At the University Hospital for Radiation Oncology Innsbruck, prostate cancer treatment is built on precision and teamwork. Treating 15–20 patients each day, the department has refined an implanted marker workflow that gives clinicians full control over imaging and positioning. Under Professor Ute Ganswindt’s leadership, the team has made accuracy a shared focus across every step of care.
The challenge: motion that doesn’t wait - Even in treatments lasting only a few minutes, the prostate can shift without warning. In Innsbruck, this unpredictable movement appeared in one third of monitored sessions. Small deviations could accumulate across a VMAT arc with the potential to affect dose coverage and increase toxicity. To move toward shorter, more efficient treatment schedules, the team needed a way to quantify and correct that motion reliably in real time.
The innovation: an implanted marker workflow built for precision -Â Using the Brainlab ExacTrac Dynamic implanted marker workflow, the Innsbruck team was able to detect and correct for prostate motion. Continuous X-ray monitoring of fiducial markers helped clinicians maintain target alignment throughout treatment and prevent deviations from building over time. With marker implantation performed directly within the radiation oncology department, the workflow also allowed seamless integration with imaging and planning protocols and ensured strong ownership of each step.
The shift: confidence to move toward ultra-hypofractionation -Â With precise, reliable motion management in place, the team began transitioning from conventional and moderately hypofractionated regimens to ultra-hypofractionated protocols. Their goal was clear: shorten the overall treatment pathway while maintaining the accuracy necessary to protecting nearby healthy structures and minimizing toxicity. The established collaboration across teams and the efficiency and precision of the implanted marker workflow provided the necessary foundation to make that shift safely.
In their words: “Progress like this only happens when everyone is aligned around the same goal: delivering precise, reliable care for every patient, every day. The collaboration across teams and the efficiency of the implanted marker workflow provided the foundation we needed to make that shift safely.” – Dr. Angela Ginestet, Radiation Oncologist, University Hospital for Radiation Oncology Innsbruck.
The impact: precision that supports patient-centered treatments -Â A recent evaluation from the University Hospital for Radiation Oncology Innsbruck confirmed that the implanted marker workflow with ExacTrac Dynamic accurately identified and corrected clinically relevant motion during prostate treatments. For a department committed to delivering precise care at high daily volumes, this capability is helping shape a future where shorter treatment schedules can coexist with uncompromised accuracy.
Please join us in celebrating the Innsbruck team for leading the way toward ultra-hypofractionated prostate cancer care. If you want to learn more about their work, read the study here:Â https://pubmed.ncbi.nlm.nih.gov/37523057/
Picture: ©Tirol Kliniken Innsbruck, Dr. Julian Mangesius, Dr. Angela Ginestet, University Hospital for Radiation Oncology, Innsbruck, Austria
The statements made by the clinician represent their personal opinion and experience. These statements may not be supported by scientific evidence or peer-reviewed research. For verified information about the device, please refer to the manufacturer's official documentation.
St. Luke’s Radiation Oncology Network: Leveraging Brainlab advanced stereotactic planning and image-guided patient positioning and monitoring to support brain and spine radiosurgery.
As Ireland’s largest public radiation oncology provider, St. Luke’s Radiation Oncology Network operates across three sites in Dublin, Ireland. Two of the centers are located on the campuses of major acute hospitals: St. James and Beaumont. The Beaumont Hospital site serves as the national referral center for craniospinal and skull base radiosurgery treatment, delivering specialized care for complex intracranial and spinal conditions.
The challenge: Achieving the seemingly unachievable. With rising demand for both intracranial and spine radiosurgery, the Beaumont RCSI Cancer Centre team needs to deliver precise, consistent treatments in both routine and high-risk scenarios while maintaining efficiency across a high-volume clinical schedule. This becomes especially critical in spine radiosurgery, where clinicians aim to deliver a sufficiently high dose to control the tumor while sparing the spinal cord just millimeters away. Achieving this balance requires a highly advanced algorithm—one that can sculpt dose in a concave target such as the vertebrae and create high-gradient plans that protect the cord without compromising tumor coverage. Once the optimal plan is created, the patient needs to be correctly positioned and monitored throughout treatment to enable intended delivery, with submillimetric accuracy from start to finish if needed. Multidisciplinary collaboration and robust high-quality technology are essential for this busy center that treats many different indications, from purely palliative to extremely complex radiosurgery.
