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Case study


Figure 3: Schematic drawing of the steps of Kypho-IORT (courtesy of Carl Zeiss)


Collapsed vertebral body containing a bone metastasis


A B


Step 1: A minimal invasive access is created


C


D


Figure 1: Pre-operative CT showing an osteolytic metastasis of the 8th thoracic vertebra (A+B); axial and coronary CT demonstrating stable disease of the metastasis three months after Kypho-IORT (C+D)


Step 2: Radiation (< 2 min) of the bone metastasis at its precise location


Step 3: A balloon is inserted in the collapsed vertebral body


Step 4: The balloon is carefully inflated, returning the vertebral body to its normal position


Step 5: The cavity created by the balloon is filled with bone cement for stabilisation


A Figure 2: INTRABEAM® (Carl Zeiss, Surgical, Oberkochen, Germany).


(A); newly developed needle applicator adapted on the X-ray source of the INTRABEAM®


system with sterile coverage (B)


B


Step 6: Stabilised vertebral body without bone metastasis


bremsstrahlung is emitted from the needle tip in a spherically symmetrical pattern. The XRS4 itself is connected with a carrier system, which allows six degrees of freedom, providing various treatment positions. To enable the use of this system for Kypho-IORT a new needle


applicator was developed (Figure 2B). This applicator, including the drift tube of the INTRABEAM®


, was guided


through the metallic sleeves into the metastasis of the vertebral body. After verification of the correct position using biplanar X-rays, a single dose of 8Gy in a


distance of 8mm according to the protocol of an ongoing dose escalation study (NCT 01280032) was applied.3 IORT took approximately two minutes. After IORT the INTRABEAM®


removed and the kyphoplasty balloon (KyphX®


, Kyphon Inc, Sunnyvale,


device was 21


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