r o b o t i C r a d i o s u r g e r y s y s t e m - CyberKnife ... Brochure.pdfprovide pre-treatment image guidance with technologies such as IGRT and Cone Beam CT, the CyberKnife®

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U n p r e c e d e n t e d T a r g e t i n g A c c u r a c y D e l i v e r e d A n y w h e r e i n t h e B o d y

C y b e r K n i f e ® r o b o t i C r a d i o s u r g e r y s y s t e m

With traditional radiosurgery, clinicians can treat only intracranial tumors.

The CyberKnife® Robotic Radiosurgery System not only removes this limitation–

it takes radiosurgery to a new level.

A true robotic radiosurgery system, the CyberKnife System’s innovative design

enables clinicians–for the first time–to target tumors anywhere in the body with

sub-millimeter targeting accuracy.

With the unique ability to automatically track, detect and correct for tumor and patient

movement throughout the treatment, the CyberKnife System gives clinicians a pain-free

treatment alternative for their patients without the use of head and body frames.

“Accuray’s CyberKnife System offers patient treatment options that, before now,

were not available. Accuray has partnered with clinicians, researchers and patients

to develop a system that redefines radiosurgery and provides a new standard of

patient care. The fact that clinicians the world over have successfully treated tens

of thousands of patients is testament to their confidence in the effectiveness of

the CyberKnife System.”

Euan S. Thomson, Ph.D. President and Chief Executive Officer Accuray Incorporated

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Unprecedented Targeting Accuracy

Unrivaled Conformality and Dose Gradient

Unparalleled Healthy Tissue Preservation

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radiosurgery system

sub-millimeter accuracy

treatment anywhere in the body

tracks patient and tumor movement

A new paradigm in full body radiosurgery, the CyberKnife® System leads the field with

groundbreaking technology.

Continual Image Guidance Throughout the Treatment – Many tumors, even when

immobilized, have proven to shift during treatment delivery. Using advanced robotic

technology and continual image guidance, the CyberKnife System delivers unprecedented

targeting accuracy with the unique ability to automatically correct for intra-fraction target

motion–without interrupting the treatment or having to reposition the patient.

Automated Non-Coplanar Treatment Delivery – Unconstrained by the clockwise /

counter-clockwise gantry rotations of conventional radiotherapy systems, the robotic

mobility of the CyberKnife System delivers automated non-coplanar treatments without

clinician intervention or treatment interruption. This capability efficiently enables unrivaled

conformality and dose gradient for treating even the most complex targets.

Beams Move in Real-Time with 3D Respiratory Tumor Motion –Without the limitations

of conventional respiratory gating and breath-holding techniques, the CyberKnife System

delivers beams that move precisely with tumor motion throughout the respiratory cycle.

By dramatically reducing the planning margins to only that which are clinically relevant,

the CyberKnife System has proven to provide unparalleled healthy tissue preservation.

d e f i n i n g r o b o t i C r a d i o s u r g e r y

First and Only

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tracks patient and tumor movement

With the CyberKnife® System, physicians can treat tumors anywhere

in the body–including the brain, spine, lungs, liver, pancreas and

prostate –without the limitations of time-consuming, uncomfortable

head and body frames or other immobilization devices.

The number of CyberKnife extracranial treatments grew by more than 320%

between 2004 and 2007 and a record number of presentations on extracranial

applications have been delivered at both clinical and scientific meetings

worldwide. The increase in extracranial treatments and presentations

demonstrates the proven clinical experience with the CyberKnife System in

treating tumors anywhere in the body.

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IntracranialPatients ExtracranialPatients

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“The addition of the CyberKnife System to Hong Kong Adventist Hospital means that for the first time ever,

patients in Hong Kong and the surrounding region have access to the most advanced cancer treatments

available today. The CyberKnife System complements our Cancer Center and will enable us to treat complex

tumors in the brain, spine, lung and prostate effectively and with unprecedented accuracy.”

Frank Yeung CEO and President Hong Kong Adventist Hospital, Hong Kong, China

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“After extensively researching other radiosurgery systems, we chose the CyberKnife

System because it’s the only true robotic radiosurgery system available today.

