cyberknife (device) cyberknife (device) the cyberknife system is a radiation therapy device manufactured by accuray incorporated. the cyberknife system is the only radiation delivery system in the world that features a linear accelerator (linac) directly mounted on a robot to deliver high-energy x-rays or photons used in radiation therapy and combines real-time artificial intelligence (ai)-driven target tracking and treatment delivery. the platform is designed to deliver precise stereotactic radiosurgery (srs) and stereotactic body radiation therapy (sbrt) for the treatment of benign tumors, malignant tumors, neurologic disorders and other medical conditions. patient being set-up on the cyberknife system the cyberknife system combines a robotic arm that can autonomously move a compact linear accelerator with an option of fixed collimators, iristm variable aperture collimator and incisetm mlc. the cyberknife system incorporates an image guidance system that creates images from two orthogonal diagnostic x-ray sources/detectors mounted in the room. during treatment, the patient’s x-ray images are compared in real-time with digitally reconstructed radiographs, and the robot’s position is adjusted according to the findings from comparing those images. synchrony technology cyberknife system (robotic radiotherapy) the cyberknife system uses real-time target tracking with dynamic delivery technology called synchrony. using external markers in conjunction with diagnostic x-ray images, synchrony helps guide the robotic arm to shift the radiation beam in real-time such that the beam always remains aligned with the target. this design is intended to enable the cyberknife system to deliver high-dose radiation with sub-millimeter precision and accuracy, minimizing damage to surrounding healthy tissue without the need for invasive fixation devices. history the system was invented by john r. adler, a stanford university professor of neurosurgery and radiation oncology, and peter and russell schonberg of schonberg research corporation. the cyberknife system was developed to address limitations of a radiosurgery delivery system that required a rigid frame to be bolted to the patients' head, from imaging through to treatment. wearing this head frame limited the use of the system to single treatments within the brain or base of the skull. the first cyberknife system was installed at stanford university in 1991. the device was approved by the fda for the treatment of intracranial tumors in 1999 and for the treatment of tumors anywhere in the body in 2001. since the original design, accuray incorporated released several cyberknife system models, with significant features and clinical improvements over the years: the cyberknife g3 system in 2005, the cyberknife g4 system in 2007, the cyberknife vsi system in 2009, the cyberknife m6 system in 2012, and the cyberknife s7 system in 2020. clinical application the system is used to treat most types of intracranial tumors with srs and notably paved the way for the use of sbrt anywhere in the body. srs is commonly used in the treatment of brain metastases as well as other intracranial indications, with the advantage of delivering high doses to the tumor while minimizing dose to surrounding organs at risk. sbrt requires precise image-guided delivery and is now commonly used in localized prostate cancer patients, demonstrating encouraging control rates. sbrt is also widely utilized in the treatment of patients with inoperable lung cancer or those that may refuse surgery.the cyberknife system plays a crucial role in the treatment of local recurrence as it allows very precise re-irradiation in areas close to critical structures. oligometastases represent a limited number of metastatic sites that can benefit from radiation therapy to achieve long-term disease control. these metastatic sites are amenable to direct treatment approaches to control disease effectively. several studies have shown the benefit of the cyberknife system and effective oligometastatic sbrt in breast and gynecological cancers. clinical citations brain metastases borzillo v, di franco r, giannarelli d, cammarota f, scipilliti e, d'ippolito e, petito a, serra m, falivene s, grimaldi am, simeone e, festino l, vanella v, trojaniello c, vitale mg, madonna g, ascierto pa, muto p. ipilimumab and stereotactic radiosurgery with cyberknife® system in melanoma brain metastases: a retrospective monoinstitutional experience. cancers (basel). 2021 apr 13;13(8):1857. doi: 10.3390/cancers13081857. pmid: 33924595; 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