Talk:Cyberknife (device)

Untitled

Made a few change in the opening paragraph. "Precisely controlled" is ill-defined, especially when no comparison to gantry-based systems' precision is given. Clarified that the IRIS gives a variable aperture, supplanting the need for the separate cones. There is not "complete" freedom to position the source (it can't get under the patient, for example). Gantry systems give a similar freedom, but require moving both the patient and the source to do so. "Feasibly short treatment time" is entirely subjective, but much of the sentence was valuable as a lead-in to the source location topic. It does seem that the source details (dose rate, collimation features, etc.) should be moved out of the "robotic mounting" paragraph as they're not related to how it's mounted, but I didn't see a good place for that content and wasn't ready to start a new section.Mweir2 (talk) 20:25, 2 July 2010 (UTC)

Added a few sentences to this article as I do not think it accurately reflected the cyberknife's level of availability. Also to clarify that the clinical evidence cited are early studies which do not yet show any survival benefits over conventional treatment. Due to recent stories in the press I have been coming across many badly informed patients and I don't think this article is very helpful from a patient's perspective. --Epid (talk) 19:51, 20 January 2009 (UTC)

This page is heavily biased, and appears to be written by someone Accuray hired to advertise their machine. The page fails to mention two of the major competitor machines (Varian's Trilogy and Elekta's Synergy). The Linac based radiosurgery machines can not only deliver a comparable treatment, but likely would do so in significantly less time. Also, the Trilogy or Synergy can also be used as conventional linear accelerators. —Preceding unsigned comment added by 24.61.62.26 (talk • contribs)

I believe this exact same article was deleted a month or two ago; now it is back, and I don't notice any substantial edits. The Cyberknife is a radiosurgical device, much like Kleenex is a tissue. There should be no articles solely about Kleenex or Cyberknife on Wikipedia IMHO. Scarbrtj 05:34, 15 August 2007 (UTC)

Actually, there seems to be some discussion of equipment offered by major competitors (such as the GammaKnife). However, the pages of competitors don't seem to discuss the CyberKnife. Strange. ccchhhrrriiisss 11:30, 16 December 2008 (GMT) —Preceding unsigned comment added by 67.108.13.66 (talk)

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BetacommandBot 05:16, 5 August 2007 (UTC)

what comes out of the Cyberknife

What comes out of the Cyberknife? X-ray, gamma ray, proton, positron, or something else? --76.209.28.222 (talk) 21:22, 12 February 2009 (UTC)

What type of radiation?

If you read the article you would find this information:

Mounted on the Robot is a compact X-band linac that produces 6MV X-ray radiation.

92.27.156.88 (talk) 21:37, 31 October 2009 (UTC) I had trouble with this "fact" as well -- megavolts (MV) really aren't a unit relevant to the production of radiation. Does the Cyberknife system produce EM radiation with photon energy of 6 mega-electron-volts (MeV), which would be the relevant and useful information? This is in units of energy rather than potential, and so is more useful in terms of converting among the various properties relevant to radiation therapy (wavelength, beam absorption per tissue depth, etc.). If the reference is to a 6 MeV photon energy, though, this still doesn't express the total beam energy available (which would be the information from which one would like to calculate the available dose per second at various depths, etc.). A measure in megavolts doesn't provide either of these bits of information (and doesn't seem to make sense in this context), but information on photon energy (in MeV) and available beam intensity (in Gy/s) would be more suitable to a Wikipedia article. (The article as it stands refers to 600 or 800 cGy/min, or 10 to 13.3 cGy/s, which is appropriate; a number with the appropriate units for photon energy would be useful for those of us who aren't familiar with the system to understand what it does and give a sense of the tissue penetration depth available.)

M Groesbeck (talk) 03:54, 24 May 2012 (UTC)

"robot" suggestion

I would find inclusion of this article too broad, too distracting and too lengthy for readers in a hurry. Just yesterday I was discussing robots for laproscopy with a surgeon. Quite different subjects, where specialized information needs to be in reasonable sized articles.--Stageivsupporter (talk) 11:57, 1 April 2011 (UTC)

merge Radiosurgery

Because of particular proprietary technology features are discussed, I think a separate article may create less confusion about which features are on which kind of related, but different, medical devices. Just like there is an article on Operating systems, there are articles on Microsoft and Windows.

references

What this article really lacks are current medical references, in the last five years, in areas concerning SBRT and efficacy.--Stageivsupporter (talk) 12:39, 1 April 2011 (UTC)

Significant Problems with this article

There are (IMHO) significant problems with this article. I second the comment about references.

In particular, the section under the heading "Frameless" suggests that there is improved workflow with CyberKnife vs. other systems. This does not seem to be the case.

"Unlike whole brain radiotherapy, which must be administered daily over several weeks" is incorrect.

