A Groundbreaking Technology Celebrates 30 Years
Trivia Tuesday: What medical device, first used clinically in 1994, marked a new era in radiation medicine?
September 17, 2024
It took years for Madison, WI-based Accuray to develop its flagship CyberKnife System, but the lengthy path to development was worth the wait. The company’s robotic radiosurgery system was invented at Stanford Health Care by John Adler, MD, and first debuted in 1994.
As noted by Accuray, the inception of the CyberKnife marked a new era in radiation medicine, introducing a disruptive technology that addressed existing limitations and unlocked new possibilities in radiation treatments.
The CyberKnife was designed leveraging robotics, computer science, medical physics, and imaging. The result was a platform that combined precision and accuracy with image-guidance, offering a non-invasive approach to radiation therapy.
This year, the CyberKnife celebrates its 30th anniversary. In 2014, Adler and his Stanford colleagues celebrated the 20th anniversary of the technology with the video below.
Video transcripts
Off-screen female voice: The first reaction was wow this looks like something from Star Wars very quickly it became apparent that this could change the way we treat patients now we could actually treat formerly untreatable conditions. It's the idea that one should do surgery in the least destructive way possible.
Gary Steinberg, MD, Chair, Dept. of Neurosurgery at Stanford Health Care: CyberKnife in itself represents one of the major advances in medicine over the last 50 years these cyber knife was invented at Stanford by John Adler John studied with Lars Leksell in Sweden who introduced the invention of the gamma knife to neurosurgery.
John Adler, MD, emeritus professor of neurosurgery: I was in Stockholm and got caught up under the spell of Lars Leksell and it seemed to me that Leksell was describing the future of much of neurosurgery, and I just couldn't get it out of my head. This drawing was actually made in 1988. I tried to depict my ideas for the core technologies that would eventually become the CyberKnife. The challenges of bringing a team together and finding the money to make it real was just a huge challenge. Perhaps most lucky of all was the ready proximity of people who had to make linear accelerators. The linear accelerator industry is based here in Silicon Valley and it's an example of Stanford's seminal role in creating modern radiotherapy. This drawing was done in 1990. At this point I decided that I had a small little linear accelerator that I could attach to the robot, and it was clear that this was going to be the final solution in terms of aiming the linear accelerator. So, this device right here is the heart of a linear accelerator. Electrons are injected and at the other end they can achieve the speed of light before hitting a tungsten target and this basic concept was created at Stanford.
Iris Gibbs, MD, co-director of CyberKnife Radiosurgery: At that point in time, we had been doing radiosurgery using a stereotactic headframe system similar to the Gamma Knife system. It required rigid fixation and a frame placement on our patients.
John Adler, MD: Instead of the frame which anchored to the patient's skull. I realized that with modern technology we would be able to target tissue anywhere in the body with computerized image correlation.
Steven Chang, MD, co-director of CyberKnife Radiosurgery: One of the advantages that the CyberKnife has over conventional radiation is that it's very precise. It has accuracy of less than a millimeter of error when delivering radiation.
Quynh Thu Le, MD, chair of radiation oncology: We can see the tumor better with improved imaging study and we can also be able to track the tumor better. And because of that, we spare more of the normal tissue and that gives us the ability to give more intense radiation treatment over a shorter period of time, which really has revolutionized the way we treat the patient.
John Adler, MD: The standard radiation oncology treatment is 678 now, with the CyberKnife, you could reduce these big long radiation treatments to literally a matter of a day or a few days.
Gary Steinberg, MD: It has the versatility of being able to treat structures outside the brain and so you can treat the spine, and also outside the central nervous system you can treat the prostate, lung, abdominal, and even cardiac problems.
Steven Chang, MD: The limits of the CyberKnife I don't think have been really fully pushed. The most cutting-edge treatments on the horizon are treatments of things such as depression, back pain, obsessive compulsive disorders, and then certainly to make the leap even beyond the realm of neurosciences.
Iris Gibbs, MD: The risk to think outside of the box, it's these sorts of thought processes to think beyond really what is currently available that really change the world.
John Adler, MD: I think the CyberKnife has shown us that it isn't just the magical nature of radiation itself. It's the precision with which that radiation is administered. So, what we've done is we've taken Marie Curie's magical energy source and we've made it precise for the modern world and in doing so, I think, made something very, very special and almost magical in its own way.
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