Receive a Virtual Medical Consultation from our Board of Medical Advisors by uploading your patient’s MRI and or CT Images through our advanced Internet Imaging Software System.
Beyond a Medical Consultation, the Medical Staff at the CyberKnife Center is committed to serving the needs of Physicians looking to Refer a Patient for a CyberKnife procedure. We will provide your patients with the most effective treatment options available, and we will work closely with the Referring Physicians to keep them up-to-date on their patients, coordinating the entire patient experience with the Referring Doctors.
If you would like to Refer a Patient or if you have any questions, please call us at 1-800-208-5050, or email us at firstname.lastname@example.org.
The Artemis CyberKnife Center is an Open Center, offering the opportunity to become Credentialed to all qualified Physicians, including the facilitating of a Doctor's Training and Certification in Cyberknife techniques. If you are interested in becoming a treating CyberKnife Physician, please contact us and we will outline the training, certification, and application requirements to become Credentialed as a member of the Medical Staff at the Artemis CyberKnife Center.
For complete information on Certification and Credentialing contact us at 1-800-208-5050, or email us at email@example.com.
International Doctors are very important to the Artemis CyberKnife Center. The CyberKnife Center provides additional support and services to International Doctors.
To find out more about these additional services that might be provided to international patients and International Doctors, please call us at 1-800-208-5050, or send us an email: firstname.lastname@example.org
Iris™ Variable Aperture Collimator
Rapidly manipulates beam geometry to deliver up to 12 beam sizes from each linac position with characteristics virtually identical to that of fixed circular collimators.
Xsight® Spine Tracking System
Eliminates the need for surgical implantation of fiducials by using the bony anatomy of the spine to automatically locate and track tumors, making radiosurgery more precise and less invasive.
Synchrony® Respiratory Tracking System
Continuously synchronizes beam delivery to the motion of the tumor, allowing clinicians to significantly reduce margins while eliminating the need for gating or breath-holding techniques.
Xsight® Lung Tracking System
Directly tracks the movement of lung tumors without fiducials while maintaining precision, reliability and self-adjusting repeatability.
Monte Carlo Dose Calculation
Often considered the gold standard when treating lung tumors, the CyberKnife System’s Monte Carlo Dose Calculation produces results in minutes compared to what commonly requires hours or days with other systems.
|Intercranial Guidelines||Extracranial Guidelines|
Radiosurgery is Indicated
|Note: Other conditions may be treatable, please consult the CyberKnife Center for a recommendation.|
Step 1: Initial Consultation
During the initial consultation, the patient will meet with several members of our highly trained staff, including the radiation oncologist, the CyberKnife coordinator, the radiation therapist, and/or a surgical specialist if needed. At this time, the procedure, treatment objectives and risks and benefits will be explained in depth; questions are welcomed and encouraged.
Step 2: Patient Treatment Preparation
Soft Tissue Fiducial Placement (not required for all cases): The CyberKnife is a completely frameless treatment system, which often utilizes bony structures in the body as landmarks to track tumor location. For some tumors or lesions, however, tiny gold seeds, called fiducials, may be implanted to accurately guide the radiation beams. These are typically used to mark tumors in the chest, the abdomen, pelvis or other soft tissue areas. If fiducial placement is needed, the CyberKnife Center will typically coordinate this procedure with an interventional radiologist or a surgeon (see Fiducial insert for more information).
Making a Mask or Body Immobilizer: In addition, either a plastic “mesh” mask (used with brain, head or neck tumors) or a comfortable foam body mold will be made to help minimize movement during treatment. This simple and painless process is done in the CyberKnife Center. The patient will then undergo imaging (CT, MRI, PET, etc.) with the mask or the body mold.
Imaging: CT Scan, MRI, PET scan, CT cisternogram / myelogram One or more of the imaging tests outlined below may be prescribed in order to provide the most detailed map possible of your treatment area. When you are consulting with your radiation oncologist, you will be informed of which imaging out of those listed below is needed to plan for your treatment.
Computed Tomography (CT) uses x-rays to capture extremely detailed cross-sectional images of your body, called slices. The image slices allow physicians to view internal organs, tissue, bones, and blood vessels at various angles.
What to expect:
Magnetic Resonance Imaging (MRI) uses a huge magnet and radio waves to create a high resolution image of body tissues. The open design facilitates ease and comfort for each patient.
