Stereotactic Radiosurgery Jimmy Johannes Physics 335 – Spring 2004 Final Presentation
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Transcript of Stereotactic Radiosurgery Jimmy Johannes Physics 335 – Spring 2004 Final Presentation
Stereotactic Stereotactic RadiosurgeryRadiosurgery
Jimmy JohannesJimmy Johannes
Physics 335 – Spring 2004Physics 335 – Spring 2004
Final PresentationFinal Presentationhttp://www.sdgkc.com/
http://www.sdgkc.com/
OutlineOutline Case StudyCase Study What is Stereotactic Radiosurgery?What is Stereotactic Radiosurgery?
Stereotactic LocalizationStereotactic Localization RadiosurgeryRadiosurgery ApplicationsApplications
Different technologiesDifferent technologies Gamma KnifeGamma Knife LINAC-based systemsLINAC-based systems CyberKnifeCyberKnife
Case StudyCase Study Imagine…Imagine…
You’re an undergrad at NU…You’re an undergrad at NU… As you approach Finals Week you acquire As you approach Finals Week you acquire
the following symptoms:the following symptoms: HeadachesHeadaches NauseaNausea
Searle? Searle? Mono Mono Evanston Northwestern Healthcare Evanston Northwestern Healthcare MRI MRI
MRI Result:MRI Result:
http://splweb.bwh.harvard.edu:8000/pages/papers/kaus/radiology2001/5a.gif
Diagnosis and TreatmentDiagnosis and Treatment
Diagnosis: Benign Brain TumorDiagnosis: Benign Brain Tumor Treatment:?Treatment:?
Chemo/Immuno therapyChemo/Immuno therapy Invasive brain surgeryInvasive brain surgery Non-invasive radiotherapyNon-invasive radiotherapy Non-invasive stereotactic radiosurgeryNon-invasive stereotactic radiosurgery
Diagnosis and TreatmentDiagnosis and Treatment
Diagnosis: Benign Brain TumorDiagnosis: Benign Brain Tumor Treatment:?Treatment:?
Chemo/Immuno therapy Chemo/Immuno therapy Blood Brain Blood Brain BarrierBarrier
Invasive brain surgery Invasive brain surgery Non-invasive radiotherapyNon-invasive radiotherapy Non-invasive stereotactic radiosurgeryNon-invasive stereotactic radiosurgery
Diagnosis and TreatmentDiagnosis and Treatment
Diagnosis: Benign Brain TumorDiagnosis: Benign Brain Tumor Treatment:?Treatment:?
Chemo/Immuno therapy Chemo/Immuno therapy Blood Brain Blood Brain BarrierBarrier
Invasive brain surgery Invasive brain surgery High Risk High Risk Non-invasive radiotherapyNon-invasive radiotherapy Non-invasive stereotactic radiosurgeryNon-invasive stereotactic radiosurgery
Diagnosis and TreatmentDiagnosis and Treatment
Diagnosis: Benign Brain TumorDiagnosis: Benign Brain Tumor Treatment:?Treatment:?
Chemo/Immuno therapy Chemo/Immuno therapy Blood Brain Blood Brain BarrierBarrier
Invasive brain surgery Invasive brain surgery High Risk High Risk Non-invasive radiotherapy Non-invasive radiotherapy Too Non- Too Non-
SpecificSpecific Non-invasive stereotactic radiosurgeryNon-invasive stereotactic radiosurgery
Diagnosis and TreatmentDiagnosis and Treatment
Diagnosis: Benign Brain TumorDiagnosis: Benign Brain Tumor Treatment:?Treatment:?
Chemo/Immuno therapy Chemo/Immuno therapy Blood Brain Blood Brain BarrierBarrier
Invasive brain surgery Invasive brain surgery High Risk High Risk Non-invasive radiotherapy Non-invasive radiotherapy Too Non- Too Non-
SpecificSpecific Non-invasive stereotactic radiosurgeryNon-invasive stereotactic radiosurgery
What is Stereotactic What is Stereotactic Radiosurgery?Radiosurgery?