The System’s conforming capabilities and sub-millimeter accuracy ensures a

highly effective treatment plan.”

Irving Kaplan, M.D. Radiation Oncologist Beth Israel Deaconess Medical Center, Boston, USA

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“Respiration and tumors–the CyberKnife® System solves the equation.”

Professor Peter C. Levendag, M.D., Ph.D. Chairman, Department of Radiation Oncology Erasmus MC-Daniel den Hoed, Rotterdam, The Netherlands

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Sub-Millimeter Targeting Accuracy –Where conventional radiation delivery systems often

provide pre-treatment image guidance with technologies such as IGRT and Cone Beam CT,

the CyberKnife® System extends targeting accuracy beyond patient set-up and maintains

radiosurgical accuracy throughout the treatment – from the first beam to the last. Because

many tumors have proven to shift dramatically during treatment delivery, the CyberKnife

System stands alone in its ability to account for intra-fraction motion.

t H e m o s t a C C u r a t e r a d i o s u r g e r y s y s t e m

“The CyberKnife System now allows us to track unpredictable tumor motion due to normal

functions of the nearby bowel and bladder. It tells us when the tumor moves even when

the patient is stationary and takes the ‘guessing’ out of tumor positioning. The System

shows us–in real-time–tumor position from the beginning to the end of the treatment and

automatically corrects for tumor movement.”

Robert Meier, M.D. Radiation Oncologist Swedish Cancer Institute, Seattle, USA

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Tumors That Move with Respiration –Safely delivering

radiosurgery to the lung and liver presents considerable

challenges given continuous respiratory motion and

significant surrounding healthy tissue. With the CyberKnife

System and the integrated Synchrony® Respiratory Tracking

System, planning margins are only a fraction of that which

are required with other respiratory compensation techniques.

Without the need for gating or breath-holding, patients

breathe normally while the CyberKnife System continously

delivers the beam throughout the respiratory cycle and

instantly adapts to any change in breathing patterns.

Image courtesy of Barrow Neurological Institute Image courtesy of Barrow Neurological Institute

Image courtesy of University of Pittsburgh Medical Center Image courtesy of University of Pittsburgh Medical Center

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Intracranial Radiosurgery

As a completely frameless system, the CyberKnife® System utilizes continual image guidance

and automatic targeting corrections to compensate for even the slightest target shift that

might occur with non-invasive immobilization. Rendering stereotactic headframes obsolete,

the CyberKnife System provides the versatility to efficiently and painlessly deliver both single

and multiple fraction intracranial treatments.

Spine Radiosurgery

Extending the proven benefits of diverse non-coplanar treatment delivery to applications

outside of the head, the CyberKnife System automatically delivers hundreds of uniquely

angled beams per fraction in routine, daily clinical practice. And with both isocentric and

non-isocentric capabilities, the CyberKnife System has an unrivaled ability to precisely

sculpt delivered dose around the spinal cord and other sensitive critical structures.

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Image courtesy of San Diego CyberKnife Centers Image courtesy of San Diego CyberKnife Centers

Image courtesy of Georgetown University Hospital Image courtesy of Georgetown University Hospital

Lung Radiosurgery

Without conventional gating or breath-holding, the CyberKnife System delivers tightly

contoured beams that move precisely with 3D tumor motion throughout the respiratory

cycle. With this unique capability, margins are limited to only that which are clinically

relevant, dramatically decreasing the additional margins required of other systems to

account for set-up and treatment delivery inaccuracies.

Prostate Radiosurgery

Because the prostate has demonstrated the potential to shift rapidly and unpredictably,

the safe delivery of radiosurgery necessitates frequent and repetitive image guidance.

With this unique capability, the CyberKnife System can deliver both homogeneous IMRT-

style and heterogeneous HDR-style treatments while precisely limiting exposure to the

rectal wall and urethra.

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The CyberKnife System and CyberKnife options may not be available in some countries. For a complete list of CyberKnife Systems and options available, please contact Accuray at [email protected].

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em Robotic Manipulator – The high precision robotic manipulator capable of

delivering repeatable sub-millimeter accuracy, positions the linear accelerator

in virtually any direction.

