Robotic Cyberknife in the Medical Field - Research Paper Example

Robotic Cyberknife in the Medical Field School: Outline THESIS: CyberKnife robotics technology is an innovative robotic radio surgery system which has entered the medical field and created a sense of overdependence by the medical practitioners. 1. INTRODUCTION A. Cyberknife robotics presents an opportunity with its innovative versions in the medical field. B. Cyberknife is used to treat a number of complicated tumors in an effective way. 2. Treatment Procedure Overview A. Treat Planning starts by a number of 3D images. B. Treatment delivery is based on the automatic delivery of the DPR. 3. Major Sub-systems of the Cyberknife robotics: A. Treatment delivery hardware constitutes of stereo camera system, LINAC, Robotic manipulator and X-ray, imaging system. B. Treatment Delivery system software which constitutes of 6D skull tracking, Xsight, spine tracking, Xsight lung tracking and Fiducial marker tracking. 4. Effectiveness in treating tumor in motion is made possible with the use of synchrony system. 5. There are a number of future considerations for Cyberknife treatment which includes dosimetry, optimal dose and potency preservations. 6. There are a number of benefits that accrue with the use of robotic cyberknife: A. Clinical benefits that give way to clinical dependence. B. Benefits to the patients which motivates them to largely depend on the cyberknife. C. Hospital benefits which encourages them to invest in cyberknife. 7. The conclusion addresses the future of the cyberlink with minimal side effects. INTRODUCTION A Cyberknife is an innovative frameless robotic radiosurgery system that is based on the original concept of the old technology of the frame based radiosurgical system (Yarbo, Barbara, & Gobel, 297). For twenty year of technical development alterations, Cyberknife Robotic Radiosurgery system saw an installation of recent version of cyberknife system VSITIM in April 2010 (Accuracy incorporated, Sunnyvale, CA, USA). The Cyberknife consists of three components; a robot, an advanced light weight LUNAC and X-ray came as (Yarbo, Barabara, & Gobel, 297). It is surpassing technological advancement offer an alternative and complimentary option of treatment for patients with many types of cancer (Yarbo, et. al. 298). The robotic Cyberknife technology is applied worldwide by clinician on a daily basis to treat brain (Colombo et.al. 17), spine (Gagnon et.al 177) head and neck (Rwigema et al, 10), liver (Allen 326), prostrate (Friedland, 73) and lung (Coon et al. 264). Cyberknife treat tumors anywhere in the human body non-invasively. The system is motion in a full range with the specially designed software maps that patient’s anatomy (Yarbo et al, 299). This allows the cyberknife system to position and to specifically target the desired tumor for treatment. TREATMENT PROCEDURE OVERVIEW Treatment planning Treatment planning starts by obtaining a number of three dimensional (3D) images of the target organ (Yarbo et al. 297). This enables clear visualization of the nearby organs and the target organs (Kilby 432; vol. 9). While the treatment plan is being formulated, the cyberknife planning technology does not require confinement of the patient in any acute care setting (Yarbo et al, 299). Using a dedicated database server, the acquired images in 3D are relayed to the Multiplan Treatment Planning System (TPS). A 3D patient model that is generated from the volumetric CT study enables the positioning of the treatment beams (Kilby et al, 434, vol. 9). Treatment Delivery According to (Kilby et al, 435 vol. 9), the target beam is aligned based on the automatic registration of DRR (Digitally Reconstructed Radiograph), which is generated from the 3D model of the patient. Live images are acquired in the patient treatment room using X-ray imaging system. Beam alignment results into live images and digitally reconstructed radiograph, which are two independent imagery transformations. These transformations are converted by geometric backgrounds into 3D transformations. The proportionality of the treatment room space and the x-ray imaging system enables the transformations of the target space and the room to be obtained, (Rwigema et al, 76). This in response allows the position and orientation of each beam for treatment and in relative to the target volume to be achieved, (Kilby et al 435, vol. 9 No. 5). Based on the desired stability of the target position, acquisition of images, localization of the target and alignment corrections are