Introduction. Introduction. The CyberKnife SRS/SBRT System. Introduction. Contour Structures. CyberKnife Components
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1 Introduction The CyberKnife SRS/SBRT System James M. Hevezi,, Ph.D., FACR CyberKnife Unit San Antonio, Texas CyberKnife Components Treatment Delivery (G3 Platform San Antonio) Robot (modified German auto manufacture) Mounted modified industrial 6MV linac 6D remote motion patient couch Treatment Planning Closed network system Inverse planning optimization (MultiPlan( MultiPlan) Plan loaded in tx console for delivery Introduction Image Guidance Two orthogonal ceiling mounted x-ray x tubes Real time silicon image receptors Correlate with 45 deg oblq DRR s from plan Methodology Intra-cranial = 100 nodes, 12 angles, 80 cm spherical surface Extra-cranial = 100 nodes, 12 angles, 100 cm ellipsoidal surface Introduction Treatment Methods Static (3 Translation-3 3 Rotation Directions) 6D Skull Tracking Spine Tracking (fiducial( fiducial-less) less) Fiducial Tracking (gold seed markers) Dynamic Synchrony Motion Tracking Static plan Setup correlation between respiratory surrogate (beacons on chest) and fiducial(s) ) in target Subsequent tracking follows beacons with updates at each IGRT imaging session Treatment Planning PC Based, Inverse Planning System Contour Target(s), Critical Structures MRI/PET/CT Fusion capable Treatment in 3 Paths (Lt, Cnt, Rt) Choose cyln.. Collimator (5-60 mm)/path Beams weighted to optimize target coverage, critical structure avoidance Contour Structures 1
2 Treatment Planning Choose min/max Monitor Units Realtime display of Target DVH as calculation proceeds Iterative or Simplex algorithms available Iterative allows interruption of calculation, ability to change parameters and continue Simplex drives down to a solution with criteria presented and displays solution Treatment Planning Usually, draft plans are developed with different collimators, eg. number of beams, beam weights, Mu s will differ Physician(s) ) evaluate plans and choose best plan to treat (DVH, 3 plane display) This plan is moved to treatment console for subsequent treatment. This is a closed loop network Beam Evaluation Screen Patient Treatments w/ CK Patient is approved for CK SRS/SBRT by their carrier Fiducial placement scheduled, if necessary Planning CT (MRI or PET fusion) done Physician draws targets, critical structures Several draft plans done: RO chooses Plans sent to console for DRR, RX, TX 2
3 TARGETING SYSTEM X-ray sources Synchrony camera Linear accelerator Manipulator ROBOTIC DELIVERY SYSTEM Fiducials for Synchrony Motion Tracking Treatment Couch Image detectors Beacons for Synchrony Motion Tracking Synchrony Respiratory Tracking System Synchrony camera Synchrony tracking markers Fiber optic sensing technology Tracks patient s s respiratory motion Synchrony Correlation Screen 3
4 Site Mix in San Antonio We treat in 4 daily treatment slots: 8 am, 10 am, 1 pm and 3 pm We do validations on all Synchrony pts and some XSight patients We re divided ~50% cranial/spine and 50% extra-cranial We use Synchrony on lung, pancreas, liver and upper abdominal lesions Staffing CyberKnife housed in the Methodist Hosp. Cancer Center 2 FTE Therapists, 1 FTE Nurse/coordinator 1 FTE Physicist, 1 FTE Dosimetrist,, 1 B/U Physicist In 2006, we treated ~200 pts, ~500 treatments (3 rd busiest in US) Quality Assurance After commissioning, QA is performed on a daily, monthly and annual basis A modified TG51 calibration protocol is used We have 12 collimators from 5mm to 60 mm in diam with which we plan & treat Everything is normalized to 1.0 for the 60 mm collimator at d max (6MV=1.5 cm) Quality Assurance Calculation algorithm uses Output Factors for each collimator, TMR tables for each collimator as fcn of depth, OCR tables for each collimator as fcn of depth Head algorithm uses 800 mm SAD; Body algorithm uses mm SAD 100 nodal stopping points for both head and body w/ 12 angles possible at each Collimator Output Factors 4
5 15 depth (mm) OUTPUT FACTOR TABLE Colim. (mm) Birdcage Daily Cal Jig Require daily calibrations due to non- sealed monitor chambers Accuray going to sealed chamber in near future Methodist Cancer Center at San Antonio, Tx End to End Static QA Test CIRS head phantom with ball cube target is used to test overall positional accuracy of system Load ball cube with Gaf Chromic film in orthogonal arrangement in phantom Irradiate according to plan Scan films into software program Require < 1mm positional accuracy 5
6 Gaf Chromic E2E Results Synchrony QA Using modified CIRS Dynamic Phantom 6
7 Processed Gaf Chromic Films Table 1. Plan Summaries and Results Collim # nonzero # fiducials Avg. Tx. Total position IDL Dose IDL Dose Dose IDL # fx size beams tracked Time (min) Error (mm) Ant/Sup Ant/Lt , , /13/ , /16/ /22/ /29/ /5/ /10/
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