Assignment

X-Ray Knife

Stereostatics surgury

"Stereotactic" stems from the Greek "stereo" (solid) and "taxis" (arrangement, order). is
it is a minimally invasive form of surgical intervention which makes use of a three-dimensional
coordinate system to locate small targets inside the body and to perform on them some action
such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS) etc.

History

In 1978, Russell A. Brown, an American physician and computer scientist, invented an

ingenious device known as the N-localizer that guides stereotactic surgery using tomographic
images that are obtained via medical imaging technologies such as magnetic resonance imaging
(MRI) or computed tomography (CT). The N-localizer significantly improves surgical precision
because MRI and CT permit accurate visualization of intracranial anatomic detail. The N-
localizer creates extracranial fiducial marks or landmarks in each tomographic image. These
fiducial marks specify the spatial orientation of that image with respect to the stereotactic
instrument. Brown's invention stimulated intense interest in, and further development of,
stereotaxy and radiosurgery. It is widely used today in the Brown-Roberts-Wells (BRW) and
Cosman-Roberts-Wells (CRW) stereotactic systems, as well as other stereotactic and
radiosurgical instruments.

The stereotactic method has continued to evolve, and at present employs an elaborate mixture of
image-guided surgery that uses computed tomography, magnetic resonance imaging and
stereotactic localization.

Procedure:-

Stereotactic surgery works on the basis of three main components:

A stereotactic planning system, including atlas, multimodality image matching tools, coordinates
calculator, etc.
A stereotactic device or apparatus
A stereotactic localization and placement procedure

It is three coordinate system surgury. In most atlases, the three dimensions are: latero-lateral (x),
dorso-ventral (y) and rostro-caudal (z).

The main types of Stereostatic surgury are

X-ray Knife

Gamma Knife

X-Ray Knife
In this technique of Stereo staticsurgury we use x rays and collimate the beem at one point where
the area is effected and the X-rays of the area are ataken from alll
sides and the treatmentis done. As shown in figure aside.

Additional image guidance methods are available for

spinal tumors and for tumors located in the lung. For a tumor
located in the spine, a variant of the image guidance called
Xsight-Spineis used. The major difference here is that instead of
taking images of the skull, images of the spinal processes are
used. Whereas the skull is effectively rigid and non-deforming,
the spinal vertebrae can move relative to each other, this means
that image warping algorithms must be used to correct for the distortion of the X-ray camera
images.

A recent enhancement to Xsight is Xsight-Lung which allows tracking of some lung

tumors without the need to implant fiducial markers.

For soft tissue tumors, a method known as fiducial tracking can be utilized. Small metal
markers (fiducials) made out of gold for bio-compatibility and high density to give good contrast
on X-ray images are surgically implanted in the patient. This is carried out by an interventional
radiologist, or neurosurgeon. The placement of the fiducials is a critical step if the fiducial
tracking is to be used. If the fiducials are too far from the location of the tumor, or are not
sufficiently spread out from each other it will not be possible to accurately deliver the radiation.
Once these markers have been placed, they are located on a CT scan and the image guidance
system is programmed with their position. When X-ray camera images are taken, the location of
the tumor relative to the fiducials is determined, and the radiation can be delivered to any part of
the body. Thus the fiducial tracking does not require any bony anatomy to position the radiation.
Fiducials are known however to migrate and this can limit the accuracy of the treatment if
sufficient time is not allowed between implantation and treatment for the fiducials to stabilize

The final technology of image guidance that the X-Ray Knife system can use is called the
Synchrony system. The Synchrony system is utilized primarily for tumors that are in motion
while being treated, such as lung tumors and pancreatic tumors.

The synchrony system uses a combination of surgically placed internal fiducials, and light
emitting optical fibers (markers) mounted on the patient skin. Since the tumor is moving
continuously, to continuously image its location using X-ray cameras would require prohibitive
amounts of radiation to be delivered to the patients skin. The Synchrony system overcomes this
by periodically taking images of the internal fiducials, and predicting their location at a future
time using the motion of the markers that are located on the patient's skin. The light from the
markers can be tracked continuously using a CCD camera, and are placed so that their motion is
correlated with the motion of the tumor.

A computer algorithm creates a correlation model that represents how the internal fiducial
markers are moving compared to the external markers. The Synchrony system is therefore
continuously predicting the motion of the internal fiducials, and therefore the tumor, based on the
motion of the markers. The correlation model can be updated at any time if the patient breathing
becomes in any way irregular. The advantage of the Synchrony system is that no assumptions
about the regularity or reproducibility of the patient breathing have to be made.

To function properly, the Synchrony system requires that for any given correlation model there is
a functional relationship between the markers and the internal fiducials. The external marker
placement is also important, and the markers are usually placed on the patient abdomen so that
their motion will reflect the internal motion of the diaphragm and the lungs.