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Original article
peer-reviewed

Treatment Planning for Self-Shielded Radiosurgery



Abstract

A five degree of freedom, robotic, radiosurgical system dedicated to the brain is currently under development. In the proposed design, the machine is entirely self-shielded. The main advantage of a self-shielded system is the simplification of the system's installation, which can reduce the cost of radiosurgery. In this way, more patients can benefit from this minimally invasive and highly effective type of procedure. For technical reasons, space inside the shielded region is limited, which leads to constraints on the design. Here, two axes of rotation move a 3-megavolt linear accelerator around the patient’s head at a source axis distance of 400 millimeters (mm), while the integrated patient table is characterized by two additional rotational, and one translational, degrees of freedom. Eight cone collimators of different diameters are available. The system can change the collimator automatically during treatment, using a collimator wheel. Since the linear accelerator can only move with two rotational axes, it is not possible to reposition the beam translationally (as it is in six degrees of freedom robotic radiosurgery). To achieve translational repositioning, it is necessary to move the patient couch. Thus, translational repositioning must be kept to a minimum during treatment. Our goal in this contribution is a preliminary investigation of dose distributions attainable with this type of design. Thus, we do not intend to design and evaluate the treatment planning system itself, but rather to establish that appropriate dose distributions can be achieved with this design under realistic clinical circumstances. Our simulation suggests that dose gradients and conformity for complex target shapes, corresponding to state-of-the-art systems, can be achieved with this construction, although a detailed evaluation of the system itself would be needed in the future.



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Original article
peer-reviewed

Treatment Planning for Self-Shielded Radiosurgery


Author Information

John R. Adler

Department of Neurosurgery, Stanford University School of Medicine

Department of Radiation Oncology, Stanford University Medical Center

Achim Schweikard Corresponding Author

Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck

Younes Achkire

Zap Surgical Inc.

Oliver Blanck

Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany

Mohan Bodduluri

Zap Surgical Inc.

Lijun Ma

Department of Radiation Oncology, University of California, San Francisco

Hui Zhang

Zap Surgical Inc.


Ethics Statement and Conflict of Interest Disclosures

Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: AS declares a 2015 consultancy with ZAP Surgical Systems Inc., San Carlos, CA, USA.
JRA, YA, MB, and HZ are all employees of ZAP Surgical Systems Inc., San Carlos, CA. USA.

. Financial relationships: John Adler, Mohan Bodduluri, Younes Achkire, Hui Zhang declare(s) employment from ZAP Surgcial Systems Inc, San Carlos, CA, USA. Intellectual property info: JRA and YA hold US and Chinese patents on the design of the radiosurgery system in the article. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Treatment Planning for Self-Shielded Radiosurgery


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Original article
peer-reviewed

Treatment Planning for Self-Shielded Radiosurgery

John R. Adler">John R. Adler, Achim Schweikard">Achim Schweikard , Younes Achkire">Younes Achkire, Oliver Blanck">Oliver Blanck, Mohan Bodduluri">Mohan Bodduluri, Lijun Ma">Lijun Ma, Hui Zhang">Hui Zhang

  • Author Information
    John R. Adler

    Department of Neurosurgery, Stanford University School of Medicine

    Department of Radiation Oncology, Stanford University Medical Center

    Achim Schweikard Corresponding Author

    Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck

    Younes Achkire

    Zap Surgical Inc.

    Oliver Blanck

    Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany

    Mohan Bodduluri

    Zap Surgical Inc.

    Lijun Ma

    Department of Radiation Oncology, University of California, San Francisco

    Hui Zhang

    Zap Surgical Inc.


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: AS declares a 2015 consultancy with ZAP Surgical Systems Inc., San Carlos, CA, USA.
    JRA, YA, MB, and HZ are all employees of ZAP Surgical Systems Inc., San Carlos, CA. USA.

    . Financial relationships: John Adler, Mohan Bodduluri, Younes Achkire, Hui Zhang declare(s) employment from ZAP Surgcial Systems Inc, San Carlos, CA, USA. Intellectual property info: JRA and YA hold US and Chinese patents on the design of the radiosurgery system in the article. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 08, 2017

    DOI

    10.7759/cureus.1663

    Cite this article as:

    Adler J R., Schweikard A, Achkire Y, et al. (September 08, 2017) Treatment Planning for Self-Shielded Radiosurgery. Cureus 9(9): e1663. doi:10.7759/cureus.1663

    Publication history

    Received by Cureus: April 20, 2017
    Peer review began: May 02, 2017
    Peer review concluded: September 04, 2017
    Published: September 08, 2017

    Copyright

    © Copyright 2017
    Adler et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

A five degree of freedom, robotic, radiosurgical system dedicated to the brain is currently under development. In the proposed design, the machine is entirely self-shielded. The main advantage of a self-shielded system is the simplification of the system's installation, which can reduce the cost of radiosurgery. In this way, more patients can benefit from this minimally invasive and highly effective type of procedure. For technical reasons, space inside the shielded region is limited, which leads to constraints on the design. Here, two axes of rotation move a 3-megavolt linear accelerator around the patient’s head at a source axis distance of 400 millimeters (mm), while the integrated patient table is characterized by two additional rotational, and one translational, degrees of freedom. Eight cone collimators of different diameters are available. The system can change the collimator automatically during treatment, using a collimator wheel. Since the linear accelerator can only move with two rotational axes, it is not possible to reposition the beam translationally (as it is in six degrees of freedom robotic radiosurgery). To achieve translational repositioning, it is necessary to move the patient couch. Thus, translational repositioning must be kept to a minimum during treatment. Our goal in this contribution is a preliminary investigation of dose distributions attainable with this type of design. Thus, we do not intend to design and evaluate the treatment planning system itself, but rather to establish that appropriate dose distributions can be achieved with this design under realistic clinical circumstances. Our simulation suggests that dose gradients and conformity for complex target shapes, corresponding to state-of-the-art systems, can be achieved with this construction, although a detailed evaluation of the system itself would be needed in the future.



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John R. Adler, M.D.

Department of Neurosurgery, Stanford University School of Medicine

Achim Schweikard, Ph.D.

Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck

For correspondence:
schweikard@rob.uni-luebeck.de

Younes Achkire

Zap Surgical Inc.

Oliver Blanck, Ph.D.

Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany

Mohan Bodduluri

Zap Surgical Inc.

Lijun Ma, Ph.D.

Department of Radiation Oncology, University of California, San Francisco

Hui Zhang

Zap Surgical Inc.

John R. Adler, M.D.

Department of Neurosurgery, Stanford University School of Medicine

Achim Schweikard, Ph.D.

Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck

For correspondence:
schweikard@rob.uni-luebeck.de

Younes Achkire

Zap Surgical Inc.

Oliver Blanck, Ph.D.

Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany

Mohan Bodduluri

Zap Surgical Inc.

Lijun Ma, Ph.D.

Department of Radiation Oncology, University of California, San Francisco

Hui Zhang

Zap Surgical Inc.