continuously repeated during treatment delivery and the images adjusted for every 30 – 60s (Kilby et al 436, vol. 9 No. 5). After correlation of the target images, the computer identifies where the lesion of 3D space is exactly located. (Yarbo et al, 298). In general, planning the cyberknife treatment utilizes a clinical experience of three main combinations; a physicist, an oncologist and a high speed computer. This will help in prescription which includes determination of radiation volume, pattern an dose (Yarbo et al, 299). Cyberknife determines the effectiveness of the radiation delivery plan by performing millions of calculations. Which enables the cyberknife to treat large lesions (Yarbo etal. 299)? Major Subsystem Treatment Delivery System Hardware Stereo Camera System: it is used to measure the position of the optical markers that are attached to the patient. It has three CCD cameras which is combined with the X-ray imaging systems to allow easy tracking of tumors. LINAC: It uses X-band cavity to generate a 6MV X-ray treatment beam (Kilby et al, 437, Vol. 9, No. 5). It is designed with Collimators for flexibility during treatment (Accuray, Cyberknife, VSI 2) Robotic Manipulator: The LINAC is mounted on the robotic arm. The robotic manipulator enables each treatment beam to be delivered or directed in the required unique point for effectiveness and reduced effects on surrounding tissues (Kilby et al 437; Vol. 9, No 5) Treatment Delivery System Software The software has been designed to treat different tumor locations. They are applied depending on the complexity, location and the beam volume desired. This includes: 6D skull tracking: According to FU & Kuduvalli, this method is used to target intracranial tumors and the head and neck tumors (315). Xsight Spine tracking: It is utilized to locate a target anywhere in the spine (Kilby et al, 439, vol. 9 No. 5). Registration of the image is based on the bone information contrast (Kilby, et al, 438. Vol. 9, No. 5). Xsight Lung Tracking: Without the help of an implanted Fiducial markers, this method is utilized in locating tumors within the lungs (Kilby, et al 439. Vol. 9, No.5). Fiducial Marker Tracking: Xsight lung tracker is not suitable for soft tissue targets. Within Fiducial marker tracking, all soft tissue targets are easily monitored particularly the prostate, pancreas and the liver (Kilby et al, 439, vol. 9 No. 9). Effectiveness in Treating Tumors in Motion Cyberknife uses a synchrony system technology primary t treat moving tumors such as pancreatic tumors and lung tumors (Koong et al, 1018, vol. 58. No. 4). The synchrony system utilizes optical fibres which are mounted on the patient’s skin combination of an internal fiducial which is surgically placed. Increased surgery is not an option to metastatic tumor, a cyberknife technology in combination with investigational software and hardware can be used to deliver conformal radiation to the tumors in motion. The synchrony system in the cyberknife which is designed for modification, minimizes toxicity to the surrounding tissues. This is possible as it delivers a maximal therapeutic dose. Lately patients with lung cancer have been treated based on a close escalation study. This uses 15 to 25 Gy which is monitored carefully for toxicity. The treatment plan is designed by both a medical physicist and radiation oncologist. The patients are encouraged to breathe normally while the radiation prescription is done by the cyberknife. This is made possible since the rhythmic breathing will allow the computer to easily track the process (Yarbo et al, 299). Future Considerations for Cyberknife Treatment The following studies are aimed at optimizing cyberknife SBRT in the prostrate cancer treatment Dosimetry: Katz expresses that cyberknife models installed with faster Linac and the IRIS will be able to treat prostrate cancer within 30-35 minutes (468). This will utilize a homogenous dose distribution all over the prostrate. This will in return simulate an HDR brachy therapy plan. (Katz, 468; vol. 9, No. 5). Optimal Dose: Katz proposes a positive speculation that will foresee a long-term disease control however researchers are yet to demonstrate this (468). Testicular Dose: King has cautioned (42) the plans to use cyberknife to prescribe testicular doses which may result to hypogonadism. Katz et al measured the dose to the testicles and found it to be SGY range. Although Katz et al never measured the level of testosterone, there were no hypogonadism that were clinically observed. This is