Best Cyber Knife Radiosurgery Doctors in India
- Dr. Aditya Gupta is one of the top Neurosurgeons in India who co-founded the Institute of Neurosciences at Medanta and functioned there as the Additional Director of the Department of Neurosurgery.
- He is an active member of the Congress of Neurological Surgeons (US), Neurological Society of India, International Gamma Knife Society Treasurer, Indian Society for Stereotactic and Functional Neurosurgery, and Skull Base Surgery Society.
- Completing over 9000 successful neurological procedures, and still counting, Dr. Sudhir Tyagi is one of the top-notch names in India, diligently catering to neurological assistance with his vast knowledge and adept expertise.
- In fact, Dr. Sudhir Tyagi is the first neurosurgeon to use the Image Fusion Technique to localize targets in the deep part of the brain to perform functional stereotactic surgeries. He has great experience in all types of brain and spine surgeries.
- Dr. V P Singh is a renowned Neurosurgeon with over 30 years of veteran experience. His competence in cranial, spinal, and peripheral nerves has helped him successfully perform 400+ Intracranial Aneurysm surgical procedures.
- Dr. Singh has also been credited for initiating the Gamma Knife Unit and epilepsy surgery program at All India Institute of Medical Sciences, New Delhi. He is proactively involved in the treatment of arteriovenous malformations by radiosurgery techniques and is currently the chairman of the Institute of Neurosciences, Medanta.
- Dr. Tejinder Kataria is a renowned radiation oncologist who holds an experience of about 32 years in the field of radiation oncology.
- She founded the Department of Radiation Oncology at Artemis Health Institute and Rajiv Gandhi Cancer Institute.
- Her interests lie in stereotactic radiotherapy (SBRT), Image-Guided Radiotherapy (IGRT), Intensity Modulated Radiotherapy (IMRT)and 3-D Conformal Radiation (3D CRT), PET-CT, MRI, SPECT, DSA and CT-Simulator fusion for treatment planning.
- Dr. Mahadev P is a radiation oncologist with 25+ years of experience and has played a major role in starting the Diplomate of National Board course in Radiotherapy in 2005.
- After getting trained in Australia, Dr. Mahadev P started Prostate brachytherapy at Apollo Specialty Cancer Hospital.
- Dr. Mahadev is also trained in Cyberknife radiosurgery – the only system in the world to treat tumors in the body with sub-millimeter accuracy.
- Dr. Subodh Chandra Pande is a well-known radiation oncologist in India. He has a long and rich clinical and teaching experience in the specialty of radiation oncology.
- He included a Dual Energy Linear Accelerator with Multi-Leaf Collimator at Bhagwan Mahaveer Cancer Hospital and Research Centre (BMCHRC), Jaipur & which was a first for the State of Rajasthan.
- Dr. Rathna Devi is a senior Radiation Oncologist who has an experience of 24 years in the field.
- She completed MBBS from M.S. Ramaiah Medical College, Bangalore University, and a Diploma in Radiotherapy from Madras Medical College, Dr. MGR Medical University.
- Dr. Rathna Devi’s areas of expertise include Cranial Cyberknife Radiosurgery, Intensity Modulated Radiotherapy (IMRT), and Stereotactic Body Radio Therapy (SBRT).
- Dr. Sudhir Dubey is a leading Neurosurgeon whose primary area of specialization is Endoscopic Neurosurgery and has been perfecting the procedure since 1998. He has also developed various new Endoneurosurgery techniques for surgeries on the brain, spine, and skull.
- He holds an experience of more than 2 decades in neurosurgery and finds interest in skull base surgery, Pituitary tumor surgery, Brain Aneurysm surgery, CyberKnife Radiosurgery, and brain and spine tumor surgeries.
- Dr. Ravi Bhatia is a veteran neurosurgeon and spine surgeon at Indraprastha Apollo Hospital New Delhi.
- He has about six decades of experience in the management and surgeries of neurological disorders. Before retiring, Dr. Bhatia worked at another prestigious Indian hospital, AIIMS, New Delhi.
- He is particularly interested in Neuro-Oncology, Brain and Spine Tumors, Cerebrovascular Surgery, and Craino vertebral abnormalities.