Linear Accelerator – This compact, light weight 6MV X-band linear accelerator with

an output of 800 MU/min, precisely delivers highly collimated beams of radiation.

X-Ray Sources – The low-energy X-ray sources generate orthogonal X-ray images

to determine the location of bony landmarks, implanted fiducials or soft tissue

targets throughout the treatment.

Image Detectors – The flush mounted detectors capture high-resolution anatomical

images throughout the treatment. These live images are continually compared to pre-

viously generated DRR’s to determine real-time patient positioning and target location.

Synchrony® Respiratory Tracking System – Continuously synchronizes beam

delivery to the motion of the tumor, allowing clinicians to significantly reduce

margins while eliminating the need for gating or breath-holding techniques.

Iris™ Variable Aperture Collimator – Rapidly manipulates beam geometry to

deliver up to 12 beam sizes from each LINAC position with characteristics virtually

identical to that of fixed circular collimators.

Xchange™ Robotic Collimator Changer – Automatically exchanges collimators

robotically, enabling highly conformal treatments delivered with greater efficiency.

RoboCouch® Patient Positioning System – Robotically aligns patients precisely

with six degrees of freedom, enabling faster patient setup. The Seated Load option

enables simple and comfortable loading of mobility-limited patients.

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The CyberKnife System and CyberKnife options may not be available in some countries. For a complete list of CyberKnife Systems and options available, please contact Accuray at [email protected].

* Limited to specific tumor size and location.

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em MultiPlan® Treatment Planning System – An intuitive workflow-based

application designed specifically for radiosurgery, allowing for the simple and

efficient creation of even the most complex treatment plans.

Xsight® Lung Tracking System – Directly tracks the movement of lung

tumors without fiducials while maintaining precision, reliability and self-

adjusting repeatability.*

Xsight Spine Tracking System – Eliminates the need for surgical implantation

of fiducials by using the bony anatomy of the spine to automatically locate and

track tumors, making radiosurgery more precise and less invasive.

Monte Carlo Dose Calculation – Often considered the gold standard when

treating lung tumors, the CyberKnife® System’s Monte Carlo Dose Calculation

produces results in minutes compared to what commonly requires hours or days

with other systems.

4D Treatment Optimization and Planning System – True 4D treatment

planning that takes into account not only the movement of the target but

also the movement and deformation of the surrounding healthy tissue

and critical structures.

Sequential Optimization – An intuitive and intelligent advancement for rapidly

developing custom tailored treatment plans specific to the unique clinical

characteristics of each patient.

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A safe and effective treatment program proven by clinical research

The clinical success of the CyberKnife® System is due in large part to the collaborative

partnerships Accuray has developed over the last decade with clinicians, researchers

and patients. Accuray proactively seeks out and relies on feedback from CyberKnife

System users, to learn what is needed to advance the technology.

As a collaborative process, Accuray continually refines and upgrades the CyberKnife

System–ensuring the technology is always on the cutting edge while staying patient focused.

Industry Partnerships

Accuray Clinical Advisory Board

A diverse group of respected and experienced physicians and physicists, the Clinical Advisory

Board advises Accuray on the CyberKnife System’s clinical direction and product technology.

Accuray Research Grant Program

Accuray funds physics technology research and clinical studies in all areas of the body.

Accuray also works with researchers in providing assistance for research grants with other

organizations. Grant process and applications are available on Accuray’s Website.

C L i n i C a L C o n f i d e n C e

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Peer-to-Peer Interaction

The CyberKnife® Society

The CyberKnife Society was established in 2002 as an organization committed to bringing

together diverse users worldwide to foster scholarly exchange and share other clinical

information pertaining to the CyberKnife® System. Through online collaboration via the

discussion boards, as well as at the annual Users’ Meeting, Society members involved in

many different aspects of patient care share research results, discuss clinical experiences

and confer on treatments utilizing the CyberKnife System.

Peer-Reviewed Articles and Case Studies

Over 250 peer-reviewed articles and dozens of academic journals have established the CyberKnife System

as a safe and highly effective technology.

“The partnerships being developed between the surgery and oncology departments will

allow us to quickly investigate the most sophisticated aspects of the CyberKnife System

for treating lung cancer–it involves true team collaboration, focusing intently on the

health and welfare of our patients.”

