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A type of radiosurgery (radiation therapy) machine that acts by focusing low-dosage gamma radiation from many sources on a precise target. Areas adjacent to the target receive only slight doses of radiation, while the target gets the full intensity.The gamma knife may be used to treat brain tumors, metastatic tumors in the brain (from sites such as the breast, lung, and skin), vascular malformations of the brain, acoustic neuromas (a tumor of the hearing nerve); meningiomas (tumors on the protective layers of the brain); trigeminal neuralgia causing severe facial pain; and temporal lobe epilepsy.

What to Expect During Gamma Knife™ Treatment

Preparation : Patients are admitted to Hospital in the morning of the procedure. Like most surgical procedures, patients wear a hospital gown and remove jewelry, eyeglasses, contact lenses, dentures, wigs or hairpieces. Patients will receive a mild sedative through an IV.

Headframe application : Patients are fitted for a lightweight frame which holds the head still during the procedure. A local anesthetic is injected in the four areas where the frame is attached to the head with mounting pins.Patients feel slight pressure during the headframe application, but this sensation usually goes away when the headframe is in place.

Imaging to pinpoint the target : This may include CT (computed tomography), MRI (magnetic resonance imaging) and cerebral angiography. Patients may have had these studies performed before, but they must be repeated with the headframe in place to precisely map the area to be treated.

Computerized dose planning : Physicians use computers to plan the radiation so it matches the desired target. Dose planning generally takes less than one hour.

Treatment : when the radiation plan is ready, patients lie on the Gamma Knife™ couch and are positioned into a guiding device that holds their heads securely in the Gamma Knife™ helmet. After patients are in position, the staff goes into an adjoining room to monitor the procedure with video cameras and an intercom system. Patients can talk to the physicians and nurses during the procedure. The number of minutes that each radiation dose lasts is determined during dose planning. The procedure usually includes multiple doses that are delivered one after the other, all on the same day.

Benefits of the Gamma Knife : The benefits of the Gamma Knife impact all concerned; physicians, patients, hospitals and society as a whole. These benefits are derived from its unique non-invasive nature, minimal hospitalization requirements, affordable cost and impressive long-term results.

Reduced Health Risk : Gamma Knife radiosurgery requires no incision, thereby eliminating the risk of infection associated with open craniotomy. Other risks that are eliminated include potential damage to healthy tissue and adverse reaction to general anesthesia. The Gamma Knife design and advance treatment planning software ensure that only abnormal tissue is treated, minimizing injury to the surrounding healthy brain tissue.

Overnight Hospitalization : Conventional neurosurgery requires hospitalization and convalescence, rehabilitation and restrictions on physical activity are often necessary. Radiosurgery patients are seldom hospitalized and can resume regular activities within one to two days.

No Hair Loss or Scarring : Gamma Knife radiosurgery treatment is specifically designed to protect the patient from diffuse exposure to radiation, avoiding disfigurement and scarring problems associated with neurosurgery.

Reduced Cost : Radiosurgery provides a cost savings of an estimated 20 to 50 percent when compared to conventional surgery.
X-knife radiosurgery/ radiotherapy

The X-knife system is specially designed to treat brain disorders. It consistsof a specialized treatment planning system and certain hardware to be used along with the linear accelerator. X-knife radiosurgery, also called stereotactic radiosurgery, is a technique that delivers a very high level of radiation dose to brain tumors, both malignant and benign such as meningiomas, arterious malformations (AVM) and secondary metastases.

Positron Emission Tomography (PET) is a powerful imaging technique that holds great promise in the diagnosis and treatment of many diseases, particularly cancer. A non-invasive test, PET scans accurately image the cellular function of the human body.

PET scans are performed to:
  • Detect cancer
  • Determine the how much a cancer has spread in the body
  • Assess the effectiveness of a treatment plan, such as cancer therapy
  • Determine if a cancer has returned after treatment
  • Decide the best treatment for your cancer
  • Show how well chemotherapy is working
  • Show the difference between scar tissue and active cancer tissue

How the PET scan works
A PET scan involves the painless injection of a small amount of a ‘positron emitting’ radioactive material (called a radiopharmaceutical). Images of the body are then taken using a PET scanner. The camera detects emissions coming from the injected radiopharmaceutical, and the computer attached to the camera creates two- and three-dimensional images of the area being examined.

Areas that are more metabolically active (for example, fast-growing cancer cells) take up more of the injected substance and appear ‘brighter’ than normal tissues on the images.

PET scan procedure
Before the scan you will be given a small injection of radioactive material. The injection is painless and it does not make you feel any different at all. The PET scanner then takes a series of images. For some tests, the procedure begins as soon as you have the injection. In other cases, you may have to wait 30 minutes to an hour after the injection before the scan is taken.

In most cases you will need to be calm and still before and after the injection of the radioactive material. For example, if you are having a brain PET scan, you will lie quietly in a darkened room before and after the injection to ensure your brain remains relaxed and is not stimulated by light, or noise or reading.

Once the appropriate amount of time has passed, you will be asked to lie on the imaging bed. This bed has special rests for your legs, arms and head to help keep them still and comfortable.

You must lie quietly and still as the scanning table moves through the scanner ‘ring’. The scanner detects the radioactivity released by the radioactive material that has localised in the area of your body being investigated, and uses it to create images of your internal body structures.

Imaging may take between 15 minutes and two hours, depending on the type of scan. The nuclear medicine scientist who performs the test will tell you exactly how long your procedure will take. They will be there to look after you during the procedure. A PET scan is completely painless and you will not feel any different after the injection, during imaging or after the scan.

After your PET scan, you can go on with your normal activities straight away. The injection of the radioactive material does not make you feel any different or drowsy. There are no sedative drugs or anesthesia used during this procedure. Your scan results will not be available immediately. Before you leave, the nuclear medicine scientist will tell you when your doctor will have the results. You will need to make a follow-up appointment with your doctor to discuss the results of your PET scan.
Linear accelerator (linac)

A linear accelerator produces high-energy X-rays. Linac machines are used in standard radiation therapy to treat cancer, but the machines can be modified for use in stereotactic radiosurgery. Linacs designed for radiosurgery are marketed under many trade names, including Clinac, CyberKnife, Peacock, Shaped Beam Surgery and X-Knife.
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