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Abstract and Introduction
Abstract
Stereotactic radiosurgery has undergone a remarkable evolution since its conception and the subsequent introduction of image-guided radiosurgery, primarily because of the concurrent advances in imaging and computer technology. However, recent improvements in real-time imaging, inverse planning techniques, and frameless alternatives have greatly enhanced the conformity and accuracy of the radiosurgical procedure. As a consequence, the possibility of hypofractionation is offered, and both intra- and extracranial targets can now be ablated with sustained submillimetric precision. Although all indispensable features, none is as impressive or useful as the incorporation of robotics, robotic beam delivery, or robotic-assisted planning, which has only served to improve the accuracy and homogeneity of therapy. The aim of this article was to describe the general technological basis of robots in radiosurgery and to review current clinical usage of robotic radiosurgery devices. Emphasis has been placed on robotic principles and the various popular applications currently available.
Introduction
THE idea of artificial people can be traced to the ancient Greek myth of Cadmus and later to the first recorded designs of a humanoid robot by Leonardo da Vinci (Fig. 1). The word "robot" was introduced by Czechoslavakian writer Karel Capek in his play R.U.R. (Rossum's Universal Robots), which premiered in 1920. The name was coined by Capek's brother Josef, who derived it from the noun robota, which means "forced labor or drudgery" in Czechoslovakian. Many consider the first truly modern robot to be the teleoperated boat (similar to a modern remotely operated vehicle) devised by Nikola Tesla and subsequently demonstrated at an 1898 exhibition at Madison Square Garden. The word "robotics" was first used in print by Isaac Asimov, in his science fiction short story "Runaround," which appeared in 1941. Simultaneously, in the 1930s and 1940s, further advancements in technology allowed the development of the robots Elektro and Elsie (Bristol Tortoise), although it was not until 1960 that the first truly modern robot, the Unimate, was produced and actually commissioned into industrial use.
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Figure 1.
Photograph showing Leonardo da Vinci's robot model (left) with inner workings (right). The robot is able to make several human-like motions including sitting up and moving its arms and neck and has an anatomically correct jaw. Its design is based on anatomical research that da Vinci described in the Canon of Proportions from the "Vitruvian Man," ca 1492.
The invention of the cyclotron (Fig. 2) by Ernest Lawrence in 1929 and its subsequent improvements, along with Robert Wilson's 1946 proposal to use charged particles for clinical use, made the device the primary choice at that time for "therapeutic radiation"—a therapeutic modality introduced at the end of the 19th century by German physicist Wilhelm Röntgen and frequently utilized by Marie Curie in her work with x-rays, polonium, and radium.
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Figure 2.
Photograph illustrating an example of a cyclotron. This 60-inch cyclotron shows a beam of accelerated ions (perhaps protons or deuterons) escaping the accelerator between the "dees" (marked with an a), ionizing the surrounding air, and causing a blue glow (contrast enhanced).
Lars Leksell's invention of the arc-quadrant stereotactic system in 1949 further cemented the ability of clinicians and scientists to accurately target selected areas in the brain. Leksell and Borje Larsson subsequently introduced the concept of radiosurgery. By the end of the 1950s and 1960s, the use of cyclotrons and later synchrotrons in a clinical setting was well established. In 1967, Leksell and Larsson developed and successfully introduced the Gamma Knife, which they subsequently and effectively utilized to treat a variety of intracranial tumors. These modalities remained primary in radiosurgery until the development of the LINAC system by Betti et al. and Colombo et al. in the 1980s and the subsequent invention of the CyberKnife system by John Adler and colleagues in 1997.
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