"The delivery of a radiation treatment over several days or even weeks (referred to as fractionation) can also be beneficial from a therapeutic point of view." is correct.However, the CyberKnife is HYPO-fractionated (i.e. less fractions than usual), and therefore the (possible) benefit of fractionation would weigh against Cyberknife compared to conventional RT.

"Overlook Hospital in Summit, New Jersey was the first hospital in the New York metro area to offer the CyberKnife Stereotactic Radiosurgery System. Today, Overlook has performed the second most treatments of prostate cancer with the cyberknife in the world." Should this be included at all? Is this not just PR?

I thought I should discuss before editing, though. — Preceding unsigned comment added by MattWilliamsUK (talk • contribs) 09:44, 30 September 2011 (UTC)

October 2012

Can someone please correct the title of this article? Should have a capital "K", CyberKnife. — Preceding unsigned comment added by 156.77.111.22 (talk) 18:00, 24 October 2012 (UTC)

What a useless sentence to include in the article this is: "In 2008 actor Patrick Swayze was among the people to be treated with Cyberknife radiosurgery.[37". Has Britney Spears been treated on a CyberKnife yet? — Preceding unsigned comment added by 156.77.111.22 (talk) 18:15, 24 October 2012 (UTC)

No general survival benefit over conventional treatments?

Under the heading "Clinical uses", it states "None of these studies have shown any general survival benefit over conventional treatment methods." This is a troubling claim, not least because it has no citations to support it. But is also suggests that "Cyberknife" treatments are clinically ineffectual. That does not seem to be the case. For example, the medical journal The Lancet recently published a study that demonstrated the efficacy of stereotactic ablative radiotherapy such as CyberKnife, over conventional surgical interventions for some kinds of cancers http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2815%2970168-3/abstract . That unsourced claim of inefficacy should be removed. Bricology (talk) 20:44, 4 October 2015 (UTC)

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NOTMANUAL; advertisement

The content below is mostly unsourced; where it is sourced, it is sourced to SPS or primary sources. This is not OK content in WP.

Main features==

There are two major features of the CyberKnife system that are different from other stereotactic therapy methods.

Robotic mounting===

The first is that the radiation source is mounted on a general purpose industrial robot. The original CyberKnife used a Japanese Fanuc robot; however, the more modern systems use a German KUKA KR 240. Mounted on the Robot is a compact X-band linac that produces 6MV X-ray radiation. The linac is capable of delivering approximately 600 cGy of radiation each minute – a new 800 cGy / minute model was announced at ASTRO 2007. The radiation is collimated using fixed tungsten collimators (also referred to as "cones") which produce circular radiation fields. At present the radiation field sizes are: 5, 7.5, 10, 12.5, 15, 20, 25, 30, 35, 40, 50 and 60 mm. ASTRO 2007 also saw the launch of the IRIS variable-aperture collimator which uses two offset banks of six prismatic tungsten segments to form a blurred regular dodecagon field of variable size which eliminates the need for changing the fixed collimators. Mounting the radiation source on the robot allows near-complete freedom to position the source within a space about the patient. The robotic mounting allows very fast repositioning of the source, which enables the system to deliver radiation from many different directions without the need to move both the patient and source as required by current gantry configurations.

Image guidance===

The second is that the CyberKnife system uses an image guidance system. X-ray imaging cameras are located on supports around the patient allowing instantaneous X-ray images to be obtained.

6D skull====

The original (and still utilized) method is called 6D or skull based tracking. The X-ray camera images are compared to a library of computer generated images of the patient anatomy. Digitally Reconstructed Radiographs (or DRR's) and a computer algorithm determines what motion corrections have to be given to the robot because of patient movement. This imaging system allows the CyberKnife to deliver radiation with an accuracy of 0.5mm without using mechanical clamps attached to the patient's skull. The use of the image-guided technique is referred to as frameless stereotactic radiosurgery. This method is referred to as 6D because corrections are made for the 3 translational motions (X, Y and Z) and three rotational motions. It should be noted that it is necessary to use some anatomical or artificial feature to orient the robot to deliver X-ray radiation, since the tumor is never sufficiently well defined (if visible at all) on the X-ray camera images.

Xsight====

Additional image guidance methods are available for spinal tumors and for tumors located in the lung. For a tumor located in the spine, a variant of the image guidance called Xsight-Spine is used. The major difference here is that instead of taking images of the skull, images of the spinal processes are used. Whereas the skull is effectively rigid and non-deforming, the spinal vertebrae can move relative to each other, this means that image warping algorithms must be used to correct for the distortion of the X-ray camera images.

A recent enhancement to Xsight is Xsight-Lung which allows tracking of some lung tumors without the need to implant fiducial markers.

