GAMMA KNIFE SURGERY. Leksell Gamma Knife 4C. Refining the Art of Radiosurgery. Refining the Art of Radiosurgery

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1 GAMMA KNIFE SURGERY Leksell Gamma Knife 4C Refining the Art of Radiosurgery Refining the Art of Radiosurgery

2 As an active user of both I first evaluated the role of the or emerging technology merits Leksell Gamma Knife and linear Gamma knife in Sweden in comparable consideration for its accelerator stereotactic radiosur- 1979, 4 years after the installa- well defined role in a broad gery, my experience has been tion of the second prototype spectrum of vascular, tumor, and that Leksell Gamma Knife unit. While it took almost 8 functional cases. For that reason allows me to achieve unsurpas- years after that to introduce the we have now installed a third sed treatment accuracy and con- first 201 source Gamma Knife Gamma Knife at our academic formality. Combined with the in Pittsburgh in 1987, we have teaching hospital. Gamma Knife most user-friendly treatment experience now in more than represents the prime example of planning system available, 6,200 patients. We perform minimal access, minimally inva- Leksell Gamma Knife is right- about 7500 neurosurgical proce- sive brain surgery. 2 fully referred to as the»gold standard«of radiosurgery. volker Stieber m.d. wake forest university baptist medical center, north carolina, usa dures a year, of which about 10% are Gamma Knife. The technology has steadily advanced, merging dramatic gains in imaging, robotics, and computer planning. Leksell Gamma Knife dade lundsford, m.d. university of pittsburgh medical center center for image guided radiosurgery, pennsylvania, usa is the platinum standard for intracranial radiosurgery, providing precision, minimizing risk, and maximizing the therapeutic response. We have outcome studies now extending to 17 years out our center- no existing

3 Leksell Gamma Knife 4C Refining the Art of Radiosurgery

4 REFINING THE ART OF RADIOSURGERY

REFINING THE ART OF RADIOSURGERY The neurosurgical revolution the tools used by the surgeon must be adapted to the UNIQUE TECHNOLOGY Today, the technique is performed HOW DOES GAMMA KNIFE TREATMENT

5 REFINING THE ART OF RADIOSURGERY The neurosurgical revolution the tools used by the surgeon must be adapted to the UNIQUE TECHNOLOGY Today, the technique is performed HOW DOES GAMMA KNIFE TREATMENT WORK? task and where the human brain in hundreds of leading hospitals Ionizing radiation is delivered is concerned they cannot be too and clinics around the world. from a total of 201 cobalt-60 refined. So said Lars Leksell, Around 40,000 patients undergo sources arranged in a hemi- developer of radiosurgery, the Gamma Knife surgery every year, spherical pattern. The beams of principle behind the concept of and this unique procedure has ear- gamma radiation always coincide Gamma Knife surgery. In ned an outstanding scientific track at a fixed focal point within the radiosurgery the scalpel is repla- record with thousands of peer- radiation unit. Each beam will ced by highly-focused radiation reviewed articles. only contribute with a small dose beams which produces the desired In fact, no other alternative and have a minimum impact on biological effect at the precisely treatment in this field has gained the tissue on its way to the target, predetermined target in the brain. greater clinical acceptance. but in the focal point were all 5 Since its introduction, Gamma beams meet the resulting dose will Knife surgery has revolutionized the treatment of intracranial MINIMALLY INVASIVE MAXIMUM EFFICIENCY give the desired therapeutic effect. The dose in the sharp focal point pathology. The minimally-invasive technique is very precisely defined, which of Gamma Knife surgery offers makes it possible to treat targets important benefits for medical very close to sensitive structures. practitioners and patients alike. It By combining focal points called means fewer complications and isocenters even the most complex faster recovery times when shaped target can be covered with compared with conventional minimum impact on surrounding methods of surgery. In turn, this tissue. results in shorter hospital stays The built in robotic move- and more cost-effective outcomes. ments of Automatic Positioning Not surprisingly, Gamma Knife System automatically sets the surgery has become the treatment coordinates directly from the of choice and a complementary treatment plan giving improved procedure to micro surgery for performance and speed. small to medium sized intracranial targets.

