Robotics and its applications in stereotactic radiosurgery

Stereotactic radiosurgery has undergone a remarkable evolution since its conception and the subsequent introduction of image-guided radiosurgery, primarily because of the concurrent advances in imaging and computer technology. However, recent improvements in real-time imaging, inverse planning techniques, and frameless alternatives have greatly enhanced the conformity and accuracy of the radiosurgical procedure. As a consequence, the possibility of hypofractionation is offered, and both intra- and extracranial targets can now be ablated with sustained submillimetric precision. Although all indispensable features, none is as impressive or useful as the incorporation of robotics, robotic beam delivery, or robotic-assisted planning, which has only served to improve the accuracy and homogeneity of therapy. The aim of this article was to describe the general technological basis of robots in radiosurgery and to review current clinical usage of robotic radiosurgery devices. Emphasis has been placed on robotic principles and the various popular applications currently available.