Fiducial====

For soft tissue tumors, a method known as fiducial tracking can be utilized. Small metal markers (fiducials) made out of gold for bio-compatibility and high density to give good contrast on X-ray images are surgically implanted in the patient. This is carried out by an interventional radiologist, or neurosurgeon. The placement of the fiducials is a critical step if the fiducial tracking is to be used. If the fiducials are too far from the location of the tumor, or are not sufficiently spread out from each other it will not be possible to accurately deliver the radiation. Once these markers have been placed, they are located on a CT scan and the image guidance system is programmed with their position. When X-ray camera images are taken, the location of the tumor relative to the fiducials is determined, and the radiation can be delivered to any part of the body. Thus the fiducial tracking does not require any bony anatomy to position the radiation. Fiducials are known however to migrate and this can limit the accuracy of the treatment if sufficient time is not allowed between implantation and treatment for the fiducials to stabilize.

Synchrony==== Another technology of image guidance that the CyberKnife system can use is called the Synchrony system or Synchrony method. This method uses a combination of surgically placed internal fiducials (typically small gold markers, well visible in x-ray imaging), and light emitting optical fibers (LED markers) mounted on the patient skin. LED markers are tracked by an infrared tracking camera. Since the tumor is moving continuously, to continuously image its location using X-ray cameras would require prohibitive amounts of radiation to be delivered to the patient's skin. The Synchrony system overcomes this by periodically taking images of the internal fiducials, and computing a correlation model between the motion of the external LED markers and the internal fiducials. Time stamps from the two sensors (x-ray and infrared LED) are needed to synchronize the two data streams, hence the name Synchrony.

Motion prediction is used to overcome the motion latency of the robot and the latency of image acquisition. Before treatment, a computer algorithm creates a correlation model that represents how the internal fiducial markers are moving compared to the external markers. During treatment, the system continuously infers the motion of the internal fiducials, and therefore the tumor, based on the motion of the skin markers. The correlation model is updated at fixed time steps during treatment. Thus, the Synchrony tracking method makes no assumptions about the regularity or reproducibility of the patient breathing pattern.

To function properly, the system requires that for any given correlation model there is a functional relationship between the markers and the internal fiducials. The external marker placement is also important, and the markers are usually placed on the patient abdomen so that their motion will reflect the internal motion of the diaphragm and the lungs. This method was invented in 1998. The first patients were treated at Cleveland Clinic in 2002. Synchrony is utilized primarily for tumors that are in motion while being treated, such as lung tumors and pancreatic tumors.

Frameless=== The frameless nature of the CyberKnife also increases the clinical efficiency. In conventional frame-based radiosurgery, the accuracy of treatment delivery is determined solely by connecting a rigid frame to the patient which is anchored to the patient’s skull with invasive aluminum or titanium screws. The CyberKnife is the only radiosurgery device that does not require such a frame for precise targeting. Once the frame is connected, the relative position of the patient anatomy must be determined by making a CT or MRI scan. After the CT or MRI scan has been made, a radiation oncologist must plan the delivery of the radiation using a dedicated computer program, after which the treatment can be delivered, and the frame removed. The use of the frame therefore requires a linear sequence of events that must be carried out sequentially before another patient can be treated. Staged CyberKnife radiosurgery is of particular benefit to patients who have previously received large doses of conventional radiation therapy and patients with gliomas located near critical areas of the brain. Unlike whole brain radiotherapy, which must be administered daily over several weeks, radiosurgery treatment can usually be completed in 1–5 treatment sessions. Radiosurgery can be used alone to treat brain metastases, or in conjunction with surgery or whole brain radiotherapy, depending on the specific clinical circumstances.

By comparison, using a frameless system, a CT scan can be carried out on any day prior to treatment that is convenient. The treatment planning can also be carried out at any time prior to treatment. During the treatment the patient need only be positioned on a treatment table and the predetermined plan delivered. This allows the clinical staff to plan many patients at the same time, devoting as much time as is necessary for complicated cases without slowing down the treatment delivery. While a patient is being treated, another clinician can be considering treatment options and plans, and another can be conducting CT scans.

In addition, very young patients (pediatric cases) or patients with fragile heads because of prior brain surgery cannot be treated using a frame based system. Also, by being frameless the CyberKnife can efficiently re-treat the same patient without repeating the preparation steps that a frame-based system would require.

The delivery of a radiation treatment over several days or even weeks (referred to as fractionation) can also be beneficial from a therapeutic point of view. Tumor cells typically have poor repair mechanisms compared to healthy tissue, so by dividing the radiation dose into fractions the healthy tissue has time to repair itself between treatments. This can allow a larger dose to be delivered to the tumor compared to a single treatment.

References

-- Jytdog (talk) 21:59, 27 August 2018 (UTC)

Template removed

This page did have a 'multiple issues' template, dating back to 2015, for both template:manual and template:advert, but this was removed on 6th March 2023 by 141.226.236.230. No talk discussion or significant editing was done to this article to address the issues stated - I think the template should still be in place, but would like this to be a consensus. 208.127.196.23 (talk) 13:26, 6 June 2023 (UTC)

given the lack of input, and the fact that the no edits were made to justify the initial removal of the template, I have reinstated it. 208.127.196.23 (talk) 13:03, 30 June 2023 (UTC)