Since its introduction nearly 60 years ago, stereotactic radiosurgery has become the standard of care for the noninvasive destruction of intracranial tissues or lesions that may be inaccessible or unsuitable for open surgery. Today, modern stereotactic radiosurgery is practiced using advanced image guided treatment planning and specialized delivery systems including micro‐ MLC equipped linacs, CyberKnife, and Gamma Knife machines. Stereotactic radisourgery delivers a large dose to a precisely defined volume in a short time, and as such requires the utmost attention to precision and quality assurance. Also critical is the meticulous design of treatment processes that eliminate the possibility of potentially disastrous errors. In this presentation we review the fundamental aspects of stereotactic targeting and delivery, the technologies for stereotactic localization and treatment of cranial targets, and the quality assurance aspects associated with establishing and maintaining a clinical radiosurgery program. Examples of radiosurgery cases will be presented from the best practice sites utilizing Gamma Knife, CyberKnife, and linac delivery systems, followed by an expert panel discussion of quality measures for treatment planning and delivery. Learning Objectives: 1. Differentiate how radiation is delivered for Gamma Knife, CyberKnife and Linac‐based (conventional and robotic) stereotactic radiosurgery. 2. Define the treatment planning parameters, imaging requirements and workflow for Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery. 3. Discuss measures for assuring accuracy in stereotactic localization and dose delivery for Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery. 4. Discuss uncertainties and limitations associated with Gamma Knife, CyberKnife and Linac‐based stereotactic radiosurgery.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging