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@ARTICLE{Hofmann:301572,
      author       = {T. Hofmann and M. Sammer and N. Kohlhase and D. Eftimova
                      and F. Ehret$^*$ and A. Santacroce and A. Muacevic and C.
                      Fürweger},
      title        = {{T}reatment {P}lan {C}omparison {B}etween
                      {S}elf-{S}hielding {G}yroscopic {R}adiosurgery and {R}obotic
                      {R}adiosurgery.},
      journal      = {Cureus},
      volume       = {17},
      number       = {4},
      issn         = {2168-8184},
      address      = {Palo Alto, Calif.},
      publisher    = {Cureus, Inc.},
      reportid     = {DKFZ-2025-01080},
      pages        = {e82990},
      year         = {2025},
      abstract     = {Stereotactic radiosurgery with established systems like the
                      Gamma Knife and CyberKnife (Accuray Inc., Madison, WI, USA)
                      is a well-characterized treatment concept. The novel ZAP-X®
                      platform (ZAP Surgical Systems Inc., San Carlos, CA, USA)
                      for vault-free, self-shielding gyroscopic radiosurgery (GRS)
                      promises high plan quality due to advantageous beam
                      properties. However, the clinically usable workspace in GRS
                      is reduced due to potential collisions with a spacious
                      headrest. A novel 'conformal' headrest was introduced to GRS
                      in December 2023 to remedy this, using narrower masks to
                      minimize collision zones and maximize the usable solid
                      angle. This study analyzes the GRS plan quality for 30
                      simple and complex cases, comparing GRS plans with the old
                      and new headrests to robotic radiosurgery (RRS) as an
                      established reference platform. The GRS system consists of a
                      3 MV linear accelerator mounted on coupled gimbals for
                      non-coplanar beam delivery, a collimator wheel for circular
                      beam shaping, and a kV image guidance system. The RRS system
                      is a full-body treatment platform with a 6 MV linear
                      accelerator on a robotic arm for non-coplanar,
                      non-isocentric beam delivery. A total of 30 clinical
                      single-fraction plans treated with the GRS system prior to
                      the headrest update is selected. Clinical GRS treatment
                      plans are created by manually placing isocenters within the
                      target volume and using an inverse optimization algorithm.
                      GRS plans are reoptimized using the new software and
                      headrest (further referred to as GRS*) for comparison. RRS
                      plans are generated using circular apertures and the VOLO™
                      optimization technique. Treatment plans from the GRS, GRS*,
                      and RRS platforms are compared with respect to quality
                      metrics, number of beams, total monitor units (MU), and
                      expected treatment time. The updated GRS* plans show a
                      significantly better new conformity index (nCI) and gradient
                      index (GI) than the clinical GRS plans. The volume of the
                      brainstem receiving 8 Gy or more is significantly reduced
                      with the GRS* platform. The number of beams, total MU, and
                      expected treatment time increase significantly with the new
                      GRS* treatment planning system. Compared to GRS* plans, the
                      nCI of RRS plans is better, but the GI is worse. The total
                      number of beams and MU were significantly lower with the RRS
                      platform, while the expected treatment times were
                      equivalent. The introduction of the new headrest design in
                      the GRS* system has led to a notable improvement in the
                      treatment plans of GRS. As a trade-off for the overall
                      improvement in dosimetric quality, the number of beams and
                      the expected treatment time increase. RRS and GRS* systems
                      now exhibit equivalent plan quality, with a trend of the
                      GRS* toward sharper dose gradients but lower conformity,
                      attributed to the specialized delivery design.},
      keywords     = {cyberknife (Other) / dosimetric evaluation (Other) /
                      gyroscopic radiosurgery (Other) / robotic radiosurgery
                      (Other) / single-fraction radiotherapy (Other) /
                      stereotactic radiosurgery (Other) / treatment plan
                      comparison (Other) / zap-x (Other)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40416107},
      pmc          = {pmc:PMC12103933},
      doi          = {10.7759/cureus.82990},
      url          = {https://inrepo02.dkfz.de/record/301572},
}