• Journal of Radiation Protection and Research
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• v.34 no.3
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• pp.137-143
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• 2009

This study was conducted to evaluate the accuracy of CyberKnife $Synchrony^{TM}$ respiratory tracking system which was applied to Stereotactic Radiosurgery (SRS) for moving tumors in chest and abdomen with breathing motion. For accurate evaluation, gold fiducial marks were implanted into a moving phantom. The moving phantom was a cube imbedding an acryl ball as a target. The acryl ball was prescribed to 20 Gy at 70% of isodose curve in a virtual treatment and radiochromic films were inserted into the acryl ball for dose verification and tracking accuracy evaluation. The evaluation of position tracking consists of two parts: fiducial mark tracking in a stationary phantom and $Synchrony^{TM}$ respiratory tracking in a moving phantom. Each measurement was done in three directions and was repeated to 5 times. Range of position error was 0.1957 mm to 0.6520 mm in the stationary phantom and 0.4405 mm to 0.7665 mm in the moving phantom. Average position error was 0.3926 mm and 0.5673 mm in the stationary phantom and the moving phantom respectively. This study evaluates the accuracy of CyberKnife $Synchrony^{TM}$ Respiratory tracking system, and confirms the usefulness when it's used for Stereotactic Radiosurgery of body organs.

• Journal of radiological science and technology
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• v.33 no.4
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• pp.379-386
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• 2010

This study evaluated the motion of tumors during the entire period of therapy and the accuracy of radiosurgery among forty eight lung tumor patients who were underwent radiosurgery using the CyberKnife Synchrony Respiratory Tracking System. The motion of lung tumor was measured by the coordinates of a gold acupuncture needle inserted into the tumor or the area around the tumor using the CyberKnife image guided system. Then the accuracy of radiosurgery was evaluated based on the error of correlation computed with the motion tracking system. The lung tumor motion is Cranio-Caudal direction by an average of $2.63{\pm}1.87\;mm$, moved left-right direction by $1.13{\pm}0.71\;mm$, and anterior-posterior direction by $1.74{\pm}1.16\;mm$. The degree of rotational movement was $1.66{\pm}1.66^{\circ}$ on X axis, $1.20{\pm}0.97^{\circ}$ on Y axis, and $1.18{\pm}0.73^{\circ}$ on Z axis. The vector of translation movement was measured to be $3.78{\pm}2.00\;mm$ on the average. The results show that directions of Cranio-Caudal(p < 0.001), anterior-posterior direction(p < 0.029), and three dimensional vector value(p < 0.002) showed statistical significance, because the lower side of tumor showed more intensive movement compared to the upper side of tumor. The radiosurgery was carried out by compensating the motion of tumor after accurate investigation of the correlation error with the average of $0.95{\pm}0.62\;mm$ during the lung tumor radiosurgery with the CyberKnife Synchrony Respiratory Tracking System.

• Progress in Medical Physics
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• v.20 no.4
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• pp.324-330
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• 2009

In this study, we evaluated accuracy and usefulness of CyberKnife Respiratory Tracking System ($Synchrony^{TM}$, Accuray, USA) about a moving during stereotactic radiosurgery. For this study, we used moving phantom that can move the target. We also used Respiratory Tracking System called Synchrony of the Cyberknife in order to track the moving target. For treatment planning of the moving target, we obtained an image using 4D-CT. To measure dose distribution and point dose at the moving target, ion chamber (0.62 cc) and gafchromic EBT film were used. We compared dose distribution (80% isodose line of prescription dose) of static target to that of moving target in order to evaluate the accuracy of Respiratory Tracking System. We also measured the point dose at the target. The mean difference of synchronization for TLS (target localization system) and Synchrony were $11.5{\pm}3.09\;mm$ for desynchronization and $0.14{\pm}0.08\;mm$ for synchronization. The mean difference between static target plan and moving target plan using 4D CT images was $0.18{\pm}0.06\;mm$. And, the accuracy of Respiratory Tracking System was less 1 mm. Estimation of usefulness in Respiratory Tracking System was $17.39{\pm}0.14\;mm$ for inactivity and $1.37{\pm}0.11\;mm$ for activity. The mean difference of absolute dose was $0.68{\pm}0.38%$ in static target and $1.31{\pm}0.81%$ in moving target. As a conclusion, when we treat about the moving target, we consider that it is important to use 4D-CT and the Respiratory Tracking System. In this study, we confirmed the accuracy and usefulness of Respiratory Tracking System in the Cyberknife.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.263-270
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• 2008

