Radiosurgery
Radiosurgery
Radiosurgery was coined by Dr Lars Leksell in 1951. He defined Radiosurgery as “delivery of a single, high dose of irradiation to a small and critically located intra-cranial volume through the intact skull ”. He called this technique "Stereotactic Radiosurgery." The first Stereotactic Gamma Knife using cobalt-60 sources was constructed and installed in Sophiahammet, Stockholm in 1968. That unit was primarily intended for use in functional brain surgery for the section of deep fiber tracts as in the treatment of intractable pain and movement disorders.
Dr Lars Leksell
Dr. Lars Leksell was born in Fassberg, Sweden on November 23rd 1907, Lars Leksell completed medical studies at the Karolinska Institute and began his Neurosurgical training in 1935 under Dr. Herbert Olivercrona. Development of electronystagmography and his thesis on muscular control and Gamma Motor Neurons were his early scientific achievements. In 1949, he developed his Arc Centered Stereotactic Frame based on Cartesian coordinate system.
In 1951, using the Uppsala University cyclotron, Leksell and the physicist and radiobiologist Borje Larsson, developed the concept of Radiosurgery. Leksell and Larsson first employed proton beams coming from several directions into a small area into the brain, in experiments in animals and in the first treatments of human patients. Thus, he achieved a new non-invasive method of destroying discrete anatomical regions within the brain while minimizing the effect on the surrounding tissues.
In 1961 he succeeded as & Chairman of Neurosurgery at Karolinska institute and perused his work on Stereotactic Radiosurgery and refinement of Stereotactic methods. First prototype of Gamma Knife was installed in Sophiahemmet in 1968.
Today, Leksell's technique is used as an effective treatment for many conditions such as arteriovenous malformations, pituitary tumors, acoustic neuromas, craniopharyngiomas, Meningioma, Matastatic and skull base tumors, and primary brain tumors. The Gamma Knife is manufactured by Elekta Instruments, Inc., a Swedish company which manufactures Stereotactic surgery and Radiosurgery equipment, based on the inventions of Lars Leksell. It was founded by him in 1972
Types of Radiosurgery
Historically the basic concept of Radiosurgery or Stereotactic Radiosurgery has been of a Single Session treatment however overtime things changed as many new technologies developed where either Gamma knife can perform radiosurgery. Most Commonly linac based radiosurgery and proton based radiosurgery. Since the start of Gamma Knife in 1968 typical Treatment involves a head frame fixation and single session treatmentHowever, over time Linac companies too tried to use fram and simulate gamma knife planning and treatment. O, Betty in Paris, J Barsi-Salario in Madrid and F. Colombo started usingLinac for radiosurgery around 1982. Early Linac based radiosurgery used frames with Linac technique of Coplanar arc. Over time Linac group decided to do radiosurgery with stereotactic guidance without frame. Various systems like Novalis and Radionics developed dedicated Linac. In 80’sWorking independently,in Buenos Aires, Argentina, and in Vicenza, Italy, respectively, Betti and Colombo reported the successful adaptation
of linacs for SRS.
In 1992, the relocatable Gill-Thomas- Cosman (GTC) frame was introduced. This device relied on an
attached bite block, custom molded for each patient, and was shown to have a stereotactic accuracy of just over 2 mm.Although not sufficiently accurate and precise for single-session SRS, the GTC frame opened up the era of fractionated stereotactic irradiation. This brought fractionated radiotherapy to stereotactic Radiotherapy or fractionated radiosurgery. It was differentiated by the number of fractions only.
Dr John adler with engineers at Stanford University and with private financial backing developed the CyberKnife in 1994. The CyberKnife delivers SRS via an X-band linac with an output of 6 MV, which was small enough to be mounted on an industrial robot, allowing for a theoretically infinite number of beams to be aimed at the target. This was also the advent of Non-isocentric SRS.
As the debate of Radiosurgery escalated, multiple terminology appeared and was used by various schools. The International Commission on Radiation Units and Measurements [ICRU] tried to summarize and standardized this debate and tried to set definations and give space to all technologies in the field of radiosurgery.
Stereotactic Radiosurgery :Stereotactic radiosurgery is typically performed in a single session, using a rigidly attached stereotactic guidance device, other immobilization technology and/or a stereotactic image guidance system, but can be performed in a limited number of sessions, up to a maximum of five.
Fractionated Radiosurgery : target and with the same dose distribution up to 5 sessions.
[ It has not been distinguished from stereotactic radiotherapy except by an arbitrary limit of 5 sessions]
Staged Radiosurgery : repeated sessions in different areas of the same target [ Volume staging] or the same target with a large time interval.[Dose Staging]
Leksell Gamma Knife® Icon™
Leksell Gamma Knife® Icon™
is preferred for its extreme accuracy, efficiency and outstanding therapeutic response. Gamma Knife radiosurgery is performed in hundreds of leading hospitals and clinics around the world. Around 80,000 patients undergo Gamma Knife radiosurgery every year. No other non-invasive treatment method in this field has greater clinical acceptance. an integrated stereotactic CBCT imaging system that is mounted onto the right side of the system.
Leksell Gamma Knife® Icon™ gives clinicians the option to perform single or fractionated frame-based or frameless treatments, allowing for more individualized delivery—without sacrificing precision and accuracy. Fully integrated, non-complex system design with accuracy average of 0.15 mm and 2-4 times lower dose to healthy brain
The CyberKnife® S7™
is stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) system. It's a robotic radiosurgery system that can deliver non-surgical stereotactic treatments with sub-millimeter accuracy, anywhere in the body — including the prostate, lung, brain, spine, liver, pancreas and kidney.
The CyberKnife S7 System redefines the future of hypofractionated radiation, combining best-in-class robotic precision with proven Synchrony® technology to enable the world’s only motion-synchronized, AI-driven, real-time treatment delivery adaptation for all indications and treatments.
The CyberKnife® S7™
Edge® Radiosurgery
The Edge® radiosurgery system
from Varian embodies the next generation of radiotherapy: radiosurgery. Fully equipped with integrated features, the Edge system allows you to treat patients quickly and precisely, while potentially reducing time spent in a clinic for individual patients. This allows patients more free time away from treatment and enables clinics to treat more patients in established time slots.
As a dedicated radiosurgery machine with conventional treatment features available, the Edge system meets the needs of clinics that want to offer a wide variety of treatment options to patients.The Edge system represents an evolution in how radiosurgery is delivered, enabling you to perform non-invasive, ablative intracranial and extracranial radiosurgery treatments in addition to highly precise radiotherapy treatments across a range of clinical indications.
Novalis® Radiosurgery
is an advanced configuration of specialized tools dedicated to fast, precise and highly targeted SRS and SBRT treatments. Novalis features a dedicated high definition beam shaping device. Novalis Radiosurgery centers all have access to integrated collimation and treatment planning solutions designed to deliver elevated radiosurgical accuracy.High-resolution multi-leaf collimator accurately mirrors the contours of the tumor with constant adaptation of the beam shape enables steep dose fall-off at lesion boundaries
ExacTrac Dynamic unifies the power and precision of cutting-edge tracking technologies. Deliver high-precision treatments for a wide range of patient positioning and monitoring workflows. This all-in-one system’s revolutionary new thermal-surface camera technology works in tandem with real-time X-Ray tracking for extraordinary accuracy.
