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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 13 (2011), No. 4     15. Dec. 2011

Int Poster J Dent Oral Med 2011, Vol 13 No 4, Poster 569


Slicing Knife – A Boon without Pain

Language: English

Dr. Cristalle Soman, Post Graduate Student, Prof. Dr.Lingappa Ashok,
Department of Oral Medicine & Radiology, Bapuji Dental College and Hospital, Rajiv Gandhi University of Health Sciences, Davangere, Karnataka, India

September 4th-5th, 2010
National P.G Convention in Indian Academy of Oral Medicine and Radiology 2010
Le Meridien,Chennai, India

Poster Award


Cyberknife is a high precision, painless, non-invasive robot guided frameless stereotactic radiosurgery system.



Dr. John Adler, Prof. of neurosurgery, Dr. Lars Lekshell, creator of Radiosurgery.

Fig. 1: Dr. John Adler Fig. 2: Dr. Lars Lerkshell


X-ray -> CT imaging -> MRI, IMRT ->PET-CT ->Cyberknife

Fig. 3: Evolution


Stereotactic Radiosurgery – combination of stereotaxy & radiosurgery.


Multijoint robotic arm, Image Guidance system, Linear accelerator (Linac), Synchrony system, Treatment couch.

Fig. 4: Components


Patient consultation, Patient preparation, Facemask to hold the head steady during head & neck treatment & Fiducials-metal markers placed near the tumor site to guide the beam for treatment outside the head, Image acquisition using PET CT & Treatment planning, Treatment delivery (30-90min procedure) in single/hypofractioned doses, Follow up: Imaging & consultation to monitor treatment efficacy (6 months).

Fig. 5: Patient Counsultation Fig. 6: Step 2-patient preparation
Fig. 7: Step 3(a) face mask Fig. 8: Step-3(b) fiducials
Fig. 9: Step 3(b) pink marks indicating fiducials to guide tumors Fig. 10: Step 3(b) pink marks indicating fiducials to guide tumors
Fig. 11: Step 6 targeting and treatment delivery
Fig. 12: Step 7-follow up imaging

Treatment team:

Radiation oncologist, Neuroradiologist, Neurosurgeon, Physicist, Dosimetrist, Radiation therapy nurse, Neurologist.

Fig. 13: Treatment team


Cervical tumors, Radiosensitive structures, Nasal tumors, Orbital tumors, Multiple tumors, AV malformation, Vascular tumors, Inoperable tumors, Maximum irradiated patients, Trigeminal neuralgia.

Fig. 14: Cervical Tumors Fig. 15: Radiosensitive structures
Fig. 16: Nasal tumors Fig. 17: Orbital tumors
Fig. 18: Multiple Tumors Fig. 19: AV malformations
Fig. 20: Trigeminal Neuralgia Fig. 21: Vascular Tumors
Fig. 22: Maximum Irradiated Patients Fig. 23: Inoperable tumors
Fig. 24: Applications


Pinpoint accuracy, Noninvasive, Frameless, Reduced risk of infections, Quick recovery, Better quality of life, Continuous tumor tracking, Multiple tumor treatment.

Fig. 25: Advantages and disadvantages Fig. 26: Pinpoint accuracy
Fig. 27: Non-invasive Fig. 28: Frameless
Fig. 29: Reduced Risk for Infections Fig. 30: Quick Recovery
Fig. 31: Better Quality of Life Fig. 32: Continuous Tumor Tracking
Fig. 33: Multiple Tumors


Nausea, vomiting, diarrhoea, fatigue, skin itching. Longer time when multiple tumors are ablated during the same session. Placement of fiducials for treating lesions outside head region.

Fig. 34: Side effects: Nausea, vomitting, diarrhoea, Fatigue,Skin Itching Fig. 35: Placement of fiducials
Fig. 36: Longer Time


Pinpoint accuracy, Ultraflexibility- robot with six joints & delivers over 1200 beams, Continuous tumor tracking, Treatment of sites anywhere in the body, Noninvasive, painless, frameless, Quick recovery & return to normal life.

Fig. 37: Uniqueness


Cyberknife is the first and only radiosurgery system designed for treatment anywhere in the body & it uses continual X-ray image guidance technology and computer-controlled robotic mobility to automatically track, detect, and correct for patient movements and target without interrupting the treatment. Cyberknife gives a renewed ray of hope for a better quality of life especially for patients with previously diagnosed inoperable or inaccessible tumors and for those who have already received the maximum amount of radiation through other treatment methods and offers quick recovery and return to normal life.

This Poster was submitted by Dr. Cristalle Soman.

Correspondence address:
Dr. Cristalle Soman
Bapuji Dental College and Hospital
Department of Oral Medicine & Radiology
Davangere - 577 004
Karnataka, India