Application of IGRT for lung stereotactic body radiotherapy
Jing Cai, Joe Y. Chang, Fang-Fang Yin in Principles and Practice of Image-Guided Radiation Therapy of Lung Cancer, 2017
CyberKnife is the alternative to typical rigid linac-based radiotherapy. This image-guided stereotactic imaging radiosurgery system utilizes a 6 MV linac mounted to a robotic arm capable of delivering 50–100 non-isocentric beams to targets within the patient [147–153]. CyberKnife uses an integrated stereoscopic kV imaging system to monitor patient position during the treatment. CyberKnife generally patients lie directly on the treatment couch with only fiducial markers placed on their anatomy which can be compared to their bony anatomy and digitally reconstructed radiographs (DRRs) derived from the CT simulation dataset to assess motion during treatment. CyberKnife uses the Synchrony® Respiratory Tracking system to dynamically compensate for respiratory motion. Synchrony optically tracks the external fiducial markers on the patient and predicts the tumor motion which then guides the robotic arm as it tracks the tumor. Studies have shown that although CyberKnife may give higher doses to normal lung for posterior tumors than other linac-based methods and require more MUs for treatment, it is comparable to standard rigid linac-based SBRT treatment methods [154]. CyberKnife SBRT treatment plans use more beams than regular linac-based treatments, on the order of >100 beams for CyberKnife in some cases compared to 7–10 beams for typical 3D-conformal treatments.
CyberKnife, TomoTherapy and MR-Guided Linear Accelerators
W. P. M. Mayles, A. E. Nahum, J.-C. Rosenwald in Handbook of Radiotherapy Physics, 2021
The CyberKnife is a fully robotised, image-guided system that allows a target to be located and tracked in three-dimensional (3D) space and irradiated with multiple non-coplanar beams. The fixed frame that was originally used to define the cartesian coordinates for stereotactic radiotherapy (see Section 40.3) is replaced by image guidance, which allows frameless intra- and extra-cranial stereotactic radiotherapy. The CyberKnife meets the criteria of stereotactic radiotherapy: tight margins and steep dose gradients. Tight margins are obtained because of the accurate alignment of the beams associated with the imaging system and the ability to adapt the beam direction to the volume, even with breathing motion. Steep dose gradients are obtained in all directions with multiple non-coplanar beams.
Use of radiochromic films in commissioning and quality assurance of CyberKnife®
Indra J. Das in Radiochromic Film, 2017
The CyberKnife® (CK) Robotic Radiosurgery System as shown in Figure 11.1 is a stereotactic radiosurgery (SRS) device manufactured by Accuray, Inc. (Sunnyvale, CA, and USA) [1–3] that combines advanced robotic, image guidance, and linear accelerator (Linac) technologies to deliver high doses of ionizing radiation to lesions anywhere in the body [4–8]. It has a 6-MV Linac mounted on a robotic arm capable of pointing the radiation beam at the target from an increased number of noncoplanar directions. The robotic arm is spatially calibrated to an image-guidance system consisting of 2-kV X-ray generators and two digital detectors fixed on the ceiling and the floor of the treatment room, respectively. During treatment, the image guidance system takes images of the target region and compares them with corresponding digital reconstructed radiographs (DRRs) [9] obtained from the planning computed tomography (CT) scan. The calculated deviations of the position and orientation of the target are corrected automatically by adjusting the position and direction of each treatment beam [3].
Cyberknife radiosurgery on the brainstem metastases of non-small cell lung cancer
Published in International Journal of Neuroscience, 2021
Guanghai Mei, Xiaoxia Liu, Kun Song, Yizheng Lv, Ming Xu, Hongzhi Xu, Enmin Wang
The Cyberknife technique provides the precise distribution of a high dose of radiation in 1–5 fractions. A steep dose gradient allows the protection of surrounding radiosensitive normal structures, and thus, it minimizes early as well as later-stage toxicities of the treatment. Furthermore, the Cyberknife system integrates the high precision and advantages of fractionating treatment, which is crucial in the optimal management of tumors located in the brainstem. In the current study, all but one lesion were effectively controlled by the CKRS, which was consistent with a review by Patil et al., who reported that WBRT plus SRS yielded better local tumor control (HR 0.27; 95%CI 0.14–0.52) and improved KPS performance status although it was not associated with longer survival [16].
Daily dose to organs at risk predicts acute toxicity in pancreatic stereotactic radiotherapy
Published in Acta Oncologica, 2020
Mauro Loi, Alba Magallon-Baro, Mustafa Suker, Casper Van Eijck, Mischa Hoogeman, Joost J. Nuyttens
Detailed description of the system and clinical application for daily dose evaluation has been previously reported [12,14]. In summary, in our institution, a treatment platform integrating a CyberKnife with a CT scanner on-rail allows to perform daily imaging before irradiation. According to the LAPC-1 protocol, for the first three fractions of the treatment, an end-expiration CT scan with IV contrast was acquired in treatment position and was used for comparison. Daily CT scans were matched offline to the planning CT by applying a rigid registration based on spine match followed by a fiducials match correction, which was used to overlay the planned dose distribution on the daily CT after OAR delineation according to RTOG recommendations, as previously described [12,14].
Twelve tips for teaching oncology to non-oncologists
Published in Medical Teacher, 2020
Jason A. Freed, Andrew J. Hale, Deepa Rangachari, Daniel N. Ricotta
Oncology is filled with terminology not used outside of the field, much of which is non-intuitive or confusing. For example: stereotactic radiosurgery is not surgery, and cyberknife does not involve knives. These terms are so ingrained into daily practice for oncologists that it can be hard to remember that few if any of them are taught in medical school (Cave et al. 2007). What is the difference between adjuvant and neoadjuvant? What is a nadir? What makes a lymph node a “sentinel” node? How is a bone scan different from a skeletal survey? Generalist trainees have much to benefit from deepening their understanding of such terms (Barton et al. 2006).
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