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The Cyberknife Stereotactic Surrgery By John R. Adler

1223 words - 5 pages

The Cyberknife stereotactic surgery, developed in 1997 by John R. Adler, a professor of Neurosurgery and Radiation Oncology from Stanford University, and manufactured by Accuracy, Inc., involves a frameless robotic system focusing high concentrations of radiation to target small, critically located tumors without invasive surgery of the skull. This image guided robotic radiosurgery has helped replace external beam radiotherapy and have proved to be a safe and effective for patients with pituitary adenomas (Cho et al., 2009).
This procedure utilizes a robot, which manipulates an X-band linear accelerator that is coupled to a radiographic tracking system to monitor potential target movement ...view middle of the document...

After position of the patient has been adjusted, the offset should be less than 10 mm and the Cyberknife tracking system will automatically compensate for any alignment offset that occurs and any movement by the patient with the help of adjusting the location of the “isocenter” (Chang et al., 2003). If the patient moves, the change is detected during the next imaging cycle and the beam is re-aligned with the target location accordingly (Adler et al., 1999).
The tracking modes are either six-dimensional/three-dimensional or fiducial modes. Both track the target location with the help of orthogonal imaging pairs. The 6D/3D is more so designed for masses in the head and neck. The patient alignment is with six degrees of freedom that include anteroposterior, mediolateral, and inferosuperior for 6D. It also includes rotation around anteroposterior axis, mediolateral axis, and inferosuperior axis. Subsequently, the 3D tracking adjusts alignment for three degrees of freedom with anteroposterior, mediolateral, and inferosuperior axes. With this tracking mode the images generated of the head can be used in sync with digitally reconstructed x-ray images produced from the CT scan. The fiducial tracking mode is designed for intracranial lesions where landmarks may not be accessible. Three to five metal markers are inserted via surgery into the target region. The Cyberknife then locates the target by utilizing the fiducial position in the CT and x-ray images cooperatively (Chang et al., 2003).
The treatment follows a step-and-shoot sequence. Once the patient is in position, the imaging system obtains a pair of alignment radiographs and determines location of treatment site in the robotic coordinate system. The information is then sent to the robot to initialize the focus of the LINAC beam to the appropriate coordinates and the robotic arm maneuvers the LINAC through sequences of nodes around the patient. A new pair of images is generated at each node where the target location is redefined and the corrected position is then transferred to the robot. The robot consequently changes the direction of the beam pointing to compensate for any movement and change in location. The LINAC delivers the pre-planned dose of radiation at the direction it is set for and the whole process is repeated at each node. Typical cases delivers 6 to 30 Gy targeting tumors and utilizes up to 100 intersecting beams at intervals of 20-40 seconds (Adler et al., 1999).
Pituitary adenomas are benign tumors that have different treatments based on being a functioning or nonfunctioning tumor. In general, functioning pituitary adenoma treatment is focused on preventing the over secretion of a hormone from the anterior pituitary. In treating nonfunctioning pituitary adenoma, the focus is primarily on regulating tumor volume growth and preventing visual disorders or...

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