Creating the Future

Abstract

During the earliest days of developing the CyberKnife, it was never obvious to me how the technology might impact neuroradiosurgery. Embracing the innovative spirit of Silicon Valley, my Stanford team and I were simply embarking on a mission to free stereotactic radiosurgery from “stereotactic frame”-based immobilization and targeting, primarily with the goal of enabling this procedure to be performed almost anywhere in the human body. However, in time, the late 1980s and early 1990s, it became clear that the practice of neuroradiosurgery was too often dictated by the practical realities of stereotactic frames and not radiobiological or clinical considerations. Moreover, reimbursement at the time (and still largely today) reinforced the existing paradigms of therapeutic radiation, whether single-fraction Gamma Knife SRS or the fractionation schema of conventional radiation therapy. How ironic that two fields of clinical medicine that pride themselves on their scientific roots, and who proudly proclaim to embrace innovation, were so heavily influenced (or blinded) by dogma and money. Regardless, these practical realities have formed the headwinds into which the modern practice of neuroradiosurgery with the CyberKnife has evolved over the past two decades.