===== Radiosurgery Systems ===== //[[J.Sales-Llopis]]// //Neurosurgery Department, [[General University Hospital Alicante]], [[Spain]]// ---- ---- Radiosurgery is a non-invasive treatment modality using focused radiation to target brain tumors, AVMs, and functional targets with sub-millimetric precision. Below is a classification of the main systems used globally in **neurosurgery**: ==== 1. Gamma Knife (Elekta) ==== * **Modality**: Cobalt-60 based photon beams * **Indications**: Intracranial only * **Notable models**: Perfexion®, Icon™ * **Strengths**: * High precision (sub-mm) * Proven track record (>1 million patients treated) * Widely used for AVMs, vestibular schwannomas, trigeminal neuralgia * **Limitations**: * Requires rigid head frame (except Icon with mask-based option) * Cranial-only use ==== 2. CyberKnife (Accuray) ==== * **Modality**: Linear accelerator with robotic arm * **Indications**: Cranial + body * **Strengths**: * Frameless, non-isocentric delivery * Real-time motion tracking (Synchrony®) * Useful for irregular and multiple brain metastases * **Limitations**: * Longer treatment times * Lower cranial-specific adoption ==== 3. Zap-X (Zap Surgical) ==== * **Modality**: Self-shielded gyroscopic LINAC * **Indications**: Intracranial and head & neck * **Strengths**: * No need for vault/shielded room * Designed specifically for neurosurgeons/radiosurgeons * Modern targeting and imaging suite * **Limitations**: * New market entrant (adoption limited) * Few long-term clinical outcome studies ==== 4. Novalis/ExacTrac (Brainlab) ==== * **Modality**: LINAC with advanced positioning * **Use**: Platform for multiple linear accelerators (e.g. TrueBeam, Versa HD) * **Strengths**: * Sub-mm accuracy via ExacTrac * Versatile (integrates with multiple LINACs) * **Limitations**: * Not a standalone radiosurgery device—relies on partner hardware ==== 5. TrueBeam STx (Varian/Siemens Healthineers) ==== * **Modality**: LINAC with image-guidance * **Indications**: Body + brain * **Strengths**: * Widely used in radiation oncology * RapidArc, HyperArc for intracranial radiosurgery * **Limitations**: * General-purpose; cranial radiosurgery is not primary focus ==== 6. Edge® (Varian) ==== * **Modality**: LINAC-based SRS system * **Indications**: Intracranial and extracranial * **Strengths**: * Combines precise beam shaping with IGRT * Often paired with couch and respiratory motion management * **Limitations**: * Still shares base platform with standard radiotherapy LINACs ==== 7. TomoTherapy / Radixact (Accuray) ==== * **Modality**: Helical IMRT * **Use**: Spine and craniospinal cases; rarely primary choice for brain SRS * **Strengths**: * Excellent for extended fields (e.g. craniospinal irradiation) * **Limitations**: * Not optimized for single-lesion radiosurgery ---- ===== Comparison Table ===== ^ System ^ Intracranial Only ^ Frame-free ^ Robotic ^ Real-time Tracking ^ Manufacturer ^ | Gamma Knife | ✔️ | Icon: ✔️ | ❌ | ❌ | Elekta | | CyberKnife | ❌ | ✔️ | ✔️ | ✔️ | Accuray | | Zap-X | ✔️ | ✔️ | ❌ | ❌ | Zap Surgical | | TrueBeam STx | ❌ | ✔️ | ❌ | Optional | Varian | | Novalis ExacTrac | ❌ | ✔️ | ❌ | ✔️ | Brainlab + LINAC | | Edge | ❌ | ✔️ | ❌ | Optional | Varian | | Radixact | ❌ | ✔️ | ❌ | Optional | Accuray | ---- ====== Future of Radiosurgery Systems in Neurosurgery ====== ===== 🚀 Summary and Outlook ===== Neurosurgical radiosurgery is evolving rapidly. Among current technologies, only a few show clear potential for long-term leadership in **precision**, **cost-efficiency**, and **adaptability**. * 🥇 **Zap-X**: Compact, frameless, self-shielded, and neurosurgery-specific. Poised to disrupt. * 🥈 **Gamma Knife Icon**: Proven gold standard, now