- To date, Dr. Bhatia has treated neuro patients with a great success rate.
- He authored chapters in many textbooks and has around 95 papers for medical journals to his credit.
Best Cyber Knife Radiosurgery Hospitals in India
Indraprastha Apollo Hospital, New Delhi
- Indraprastha Apollo Hospital is a 700-bedded multispecialty hospital in the heart of the capital of India. It is a part of Apollo Hospital group, one of India’s most reputed healthcare chains. Indraprastha Apollo Hospital has been accredited by Joint Commission International, making it the first internationally accredited hospital in the country in 2005.
- There are 52 specialties in the hospital with one of the best cardiology centers in the country. The hospital is also equipped with State of the art infrastructure facilities with the largest Sleep Lab in Asia and the largest number of ICU bed facilities in India.
- The hospital also has one of the largest dialysis units in India along with a dedicated Bone Marrow Transplant unit.
- The latest and highly advanced technologies that are installed in the hospital include Da Vinci Robotic Surgery System, PET-MR, PET-CT, Cobalt-based HDR Brachytherapy, Brain Lab Navigation System, Tilting MRI, Portable CT scanner, 3 Tesla MRI, 128 Slice CT scanner, DSA Lab, Endosonography, Hyperbaric Chamber and Fibro scan.
Medanta-The Medicity, Gurgaon
- One of India’s best and largest multi-specialty hospitals, Medanta was built with the aim to bring India to the highest standards of medical care. The hospital has been providing the best medical services to its patients, since its inception, with care, commitment, and compassion.
- Equipped with 1250 beds, the hospital was founded by Dr. Naresh Trehan in the year 2009 with an aim to provide the best medical care at affordable costs. The hospital is spread across 43 acres and includes 45 operation theatres and 350 beds dedicated solely to ICU. The hospital includes over 800 doctors, and more than 22 specialty departments and has a dedicated floor for individual specialty in order to offer the best services under one roof.
- The hospital is considered one of the premier institutes in India for Cardiac Care and includes staffs and members of high caliber. The hospital has 6 distinct centers of excellence.
Max Super Specialty Hospital, New Delhi
- One of the well-regarded providers in India committed to the highest standards of clinical excellence and patient care, Max Super Specialty Hospital is a part of Max Healthcare, which is the second-largest healthcare chain in India. Regarded as one of the most well-regarded healthcare providers in the country, Max Super Specialty Hospital is committed to the highest standards of clinical excellence as well as patient care. The hospital is also equipped with the latest technology as well as cutting-edge research. The hospital is known to deliver and ensure the highest level of patient care.
- The hospital has more than 500 beds and offers treatment for over 35 specialties. The hospital also holds the credit of having installed the first Brain Suite in Asia. This is a highly advanced Neurosurgical machine that allows MRI to be taken while surgery is ongoing.
- Other advanced and latest technologies are also installed in the hospital such as the 1.5 Tesla MRI machine, 64 Slice CT Angiography, 4D ECHO, LINAC, and 3.5T MRI machine.
Fortis Escorts Hospital, New Delhi
- Over the last 33 years, the Fortis Escorts Heart Institute has set new standards in cardiac treatment with groundbreaking research. It is now known around the world as a centre of expertise for Cardiac Bypass Surgery, Interventional Cardiology, Non-invasive Cardiology, Paediatric Cardiology, and Paediatric Cardiac Surgery.
- The hospital has cutting-edge laboratories that perform a wide range of diagnostic tests in Nuclear Medicine, Radiology, Biochemistry, Haematology, Transfusion Medicine, and Microbiology.
- Fortis Escorts Heart Institute boasts a diverse group of bright and experienced doctors who are backed up by a team of highly qualified, experienced, and devoted support professionals as well as cutting-edge equipment such as the recently installed Dual CT Scan.
- Approximately 200 cardiac doctors and 1600 personnel currently collaborate to manage over 14,500 admissions and 7,200 emergency situations each year. The hospital now has a 310-bed infrastructure, as well as five cath labs and a slew of other world-class amenities.
Apollo Hospital, Chennai
- Apollo Hospitals, Chennai, is one of the best hospitals for heart care in India. Over the years, Apollo has expanded all over India, as a healthcare chain.
- India’s first ‘Only Pancreas’ transplant was performed in Apollo Hospital. The hospital is known for successfully performing Asia’s first en-bloc combined heart and liver transplant, and over the years, it has attained a remarkable achievement in the global healthcare space. Around 3-4 organ transplants are performed in the hospital per day.
- Equipped with over 500 beds, this hospital in Chennai was established in 1983 and since then has been among the most preferred hospital for patients from all over the world.
- The hospital holds accreditation of the NABH and JCI and is the first hospital in India to be ISO 9001 and ISO 14001 certified. It is also the first South Indian Hospital to receive subsequent reaccreditation from the JCI USA 4 times.
Rela Hospital, Chennai
- RIMC is a multi-specialty hospital in a sprawling area of 36 acres located in Chromepet, Chennai, Tamil Nadu, India.
- The facility has 450 beds including 130 critical care beds, 9 operating rooms, modern reference laboratories and radiology services, and is conveniently located near road, rail and air transportation.
- RIMC is led and managed by world-renowned physicians committed to healthcare.
- RIMC offers the broadest range of clinical care, education, and research. The hospital offers state-of-the-art technology and modern treatment facilities designed to provide health care at an affordable cost.
- Rela Institute is driven by patient needs, comfort and confidence.
Artemis Hospital, Gurugram
- One of the most well-known hospitals in the Delhi NCR, Artemis Hospital is the first hospital in Gurugram to get accredited by the Joint Commission International.
- With more than 40 specialties, the hospital has been designed to be one of the most technically advanced hospitals in the country, with the best medical and surgical health care. The hospital has eleven special and dedicated centers, for Heart, Cancer, Neurosciences, etc.
- The latest technologies in the hospital include Endovascular Hybrid Operating Suite and Flat panel Cath Labs for the cardiovascular department, 3 Tesla MRI, 16 slice PET CT, 64 Slice Cardiac CT Scan, HDR Brachytherapy, and highly advanced Image Guided Radiation Therapy techniques (LINAC) are installed in the hospital.
- The hospital has won several awards as well, since its inception.
BLK Max Super Specialty Hospital, New Delhi
- Equipped with 650 beds, BLK Superspecialty Hospital is the largest stand-alone private sector hospital in Delhi. With over 1500 healthcare providers and 150 globally renowned super specialists, the hospital is one of Asia’s largest Bone Marrow Transplant Centres. The hospital is known for having some of the best cancer doctors in the country.
- The hospital is NABH and NABL accredited and was inaugurated by the first Prime Minister of India. Pt. Jawahar Lal Nehru. It is one of the largest tertiary care private hospitals in India which was spread across 5 acres and has a capacity of 650 beds.
- The hospital has 80 consultation rooms spread across two floors, especially for OPD services.
- With one of the largest critical care programs, the hospital is equipped with 125 ICU beds specifically dedicated to the surgical, medical, neonatal, cardiac, pediatric, neuroscience and organ transplant units.
CARE Hospitals, Hyderabad
- CARE Hospitals were established in the year 2000, by CARE Group.
- The multispecialty hospital has 435 beds, including 120 critical care beds, with an annual inflow of 180000 outpatients and 16,000 in-patients.
- The hospital provides specialty medical services in Cardiology, Cardiothoracic Surgery, Pediatric Cardiology, Pediatric Cardiothoracic Surgery, Neurology, Neurosurgery, Nephrology, and Urology.
- The hospital has the first dual source, 128 slice CT scanner (for high precision cardiac imaging) – the first of its kind in south India.
- The hospital offers a wide range of accommodation facilities for the convenience of its varied patient base, ranging from general wards to super deluxe rooms.
Fortis Hiranandani Hospital, Mumbai
- Fortis Hiranandani hospital was established in 2007.
- The hospital is an advanced tertiary care, multi-specialty hospital equipped with 149 beds.
- The hospital is equipped with a super ICU to provide emergency medical care to critically ill patients.
- The hospital is NABH accredited.
- The critical care facility in the hospital is augmented with the state-of-the-art facilities that facilitate speedier diagnosis and efficient monitoring.
- The hospital provides specialty medical services in cardiology, orthopedic science, pediatric science, neurology, diabetic care, urology, nephrology, ENT, obstetrics, gynecology, cosmetic surgery, bariatric surgery, neuro and spine care.
What is Cyberknife Radiosurgery?
Cyberknife Radiosurgery is a non-invasive form of surgery that uses high doses of radiation to treat a broad range of non-cancerous and cancerous tumors throughout the body. This includes ailments in the prostate, lung, brain, spine, liver, pancreas, and kidney. Cyberknife delivers about 1400 highly pinpointed beams of radiation to control or kill the tumor. It has extremely high precision and accuracy.
Cyberknife system comprises of computer-controlled robot that slowly moves around the patient, delivering radiation to the tumor from various angles, which helps to spare surrounding healthy tissues. Each session of treatment lasts for between 30 to 90 minutes, for one to five days.
Cyberknife today is probably the most popular stereotactic radiosurgery. It is the best alternative for surgically complex or inoperable tumors. The location, shape, and size of the tumor determine the total dose and number of radiation treatments.
How does Cyberknife work?
Cyberknife does not require surgery & there is no cutting or anesthesia required. Cyberknife is comprised of a compact linear accelerator – a machine that generates a radiation beam- attached to a highly maneuverable robotic arm.
- The machine’s robotic arms move around you, aiming & firing targeted radiation beams from numerous angles.
- The imaging & tracking system continually updates the tumor location throughout the treatment procedure compensating for a patient movement like breathing.
- A treatment session typically lasts for 30-90 minutes.
During the CyberKnife procedure, the patient will lie on a treatment table while the machine’s robotic arm moves around his or her body delivering high doses of radiation directly to their tumor with pinpoint precision minimizing exposure to the surrounding healthy tissues.
Difference between SRS and SBRT
Stereotactic radiosurgery is a non-surgical therapy for treating small tumors and abnormalities of the brain. With its accurately targeted beams, it helps preserve healthy tissue by targeting radiation on the cancerous area.
When Stereotactic Radiosurgery is involved in the treatment of other body tumors rather than brain tumors, it is termed Stereotactic Body Radiation Therapy.
Reliability on the technology
The two types of treatment rely on different technologies that include:
- System for immobilizing and accurate positioning of the patient to maintain the same until the session lasts
- IGRT or image-guided radiation therapy uses imaging for localizing the tumor before the radiation treatment. The accuracy and precision of this procedure is through the IGRT
- 3-D imaging and other techniques for locating the tumor and determining the target coordinates
- Focused x-ray or gamma-ray beams converging on the abnormality or the tumor.
Why the Cyberknife surgery?
Cyberknife surgery is generally a preferred choice for patients who cannot opt for conventional surgery. The health problems and/or the age of such patients don’t allow them to go for a conventional surgery due to the involvement of associated risks. However, the SRS surgery is essential as the tumor is present in an area close to the vital structures. The tumors treated with this type of radiosurgery are:
- An acoustic neuroma (slow-growing nerve tumor connecting the brain and the ear)
- Spinal cord tumors
- Inaccessible abnormalities
- Metastasizing cancer or cancer that spreads from any area of the body to the brain
- Pituitary tumors
- Residual cells after a tumor removal surgery
- Cancers of kidney, lung, and prostate
- Cancers of breast, liver, and pancreas
- Melanoma of the eye (type of eye cancer)
- Arteriovenous malformations
- Shaking or tremors
- Tumors at the base of the skull
- Trigeminal neuralgia or pain in the nerve of the face
- Parkinson’s disease
- Orbital or intracranial tumors
Benefits of Cyberknife Radiosurgery
- No anesthesia is required.
- Exceptional accuracy, spares healthy tissues & organs.
- No invasive head or body frame.
- Immediate return to normal activity.
Preparing for the surgery
Both the types of procedures- whether SRS or SRBT are performed on an immediate basis. You can assume to spend around half of your day or even more at the hospital. The doctor will inform you if there’s a need for somebody to accompany you and/or take you home after the procedure. Your doctor will give an appointment within 1-2 days of your first visit to the hospital. You might need to do overnight fasting a night before the procedure is scheduled. You must ask your doctor if there’s a need for any kind of medication immediately before the treatment.
Alternatively, your doctor might also ask you to bring those particular medicines with you to consume the same minutes before the procedure starts. You must inform your doctor about anything that you are consuming or any other ailment that you are suffering from. If you are diabetic and/or under medications, inform the same to your doctor. If you have an allergy again anything, it is important to mention it too. Apart from this, if you have any kind of implants, pacemaker, or any stent, provide your doctor with the relevant details.
Who will perform the procedure?
A team of medical professionals performs the treatment who specialize in performing such procedures. The team may include a medical radiation physicist, a dosimetrist, a radiation therapy nurse, a radiation oncologist, a radiologist, a radiation therapist, and a neurooncologist.
- The medical radiation physicist adjusts the dose of radiation to be provided during the procedure.
- A dosimetrist or physicist will produce the treatment plan with the help of specialized software. He or she is also responsible for calculating the beam configuration and the exposure in the required dose for the treatment.
- A radiation therapy nurse will evaluate the patient and educate the patient about the entire treatment procedure. The nurse will also be responsible for monitoring the patient while undergoing the procedure and instructing him or her after the procedure is over.
- The radiation oncologist along with a neurosurgeon (in some cases) will lead the entire team. He or she will approve the treatment plan, locate the target area locate the tissues or organs adjacent to it that might be at risk, make a decision regarding the dose of the radiation for treatment, and finally infer the results of this procedure.
- A radiologist will interpret the images that helped identify the location of the tumor in the body.
- A radiation therapist is trained in positioning the patient accurately on the table and for operating the machine from the protected area. He or she will observe the patient through a closed-circuit television while communicating with the patient till the procedure gets over.
- A neurooncologist or neurologist will evaluate the various treatment possibilities available for the patient with the neurosurgeon and radiation oncologist. He or she will also decide if the radiosurgery will be beneficial for the particular case of the patient or the brain lesion that the patient is having.
Equipment for the procedure
The treatment procedure can be performed using any of the three types of equipment that involves the use of different sources of radiation as well as instruments.
- LINAC MACHINE: Linear Accelerator machines deliver photons or high-energy X-rays. These machines perform SRS in one or multiple sessions to destroy the bigger tumors. The procedure is fractionated stereotactic radiotherapy if it involves multiple sessions.
- GAMMA KNIFE: This machine uses 201 or 192 beams of gamma rays. These rays are highly directed towards the target tumor. The procedure is the best for tumors that are small or medium in size.
- PROTON BEAM RADIOSURGERY: It involves the use of heavily charged particles for performing the procedure and eliminating the intracranial lesions.
Performing the procedure
As there are three types of instruments used for the treatment procedure, there are three ways of performing the treatment.
- SRS USING LINAC: It involves four phases that are imaging, radiation delivery, head frame placement, and computerized dose planning. The machine has a gantry that moves around the patient to target the radiation beams towards the lesion. With the use of Cyberknife, the robotic arm is responsible for moving the LINAC at different angles surrounding the patient. A majority of LINAC-based SRS is now frameless allowing the procedure to be fractionated. This is beneficial in cases of large-sized tumors or tumors at risky locations.
- SRS USING GAMMA KNIFE: This procedure also involves four phases similar to LINAC-based SRS.
a. For the first phase, the nurse will position a needle in your arm for imaging and/or medications. The neurosurgeon will anesthetize two spots on the back portion of your head as well as your forehead using anesthesia. A frame will be connected to your head with the use of pins to prevent head movement during the procedure.
b. Next, an MRI will be taken in a separate room to locate the tumor concerning the frame. Alternatively, a CT scan might also be recorded.
c. The medical team will now assess the tumor and plan the treatment according to it. They will use special software to plan everything and ensure minimal radiation exposure to the surrounding normal tissues.
d. Finally, the team will move to the control area from where they will observe you and communicate with you through a microphone. The bed on which you are lying will move into the machine and undergo the treatment without any interruption. The treatment duration may vary between 1 hour to 4 hours. With a sound, the bed will get back to its original position when the procedure gets completed. The team will now remove the frame from your head and allow you to go home.
