{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,16]],"date-time":"2026-08-16T07:10:14Z","timestamp":1786864214506,"version":"build-2736575974"},"reference-count":45,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2017,8,2]],"date-time":"2017-08-02T00:00:00Z","timestamp":1501632000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Physics"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>This article reports on the integration of a sliding\u2010gantry <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>\u2010on\u2010rails with a robotic linear accelerator.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The system consists of a <jats:styled-content style=\"fixed-case\">SOMATOM<\/jats:styled-content> Definition <jats:styled-content style=\"fixed-case\">AS CT<\/jats:styled-content> scanner (Siemens Healthcare, Forchheim, Germany) and a CyberKnife M6 <jats:styled-content style=\"fixed-case\">FIM<\/jats:styled-content> (Accuray, Inc., Sunnyvale, CA, USA). Additional movement programs were implemented in the robotic treatment table (RoboCouch, Accuray Inc.) to move between <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> and treatment position. Acceptance testing was performed on the <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scanner according to <jats:styled-content style=\"fixed-case\">AAPM<\/jats:styled-content>83 guidelines, as well as safety tests for collision avoidance and electromagnetic (<jats:styled-content style=\"fixed-case\">EM<\/jats:styled-content>) compatibility. For the first clinical application of the system, daily dose was evaluated in five pancreas <jats:styled-content style=\"fixed-case\">SBRT<\/jats:styled-content> patients. A second envisioned use is the optimal alignment of the treatment beams to soft\u2010tissue targets without the use of implanted fiducials. To this end, an offset vector feature has been implemented, which shifts the treatment center according to the daily position of the tumor relative to the spine (established by a <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan). This offset can be applied by either moving the treatment couch (physical couch shift) or by moving the CyberKnife robot (virtual couch shift). An End\u2010to\u2010End (E2E) test was specifically designed to evaluate the accuracy of this feature using the Xsight Lung Tracking Phantom (Computerized Imaging Reference Systems, Inc., Norfolk, <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>, USA). The position of the tumor with respect to the spine was varied by moving the insert inside the phantom and a <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scan was made for each position. The treatment plan was subsequently delivered to the phantom employing spine tracking. The test was repeated four times for a physical couch shift and four times for a virtual couch shift.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All acceptance, safety and <jats:styled-content style=\"fixed-case\">EM<\/jats:styled-content> compatibility testing was successful. For the first pancreas <jats:styled-content style=\"fixed-case\">SBRT<\/jats:styled-content> patients treated using daily <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> imaging, the volume of stomach, duodenum, or small bowel receiving &gt;35 Gy was found to increase or remain constant during treatment; however, the clinical constraint of 5 cc was not violated. For the offset vector E2E test, the reference accuracy (without any tumor shift) was (0.74, \u22120.61, \u22120.33) mm in the inferior, left, and anterior direction respectively. The difference in deviation with respect to the reference was (\u22120.1 \u00b1 0.15, 0.01 \u00b1 0.16, \u22120.17 \u00b1 0.25) mm, when applying a physical couch shift. With a virtual couch shift, the deviations were (0.02 \u00b1 0.15, 0.06 \u00b1 0.23, \u22120.4 \u00b1 0.31) mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The first combination of a CyberKnife treatment unit with a sliding\u2010gantry <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> scanner is operational in our department enabling future developments toward image\u2010guided online\u2010adaptive <jats:styled-content style=\"fixed-case\">SBRT<\/jats:styled-content> supported by diagnostic\u2010quality <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> imaging.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mp.12432","type":"journal-article","created":{"date-parts":[[2017,6,28]],"date-time":"2017-06-28T09:12:39Z","timestamp":1498641159000},"page":"4816-4827","source":"Crossref","is-referenced-by-count":34,"title":["CyberKnife with integrated <scp>CT<\/scp>\u2010on\u2010rails: System description and first clinical application 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