The innovation: “Brainlab technology is deeply integrated into Beaumont RCSI Cancer Centre’s radiosurgery department.” Central to the Network’s approach are Elements Radiosurgery Solutions and ExacTrac, a configuration that supports complex radiotherapy planning, precise patient positioning and monitoring for a wide range of conditions from spinal metastases to intracranial metastases and benign intracranial conditions (including arteriovenous malformations, or AVMs, vestibular schwannomas and trigeminal neuralgia).
The intracranial radiosurgery program began using Brainlab solutions in 2013 and Beaumont RCSI Cancer Centre was the first in Europe to offer frameless radiosurgery treatments for trigeminal neuralgia. Brainlab Elements was introduced in 2018, initially used to treat multiple brain metastases, and became the primary planning platform for central nervous system cases in 2022. Single isocenter planning for multiple brain lesions enabled more consistent scheduling and workflow efficiency for a busy center treating a wide range of conditions.
The Beaumont RCSI Cancer Centre features the St. Luke’s Network’s flagship linac, Delvin, named after a river in Ireland through a patient-led naming initiative. This linac is equipped with ExacTrac which through image guidance allows for reduction in setup margins, making it very attractive to all consultants.
There is constant high demand for Delvin treatment slots and the ability to treat multiple brain metastases with a single isocenter has been practice changing for the Network. Today, nearly a third of the Network’s metastatic brain patients are treated using Elements Multiple Brain Mets SRS with a single isocenter.
Elements Radiosurgery Solutions have become a cornerstone of the Network’s rapidly expanding spine radiosurgery program. Since patients cannot be in the same position for their MR and CT scans, Elements Curvature Correction Spine—a dedicated deformable co-registration tool—enables them to use information from both modalities to better define the spinal anatomy and targets. In combination with AI-powered extra-cranial segmentation, organs at risk can be easily segmented.
In their words: “Our spine radiosurgery service has taken off over the last couple of years. We have designed a country-wide clinical trial to evaluate the safe dose escalation for patients with spinal metastases which is reaching our accrual targets much faster than expected.” — Professor Clare Faul, Consultant Radiation Oncologist at St. Luke’s Radiation Oncology Network.
Plans are generated using Elements Spine SRS, which enables accurate dose plan optimization and calculation with a Monte Carlo algorithm, which the team considers the most significant gain.
“All two-fraction patients are planned exclusively in Elements Spine SRS. Internal plan comparisons show a far better conformity to the target and sparing of organs at risk for those plans created in RT Elements. Possibly the most significant gain is the ability to optimize and calculate with a true Monte Carlo algorithm. With the newest software release, the fast Monte Carlo allows us to optimize and calculate with high accuracy in less than 20 minutes. The dedicated optimizer is extraordinary, too. We have been able to dose escalate in high-risk patients, where over 50% of the target is made of the gross target volume (GTV), without compromising proximal organs at risk. We get very excited every time we achieve the seemingly unachievable.” — Dr. Christina Skourou, Senior Physicist at St. Luke’s Radiation Oncology Network.
Treating so close to the spinal cord, nerve roots and esophagus are inherently challenging. For this reason, early on, the team performed extensive setup validation to establish safe and realistic planning target volume (PTV) margins. They would also acquire multiple CBCTs during each treatment fraction, but as they gained confidence in ExacTrac, they realized they could safely reduce patient imaging dose and shorten treatment time by relying on the device alone for intrafraction monitoring and correction. Today, spine stereotactic ablative radiotherapy (SABR) patients receive one posterior kV image to confirm the correct vertebral level, a CBCT to verify internal anatomy against plan and multiple ExacTrac kV images throughout treatment. Overall, treatment time per fraction is only slightly longer than for conventionally fractionated treatments.
The impact: Expanding access to radiosurgery for patients with complex brain and spine conditions. Together, Elements Radiosurgery Solutions and ExacTrac offer the Beaumont team greater confidence to deliver radiosurgery in high-risk scenarios. Consistent target definition and high-quality dose planning, together with precise patient positioning and continuous monitoring, enable submillimetric accuracy throughout treatment. The high level of accuracy supports evolving treatment pathways and allows radiosurgery to be integrated into clinical decision-making across a wider array of conditions.
