CYBERKNIFE-Robotic Radio-surgery system a hope for cancer patients

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THE PAST few decades have witnessed a remarkable progress in the development of instrumentation and in the use and applications of medical imaging techniques.


Imaging possibilities and their use from diagnostics to treatment have revolutionized radiology and imaging practices dramatically. The exploration of ongoing modern radiological techniques and research has led to a volatile growth in clinical practices of medical imaging.


From 1960s radiographs to the modern techniques of today such as Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Single Photon Emission Computed Tomography (SPECT) and Positron Emission Tomography (PET), human body has been revealed non-invasively in a more befitting manner.


However, despite this tremendous progress in the performance of radiological and imaging techniques, the challenge remains one of the early, precise and accurate detection of tumors to be treated among the body.


Keeping this whole scenario in mind, in 1987 Mr. John R. Adler, M.D., the professor of neurosurgery and radiation oncology, at Stanford University Medical Center, was the first person who developed the CyberKnife System after completing his fellowship in Sweden along with Lars Leksell, MD, the founder of radio-surgery. With the CyberKnife System, Adler – s vision was to develop a non-invasive robotic radio-surgery system with extreme precision and superior accuracy for treatment of tumors located anywhere in the body. This revolutionary concept of Adler achieved substantial success far beyond the practice of radio-surgery at the time, which had restricted radio-surgery for the treatment of intracranial tumors and critical organs.


CyberKnife radio-surgery is so precise, that radiation beams can be sent to small, complex-shaped tumors near critical structures, such as hearing and vision nerves too.


This ability to accurately focus only the tumor and protecting healthy tissue distinguishes the CyberKnife from all other radio-surgery systems and old traditional radiotherapy techniques which may be considered inoperable or untreatable.


The CyberKnife is a noninvasive technique that uses image-guided localization, and a robotic delivery system. This unique combination and contrast of technologies enable the CyberKnife to overcome the limitations of older frame-based radio-surgeries such as the Gamma Knife and LINAC.


The CyberKnife is based on a new category of radiotherapy techniques called IGRT (image-guided radio-therapy). The CyberKnife is unique in its use and applications in a manner that it uses a compact linear accelerator (LINAC) which is mounted on an image-guided robotic arm that is responsible to deliver multiple beams of high energy x-rays to a particular tumor target. The CyberKnife accomplishes this task by cross-firing approximately 150 beams of radiation accurately at the target from multiple cross-directions.


These multiple beams containing high energy radiation are delivered from multiple directions and points outside of the body and converge precisely at the tumor inside the body.


Throughout the last decades, traditional radio-surgery systems that were practiced were only performed primarily to destroy brain tumors. The leading success of CyberKnife System is that it is the world – s first and only radio-surgery system that is designed to treat tumors anywhere in the body with extreme sub-millimeter accuracy. Its pin-point accuracy, extreme precision, ultra-flexibility and continuous tumor tracking characteristics make it unique in nature.


CyberKnife System has enabled next generation of radio-surgery systems to continuously track, detect and correct for tumor and patient movement throughout the treatment. This all success has been incepted by combining continual image guidance technology, computer controlled robotics with a compact linear accelerator that has the ability to move in three dimensions according to the treatment plan. This combination, which is called as intelligent robotics, has extended the benefits of radiosurgery to treat tumors located anywhere in the body.


Like in past decades, traditional radio-surgery systems had a limited mobility that it generally requires the use of rigid frames or the so-called – orfits – that were attached to a patient – s skull to provide a coordinate system for marking and planning to effectively target a tumor, restricting their ability to effectively treat tumors outside of the brain. Unlike this all, the CyberKnife System does not have these limitations or restrictions and, therefore, it has enlarged flexibility to treat each and every tumor throughout the body from many different directions, while minimizing the harm of delivery of radiation to healthy tissue and critical organs more precisely.


While under the treatment process, the CyberKnife procedure does not require anesthesia, it can be performed directly on an outpatient basis and allows treatment of patients that otherwise would not have been treated with radiation. It is an outstanding step for the patients who may not have been good candidates for surgery. For such of its remarkable steps, extreme precision and better accuracy CyberKnife System procedure avoids many of the potential risks and complications that are associated with other treatment options and consequently it is more cost effective than traditional surgery.


In CyberKnife System, unlike the old traditional radiosurguries in which fixed collimeters were used, it uses Multi Leaf Collimeters (MLC) which not only formulates the collimeter according to the size and shape of the tumor but also detects and treats the exact tumor without damaging the nearer healthy tissues.


One of the main beauties of CyberKnife system is that it has 6� rotational freedom which allows it to detect and treat broad range of tumors of any organ, unlike the GammaKnife and the old traditional radio-surgery system that were specified to head and neck region only. Due to this beauty, not only head and neck but also tumors of different organs including the prostate, lung, brain, spine, liver, pancreas, and kidney can be treated easily. The other beauty is that in CyberKnife procedure, the position of the patient and tumor site is confirmed by taking real-time images, unlike all other traditional radio-surgery modalities.


Some of the advantages of CyberKnife system include:


– Pain free and purely non-invasive technique


– Does not require Anesthesia


– Better accuracy and extreme precision of radiation to tumors.


– Offering the patient more better chance for cure


– hard-to-reach – tumors that may have been diagnosed as inoperable, are treated more significantly


– Radiations are sent from multiple directions with greater accuracy, that minimizes the damage to healthy tissue


– Does not require any rigid/metal frame or orfit for skull


– Outpatient Treatment


– Quick recovery, which allow patient to Return to normal immediately


– No need to hold breath during treatment.


In recent years, medical imaging has introduced such an advance technologies and new innovations that it has become not only an essential diagnostic tool, but also a critical component of a patient – s treatment.


By the beginning of CyberKnife System, advancements in radiology and medical imaging have led to profound results that radiation oncologists have achieved more choices than ever before for treating patients with tumors.


The future of CyberKnife System will be bright by making more significant advancements in clinical practices of medical imaging and radiological treatments and the research associated with it; which will not only reduce the expense for a treatment session but also reduce the side effects.


The effectiveness/success rate of CyberKnife System will be greatly improved, by shortening the procedure times and making the treatment plans more flexible. Consequently, CyberKnife system will yield unexpected results which will facilitate potential benefits to humanity by means of improved healthcare, disease prevention and better health maintenance.


The writer is Chairman of Biomedical Association of Students for Excellence and Biomedical Engineering, Mehran University of Engineering and Technology, Jamshoro, Sindh, Pakistan.


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