvale, CA). Thirteen radiosurgery plans were analyzed for compliance with conventional radiation therapy. RESULTS Tests demonstrated alignment of the treatment dose with the target volume within ± 1 mm by use of spine fiducials and the CyberKnife treatment planning system. Tumor patients with at least 6 months of follow-up have demonstrated no progression of disease. Radiographic follow-up is pending for the remaining patients. To date, no patients have experienced complications as a result of the procedure. CONCLUSION This experience demonstrates the feasibility of image-guided robotic radiosurgery for previously untreatable spinal lesions.

Download Full-text