1. Novalis Frameless Radiosurgery
Department of Radiation Oncology
University of Arizona
Russell J. Hamilton, Ph.D.
Medical Physicist

2. Novalis Linear Accelerator
Photons ( 6 MV )

3. Gantry Rotation

4. Gantry Rotation

5. Gantry Rotation

6. Table Rotation

9. CT Simulation

10. CT Simulation Mask Fabrication

11. CT H&N Localizer

12. CT Simulation Positioning

13. CT Simulation Acquisition Definition

14. CT Simulation Localization Box Image

15. CT Simulation Targets

16. BrainScan Treatment Planning Isocenter 1

17. BrainScan Treatment Planning Isocenter 1

18. BrainScan Treatment Planning Isocenter 1

19. BrainScan Treatment Planning Isocenter 2

20. BrainScan Treatment Planning Isocenter 2

21. Novalis Head Frame Positioing
Head ring placed on patient
Patient CT scanned with localizer
Treatment plan generated
Isocenter position printed on paper
Paper attached to TAPO
Patient placed on treatment couch in localizer box
Box aligned using TAPO

22. Novalis Head Frame Positioning

23. Novalis Head Frame Positioning

24. Novalis Head Frame Positioning

25. Novalis Head Frame Positioning

26. Novalis Head Frame Positioning

27. Novalis Head Frame Positioning

28. Novalis Head Frame Positioning
Assumes target is in the identical position relative to the head ring as it was for CT scan
Alignment based on visual alignment of lasers with TAPO on localizer box

29. ExacTrac Positioning Patient placed on table in mask array
Preposition with Robtics
X-ray guided alignment
X-rays fused with DRRs (from planning)
3 translations and 3 rotations determined
Position with Robotics
Verification of position with X-rays

30. Novalis Frameless Treatment Setup

31. Novalis Frameless Treatment Setup

32. Novalis Frameless Treatment Setup

33. Novalis Frameless Treatment Setup

34. Novalis Frameless Treatment Setup

35. ExacTrac Software

36. ExacTrac Prepositioning

37. ExacTrac Ready to Position

38. ExacTrac Isocenter 1

39. ExacTrac Software

40. ExacTrac X-ray 1

41. ExacTrac X-ray 2

42. ExacTrac Fusion

43. ExacTrac Determined Shifts and Rotations

44. ExacTrac Robotic Positioning

45. ExacTrac Alignment Verification

46. ExacTrac Final Alignment

47. ExacTrac Positioning Patient placed on table in mask array
Preposition with Robtics
X-ray guided alignment
X-rays fused with DRRs (from planning)
3 translations and 3 rotations determined
Position with Robotics
Verification of position with X-rays

48. ExacTrac IC2 Initial X-ray

49. ExacTrac IC2 Prefusion

50. ExacTrac IC2 Fused

51. ExacTrac IC2 Position Screen

52. ExacTrac IC2 Final Alignment Verification

53. ExacTrac IC2 Final Alignment Verification

54. ExacTrac IC2 Final Alignment Verification

55. Thank you