A SEAMLESS TREATMENT FLOW A complete system. A seamless treatment flow leksell gamma knife 4c is a res deep within the organ.

advanced treatment techno- standards for precise localization logy including the robotic and treatment of targets within Automatic Positioning System. the skull.

seamless information flow. Leksell Coordinate Frame is easily secured to the patient s head REDEFINING THE NOTION OF ACCURACY and gives the reference for the stereotactic coordinate system.

6 A SEAMLESS TREATMENT FLOW A complete system. A seamless treatment flow leksell gamma knife 4c is a res deep within the organ. Since it complete system which comprises was first introduced by Professor a dedicated treatment planning Lars Leksell in 1949, this tech- software Leksell GammaPlan 4C nique has been setting the and advanced treatment techno- standards for precise localization logy including the robotic and treatment of targets within Automatic Positioning System. the skull. This system digitally integrates 6 diagnostic images, treatment planning and dose delivery into a FULLY COMPATIBLE WITH ALL IMAGING MODALITIES Treatment Planning with Leksell GammaPlan single, seamless information flow. Leksell Coordinate Frame is easily secured to the patient s head REDEFINING THE NOTION OF ACCURACY and gives the reference for the stereotactic coordinate system. It Leksell Stereotactic System plays ensures that the head is securely a key role in the success of supported throughout the whole Gamma Knife surgery. The procedure. A selection of Stereotactic technique makes it exchangeable components provi- possible to accurately map the brain in three dimensions, then to des maximum flexibility when attaching the frame. Leksell Treatment preparations precisely locate the target structu- Stereotactic System is compatible with all types of imaging modalities such as CT, MR, X-ray. Watching and controlling the treatment

7 A SEAMLESS TREATMENT FLOW 7 Leksell Coordinate Frame Compatible with all types of imaging modalities. The accuracy of Leksell Stereotactic System plays a key role in the treatment s success.

8 TREATMENT PLANNING Planning for excellence leksell gammaplan is the DESIGNED FOR NEUROSURGEONS data import. And based on the dedicated planning system for BY NEUROSURGEONS advanced ImageMerge co-regist- Gamma Knife surgery. This is the Designed in collaboration with the ration algorithm, any frameless most advanced and accurate very people who spend time using image study can be matched with system of its type available today. the system neurosurgeons and any other image study scanned It incorporates over 30 years of physicists this comprehensive with Leksell Coordinate Frame. clinical experience and over and powerful tool also manages to Leksell GammaPlan 4C enhances 350,000 patient treatments. combine speed and accuracy with flexibility and cost efficiency in Utilizing the planning system with true user-friendliness. This results planning since it allows image 8 Leksell Gamma Knife enables in a versatile system that can be studies to be scanned at any efficient planning and irradiation handled intuitively, offering the remote imaging center, for of targets with high conformity user a clinically recognizable example a PET center. and selectivity, while ensuring environment. minimum effect on surrounding SAVE VALUABLE TIME healthy tissue. VIEW ALL THE AVAILABLE The system allows the user to OPTIONS rapidly plan as many isocenters as Leksell GammaPlan 4C the may be clinically optimal in latest generation of the software seconds. The final dose plan is includes a Multiview function. then transferred to the Operator This gives the ability to process all Console of Leksell Gamma forms of imagery. The user can Knife, thus streamlining and visualize and analyze a wide range optimizing treatment planning. of surgical approaches; all in 3-D The software also includes a and real time. Leksell Gamma- Wizard for inverse, automatic Plan 4C provides displaying of treatment planning, back-up and physiological images, PET, 3D use in educational programs. brain atlas structures, AC-PC targeting, image fusion and MEG

TREATMENT PLANNING 9 Different formats can be displayed on one screen

With Leksell GammaPlan 4C any frameless/nonstereotactic image can be

A graph on the screen helps to keep track on volume and dose.

extremly high conformity and selectivity thus keeping damage to

9 TREATMENT PLANNING 9 Different formats can be displayed on one screen and can be used to create volumetric 3-D views. With Leksell GammaPlan 4C any frameless/nonstereotactic image can be matched with a Leksell Coordinate Frame scanned image. A graph on the screen helps to keep track on volume and dose. Leksell GammaPlan enables contouring and placement of isodoses with extremly high conformity and selectivity thus keeping damage to surrounding tissue to an absolute minimum. Leksell GammaPlan enables treatment of multiple targets and different plans for the same target.

10 AUTOMATIC POSITIONING SYSTEM, APS 10 Even the most complex shaped target can be covered with minimum impact on surrounding tissue.

AUTOMATIC POSITIONING SYSTEM, APS Accuracy of treatment once the frame has been secured to the patient, and the treatment imaging and planning devised, the patient is ready to receive treatment.

A tv monitor and intercom provide audio-visual contact between the patient and the operator. The accuracy for Leksell Gamma Knife 4C is guaranteed to better than 0.5mm.

11 AUTOMATIC POSITIONING SYSTEM, APS Accuracy of treatment once the frame has been secured to the patient, and the treatment imaging and planning devised, the patient is ready to receive treatment. The patient is placed on the couch with the frame attached to the treatment unit. All actions are controlled from the Operator Console. A tv monitor and intercom provide audio-visual contact between the patient and the operator. The accuracy for Leksell Gamma Knife 4C is guaranteed to better than 0.5mm. The treatment plan produces a number of isocenters based on the coordinates defined by the stereotactic coordinate system. These isocenters are then irradiated, ensuring that the target is covered precisely. By using Automatic Positioning System, even the most complex plans can be easily administered. INCREASED COMFORT, REDUCED TREATMENT TIME Automatic Positioning System adds to the elegance and efficiency of Gamma Knife surgery. This robotic system automatically positions the head frame coordinates, repositioning the patient for each isocenter. The system works quietly and smoothly, ensuring the patient s comfort during treatment, and helps to reduce the average length of treatment time. 11

ELEKTA LIFECYCLE SERVICES Educating for confidence in clinical practice elekta is committed to CLINICAL TRAINING technical- and clinical training.

helping them gain the maximum centers, headed by experts in accompanied by on-site start-up clinical advantage from their Gamma Knife surgery. The training with guidance of an systems.

12 ELEKTA LIFECYCLE SERVICES Educating for confidence in clinical practice elekta is committed to CLINICAL TRAINING technical- and clinical training. making its customers confident in All training courses are organized Additionally, all new Leksell the use of their equipment, and to by selected Leksell Gamma Knife Gamma Knife installations are helping them gain the maximum centers, headed by experts in accompanied by on-site start-up clinical advantage from their Gamma Knife surgery. The training with guidance of an systems. This commitment is supp- courses include didactic lectures, experienced neurosurgeon and a orted through Elekta s Lifecycle observations of patient treatment, physicist. Services staff competence, which and practical hands-on training. Over the last 10 years, more offers a wide range of training and Training programs include intro- than 1,500 physicians and physi- 12 education courses covering all ductions to Leksell Stereotactic cists have participated in training phases of Gamma Knife surgery. System ; physics and radio- courses provided by Elekta. These high quality courses have biology; treatment planning; Regular updates on improvements been created for physicians and in Gamma Knife surgery and technicians with levels from begin- technology are offered through ner to advanced. advanced training courses and complimentary membership of Leksell Gamma Knife Society.

13 ELEKTA LIFECYCLE SERVICES

14 length 4,640 mm height 1,935 mm total weight 20,000 kg number of radiation sources 201 total accuracy 0.5 mm mechanical accuracy 0.2 mm cobalt weight 25 grams

ELEKTA LIFECYCLE SERVICES A lifetime commitment to continuous improvement elekta lifecycle services is ence in Elekta training courses more than just an after-sales servi- provides care-givers with

On-site refresher courses improving clinical effectiveness, and supplementary training pro- through ensuring staff competence vide staff with added competence. to smoothing patient flow.

18 ELEKTA LIFECYCLE SERVICES A lifetime commitment to continuous improvement elekta lifecycle services is ence in Elekta training courses more than just an after-sales servi- provides care-givers with speciali- ce and support program. It is a zed knowledge they can apply commitment to optimizing the with confidence to their daily entire continuum of care, from tasks. On-site refresher courses improving clinical effectiveness, and supplementary training pro- through ensuring staff competence vide staff with added competence. to smoothing patient flow. And, of reduce the number of unplanned course, it is about maximizing the investment in Leksell Gamma IMPROVING CLINICAL EFFECTIVENESS stops; eliminate clinical disturbances; deliver consistent treatment 18 Knife 4C. Keeping the clinic s Leksell quality and enable more treat- Gamma Knife 4C and ancillary ments per day. A wide range of ENSURING STAFF COMPETENCE equipment up to state-of-the-art Customer Support and Service Elekta s Lifecycle Services incorpo- condition can add value in many Programs can be tailored to meet rate a wide range of education ways. It can help improve patient individual requirements in all and training courses developed by outcomes, as well as reduce a pati- respects. experienced teachers at leading ent s length of stay. Elekta institutions, and which cater for Lifecycle Services can add to these PROTECTING THE INVESTMENT all levels of physician and techni- benefits through a range of upgra- Elekta Lifecycle Services exists to cian from beginner to advanced des, system enhancements, access- help clinics achieve full potential level. Supervised hands- on experi- ories and new imaging and moni- from their investment in the years toring capabilities. to come. The more patients served, the lower the costs. We offer SMOOTHING THE FLOW OF PATIENTS help and advice with marketing programs to help attract more Elekta Lifecycle Services are patients, and expert site planning designed to deliver equipment programs for help in designing performance that meets or exceeds facilities to serve more patients. original specifications for the life of the equipment. The goal is to

19 ELEKTA LIFECYCLE SERVICES 19 Elekta Lifecycle Services provide continuous improvements to help optimize every facet of clinical performance. One improvement inspires the next to extend the lifetime of the Leksell Gamma Knife system and improve overall patient satisfaction.

A GROWING STANDARD OF CARE AND SCIENTIFIC COLLABORATION Gamma Knife surgery an investment in standards of care Costs in % 100 gamma knife surgery revolutionized the treatment of cranial THE TREATMENT

20 A GROWING STANDARD OF CARE AND SCIENTIFIC COLLABORATION Gamma Knife surgery an investment in standards of care Costs in % 100 gamma knife surgery revolutionized the treatment of cranial THE TREATMENT OF CHOICE For these reasons, Gamma Knife 80 pathology when it was introduced over thirty years ago today, the surgery has emerged as the treatment of choice for small-to- 60 potential for its use and the medium sized neurosurgical indi- 40 benefits that it brings are bigger than ever. cations such as intracranial lesions, vascular malformations 20 Compared with alternative and certain functional disorders. treatments, this non-invasive Gamma Knife surgery is also 20 0 Conventional procedures Gamma Knife Surgery van Roijen L, Nijs HG, Avezaat CJ, Karlsson G, Linquist C, Pauw KH, Rutten FF. Costs and effects of open surgery versus SRS in treating vestibular schwannoma. Acta Neurochir (Wien), 1997; 139(10): therapy has achieved greater clinical acceptance with fewer complications; cost effective outcomes; faster patient recovery; shorter used as a complementary procedure to microsurgery, treating residual or recurrent tumours. And new applications and indications are Rutigliano MJ, Lunsford LD, Kondziolka D, Strauss MJ, Khanna V, Green M. The cost effectiveness of SRS versus surgical resection in the treatment of solitary metastatic brain tumours. Open Surgery, 1995;37(3): hospital stays, and better quality of life for patients. Typically, Gamma Knife surgery is 30 being explored constantly. Soon, half a million people will have been treated with Leksell Gamma 70% less costly than conventional Knife. procedures. Convalesence and time to return to normal life is significantly reduced.

21 A GROWING STANDARD OF CARE AND SCIENTIFIC COLLABORATION 21

LEKSELL GAMMA KNIFE SOCIETY Scientific collaboration 22 each gamma knife user receives automatic membership of Leksell Gamma Knife Society, a

The Society has over 2,000 active members, and the proceedings from the bi-annual meetings are being published in The Journal of Neurosurgery.

22 LEKSELL GAMMA KNIFE SOCIETY Scientific collaboration 22 each gamma knife user receives automatic membership of Leksell Gamma Knife Society, a scientific global resource for sharing clinical experience and education. The Society has over 2,000 active members, and the proceedings from the bi-annual meetings are being published in The Journal of Neurosurgery. Over 2,000 peer-reviewed articles about Gamma Knife surgery have been published to date, reflecting the original vision of Professor Lars Leksell: to provide the tools that neurosurgeons need to perfect their art.

