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Frameless image guided robotic radiosurgery of arteriovenous malformation localized on spatially correlated digital subtraction and C-arm CT angiography images
  1. Dimitre Hristov1,
  2. John R Adler1,2,
  3. Iris C Gibbs1,
  4. Robert Dodd2,3,
  5. Michael Marks2,3,
  6. Steve D Chang2,
  7. Huy M Do2,3
  1. 1Radiation Oncology, Stanford University School of Medicine, Stanford, California, USA
  2. 2Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
  3. 3Diagnostic Radiology, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Mr D Hristov, Radiation Oncology, Stanford University School of Medicine, Stanford 875 Blake Wilbur Dr, Stanford, CA 94305-5847, USA; dimitre.hristov{at}


A case is reported of frameless image guided robotic radiosurgery for an arteriovenous malformation (AVM). C-arm CT (CACT) and concurrent digital subtraction angiography images were used for AVM localization within the CACT volume. Treatment planning was performed on CT images registered with the CACT dataset. During delivery, a robotic linear accelerator tracked the target based on localization with frequent stereoscopic x-ray imaging. This case demonstrates that a frameless approach to AVM radiosurgery is possible.

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  • Competing interests ICG is an unpaid advisory board member of Accuray Inc. JRA has ownership interest in Accuray Inc.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Stanford University School of Medicine.

  • Provenance and peer review Not commissioned; externally peer reviewed.