What to expect:
Positive Emission Tomography (PET)/CT detects changes in cells in internal organs and living tissue, diagnosing the presence of disease at the molecular level. The CT pinpoints exact location with fine structural detail of the anatomy. For the PET you will be injected with a drug that contains a dose of radiation to localize the disease.
What to expect:
Myelography is a type of radiographic exam of the spinal cord by the use of contrast medium injected into the space around the spinal cord and the nerves, visualization using fluoroscopy and a series of x-rays. A cisternogram is a similar exam of the cerebral (brain) spinal fluid. Both tests will show soft tissues that regular x-ray and other imaging may not show in order to develop your individualized CyberKnife treatment plan.
What to expect:
Step 3: Treatment Planning
The CyberKnife physician(s) and the medical physicist will use the high resolution imaging conducted above to identify the exact size, shape and location of the tumor, along with the surrounding health tissues to be avoided. The imaging data is downloaded to the CyberKnife treatment planning computer where physicians use advanced software to customize the number, intensity, and direction of radiation beams the robot will send to the target. This may take a few days depending upon the complexity. The patient is not present during this step. When the planning is complete, a date and time for treatment(s) will be scheduled.
Step 4: CyberKnife Treatment
When you are preparing for your first treatment, you may want to enlist the help of a close friend, family member or driver in case you should require sedation for treatment. Wear comfortable clothes and avoid wearing jewelry. A blanket will be provided for warmth if needed. Take all medication as usual unless specifically told otherwise – avoid diuretics.
CyberKnife treatment will be given once or up to 5 times depending on your unique situation. When the treatment begins, the patient lies flat on the treatment couch while the imaging system acquires the first set of x-rays. The treatment table then moves to the correct position for accurate alignment with the robotic arm. The robotic arm then moves around the patient to deliver the radiation beams—often greater than 100 times. This process takes anywhere from 20 to 130 minutes; so patients need to prepare to lie still for this time frame. Plan on spending two hours at the center on the first day of treatment to allow for variability, though if more than one treatment is given, this time will be more firm after the first treatment.
There are cameras in the treatment room so the CyberKnife team can monitor the entire process. A microphone allows the patient, who is alone in the treatment room, to communicate directly with the radiation therapist at all times. The entire process is painless, but if the patient becomes uncomfortable during treatment, the patient should tell the radiation therapist.
If the treatment plan calls for more than one treatment session, the radiation therapists will schedule all appointment times with you.
The proximity of these tumors to vital nerve and vascular structures makes them surgically problematic. Risk of injury, infection and residual tumor growth make CyberKnife a leading treatment.
Fiducial markers are gold seeds or stainless steel screws that are implanted in and/or around a soft tissue tumor, or within the bony spine, to act as a radiologic landmark, to define the target lesion's position with millimeter precision. They are typically placed using a CT or other image-guided percutaneous method. There may be other appropriate fiducial placement methods as well, including endoscopic or surgical approaches, if determined best by the participating physicians. To track lesions in 6 degrees (translational and rotational movements), fiducials may be recommended, depending upon the exact circumstance and lesion. Fiducials must be fixed relative to other fiducials and relative to the tumor to ensure targeting accuracy.
Stainless Steel Screw (2.0 x 5.0mm) embedded within bone. Self-drilling and self-tapping screws provide optimal contrast against the bone and minimize migration. These are typically used for spine applications.
Gold Seeds ( 0.8 mm x 5 mm) are typically used for soft tissue lesions
Specific Clinical Situations Potentially Requiring Fiducial Placement
Key Fiducial Placement Principles
Any fiducial migration will degrade the accuracy of fiducial-based targeting. If CyberKnife targeting fiducials migrate more than 1.5 mm from time of CyberKnife CT planning to actual CyberKnife treatment, it may render the patient untreatable without repeating the entire CyberKnife treatment planning process.
As there may be some migration or “settling” of fiducials for up to 7 days following their placement into soft tissue, it is recommended that the CyberKnife planning CT study be obtained approximately 7 days after fiducial placement for soft tissue lesions, to allow them to settle into stable position. For spine lesions, where fiducials are anchored into bone, the planning CT may be accomplished as soon as the following day. Once the CyberKnife planning CT has been accomplished, the time to the actual CyberKnife treatment itself should be minimized, to reduce the probability of fiducial mis-registration between the planning and treatment stage due to additional potential fiducial migration.