Purpose: This study aimed to quantitatively measure the movement of tumors in real-time and evaluate the treatment accuracy, during the treatment of a liver tumor patient, who underwent radiosurgery with a Synchrony Respiratory motion tracking system of a robot CyberKnife. Materials and Methods: The study subjects included 24 liver tumor patients who underwent CyberKnife treatment, which included 64 times of treatment with the Synchrony Respiratory motion tracking system ($Synchrony^{TM}$). The treatment involved inserting 4 to 6 acupuncture needles into the vicinity of the liver tumor in all the patients using ultrasonography as a guide. A treatment plan was set up using the CT images for treatment planning uses. The position of the acupuncture needle was identified for every treatment time by Digitally Reconstructed Radiography (DRR) prepared at the time of treatment planning and X-ray images photographed in real-time. Subsequent results were stored through a Motion Tracking System (MTS) using the Mtsmain.log treatment file. In this way, movement of the tumor was measured. Besides, the accuracy of radiosurgery using CyberKnife was evaluated by the correlation errors between the real-time positions of the acupuncture needles and the predicted coordinates. Results: The maximum and the average translational movement of the liver tumor were measured 23.5 mm and $13.9{\pm}5.5\;mm$, respectively from the superior to the inferior direction, 3.9 mm and $1.9{\pm}0.9mm$, respectively from left to right, and 8.3 mm and $4.9{\pm}1.9\;mm$, respectively from the anterior to the posterior direction. The maximum and the average rotational movement of the liver tumor were measured to be $3.3^{\circ}$ and $2.6{\pm}1.3^{\circ}$, respectively for X (Left-Right) axis rotation, $4.8^{\circ}$ and $2.3{\pm}1.0^{\circ}$, respectively for Y (Crania-Caudal) axis rotation, $3.9^{\circ}$ and $2.8{\pm}1.1^{\circ}$, respectively for Z (Anterior-Posterior) axis rotation. In addition, the average correlation error, which represents the treatment's accuracy was $1.1{\pm}0.7\;mm$. Conclusion: In this study real-time movement of a liver tumor during the radiosurgery could be verified quantitatively and the accuracy of the radiosurgery with the Synchrony Respiratory motion tracking system of robot could be evaluated. On this basis, the decision of treatment volume in radiosurgery or conventional radiotherapy and useful information on the movement of liver tumor are supposed to be provided.

• Progress in Medical Physics
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• v.25 no.4
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• pp.264-270
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• 2014

This study developed a portable respiratory training device to improve breathing stability, which is an important element in using the CyberKnife Synchrony respiratory tracking device, one of the typical Stereotactic Radiation Therapy (SRT) devices. It produced an interface for users to be able to select one of two displays, a graph type and a bar type, supported an auditory system that helps them expect next respiration by improving a sense of rhythm of their respiratory period, and provided comfortable respiratory inducement. By targeting 5 applicants and applying individual respiratory period detected through a self-developed program, it acquired signal data of 'guide respiration' that induces breathing through signal data gained from 'free respiration' and an auditory system, and evaluated the usability by comparing deviation average values of respiratory period and respiratory amplitude. It could be identified that respiratory period decreased $55.74{\pm}0.14%$ compared to free respiration, and respiratory amplitude decreased $28.12{\pm}0.10%$ compared to free respiration, which confirmed the consistency and stability of respiratory. SBRT, developed based on these results, using the portable respiratory training device, for liver cancer or lung cancer, is evaluated to be able to help reduce delayed treatment time due to respiratory instability and improve treatment accuracy, and if it could be applied to developing respiratory training applications targeting an android-based portable device in the future, even use convenience and economic efficiency are expected.

• Progress in Medical Physics
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• v.20 no.3
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• pp.174-179
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• 2009

To track moving tumor in real time, CyberKnife system imports a technique of the synchrony respiratory tracking system. The fiducial marker which are detectable in X-ray images were demand in CyberKnife Robotic radiosurgery system. It issued as reference markers to locate and track tumor location during patient alignment and treatment delivery. Fiducial marker implantation is an invasive surgical operation that carries a relatively high risk of pneumothorax. Most recently, it was developed a direct lung tumor registration method that does not require the use of fiducials. The purpose of this study is to measure the accuracy of target applying X-sight lung tracking using the Gafchromic film in dynamic moving thorax phantom. The X-sight Lung Tracking quality assurance motion phantom simulates simple respiratory motion of a lung tumor and provides Gafchromic dosimetry film-based test capability at locations inside the phantom corresponding to a typical lung tumor. The total average error for the X-sight Lung Tracking System with a moving target was $0.85{\pm}0.22$ mm. The results were considered reliable and applicable for lung tumor treatment in CyberKnife radiosurgery system. Clinically, breathing patterns of patients may vary during radiation therapy. Therefore, additional studies with a set real patient data are necessary to evaluate the target accuracy for the X-sight Lung Tracking system.