Method to non-invasively & Method to non-invasively & specifically treat benign/malignant specifically treat benign/malignant tumors and tissue abnormalitiestumors and tissue abnormalities Uses methods of stereotactic 3-D Uses methods of stereotactic 3-D
localization of surgical sitelocalization of surgical site Uses radiosurgical techniques to Uses radiosurgical techniques to
perform the “surgery”perform the “surgery”
3-D Stereotactic 3-D Stereotactic LocalizationLocalization
Goal: To target the tissue of interest with as much accuracy Goal: To target the tissue of interest with as much accuracy as possibleas possible
Use imaging and 3-D mapping techniques to target tissue Use imaging and 3-D mapping techniques to target tissue of interestof interest 4 general medical imaging modalities used:4 general medical imaging modalities used:
X-RayX-Ray PET PET MRIMRI Digital Subtracted AngiographyDigital Subtracted Angiography
Use the patient as a reference for the localizationUse the patient as a reference for the localization 2 general methods:2 general methods:
Frame stereotactic localization (old school)Frame stereotactic localization (old school) Frameless stereotactic localization (new school)Frameless stereotactic localization (new school)
The Imaging ModalitiesThe Imaging Modalities
Tomographic Techniques:Tomographic Techniques: PET (CT) and MRIPET (CT) and MRI Good for tumor pathologiesGood for tumor pathologies Use multiple layers to get 3-D imageUse multiple layers to get 3-D image
X-ray-based Techniques:X-ray-based Techniques: X-ray and Digital Subtracted AngiographyX-ray and Digital Subtracted Angiography Good for vascular imaging (for treatment of Good for vascular imaging (for treatment of
vascular malformations)vascular malformations) Use pins and depth perception methods to get Use pins and depth perception methods to get
3-D localization3-D localization
Frame TechniquesFrame TechniquesWith tomographic imaging modalities (CT and MRI), use the N-frame as a basis for 3-D visualization:
CT
N-Frame
MRI
Gibson D, et al. Stereotactic Localization in Medical Imaging: A Technical and Methodological Review. Journal of Radiosurgery, Vol 2, No. 3, 1999
Frame Frame TechniquesTechniques
With X-ray imaging modalities:
Schematic
Angiography (X-ray)
Schematic of basis for 3-D imaging
Frameless StereotaxyFrameless Stereotaxy
Implanted Gold Markers
Amorphous silicon detectors (CyberKnife)
Display of treatment planning:
http://virtualtrials.com/jhrs.cfm
RadiosurgeryRadiosurgery
Focused radiation beams delivered to a Focused radiation beams delivered to a specific tissue volume specific tissue volume
Multiple beams or multiple passes Multiple beams or multiple passes (fractionated treatment) that intersect(fractionated treatment) that intersect Keeps radiation exposure to surrounding tissue Keeps radiation exposure to surrounding tissue
at benign levelsat benign levels Treats targeted tissue (the point of intersection) Treats targeted tissue (the point of intersection)
with a higher dose of radiation with a higher dose of radiation
http://neurosurgery.medsch.ucla.edu/programs/radiosurgery/radiosurgery_intro.html
How does it work?How does it work? How is it therapeutic?How is it therapeutic?
Radiation Radiation does notdoes not remove the tumor or tissue remove the tumor or tissue abnormalityabnormality
For tumors, radiation distorts DNA (ionizing For tumors, radiation distorts DNA (ionizing radiation induces mutations and other forms of radiation induces mutations and other forms of DNA damage)DNA damage)
High incidence of DNA damage and ionization induces High incidence of DNA damage and ionization induces cell-cycle arrest (cells stop growing and replicating) and cell-cycle arrest (cells stop growing and replicating) and causes the cell to lose its ability to retain watercauses the cell to lose its ability to retain water
Tumor reduction happens at the rate of the normal Tumor reduction happens at the rate of the normal growth rate of that tumorgrowth rate of that tumor
For arteriovenous malformations (tangle of blood For arteriovenous malformations (tangle of blood vessels), radiation induces the thickening and vessels), radiation induces the thickening and closing off of the blood vesselclosing off of the blood vessel
How does it work?How does it work?