attributed to the deprivation radiation rather than androgen. Potency preservation: The 40% potency rate reported by standard and the 80% rate reported by Friedland et al ad Katz et al has a big disparity. However large number of follow up patients may be helpful in further research (Katz 469). The robotic cyberknife has proved beneficial in many ways according to the Accuracy Investor Fact Sheet. It categorizes the benefits in three groups. Clinical Benefits Unprecedented targeting Accuracy: Cyberknife delivers an optimal dose radiation with high levels of accuracy to the targeted tumor reducing destruction and damages to the surrounding health soft tissues. Autonomous Robotics: Cyberknife allows for complex tumor treatment by the use of its intelligent automation process. Continual Image Guidance: By the use of its hardware and software appliances, it can track, detect and automatically correct patient movement and tumors in motion throughout the treatment. New Treatment Plan Option: Being non-invasive, it provides patients with a pain-free treatment. Unmatched Agility: Cyberknife surgical system treats tumors from multiple positions. Benefits to Patients Pain-free procedure: The use of a plastic mask makes it be non-invasive hence pain free. Return to normal activities: The pain free treatment and the outpatient procedures reduces the recovery time to minimally zero which allow for return to normal activities immediately. Minimal Risk and Recovery Time: Cyberknife Surgery allows room for outpatient procedure with its pain free treatment. This also reduces post treatment complications. Hospital/Centre Benefits These are the economic cost-effective analysis. This includes: Established Reimbursement: Major carriers like Medicare find sense to reimburse the centre. Strong Economics: based on the centers’ current reimbursement, it provides an opportunity to even in the first year. Generates New Patient Referrals Cyberknife technology demonstrates the ability to any existing radiation therapy treatment practice. According to the University of Miami Health System, the cyberknife technology has created opportunities that are great and beneficial options to the patients and this is likely to intensify future dependency. Conclusion Although it is necessary to have a long-term follow-up of cyberknife to validate its effectiveness, much can be learnt from the available data. The side effects that have been observed may be probably due to error in dosing schedule, reduced target volumes and conformality of the treatment plans since the cyberknife has the ability of the real time tracking. Works Cited Accuray investor fact sheet. Available at www.accuray.com/healthcare-proffessionals/clinical-publications/cyberknife-publications on April 21, 2012. Allen L., Adaptive Radiation Therapy: Imaging in Medical Diagnosis and Therapy. CRC Press, 2011, p324-330. Colombo, F., Cavedon. C., Casentini, L., Francescon, P., Causin, F., 15. Pinna, V. Early results of CyberKnife radiosurgery for arteriovenous malformations. J Neurosurg 111, 807-819 (2009). Coon, D., Gokhale, A. S., Burton, S. A., Heron, D. E., Ozhasoglu, C., 26. Christie, N. Fractionated stereotactic body radiation therapy in the treatment of primary, recurrent, and metastatic lung tumors: the role of positron emission tomography/computed tomography-based treat­ment planning. Clin Lung Cancer 9, 217-221 (2008). Cyberknife robotic radiosurgery at Sylvester. University of Miami. Retrieved on April 21, 2012 from www.tcrt.org/c4309/The-cyberknife-robotic-radiosurgery-system-in-2010 Echner, G. G., Kilby, W., Lee, M., Earnst, E., Sayeh, S., Schlaefer, 43. 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Ste­10. reotactic body radiotherapy for organ-confined prostate cancer. BMC Urol 10, 1 (2010). Katz, A., Santoro, M. CyberKnife radiosurgery for early carcinoma of the prostate: A three year experience. Int J Radiat Oncol Biol Phys 75, S312-S313 (2009). Kilby, W., Main, W. M., Dieterich, S., Taylor, D., Wu, X. In-vivo 88. assessment of the Synchrony Respiratory Tracking System accuracy In: 5th Annual CyberKnife Users’ Meeting CyberKnife Society. Sunnyvale, CA (2006). Muacevic, A., Drexler, C., Wowra, B., Schweikard, A., Schlaefer, A., 102. Hoffmann, R. T., Wilkowski, R., Winter, H., Reiser, M. Technical Description, Phantom Accuracy, and Clinical Feasibility for Single-ses­sion Lung Radiosurgery Using Robotic Image-guided Real-time Respi­ratory Tumor Tracking. Technol Cancer Res Treat 6, 321-328 (2007). 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