{"doi":"10.1016/j.ijrobp.2025.09.029","title":"Performance of a Novel Frameless and Maskless Robotic Head Motion Compensation System for Stereotactic Radiosurgery in a Realistic Clinical Environment with Healthy Volunteers","abstract":"PURPOSE: Stereotactic radiosurgery (SRS) is a nonsurgical method for treating brain abnormalities and small tumors. Traditional high-accuracy SRS requires a rigid metal head frame screwed into the skull, which causes discomfort and reduces patient compliance. Thermoplastic masks offer a less invasive alternative but compromise accuracy because of flexing and are often still uncomfortable. To address these issues, we developed a novel robotic head motion compensation (RHMC) device that enables frameless and maskless SRS. METHODS AND MATERIALS: A compact, portable RHMC device was developed that can be quickly attached to or detached from the end of a linear accelerator treatment table. Real-time 6° head position tracking was performed using 3-dimensional surface-guided radiation therapy imaging, which was fed into the robot control computer. Device performance was evaluated by administering virtual SRS treatments to a phantom and 20 healthy volunteers, simulating a clinical environment but without delivering radiation. The primary success metric was defined as maintaining the 6D target position under a 1.0 mm and 1.0° threshold for more than 95% of beam-on time (denoted as DC95%_1.0 mm and 1.0°). RESULTS: Two of the 20 volunteers were excluded because of incompatibility with the RHMC device. Among the remaining 18 volunteers, the DC95%_1.0 mm and 1.0° success metric was achieved in all cases. Without the RHMC device, 9 of the 18 volunteers were able to meet this metric. For a tighter tolerance of DC95%_1.0 mm and 0.5°, 17 volunteers achieved the metric with the RHMC device, compared with 4 without. For a tolerance of 1.0 mm and 1.0°, across all 18 volunteers, the mean and range were 99% and 96% to 100% using the RHMC device, respectively, compared with 73% and 9% to 100% without the RHMC device. CONCLUSIONS: The RHMC device effectively maintained accurate head motion control under simulated clinical conditions, achieving the DC95%_1.0 mm and 1.0° success metric for all suitable candidates. This technology has the potential to enable frameless and maskless SRS delivery within or better than current standard-of-care tolerance guidelines.","journal":"International Journal of Radiation Oncology*Biology*Physics","year":2025,"id":575771,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9584,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1186919,"name":"Ahmad Sakaamini","orcid":"0000-0001-7335-9290","position":1,"is_corresponding":false},{"id":349304,"name":"Wenbo Gu","orcid":null,"position":2,"is_corresponding":false},{"id":1484355,"name":"Carl Denis","orcid":null,"position":3,"is_corresponding":false},{"id":1160077,"name":"Michelle Alonso‐Basanta","orcid":"0000-0001-9214-7656","position":4,"is_corresponding":false},{"id":411418,"name":"R Wiersma","orcid":"0000-0002-7279-5813","position":5,"is_corresponding":false},{"id":1483989,"name":"Xinmin Liu","orcid":"0000-0002-5410-2796","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:57:52.712371Z","pmid":"40998271","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}