NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Tipton KN, Sullivan N, Bruening W, et al. Stereotactic Body Radiation Therapy [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 May. (Comparative Effectiveness Technical Briefs, No. 6.)
| Elekta Axesse581 | Elekta Synergy-S581 | Elekta Synergy581 | Elekta Infinity581 | Tomo- Therapy- HiArt582 | Accuray CyberKnife® Robotic Radiosurgery System583 | Varian Clinac iX584 | Varian Trilogy584 | Varian/BrainLAB Novalis Tx584 | |
|---|---|---|---|---|---|---|---|---|---|
| Device Type (e.g., robot, ring gantry, standard linac) | Standard linac and robotic table | Standard linac and robotic table | Standard linac and robotic table | Standard linac and optional robotic table | Ring gantry | Robotic mounted linac | C-Arm Linac | C-Arm Linac | C-Arm Linac |
| Photon Energy, MV | 6, 10, 12, or 15 MV | 6, 10, 12, or 15 MV | 6, 10, 12, 15, or 18 MV | 6, 10, 12, 15, or 18 MV | 6 MV | 6 MV | 6 MV plus one of 10,15,18,20 HighX | 6 MV plus one of 10,15,18,20 HighX | 6 MV plus one of 10, 15, 18, 20 HighX |
| Maximum Dose Rate (MU/min) | 600 MU/min | 600 MU/min | 600 MU/min | 600 MU/min | 850 cGy/min | 1,000 MU/min | 600 MU/min1 | 1,000 MU/min1 | 1,000 MU/min1 |
| Number of Independent Beam Angles | Infinite2 | Infinite2 | Infinite2 | Infinite2 | 51 per rotation, continuous delivery modeled by treatment (7 degree arcs) | >1,200 noncoplanar, independent beam angles | Continuously variable along gantry, collimator & couch rotational axes plus couch & collimator translational axes3 | Continuously variable along gantry, collimator & couch rotational axes plus couch & collimator translational axes3 | Continuously variable along gantry, collimator & couch rotational axes plus couch & collimator translational axes3 |
| Collimation Technique (e.g., MLC, etc.) | MLC or cones | MLC or cones | Add-on MLC or cones | Add-on MLC or cones | MLC | Variable aperture collimator and fixed circular collimator4 | MLC5 | MLC5 | MLC and SRS cones6 |
| Smallest Collimation Resolution | 4 mm throughout or cones7 | 4 mm throughout or cones7 | 3 mm or 2.5 mm throughout or cones7 | 3 mm or 2.5 mm throughout or cones7 | 6.25 mm × 10 mm | Field sizes of 5 mm8 | 5.0 mm | 5.0 mm | 2.5 mm |
| Minimum Treatment Size | MLC: 4 mm | MLC: 4 mm | MLC: 3 mm or 2.5 mm | MLC: 3 mm or 2.5 mm | Not limited by collimator | 5 mm8 | MLC: 5 mm × 5 mm SRS cone: 4 mm | MLC: 5 mm × 5 mm SRS cone: 4 mm | MLC: 2.5 mm × 2.5 mm SRS cone: 4 mm |
| Maximum Treatment Size | MLC: 16 cm × 21 cm | MLC: 16 cm × 21 cm | MLC: 7 cm × 7 cm or 12 cm × 12 cm | MLC: 7 cm × 7 cm or 12 cm × 12 cm | NR | Conformal beam targeting allows treatment of tumors >maximum field size of 60 mm | Fixed field: 40 cm × 40 cm Modulated field: 40 cm × 32 cm | Fixed field: 40 cm × 40 cm Modulated field: 40 cm × 32 cm | Fixed field: 22 cm × 40 cm Modulated field: 22 cm × 32 cm |
| Body Immobilization Technique (e.g., third party) | BodyFIX or HeadFIX | BodyFIX or HeadFIX | BodyFIX or HeadFIX | BodyFIX or HeadFIX | BodyFIX9 | Not required, optional “vac-bags”9 | Medical Intelligence CIVCO; Q-Fix; Aktina9 | Medical Intelligence CIVCO; Q-Fix; Aktina9 | Medical Intelligence; CIVCO; Q-Fix; Aktina9 |
| Treatment Planning Imaging (e.g., CT, PET-CT, MRI, etc.) | CT and/or MRI and/or PET | CT and/or MRI and/or PET | CT and/or MRI and/or PET | CT and/or MRI and/or PET | CT on HiArt planning station, multi- modality on third party fusion/contouring station | CT, 4D CT, MR, PET, and XA (3DRA) | CT, MR, PET, CT/PET | CT, MR, PET, CT/PET | CT, MR, PET, CT/PET |
| Treatment Planning Options (e.g., software) | ERGO++ and/or Pinnacle39 | ERGO++ and/or Pinnacle39 | ERGO++ and/or Pinnacle39 | ERGO++ and/or Pinnacle39 | Tomo- Helical and Tomo- Direct delivery mode, each with IMRT and 3D options | The MultiPlan® Treatment Planning System | Varian Eclipse recommended | Varian Eclipse recommended | BrainLAB iPlan Standard; Varian Eclipse recommended in addition |
| Treatment Planning Algorithm (e.g., Monte Carlo, forward, inverse) | Inverse and/or Monte Carlo | Inverse and/or Monte Carlo | Inverse and/or Monte Carlo | Inverse and/or Monte Carlo | Convolution/super- position | Inverse planning with Monte Carlo or ray-tracing methods | Eclipse: AAA and Pencil Beam | Eclipse: AAA and Pencil Beam | Varian Eclipse: AAA and Pencil Beam, BrainLAB iPlan: Pencil Beam and Monte Carlo |