Benign tumors take up to 2 years to Benign tumors take up to 2 years to disappeardisappear
Metastatic (Cancerous) tumors (with Metastatic (Cancerous) tumors (with a much faster growth rate) take only a much faster growth rate) take only months to disappearmonths to disappear
Side EffectsSide Effects Swelling:Swelling: cells lose ability to retain cells lose ability to retain
fluid, edema may occurfluid, edema may occur Necrosis:Necrosis: dead tumor cells may cause dead tumor cells may cause
complications (inflammation, fibrosis)complications (inflammation, fibrosis) Psychological side effects:Psychological side effects: loss of loss of
memory, decreased cognitive abilities, memory, decreased cognitive abilities, etc. (you are taking out a chunk of etc. (you are taking out a chunk of brain!)brain!)
Radiation-induced tumor/cancer:Radiation-induced tumor/cancer: radiation-induced mutations may result radiation-induced mutations may result in a new tumor or cancerin a new tumor or cancer
ApplicationsApplications Mostly used for brain surgery Mostly used for brain surgery
It’s where other more invasive procedures are It’s where other more invasive procedures are deemed too riskydeemed too risky
Machines are designed mostly for brain surgeriesMachines are designed mostly for brain surgeries Frame stereotaxy only allows for brain surgeryFrame stereotaxy only allows for brain surgery But new machines and stereotaxy techniques But new machines and stereotaxy techniques
are allowing for application in other parts of the are allowing for application in other parts of the bodybody
Mostly used for tumors and vascular Mostly used for tumors and vascular malformationsmalformations But new therapeutic applications have been But new therapeutic applications have been
developed for other tissue diseases and developed for other tissue diseases and functional disordersfunctional disorders
Types of RadiationTypes of Radiation Differs with different machines:Differs with different machines:
High-energy X-ray High-energy X-ray From linear accelerator systemsFrom linear accelerator systems
Gamma radationGamma radation From Cobalt-60 sourceFrom Cobalt-60 source
ProtonProton From particle beam or cyclotronFrom particle beam or cyclotron Limited use in the USLimited use in the US Uses Bragg Peak principle:Uses Bragg Peak principle:
As proton slows down, it gives off disproportionately As proton slows down, it gives off disproportionately more energymore energy
Right before it stops, it gives off most of its energy, Right before it stops, it gives off most of its energy, resulting in a peak at that depth of tissueresulting in a peak at that depth of tissue
Different Machines in UseDifferent Machines in Use
Gamma KnifeGamma Knife Gamma radiation from Cobalt-60 SourceGamma radiation from Cobalt-60 Source Use multiple beams to treat tissue volumeUse multiple beams to treat tissue volume
LINAC-based systems (X-Knife)LINAC-based systems (X-Knife) High-energy X-ray from Linear Accelerator deviceHigh-energy X-ray from Linear Accelerator device Use fractionationUse fractionation
CyberKnifeCyberKnife Also a LINAC system, but LINAC is on a robotic armAlso a LINAC system, but LINAC is on a robotic arm Use fractionationUse fractionation Can be used for parts of body other than the headCan be used for parts of body other than the head
Gamma KnifeGamma Knife
-Over 30 years of clinical use and a great deal of publications
-Targeting Precision of within 2mm
-Multiple targets can be easily treated in one session
http://www.elekta.com/ContentUS.nsf
LINAC-Based SystemsLINAC-Based Systems
-Less accurate
-In use in more hospitals
-Less efficient (longer treatment times)
http://www.radionics.com/resources/patient/xknife_description.shtml
CyberKnifeCyberKnife
-Can treat most regions of body
-w/ Stereotactic frame, can approach accuracy of LINAC or GammaKnife
-Real-time frameless stereotaxy can be used
Questions?Questions?