frameless. Stable, conservative. * ⚠️ **CyberKnife**: Flexible but unfocused. Needs reinvention to avoid obsolescence. > The future belongs to **dedicated, AI-ready systems** with low setup cost, no vault, and optimized cranial workflows. ---- ===== 📊 Cost and Technical Comparison Table ===== ^ System ^ Cost per Treatment (USD) ^ Treatment Time (min) ^ Setup Cost (Million USD) ^ Brain-Specific ^ Vault Required ^ AI/Automation Ready ^ | Gamma Knife Icon | $8,000 | 60 | 5.0 | ✅ Yes | ✅ Yes | ❌ No | | Zap-X | $5,000 | 45 | 2.5 | ✅ Yes | ❌ No | ✅ Limited | | CyberKnife | $7,000 | 90 | 3.5 | ❌ No | ❌ No | ✅ Limited | | TrueBeam STx | $4,000 | 30 | 3.0 | ❌ No | ✅ Yes | ✅ Optional | | Edge (Varian) | $4,500 | 40 | 3.2 | ❌ No | ✅ Yes | ✅ Optional | | Radixact | $6,000 | 70 | 4.0 | ❌ No | ✅ Yes | ❌ No | ---- ===== 🔎 Key Definitions and Interpretation ===== * **Cost per Treatment**: Average operational + amortized capital cost per session. * **Treatment Time**: Time per radiosurgical session for a single cranial lesion. * **Setup Cost**: Estimated infrastructure and hardware investment. * **Brain-Specific**: Designed specifically for cranial neurosurgical use. * **Vault Requirement**: Needs radiation-shielded vault (adds to infrastructure cost). * **AI/Automation Ready**: Includes or supports motion tracking, adaptive therapy, AI planning. ---- ===== 💡 Final Insight ===== Systems like **Zap-X** and **Gamma Knife Icon** combine specialization with practical usability. General-purpose LINACs (TrueBeam, Edge) will persist in radiotherapy, but **lack competitive edge in neurosurgery**. **CyberKnife must redefine itself**, or risk irrelevance. ====== ✅ Recommended System: Zap-X for Neurosurgical Radiosurgery ====== Zap-X is the only system designed **exclusively for cranial radiosurgery**, offering a future-ready, cost-efficient, and patient-friendly platform. It combines **clinical focus** with **infrastructure flexibility**, making it ideal for both private and public neurosurgical centers. ===== 🔍 Why Choose Zap-X? ===== ^ Feature ^ Zap-X ^ Why It Matters ^ | **Brain-Specific** | ✅ Yes | 100% focused on cranial applications — not a multipurpose LINAC | | **Frameless Workflow** | ✅ Yes | Non-invasive, patient-friendly treatment | | **Vault-Free Installation** | ✅ Yes | Self-shielded → no need for radiation vault, reducing infrastructure cost | | **Setup Cost** | 💰 Low (~$2.5M) | Much cheaper than Gamma Knife (~$5M) or CyberKnife (~$3.5M) | | **Outpatient-Friendly** | ✅ Yes | Can be deployed in ambulatory surgical centers or small hospitals | | **AI & Future-Ready** | 🚀 High | MRI compatibility and automation support in development | | **Design & Innovation** | 🆕 Modern | Designed post-2018, based on CyberKnife/Gamma Knife lessons | | **Creator Credentials** | 🧠 John Adler (CyberKnife inventor) | Deep insight into radiosurgical evolution | ===== 💬 Final Justification ===== Zap-X is the **first and only self-contained, self-shielded, frameless radiosurgery system** built entirely for **neurosurgeons**. It breaks the dependency on radiation oncology departments and opens the door to **autonomous neurosurgical radiosurgery units**. ===== 💡 Strategic Advantage ===== Zap-X enables: * Cost-efficient radiosurgery in **non-hospital settings** * **Rapid ROI** for private clinics and university spin-offs * Expansion into underserved regions where vault construction is not feasible * True **ownership and control by neurosurgeons** ===== 📌 Summary Verdict ===== **Recommendation**: Choose **Zap-X** as your radiosurgery platform if your goal is: * Neurosurgery-led radiosurgery * Low setup costs * Frameless workflows * Long-term strategic autonomy ---- ((More information: https://www.zapsurgical.com/))