James D. Luketich, M.D. Sampson Family Endowed Professor of Surgery Chief, The Heart, Lung and Esophageal Surgery Institute University of Pittsburgh Medical Center, Pittsburg USA

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Because the CyberKnife® System enables the treatment of intracranial and extracranial

tumors that cannot be addressed with traditional radiation delivery systems, it

has proven to attract new patient populations to physicians’ practices. By treating

patients with surgically complex and inoperable tumors, the CyberKnife System has

been shown to complement existing radiation therapy, IMRT or IGRT programs.

Medical institutions worldwide have expanded their clinical programs using the CyberKnife

System by treating patients that may have been considered untreatable, while building

a more comprehensive oncology practice.

“Not only has the CyberKnife Robotic Radiosurgery System expanded our ability to help our existing

cancer patients, it has enabled us to treat an entirely new group of patients that we could not

adequately serve with radiotherapy alone. By expanding our capabilities to treat more patients,

Accuray’s CyberKnife System has contributed greatly to the growth of the hospital’s revenue.”

Linda Winger Vice President of Professional Services and Research Administration Georgetown University Hospital, Washington DC, USA

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The CyberKnife® System improves patients’ lives during and after treatment. The ability to

receive pain-free, non-invasive treatment for aggressive and/or unresectable tumors means

patients can resume their normal lives with renewed hope and vigor.

New Hope to More Patients – Able to treat tumors often considered “inoperable” with invasive

surgery or conventional radiation delivery techniques, the CyberKnife System provides another

option in the fight against cancer.

Pain-Free, Non-Invasive Treatment – The CyberKnife System eliminates invasive surgery

and frames, offering patients a pain-free treatment experience with minimal risk and few

post-treatment complications.

Shorter Course of Treatment – Where conventional radiotherapy can require up to 2 months

to complete, radiosurgery with the CyberKnife System is delivered in only 1 to 5 outpatient visits,

allowing patients to quickly return to normal activities.

“When I was diagnosed with prostate cancer and I researched my treatment options, I was worried

about the possible risks and side effects of other more invasive procedures. The CyberKnife System

allowed me to avoid these potentially devastating complications and get back to my normal life

with almost no side effects.”Scott Prostate Cancer Patient

“After a long, painful recovery from the surgery that removed my first lung tumor, I elected to have

the second tumor removed non-invasively using the CyberKnife System. The CyberKnife treatment

was very easy. I relaxed and even slept during the treatment and was able to return to work

immediately. I had no side effects and am grateful for the CyberKnife.”Joan Lung Cancer Patient

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Accuray offers unique service programs to ensure that clinicians get the full benefits

of their technology investment, now and in the future.

Working together for success–Accuray has dedicated account managers to coordinate

teams through the many aspects of startup and initial patient treatments. This teamwork

enables fast, effective startups with immediate clinical results while optimizing utilization.

Supporting success with technology and value–Accuray offers a unique upgrade

program designed to address key clinical and business needs during the life of the system.

Created from customer input, Accuray offers the Diamond Elite Service Agreement, which

provides system modular enhancements to protect against obsolescence in addition to

high quality service programs.

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“We placed our first CyberKnife® System in 2003 and have recently placed a second

system. Although our 2003 system is the “previous generation”, we were able to

upgrade it using our Diamond service agreement. Now we have two identical systems,

with the latest system features .”

Linda J. Rogers Administrative Director The Alvin & Lois Lapidus Cancer Institute Sinai Hospital/LifeBridge Health, Baltimore, USA

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For more information on the CyberKnife® Robotic Radiosurgery System,

please contact Accuray Incorporated.

www.accuray.com

[email protected]

The CyberKnife System and CyberKnife options may not be available in some countries. Specifications, features, and functionality subject to change without prior notification. For a complete list of CyberKnife Systems and options available, please contact Accuray at [email protected].

© 2008 Accuray Incorporated. All Rights Reserved. Accuray, the stylized logo, CyberKnife, Synchrony, Xsight, Xchange and RoboCouch are among the trademarks and/or registered trademarks of Accuray Incorporated in the United States and other countries. 500070.B

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