- SBRT: This type of treatment procedure involves one or multiple sessions over a week or two.
- For Cyberknife treatment, there will be the placement of a fiducial marker near the tumor in your head. The placement of the fiducial marker will be done by your radiation oncologist, gastroenterologist, pulmonologist, and radiologist.
- The radiation oncologist will choose the right method to bring your body and beams of the LINAC in alignment. This process is termed simulation to maintain precision during the treatment.
- The team will collectively decide upon the best beam arrangement for your case and may incorporate the use of some other imaging techniques also.
- The radiation delivery is finally done after placing you in the immobilization device. You will be positioned by the radiation therapist and the radiation oncologist followed by delivery of the treatment. The duration of the procedure will be around 1 hour or even more, in rare cases.
Pre-operative and post-operative instructions
The patient can neither hear nor feel the X-rays being recorded. However, one may experience flashes of light in some exceptional cases. One will not experience any kind of discomfort or pain during the entire procedure. In case of any pain, the patient must inform about the same to the doctor or radiologist. The team will bandage the pin sites upon removing the head frame to stop the minor bleeding. If you are suffering from a headache because of this, you can ask the team or any of them to prescribe you medications.
A majority of patients can get back to their routine activities within a day or two after the procedure. The doses of radiation you receive will determine the number of side effects. For the management of these side effects, you can talk to your doctor or the nurse. The side effects will go away within a few weeks post-treatment. These side effects may be but do not limit to:
- Skin problems
- Red and sensitive skin
- Swelling and irritation on the skin
- Dryness, peeling, or blistering of the skin
- Eating and digestion problems
- Nausea and/or vomiting
- Swelling and soreness in the area where treatment was performed
- Hair loss in the area of the treatment
- Difficulty in swallowing and mouth problems
- Urinary changes
In some cases, the side effects are quite late but may be permanent. This includes:
- Spinal cord changes
- Kidney changes
- Secondary cancer
- Brain changes
- Rectal and colon changes
- Fracture of bones
- Lung changes
- Joint changes
To avoid the chances of secondary cancer, you must regularly go for follow-ups and get yourself checked. Your radiation oncologist will assess you for any new or recurring cancer.
What makes cyberknife treatment accurate?
- Levels of the accuracy of Cyberknife are sub-millimetric and added with the benefits of real-time image guidance & tumor motion tracking, Cyberknife can aim at targets with pinpoint accuracy.
- Cyberknife has capabilities of automatic error correction. It continuously corrects for any changes in patient position during the treatment, thus allowing the patient to lie comfortably during the treatment.
- The availability of real-time image guidance & tumor motion tracking helps to treat tumors in moving areas with the greatest accuracy- by treating in synchrony.
- The use of a robotic arm in treatment helps in treatment from angles not easily accessible by conventional radiotherapy machines.
Precision for Cyberknife treatment
The cyberknife radiosurgery treatment is a desirable option for operating on varying kinds of tumors of the body. The accuracy and precision of this treatment are vital to destroy the cancerous cells with minimal exposure to the surrounding healthy tissues. This also minimizes the risk of side effects while offering the patient a better life quality before & after the treatment.
The patient might change his or her position while breathing or slightly move the head. Sometimes, the muscles of the patient tense or relax while coughing or sneezing. With Cyberknife treatment, motion management of the tumor as well as the patient is easy. The use of a cyberknife system eliminates the risk of irradiation to surrounding healthy tissues. This is because the cyberknife system has advanced technology to detect the location of tumors and keep the radiation doses restricted to the tumor.
Synchrony in the cyberknife system is the sole most real-time adaptive technology in the world. It precisely synchronizes the beam motion for treatment delivery towards the target and maintains the accuracy of radiation treatment to the body tumor. It has motion synchronization technology which makes it delivering treatment easier. The patient need not hold his or her breath for radiation treatment to the tumor.