23 LEKSELL GAMMA KNIFE SOCIETY 23 Leksell Gamma Knife Society meeting in Vienna, 2004

24 TESTIMONIALS What users say about Leksell Gamma Knife 24 Edward Shaw, M.D. Roman Liscák M.D. Stephen B. Tatter, M.D., Ph.D

25 TESTIMONIALS The use of Leksell Gamma Knife has won acclaim from both patients and physicians alike around the world. The following are just some of the many reasons why physicians and care-givers prefer Gamma Knife surgery over other treatment technologies. GOLD STANDARD OF RADIOSURGERY There is no doubt in mind that Gamma Knife surgery is the gold standard of radiosurgery for the neurosurgery community. To grow the program further, we Knife. Consequently, treatments are much more conformal. This results in a greater degree dose inhomogeneity, allowing us to give more dose to the central areas of the tumor, which is the most radioresistant. edward shaw, m.d. radiation oncologist, wake forets university, baptist medical center, winston-salem, nc. PARKINSON S DISEASE Any patients with tremor from Parkinson s disease, essential tremor, multiple sclerosis, etc, THE TREATMENT BECOMES EFFICIENT AND FAST Metestases represents the largest increase, from 150 to 200 cases last year. With the robotic Automatic Positioning System, adjusting the coordinates for each isocenter, the treatment becomes efficient and fast and it is also convenient for the patient dr. roman liscák. na homolce hospital, prague, czech republic. gamma knife center (treating around 900 patients each year) needed the gold standard. I believe, for example, many acoustic neuroma patients who have surgery and the associated risk of deafness and facial paralysis may be much better served with Gamma Knife surgery. It is much simpler to plan and deliver multiple isocenter treatments with Leksell Gamma may be good candidates for Gamma Knife surgery. stephen b. tatter, m.d., ph.d. department of neurosurgery wake forest university school of medicine winston-salem, north carolina 25 Na Homolce Hospital, Prague Czech Republic

26 26 "

27 Gamma Knife radiosurgery What does Gamma Knife sur- We believe the gold standard in constitutes a versatile and user- gery mean for a neurosurgeon the brain is Leksell Gamma friendly treatment platform ulti- or a radiation oncologist? It Knife. Why is this? Tremendous mately to help our patients. Its simply means that you can get accuracy, efficiency, ease-of-use, accuracy gives our team the con- your patients done, and the rest in terms of creation of sophisti- fidence to both treat difficult of the day is free to do other cated conformal dose plans that cases and carry out experimen- things. You can go treat other are unparalleled. And the ability tal research in new indications. kinds of patients, do other ope- to treat virtually the spectrum of robert d. timmerman, m.d. department of radiation oncology indiana university school of medicine rations, do research, see patients in your office, you're not there all day. And, the efficiency of this is unparalleled. For that reason, I can think of no better tool to fit into my practice. The reason Gamma Knife surgery has caught on, and it's brain disorders that we see fit, with results that justify it for being the best. douglas kondziolka, m.d. university of pittsburgh medical center center for image guided radiosurgery, pennsylvania, usa 27 still growing, is because, simply put, it works. As we look ahead, the use of radiosurgery, and Gamma Knife surgery in cancer is just beginning.

28 Fighting serious disease Corporate Head Office Stockholm, Sweden Tel Fax info@elekta.com Worldwide Product Support Center Tel Fax info.neuro@elekta.com North America Atlanta, USA Tel Fax info.america@elekta.com Europe, South America, Africa & Middle East Tel Fax info.europe@elekta.com Japan Kobe, Japan Tel Fax info.japan@elekta.com Stereotactic Neurosurgery Gamma Knife surgery Functional Mapping Precision Radiation Therapy Image Guided Radiation Therapy Stereotactic Radiation Therapy Asia Hong Kong, China Tel Fax info.asia@elekta.com Document / Art. No Sept: Elekta Instrument AB. All mentioned trademarks and registered trademarks are the property of Elekta AB (publ) and/or its subsidiaries. All rights reserved. No part of this document may be reproduced in any form without permission from the copyright holder. Specifications subject to change without notice.

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