| Patient Positioning Accuracy (mm) | <1 mm | <1 mm | <1 mm | <1 mm | Approx 0.5 mm | During set-up: 1 mm | Follows AAPM and ASTRO recommendations10 | Follows AAPM and ASTRO recommendations10 | Follows AAPM and ASTRO recommendations10 |
| Patient Position Correction (degrees of freedom) | 6D standard | 3D standard, optional 6D | 3D standard, optional 6D | 3D standard, optional 6D | Translation plus roll | RoboCouch® System provides 6-DOF motion capabilities | 4 | 4 | 6 |
| Image Guided Technology (during treatment) | 2D or 3D cone-beam CT | 2D or 3D cone-beam CT | 2D or 3D cone- beam CT | 2D or 3D cone- beam CT | MVCT prior to delivery | Orthogonal X-ray (kV), registers to DRRs | Varian Cone- Beam CT; MV Portal Imaging; Fluoro kV, MV/kV | Varian Cone-Beam CT; MV Portal Imaging; Fluoro kV, MV/kV | Varian Cone-Beam CT; MV Portal Imaging; Fluoro kV, MV/kV, BrainLAB, ExacTrac Stereo X-Ray, ExacTrac Optical (IR), SNAP (kV image w/beam on) |
| Tumor Tracking (e.g., fiducials, third party, manufacturer) | Active Breathing Coordinator (ABC) and/or Elekta Symmetry 4D cone-beam CT | ABC and/or Elekta Symmetry 4D cone-beam CT | ABC and/or Elekta Symmetry 4D cone-beam CT | ABC and/or Elekta Symmetry 4D cone-beam CT | No tracking during treatment | Xsight Lung Tracking System and fiducial-based tracking | Varian Fluoro kV and via Calypso or VisionRT9 | Varian Fluoro kV and via Calypso or VisionRT9 | Varian Fluoro kV and via BrainLAB SNAP (kV image w/beam on) and Calypso or VisionRT9 |
| Respiratory Gating (Yes/No) | Yes, ABC | Yes, ABC | Yes, ABC | Yes, ABC | No | No—Uses Synchrony® Respiratory Tracking System | Varian RPM: Respiratory Position Management | Varian RPM: Respiratory Position Management | Varian RPM: Respiratory Position Management BrainLAB: Adaptive Gating |
| Standard Treatment Time Per Fraction11 | 2–45 mins (lower with VMAT, higher with SRS) | 2–45 mins (lower with VMAT, higher with SRS) | 2–45 mins (lower with VMAT, higher with SRS) | 2–45 mins (lower with VMAT, higher with SRS) | Typically beam on 20 minutes and time in room 45 minutes | Avg. 30–60 min per fraction imaging interval and tracking method used | 5–3512 | 3–2012 | 3–2012 |
- 1
Varian states the dose rate is at 100 centimeters (cm).
- 2
Based on rotation of linac and control of patient table.
- 3
Varian states: linacs rotate continuously + 185 degrees (370 degrees total) about the isocenter from vertical; the couch can yaw + 100 degrees; rotate the multileaf collimator + 165 (+ 0.5 degrees); the leaf positions are continuously variable with a + 0.01 mm leaf position resolution; Exact Couch has a lateral travel of + 25 cm and a longitudinal travel of 145.8 cm; BrainLAB’s robotic couch top, standard on the Novalis Tx (and optional on the Trilogy and Clinac iX), can roll and pitch + 2.7 degrees and + 4 degrees respectively.
- 4
5–60 mm diameter.
- 5
Millennium 120 MLC: 80-5 mm leafs bounded by 40 (2 × 20) 10 mm leafs.
- 6
HD120 MLC: 64 2.5 mm leafs bounded by 56 (2 × 28) 5 mm leafs.
- 7
2.5 mm to 50 mm.
- 8
This represents the smallest collimator size; Accuray states collimator resolution is not applicable for the CyberKnife system.
- 9
Third party device or software.
- 10
Varian states they follow recommendations of AAPM and ASTRO585
- 11
Standard treatment time may vary with each patient depending on factors such as tumor size, etc.
- 12
Varian based the treatment time on a treatment dose range of 8–20 Gy and delivery using RapidArc or Fixed Gantry.
4D CT: Four-dimensional computed tomography
AAA: Anisotropic analytical algorithm
AAPM: American Association of Physicists in Medicine
ABC: Active Breathing Coordinator
ASTRO: American Society for Radiation Oncology
cGY/min:Centigray per minute
cm: Centimeter
CT: Computed tomography
DOF: Degrees of freedom
DRR: Digitally reconstructed radiograph
IMRT: Intensity modulated radiation therapy
kV: Kilovolt
MLC: Multi-leaf collimator
mm: Millimeter
MRI: Magnetic resonance imaging
MU/min: Monitor units per minute
MV: Megavolt
MVCT: Megavoltage computed tomography
PET: Positron emission tomography
SRS: Stereotactic radiosurgery
VMAT: Volumetric modulated arc therapy
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