St Luke’s Radiation Oncology Network was the first center in Ireland to achieve Novalis Certification, underscoring its leadership in advanced stereotactic radiotherapy. “The Novalis Certified program has played an important role in quality assurance and patient safety at the Network by independently validating that stereotactic radiotherapy is delivered to the highest international standards” — Paul Davenport, Principal Physicist at St. Luke’s Radiation Oncology Network.Â
Pictures: © St. Luke’s Radiation Oncology Network, Dublin, Ireland
Disclaimer: The statements made by the clinicians represent their personal opinion and experience. These statements may not be supported by scientific evidence or peer-reviewed research. For verified information about the device, please refer to the manufacturer's official documentation.
We are pleased to invite you to join our Novalis Circle Lunch Symposium "ExacTrac Dynamic: The Gold Standard for IGRT and SGRT Clinical Applications" at the European Society for Radiotherapy and Oncology (ESTRO) Annual Congress in Stockholm.
We are honored to welcome the following speakers, who will share their latest insights and experiences with Brainlab technology.
Chair:Â Carmen Rubio RodrĂguez, MD, PhD, HM Sanchinarro University Hospital, Madrid, SpainÂ
🎙️ Per Munck af Rosenschöld, PhD, SkĂĄne University Hospital, Lund, Sweden: The Importance of IGRT for Linac-based Radiosurgery Â
🎙️ Nils Temme, PhD, Strahlentherapie Radiologie MĂĽnchen, Munich, Germany: Clinical Versatility of ExacTrac Dynamic Surface in a Tattoo-less Department Â
🎙️Ovidio Hernando Requejo, MD, PhD, HM Sanchinarro University Hospital, Madrid, Spain: The Role of Motion Management with ExacTrac Dynamic for Prostate SBRTÂ
🎙️Cihan Gani, MD, University Hospital TĂĽbingen, TĂĽbingen, Germany: Modern Lung SBRT Treatments with Both Real-time Adaptation and Intrafraction Motion ManagementÂ
We look forward to the valuable insights they will present!
From a clinical workflow and technology standpoint, I was wondering—given the geometric limitations in ring gantry systems, is the likely direction toward surface imaging with AI-based prediction, or are there ongoing developments for internal tracking within closed-bore architectures?
What troubleshooting steps do you follow when ExacTrac shows repeated positioning deviations despite correct initial setup?
First of all thank you for this platform.
May i know Sir from your experience, what are the most effective strategies for managing intrafraction motion during SBRT, particularly in spine and lung cases?
Join us in Philadelphia for our Mid-Atlantic Regional Symposium with insightful clinical talks by renowned clinical experts and inspirational discussions on SRS and SBRT.
Experience cutting edge of radiotherapy and radiosurgery at our exciting two days symposium focused on precision, personalization, and standardization in Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT).
This event will bring together medical physicists, dosimetrists, radiation oncologists and radiation therapists to share valuable clinical techniques and innovative management strategies, as well as to gain insights into how complex data is reshaping the field of radiosurgery.
Brainlab Mid-Atlantic Regional Symposium
May 8 and 9, 2026
Click here to have the program.
We look forward to welcoming you to Philadelphia for this inspiring event!
To register click here
We’re pleased to host the Advanced Clinical Course "Brain Metastases and Skull-base Tumors" in cooperation with Universitätsklinikum Hamburg-Eppendorf and the clinical team of Prof. Dr. med. Cordula Petersen and Dipl.-Phys. Manuel Todorovic.
This course will provide participants with the opportunity to learn from clinical experts about the clinical implementation and requirements for a successful radiosurgery program for brain metastases and skull-base tumors. During the course, medical physicists will learn about specific quality assurance techniques as well as expert tricks for treatment planning with Brainlab radiosurgery software. Radiation oncologists and neurosurgeons will learn about contouring, clinical prescriptions and planning approaches.
More information here.
Interested? Contact your local Brainlab Sales representative.
*Please note: A Brainlab Academy ticket is needed to be able to attend this course.
We’re pleased to host the Advanced Clinical Course “ExacTrac Dynamic for Breast Cancer” in cooperation with the Universitair Ziekenhuis Brussel and the clinical team of Thierry Gevaert, PhD.
This course is a comprehensive training program aimed at supporting the use of ExacTrac Dynamic for breast cancer treatments. Attendees will learn about specific imaging, CT simulation, breath-hold techniques, and general strategies for treating breast cancer and will familiarize themselves with using the ExacTrac Dynamic Breath-Hold modules.
More information here.
Interested? Contact your local Brainlab Sales representative.
*Please note: A Brainlab Academy ticket is needed to be able to attend this course.