Frameless Image Guidance in Stereotactic Radiosurgery

  • Nzhde Agazaryan
  • Stephen Tenn
  • Sonja Dieterich
  • Thierry Gevaert
  • Steven J. Goetsch
  • Tania Kaprealian


Stereotactic accuracy and target engagement largely rely on rigid immobilization of the skull. However, advanced imaging, image reconstructions, and adaptive treatment algorithms have made frameless image guidance without rigid immobilization a mainstay of stereotactic radiosurgery and radiotherapy deliveries. While these methods for achieving stereotactic precision require some immobilization, these obviate the need for an invasive head ring fixation. Because these approaches allow the target to still move to some degree and this movement must be compensated for, frameless image guidance requires intra-treatment imaging and target tracking and, critically, requires verification of accuracy. In this chapter, the different approaches are described, including key technological features of various frameless image-guided approaches. The anticipation is that these methods, which are primarily used for stereotactic radiosurgery, will continue to evolve to incorporate other imaging modalities, such as MRI, and eventually be generalized to other stereotactic procedures.


Radiosurgery Stereotactic SRS Stereotaxy Frameless Image guidance IGRT Functional 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Nzhde Agazaryan
    • 1
  • Stephen Tenn
    • 1
  • Sonja Dieterich
    • 2
  • Thierry Gevaert
    • 3
    • 4
  • Steven J. Goetsch
    • 5
  • Tania Kaprealian
    • 1
  1. 1.Department of Radiation OncologyUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Department of Radiation OncologyUniversity of California DavisSacramentoUSA
  3. 3.Department of RadiotherapyUniversitair Ziekenhuis Brussel (UZB)BrusselsBelgium
  4. 4.Vrije Universiteit Brussel (VUB)BrusselsBelgium
  5. 5.Medical Physics, San Diego Gamma Knife CenterLa JollaUSA

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